Unplanned pregnancy and subsequent psychological distress in partnered women: a cross-sectional study of the role of relationship quality and wider social support

Reducing behavior problems in children born after an unintended pregnancy: the generation R study

OBJECTIVES

To examine differences in behavior problems between children from intended versus unintended pregnancies, and to estimate how much the difference in problem behavior would be reduced if postnatal depression was eliminated and social support was increased within 6 months after birth.

METHODS

Data from the Generation R Study were used, a population-based birth cohort in Rotterdam, the Netherlands (N = 9621). Differences in child internalizing and externalizing behavior at ages 1.5, 3, 6, 9 and 13 years between pregnancy intention groups were estimated using linear regression. Associations of postnatal depression and social support with internalizing and externalizing problems were also estimated using linear regression. Child behavior outcomes where compared before and after modelling a situation in which none of the mothers experienced a postnatal depression and all mother experienced high social support.

RESULTS

Most pregnancies (72.9%) were planned, 14.8% were unplanned and wanted, 10.8% were unplanned with initially ambivalent feelings and 1.5% with prolonged ambivalent feelings. Children from unplanned pregnancies had more internalizing and externalizing problems at all ages as compared to children from a planned pregnancy, especially when ambivalent feelings were present. Hypothetically eliminating on postnatal depression reduced the differences in internalizing and externalizing problems by 0.02 to 0.16 standard deviation. Hypothetically increasing social support did not significantly reduce the difference in internalizing and externalizing problems.

CONCLUSIONS

Children from an unplanned pregnancy have more behavior problems, in particular when mothers had prolonged ambivalent feelings. Eliminating postnatal depression may help to reduce the inequality in child behavior related to pregnancy intention.

Psychological needs fulfillment and perinatal well-being among low-SES individuals: a mixed methods investigation

Poor perinatal mental health is associated with deleterious effects and individuals with low socioeconomic status (SES) are at elevated risk. Fortifying multi-level resources of low-SES pregnant individuals to boost their well-being is a crucial step toward achieving equity in perinatal health. The purpose of this project was to explore what patterns of resources supported well-being among low-SES pregnant individuals in Colorado. In a prospective mixed methods cohort study, 23 low-SES pregnant individuals completed surveys and interviews. Participants were separated into 3 subgroups based on their overall Warwick-Edinburgh Mental Well-being Scale (WEMWBS) score and interviewed to identify multi-level resources that supported their well-being. Our analysis was framed by Self-Determination Theory which contends that three universal basic psychological needs are required for individuals to function in a healthy manner: autonomy, competence, and relatedness. We extrapolated resources that promoted perinatal competence, autonomy, and relatedness from the high well-being group. Perinatal-related knowledge (construct related to competence); mindfulness and intended pregnancy (constructs related to autonomy); and emotional, informational, and friend support, social capital, and connection to nature (constructs related to relatedness) were identified as the resources more frequently endorsed in the high well-being group. Targeting interventions to fortify specific multi-level resources that support the autonomy, competence, and relatedness of pregnant individuals facing socioeconomic disadvantage is a crucial step toward achieving equity in perinatal health.

The Impact of Pregnancy Readiness on Lupus Activity, Maternal Mental Health, and Pregnancy Outcomes

OBJECTIVE

Among individuals with systemic lupus erythematosus (SLE) who became pregnant, we explored the impact of medical readiness for pregnancy and personal readiness for pregnancy on the following aspects of maternal health: (1) provider-reported disease activity, (2) patient-perceived disease activity, (3) mood symptoms, (4) pregnancy-related health behaviors, and (5) pregnancy outcomes.

METHODS

All study participants were enrolled in a prospective registry, met Systemic Lupus Collaborating Clinics (SLICC) criteria for SLE, and had at least one pregnancy. Patient-reported outcomes were collected at the first rheumatology visit during pregnancy. "Medically ready" for pregnancy was defined as (1) <1 g of proteinuria, (2) no rheumatic teratogens at conception, and (3) continuing pregnancy-compatible SLE medications after conception. "Personally ready" was defined as planned pregnancy based on a London Measure of Unplanned Pregnancy score ≥10. Multivariable logistic regression models estimated the association of pregnancy readiness with each outcome of interest.

RESULTS

Among the 111 individuals enrolled, lack of medical readiness for pregnancy was associated with significantly higher rates of active disease and worse pregnancy outcomes; however, these patients did not perceive themselves as having higher disease activity. Lack of personal readiness for pregnancy was associated with significantly higher patient-perceived disease activity. Although medical readiness did not impact depressive symptoms substantially, lack of personal readiness for pregnancy was associated with much higher maternal depressive symptoms.

CONCLUSION

To improve pregnancy outcomes among individuals with SLE, greater focus is needed on improving medical optimization before conception. For maternal mental health and quality of life, greater focus is needed on decreasing the incidence of unplanned pregnancy.

Association between pregnancy intention and completion of newborn and infant continuum of care in Sub-Saharan Africa: systematic review and meta-analysis

BACKGROUND

The newborn and infant continuum of care such as essential newborn care, early initiation and exclusive breastfeeding, and immunisation are highly recommended for improving the quality of life and survival of infants. However, newborn and infant mortality remains high across Sub-Saharan African countries. While unintended pregnancies are associated with adverse newborn and infant health outcomes, there is inconclusive evidence on whether pregnancy intention influences newborn and infant continuum of care completion. Therefore, this review aimed to pool findings reported in the literature on the association between pregnancy intention and newborn and infant health care across the continuum of care in Sub-Saharan Africa.

METHODS

We searched MEDLINE Complete, EMBASE, CINAHL Complete, and Global Health databases for studies potentially eligible for this systematic review and meta-analysis. Two researchers independently screened the identified articles by abstract and title, and then full-text using Covidence. We used the Newcastle-Ottawa Scale to assess the quality of the included studies. The Cochran's Q test and I2 were executed to detect and quantify the presence of statistical heterogeneity in the studies. Meta-analysis was done for each outcome when more than one original study reported relevant data, using Stata statistical software version 18.

RESULTS

Eleven studies were included from a total of 235 articles identified by the search. The odds of completing essential newborn care (pooled odds ratio: 3.04, 95% CI: 1.56, 5.90), early initiation of breastfeeding (pooled odds ratio: 1.30, 95% CI: 1.13, 1.52), exclusive breastfeeding (pooled odds ratio: 2.21, 95% CI: 1.68, 2.89), and being fully immunised (pooled odds ratio: 2.73, 95% CI: 1.16, 6.40) were higher among infants born to women with intended pregnancies as compared to women with unintended pregnancies.

CONCLUSION

Intended pregnancy was positively associated with essential newborn care completion, early initiation and exclusive breastfeeding, and full immunisation of infants in SSA countries. Thus, policy-makers and stakeholders should strengthen the provision of quality family planning services to prevent unintended pregnancy. Furthermore, follow-up of women with unintended pregnancies is needed to increase women's opportunity to access essential newborn health care services that further reduce the risk of newborn and infant morbidity and mortality.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42023409148.

A Comprehensive and Longitudinal View of Pregnancy from the Perspective of the Couple, Maternal Mental Health and Fetal Growth

OBJECTIVE

This study investigates the impact of both maternal psychopathological factors and adaptive psychological changes within the couple on fetal growth, emphasizing the importance of evaluating pregnancy from the perspectives of the couple, the mother, and the fetus collectively. A "couple" in this context refers to heterosexual partners engaged in the pregnancy process together, whether married or in a stable relationship.

METHODS

We included 189 pregnant women in their first trimester, tracking maternal depression, anxiety, body appreciation, prenatal attachment, and the couple's adjustment level across each trimester. Fetal growth parameters measured include biparietal diameter, femur length, humerus length, abdomen circumference, head circumference, β-HCG, and amniotic fluid levels, with relationships between these variables being modeled accordingly.

RESULTS

Our findings indicate stable levels of maternal depression, anxiety, body appreciation, and couple's adjustment throughout the pregnancy, with a significant increase in prenatal attachment levels in each subsequent trimester. Prenatal attachment in the first trimester and maternal depression levels in the second and third trimesters were found to directly influence fetal growth, while other variables exhibited indirect effects.

CONCLUSIONS

Fetal growth is influenced by a myriad of biopsychosocial factors. Ensuring healthy pregnancy and fetal development necessitates close monitoring and support of the mother's adaptive psychological changes, early identification and treatment of potential psychopathologies, and maintenance of the psychosocial health of the couple.

Who receives support during pregnancy? Variation by intendedness

Social support makes a vital contribution to health and life outcomes, particularly during the transition to motherhood in young adulthood, an often-challenging experience. Women should have the right not only to bear children but also to raise them in a secure environment, which is often aided by support. This study gives attention to how pregnancy intendedness contributes to pregnant women's receipt of support. Using novel data from a weekly survey of 18- to 22-year-old women over two and a half years, I investigate how intendedness is associated with the receipt of support and how support types vary throughout pregnancy. This study reveals new insight into the beginning trajectories of young mothers and highlights variation in the provision of support within social networks. Women with intended pregnancies are less likely to receive social support during pregnancy compared to those with unintended pregnancies. A lack of support may impact the health of both mother and child.

"Little by little, I started feeling I am unable to handle my child alone" - Lived experiences of mothers with postpartum depression and anxiety

Background

Anxiety and depression during the postpartum period can have a significant impact on mothers' perceived sense of responsive caregiving, causing considerable distress. This association may be affected by mothers' perception about social support. In the context of low-and-middle-income countries where prevalence rates of maternal mental illnesses are high and access to health care services is limited, informal supports become more relevant.

