The relationship between depressive/anxiety symptoms during pregnancy/postpartum and sexual life decline after delivery

A systematic review of the benefits of breastfeeding against postpartum depression in low-middle-income countries

BACKGROUND

The positive impact of breastfeeding against postpartum depression has been increasingly reported. However, no studies have systematically and critically examined current evidence on breastfeeding practices' influences on postpartum depression in LMICs.

AIM

To review the influence of breastfeeding on postpartum depression in LMICs.

METHODS

We searched original research in English published over the last ten years (2012 - 2022) within 8 databases: EBSCOhost, EMBASE, Pubmed, Sage Journals, Science Direct, APA PsycArticles, Taylor & Francis, Google Scholar, and citation tracking. The risk of bias assessment used The Newcastle Ottawa Scale and The Modified Jadad Scale. We followed the PRISMA statement after the protocol had been registered on the PROSPERO. The review included 21 of 11015 articles.

RESULTS

Of 21 articles, 16 examined breastfeeding practices, 2 each investigated breastfeeding self-efficacy and breastfeeding education, and 1 each assessed breastfeeding attitude and breastfeeding support. 3 randomized control trials and 5 cohorts revealed that breastfeeding decreased the EPDS scores. However, 4 cross-sectional studies indicated that breastfeeding is nonsignificantly associated with postpartum depression.

CONCLUSION

This review indicated that breastfeeding may alleviate or prevent postpartum depression. Our findings indicated that integrating breastfeeding-related programs and policies into postpartum depression prevention may benefit public health.

REGISTRATION

PROSPERO (CRD42022315143).

The Effect of Clinical Pilates Exercises and Prenatal Education on Maternal and Fetal Health

OBJECTIVE

The mental, physical and sexual health of women as well as maternal and fetal health should be considered during the prenatal and postnatal periods. Investigating the effect of clinical Pilates exercises and prenatal education (CPE & PE) on obstetric and neonatal outcomes as well as the mental, physical, and sexual health of women was intended.

METHODS

In the second trimester, mothers with singleton pregnancies who attended (n=79, study group) or did not attend (n=80, control group) CPE & PR were recruited to this prospective cohort study, and were evaluated in the prenatal and postnatal periods. Depression was assessed with Beck Depression Inventory (BDI), sexual functions with Female Sexual Function Index (FSFI), muscle strength with Gross Muscle Scales (GMS), and labor pain with Visual Analogue Scale (VAS). In addition, the presence of low back pain (LBP) was questioned.

RESULTS

No significant association of CPE & PE with obstetric outcomes such as cesarean rates, preterm birth, and neonatal outcomes such as birth weight and Apgar scores were identified. Changes in VAS scores, the incidence of perineal trauma, and episiotomy were not associated with CPE & PE. However, CPE & PE was associated with lower BDI scores, a gradual increase in the total scores of FSFI, increased GMS, and reduced LBP.

CONCLUSION

CPE & PE had no adverse effects on obstetric and neonatal outcomes and was associated with improved mental, physical, sexual health scores during pregnancy and postpartum.

Postpartum depression and associated factors in Afar Region, northeast Ethiopia

Background

To effectively address the burden of postpartum depression (PPD), it is crucial to gain a comprehensive understanding of its magnitude and the factors associated with it in the pastoral and hot region of the Afar Region. This will help identify the progress made thus far and highlight areas that require further attention to accelerate efforts toward reducing the impact of PPD. Notably, no previous study has examined the prevalence and associated factors of PPD specifically in pastoral communities within Ethiopia, including the Afar Region. Accordingly, we investigated the prevalence and associated factors of PPD among postpartum women in the Afar Region, Northeast Ethiopia.

Methods

An institution-based cross-sectional study was conducted in the Awsi Rasu Zone of Afar Regional State from June to July 2021. The study employed a systematic random sampling method to select a total of 302 postpartum mothers who had visited the Expanded Program of Immunisation (EPI) clinics in public health facilities within the Awsi Rasu Zone of the Afar Region. The measurement of PPD was performed using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable binary logistic regression modelling was used to investigate associations between sociodemographic, obstetric and health service, and psychosocial factors with PPD.

