Resilience and Stress during Pregnancy: A Comprehensive Multidimensional Approach in Maternal and Perinatal Health

Exploring the influence of nurses' demographics and hospital work environment on medical error reporting practices in Jordan: a cross-sectional study

OBJECTIVE

Nurses have a significant role in maintaining patient and healthcare safety. Thus, healthcare administrators should focus on nurse performance and create a friendly hospital work environment to ensure patient safety and healthcare quality. Limited studies have investigated the impact of nurses' demographics on nurses' error reporting practices and nurses' perceptions of the hospital work environment, especially in Jordan. This study aims to investigate the factors influencing nurses' medical error reporting practices in Jordan, specifically focusing on the role of nurses' demographics and the hospital work environment. Design: This is a descriptive cross-sectional study.

SETTING

Data collection was done in three hospitals (public, university-affiliated and private) in Jordan, using surveys that included demographics, the incident reporting practice scale and the Practice Environment Scale-Nursing Work Index from 11 June 2023 to 13 August 2023.

PARTICIPANTS

350 nurses with a diploma, associate degree, bachelor's degree or postgraduate degree had worked at the targeted hospitals for at least 6 months and were responsible for direct inpatient care.

PRIMARY OUTCOME MEASURE

The level of medical error reporting practices and the nursing work environment. Also, differences were assessed among demographic characteristics and investigated the factors for medical error reporting practices.

RESULTS

Jordanian nurses had low medical error reporting practices (M=2.34; SD=0.57) and nursing work environment (M=2.4; SD=0.56). Nurses who were single and in private hospitals had higher medical error reporting practices (p<0.05). Medical error reporting practices positively correlated with the nursing work environment (r=0.807, p<0.01) and negatively correlated with the average number of patients per shift (r=-0.109, p<0.05). The nursing work environment was a significant predictor, with an 81.0% variance in medical error reporting practices.

CONCLUSIONS

The study found that Jordanian nurses have low perceptions of their work environment and medical error reporting practices, which are influenced by marital status and hospital type. Enhancing the nurse work environment and providing ongoing standards training are critical for improving safety behaviours, patient outcomes and care quality. Future research should investigate the long-term consequences of interventions on reporting practices and patient outcomes.

Stress and its associated factors in mothers with preterm infants in a private tertiary care hospital of Karachi, Pakistan: an analytical cross-sectional study

OBJECTIVES

This goal of this research is to present a comprehensive method for evaluating stress and the factors that contribute to it in mothers of premature babies.

DESIGN

Analytical cross-sectional study.

SETTING

Data were collected from inpatient service for preterm infants including neonatal intensive care unit, and neonatal step-down units of the Aga Khan University Hospital-a private tertiary care hospital in Karachi, Pakistan.

PARTICIPANTS

Mothers aged 18 years and above who delivered preterm infants (gestational age of preterm below 37 weeks) in a private tertiary care hospital in Karachi, Pakistan.

PRIMARY OUTCOME

Stress in mothers of preterm infants.

RESULTS

200 participants with a mean age of 30.12 years (SD ±5.21) were assessed. The level of stress identified using the perceived stress scale (PSS) among mothers who had delivered preterm infants was significantly higher as compared with other countries around the world. Based on the criteria of PSS scoring, the majority of the participants (92%, n=184) were categorised as having high perceived stress and 8% (n=16) of the mothers fell into the category of moderate stress.

CONCLUSIONS

The study findings suggest high levels of perceived stress among mothers of preterm infants. The factors associated with the stress among mothers of preterm infants included immunisation of newborn, education and occupation status of mothers, substance abuse by mother, gender preference from family, planning for further children, consumption of balance diet, education status of husband, mode of socialisation, years of marriage and hours of sleep.

Obstetric Violence (OV) Consequences and Coping Strategies: Insights Through the Voices of Arab and Jewish Women in Israel

This qualitative research amplifies the voices of Jewish and Arab women in Israel, illuminating their experiences with obstetric violence, its consequences, and coping strategies. The premise of this study is the feminist approach that aims to eradicate phenomena related to gender and patriarchal structures affecting women, their bodies, and their health. The research was based on the qualitative-constructivist methodology, by means of thematic analysis of 20 in-depth semistructured interviews. Two main themes emerged: first, consequences (e.g., physical, emotional, spousal relationships, and mistrust) and second, women's coping strategies (e.g., repression, avoidance, garnering inner strengths, resilience, and relying on external help).

Stress, Anxiety, and Depression During Pregnancy: A Survey Among Antenatal Women Attending Primary Health Centers

Background/Objectives: Maternal mental health problems such as stress, anxiety, and depression (SAD) in antenatal women are major public health challenges. This study aimed to determine the levels of SAD in antenatal women and associate the selected variables with them. Methods: A cross-sectional study was conducted in selected primary health centers (PHC) in Al-Ahsa, Saudi Arabia. The pregnant women were selected using systematic randomization, and their SAD levels were assessed using the perceived stress scale (PSS), the state anxiety scale (SAS), and the patient health questionnaire (PHQ-9), respectively. Linear regression was used to associate factors related to stress, anxiety, and depression. Results: Out of 346 antenatal women, 4% had a high level of stress and 27.2% had a moderate level of stress. Regarding the level of anxiety, 2.6% of them had high anxiety, and 32.9% had moderate anxiety. Around 32 (9.2%) women had moderate depression, and 4 (1.2%) had severe depression. The mean score of SAD was 11.99, 28.88, and 4.73, respectively. A linear regression proved that there was an association between stress and age, occupation, gestational age (GA), gravida, para, abortions, and social support (SS) (p < 0.05). Anxiety was associated with age, GA, gravida, para, abortions, past obstetrical complications, and SS (p < 0.05). Depression was related to age, education, occupation, para, abortions, past obstetrical complications, and SS (p < 0.05). Conclusions: Due to the prevalence of SAD in pregnancy, the screening of these conditions and awareness creation about the associated factors can help to identify potential risks earlier and prevent maternal and fetal complications.

