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Elias DE, Santos MR, Campaña H, Poletta FA, Heisecke SL, Gili JA, Ratowiecki J, Cosentino V, Uranga R, Saleme C, Rittler M, Krupitzki HB, Lopez Camelo JS, Gimenez LG. Indirect Effects of Neighbourhood Socioeconomic Status on Preterm Birth Risk in an Argentine Population. Matern Child Health J 2024; 28:1578-1591. [PMID: 38831170 DOI: 10.1007/s10995-024-03951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Preterm birth (PTB) is the main condition related to perinatal morbimortality worldwide. The aim of this study was to determine the indirect effects of neighbourhood socioeconomic status (NSES) on the risk of spontaneous PTB. METHODS We carried out a retrospective case-control study including sociodemographic and obstetric data of multigravid women who gave birth at a maternity hospital in Tucumán, Argentina, between 2005 and 2010: 949 women without previous PTB nor pregnancy loss who delivered at term and 552 who had spontaneous PTB. NSES was estimated from the Unsatisfied Basic Needs index of census data. Variables selected through penalised regressions were used to create a data-driven Bayesian network; then, pathways were identified and mediation analyses performed. RESULTS Maternal age less than 20 years mediated part of the protective effect of high NSES on spontaneous PTB [natural indirect effect (NIE) -0.0125, 95% confidence interval (CI) (-0.0208, -0.0041)] and on few prenatal visits (< 5) [NIE - 0.0095, 95% CI (-0.0166, -0.0025)]. These pathways showed greater sensitivity to unobserved confounders that affect the variables mediator-outcome in the same direction, and exposure-mediator in the opposite direction. They did not show sensitivity to observed potential confounders, nor to the parameterization used to define NSES. Meanwhile, urinary tract infections showed a trend in mediating the effect of low NSES on spontaneous PTB [NIE 0.0044, 95% CI (-0.0006, 0.0093), P 0.0834]. CONCLUSIONS High NSES has protective indirect effects on spontaneous PTB risk, mainly associated with a lower frequency of teenage pregnancy.
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Affiliation(s)
- Dario E Elias
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.
| | - Maria R Santos
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Comisión de Investigaciones Científicas, Buenos Aires, Argentina
- Instituto Multidisciplinario de Biología Celular, Buenos Aires, Argentina
| | - Hebe Campaña
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Comisión de Investigaciones Científicas, Buenos Aires, Argentina
| | - Fernando A Poletta
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvina L Heisecke
- Dirección de Investigación, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan A Gili
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Académico Pedagógico de Ciencias Humanas, Universidad Nacional de Villa María, Córdoba, Argentina
| | - Julia Ratowiecki
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Viviana Cosentino
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Hospital Interzonal General de Agudos Luisa C. de Gandulfo, Buenos Aires, Argentina
| | - Rocio Uranga
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Hospital San Juan de Dios, Buenos Aires, Argentina
| | - César Saleme
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, Tucumán, Argentina
| | - Mónica Rittler
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Hospital Materno Infantil Ramón Sardá, Ciudad Autónoma de Buenos Aires, Argentina
| | - Hugo B Krupitzki
- Dirección de Investigación, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Universitario, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-IUC), Ciudad Autónoma de Buenos Aires, Argentina
| | - Jorge S Lopez Camelo
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Lucas G Gimenez
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
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Bestman PL, Kolleh EM, Moeng E, Brhane T, Nget M, Luo J. Association between multimorbidity of pregnancy and adverse birth outcomes: A systemic review and meta-analysis. Prev Med 2024; 180:107872. [PMID: 38272269 DOI: 10.1016/j.ypmed.2024.107872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/18/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
Multimorbidity (≥2 co-existing conditions) in pregnancy is a significant public health issue with a rising prevalence worldwide. However, the association between pregnancy multimorbidity and adverse birth outcomes is unclear. So, this review assessed the association between pregnancy-multimorbidity and adverse birth outcomes (preterm birth, abnormal birth weight, neonatal mortality, and stillbirth). Relevant peer-reviewed papers in PubMed, Web of Science, Elsevier/ScienceDirect, and Google Scholar were systematically search from January 1990 to March 2023. We used the random-effects model to calculate the multimorbidity pooled odds ratio, quantified heterogeneity using I2 statistics, and performed subgroup and sensitivity analyses in Stata version 17. The review protocol is registered with PROSPERO (CRD42023421336). The meta-analysis included 21 observational studies involving 6,523,741 pregnant women. The overall pooled odds of pregnancy multimorbidity associated with adverse birth outcomes were 3.11(2.14-4.09), 3.76(2.56-4.96) in Europe, 3.38(1.18-5.58) in North America, and 2.94(0.78-5.09) in Asia. Pregnant women with psychological and physical multimorbidity had increased odds of 5.65(1.71-9.59) and 2.75(1.71-9.58), respectively, for adverse birth outcomes. Pregnancy multimorbidity was associated with preterm birth 4.28(2.23-6.34), large gestational age (>90 percentile) 3.33(1.50-5.17), macrosomia (≥4000 g) 2.16(0.34-3.98), and small gestational age (<10th percentile) 3.52(1.54-5.51). There is substantial variance in the odds of pregnancy multimorbidity by type of comorbidity and type of adverse birth outcome, attributed to differences in the healthcare system by geographical location. Therefore, prioritizing pregnant women with multimorbidity is crucial for effective and integrative interventions.