Results

The overall prevalence of PPD was 37.4% with a 95% confidence interval (CI) from 32.0% to 43.0%. Postpartum women who attained high school education were associated with a lower odds of PPD compared to those who did not attain formal schooling (adjusted odds ratio [AOR] = 0.31; 95% CI: 0.12, 0.82). Postpartum women with a family history of mental illness (AOR = 2.34; 95% CI: 1.24, 4.41), those who had trouble in infant feeding (AOR = 4.26; 95% CI: 2.32, 7.83), and those who experienced intimate partner violence (AOR = 3.09; 95% CI: 1.58, 6.04) were positively associated with PPD.

Conclusion

The results of our study revealed that the prevalence of PPD in the Awsi Rasu Zone of the Afar Region is higher than both the national and global averages. The findings also highlighted the need for targeted interventions addressing the needs of pastoral postpartum women who experience various stressors, such as feeding difficulties and intimate partner violence.

Relationship Between the Genital Self-Image and the Sexual Quality of Life of Primiparous Women in the Postpartum Period in Heterosexual Couples

Objectives: This study was planned to investigate the relationship between the genital self-image of primiparae and their sexual quality of life in the postpartum period in heterosexual couples. Method: In this cross-sectional and correlational study, the data were collected through face-to-face interviews in the eastern part of Turkey. Results: The results demonstrated that the relationship between the genital self-image and sexual quality of life of the participants who were sexually active after birth was moderate (r = 0.52, p <.001). Both the genital self-image and sexual quality of life of the participating women were affected by the romantic relationship between them and their partners after birth (p <.01). Conclusions: Healthcare professionals should encourage and support couples to look over their relationship and problems they experience in their romantic relationship after birth.

Exercise for perinatal depressive symptoms: A systematic review and meta-analysis of randomized controlled trials in perinatal health services

BACKGROUND

Exercise improves perinatal depressive (PD) symptoms, but reports call for more robust evidence. This systematic review and meta-analysis aimed at synthesizing evidence exclusively from randomized controlled trials (RCTs) examining the effects of exercise on PD symptoms in women recruited through perinatal health services.

METHODS

Nine e-databases and fifteen systematic reviews were searched for relevant RCTs. Exercise-specific tools extracted/coded data. A meta-analysis using a random effects model (Standardized Mean Difference [SMD]) investigated the effects of exercise on PD scores post-intervention.

RESULTS

From 285 records, 14 RCTs (2.025 participants) were considered eligible including two RCTs with clinically diagnosed PD women. Exercise showed a statistically significant, small, overall antidepressant effect (SMD = -0.21, 95% CI = -0.31, -0.11, p = 0.0001) with low/non-significant heterogeneity (Q = 17.82, I ² = 16%, p = 0.27). Only the fail-safe criterion recorded marginally significant publication bias, but trim-fill analysis added no study. Sensitivity analyses increased the overall effect in RCTs showing lower risk of bias or delivering ≥150 min/week moderate intensity aerobic exercise. Subgroup analyses revealed significant antidepressant effects for exercise across various settings, delivery formats, depressive symptoms severities and outcome measures used. Heterogeneity was low/non-significant in all analyses (I ² ≤ 50%). Hedges' g corrections did not influence the results.

LIMITATIONS

Study limitations include the small number of available trials and clinically diagnosed PD samples and the variety of exercise modalities.

CONCLUSIONS

Exercise improved PD symptoms, especially in RCTs with lower risk of bias or with ≥150 min/day moderate intensity aerobic exercise interventions. Findings are clinically useful but more RCTs for clinically diagnosed PD women are needed for firmer conclusions.

A descriptive qualitative study exploring the experiences of fathers with partners suffering from maternal perinatal depression

OBJECTIVE

The onset of maternal perinatal depression poses many challenges for fathers, yet in Singapore and Asia, the topic remains largely unexplored. This study aimed to gain insight into the experiences of fathers whose partners suffer from perinatal depression in the Asian milieu.