Aim

The study aims to understand the lived experience of mothers who had postpartum depression or anxiety and their perceived distress related to infant care giving. It also explores the role of social support in the motherhood experience.

Methods

Six mothers with postpartum depression or anxiety were interviewed to understand their experience of postpartum depression and/or anxiety and their perceptions about social support. The interviews were analyzed using a reflexive thematic analysis approach.

Results

The thematic analysis revealed four themes, namely, (a) uncertainty and helplessness, (b) misattunement with the immediate family, (c) personal strength rooted in the family support system, and (d) other means of coping. Mothers with postpartum anxiety and depression can have emotional, informational, and tangible social support needs in the context of uncertainty and helplessness, which are associated with different challenges and barriers for infant care in the Indian context.

Conclusion

Support from family members is viewed as a pillar of comfort and recovery for the mothers. At the same time, if it is not adequately attuned to the needs of the mother, it can become a major source of distress.

Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: a prospective cross-sectional descriptive multicentred study

OBJECTIVE

To assess the prevalence of anxiety and depression and their associated risk factors throughout the pregnancy and postpartum process using a new screening for the early detection of mental health problems.

DESIGN

A prospective cross-sectional descriptive multicentred study. Participants were consecutively enrolled at ≥ 12 weeks' gestation and followed at three different time points: at 12-14 weeks of pregnancy, at 29-30 weeks of pregnancy, and 4-6 weeks postpartum. All women completed a mental screening at week 12-14 of pregnancy consisting of two questions from the Generalised Anxiety Disorder Scale (GAD-2) and the two Whooley questions. If this screening was positive, the woman completed the Edinburgh Postnatal Depression Scale (EPDS).

SETTING

Seven primary care centres coordinated by a Gynaecology and Obstetrics Department in the city of Terrassa (Barcelona) in northern Spain.

PARTICIPANTS

Pregnant women (N = 335, age 18-45 years), in their first trimester of pregnancy, and receiving prenatal care in the public health system between July 2018 and July 2020.

FINDINGS

The most relevant factors associated with positive screening for antenatal depression or anxiety during pregnancy, that appear after the first trimester of pregnancy, are systematically repeated throughout the pregnancy, and are maintained in the postpartum period were: a history of previous depression, previous anxiety, abuse, and marital problems. In weeks 12-14 early risk factors for positive depression and anxiety screening and positive EPDS were: age, smoking, educational level, employment status, previous psychological/psychiatric history and treatment, suicide in the family environment, voluntary termination of pregnancy and current planned pregnancy, living with a partner and partner's income. In weeks 29-30 risk factors were: being a skilled worker, a history of previous depression or anxiety, and marital problems. In weeks 4-6 postpartum, risk factors were: age, a history of previous depression or anxiety or psychological/psychiatric treatment, type of treatment, having been mistreated, and marital problems.

CONCLUSIONS

Early screening for anxiety and depression in pregnancy may enable the creation of more effective healthcare pathways, by acting long before mental health problems in pregnant women worsen or by preventing their onset. Assessment of anxiety and depression symptoms before and after childbirth and emotional support needs to be incorporated into routine practice.

Mothering in the Aftermath of Reproductive Coercion and Abuse

A partner's reproductive coercion and abuse (RCA) can significantly undermine women's physical health and psychological wellbeing. Yet little research has explored how RCA affects experiences of mothering and relationships with children. Based on an analysis of interviews with 30 Australian mothers, we found that RCA affected mothering in complex ways. Many struggled with feeling detached, resentful, and guilty toward their children, while some found mothering an emotionally and morally restorative experience after the RCA. All felt compelled to conceal their abuse from their children and others. The findings have implications for how healthcare practitioners can support mothers in the aftermath of RCA.

Women's mental health during late pregnancy: A survey conducted in Shandong Province, China

BACKGROUND

  The study aimed to investigate the general mental health status and its associated factors in women during late pregnancy. The objective was to provide a scientific basis for developing psychological interventions tailored to this specific population.

METHODS

  The research was conducted from May 2021 to July 2022, involving the recruitment of 200 women attending maternal and child health clinics for their late-pregnancy checkups. Data collection was carried out using a comprehensive approach, involving several validated tools. The participants completed a general demographic and sociological questionnaire along with four standardized psychological assessment scales: the 12-item General Health Questionnaire (GHQ-12), the Athens Insomnia Scale (AIS-8), the Generalized Anxiety Disorder 7 (GAD-7), and the 9-question Patient Health Questionnaire (PHQ-9). A total of 200 valid questionnaires were collected for analysis.

RESULTS

  The study revealed that the overall prevalence of positive detection of general mental health problems in women during late pregnancy was 11%. Significant differences were observed in the positive detection rate of general mental health status based on various factors such as the quality of relationships with husbands, pregnancy intentions, insomnia, anxiety, and depression (p<0.01). Furthermore, participants with general mental health problems displayed notably higher scores on the AIS-8, PHQ-9, and GAD-7 scales compared to those without such problems (p<0.01). Regression analysis indicated that pregnancy intention and PHQ-9 scores were influential factors affecting the general mental health of women during late pregnancy (p<0.05).

CONCLUSION

  The study highlights high rates of general mental health problems during late pregnancy, with unplanned pregnancy and elevated depression scores as key risk factors. Regular mental health screening and targeted interventions are essential to support women during this critical period and enhance the well-being of both mothers and babies.

Influence of Pregnancy Intention on Postpartum Contraceptive Choice at an Urban Academic Medical Center

OBJECTIVE

 This study aimed to describe postpartum contraception preferences in the context of pregnancy intention (PI).

STUDY DESIGN

 A prospective cohort study analyzing postpartum contraceptive choice (PCC) in 431 postpartum women who delivered at a single academic medical center. PCC in women with an unintended or mistimed pregnancy was compared to contraceptive choice in women with an intended pregnancy using the adapted National Survey of Family Growth categorization. Mistimed and unintended pregnancies were grouped for analysis. Generalized linear modeling estimated the relative influence of PI on PCC adjusting for maternal age, race, and parity.

RESULTS

 Nearly three out of four (71.9%) pregnancies were mistimed or unintended. These pregnancies were more likely in women who were non-Hispanic Black (62.3%), unmarried (86.3%), 18 to 24 years (51.3%), and insured by Medicaid or Medicare (82.1%), compared to women with an intended pregnancy, p-value <0.001. Women with mistimed or unintended pregnancy were 83% more likely to choose highly effective, user-independent methods compared to any other or no method, adjusted relative risk (aRR) = 1.83 (95% confidence interval [CI]: 1.36, 2.47), and more likely to desire voluntary sterilization, aRR = 2.70 (95% CI: 1.58, 4.59). Additionally, women with these pregnancies were 56% more likely to use user-independent methods compared to user-dependent methods, aRR = 1.56 (95% CI: 1.18, 2.06).

CONCLUSION

 Women with mistimed or unintended pregnancies are 83% more likely to choose highly effective postpartum contraception or voluntary sterilization, and thus initiatives are necessary to increase access and affordability to these methods before hospital discharge after delivery.

KEY POINTS

· Nearly three out of four pregnancies in this study were mistimed or unintended.. · Women with mistimed or unintended pregnancies are more likely to choose highly effective postpartum contraception or voluntary sterilization.. · Public health initiatives to improve access to family planning services and postpartum contraception, including surgery for bilateral tubal ligation before discharge from the hospital postdelivery, are important areas of focus to help attenuate the rates of unintended pregnancy in the United States..

A Bayesian nonparametric approach for multiple mediators with applications in mental health studies

Mediation analysis with contemporaneously observed multiple mediators is a significant area of causal inference. Recent approaches for multiple mediators are often based on parametric models and thus may suffer from model misspecification. Also, much of the existing literature either only allow estimation of the joint mediation effect or estimate the joint mediation effect just as the sum of individual mediator effects, ignoring the interaction among the mediators. In this article, we propose a novel Bayesian nonparametric method that overcomes the two aforementioned drawbacks. We model the joint distribution of the observed data (outcome, mediators, treatment, and confounders) flexibly using an enriched Dirichlet process mixture with three levels. We use standardization (g-computation) to compute all possible mediation effects, including pairwise and all other possible interaction among the mediators. We thoroughly explore our method via simulations and apply our method to a mental health data from Wisconsin Longitudinal Study, where we estimate how the effect of births from unintended pregnancies on later life mental depression (CES-D) among the mothers is mediated through lack of self-acceptance and autonomy, employment instability, lack of social participation, and increased family stress. Our method identified significant individual mediators, along with some significant pairwise effects.

Comparison of maternal-fetal attachment, anxiety, depression, and prevalence of intimate partner violence in Iranian women with intended and unintended pregnancy: a cross-sectional study

BACKGROUND

Unintended pregnancies and intimate partner violence can adversely affect women, infants, and their psychological well-being. The study aimed to compare depression, anxiety, maternal-fetal attachment, and the prevalence of intimate partner violence between women with and without unintended pregnancies in Tabriz, Iran. The study sought to address the lack of research on this topic in the Iranian context.

METHODS

This cross-sectional study was conducted on 486 pregnant women attending health centers in Tabriz City between 2022 and 2023. A cluster sampling method was utilized, and data were gathered through the administration of socio-demographic, Maternal Fetal Attachment, Edinburgh Postnatal Depression, World Health Organization Domestic Violence, and Pregnancy Anxiety instruments. A general linear model (GLM), controlling for potential confounding variables, was used to compare anxiety, depression, and maternal-fetal attachment between the two groups. Multivariable logistic regression analysis, also controlling for potential confounding variables, was employed to compare the prevalence of domestic violence between the two groups.