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Affiliation(s)
- Prince L Bestman
- Department of Maternal and Children Health, Xiangya School of Public Health, Central South University, Changsha 410078, Hunan Province, China
| | - Edwina M Kolleh
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, Hunan Province, China
| | - Eva Moeng
- Department of Maternal and Children Health, Xiangya School of Public Health, Central South University, Changsha 410078, Hunan Province, China
| | - Tesfit Brhane
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, Hunan Province, China
| | - Musa Nget
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, Hunan Province, China
| | - Jiayou Luo
- Department of Maternal and Children Health, Xiangya School of Public Health, Central South University, Changsha 410078, Hunan Province, China.
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Patra BG, Sun Z, Cheng Z, Kumar PKRJ, Altammami A, Liu Y, Joly R, Jedlicka C, Delgado D, Pathak J, Peng Y, Zhang Y. Automated classification of lay health articles using natural language processing: a case study on pregnancy health and postpartum depression. Front Psychiatry 2023; 14:1258887. [PMID: 38053538 PMCID: PMC10694448 DOI: 10.3389/fpsyt.2023.1258887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/25/2023] [Indexed: 12/07/2023] Open
Abstract
Objective Evidence suggests that high-quality health education and effective communication within the framework of social support hold significant potential in preventing postpartum depression. Yet, developing trustworthy and engaging health education and communication materials requires extensive expertise and substantial resources. In light of this, we propose an innovative approach that involves leveraging natural language processing (NLP) to classify publicly accessible lay articles based on their relevance and subject matter to pregnancy and mental health. Materials and methods We manually reviewed online lay articles from credible and medically validated sources to create a gold standard corpus. This manual review process categorized the articles based on their pertinence to pregnancy and related subtopics. To streamline and expand the classification procedure for relevance and topics, we employed advanced NLP models such as Random Forest, Bidirectional Encoder Representations from Transformers (BERT), and Generative Pre-trained Transformer model (gpt-3.5-turbo). Results The gold standard corpus included 392 pregnancy-related articles. Our manual review process categorized the reading materials according to lifestyle factors associated with postpartum depression: diet, exercise, mental health, and health literacy. A BERT-based model performed best (F1 = 0.974) in an end-to-end classification of relevance and topics. In a two-step approach, given articles already classified as pregnancy-related, gpt-3.5-turbo performed best (F1 = 0.972) in classifying the above topics. Discussion Utilizing NLP, we can guide patients to high-quality lay reading materials as cost-effective, readily available health education and communication sources. This approach allows us to scale the information delivery specifically to individuals, enhancing the relevance and impact of the materials provided.
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Affiliation(s)
- Braja Gopal Patra
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Zhaoyi Sun
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Zilin Cheng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | | | - Abdullah Altammami
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Yiyang Liu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Rochelle Joly
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States
| | - Caroline Jedlicka
- Kingsborough Community College, City University of New York, New York, NY, United States
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, United States
| | - Diana Delgado
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, United States
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Yifan Peng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
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Adhikari K, Racine N, Hetherington E, McDonald S, Tough S. Women's Mental Health up to Eight Years after Childbirth and Associated Risk Factors: Longitudinal Findings from the All Our Families Cohort in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:269-282. [PMID: 36947012 PMCID: PMC10037742 DOI: 10.1177/07067437221140387] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study examined the prevalence of elevated maternal anxiety and/or depression symptoms up to eight years after childbirth and the association between role and relationship strains during parenting and mental health challenges from three to eight years after childbirth. METHODS This study used data from the All Our Families longitudinal pregnancy cohort. Role and relationship strain factors and anxiety and depression symptoms were measured at repeated time points from four months to eight years after childbirth. The proportion of women with elevated anxiety and/or depression was calculated at each available time point. Generalized estimating equation models were used to examine the association between role and relationship strain factors and anxiety and/or depression from three to eight years after childbirth. Predicted probability of having anxiety and/or depression was estimated across those with and without challenges with roles and relationships. The models were adjusted for known risk factors such as maternal income and perinatal anxiety and/or depression. RESULTS The prevalence of elevated anxiety and/or depression ranged from 18.8% (at four months) to 26.2% (at eight years). The adjusted odds ratio of anxiety and/or depression was 3.5 (95% CI = 2.9, 4.3) for those juggling family responsibilities and 2.4 (95% CI = 2.0, 3.0) for those with stressful partner relationship compared to their counterparts. Similarly, experiencing financial crunch and poor partner relationship were associated with increased mental health difficulties. Women without challenges in roles or relationships had a 23% lower predicted probability of anxiety and/or depression than those with the challenges. CONCLUSIONS Monitoring mothers for anxiety and depression beyond the postpartum period and strategies that address role and relationship challenges may be valuable to women at risk of anxiety and depression.