Latina Women's Perinatal Experiences and Perspectives Around Discrimination, Anti-immigrant Policies, and Community Violence

OBJECTIVE

To describe experiences of Latina women who were currently pregnant or recently gave birth around discrimination, anti-immigrant policies, and community violence during the early COVID-19 pandemic.

DESIGN

Qualitative secondary analysis.

SETTING

Online or phone interviews.

PARTICIPANTS

Latina women who were currently pregnant or recently gave birth (N = 26).

METHODS

We used reflexive thematic analysis to examine transcribed data from semistructured interviews conducted during the early COVID-19 pandemic with a subgroup of participants enrolled in a larger study related to prenatal care. Participants were English- or Spanish-speaking, Medicaid-eligible, Latina-identifying women who resided in Fresno County, California. We analyzed responses to questions about personal discrimination, the Black Lives Matter movement, and immigration policies using the theoretical frameworks of critical race theory and the political economy of health.

RESULTS

We identified four major themes: Avoidance of Community Engagement, Chronic Fear and Vigilance, The Role of Media, and Everyday Discrimination and Injustice.

CONCLUSION

Participant experiences reflect the pervasiveness of fear and socioeconomic inequity and call attention to the racialized structures that affect health and health care access for Latina women. These exposures during the perinatal period may have intergenerational effects. These findings underscore the need for responsive and race-conscious perinatal nursing care for Latina women, assessment of the effect of the current sociopolitical environment on well-being, and policies that support equitable access to health and social care.

Examining emotion regulation and inflammation as predictors of maternal mental health after fetal anomaly diagnosis

OBJECTIVE

Fetal anomalies occur in approximately 3% of pregnancies and receiving the diagnosis may be a potentially traumatic experience for families. The mental health of mothers receiving diagnoses and what predicts resilience or poor mental health is understudied. Emotion regulation is an important, modifiable, transdiagnostic factor of mental health, and may be protective post-diagnosis. Evaluating biomarkers of stress, including IL-6 and Allostatic Load (AL), can also serve as early indicators of risk, indicative of early intervention. This study assessed whether reappraisal, suppression, IL-6, and AL was associated with mental health outcomes and resilience in women after receiving a fetal anomaly diagnosis.

METHODS

Pregnant women (N=108) presenting to a fetal concerns clinic for initial consultation completed measures of emotion regulation (i.e., reappraisal and suppression), depression, anxiety, posttraumatic stress symptoms, and resilience between 2019-2022. A blood draw was used to assess IL-6 and create composite allostatic load measure including: IL-6, blood pressure, heart rate, glucose, cortisol, and body mass index.

RESULTS

Linear regressions controlling for age, gestational age, and perceived fetal diagnosis severity, demonstrated that IL-6 was negatively associated with resilience and positively associated with depression. Reappraisal was positively associated to resilience and negatively associated with depression, anxiety, and PTSD, whereas state insurance status was positively associated to anxiety and PTS symptoms. Suppression and allostatic load were not significant.

CONCLUSIONS

Women experiencing fetal anomaly diagnosis represent an understudied population with unaddressed mental health needs. Reappraisal serves as not only a protective factor, but one that can be enhanced to promote maternal resilience and mental health. Furthermore, elevated IL-6 may be a critical early indicator of potential intervention needs among women who are pregnant, to mitigate negative psychological states and enhance resilience.

Effect of Music Therapy on Anxiety in Pregnancy: A Systematic Review of Randomized Controlled Trials

Pregnancy can heighten anxiety levels, impacting both maternal and fetal well-being. This systematic review synthesizes evidence from 33 randomized controlled trials exploring the effects of music therapy on anxiety in pregnant women. The studies included diverse populations, ranging from women undergoing in vitro fertilization (IVF) to those facing high-risk pregnancies. Music therapy interventions varied widely, including virtual reality experiences, classical music, lullabies, and patient-selected music, administered at different pregnancy stages such as IVF treatments, elective cesarean sections, and high-risk hospitalizations. The findings consistently demonstrated that music therapy significantly reduces anxiety levels in pregnant women. Positive outcomes included reductions in both state and trait anxiety, improved pregnancy rates, and enhanced maternal-fetal parameters. Additionally, music therapy showed promise in reducing anxiety during labor, cesarean deliveries, and high-risk hospital stays. These varied interventions and their positive outcomes highlight the potential of music therapy as an effective, non-pharmacological approach to managing pregnancy-related anxiety. This review provides a comprehensive overview of the existing evidence on music therapy's efficacy in alleviating anxiety during pregnancy. It underscores the need for further research to standardize interventions and incorporate music therapy into routine prenatal care. By enhancing the overall well-being of expectant mothers, music therapy could become a valuable adjunct to conventional prenatal care practices.