RESULTS

The results of the adjusted GLM indicated that women with unintended pregnancies had significantly lower maternal-fetal attachment (Adjusted mean difference (AMD):-9.82, 95% CI:-12.4 to -7.15 ; p < 0.001)), higher levels of depression (AMD: 2.89; CI: 1.92 to 3.86 ; p < 0.001), and higher levels of anxiety (MD: 5.65; 95% CI: 3.84 to 7.45; p < 0.001) compared to women with intended pregnancies. During pregnancy, 40% of women with unintended pregnancies and 19.2% of women with intended pregnancies reported experiencing at least one form of physical, sexual, or emotional violence. The results of the adjusted multivariable logistic regression revealed that women with unintended pregnancies had a significantly higher odds of experiencing emotional violence (adjusted odds ratio [aOR]: 2.94; 95% CI: 1.64 to 5.26; p < 0.001), sexual violence, (aOR: 2.25; 95% CI: 1.32 to 3.85; p = 0.004), and physical violence (aOR: 2.38; 95% CI: 1.50 to 3.77; p < 0.001) compared to women with intended pregnancies.

CONCLUSIONS

The study found that women with unintended pregnancies had lower levels of maternal-fetal attachment, higher levels of anxiety and depression, and a high prevalence of intimate partner violence, including physical, sexual, and emotional violence, compared to women with intended pregnancies. These results emphasize the importance of implementing policies aimed at reducing unintended pregnancies.

The prevalence of unintended pregnancy and its influence on pregnancy experience in Tabriz, Iran, 2023: a cross-sectional study

BACKGROUND

There is a lack of quantitative studies that specifically measure the association between the experience of pregnancy and unintended pregnancy. The present study aims to address the prevalence of unintended pregnancy and identify its predictors. Additionally, the study explores whether unintended pregnancy is associated with pregnancy uplifts and hassles.

METHODS

This cross-sectional study was conducted on 488 pregnant women between 20 to 40 weeks' gestation at the comprehensive health center in Tabriz City from February 2022 to January 2023. A cluster sampling method was used for sampling, and data were collected using socio-demographic questionnaires and the Pregnancy Experience Scale (PES). Descriptive statistics were used to describe the socio-demographic characteristics and the prevalence of unintended pregnancy. Binary logistic regression was employed to identify the predictors of pregnancy desirability. To examine the relationship between unintended pregnancy and pregnancy experience, an independent t-test was used for bivariate analysis, and a general linear model (GLM) was utilized for multivariate analysis, with control for potential confounding variables.

RESULTS

The prevalence of unintended pregnancies was 30.7% (24.3% unwanted pregnancies, and 6.4% mistimed pregnancies). The results of the binary logistic regression indicated that the lower age of both the woman and her spouse were significant predictors for unintended pregnancy (P < 0.05). Based on an independent t-test, the mean score for uplifts in women with unintended pregnancy was significantly lower than in women with intended pregnancy (mean difference (MD): -4.99; 95% confidence interval (CI): -5.96 to -4.02; p < 0.001), While the mean score of hassles in women with unintended pregnancy was significantly higher than women with intended pregnancy (MD: 2.92; 95% CI: 2.03 to 3.80; p < 0.001). The results of GLM showed that women who had unintended pregnancies had significantly lower scores for uplifts (B = -4.99; 95% CI: -5.96 to -4.03; P < 0.001) and higher scores for hassles (B = 2.92; 95% CI: 2.06 to 3.78; P < 0.001).

CONCLUSIONS

The high prevalence of unintended pregnancies in Tabriz highlights the importance of targeted interventions to address this issue, considering the policy framework and unique challenges faced by women. Future studies should focus on developing context-specific interventions that effectively meet the needs of women with unintended pregnancies.

Comparing Relationship Satisfaction and Body-Image-Related Quality of Life in Pregnant Women with Planned and Unplanned Pregnancies

This comparative cross-sectional study conducted at the "Pius Brinzeu" healthcare center in Timisoara explored the differential impacts of pregnancy planning status on sexual function, body image, and relationship satisfaction among pregnant women. Employing the Female Sexual Function Index (FSFI), Body Esteem Scale for Adolescents and Adults (BESAQ), and the Beck Depression Inventory (BDI-II), the study analyzed responses from 107 participants divided into groups of planned (n = 59, mean age 28.5 ± 5.2) and unplanned (n = 48, mean age 27.3 ± 4.8) pregnancies. In the first trimester, unplanned pregnancies reported higher median scores in desire (4.7 vs. 3.6, p = 0.005), arousal (4.5 vs. 3.8, p = 0.001), and lubrication (4.6 vs. 3.7, p = 0.015) compared to planned pregnancies. Satisfaction scores also favored unplanned pregnancies in the first trimester (4.8 vs. 3.9, p = 0.009). Similar trends were observed in subsequent trimesters, with unplanned pregnancies consistently reporting higher FSFI scores, indicating a robust sexual function. Risk factors significantly associated with sexual dysfunction were a higher BMI in the first trimester (beta coefficient: -0.124, p = 0.019), unmarried civil status (beta coefficient: -0.323, p = 0.045), history of previous abortion (beta coefficient: -0.451, p = 0.012), irregular menstrual cycles (beta coefficient: -0.384, p = 0.026), and rural living area (beta coefficient: -0.278, p = 0.034). Notably, unplanned pregnancy itself was not a significant risk factor for sexual dysfunction (beta coefficient: -0.054, p = 0.095). Regarding relationship dynamics, planned pregnancies exhibited significantly higher satisfaction with partner support (4.1 ± 0.9 vs. 3.7 ± 1.1, p = 0.041) and communication within the couple (4.0 ± 1.0 vs. 3.5 ± 1.2, p = 0.020), whereas unplanned pregnancies reported higher satisfaction with emotional closeness (4.3 ± 0.7 vs. 3.8 ± 1.0, p = 0.004). Concerns about managing professional activities and household chores were significantly more prevalent in the unplanned pregnancy group (62.50% vs. 33.90%, p = 0.014). Unplanned pregnancies demonstrated better initial sexual function but faced greater challenges in relationship satisfaction and managing pregnancy demands. Identifying and addressing the risk factors associated with sexual dysfunction can provide targeted interventions to improve the well-being of pregnant women, regardless of pregnancy planning status.

Self-Reported Causes of Psychological Distress Among Czech Perinatal Women

BACKGROUND

Various risk factors to perinatal mental health disorders have been described; however, there is a dearth of data on the perspectives of women themselves regarding what increases the risk of psychological distress. This qualitative study explores women's perceptions of factors that increase the risk of perinatal psychological distress.

AIM

The aim of this study was to elucidate women's perceptions of factors that increase the risk of perinatal psychological distress.

METHODS

A qualitative design with an exploratory and descriptive approach is used. Women (N = 188) aged 18 to 45 years who self-report experiencing perinatal psychological distress complete an online survey.

RESULTS

Perceived causes of perinatal psychological distress include: adverse experiences with childbirth and/or breastfeeding, negative attitudes of people close to the participant, financial and social challenges, health challenges, staff behavior in a maternity hospital, a challenging baby, family circumstances, and the new role as mother.

CONCLUSION

Women's perceived causes of perinatal psychological distress may allow for women-centered innovations in perinatal mental health care. The results highlight the need to train maternity staff regarding perinatal mental health and communication. These findings can serve as important guidelines on women-centered planning of innovations of perinatal mental health care. Interventions need to focus on the role of partners and others close to women so as to support the women during the perinatal period.

Social Support and Spousal Relationship Quality Improves Responsiveness among Anxious Mothers

Maternal responsiveness, a mother's ability to consistently identify infant cues and then act on them, is critical for healthy child development. A woman's social support and spousal relationship may affect responsiveness to an infant, especially among mothers with anxiety. We assessed how social support and spousal relationship quality is associated with responsiveness among anxious mothers, and if postpartum depression (PPD) moderated these associations. Cross-sectional data were collected from 2019 to 2022 in a public hospital in Pakistan from 701 women at six-weeks postpartum. Eligible women had at least mild anxiety in early- to mid- pregnancy. Linear regression analyses assessed if spousal relationship quality and social support from family and friends were associated with maternal responsiveness, measured using the Maternal Infant Responsiveness Instrument. Interaction terms were used to examine if PPD moderated these associations. Spousal relationship quality (B = 2.49, 95% CI: 1.48, 3.50) and social support (B = 1.07, 95% CI: 0.31, 1.83) were positively related to maternal responsiveness to the infant. Emotional support from a spouse was positively associated with responsiveness (B = 1.08, 95% CI: 0.12, 2.03 depressed; B = 2.96, 95% CI: 1.34, 4.58 non-depressed), and conflict with the spouse was negatively associated with responsiveness (B=-1.02, 95% CI: -1.94, -0.09 depressed; B=-2.87, 95% CI: -4.36, -1.37 non-depressed). However, social support was related to responsiveness only in non-depressed women (B = 2.61, 95% CI: 1.14, 4.07). While spousal relationships and social support enhance maternal responsiveness, for depressed women, spousal relationships were particularly critical. In considering maternal-infant interventions to improve child development outcomes, our study indicates the importance of supportive relationships that foster effective responsiveness.

Maternal childhood adversity and pregnancy intentions as predictors of pregnancy happiness

OBJECTIVES

Nearly half of all pregnancies in the U.S. are classified as unintended (e.g. unplanned, mistimed, or unwanted), which have been linked to numerous adverse consequences for maternal and child outcomes. Recent evidence suggests that happiness about a pregnancy is often a better predictor of maternal and infant health outcomes than pregnancy intentions, but few studies have examined maternal predictors of pregnancy happiness.