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Affiliation(s)
- Kamala Adhikari
- Provincial Population and Public Health, Alberta Health Services,
Edmonton, Alberta, Canada
- Department of Community Health Sciences, University of Calgary,
Calgary, Alberta, Canada
| | - Nicole Racine
- School of Psychology, University of Ottawa, Calgary, Alberta,
Canada
| | - Erin Hetherington
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Québec, Canada
| | - Sheila McDonald
- Provincial Population and Public Health, Alberta Health Services,
Edmonton, Alberta, Canada
- Department of Community Health Sciences, University of Calgary,
Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta,
Canada
| | - Suzanne Tough
- Department of Community Health Sciences, University of Calgary,
Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta,
Canada
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5
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Deutsch AR, Vargas MC, Lucchini M, Brink LT, Odendaal HJ, Elliott AJ. Effect of individual or comorbid antenatal depression and anxiety on birth outcomes and moderation by maternal traumatic experiences and resilience. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022; 9:100365. [PMID: 35966253 PMCID: PMC9373828 DOI: 10.1016/j.jadr.2022.100365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Although antenatal depression and anxiety (e.g., negative antenatal mental health; NAMH) are individually associated with preterm birth (PTB) and infant neurological impairment, few studies account for comorbidity. Understanding how NAMH impacts PTB and infant neurological functioning by either singular (depression or anxiety) or comorbid status, as well as the way in which these effects can be moderated by additional risk or protective factors (traumatic experiences and trait resiliency) can contribute further understanding of NAMH effects on birth outcomes. Methods The sample included 3042 mother-infant dyads from U.S. and South Africa cohorts of the Safe Passage Study (N = 3042). A four-category NAMH variable was created to categorize depression-only, anxiety-only, comorbid, or no NAMH statuses. Results There were no NAMH main effects on PTB, however, anxiety-only and comorbid NAMH increased odds of PTB for mothers with higher rates of traumatic life experiences. Anxiety-only and comorbid NAMH were associated with increased odds of newborn neurological impairment, and the effect of comorbid NAMH was stronger for mothers with higher rates of traumatic experiences. Resiliency decreased odds of neurological impairment for mothers who reported depression-only or anxiety-only NAMH. Limitations Limitations included potential artefacts of two cohorts that differed in rates of almost all variables, a single time point for measuring NAMH, and lack of pregnancy-specific NAMH measures. Conclusions Especially when compared to mothers with no NAMH, comorbidity or singular-condition NAMH statuses associate with negative birth outcomes in nuanced ways, especially when considering additional contexts that may foster or protect against NAMH.
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Affiliation(s)
- Arielle R. Deutsch
- Avera Research Institute
- University of South Dakota School of Medicine, Department of Pediatrics
| | | | - Maristella Lucchini
- Columbia University Irving Medical Center, Department of Psychiatry
- New York State Psychiatric Institute, Division of Developmental Neuroscience
| | - Lucy T. Brink
- Stellenbosch University, School of Medicine and Health Science, Department of Obstetrics and Gynaecology
| | - Hein J. Odendaal
- Stellenbosch University, School of Medicine and Health Science, Department of Obstetrics and Gynaecology
| | - Amy J. Elliott
- Avera Research Institute
- University of South Dakota School of Medicine, Department of Pediatrics
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McHale P, Maudsley G, Pennington A, Schlüter DK, Barr B, Paranjothy S, Taylor-Robinson D. Mediators of socioeconomic inequalities in preterm birth: a systematic review. BMC Public Health 2022; 22:1134. [PMID: 35668387 PMCID: PMC9172189 DOI: 10.1186/s12889-022-13438-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Rates of preterm birth are substantial with significant inequalities. Understanding the role of risk factors on the pathway from maternal socioeconomic status (SES) to preterm birth can help inform interventions and policy. This study therefore aimed to identify mediators of the relationship between maternal SES and preterm birth, assess the strength of evidence, and evaluate the quality of methods used to assess mediation. METHODS Using Scopus, Medline OVID, "Medline In Process & Other Non-Indexed Citation", PsycINFO, and Social Science Citation Index (via Web of Science), search terms combined variations on mediation, socioeconomic status, and preterm birth. Citation and advanced Google searches supplemented this. Inclusion criteria guided screening and selection of observational studies Jan-2000 to July-2020. The metric extracted was the proportion of socioeconomic inequality in preterm birth explained by each mediator (e.g. 