The relationships between prenatal attachment, maternal anxiety, and postpartum depression: A longitudinal study

Effect of lite touch on the anxiety of low-risk pregnant women in the latent phase of childbirth: a randomized controlled trial

Introduction

Women with perinatal anxiety have reduced coping capacity during labor, which affects labor progress and increases the likelihood of a cesarean section. Several non-pharmacological interventions for anxiety during childbirth are available. This study used the "lite touch" method, a non-pharmacological intervention based on physiological responses and obstetric clinical experience in women. We aimed to evaluate whether lite touch could relieve perinatal anxiety and investigate the effect of light skin stroking on the maternal hormones, catecholamine, and cortisol.

Methods

This randomized clinical trial involved women with low-risk singleton pregnancies at full term or near term. Eligible pregnant women who were latent and did not undergo epidural anesthesia were randomized into two groups. Participants in the intervention group underwent routine prenatal care, including lite touch, whereas the control group underwent routine prenatal care alone. Demographic data were collected through a questionnaire. Labor anxiety was assessed using the State Anxiety Inventory, and saliva was collected before and after the intervention. Changes in saliva cortisol and catecholamine levels were analyzed using a double-antibody sandwich enzyme-linked immunosorbent assay.

Results

In total, 83 participants were included, with 43 and 40 in the intervention and control groups, respectively. In the intervention group, pre-intervention anxiety scores were significantly lower (p < 0.01) than post-intervention anxiety scores, whereas the control group showed no difference in anxiety scores before and after intervention (p > 0.05). Cortisol and catecholamine levels in saliva were significantly lower in the intervention group than in the control group after the intervention (p < 0.01).

Discussion

Lite touch can reduce the latent anxiety state of low-risk pregnant women, thereby maintaining in vivo stability and facilitating labor.

Clinical trial registration

https://www.chictr.org.cn/aboutEN.html, ChiCTR2300070905, Retrospectively Registered Date: April 26, 2023.

Prevalence of postpartum major depression and depressive symptoms in Spanish women: A longitudinal study up to 1 year postpartum

OBJECTIVE

Depression is a prevalent mental disorder in the postpartum period, with consequences for both the mother and her offspring. However, longitudinal studies determining the moments of greatest vulnerability and severity of depression during the postpartum period are scarce. The aims of this research were to determine the prevalence and trajectories of probable depression and major depression during the first year postpartum.

DESIGN

Longitudinal study.

SETTING

Interviews were conducted personally at three times: 2 months, 6 months and 1 year postpartum.

PARTICIPANTS

561 postpartum women.

MEASUREMENTS AND FINDINGS

Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders (DSM). Descriptive and comparative analyses have been carried out. The prevalence of probable depression at 2 months, 6 months and 1 year postpartum, using a cut-off point ≥ 10, was 30.3%, 26.0% and 25.3%, respectively; and that of major depression using SCID was 10.3%, 10.9% and 14.8, respectively. The prevalence of probable depression was highest at 2 months postpartum and that of major depression at 1 year postpartum. Probable depression followed a downward trajectory and major depression followed an upward trajectory.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The clinical relevance of this research is that it has made it possible to demonstrate that depression is very prevalent in the first year postpartum and that, far from subsiding, the prevalence remains very high even at 1 year postpartum. Our findings highlight the importance of taking mental health care into account throughout at least the first year postpartum.

The precursors's adaptation to pregnancy, prenatal attachment and maternal self-confidence

We investigated the precursors for prenatal attachment (PA), adaptation to pregnancy and maternal self-confidence, and the relationship of these variables with each other. This cross-sectional study was conducted between July and December 2020. Data were obtained using an online survey from social media groups. The mean Prenatal Self Evaluation Questionnaire scores of women had a negative and moderate correlation with mean Pharis Self-Confidence Scale (r=-0.287, p=.000) and negative and weak correlation with mean Prenatal Attachment Inventory scores (r=-0.317, p=.000). Women who conceived following assisted reproductive techniques had a higher level of readiness to give birth (17.62 ± 5.22) than women who conceived spontaneously (29.57 ± 6.15) (β=-0.285, t=-3.547, p=.002). We concluded that when women's adaptation to pregnancy increased in the prenatal period, their PA level and self-confidence towards baby care increased. The results of this study may guide healthcare professionals in terms of improving care for women who have attachment and adaptation problems during pregnancy. Women who conceived following assisted reproductive techniques can be reassured that infertility does not have a negative impact on their readiness for birth. Healthcare professionals could ensure adaptation in women who have problems with adaptation during pregnancy by initiating interventions that support PA and increase the maternal self-confidence levels of women.Impact StatementWhat is already known on this subject? There were few studies examining the relationship between women's conception style with prenatal attachment (PA), adaptation to pregnancy, and maternal self-efficacy.What do the results of this study add? In this study, it was determined that women who conceived following assisted reproductive techniques have higher levels of being ready to give birth than women who conceived spontaneously without medical assistance. Additionally, it was found that as women evaluate themselves positively in the prenatal period, their PA and maternal self-confidence level regarding baby care increased.What are the implications of these findings for clinical practice and/or further research? Since this study examines the precursors of maternal self-confidence, PA and adaptation to pregnancy in Turkish pregnant women, it was shown that studies in different cultures are needed in terms of generalisability of the results. In addition, there is a need to identify risky women who have low self-confidence in baby care during pregnancy and have attachment and adjustment problems, and to culture-specific intervention programs need to be developed and tested.

Incidence of conversion to general anaesthesia and need for intravenous supplementation in parturients undergoing caesarean section under spinal anaesthesia: A retrospective observational study

BACKGROUND

Conversion from spinal anaesthesia to general anaesthesia (GA) was shown to be associated with more complications. It has been postulated that spinal injection of a low dose of local anaesthetic is a risk factor. We aimed to discover the rate of conversion from spinal anaesthesia to GA in women who received at least 10 mg heavy bupivacaine and opioids and assess its risk factors.

METHODS

All women that underwent spinal anaesthesia for caesarean section from 1 January 2017 to 31 December 2020 were included in this analysis. Spinal anaesthesia was performed according to department protocol using heavy bupivacaine 0.5% 10-13 mg, fentanyl 20 μg, and morphine 0.1 mg. We examined rate of conversion from spinal anaesthesia to GA and rate of need for analgesia/sedation.

RESULTS

There were 1.7% of women that required conversion to GA. Bupivacaine dose (OR 0.54 [95% CI 0.38 to 0.75], p < 0.001), surgery time (OR 1.03 [95% CI 1.02 to 1.04], p < 0.001), emergency caesarean section (OR 1.06 [95% CI 1.16 to 3.76], p = 0.015), and postpartum haemorrhage (OR 5.96 [95% CI 1.09 to 25.18], p = 0.025) were independent predictors of need for conversion to GA. Of the women who had CS under spinal anaesthesia, 4.1% of parturients required intraoperative analgesics/sedatives and 9.1% required anxiolysis.

CONCLUSIONS

A small proportion of women required conversion to GA. This conversion occurred especially with emergency caesarean section and when low spinal bupivacaine doses were used.