METHODS

Using a clinic-based sample of pregnant women (n = 177), we apply multiple regression analysis to examine the association between maternal adverse childhood experiences and pregnancy happiness, as well as the moderating role of pregnancy intentions.

RESULTS

Women with more childhood adversity and pregnancies that were unplanned and mistimed or unwanted reported lower levels of pregnancy happiness, compared with women with less childhood adversity and intended pregnancies. However, pregnancy intentions did not moderate the relationship between maternal adverse childhood experiences and pregnancy happiness.

CONCLUSION

Our results suggest that pregnancy happiness is lower among mothers with a history of childhood adversity and pregnancies classified as unplanned and mistimed or unwanted. Understanding the factors that impact pregnancy happiness is critical to inform prenatal clinical practice and health policy, particularly when caring for those with a history of adversity.

Abortion Legal Reform and Neonatal Mortality in Mozambique

INTRODUCTION

Abortion law reforms have been hypothesized to influence reproductive, maternal, and neonatal health services and health outcomes, as well as social inequalities in health. In 2014, Mozambique legalized abortion in specific circumstances. However, due to challenges implementing the law, there is concern that it may have negatively influenced neonatal outcomes.

METHODS

Using a difference-in-differences design, we used birth history data collected via the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) between 2004 and 2018 to assemble a panel of 476 939 live births across 17 countries including Mozambique. We estimated the effect of the abortion reform on neonatal mortality by comparing Mozambique to a series of control countries that did not change their abortion policies. We also conducted stratified analyses to examine heterogeneity in effect estimates by household wealth, educational attainment, and rural/urban residence.

RESULTS

The reform was associated with an additional 5.6 (95% CI = 1.3, 9.9) neonatal deaths per 1,000 live birth. There was evidence of a differential effect of the reform, with a negative effect of the reform on neonatal outcomes for socially disadvantaged women, including those with no schooling, in poorer households, and living in rural areas.

DISCUSSION

Given the delay in implementation, our analyses suggest that abortion reform in Mozambique was associated with an initial increase in neonatal mortality particularly among socially disadvantaged women. This may be due to the delay in effective implementation, including the dissemination of clear guidelines and expansion of safe abortion services. Longer-term follow-up is needed to assess the impact of the reform after 2018, when services were expanded. Abortion legal reform without adequate implementation and enforcement is unlikely to be sufficient to improve abortion access and health outcomes.

Trends in prevalence and factors associated with unintended pregnancies in Zambia (2001-2018)

BACKGROUND

Unintended pregnancies can pose significant public health concerns for both maternal and child health because of their associated risks and implications. Experience of unintended pregnancies may lead to delay in seeking antenatal care, thus leading to increased risk of complications during pregnancy and childbirth. Globally, the prevalence of unintended pregnancies has declined. However, the problem remains acute in sub-Saharan Africa. This study was conducted to examine the factors associated with an experience of unintended pregnancy among women of reproductive ages in Zambia.

METHODS

This study used secondary data from the Zambia Demographic and Health Surveys (ZDHSs) which were conducted between 2001 and 2018. A pooled weighted sample of 4,090 pregnant women of reproductive age 15-49 years at the time of the survey was included in the analysis. Multivariable binary logistic regression model was employed to examine the association between independent correlates and experience of unintended pregnancy. All statistical analyses were conducted using Stata software.

RESULTS

Findings show that the proportion of women of reproductive age who experienced unintended pregnancy in Zambia declined from 50.4% (95% CI: 47.1, 53.8) in 2001 to 45.2% (95% CI: 40.5, 49.9) in 2018. The decline in the prevalence of unintended pregnancy is more pronounced among women age groups 25-29 years and 30-34 years. Increasing age was associated with an increased risk of experiencing unintended pregnancies. On the other hand, women who were living in rural areas (aOR = 0.76; 95% CI: 0.58, 1.00) and those with tertiary education (aOR = 0.46; 95% CI: 0.26, 0.80) were less likely to experience an unintended pregnancy. Women who desired a large family (aOR = 0.45; 95% CI: 0.24, 0.85) and those who watched television (aOR = 0.75; 95% CI: 0.59, 0.94) had lower odds of experiencing unintended pregnancies.

CONCLUSIONS

The study has established that the prevalence of unintended pregnancy is still high in Zambia. Women's age, place of residence, level of education, desired family size and exposure to media were associated with the risk of experiencing an unintended pregnancy. Enhancing access to family planning services and commodities targeting women with low education levels will be key to further reduce unintended pregnancies.

Young Women's Needs Regarding Sexual Preventive Behaviours and Unwanted Pregnancies

Unwanted pregnancies are considered a public health problem that affects women's mental health and quality of life. The aim of this paper was to access university students' understanding and behaviours regarding unwanted pregnancies and identify their needs to prevent them. Qualitative descriptive design was used, and 13 semi-structured interviews were carried out. Women between 18 and 20 years old participated. They discussed a lack of training for themselves, their partners, and their families, their desire to have access to non-in-person health care resources, and their belief that contraception was expensive. Emotional aspects were relevant, affecting the way communication is established with those close to them and with health professionals. Despite the existence of access to sexual health resources, the findings show the existence of needs related to the prevention of unwanted pregnancies. The findings are presented grouping the main identified needs as "related to capability", "related to opportunity", and "related to motivation". Among the aspects to consider when designing interventions to prevent unwanted pregnancies are the feelings shown by these women, the inclusion of couples and family members in educational programs, and access to non-face-to-face health resources and less expensive contraceptive methods. Interventions for social support and understanding of women are necessary both to prevent unwanted pregnancies and to support adolescents with unwanted pregnancies by avoiding criminalization or blame.

Unplanned pregnancy and risk of peripartum depression: a prospective cohort study in Saudi pregnant women attending antenatal care clinic

Background

Few studies have been conducted on unintended pregnancies and peripartum depression in Saudi Arabia. This study aimed to evaluate the relationship between unplanned pregnancies and peripartum depression among pregnant women in Jeddah, Saudi Arabia.

Methods

This prospective cohort study included pregnant women attending an antenatal care clinic in 2021. The London Measure of Unplanned Pregnancy was used to assess the prevalence of unplanned pregnancy, and the Edinburgh Postnatal Depression Scale (EPDS) was used to assess antenatal and postnatal depression.

Results

A total of 236 participants were included, of which 25.8% had unplanned pregnancies, 36.0% had ambivalent pregnancies, and 38.1% had planned pregnancies. EPDS results revealed that 77.5% and 73.35% of the females were negative for antenatal and postnatal depression, respectively. A history of stressful events (P=0.001), husband (P=0.020), and family support (P=0.007) was significantly associated with antenatal EPDS score, whereas age (P=0.005), type of delivery (P=0.019), and family support (P=0.031) were significantly associated with the postnatal score.

Conclusion

Unplanned pregnancies may affect the perinatal mental health of women. We demonstrated the importance of family or husbands' support for women with perinatal depression. In addition, our research showed that pregnancy at an early age is a risk factor for postnatal depression. Therefore, these women should be closely monitored not only during their pregnancy but also during the first postpartum year.

The profile of adolescent patients presenting to a tertiary maternal mental health clinic

Background

Between March 2021 and April 2022, there were 90 037 documented adolescent pregnancies in South Africa. Statistics SA reports that this number is growing. Pregnancy places adolescents at greater risk of psychiatry-related morbidity and may have far-reaching consequences for their children. To date, there is no published data describing the patient profile of adolescent pregnancies in Gauteng Province, South Africa.

Aim

To describe the patient profile (demographics, schooling history and type of accommodation), pregnancy-related factors, substance use habits and contraceptive use in pregnant adolescents seen at a tertiary care maternal mental health clinic (MMHC).

Setting

The MMHC at Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa.

Methods

A retrospective file review of all pregnant adolescents referred to the MMHC between January and June 2022.

Results

The mean age of the patients was 15.2 years; 72% attended school and 97.4% planned to return. Most pregnancies were unplanned (97.9%), wanted (84%) and presented in the second (41.24%) and third (51.55%) trimesters. Most did not report using substances (76.7%). Fifty percent of the participants met the criteria for a major depressive disorder. Repeating a grade was an identifiable risk factor for an increased Edinburgh depression score. An unplanned pregnancy was associated with a higher risk factor assessment.

Conclusion

Pregnant adolescents represent a vulnerable population group. A greater understanding of this patient profile may inform early psychiatric and psychosocial interventions, improved service delivery and help-seeking behaviour.

Contribution

This study gives significant insights into the challenges faced, as well as the health and social needs of pregnant adolescents. This contributes to wholistic care and opportunities for early intervention, including awareness of contraceptive use and the risks of substance use and adolescent pregnancy on mental health, benefiting all South African adolescents.

Nonhormonal Male Contraceptive Development-Strategies for Progress

Despite the widely demonstrated public health benefits of contraception, limited contraceptive options are available for men, placing both the contraceptive burden and opportunity solely on women. This review outlines the need for an increased focus on male contraceptive development and highlights several related topics, including the perspectives of women and men on male contraceptives, historical challenges, and reasons behind the persistent delays in male contraceptive development. It also discusses the importance of serendipitous observations in drug discovery and the limitations of depleting sperm or spermatogenic cells as a contraceptive approach. It further provides an overview of ongoing research and development on novel methods, with a goal to offer insights into the multifaceted aspects of nonhormonal male contraceptive development, addressing its implications for the health of men and women. SIGNIFICANCE STATEMENT: Despite well over half a century of effort in developing male contraceptives, there are no approved male contraceptive drugs on the market. This review aims to present strategies for progress in nonhormonal male contraception based on lessons learned from history, with the hope of expediting development and bringing a male contraceptive drug closer to reality.