'proportion eliminated'). Included studies were narratively synthesised. RESULTS Of 22 studies included, over one-half used cohort design. Most studies had potential measurement bias for mediators, and only two studies fully adjusted for key confounders. Eighteen studies found significant socioeconomic inequalities in preterm birth. Studies assessed six groups of potential mediators: maternal smoking; maternal mental health; maternal physical health (including body mass index (BMI)); maternal lifestyle (including alcohol consumption); healthcare; and working and environmental conditions. There was high confidence of smoking during pregnancy (most frequently examined mediator) and maternal physical health mediating inequalities in preterm birth. Significant residual inequalities frequently remained. Difference-of-coefficients between models was the most common mediation analysis approach, only six studies assessed exposure-mediator interaction, and only two considered causal assumptions. CONCLUSIONS The substantial socioeconomic inequalities in preterm birth are only partly explained by six groups of mediators that have been studied, particularly maternal smoking in pregnancy. There is, however, a large residual direct effect of SES evident in most studies. Despite the mediation analysis approaches used limiting our ability to make causal inference, these findings highlight potential ways of intervening to reduce such inequalities. A focus on modifiable socioeconomic determinants, such as reducing poverty and educational inequality, is probably necessary to address inequalities in preterm birth, alongside action on mediating pathways.
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Affiliation(s)
- Philip McHale
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England.
| | - Gillian Maudsley
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
| | - Andy Pennington
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
| | - Daniela K Schlüter
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
| | - Ben Barr
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
| | - Shantini Paranjothy
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Health Data Science Research Centre, University of Aberdeen, Aberdeen, Scotland
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
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Wang SW, Chen JL, Chen YH, Wang RH. Factors Related to Psychological Distress in Multiparous Women in the First Trimester: A Cross-Sectional Study. J Nurs Res 2022; 30:e210. [PMID: 35446283 DOI: 10.1097/jnr.0000000000000485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The birth rate in Taiwan has declined rapidly; thus, encouraging women to give birth is an important issue in the country. Pregnant women may experience psychological distress, which may negatively impact the health of children and mothers. Prenatal psychological distress is more common in multiparous women than in primiparous women. In addition, compared with that in the second and third trimesters, psychological distress in the first trimester is relatively high. Understanding psychological distress and the associated factors for multiparous women in the first trimester is important to providing early interventions and preventing subsequent maternal and child health problems. PURPOSE This study was designed to examine the important predictive factors related to depression, anxiety, and stress among Taiwanese multiparous women in the first trimester. METHODS A cross-sectional design was used. In all, 216 multiparous women at 16 weeks of pregnancy were recruited from three hospitals in Taiwan. Self-reported questionnaires were used to gather data on demographic characteristics, the parenting stress of motherhood, spousal support, and psychological distress. A multiple logistic regression analysis was conducted to examine the factors associated with psychological distress. RESULTS The prevalence of depression, anxiety, and stress in multiparous women was found to be 31.9%, 42.6%, and 11.1%, respectively. The multiple logistic regression analysis indicated that the stress related to parent-child interaction was a significant predictor of depression and anxiety, the stress related to child-rearing was a significant predictor of anxiety, and low spousal instrumental support was a significant predictor of stress. The model respectively explained 30%, 27%, and 23% of the variance in depression, anxiety, and stress. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Reducing the stress related to parent-child interaction and child-rearing and encouraging spousal instrumental support should be considered during prenatal care when designing interventions to reduce the psychological distress of multiparous women in their first trimester.