DESIGN

A descriptive qualitative study design was adopted. Purposive and snowball sampling methods were used to recruit participants. Semi-structured, face-to-face interviews were conducted individually with participants to collect data, which were analysed using thematic analysis.

SETTING AND PARTICIPANTS

Twelve fathers were recruited for the study. Eleven were from a perinatal mental health service in a tertiary hospital in Singapore, while 1 father was recruited via snowball sampling.

FINDINGS

Five themes describing the fathers' journey through their partners' perinatal depression emerged from the analysis. The themes are: (1) feeling their world collapse; (2) struggling with the depression; (3) enduring the emotional toll; (4) coping with the situation; and (5) emerging from the other side.

KEY CONCLUSIONS

The findings of this study highlighted the struggles, coping methods, and support needs of fathers whose partners suffer from perinatal depression. Fathers were often unable to identify perinatal depression in their partners. Notably, they testified to the need to tolerate verbal and sometimes violent outbursts from their partners, and requested for more available information, resources, and peer support groups.

IMPLICATIONS FOR PRACTICE

The findings underscore a need for pre-emptive education on maternal perinatal depression and more accessible resources. Healthcare professionals should assess fathers' emotional responses to parenthood and their partners' depression.

Partner relationship quality predicts later postpartum depression independently of the chronicity of depressive symptoms

OBJECTIVE

Given the lifelong implications of extended postpartum depression (PPD), research is needed to examine the social factors implicated in its development (such as relationship quality) and associated predictors. This study sought to examine the association of partner relationship quality (PRQ) and decline of sexual life (DSL) with maternal PPD at 12-15 months after childbirth.

METHODS

Prospective study of 294 low-income postpartum women. A structured questionnaire and the Patient Health Questionnaire-9 (PHQ-9) captured responses for the main outcome variable and covariates.

RESULTS

The prevalence of the main outcome (PPD at 12-15 months) was 19.1%. Using logistic regression models, low PRQ (risk ratio [RR] = 1.58, 95%CI 1.01-2.49) and DSL (RR = 1.97, 95%CI 1.23-3.15) were associated with PPD at 12-15 months even after controlling for perinatal depression.

CONCLUSIONS

Late PPD (12 to 15 months after giving birth) is very common among low-income women, and is independently associated with different aspects of the couple's relationship. Improving PRQ may prevent late PPD. Future investigations are warranted.

Sexual function in Chinese women from pregnancy to postpartum: a multicenter longitudinal prospective study

Background

The aims of our research were as follows: First, to estimate the prevalence of female sexual dysfunction in early, middle, late stages of pregnancy, and postpartum 6 months after delivery. Second, to discuss relevant factors associated with female sexual dysfunction among women in 6 months after delivery in Nanjing, Yangzhou and Huaian Main, China.

Methods

Our multicenter longitudinal study was carried out from September 2017 to March 2019, with participants recruited from Southeast China: Nanjing, Yangzhou and Huaian. Participants were recruited when they built their Record of Prenatal Care in community hospitals. The online questionnaires included a set of validated tools, sociodemographic information as wells as medical history data. In the meantime, qualitative interviews were conducted during different periods of pregnancy (from the first trimester to the third trimester of pregnancy and following up to six-month postpartum) respectively. All participants have obtained written informed consent.

Results

By qualitative interview, the vast majority of the participants were inactive in having sex from pregnancy to postpartum. There were negative aspects of sexual experiences, emotional responses closely related to self-attitudes toward sexual behavior during this period. Through quantitative analysis, pre pregnancy BMI (OR = 1.15, P = 0.012), postpartum weight gain (OR = 1.057, P = 0.033) and partnership quality (OR = 1.181, P = 0.04) were associated with postpartum sexual dysfunction 6 months after delivery.

Conclusions

Women are at the risk of significantly different FSD with regard to pre-pregnancy BMI, postpartum weight gain and partnership quality. The impaired sexual function from pregnancy to postpartum period indicated the requirement for further survey as well as extensive investigation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03546-6.

A phenomenological study of Jordanian women's experience of sexual intercourse after giving birth

AIM

to explore the sexual experiences of Jordanian women on the first occasion after giving birth.