Interventions to prevent unintended pregnancies among adolescents: a rapid overview of systematic reviews

Risks associated with unintended pregnancy include unsafe abortions, poor maternal health-seeking behaviour, poor mental health, and potentially, maternal and infant deaths. Adolescent girls with unintended pregnancies are particularly vulnerable as they are at higher risk of eclampsia, premature onset of labour, and increased neonatal morbidity and mortality. Unintended pregnancy, with the right combination of interventions, can be avoided. Evidence-based decision-making and the need for a robust appraisal of the evidence have resulted in many systematic reviews. This review of systematic reviews focuses on adolescent pregnancy prevention and will seek to facilitate evidence-based decision-making. Two review authors independently extracted data and assessed the methodological quality of each review according to the AMSTAR 2 criteria. We identified three systematic reviews from low- and middle-income countries and high-income counties and included all socioeconomic groups. We used vote counting and individual narrative review summaries to present the results. Overall, skill-building, peer-led and abstinence programmes were generally effective. Interventions focused on information only, counselling and interactive sessions provided mixed results.In contrast, exposure to parenting and delaying sexual debut interventions were generally ineffective. Adolescent pregnancy prevention interventions that deploy school-based primary prevention strategies, i.e. strategies that prevent unintended pregnancies in the first place, may effectively reduce teenage pregnancy rates, improve contraceptive use, attitudes and knowledge, and delay sexual debut. However, the included studies have methodological issues, and our ability to generalise the result is limited.

Relationship Between the Psychological Distress and Spiritual Well-Being in Pregnant Women Exposed to Domestic Violence: A Cross-Sectional Study in Iran

Maternal psychological distress is often associated with domestic violence. Spiritual well-being can affect the psychological capacity to deal with distress. This study aimed to investigate the relationship between psychological distress and spiritual well-being in pregnant women exposed to domestic violence. This cross-sectional study was conducted on 305 pregnant women subjected to domestic violence in southern Iran. The participants were selected using the census method. Data were collected using the Spiritual Well-being Scale (SWB), the Kessler Psychological Distress Scale (K10), and the Hurt, Insult, Threaten, Scream (HITS) screening tool (short form) and were analyzed with descriptive and inferential statistics (t-test, ANOVA, the Spearman correlation coefficient, and multiple linear regression) in SPSS software version 24. The mean scores ± standard deviation of the participants' psychological distress, spiritual well-being, and domestic violence were 24.68 ± 6.43, 79.89 ± 18.98, and 11.24 ± 1.5, respectively. The results showed that psychological distress had a significant negative correlation with spiritual well-being (ρ = - 0.84, P < 0.001) and domestic violence (ρ = - 0.73, P < 0.001). The results of the multiple linear regression analysis also showed that spiritual well-being and domestic violence could predict the psychological distress of pregnant women who were exposed to domestic violence, which explained 73% of the psychological distress in the participants. According to the study results, spiritually oriented education can be provided for women to reduce their psychological distress. Also, it is recommended that necessary interventions be used to reduce domestic violence and empower women to prevent it.

Epidemiological profile and effectiveness of immediate postpartum contraception in Brazilian women

Purpose

To determine the epidemiological profile of women who inserted copper intrauterine device (Cu-IUD), subdermal etonogestrel implant (ENG), tubal ligation (TL), depot medroxyprogesterone acetate (DMPA) or did not choose a contraceptive method (NCM) in the immediate postpartum period and compare the contraceptive effectiveness of Cu-IUD and DPMA with non-MAC.

Methods

We analyzed the epidemiological profile of women who inserted copper intrauterine device (Cu-IUD), subdermal etonogestrel implant (ENG), tubal ligation (TL), depot medroxyprogesterone acetate (DMPA) or did not choose a contraceptive method (NCM) in the immediate postpartum. The data was collected by electronic medical records of postpartum women assisted at the University Hospital of São Bernardo do Campo (HMU-SBC) from January 2016 to December 2020. Also, we compared the contraceptive effectiveness of Cu-IUD and DPMA with non-MAC by identifying women who returned for second delivery during the study period and analyzing the contraceptive method chosen in the first hospitalization. Then the pregnancies interval and the sociodemographic characteristics were analyzed according to contraceptive method type.

Results

Data from 20,896 women were collected, of which 8,183 (39%) opted for Cu-IUD, 559 (2.5%) DPMA, and 10,989 (52.5%) chose not to use contraception at the time of hospital discharge. When comparing these groups, women in the DPMA were younger (26.5 ± 7.3, p < 0.05), and NCM showed women with a lower number of pregnancies (2.2 ± 1.3, p < 0.05). Subjects in the TL group (4.6%) had the higher number of pregnancies (3.8 ± 1.2, p < 0.05), and ENG group, the highest number of miscarriages (1.6 ± 1.3, p < 0.05). Of those women who returned pregnant, 5.5% belonged to the DPMA group, 6% to the NCM group, and 2.3% to the Cu-IUD.

Conclusions

Women who opted for Cu-IUD insertion were younger, had more pregnancies and vaginal delivery when compared to those who did not choose a method. Of those women who returned, the minority opted for Cu-IUD compared to those that opted for DPMA or no method.

Motivational interviewing for family planning and reducing risky sexual behavior among incarcerated men nearing release: A randomized controlled pilot study

Incarcerated men are at high risk for sexually transmitted infections (STIs) and unintended partner pregnancy postrelease. Limited research has been invested in developing and testing treatments targeting risky sexual behavior and unwanted pregnancy for this at-risk population. Motivational interviewing (MI) is a promising behavioral intervention for decreasing risky sexual behaviors. This study assessed the feasibility and acceptability of MI for family planning and risky sexual behaviors with incarcerated men nearing release. Preliminary efficacy of the MI intervention was also compared to an educational control group. Thirty-two men were assessed at baseline and randomized to one 90-min session. Assessment occurred 2 months after release. MI was feasibly administered, and participants were highly satisfied with both treatments. In addition, those who received MI reported higher rates of condom use with casual partners, higher rates of partner use of hormonal contraceptives, and slightly higher rates of sex that was protected against pregnancy. Increases are readiness to discuss family planning with sexual partners, as well as reported frequency of these discussions, and increases in family planning knowledge were also found in those randomized to MI. The findings from this study indicate the need to further assess MI with this population with a full-scale clinical trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Validation of the German version of the pregnancy-related anxiety scale (PrAS): psychometric properties across all trimesters of pregnancy

BACKGROUND

Pregnancy-related anxiety has received greater research attention recently given its association with adverse outcomes (e.g., negative birth experiences). The Pregnancy-related Anxiety Scale (PrAS) offers the possibility to assess pregnancy-related anxiety, but no German version is available. Therefore, the aim of this study was to validate a German version of the PrAS, a comprehensive measure with eight dimensions.

METHODS

Pregnant women of any parity or gestation completed an online survey consisting of the PrAS, PRAQ-R2, and measures of anxiety, depression, and resilience. The PrAS was translated into German (PrAS-G) using the back-translation method. Data were subjected to confirmatory factor analysis and inferential statistics.

RESULTS

Complete data were provided by 443 women. Participants were predominantly German nationals, partnered, and well-educated with a planned pregnancy. Approximately half were nulliparous. The eight-factor model was well fitting and consistent with the development of the original PrAS. Criterion-related validity was demonstrated by strong correlations with similar measures (PRAQ-R2, anxiety, and depression) and lower correlations with resilience scores. Predictive validity was shown by group comparisons for: planned versus unplanned pregnancy, trimester, and parity.

CONCLUSIONS

The PrAS-G provides a broader assessment of pregnancy-related anxiety than existing measures. Initial evaluation has demonstrated convergent, divergent, and predictive validity, excellent internal consistency, and good model fit indicating promising psychometric properties. The PrAS-G offers a comprehensive assessment of pregnancy-related anxiety which will enable tailored interventions aiming to improve birth experience and well-being of expectant mothers.

Magnitude of paternal postpartum psychological distress and associated factors in Addis Ababa, Ethiopia: a facility-based cross-sectional study

BACKGROUND

The psychological distress of fathers in the postpartum period can have adverse effects on the well-being of the family and the newborn's development in particular. However, fathers' mental health throughout the postpartum has remained understudied and clinically overlooked in many developing countries, including Ethiopia. This study aims to assess the prevalence of psychological distress among fathers in the postpartum period and to examine the associated factors in an Ethiopian population.

METHODS

A facility-based, cross-sectional study was conducted at Tikur Anbessa Specialized Hospital (TASH) and Gandhi Memorial Hospital (GMH) in Addis Ababa, Ethiopia. A systematic sampling method was employed to include 280 fathers whose partners gave birth 6 to 8 weeks before the interview. Psychological distress was assessed using a validated Amharic version of the Kessler Psychological Distress Scale (K10) through a telephone interview. The collected data was analyzed using SPSS version 26. Descriptive statistics were used to summarize the data. Multivariable logistic regression was run to determine the variables associated with paternal postpartum psychological distress (K10 total score ≥ 7, a validated cut-off score in an urban Ethiopian setting), and odds ratio with 95% confidence intervals were obtained. A two-tailed p-value < 0.05 was considered for statistical significance.

RESULTS

About one-fifth of the fathers endorsed having distress symptoms during the postpartum period. Those with lower income (AOR = 11.31, 95% CI:  4.10, 31.15), unintended pregnancy (AOR = 3.96, 95% CI: 1.02, 15.46), poor social support (AOR =3.28 95% CI: 1.43, 7.50), poor infantile health (AOR = 8.20, 95% CI: 2.35, 28.66)  and maternal postpartum distress (AOR = 12.10,  95% CI: 3.15, 46.48) had significantly higher odds of having paternal postpartum distress.