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Affiliation(s)
- Shu-Wei Wang
- PhD, RN, Assistant Professor, College of Nursing, Asia University, Taiwan, ROC
| | - Jyu-Lin Chen
- PhD, RN, CNS, FAAN, Professor, Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, USA
| | - Yi-Hsuan Chen
- BPsychSc, Research Assistant, College of Nursing, Kaohsiung Medical University, Taiwan, ROC
| | - Ruey-Hsia Wang
- PhD, RN, FAAN, Professor, College of Nursing, Kaohsiung Medical University, and Adjunct Researcher, Department of Medical Research, Kaohsiung Medical University Hospital, Taiwan, ROC
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Seage M, Petersen M, Carlson M, VanDerslice J, Stanford J, Schliep K. What Role Does Hispanic/Latina Ethnicity Play in the Relationship Between Maternal Mental Health and Preterm Birth? THE UTAH WOMEN'S HEALTH REVIEW 2022; 6:10.26054/0d-dkas-c5qe. [PMID: 35669386 PMCID: PMC9167636 DOI: 10.26054/0d-dkas-c5qe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the association of prepregnancy and prenatal depression and/or anxiety on preterm birth (PTB), while also exploring Hispanic/Latina ethnicity as a potential effect modifier. METHODS Study population included respondents of UT-PRAMS (2016-2019). Associations between prepregnancy and prenatal depression and/or anxiety and PTB were evaluated using Poisson regression models accounting for stratified survey sampling. RESULTS Women with prepregnancy and prenatal depression and anxiety, compared to those without, had a 67 percent (95% CI: 19%, 134%) higher probability of experiencing PTB, after controlling for relevant sociodemographic, lifestyle, and reproductive history factors. Impact of depression on PTB was slightly higher than impact of anxiety. Hispanic/Latina ethnicity was found to protect against PTB for those with prepregnancy and prenatal depression alone (aPR: 0.53, 95% CI: 0.24, 1.21) or both depression and anxiety (aPR: 0.51, 95% CI: 0.18, 1.40) compared to being non-Hispanic/Latina (aPR: 1.79, 95% CI: 1.25, 2.55 for depression alone; aPR: 1.62, 95% CI: 1.18, 2.21 for depression and anxiety). CONCLUSIONS Overall, Utah women reporting prepregnancy and prenatal depression and anxiety were more likely to have a PTB. Being of Hispanic/Latina ethnicity was found to mitigate the risk of PTB among women with depression and anxiety. IMPLICATIONS Prepregnancy and prenatal mental health screenings and treatment are key to lessening the impacts of depression and anxiety on both mother and infant. Hispanic/Latina ethnicity may be protective against PTB among women experiencing mental distress. Whether this is through increased social support or through a different mechanism should be explored in future research.
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Adhikari K, Patten SB, Patel AB, Premji S, Tough S, Letourneau N, Giesbrecht G, Metcalfe A. Data harmonization and data pooling from cohort studies: a practical approach for data management. Int J Popul Data Sci 2021; 6:1680. [PMID: 34888420 PMCID: PMC8631396 DOI: 10.23889/ijpds.v6i1.1680] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Data pooling from pre-existing datasets can be useful to increase study sample size and statistical power in order to answer a research question. However, individual datasets may contain variables that measure the same construct differently, posing challenges for data pooling. Variable harmonization, an approach that can generate comparable datasets from heterogeneous sources, can address this issue in some circumstances. As an illustrative example, this paper describes the data harmonization strategies that helped generate comparable datasets across two Canadian pregnancy cohort studies: All Our Families; and the Alberta Pregnancy Outcomes and Nutrition. Variables were harmonized considering multiple features across the datasets: the construct measured; question asked/response options; the measurement scale used; the frequency of measurement; timing of measurement, and the data structure. Completely matching, partially matching, and completely un-matching variables across the datasets were determined based on these features. Variables that were an exact match were pooled as is. Partially matching variables were harmonized or processed under a common format across the datasets considering the frequency of measurement, the timing of measurement, the measurement scale used, and response options. Variables that were completely unmatching could not be harmonized into a single variable. The variable harmonization strategies that were used to generate comparable cohort datasets for data pooling are applicable to other data sources. Future studies may employ or evaluate these strategies, which permit researchers to answer novel research questions in a statistically efficient, timely, and cost-efficient manner that could not be achieved using a single data source.
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Affiliation(s)
- Kamala Adhikari
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Alka B Patel
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Applied Research and Evaluation- Primary Health Care, Alberta Health Services, Calgary, Canada
| | - Shahirose Premji
- School of Nursing, Faculty of Health, York University, Calgary, Canada
| | - Suzanne Tough
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Nicole Letourneau
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Faculty of Nursing University of Calgary, Calgary, Canada
- Deprtment of Psychiatry, University of Calgary, Calgary, Canada
| | - Gerald Giesbrecht
