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Branjerdporn G, Gillespie K, Martin E, Kissane V, De Young A, Ewais T, Goldsmith K, Wilson S, Adhikary S, McGahan G, Schulz C, Beckmann M. Effectiveness and cost-effectiveness of an electronic mindfulness-based intervention to improve maternal mental health in the peripartum: study protocol for a randomised controlled trial. Trials 2023; 24:747. [PMID: 37996896 PMCID: PMC10666349 DOI: 10.1186/s13063-023-07746-7] [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] [Received: 01/15/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Perinatal women are highly vulnerable to developing mental health issues and particularly susceptible to a recurrence of psychiatric illness. Poor mental health during the perinatal period can have long-term impacts on the physical and psychiatric health of both mother and child. A potentially useful strategy to improve women's mental health is through a mobile application teaching mindfulness, an evidence-based technique helping individuals focus on the present moment. METHODS A mixed method, prospective randomised controlled trial. The study group comprise women aged 18 years and over, who are attending the public and private maternity clinics at Mater Mothers' Hospital. A sample of 360 prenatal women will be randomised into the intervention group (with the use of the mindfulness app) or usual care. Participants will remain in the study for 11 months and will be assessed at four timepoints for changes in postnatal depression, mother-infant bonding, and quality of life. A cost-effectiveness evaluation will also be conducted using quality-adjusted life year (QALY) calculations. A random selection of intervention participants will be invited to attend focus groups to give feedback on the mindfulness app. DISCUSSION Previous studies have found mindfulness interventions can reduce stress, anxiety, depression, and sleep disturbances in a prenatal population. The risks of the intervention are low, but could be of significant benefit for women who are unable to attend face-to-face appointments due to geographical, financial, or time barriers; during endemic or pandemic scenarios; or due to health or mobility issues. TRIAL REGISTRATION This study was approved by the Mater Misericordiae Human Research Ethics Committee (83,589). Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622001581752 ( https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385107&isReview=true ). Registered on 22 Dec. 2022.
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Affiliation(s)
- Grace Branjerdporn
- Mater Health, Annerley Road Campus, South Brisbane, QLD, 4101, Australia.
- Mater Research Institute - University of Queensland, Whitty Building (Ground Floor), Annerley Road, Mater Hill, South Brisbane, QLD, 4101, Australia.
| | - Kerri Gillespie
- Mater Research Institute - University of Queensland, Whitty Building (Ground Floor), Annerley Road, Mater Hill, South Brisbane, QLD, 4101, Australia
| | - Elizabeth Martin
- Mater Research Institute - University of Queensland, Whitty Building (Ground Floor), Annerley Road, Mater Hill, South Brisbane, QLD, 4101, Australia
- Wesley Research Institute, 451 Coronation Drive, Auchenflower, Qld, 4066, Australia
| | - Vivianne Kissane
- Peach Tree Perinatal Wellness Inc, 293 Ellison Rd, Geebung, QLD, 4034, Australia
| | - Alex De Young
- Queensland Centre for Perinatal and Infant Mental Health, Children's Health Queensland - Queensland Health, Nundah, QLD, 4012, Australia
| | - Tatjana Ewais
- Mater Health, Annerley Road Campus, South Brisbane, QLD, 4101, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, 4222, Australia
- Faculty of Medicine, University of Queensland, 288 Herston Rd, Herston, Qld, 4006, Australia
| | - Kathleen Goldsmith
- Mater Health, Annerley Road Campus, South Brisbane, QLD, 4101, Australia
| | - Susan Wilson
- Children's Health Queensland, Queensland Health, 501 Stanley St, South Brisbane, QLD, 4101, Australia
| | - Sam Adhikary
- Mater Health, Annerley Road Campus, South Brisbane, QLD, 4101, Australia
- Mater Research Institute - University of Queensland, Whitty Building (Ground Floor), Annerley Road, Mater Hill, South Brisbane, QLD, 4101, Australia
| | - Greg McGahan
- Mater Health, Annerley Road Campus, South Brisbane, QLD, 4101, Australia
- Mater Research Institute - University of Queensland, Whitty Building (Ground Floor), Annerley Road, Mater Hill, South Brisbane, QLD, 4101, Australia
| | - Constanze Schulz
- Mater Health, Annerley Road Campus, South Brisbane, QLD, 4101, Australia
| | - Michael Beckmann
- Mater Health, Annerley Road Campus, South Brisbane, QLD, 4101, Australia
- Mater Research Institute - University of Queensland, Whitty Building (Ground Floor), Annerley Road, Mater Hill, South Brisbane, QLD, 4101, Australia
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Pontones CA, Titzmann A, Huebner H, Danzberger N, Ruebner M, Häberle L, Eskofier BM, Nissen M, Kehl S, Faschingbauer F, Beckmann MW, Fasching PA, Schneider MO. Feasibility and Acceptance of Self-Guided Mobile Ultrasound among Pregnant Women in Routine Prenatal Care. J Clin Med 2023; 12:4224. [PMID: 37445258 DOI: 10.3390/jcm12134224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Mobile and remote ultrasound devices are becoming increasingly available. The benefits and possible risks of self-guided ultrasound examinations conducted by pregnant women at home have not yet been well explored. This study investigated aspects of feasibility and acceptance, as well as the success rates of such examinations. METHODS In this prospective, single-center, interventional study, forty-six women with singleton pregnancies between 17 + 0 and 29 + 6 weeks of gestation were included in two cohorts, using two different mobile ultrasound systems. The participants examined the fetal heartbeat, fetal profile and amniotic fluid. Aspects of feasibility and acceptance were evaluated using a questionnaire. Success rates in relation to image and video quality were evaluated by healthcare professionals. RESULTS Two thirds of the women were able to imagine performing the self-guided examination at home, but 87.0% would prefer live support by a professional. Concerns about their own safety and that of the child were expressed by 23.9% of the women. Success rates for locating the target structure were 52.2% for videos of the fetal heartbeat, 52.2% for videos of the amniotic fluid in all four quadrants and 17.9% for videos of the fetal profile. CONCLUSION These results show wide acceptance of self-examination using mobile systems for fetal ultrasonography during pregnancy. Image quality was adequate for assessing the amniotic fluid and fetal heartbeat in most participants. Further studies are needed to determine whether ultrasound self-examinations can be implemented in prenatal care and how this would affect the fetomaternal outcome.