METHODS

phenomenological qualitative research. Twenty-five Jordanian women were purposively recruited from two maternal health centres and interviewed.

FINDINGS

four themes emerged: "culture and religion v/s health professionals in resumption of sexual intercourse"; "enduring physical and psychological discomforts"; "husbands' role in resumption of sexual intercourse"; and "newborn babies' role in the experience of sexual intercourse".

CONCLUSION

health professionals need to adopt appropriate maternal clinical guidelines to meet women's needs. There is a need to give greater emphasis on sexual health care provided to women during pregnancy and after giving birth.

The Relationship Between Postpartum Depression and Lower Maternal Confidence in Mothers with a History of Depression During Pregnancy

The objective of the present study is to evaluate the association of postpartum depression and low maternal confidence in a sample of women who had depression during pregnancy. Cross-sectional study performed from 2013 to 2015 with 346 postpartum women who had participated in an intervention to treat their depression during pregnancy. This study used the Maternal Confidence Questionnaire and the Patient Health Questionnaire 9-item scale. The prevalence ratio, adjusted and non-adjusted, and the 95% CI were calculated using Poisson regression with robust variance. Multivariate models estimated the Prevalence Ratios between postpartum depression and low maternal confidence adjusted for socio-demographic variables and maternal characteristics. Statistical analysis was performed with the STATA12. Among a sample of women who were depressed during pregnancy, only 19% had probably moderate to severe depression and nearly half, 48%, reported high maternal confidence in the postpartum period. In the fully adjusted model, women with moderate/severe probable depression showed increased risk of lower maternal confidence in comparison to women without probable depression Prevalence Ratio = 1.37 (95% CI 1.10-1.71). The results reinforce the importance of the evaluation of maternal confidence feelings in primary care particularly for women with more severe forms of depression.

Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes

Introduction:

The postpartum period represents the time of risk for the emergence of maternal postpartum depression. There are no systematic reviews of the overall maternal outcomes of maternal postpartum depression. The aim of this study was to evaluate both the infant and the maternal consequences of untreated maternal postpartum depression.

Methods:

We searched for studies published between 1 January 2005 and 17 August 2016, using the following databases: MEDLINE via Ovid, PsycINFO, and the Cochrane Pregnancy and Childbirth Group trials registry.

Results:

A total of 122 studies (out of 3712 references retrieved from bibliographic databases) were included in this systematic review. The results of the studies were synthetized into three categories: (a) the maternal consequences of postpartum depression, including physical health, psychological health, relationship, and risky behaviors; (b) the infant consequences of postpartum depression, including anthropometry, physical health, sleep, and motor, cognitive, language, emotional, social, and behavioral development; and (c) mother–child interactions, including bonding, breastfeeding, and the maternal role.

Discussion:

The results suggest that postpartum depression creates an environment that is not conducive to the personal development of mothers or the optimal development of a child. It therefore seems important to detect and treat depression during the postnatal period as early as possible to avoid harmful consequences.

Depressão como mediadora da relação entre violência por parceiro íntimo e dificuldades sexuais após o parto: uma análise estrutural

RESUMO: Introdução: Não foram encontrados estudos que avaliam associação entre violência por parceiro íntimo (VPI) anterior ao parto e dificuldades na esfera da sexualidade no período pós-parto. O presente estudo avalia se existe essa associação. Método: Estudo transversal com 700 mulheres que realizaram o pré-natal em Unidade Básica de Saúde (UBS), em São Paulo, entre 2006 e 2007. As dificuldades sexuais (DS) foram avaliadas por meio de questionário elaborado pelos autores e a VPI foi investigada por questionário estruturado elaborado pela Organização Mundial da Saúde (OMS). Já a depressão pós-parto (DPP) foi avaliada por meio do Self-Reporting Questionnaire (SRQ-20) e foi considerada variável mediadora. Para calcular os coeficientes de associação das vias diretas e indiretas foi utilizada a análise estrutural (path analysis). Resultados: As prevalências de DS, a VPI e a DPP foram, respectivamente, 30, 42,8 e 27,8%. A violência ocorrida antes do parto não mostrou associação direta - ED = 0,072 (-0,06 - 0,20; p = 0,060) - nem indireta - EI: 0,045 (-0,06 - 0,20; p = 0,123) - em relação ao desfecho estudado. Conclusão: Futuras investigações sobre a relação entre as três variáveis estudadas são recomendadas. Estudos longitudinais que incluam outros mediadores podem trazer melhor entendimento da cadeia causal e elucidação das variáveis que influenciam as questões da sexualidade no pós-parto.