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
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10
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Luo Z, Xue L, Ma L, Liu Z. Comorbid Anxiety and Depression and Related Factors Among Pregnant and Postpartum Chinese Women During the Coronavirus Disease 2019 Pandemic. Front Psychol 2021; 12:701629. [PMID: 34733199 PMCID: PMC8558209 DOI: 10.3389/fpsyg.2021.701629] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/09/2021] [Indexed: 01/09/2023] Open
Abstract
Objective: To identify the prevalence of comorbid anxiety and depression (CAD) and analyze the relationship between CAD and sociodemographic and obstetric-related variables in pregnant and postpartum Chinese women during the COVID-19 pandemic. Methods: Participants were 2,237 pregnant and postpartum women (aged 19-47 years) who visited various medical institutions in China between February 28, 2020, and April 26, 2020. They were asked to complete an online survey assessing the anxiety and depression, obstetric characteristics, and sociodemographic variables. The women were grouped into the following categories in accordance with the Generalized Anxiety Disorder Scale-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9): (a) CAD, (b) "anxiety only," (c) "depression only," and (d) "no depression or anxiety." After estimating the prevalence of CAD, "anxiety only," and "depression only," we carried out chi-squared tests and multiple logistic regression analysis to examine the related factors between these groups of pregnant and postpartum Chinese women. Results: Comorbid anxiety and depression, "anxiety only," and "depression only," occurred in 6.3, 5.8, and 3.9% of participants, respectively. The prevalence rates of CAD during the first, second, and third trimesters of pregnancy and the postpartum period were found to be 7.4, 6.5, 5.7, and 8.2%, respectively. The factors that differed among the groups were age (p < 0.05), marital status (p < 0.001), level of education (p < 0.05), family support (p < 0.001), and total live births (p < 0.001). "Poor family support" (odds ratio (OR): 1.90; 95% confidence interval (CI): 1.30-2.78; p = 0.0009) and "no birth" (OR: 1.91; 95% CI: 1.32-2.75; p = 0.0006) remained significant factors for the CAD group, while "poor family support" (OR: 2.16; 95% CI: 1.34-3.47; p = 0.0015) remained a significant factor for the "depression only" group when their results were compared to those of the "no depression or anxiety" group in the multiple logistic regression analysis. Conclusion: Pregnant and postpartum Chinese women with poor family support and primipara are at high risk for CAD during the COVID-19 pandemic. These results support the need for targeted perinatal programs to address CAD in pregnant and postpartum women during the pandemic period.
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Affiliation(s)
- Zheng Luo
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Luyao Xue
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Li Ma
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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11
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Reno R, Burch J, Stookey J, Jackson R, Joudeh L, Guendelman S. Preterm birth and social support services for prenatal depression and social determinants. PLoS One 2021; 16:e0255810. [PMID: 34388192 PMCID: PMC8362957 DOI: 10.1371/journal.pone.0255810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/25/2021] [Indexed: 12/18/2022] Open
Abstract
Preterm birth (PTB; <37 weeks gestation), is a leading cause of infant mortality and morbidity. Among those born preterm, risk increases as gestational age at birth decreases. Psychosocial factors such as depression symptoms and social determinants of health (SDH) may increase risk for PTB. Research is needed to understand these risk factors and identify effective interventions. This retrospective cohort study recruited English- and Spanish-speaking women presenting symptoms of preterm labor or admitted for PTB from an urban county hospital in the San Francisco Bay Area (n = 47). We used an iterative analytic approach by which qualitative data informed an exploratory quantitative analysis. Key exposures were presence of self-reported depression symptoms during pregnancy, SDH along eight domains, and receipt of behavioral health services. The outcome was gestational age at birth. T-tests, Wilcoxon rank sum tests, and linear regression models were used to test associations between the exposures and gestational age. Most participants were Black (25.5%) or Latina (59.6%). After adjusting for covariates, participants with depression symptoms had an average gestational age 3.1 weeks shorter (95% CI: -5.02, -1.20) than women reporting no symptoms. After adjusting for covariates, high number of adverse social determinants (≥ 4) suggested an association with shorter gestational age (p = 0.07, 1.65 weeks, 95% CI: -3.44, 0.14). Receipt of behavioral health services was associated with a significantly later gestational age; the median difference was 5.5 weeks longer for depression symptoms, 3.5 weeks longer for high social determinants, and 6 weeks longer for depression symptoms and high social determinants. Among a cohort of high-risk pregnant women, both depression symptoms during pregnancy and co-occurring with exposure to high adverse SDH are associated with shorter gestational age at birth, after controlling for psychosocial factors. Receipt of behavioral health services may be an effective intervention to address disparities in PTB.