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Affiliation(s)
- Constanza A Pontones
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Adriana Titzmann
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Hanna Huebner
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Nina Danzberger
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Matthias Ruebner
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Lothar Häberle
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Bjoern M Eskofier
- Machine Learning and Data Analytics Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany
| | - Michael Nissen
- Machine Learning and Data Analytics Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany
| | - Sven Kehl
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Florian Faschingbauer
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Peter A Fasching
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Michael O Schneider
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
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Tebeka S, Le Strat Y, Mandelbrot L, Benachi A, Dommergues M, Kayem G, Lepercq J, Luton D, Ville Y, Ramoz N, Mullaert J, Dubertret C. Early- and late-onset postpartum depression exhibit distinct associated factors: the IGEDEPP prospective cohort study. BJOG 2021; 128:1683-1693. [PMID: 33656796 DOI: 10.1111/1471-0528.16688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify risk factors for early- and late-onset postpartum depression (PPD) among a wide range of variables, including sociodemographic characteristics, childhood trauma, stressful life events during pregnancy and history of personal and family psychiatric disorders, and to assess the contribution of each risk factor. DESIGN Nested case-control study in a prospective longitudinal cohort study. SETTING Eight maternity departments in the Paris metropolitan area, France. SAMPLE A cohort of 3310 women with deliveries between November 2011 and June 2016. METHODS Cases were women with early- or late-onset PPD. Controls were women without depression during pregnancy or the postpartum period. Logistic regression adjusted on sociodemographic variables was performed for each outcome and a multivariable model was proposed based on a stepwise selection procedure. MAIN OUTCOME MEASURES Early- and late-onset PPD assessed at 2 months and 1 year postpartum, respectively. RESULTS Stressful life events during pregnancy have a dose-response relationship with both early- and late-onset PPD. CONCLUSIONS Early- and late-onset PPD presented distinct patterns of determinants. These results have important consequences in terms of prevention and specific care. TWEETABLE ABSTRACT Early- and late-onset postpartum depression are associated with stressful life events and psychiatric history.
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Affiliation(s)
- S Tebeka
- INSERM U1266, Université de Paris, Paris, France.,Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
| | - Y Le Strat
- INSERM U1266, Université de Paris, Paris, France.,Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
| | - L Mandelbrot
- Departement Hospitalier Universitaire Risks in Pregnancy, Université de Paris, Paris, France.,Department of Obstetrics and Gynecology, AP-HP, Louis Mourier Hospital, Colombes, France
| | - A Benachi
- Université Paris Saclay, Clamart, France.,Department of Obstetrics and Gynecology, AP-HP, Antoine Beclere Hospital, Clamart, France
| | - M Dommergues
- Sorbonne University, Paris, France.,Department of Obstetrics and Gynecology, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - G Kayem
- Sorbonne University, Paris, France.,Department of Obstetrics and Gynecology, AP-HP, Trousseau Hospital, Paris, France
| | - J Lepercq
- Departement Hospitalier Universitaire Risks in Pregnancy, Université de Paris, Paris, France.,Port-Royal Maternity Unit, AP-HP, Cochin Hospital, Paris, France
| | - D Luton
- Departement Hospitalier Universitaire Risks in Pregnancy, Université de Paris, Paris, France.,Department of Obstetrics and Gynecology, AP-HP, Bichat Hospital, Paris, France
| | - Y Ville
- Sorbonne University, Paris, France.,Department of Obstetrics and Gynecology, AP-HP, Necker Enfant Malade Hospital, Paris, France
| | - N Ramoz
- INSERM U1266, Université de Paris, Paris, France
| | - J Mullaert
- Department of Epidemiology, Biostatistics and Clinical Research, AP-HP, Hôpital Bichat, Paris, France.,IAME, INSERM, Université de Paris, Paris, France
| | - C Dubertret
- INSERM U1266, Université de Paris, Paris, France.,Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
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Pluym ID, Holliman K, Afshar Y, Lee CC, Richards MC, Han CS, Krakow D, Rao R. Emergency department use among postpartum women with mental health disorders. Am J Obstet Gynecol MFM 2020; 3:100269. [PMID: 33103100 PMCID: PMC7574686 DOI: 10.1016/j.ajogmf.2020.100269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/02/2022]
Abstract