Fear-based reasons for not engaging in sexual activity during pregnancy: associations with sexual and relationship well-being

OBJECTIVE

Pregnant women consistently report fears that sexual activity could harm their pregnancy. Little is known, however, about the degree to which women report these fears as reasons for not having sex during pregnancy and whether these fears relate to women's well-being. The aims of this study were to assess the importance of women's fears of sexual activity harming the pregnancy in their decision not to engage in sex during pregnancy, and the associations between these fears and sexual and relationship well-being.

METHODS

Pregnant women (N = 261) were recruited online to complete a survey that included a novel scale of fear-based reasons for not engaging in sexual activity during pregnancy and validated measures of sexual functioning, sexual satisfaction, sexual distress and relationship satisfaction.

RESULTS

Over half of the women (58.6%) reported at least one fear as a reason for not engaging in sexual activity while pregnant, though total fear scores were low. Greater fear-based reasons for not having sex were associated with greater sexual distress but were unrelated to sexual functioning, sexual satisfaction and relationship satisfaction.

CONCLUSIONS

Women who reported higher rates of refraining from sex due to fear that it could harm their pregnancy reported greater sexual distress, but not lower sexual functioning or sexual and relationship satisfaction. Results suggest that interventions focused on minimizing fears of sexual activity during pregnancy may not be essential for promoting women's broader sexual and relationship well-being in pregnancy, but may help to reduce women's global feelings of worry and anxiety about their sexual relationship.

Sexual dysfunction in medical practice

PURPOSE OF REVIEW

Sexual dysfunction is associated with many medical disorders. Lack of recognition of sexual dysfunction commonly occurs in medical practice. The impact of unrecognized sexual dysfunction affects quality of life, which in turn affects the recovery from medical illness. This article reviews the recent literature regarding sexual dysfunction in medical practice published in PubMed, Clinical key, Scopus, Google scholar from November 2014 to May 2016.

RECENT FINDINGS

New findings suggest that sexual dysfunction is associated with most of the disorders affecting various systems. Sexual dysfunction associated with medical disorders, apart from having effects on patients, also has impact on spouses. Sexual dysfunction may also be a predictor of future major adverse event. Prevelance of sexual dysfunction in various major illness is in the range of 20-75%. Phosphodiesterase-5 inhibitors which are first line drugs to treat erectile dysfunction cause no increase in myocardial infarction or death.

SUMMARY

Sexual functioning is impaired in neurological, endocrinal, cardiovascular, pelvic, dermatological, and other disorders. Stroke, epilepsy, traumatic brain injury, and other neurological disorders cause significant impairment in sexual functioning. Though exact correlation between androgen and sexual functioning cannot be made, androgen plays important role various phases of sexual cycle in both men and women. Diabetes has impact on all the phases of sexual cycle. Hypertension, as well as certain drugs used to treat hypertension also causes sexual dysfunction, judicious use of hypotensive drugs is recommended.