CONCLUSIONS

Paternal postpartum distress was present in one-fifth of the fathers included in this study. This calls for due attention and efforts for early detection of those at risk of paternal distress and the development of interventions that consider their specific needs.

Postpartum Contraceptive Use, Pregnancy Intentions in Women With and Without a Delivery of a NAS-Affected Infant in Delaware, 2012-2018

Objective

Assess differences in postpartum contraceptive use and pregnancy intentions in women with a recent live birth who delivered a neonatal abstinence syndrome (NAS) affected infant.

Study Design

Using linked Delaware Birth Certificate Data, Hospital Discharge Data and PRAMS data for 2012-2018 (n = 6,358 singleton births), we assessed differences among women with and without a delivery of an NAS-affected infant by effective postpartum contraceptive use and pregnancy intentions. We calculated prevalence estimates, crude (cPOR), and prevalence odds ratios adjusted (aPOR) for NAS by maternal characteristics. We used alpha ≤ 0.05 to determine statistical significance.

Results

Prevalence of NAS was 2.2% (95% CI: 1.8 - 2.6). Effective postpartum contraceptive use was 60.4% (95% CI: 51.9-69.0) among women with delivery of an NAS-affected infant compared with a non-NAS delivery 56.4% (95% CI: 55.1-57.8%) and cPOR was 1.2 (95% CI: 0.8-1.7). Prevalence of intended pregnancy was 26.5% (95% CI: 18.9-34.0) among women with delivery of an NAS-affected infant compared with a non-NAS delivery 53.0% (95% CI: 51.7-54.4) and cPOR was 0.3 (95% CI: 0.2-0.5). After adjustment, women who delivered an NAS-affected infant had lower odds (aPOR = 0.5; 95% CI: 0.3-0.8) of indicating that their pregnancy was intended as compared to those who did not deliver an NAS-affected infant.

Conclusions

Our study found no association between delivery of an NAS-affected infant and use of an effective postpartum contraceptive method. However, we found that pregnancy intendedness was lower among women delivering an NAS-affected infant compared with women without an NAS delivery even after accounting for maternal characteristics.

Perspectives about social support among unmarried pregnant university students in South Africa

BACKGROUND

Pregnant young women in an academic environment are susceptible to stressors associated with unintended pregnancy and academic demands of universities. The challenges they face may be exacerbated by lack of social support, putting them at risk of psychological disorders such as depression. Women who receive social support during pregnancy and postpartum experience less emotional distress and report greater maternal satisfaction. However, very little is known about the perspectives about social support among unmarried pregnant students in tertiary institutions.

METHODS

Participants were purposively selected among unmarried pregnant students and those in the puerperal period at the time of the study. We conducted semi-structured qualitative interviews to explore the perspectives of unmarried pregnant students on the type of support that they need during pregnancy and the puerperium and the period when most support is needed. The data were audio-recorded and transcribed verbatim, then analysed using thematic analysis.

RESULTS

The findings show that social supports (emotional, instrumental, informational, and financial) were highlighted as important resources to cope with stressors during pregnancy and post-birth. Emotional support from male partners was the most important type of support needed as it entailed a sense of being loved and cared for. Social support was identified as important throughout the different phases of pregnancy and post birth, with different support needs expressed at each of these phases.

CONCLUSION

This study identified support needs of unmarried pregnant university students in their transition to motherhood. Given the several challenges that they are faced with, unmarried pregnant students need social support, including male partner support to enhance wellbeing as they try to cope with academic and pregnancy-related stressors.

Association between unintended pregnancy and maternal antenatal care services use in Ethiopia: analysis of Ethiopian demographic and health survey 2016

Introduction

Unintended pregnancy disproportionately affects women in low and middle-income countries including Ethiopia. Previous studies identified the magnitude and negative health outcomes of unintended pregnancy. However, studies that examined the relationship between antenatal care (ANC) utilization and unintended pregnancy are scarce.

Objective

This study aimed to examine the relationship between unintended pregnancy and ANC utilization in Ethiopia.

Methods

This is a cross-sectional study conducted using the fourth and most recent Ethiopian Demographic Health Survey (EDHS) data. The study comprised a weighted sample of 7,271 women with last alive birth and responded to questions on unintended pregnancy and ANC use. The association between unintended pregnancy and ANC uptake was determined using multilevel logistic regression models adjusted for possible confounders. Finally p < 5% was considered significant.

Results

Unintended pregnancy accounted for nearly a quarter of all pregnancies (26.5%). After adjusting for confounders, a 33% (AOR: 0.67; 95% CI, 0.57-0.79) lower odds of at least one ANC uptake and a 17% (AOR: 0.83; 95% CI, 0.70-0.99) lower odds of early ANC booking were found among women who had unintended pregnancy compared to women with intended pregnancy. However, this study founds no association (AOR: 0.88; 95% CI, 0.74, 1.04) between unintended pregnancy and four or more ANC visits.

Conclusion

Our study found that having unintended pregnancy was associated with a 17 and 33% reduction in early initiation and use of ANC services, respectively. Policies and programs designed to intervene against barriers to early initiation and use of ANC should consider unintended pregnancy.

Therapy of women with multiple sclerosis: an analysis of the use of drugs that may have adverse effects on the unborn child in the event of (unplanned) pregnancy

Background:

Although effective contraception is strongly recommended during the therapy of women with multiple sclerosis (MS) with some immunomodulatory drugs, unplanned pregnancies still occur. Adequate medication management is essential to avoid foetal harm in the event of an unplanned pregnancy.

Objective:

The aim was to screen for medications used in women of childbearing age with MS that may pose a risk of side effects on foetal development.

Methods:

Sociodemographic, clinical and medication data were collected from 212 women with MS by structured interviews, clinical examinations and medical records. Using the databases from Embryotox, Reprotox, the Therapeutic Goods Administration and on the German summaries of product characteristics, we assessed whether the taken drugs were potentially harmful regarding the foetal development.

Results:

The majority of patients (93.4%) were taking one or more drugs for which a possible harmful effect on the foetus is indicated in at least one of the four databases used. This proportion was even higher in patients who used hormonal contraceptives (birth control pills or vaginal rings) (PwCo, n = 101), but it was also quite high in patients who did not use such contraceptives (Pw/oCo, n = 111) (98.0% and 89.2%, respectively). PwCo were significantly more likely to take five or more medications with potential foetal risk according to at least one database than Pw/oCo (31.7% versus 6.3%). PwCo were also more severely disabled (average Expanded Disability Status Scale score: 2.8 versus 2.3) and more frequently had comorbidities (68.3% versus 54.1%) than Pw/oCo.

Conclusion:

Data on the most commonly used drugs in MS therapy were gathered to study the risk of possible drug effects on foetal development in female MS patients of childbearing age. We found that the majority of drugs used by patients with MS are rated as having a potential risk of interfering with normal foetal development. More effective contraception and special pregnancy information programmes regarding the therapy management during pregnancy should be implemented to reduce potential risks to mother and child.

Plain Language Summary

Use of drugs not recommended during pregnancy by women with multiple sclerosis Introduction: Patients with multiple sclerosis (MS) often have to take different drugs simultaneously. During the therapy with some immunomodulatory drugs, effective contraception is strongly recommended. Nevertheless, unplanned pregnancies occur regularly in women with MS. Methods: Here, we investigated whether the 212 patients included in this study were taking drugs with known possibility of harm to the development of an unborn child. This was done using four different drug databases. Results: A subset of 111 patients was not taking hormonal contraceptives (birth control pills or vaginal rings). Of those, 99 patients were taking at least one drug that is not recommended during pregnancy according to at least one of the four databases. Most of the medications taken have the potential to affect normal foetal development. Conclusion: To ensure safe use of medications, the patients should be reminded of the importance of effective contraception.

Fear of childbirth among pregnant women in Eastern Ethiopia: A community-based study

INTRODUCTION

Fear of childbirth refers to feelings of uncertainty and anxiety before, during, or after childbirth by thinking about future labor and birth or experience of others. Evidence on burden of fear of childbirth and its associated factors is limited in Ethiopia. In this study, we assessed magnitude of fear of childbirth and its associated factors among pregnant women in Eastern Ethiopia.

METHODS

A community-based cross-sectional study was conducted among randomly selected pregnant women recruited from Kersa Health and Demographic Surveillance System-an open cohort consisting of continuous registry of health and demographic conditions in eastern Ethiopia. Women were interviewed and fear of childbirth was assessed using the Wijma Delivery Expectancy Questionnaire. Data were entered using EpiData 3.1 and analyzed using SPSS 20. Factors associated with fear of childbirth were identified using binary and multiple logistic regression and described using adjusted odds ratio (aOR) along with 95% confidence interval (CI). Finally, statistical significance was set at p < 0.05 in the multiple logistic regression.

RESULTS

Of a total of 476 pregnant women included in the study, 111(23.3%; 95% CI 19.3-26.9) had fear of childbirth. Fear of childbirth was more likely among women who had no antenatal care (aOR = 2.6; 95% CI:1.22-5.50), no husband support (aOR = 5.7; 95% CI: 2.32-13.10), unplanned pregnancy (aOR = 7.8; 95% CI: 3.92-15.42), and had history of complication in labor and pregnancy (aOR = 10.4; 95% CI: 5.20-20.81).

CONCLUSION

A quarter of pregnant women in eastern Ethiopia had fear of childbirth. Helping women to have positive pregnancy experience requires strengthening antenatal care, partner support, and prevention of unwanted pregnancy.