A Concept Analysis of Maternal Resilience against Pregnancy-Related Mental Health Challenges in Low- and Middle-Income Countries

Suicide accounts for 33% of deaths of women during the postnatal period in many low- and middle-income countries (LMICs). Resilience refers to an ability to adapt and recover from adversity or misfortune. Resilience building against mental health challenges during pregnancy and the postnatal period is critical for women to raise their child efficiently and maintain a healthy life. The exploration of maternal resilience against mental health challenges including its developmental processes and the determinants of its successful or unsuccessful cultivation among mothers during pregnancy and childbirth is of paramount importance. Understanding why a subset of mothers effectively develops resilience while others significantly struggle is critical for devising targeted interventions and support mechanisms aimed at improving maternal well-being. This inquiry not only seeks to delineate the factors that contribute to or hinder the development of resilience but also aims to inform the creation of comprehensive support systems that can bolster maternal health outcomes. This paper endeavors to present a comprehensive analysis of maternal resilience, aiming to cultivate a nuanced and profound understanding of the concept within the framework of previous traumatic events and adverse pregnancy outcomes in LMICs. The eight-step method approach proposed by Walker and Avant was utilized for this concept analysis. Several defining attributes were identified in the analysis including social adaptation, support system, optimistic approach, and mindfulness. This analysis contributes to knowledge advancement regarding maternal resilience and provides nurses and other healthcare professionals with a clear understanding of the concept of maternal resilience to help promote resilience among mothers.

Promoting mental wellbeing in pregnant women living in Pakistan with the Safe Motherhood-Accessible Resilience Training (SM-ART) intervention: a randomized controlled trial

BACKGROUND

The negative impact of adverse perinatal mental health extends beyond the mother and child; therefore, it is essential to make an early intervention for the management of mental illness during pregnancy. Resilience-building interventions are demonstrated to reduce depression and anxiety among expectant mothers, yet research in this field is limited. This study aims to examine the effect of the 'Safe Motherhood-Accessible Resilience Training (SM-ART)' on resilience, marital adjustment, depression, and pregnancy-related anxiety in a sample of pregnant women in Karachi, Pakistan.

METHOD

In this single-blinded block randomized controlled study, 200 pregnant women were recruited and randomly assigned to either an intervention or a control group using computer-generated randomization and opaque sealed envelopes. The intervention group received the SM-ART intervention consisting of six, weekly sessions ranging from 60 to 90 min. Outcomes (Resilience, depression, pregnancy-related anxiety and marital harmony) were assessed through validated instruments at baseline and after six weeks of both intervention and control groups.

RESULTS

The results revealed a significant increase in mean resilience scores (Difference:6.91, Effect size: 0.48, p-value < 0.05) and a decrease in depressive symptoms (Difference: -2.12, Effect size: 0.21, p-value < 0.05) in the intervention group compared to the control group. However, no significant change was observed in anxiety and marital adjustment scores.

CONCLUSION

The SM-ART intervention has the potential to boost resilience scores and decrease depressive symptoms in pregnant women and offers a promising intervention to improve maternal psychological health.

TRIAL REGISTRATION

NCT04694261, Date of first trial registration: 05/01/2021.

Prenatal stress and hair cortisol in a sample of Latina women

BACKGROUND

Stress during pregnancy adversely impacts maternal and infant health. Dysregulation of the hypothalamic pituitary axis is a mediator of the relationship between stress and health. Evidence supporting an association between prenatal chronic stress and cortisol is limited, and the majority of research published has been conducted amongst White participants, who experience less chronic stress than people of color.

AIM

This study investigated associations between various measures of prenatal stress and hair cortisol concentrations which is a biomarker of the integrated stress response in a sample of Latina participants during the third trimester of pregnancy.

METHOD

Pregnant women (n=45) were surveyed with scales measuring chronic stress, perceived stress, pregnancy-related and pregnancy-specific anxiety. Hair samples were collected as an objective neuroendocrine measure of chronic stress. Linear regression analyses were performed to assess associations between stress measures and hair cortisol. Pre-pregnancy BMI, smoking during pregnancy, and steroid use during pregnancy were used as covariates in adjusted models.

RESULTS

Chronic stress, operationalized as maternal reports of neighborhood/housing strain, daily activities and relationship strain, discrimination, and financial strain, was significantly associated with higher hair cortisol concentrations. No significant associations were found between hair cortisol and perceived stress, pregnancy-related anxiety, nor pregnancy-specific anxiety in adjusted models.

CONCLUSION

Chronic stress may be a more robust correlate of physiological stress, as measured by hair cortisol in pregnancy, than other common measures of prenatal stress and anxiety.

Anxiety, prenatal distress, and resilience during the first trimester of gestation

OBJECTIVE

To describe and analyze the relationship between pregnancy-related anxiety, prenatal distress, and individual resilience in pregnant women during the first trimester of pregnancy and compare it with the obstetric variable of parity.

METHOD

Quantitative, descriptive, cross-sectional study using non-probabilistic circumstantial sampling. A total of 144 women participated. The Prenatal Distress Questionnaire, the Resilience Scale, and the Pregnancy-Related Anxiety Questionnaire were used. A descriptive analysis with measures of central tendency was performed, and the reliability of the instruments was assessed.