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Affiliation(s)
- Rebecca Reno
- Center of Excellence in Maternal, Child, and Adolescent Health, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Johanna Burch
- Dept. of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Jodi Stookey
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Rebecca Jackson
- Dept. of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Layla Joudeh
- Dept. of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Sylvia Guendelman
- Center of Excellence in Maternal, Child, and Adolescent Health, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
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12
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Wu H, Sun W, Chen H, Wu Y, Ding W, Liang S, Huang X, Chen H, Zeng Q, Li Z, Xiong P, Huang J, Akinwunmi B, Zhang CJP, Ming WK. Health-related quality of life in different trimesters during pregnancy. Health Qual Life Outcomes 2021; 19:182. [PMID: 34289867 PMCID: PMC8296584 DOI: 10.1186/s12955-021-01811-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/25/2021] [Indexed: 12/21/2022] Open
Abstract
Background Pregnant women experience physical, physiological, and mental changes. Health-related quality of life (HRQoL) is a relevant indicator of psychological and physical behaviours, changing over the course of pregnancy. This study aims to assess HRQoL of pregnant women during different stages of pregnancy. Methods This cross-sectional study was performed using the The EuroQoL Group’s five-dimension five-level questionnaire (EQ-5D-5L) to assess the HRQoL of pregnant women, and demographic data were collected. This study was conducted in a regional university hospital in Guangzhou, China. Results A total of 908 pregnant women were included in this study. Pregnant women in the early 2nd trimester had the highest HRQoL. The HRQoL of pregnant women rose from the 1st trimester to the early 2nd trimester, and dropped to the bottom at the late 3rd trimester due to some physical and mental changes. Reports of pain/discomfort problem were the most common (46.0%) while self-care were the least concern. More than 10% of pregnant women in the 1st trimester had health-related problems in at least one dimension of whole five dimensions. In the whole sample, the EuroQoL Group’s visual analog scale (EQ-VAS) was 87.86 ± 9.16. Across the gestational stages, the HRQoL remained stable during the pregnancy but the highest value was observed in the 1st trimester (89.65 ± 10.13) while the lowest was in the late 3rd trimester (87.28 ± 9.13). Conclusions During pregnancy, HRQoL were associated with gestational trimesters in a certain degree. HRQoL was the highest in the early 2nd trimester and then decreased to the lowest in the late 3rd trimester due to a series of physical and psychological changes. Therefore, obstetric doctors and medical institutions should give more attention and care to pregnant women in the late 3rd trimester.
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Affiliation(s)
- Huailiang Wu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, China
| | - Weiwei Sun
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, China
| | - Hanqing Chen
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yanxin Wu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenjing Ding
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Shangqiang Liang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, China
| | - Xinyu Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, China
| | - Haitian Chen
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Qing Zeng
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhuyu Li
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Peng Xiong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Jian Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Babatunde Akinwunmi
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, USA.,Center for Genomic Medicine (CGM), Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Wai-Kit Ming
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China. .,Faculty of Medicine, International School, Jinan University, Guangzhou, China.
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13
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Shangguan F, Wang R, Quan X, Zhou C, Zhang C, Qian W, Zhou Y, Liu Z, Zhang XY. Association of Stress-Related Factors With Anxiety Among Chinese Pregnant Participants in an Online Crisis Intervention During COVID-19 Epidemic. Front Psychol 2021; 12:633765. [PMID: 33995188 PMCID: PMC8119994 DOI: 10.3389/fpsyg.2021.633765] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/16/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Previous systematic review indicated the prevalence of prenatal anxiety as 14–54%. Pregnant women are a high-risk population for COVID-19. However, the prevalence of anxiety symptoms and related factors is unknown in Chinese pregnant women during COVID-19 outbreak. Objective: To investigate the prevalence of anxiety symptoms and the related factors in Chinese pregnant women who were attending crisis intervention during the COVID-19 pandemic. Methods: The data of this cross-sectional study were collected in about 2 months (February 28 to April 26, 2020). Data analysis was performed from April to May 2020. Participants completed a set of questionnaires via the Wechat Mini-program before starting the online self-help crisis intervention for COVID-19 epidemic. A total of 2,120 Chinese pregnant women who were attending a self-help crisis intervention participated in this study. A survey was developed to address possible stress-related factors in pregnant women during the COVID-19 outbreak, including demographic, socioeconomic, and pregnancy-related factors, as well as COVID-19 related factors. Generalized Anxiety Disorder-7 (GAD-7) scale and the 10-item perceived stress scale were, respectively, employed to measure anxiety and stress-related factors. Results: A total of 21.7% (459) of pregnant women reported at least mild anxiety (≥5 on the GAD-7 scale), and only 82 women reported moderate to severe anxiety (≥10 on the GAD-7 scale). Factors associated with at least mild anxiety included living in Hubei province (OR = 1.68, 95% CI = 1.32–2.13), nobody providing everyday life support (OR = 1.81, 95% CI = 1.18–2.77), pelvic pain or vaginal bleeding (OR = 1.67, 95% CI = 1.32–2.09), and higher perceived stress (OR = 6.87, 95% CI = 5.42–9.02). Having relatives or neighbors with a diagnosis of COVID-19 was not associated with anxiety (p > 0.05). Conclusions and Relevance: Our findings indicate that evaluation and intervention for maternal and infant health are necessary in pregnant women with anxiety during COVID-19 epidemic, especially those with higher perceived stress, less everyday life support, or vaginal bleeding. Interactions among these related medical, social and psychological factors need to be investigated in future studies.