Carrying an unintended pregnancy to term and long-term maternal psychological distress: Findings from the Dutch prospective Amsterdam Born Children and their Development study

BACKGROUND

Given the estimated high rate of unintended pregnancies, it is important to investigate long-term effects on psychological distress in women carrying an unintended pregnancy to term. However, research into associations between unintended pregnancies carried to term and psychological distress postpartum is mixed, and especially, evidence on long-term associations is scarce.

OBJECTIVE

To examine whether carrying an unintended pregnancy to term is associated with maternal psychological distress later in life, up to 12 years postpartum.

DESIGN

This study is based on the population-based birth cohort study 'Amsterdam Born Children and their Development' study, which included pregnant people in 2003 (n = 7784) and followed them up until 12 years postpartum.

METHODS

Unintended pregnancy was measured as a multidimensional construct, based on self-reported data around 16 weeks gestation on pregnancy mistiming, unwantedness and unhappiness. Symptoms of maternal psychological distress were assessed around 3 months, 5 years and 12 years postpartum using multiple questionnaires measuring symptoms of depression, anxiety and stress. Multiple structural equation modelling models were analysed, examining the associations between dimensions of unintended pregnancy and maternal psychological distress per time point, while controlling for important co-occurring risks.

RESULTS

Pregnancy mistiming and unhappiness were significant predictors of more maternal psychological distress around 3 months postpartum. Around 5 years postpartum, only pregnancy mistiming was positively associated with maternal psychological distress. Dimensions of unintended pregnancy were no longer associated with maternal psychological distress around 12 years postpartum. Strikingly, antenatal psychological distress was a much stronger predictor of maternal psychological distress than pregnancy intention dimensions.

CONCLUSION

Those who carried a more unintended pregnancy to term reported more symptoms of psychological distress at 3 months and 5 years postpartum. People carrying an unintended pregnancy to term may benefit from extra support, not because of the pregnancy intentions per se, but because they may be related to antenatal psychological distress.

Partner relationship quality, social support and maternal stress during pregnancy and the first COVID-19 lockdown

Introduction: Pregnancy has been associated with diminished maternal mental health and a deterioration in partner relationship quality. The recent COVID-19 quarantine measures have created additional stressors for pregnant women due to isolation and a surge in partner conflict.Objective: The purpose of this study was to assess how partner relationship conflict and social support may mediate mental health outcomes during the COVID-19 lockdown.Methods: A cross-sectional study with a sample of 152 pregnant women using psychological measures, (i.e. Prenatal Distress Questionnaire, Symptom Checklist-90-R, Duke-UNC-11 Functional Social Support Questionnaire, Perceived Stress Scale). Demographic characteristics, obstetrics history, and partner relationship conflict were assessed using questionnaires.Results: While there were few reports of physical violence in this sample, between 18% and 59% of women reported partner relationship conflict on the psychological subscale (e.g. afraid of one's partner or screamed at by one's partner). Further, the psychological subscale was significantly associated with symptoms of psychopathology. There was a significant negative association between social support and pregnancy-specific stress (p = .005), and perceived stress (p= .038).Conclusions: These findings suggest that partner relationship conflict and social support may act as important buffers for prenatal mental health in childbearing women during vulnerable situations, such as the COVID-19 pandemic.

Intimate relationships after receiving versus being denied an abortion: A 5-year prospective study in the United States

CONTEXT

When an individual seeking an abortion cannot obtain one, carrying that pregnancy to term may affect both her relationship with the man involved in the pregnancy and her prospects for new intimate relationships. We aimed to assess the impact of receiving versus being denied a wanted abortion on women's intimate relationships, up to 5 years after seeking an abortion in the United States.

METHODS

Using mixed-effects regression models, we compared relationship outcomes among women who presented for abortion care just under facilities' gestational age limits ("Near-limit abortion patients," n = 452) with those who presented just over, were denied an abortion ("Turnaways," n = 146) at 30 US facilities.

RESULTS

At 1 week post-abortion seeking, the predicted probability of being in a relationship with the man involved in the pregnancy was 58%, gradually declining to 27% at 5 years with no significant differences between those who received and those who were denied an abortion. However, from 2 to 5 years post-abortion seeking, participants who were denied an abortion had double the odds (aOR = 2.01, 95% CI: 1.09-3.69) of being in a poor intimate relationship, with a predicted probability of being in a poor relationship of 14% among those denied an abortion compared with 9% among those who received one (p < 0.05).

CONCLUSIONS

Carrying an unwanted pregnancy to term does not increase the chance of being in an intimate relationship with the man involved in the pregnancy but may have negative implications for the quality of future relationships up to 5 years post-abortion seeking.

The association between pregnancy intention, fertility treatment use, and postpartum depression

RATIONALE

Understanding whether postpartum depressive (PPD) symptoms vary by pregnancy intention and use of fertility treatments has implications for reproductive health policies and practices.

OBJECTIVE

The first aim of this study was to determine whether PPD symptoms differ between women who had unintended pregnancies, women who conceived spontaneously and were unsure about their pregnancy intention, women who used fertility treatments to conceive, and women who conceived spontaneously and intentionally. The second aim was to determine whether PPD symptoms differed based on the fertility treatment used to conceive (fertility drugs only, medicated insemination, or assisted reproductive technology [ART]).

METHODS

Data from the Pregnancy Risk Assessment Monitoring System (2012-2019), a cross-sectional survey administered to women throughout the U.S. who have recently given birth, was used to carry out our aims.

RESULTS

For the first aim (unweighted N = 243,677), compared to women who had spontaneous, intended pregnancies, women who had unintended pregnancies (OR: 1.32, 95% CI: 1.26-1.39, p < 0.01) and those with spontaneous pregnancies who were unsure about their intention (OR: 1.30, 95% CI: 1.23-1.38, p < 0.01) had higher odds of elevated PPD symptoms, adjusting for a range of covariates. Women who conceived with fertility treatments did not have higher odds of elevated PPD symptoms (OR: 0.97, 95% CI: 0.84-1.10, p = 0.61). For the second aim (unweighted N = 2,210), compared to those in the ART group, those who conceived using only fertility enhancing drugs had greater odds of developing elevated PPD symptoms (OR: 2.00, 95% CI: 1.24-3.24, p < 0.01).

CONCLUSIONS

These findings suggest that giving birth to an unintended pregnancy in the U.S. increases risk of elevated PPD symptoms. While overall women who conceive with the use of fertility treatments are not at increased risk of experiencing elevated PPD symptoms, there may be variability in risk based on the specific fertility treatments used.

The Mental and Physical Health Impacts of Overturning Roe v Wade

The overturning of Roe v Wade has resulted in the loss of reproductive rights for millions of women in the United States. It has also put these women at risk of severe mental and physical health consequences. When legal abortions are restricted, there is a rise in illegal abortion with the risk of hemorrhage, infection, infertility, and death. There are many more risks of carrying a pregnancy to term than health or psychological risks of a legal abortion. Women who have a miscarriage risk having to prove they did not abort. In cases of medical emergencies, doctors may be restricted from performing life-saving abortions for fear of penalties. Women or children who have been victims of rape or incest will have to either have an illegal abortion or carry an unwanted pregnancy to term. In states that allow an abortion in cases of severe risk to a mother's health, panels of internists and psychiatrist may, again, be charged with deciding whether her risks are valid. Women's physical and mental health will suffer.

Associations between breastfeeding intention, breastfeeding practices and post-natal depression during the COVID-19 pandemic: A multi-country cross-sectional study

Associations between breastfeeding intention, duration and post-natal depression (PND) have been shown in pre-COVID-19 studies. However, studies during COVID-19 have not examined the associations between breastfeeding intention, breastfeeding practices, and PND in an international sample of post-natal women, taking into consideration COVID-19 related factors. This is the first study to address this gap as both PND and breastfeeding may be affected by COVID-19, and have important long-term effects on women's and infant's health. A cross-sectional internet-based survey was conducted with 3253 post-natal women from five countries: Brazil, South Korea, Taiwan, Thailand, and the United Kingdom from July to November 2021. The results showed that women who intended to breastfeed during pregnancy had lower odds of having PND than women who did not intend to. Women who had no breastfeeding intention but actually breastfed had greater odds (AOR 1.75) of having PND than women who intended to breastfeed and actually breastfed. While there was no statistical significance in expressed breast milk feeding in multivariable logistic regression models, women who had shorter duration of breastfeeding directly on breast than they planned had greater odds (AOR 1.58) of having PND than those who breastfed longer than they planned even after adjusting for covariates including COVID-19-related variables. These findings suggested the importance of working with women on their breastfeeding intention. Tailored support is required to ensure women's breastfeeding needs are met and at the same time care for maternal mental health during and beyond the pandemic.

Low husband involvement in maternal and child health services and intimate partner violence increases the odds of postpartum depression in northwest Ethiopia: A community-based study

Background

Depression is the most common mental health problem that affects women during pregnancy and after child-birth. Postpartum depression, in particular, has both short and long-term effects on the lives of mothers and children. Women’s health is a current global concern, but postpartum depression is a neglected issue in the maternal continuum of care and is rarely addressed. Therefore, this study aimed to assess postpartum depression and associated factors in Gondar city, northwest Ethiopia.

Methods

A community-based cross-sectional study was conducted from August 1^st to 30^th, 2021 in Gondar city. A cluster sampling technique was employed to select 794 postpartum women. Data were entered by EPI DATA version 4.6 and exported to SPSS version 25 for further analysis. The multivariable logistic regression analysis was carried out to identify factors associated with postpartum depression. The adjusted odds ratio with its 95% confidence interval at a p-value of ≤ 0.05 was used to declare the level of significance.