RESULTS

The average age was 33.57 years. 58.3% were multiparous and 41.7% primiparous. Anxiety was found in 21.5% and very high levels of resilience in 54.9%. Primiparous women showed higher levels of worry about the future and fear of childbirth than multiparous women. Pregnant women with high resilience showed lower levels of anxiety and stress.

CONCLUSION

Pregnant women with higher levels of resilience show less anxiety and stress during the first trimester of pregnancy. Primiparous women show more anxiety and stress than multiparous women.

The Effect of Nonstress Device Noise Level on Stress Parameters in Primigravid Women: A Randomized Controlled Trial

INTRODUCTION

This study evaluated the effect of the noise level of the nonstress test (NST) device on stress parameters in primigravid women.

METHODS

A total of 44 pregnant women participated in a randomized clinical trial between February and October, 2021. The participants were divided randomly into 4 equal groups using an automated web-based randomization system and ensuring allocation concealment: the control group (NST device volume turned off), intervention group I (1-35 dB(A)), intervention group II (36-60 dB(A)), and intervention group III (61 dB(A) and above). A data collection form was used to record personal information and stress parameters. Stress parameters (blood pressure, heart rate, oxygen saturation [SpO2], blood glucose, salivary cortisol, and salivary adrenocorticotropic hormone [ACTH]) levels were measured pretest (0-2 minutes before NST starts), midtest (at 10 minutes of the NST), and posttest (within 0-2 minutes after NST was finished). The study was registered at ClinicalTrials.gov (identifier: NCT05488704).

RESULTS

NST sound levels above 35 dB(A) increased the average cortisol and ACTH levels in the posttest. NST sound levels were positively correlated with posttest cortisol (r = .448) and posttest glucose (r = .302). There was interaction effect on heart rate, glucose, and cortisol level by time, indicating that the intervention groups experienced a significant acceleration in heart rate, glucose, and cortisol level after a noise intervention compared with the control group.

DISCUSSION

Midwives should continue applying NST below 36 dB(A), considering the factors that may induce stress during the NST process.

Circadian rhythm and sleep disruptions in relation to prenatal stress and depression symptoms

Circadian rhythm and sleep are related to health, but there is little data on the relationship between the sleep/wake rhythm and mood at different stages of pregnancy. The aim of this prospective, longitudinal study was to investigate the associations of circadian rhythm and sleep disruptions with stress and depression among women in early and late pregnancy. The participants were 26 pregnant women. Objective and subjective estimations of circadian rhythm and sleep were administered, namely actigraphy and the Biological Rhythms Interview of Assessment in Neuropsychiatry in the form of a questionnaire. The Perceived Stress Scale and the Edinburgh Postnatal Depression Scale were also used. Subjectively perceived circadian rhythm disruptions were positively related to stress. Tendency to maintain a regular rhythm of sleep and activity in early pregnancy and subjectively perceived disruptions of circadian rhythms in late pregnancy were positively associated with prenatal depression in late pregnancy. Sleep fragmentation and long time spent in bed at night in early pregnancy were positively associated with stress and depression in late pregnancy. The results suggest the importance of flexibility and the ability to adapt one's circadian activities to the demands of the situation of pregnancy-related changes in lifestyle. They also indicate the significance of good-quality uninterrupted night sleep in early pregnancy.

Stress During Pregnancy Associated with Newborn Low Birth Weight: Experiences from the State of Rhode Island

PURPOSE

Prenatal stress is a known risk for poor birth outcomes. This study specifically looked at reported stress during pregnancy and low birth weight (LBW) in Rhode Island.

METHODS

Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2016 to 2018 for the state of Rhode Island was utilized. Stress during most recent pregnancy was dichotomized as: 'none to minimal' and 'moderate to high.' LBW was defined as less than 2,500 g. Multivariable regression analysis was performed, accounting for complex survey design.

RESULTS

In this cohort, 24% of pregnant people reported moderate to high stress leading to an adjusted odds of 1.70 (95% CI 1.43-2.03) of having a LBW newborn compared to those with none to minimal stress. Primiparity, previous preterm birth, racism, smoking history, and history of chronic medical problems were also associated with LBW newborns.

CONCLUSION

We recommend screening and provision of support services for stress in all settings where pregnant people access care.

Helping Us Grow Stronger (HUGS)/Abrazos: a community-based initiative improved perinatal mental health in an urban cohort

BACKGROUND

Targeted programs aimed at improving maternal mental health, particularly among those exposed to social determinants of health, are increasingly critical since the onset of the COVID-19 pandemic, yet the impact of such programs is poorly understood.

OBJECTIVE

This study aimed to evaluate the impact of a novel, language-concordant community-based program on perinatal mental health.

STUDY DESIGN

We conducted a prospective cohort study of peripartum individuals referred to a new community-based intervention known as Helping Us Grow Stronger (HUGS/Abrazos). Participants received up to 4 remote sessions with a cognitive behavioral therapy trained social worker, up to 3 resource navigation sessions with a community health worker, and direct relief with a grocery gift card and care package. Before and after the program, participants completed validated survey instruments to assess mental health and social determinants of health.