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Affiliation(s)
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Quan
- School of Psychology, Capital Normal University, Bejing, China
| | - Chenhao Zhou
- School of Psychology, Capital Normal University, Bejing, China
| | - Chen Zhang
- School of Psychology, Capital Normal University, Bejing, China
| | - Wei Qian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Bejing, China.,Department of Psychology, University of Chinese Academy of Sciences, Bejing, China
| | | | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Bejing, China.,Department of Psychology, University of Chinese Academy of Sciences, Bejing, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Bejing, China.,Department of Psychology, University of Chinese Academy of Sciences, Bejing, China
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14
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Shenassa ED, Widemann LG, Hunt CD. Antepartum Depression and Preterm Birth: Pathophysiology, Epidemiology, and Disparities due to structural racism. Curr Psychiatry Rep 2021; 23:14. [PMID: 33630175 DOI: 10.1007/s11920-021-01223-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Informed by the evidence of links between physiology of stress and parturition, we review recent epidemiologic evidence (2015-2020) of antenatal depression as a risk factor for preterm birth (PTB). We also explain racial/ethnic disparities in depression and preterm birth as a consequence of structural racism. RECENT FINDINGS Epidemiologic evidence is consistent in linking antepartum depression with an elevated risk of PTB. Antidepressant usage has been linked with an elevated risk of PTB. However, recent evidence suggests that severity of depression is the underlying driver of the elevated risk attributed to antidepressant usage. The number of depressive symptoms, as a proxy for severity of maternal stress, may be a more informative predictor of PTB than criterion based predictors. Across various study designs, measurement modalities, and populations, antenatal depression predicts an elevated risk of delivering preterm. The physiology of stress provides a plausible explanation for this observation. Excessive stress-induced elevations in maternal and then fetal HPA hormones can alter maternal and fetal homeostasis and hasten the timing of parturition. Antenatal depression and exposure to structural racism are two stressors that can trigger the maternal stress response. Chronically elevated levels of stress hormones among women of color in the USA provide a likely physiologic explanation for Black-White disparities in the risk of PTB. Focusing on the number of depressive symptoms as the more informative predictor of PTB raises several questions. We consider these questions as well as directions for future research in the context of recent advances in the field.
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Affiliation(s)
- Edmond D Shenassa
- Maternal & Child Health Program, Department of Family Science; and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA. .,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA. .,Department of Epidemiology & Biostatistics, School of Medicine, University of Maryland, Baltimore, MD, USA.
| | - Lea G Widemann
- Maternal & Child Health Program, Department of Family Science; and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Cole D Hunt
- Maternal & Child Health Program, Department of Family Science; and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
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15
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Ghimire U, Papabathini SS, Kawuki J, Obore N, Musa TH. Depression during pregnancy and the risk of low birth weight, preterm birth and intrauterine growth restriction- an updated meta-analysis. Early Hum Dev 2021; 152:105243. [PMID: 33190020 DOI: 10.1016/j.earlhumdev.2020.105243] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/14/2020] [Accepted: 10/18/2020] [Indexed: 12/21/2022]
Abstract
AIM Depression during pregnancy is a significant cause of adverse birth outcomes, and its prevalence has increased in recent years. This study aimed to give an updated quantification of the risk of preterm birth (PTB), low birth weight (LBW) and intrauterine growth restriction (IUGR) that is associated with antenatal depression. METHOD The search was done in different databases, including Web of Science, Scopus and PubMed, from January 2010 to March 2020, and only English-language articles were considered. We only included studies that assessed depression during pregnancy and those that reported data on antenatal depression with at least one adverse birth outcome (PTB, LBW, or IUGR). The quality of studies was assessed using an adaptation of the Newcastle-Ottawa scale assessment tool. The analysis was conducted using STATA (version 12), pooled effect sizes were calculated using the random-effects model and heterogeneity was tested for using the I2 statistic. RESULTS The analysis included 23 studies of PTB, LBW and IUGR. There was a significant risk of PTB (RR = 1.35, 95% CI 1.19-1.52), LBW (RR = 1.86, 95% CI 1.32-2.62) and IUGR (RR = 4.39, 95% CI 2.45-7.86). Control for confounders, time of assessing depression, among others altered the risk of LBW due to depression. In addition, depressed women in developing countries had a higher risk of PTB (RR = 2.07, 95% CI 1.13-3.81). CONCLUSION This study identifies a significant risk of PTB, LBW and IUGR due to antennal depression and recognises a need for targeted preventive interventions such as prompt screening to improve and promote maternal mental health care.
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Affiliation(s)
- Upama Ghimire
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Global Health School of Public Health, Southeast University, Nanjing 210009, Jiangsu Province, China.
| | - Shireen Salome Papabathini
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Global Health School of Public Health, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Joseph Kawuki
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Global Health School of Public Health, Southeast University, Nanjing 210009, Jiangsu Province, China; Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Nathan Obore
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Global Health School of Public Health, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Taha Hussein Musa
- Key Laboratory of Environmental Medicine Engineering, Department Epidemiology and Health Statistics, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, Jiangsu Province, China; Biomedical Research Institute, Darfur College, Nyala, Sudan
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