Background Mental health disorders are becoming more recognized in pregnancy. Whether mental health disorders are associated with health services utilization after child birth is not completely understood. Objective This study aimed to investigate postpartum emergency department use within 30 days of delivery among women with preexisting mental health disorders during pregnancy. Study Design This was a retrospective cohort study evaluating emergency department use among postpartum women with or without mental health disorders who delivered at an academic center between January 2014 and June 2018. Demographic and outcome data were medical record abstracted and analyzed. Multivariate regression was performed to adjust for covariates. Results During the study period, 13,605 women delivered at the institution, 2355 of whom (17.3%) had an underlying mental health disorder. The primary diagnoses of mental health disorder were anxiety (48.8%), depression (34.8%), substance use disorder (11.4%), bipolar disorder (3.4%), psychosis (0.7%), and other (0.8%). There were a total of 565 emergency department visits within 30 days of delivery. Women who presented to the emergency department after delivery were more likely to have public insurance, identify as black or Asian, and have an underlying mental health disorder. Among women with mental health disorders, 155 (6.6%) used the emergency department within 30 days of their delivery compared with 410 (3.6%) of patients without mental health disorder (adjusted odds ratio, 1.74; 95% confidence interval, 1.42–2.13; P<.001). When assessing the risk of emergency department usage per the type of mental health disorder, anxiety (adjusted odds ratio, 1.73; 95% confidence interval, 1.31–2.27) and depression (adjusted odds ratio, 2.13; 95% confidence interval, 1.59–2.86) carried the highest risk. Compared with women without mental health disorders, women with underlying mental health disorders had more presentations for hypertension (15.5% vs 11.2%) and psychiatric evaluations (4.5% vs 0.2%; both P<.001). Conclusion Women with mental health disorders use the emergency department during the postpartum period for psychiatric and obstetrical reasons more frequently than women without mental health disorders. Increased surveillance, treatment, and follow-up during pregnancy and the early postpartum period may be warranted for this high-risk population.
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Affiliation(s)
- Ilina D Pluym
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA.
| | - Kerry Holliman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA
| | - Yalda Afshar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA
| | - Connie C Lee
- Office of Population Health and Accountable Care, Faculty Practice Group, University of California, Los Angeles, Los Angeles, CA
| | - Misty C Richards
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Christina S Han
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA
| | - Deborah Krakow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA
| | - Rashmi Rao
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA
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Wszołek K, Żurawska J, Łuczak-Wawrzyniak J, Kopaszewska-Bachorz B, Głowińska A, Pięta B. Postpartum depression - a medical or a social problem? J Matern Fetal Neonatal Med 2019; 33:2556-2560. [PMID: 30513062 DOI: 10.1080/14767058.2018.1555802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: The aim of the study was to identify a group of women needed psychological support after delivery by identifying the medical and social factors that may influence the emotional changes during the postpartum period.Materials and method: A group of 835 pregnant women in second, third trimester of pregnancy, and during the postpartum period completed the Edinburgh Postnatal Depression Scale and the questionnaire consisting of difficulties that might occur in the four life fields: practical, family, emotional, and physical. The calculations have been carried out with the statistical package Statistica v10 and Cytel Studio v 9.0.0. At the Faculty of Information Science and Statistics of the Poznań University of Medical Sciences.Results: There is a series of medical and social risk factors potentially increasing the risk of postpartum depression, such as psychiatric disorders in the past, difficulties in the professional work, unsatisfactory relationship with partner, and others.Conclusions: Having selected a group of women with risk factors it seems reasonable to apply the Edinburgh Postnatal Depression Scale.
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Affiliation(s)
- Katarzyna Wszołek
- Gynaecologist-Obstetrician Clinical Hospital, Poznan University of Medical Sciences, Poznań, Poland
| | - Joanna Żurawska
- Gynaecologist-Obstetrician Clinical Hospital, Poznan University of Medical Sciences, Poznań, Poland.,Practical Midwifery Science Faculty, Poznan University of Medical Sciences, Poznań, Poland
| | | | | | - Aleksandra Głowińska
- Gynaecologist-Obstetrician Clinical Hospital, Poznan University of Medical Sciences, Poznań, Poland
| | - Beata Pięta
- Gynaecologist-Obstetrician Clinical Hospital, Poznan University of Medical Sciences, Poznań, Poland.,Practical Midwifery Science Faculty, Poznan University of Medical Sciences, Poznań, Poland
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