RESULTS

A total of 178 participants were assessed after program completion, including 133 who were assessed before and after the program. The cohort was composed of 62.9% Hispanic or Latinx participants with a mean age of 29.8 year (standard error of mean, 0.46). There were high rates of food insecurity (111/178; 62.4%), experiences of discrimination (119/178; 66.9%), and SARS-CoV-2 infection (105/178; 59.0%). The program was associated with statistically significant improvements in the Edinburgh Postnatal Depression scores (baseline [mean±standard error of mean], 8.44±0.55 vs 6.77±0.51 after program completion; P=.0001) and Perceived Stress Scale scores (baseline, 15.2±0.74 vs 14.0±0.71; P=.035). Participants exposed to stressors including food insecurity and experiences of discrimination had higher baseline depression, stress, and anxiety scores. Those with experiences of discrimination, food insecurity, and SARS-CoV-2 infection during pregnancy were more likely to have improvements in mental health scores postintervention.

CONCLUSION

In this diverse urban cohort, a novel community-based intervention was associated with improvements in depressive symptoms, perceived stress, and anxiety, particularly among those with social determinants of health.

Effects of relaxation interventions during pregnancy on maternal mental health, and pregnancy and newborn outcomes: A systematic review and meta-analysis

BACKGROUND

Stress during pregnancy is detrimental to maternal health, pregnancy and birth outcomes and various preventive relaxation interventions have been developed. This systematic review and meta-analysis aimed to evaluate their effectiveness in terms of maternal mental health, pregnancy and birth outcomes.

METHOD

The protocol for this review is published on PROSPERO with registration number CRD42020187443. A systematic search of major databases was conducted. Primary outcomes were maternal mental health problems (stress, anxiety, depression), and pregnancy (gestational age, labour duration, delivery mode) and birth outcomes (birth weight, Apgar score, preterm birth). Randomized controlled trials or quasi-experimental studies were eligible. Meta-analyses using a random-effects model was conducted for outcomes with sufficient data. For other outcomes a narrative review was undertaken.

RESULT

We reviewed 32 studies comprising 3,979 pregnant women aged 18 to 40 years. Relaxation interventions included yoga, music, Benson relaxation, progressive muscle relaxation (PMR), deep breathing relaxation (BR), guided imagery, mindfulness and hypnosis. Intervention duration ranged from brief experiment (~10 minutes) to 6 months of daily relaxation. Meta-analyses showed relaxation therapy reduced maternal stress (-4.1 points; 95% Confidence Interval (CI): -7.4, -0.9; 9 trials; 1113 participants), anxiety (-5.04 points; 95% CI: -8.2, -1.9; 10 trials; 1965 participants) and depressive symptoms (-2.3 points; 95% CI: -3.4, -1.3; 7 trials; 733 participants). Relaxation has also increased offspring birth weight (80 g, 95% CI: 1, 157; 8 trials; 1239 participants), explained by PMR (165g, 95% CI: 100, 231; 4 trials; 587 participants) in sub-group analysis. In five trials evaluating maternal physiological responses, relaxation therapy optimized blood pressure, heart rate and respiratory rate. Four trials showed relaxation therapy reduced duration of labour. Apgar score only improved significantly in two of six trials. One of three trials showed a significant increase in birth length, and one of three trials showed a significant increase in gestational age. Two of six trials examining delivery mode showed significantly increased spontaneous vaginal delivery and decreased instrumental delivery or cesarean section following a relaxation intervention.

DISCUSSION

We found consistent evidence for beneficial effects of relaxation interventions in reducing maternal stress, improving mental health, and some evidence for improved maternal physiological outcomes. In addition, we found a positive effect of relaxation interventions on birth weight and inconsistent effects on other pregnancy or birth outcomes. High quality adequately powered trials are needed to examine impacts of relaxation interventions on newborns and offspring health outcomes.

CONCLUSION

In addition to benefits for mothers, relaxation interventions provided during pregnancy improved birth weight and hold some promise for improving newborn outcomes; therefore, this approach strongly merits further research.

Perceived Stress and Depressive Symptoms Are Associated With Emotional Eating but Not Nutritional Intake During Pregnancy: A Prospective Cohort Study

INTRODUCTION

Pregnancy is a major life event during which women may experience increased psychological distress and changes in eating behaviors. However, few studies have investigated the influence of psychological distress on pregnant women's eating behaviors. The primary objective of this prospective study was to examine the associations of changes in perceived stress and depressive symptoms with emotional eating and nutritional intake during pregnancy. In addition, we examined the direct and moderating effects of perceived social support.

METHODS

Participants were racially diverse pregnant women (14-42 years) from 4 clinical sites in Detroit, MI, and Nashville, TN (N = 678). We used multiple linear and logistic regression models to determine if changes in stress and depressive symptoms across pregnancy were associated with changes in emotional eating and nutritional intake. We examined residualized change in stress and depressive symptoms from second to third trimester of pregnancy; positive residualized change scores indicated increased stress and depressive symptoms.

RESULTS

Participants showed significant improvement in emotional eating and nutritional intake from second to third trimester of pregnancy (P < .001 for both). At second trimester, higher depressive symptoms were associated with a greater likelihood of emotional eating (P < .001) and worse nutritional intake (P = .044) at third trimester. Increased stress and depressive symptoms during pregnancy were both associated with increased risk, whereas increased perceived social support reduced risk of emotional eating at third trimester (stress: adjusted odds ratio [AOR], 1.17; 95% CI, 1.08-1.26; depressive symptoms: AOR, 1.05; 95% CI, 1.01-1.08; social support: AOR, 0.93; 95% CI, 0.88-0.99). None were associated with changes in nutritional intake. Perceived social support did not show any moderating effects.