Do changes in subjective sleep and biological rhythms predict worsening in postpartum depressive symptoms? A prospective study across the perinatal period

Abnormalities of sleep and biological rhythms have been widely implicated in the pathophysiology of major depressive disorder (MDD) and bipolar disorder (BD). However, less is known about the influence of biological rhythm disruptions across the perinatal period on postpartum depression (PPD). The objective of this study was to prospectively evaluate the relationship between subjective changes in both sleep and biological rhythms and worsening of depressive symptoms from pregnancy to the postpartum period in women with and without mood disorders. Eighty-three participants (38 euthymic women with a history of a mood disorder and 45 healthy controls) were studied. Participants completed subjective assessments of sleep (Pittsburgh Sleep Quality Index), biological rhythm disturbances (Biological Rhythms Interview of Assessment in Neuropsychiatry), and depressive symptoms (Edinburgh Postnatal Depression Scale) prospectively at two time points: third trimester of pregnancy and at 6-12 weeks postpartum. Multivariate regression analyses showed that changes in biological rhythms across the perinatal period predicted worsening of depressive symptoms in both groups. Moreover, women with a history of a mood disorder showed higher levels of sleep and biological rhythm disruption during both pregnancy and the postpartum period. These findings suggest that disruptions in biological rhythms during the perinatal period increase the risk for postpartum mood worsening in healthy pregnant as well as in pregnant women with a history of mood disorders.

[What do we know about perinatal sexuality? A scoping review on sexoperinatality - part 1]

The intimate and sexual dimension of future and new parenting couples' relationship is the most affected and the most vulnerable during the transition to parenthood; couples must adapt to support their relationship and their families. The purpose of this scoping review is to identify the literature that has been published on perinatal sexuality in the last 15 years. A total of 123 empirical articles were selected. This first article of a series of two is about sexuality during pregnancy. In addition to painting a picture from the chosen articles, 23 prenatal sexual variables were analyzed. The combined data present a diversified portrait of perinatal sexuality during pregnancy: the intimate and sexual experience varies during this period. Despite some exceptions, a certain tendency towards a gradual and progressive decline in most sexual behaviors and overall sexual expression during pregnancy was noted, with a marked decrease in early pregnancy and during the third trimester. Women are particularly affected by a greater number of sexual changes, but men are too. Many simultaneous physiological and psychological factors affect the sexual expression of the couples. Sexual fluctuations are a natural phenomenon during the transition to parenthood; couples must adjust to the new conditions and to the changes associated with sexuality during pregnancy, which are considered temporary. Sexoperinatal interventions should be a part of holistic perinatal health care in order to help couples maintain an intimate relationship and a healthy and positive sexual life.

[What do we know about perinatal sexuality? A scoping review on sexoperinatality - Part 2]

The intimate and sexual dimension of future and new parenting couples' relationship is the most affected and the most vulnerable during the transition to parenthood. The purpose of this scoping review is to present the portrait of perinatal sexuality through 123 empirical articles published in the last 15 years. This second article in a series of two is about sexuality during labor and birth, during the postpartum, and in relation to breastfeeding. A total of 29 sexual variables were analyzed. Sexuality during the intrapartal and postnatal periods is very diversified. Some recurring items, however, can be identified: a period of non-sexuality in the first postnatal months, followed by a gradual return of sexuality from 3 to 6 months postpartum and continuing until 12 months or more. Sexuality during the intrapartum is considered taboo and couples' experiences can be at opposite ends: some couples' experiences are sensual and erotic during childbirth, while others experience birth trauma with a negative sexual impact postnatally. Sexuality during breastfeeding is also taboo with a negative impact on women's sexuality. In all of these circumstances, women's and men's sexuality are affected and a multitude of simultaneous physiological and psychological factors affect their experiences. Fluctuations in the intimate and sexual dimensions of the conjugal relationship are considered as a natural phenomenon but temporary. Sexoperinatal interventions should be part of holistic perinatal health care in order to help couples maintain a positive intimate and sexual relationship.

Predictors of sexual function during pregnancy

The aim of the study was to evaluate sexual functions of pregnant women and to determine the factors affecting their sexual function. The cross-sectional study recruited 286 pregnant women from a hospital. To collect data, 'Patient Information Form', 'State Anxiety Inventory' and 'Female Sexual Function Index' were used. The mean age of women was 29.15 ± 4.85 and 77.6% of them presented with sexual dysfunction. Having partner at advanced age, a history of miscarriage, a history of health problem during previous pregnancy and a high level of anxiety were found to be factors negatively affecting sexual function. Health professionals should be aware of a number of risk factors that may contribute to sexual dysfunction in pregnant women.