DISCUSSION

Increased psychological distress during pregnancy may increase emotional eating. Efforts to promote healthy eating behaviors among pregnant women should consider and address mental health.

Epigenome-wide meta-analysis of prenatal maternal stressful life events and newborn DNA methylation

Prenatal maternal stressful life events are associated with adverse neurodevelopmental outcomes in offspring. Biological mechanisms underlying these associations are largely unknown, but DNA methylation likely plays a role. This meta-analysis included twelve non-overlapping cohorts from ten independent longitudinal studies (N = 5,496) within the international Pregnancy and Childhood Epigenetics consortium to examine maternal stressful life events during pregnancy and DNA methylation in cord blood. Children whose mothers reported higher levels of cumulative maternal stressful life events during pregnancy exhibited differential methylation of cg26579032 in ALKBH3. Stressor-specific domains of conflict with family/friends, abuse (physical, sexual, and emotional), and death of a close friend/relative were also associated with differential methylation of CpGs in APTX, MyD88, and both UHRF1 and SDCCAG8, respectively; these genes are implicated in neurodegeneration, immune and cellular functions, regulation of global methylation levels, metabolism, and schizophrenia risk. Thus, differences in DNA methylation at these loci may provide novel insights into potential mechanisms of neurodevelopment in offspring.

Pregnant women's mental health during the COVID-19 pandemic according to the trimester of pregnancy

AIM

This study aimed to analyse the psychological impact of the COVID-19 pandemic on pregnant women according to the pregnancy trimester, comparing their psychopathological symptomatology, pregnancy-specific stress, resilience and perceived stress to those of women pregnant before the pandemic.

METHODS

A total of 797 pregnant women participated in the study, one group of 393 women pregnant before the pandemic and the other of 404 women pregnant during the pandemic. Student-t test was used to analyse continuous data and the Chi-square test was used for categorical data.

RESULTS

Psychopathological symptomatology was significantly higher in six subscales of the SCL-90-R in pregnant women during COVID-19: somatisation, interpersonal sensitivity, depression, anxiety, phobic anxiety, obsessions-compulsions, mainly on the first two trimesters. There is also a higher level of pregnancy-specific stress in pregnant women during the pandemic on the first two trimesters, most likely due to the hypervigilance and fears related to the COVID-19 disease. Nevertheless, perceived stress, usually elevated during pregnancy, was lower in women pregnant during the pandemic in comparison to those pregnant before, as a positive consequence of being on lockdown and diminishing the exposure to daily stressful situations.

CONCLUSIONS

Knowing the struggles these women go through during each trimester of pregnancy can be the key to a better health professional-patient relationship, consequently having a positive impact on their mental and physical health.

How Maternal Nutritional and Mental Health Affects Child Health During Pregnancy: A Narrative Review

Throughout pregnancy, the mother's nutritional and mental health significantly influences the kid's long-term growth and wellness. This review's objective is to provide a comprehensive assessment of the literature on the link between pregnancy nutrition and a sound mind and a foetus' growth, considering factors in the physical, cognitive, emotional, and social domains. A balanced, nutrient-rich diet is crucial for the baby to grow and develop properly during pregnancy. An appropriate diet of significant macronutrients and micronutrients supports good foetal organ development, cognitive function, and immune system resiliency. For instance, studies have linked iron and omega-3 fatty acids to a reduced risk of developmental delays and improved cognitive performance. Contrarily, malnutrition in mothers, such as undernutrition or excessive weight gain, has been connected with negative results, including low birth weight, poor neurodevelopment, and increased susceptibility to chronic diseases in later life. The mother's mental health, including emotional equilibrium and psychological stability, significantly impacts the child's development. Stress, anxiety, and depression experienced by mothers during pregnancy harm the developing foetus and increase the risk of cognitive, behavioural, and emotional difficulties in the offspring. The growing foetus is exposed to high levels of stress hormones due to chronic maternal stress, which might alter the fetus's brain's shape and function. Factors influencing child development outcomes include maternal-infant attachment, breastfeeding start and duration, and general caring practices. A comprehensive approach is critical since new research indicates a synergistic relationship between maternal nutrition and mental health. Inadequate nutritional intake might result from maternal mental health problems that interfere with appetite control and eating habits. On the other hand, inadequate maternal nutrition may raise maternal stress and result in mental health problems. Therefore, integrative therapies focusing on both areas are essential to maximise child development results. In conclusion, maternal nutrition and mental health during pregnancy significantly impact a child's development in various domains. Understanding the complex relationships between maternal nutrition and mental health is necessary to develop effective therapies and promote the most remarkable results for children. Further research is needed to understand better the underlying mechanisms to develop evidence-based recommendations for optimal mother care throughout pregnancy. The need of this review is to know how maternal health, physical or mental affects the child's development and how we can further prevent it by taking precautions during pregnancy.

Effect of maternal cortisol levels on fetal heart rate patterns in primiparous pregnant women in the third trimester

OBJECTIVE

This study aimed to determine whether maternal cortisol levels affect fetal heart rate patterns in primiparous pregnant women in the third trimester.

METHODS

This cross-sectional descriptive study included 400 primiparous pregnant women with uncomplicated pregnancies between November and December 2022. The study included primiparous pregnant women over 18 years old in the third trimester who had not exercised for at least 2 h before the fetal heart rate monitoring and had a healthy pregnancy without consuming any food or drink. Fetuses with decelerating heartbeats and pregnant women who showed uterine contraction and cervical dilation during the fetal heart rate monitoring were excluded from the study. Research data were collected with the data collection form. The fetal heart rate data were collected using a cardiotocograph. At least two accelerations during the 20-min nonstress test period were the basis for diagnosing a reactive nonstress test. About 5 mL of maternal saliva for cortisol measurements was collected before fetal heart rate monitoring. Research data were analyzed with IBM SPSS Statistics for Macintosh, Version 28.0. A p-value of <0.05 was considered significant.

RESULTS

There were no significant differences in the comparison of the groups in terms of education and income status, family type, fetal gender, pregnancy planning status, BMI and age averages, or gestational week averages (p>0.05). The number of at least two accelerations required for the diagnosis of reactive NST was also higher in Group 1 (maternal salivary cortisol level ≤24.20). A moderately positive relationship between fetal heart rate and maternal salivary cortisol was observed (r=0.448, p=0.000). In total, 11.9% of the total change in fetal heart rate level is explained by maternal cortisol (R2=0.119). Maternal cortisol increases fetal heart rate level (ß=0.349).

CONCLUSION

These findings suggest that stress in primiparous pregnant women with high cortisol levels may influence fetal heart rate patterns. It was revealed that the increase in cortisol level, considered a stress hormone, may be a harbinger of fetal tachycardia.

The Godmother Project: A Virtual Initiative to Support Pregnant and Postpartum Women in Brazil During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic increased maternal distress and demand for social support and educational services, while restriction measures decreased the availability of these services.

PROJECT DESCRIPTION

The Godmother Project, a person-centered, WhatsApp-based support and health education initiative, was created after all in-person perinatal educational activities offered at 3 Brazilian hospitals were canceled in 2020. The project was developed in response to pregnant/postpartum women who called the hospitals with questions for health care professionals (HCPs). Health education nurses teamed up with staff from the communication department to design a project to (1) provide a direct communication channel between women and HCPs to answer health-related questions, (2) offer reliable virtual health education material, (3) identify women in need of additional assessment/referrals, (4) offer each woman continuous support from a specific nurse educator (Godmother), and (5) offer a virtual forum where women going through similar experiences could interact.

PROJECT DEVELOPMENT AND ROLLOUT

The project provides direct communication between WhatsApp groups of 25-30 pregnant/postpartum women and a Godmother. It also offers access to a virtual library of educational materials prepared in response to women's needs/demands. The project, which began in July 2020 with 1 WhatsApp group of 5 women and 1 Godmother, currently has 305 groups, 6,942 active participants, and 4 Godmothers. Enrollments and WhatsApp groups continued to increase despite reestablishment of in-person educational activities in 2022. The vast majority of 232 participants surveyed in December 2021 were very satisfied with the project, the Godmothers, and the educational materials.

CONCLUSIONS

Our findings suggest that WhatsApp groups of pregnant/postpartum women led by dedicated nurse educators can be an important tool to educate and support women during the perinatal period. This type of initiative may be especially important in contexts of physical distancing requirements or situations where social support is unavailable.

Development and Validation of Safe Motherhood-Accessible Resilience Training (SM-ART) Intervention to Improve Perinatal Mental Health

Perinatal mental health issues in women can lead to a variety of health complications for both mother and child. Building resilience can strengthen coping mechanisms for pregnant women to improve their mental health and protect themselves and their children. The study aims to develop and validate the contextual and cultural appropriateness of the Safe Motherhood-Accessible Resilience Training (SM-ART) intervention for pregnant women in Pakistan. A three-phase approach was used to develop and validate an intervention that promotes resilience in pregnant women. Phase I comprised a needs assessment with stakeholders (pregnant women and key informants) to elicit opinions regarding module content. In Phase II, an intervention to build resilience was developed with the help of a literature review and formative assessment findings, and Phase III involved the validation of the intervention by eight mental health experts. The experts assessed the Content Validity Index (CVI) of the SM-ART intervention on a self-developed checklist. The resultant SM-ART intervention consists of six modules with strong to perfect CVI scores for each of the modules. Qualitative responses endorsed the strengths of the intervention as having innovative and engaging activities, contextual and cultural relevance, and a detailed, comprehensive facilitator guide. SM-ART was successfully developed and validated and is now ready for testing to promote the resilience of pregnant women at risk of perinatal mental illness.

Psychological Well-being across the Perinatal Period: Life Satisfaction and Flourishing in a Longitudinal Study of Black and White American Women

Psychological well-being (life satisfaction and flourishing) during the perinatal period has implications for both maternal and child health. However, few studies have investigated the extent to which psychological well-being changes from preconception to postpartum periods, particularly among diverse samples of women. Using prospectively collected data from an ongoing longitudinal study, we investigated changes in two dimensions of psychological well-being from preconception to postpartum among 173 Black and White American women. Results showed that changes in life satisfaction (i.e., global quality of life) and flourishing (e.g., self-acceptance, sense of purpose) over the perinatal period were moderated by race. For life satisfaction, White women reported an increase from preconception to pregnancy with increased life satisfaction levels remaining stable from pregnancy to postpartum. However, Black women reported no changes in life satisfaction across these timepoints. In contrast, both Black and White women reported an increase in flourishing levels across the perinatal period, although the timing of these changes differed. Findings highlight a need for greater clinical and empirical attention to the way in which psychological well-being changes during the perinatal period to optimize health and inform strengths-based intervention targets.

Resilience and prenatal mental health in Pakistan: a qualitative inquiry

Background

Women in Pakistan suffer from a high rate of depression. The stress of low-income, illiteracy, exposure to violence and living in a patriarchal society are predisposing vulnerabilities for depression, particularly during and following pregnancy. The resilience of an individual plays a significant role in promoting prenatal mental health, but this has yet to be thoroughly researched. In this article, our objective is to identify the core characteristics of resilience among pregnant women, which will then help us in developing an intervention.

Methods

The exploratory-descriptive study was conducted over 6 months in five different antenatal hospitals in Sindh, Pakistan. A total of 17 semi-structured interviews were conducted with pregnant women, purposefully selected with heterogeneous characteristics to explore diverse perspectives, while symptoms of depression were quantified by the Edinburgh Postnatal Depression Scale before the interview. Verbatim transcriptions were coded openly and merged into categories and themes.

Result

A total of six themes emerged from in-depth thematic analysis: 1) purpose of life, 2) dealing with emotions, 3) believing in yourself, 4) optimistic approach, 5) strengthening support and relationship and 6) spirituality and humanity. Women agreed that these characteristics could help them improve their mental health.

Conclusion

In conclusion, these themes were the core components of pregnant women’s resilience which ultimately could help to promote prenatal mental health. These pave a pathway towards developing culturally and contextually resilience interventions aimed at enhancing mental health of pregnant women which then may improve neonatal and family mental wellbeing.

Monitoring the Dutch Solid Start Program: Developing an Indicator Set for Municipalities to Monitor their First Thousand Days-Approach

INTRODUCTION

The Dutch Solid Start program aims to improve the collaboration between the medical and social sector to offer every child the best start in life. Municipalities form local coalitions of partners within the medical and social sector to support parents and children during the first thousand days. The aim of this study was to develop an indicator set for coalitions to monitor their local Solid Start program.

METHODS

A modified Delphi study with three rounds was carried out among Dutch experts in Solid Start practice, policy and research (n = 39) to reach consensus.

RESULTS

The indicator set included 19 indicators covering the three phases of the Solid Start program: preconception, pregnancy and after birth (up to two years). Prioritized indicators included both social and medical topics, among which poverty, psychological/psychiatric problems, stress, smoking, cumulation of risk factors, preconception care, low literacy, premature birth, and intellectual disability. Additionally, a development agenda was established with topics and indicators that lacked data or clear operationalization (e.g. stress, unintended pregnancy, loneliness).

DISCUSSION AND CONCLUSION

The developed indicator set enhances the conversation between policymakers, managers, professionals and other stakeholders about the local situation and developments in order to prioritize interventions and policies. Next, the indicator set needs evaluation to assess its usefulness.

Relationship between social support and parenting sense of competence in puerperal women: Multiple mediators of resilience and postpartum depression

BACKGROUND

Maternal role competence is an important marker of achievement in the role of the mother, but parenting sense of competence (PSOC) among puerperal women is not high. Psychosocial factors, particularly social support, postnatal depression and resilience, have been identified as significant predictors of maternal role competence. However, information is limited regarding the mechanisms through which these psychosocial factors affect maternal role competence.

OBJECTIVE

To evaluate the multiple mediators of resilience and postpartum depression (PPD) in the relationship between social support and PSOC in puerperal women.

METHODS

A cross-sectional study was performed in a tertiary general hospital in Yangzhou, China. A total of 234 puerperal women at 6-8 weeks after birth completed the socio-demographic questionnaires, Social Support Rating Scale, Connor-Davidson Resilience Scale, Edinburgh Postnatal Depression Scale, and PSOC Scale.

RESULTS

Resilience and PPD mediated the relationship between social support and PSOC. The mediation effect of resilience and PPD and the total mediation effect were significant, individually accounting for 22.96, 21.70, and 44.65%, respectively, of the total effect. Moreover, pairwise contrast between the two indirect effects was not significant. The difference between the two pathways suggests that resilience and PPD play different roles in the relationship between social support and PSOC.

CONCLUSIONS

This study showed that social support may exert its effects on PSOC in puerperal women with multiple mediators of resilience and PPD. This therefore highlights potential intervention targets to improve PSOC.

Positively Pregnant: Development and piloting of a mobile app for social and emotional well-being in pregnancy

This paper describes development of a mobile e-health application, Positively Pregnant, which provides tools to meet the psychological challenges of pregnancy and transition to parenthood. Positively Pregnant was developed with input from maternity carers and consumers, incorporating local cultures and contexts as well as international research on effective interventions for stress management and mental well-being. The prototype app was piloted with 88 New Zealand women. Participants in the pilot used an average of 11.96 (SD = 7.44) components, and most were satisfied (45.1%) or neutral (40.3%) regarding the app. For 23 of the 26 interactive components, the majority of those who tried the component reported that they found it helpful. Participants reported a significant reduction in subjective stress (η²  = .088, p = .023). Feedback from pilot participants was incorporated in a version of the app that was publically launched as a free tool to support developing families. Mobile e-health applications are a promising medium for providing preventative interventions and psychoeducation about the social and emotional challenges of pregnancy and early parenting; Positively Pregnant is an example of a tool, grounded in strength-based, empirically supported strategies, to provide parents with support and information at this critical time.