Results

A total of 794 women were included in the analysis, giving a response rate of 98.5%. The prevalence of postpartum depression was 17.25% (95% CI: 14.5, 20.2). Younger maternal age (AOR = 2.72, 95% CI: 1.23, 5.85), low average monthly income (AOR = 2.71, 95% CI: 1.24, 5.91), low decision-making power (AOR = 2.04, 95%CI: 1.31, 3.18), low husband/partner involvement in MNCH care service (AOR = 2.34, 95%CI: 1.44, 3.81), unplanned pregnancy (AOR = 3.16 95% CI: 1.77, 5.62), and experience of intimate partner violence (AOR = 3.13; 95% CI: 1.96, 4.99) were significantly associated with increased odds of postpartum depression.

Conclusion

In this study, nearly 1/5^th of the study participants had postpartum depression. Thus, it is important to integrate maternal mental health services with the existing maternal health care services. It is also crucial to advocate the need for husband’s involvement in MNCH care services and ensure women’s decision-making power in the household. Moreover, community-based sexual and reproductive health education would be better to reduce risk factors of postpartum depression.

Determinants of postpartum depression among mothers in Debre Tabor town, North-central, Ethiopia: Community-based unmatched case-control study

Background

Postpartum depression (PPD) is a non-psychotic depressive disorder of variable severity, and it can begin as early as 2 weeks after delivery and can persist indefinitely if left untreated. In Ethiopia, the prevalence of postpartum depression is high. There is a dearth of literature to determine factors associated with postpartum depression in Ethiopia, specifically in the study area.

Objective

This study aimed to identify factors associated with postpartum depression among mothers in Debre Tabor Town, Northcentral Ethiopia.

Method

A community-based unmatched case-control study was conducted among mothers who were living in Debre Tabor Town and fulfilled the inclusion criteria. Postpartum mothers were selected using a simple random sampling technique from the listed sampling frame at the health center. Then, the sample cases and controls were interviewed until the sample size was fulfilled by using a consecutive sampling method. The data were entered into the EPI data version 4.6 and then imported and analyzed using SPSS version 25. Descriptive statistics of different variables were done by cross-tabulation. Binary logistic regression was used to assess the determinant factors with the outcome variable. A P-value of < 0.05 was considered to declare statistical significance.

Results

A total of 308 postnatal mothers living in Debre Tabor Town were included, with a 97.5% response rate. History of substance use in the previous 3 months (AOR: 6.47, 95% CI; 2.61, 15.74), current baby illness (AOR: 3.9, 95% CI; 1.5, 10.12), marital dissatisfaction (AOR: 2.41, 95% CI; 1.22, 4.75), unplanned current pregnancy (AOR: 3.46, 95% CI; 1.32, 9.12), and breastfeeding (AOR: 0.22, 95% CI; 0.09, 0.55) were independent factors that affected the occurrence of PPD.

Conclusion

This study revealed that a recent history of substance use (in the past 3 months), current baby illness, marital satisfaction, unplanned current pregnancy, and breastfeeding were associated with postpartum depression. Healthcare providers working in maternal and child health clinics and health extension workers should give special attention to postpartum mothers who have had a history of substance use, current baby illness, unplanned pregnancy, non-breastfeeding mothers, and mothers with poor marital satisfaction.

The Adolescent's Right to Confidential Care When Considering Abortion

The American Academy of Pediatrics reaffirms its position that the rights of adolescents under 18 years of age to confidential care when considering legal medical and surgical abortion therapies should be protected. Most adolescents voluntarily involve parents and other trusted adults in decisions regarding pregnancy termination and should be encouraged to do so when safe and appropriate. The legal climate surrounding abortion law is rapidly becoming more restrictive and threatens to adversely impact adolescents. Mandatory parental involvement, the judicial bypass procedure, and general restrictive abortion policies pose risks to adolescents' health by causing delays in accessing medical care, increasing volatility within a family, and limiting their pregnancy options. These harms underscore the importance of adolescents' access to confidential abortion care. This statement presents a summary of pertinent current information related to the impact of legislation requiring mandatory parental involvement in an adolescent's decision to obtain abortion services.

Beyond Abortion: The Consequences of Overturning Roe

The upcoming U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization has the potential to eliminate or severely restrict access to legal abortion care in the United States. We address the impact that the decision could have on abortion access and its consequences beyond abortion care. We posit that an abortion ban would, in effect, mean that anyone who becomes pregnant, including those who continue a pregnancy and give birth to healthy newborns and those with pregnancy complications or adverse pregnancy outcomes will become newly vulnerable to legal surveillance, civil detentions, forced interventions, and criminal prosecution. The harms imposed by banning or severely restricting abortion access will disproportionately affect persons of color and perpetuate structural racism. We caution that focusing on Roe as a decision that only protects ending a pregnancy ignores the protection that the decision also affords people who want to continue their pregnancies. It overlooks the ways in which overturning Roe will curtail fundamental rights for all those who become pregnant and will undermine their status as full persons meriting Constitutional protections. Such a singular focus inevitably obscures the common ground that people across the ideological spectrum might inhabit to ensure the safety, health, humanity, and rights of all people who experience pregnancy.

Predictors of postnatal depression in the slums Nairobi, Kenya: a cross-sectional study

BACKGROUND

Postnatal depression (PND) is a universal mental health problem that prevents mothers' optimal existence and mothering. Although research has shown high PND prevalence rates in Africa, including Kenya, little research has been conducted to determine the contributing factors, especially in low-resource communities.

OBJECTIVE

This study aimed to investigate the PND risk factors among mothers attending Lang'ata and Riruta Maternal and Child Health Clinics (MCH) in the slums, Nairobi.

METHODS

This study was cross-sectional. It is part of a large study that investigated the effectiveness of a brief psychoeducational intervention on PND. Postnatal mothers (567) of 6-10 weeks postanatal formed the study population. Depression rate was measured using the original 1961 Beck's Depression Inventory (BDI). In addition, a sociodemographic questionnaire (SDQ) was used to collect hypothesized risk variables. Multivariable logistic regression analysis was used to explore predictors of PND.

RESULTS

The overall prevalence of PND in the sample of women was 27.1%. Women aged 18-24 (β = 2.04 95% C.I.[0.02; 4.05], p = 0.047), dissatisfied with body image (β = 4.33 95% C.I.[2.26; 6.41], p < 0.001), had an unplanned pregnancy (β = 2.31 95% C.I.[0.81; 3.80], p = 0.003 and felt fatigued (β = - 1.85 95% C.I.[- 3.50; 0.20], p = 0.028) had higher odds of developing PND. Participants who had no stressful life events had significantly lower depression scores as compared to those who had stressful life events (β = - 1.71 95% C.I.[- 3.30; - 0.11], p = 0.036) when depression was treated as a continuous outcome. Sensitivity analysis showed that mothers who had secondary and tertiary level of education had 51 and 73% had lower likelihood of having depression as compared to those with a primary level of education (A.O.R = 0.49 95% C.I.[0.31-0.78], p = 0.002) and (A.O.R = 0.27 95% C.I.[0.09-0.75], p = 0.013) respectively.

CONCLUSION

This study reveals key predictors/risk factors for PND in low-income settings building upon the scanty data. Identifying risk factors for PND may help in devising focused preventive and treatment strategies.

Depression and quality of life among pregnant women in first and third trimesters in Abeokuta: A comparative study

Background

Pregnancy is a dynamic time during which a woman’s emotional state may undergo extensive change. There have been conflicting views about the magnitude of emotional turmoil that occurs during pregnancy. Some investigators suggest that pregnancy is a time of particularly good psychological adjustment; others have reported high levels of psychological challenge.

Aim

Our study aimed to compare the prevalence and correlates of depression in the first and third trimesters of pregnancy and to determine the relationship between quality of life and depressive disorder.

Setting

The antenatal clinic of the State Hospital, Ijaiye.

Method

A descriptive, comparative study of depressive disorder and the quality of life between first- and third-trimester pregnant women (confirmed through a pregnancy test and an abdominopelvic ultrasound).

Result

For each trimester, 285 participants were recruited. The prevalence of depression among the pregnant women who participated in the study was 7.2%. In the first trimester of pregnancy, the prevalence of depression was 30 (10.5%), while it was 11 (3.9%) in the third trimester of pregnancy. Collectively, the relationship between depression and QoL was significant in the overall domain, satisfaction with general health domain (t = 2.27; p = 0.03), psychological domain (t = 2.74; p = 0.010, and environmental domain (t = 4.57; p ≤ 0.01).

Conclusion

Our study also highlights the need to pay closer attention to the psychological well-being and quality of life of all pregnant women and not just on their physical health and the baby’s well-being.

Social determinants of antenatal depression and anxiety among women in South Asia: A systematic review & meta-analysis

Background

Pregnancy is a time of major psychological changes making pregnant women more susceptible to depression and anxiety. Prevalence is higher among women living in Bangladesh, India and Pakistan, compared to high-income countries, due to poor understanding and lack of mental health integration within antenatal care. Antenatal depression/anxiety is associated with adverse outcomes including postnatal depression, low birth weight and impaired fetal development. Existing systematic reviews provided only limited information on the social determinants of antenatal depression/anxiety in these South Asian countries.

Objective

This review aimed to identify, synthesise and appraise the evidence on the social determinants associated with antenatal depression and anxiety in women living in Bangladesh, India and Pakistan.

Methods

We searched five databases (MEDLINE, Embase, PsycINFO, Scopus, Web of Science) and PROSPERO. Observational studies published between 1^st January 2000 and 4^th January 2021 were included if they were in the English language, used validated tools for measuring depression/anxiety in pregnant women and reported statistical associations or raw numbers. Summary estimates were obtained using random-effects model. Heterogeneity and publication bias was measured using the I² statistic and Egger’s test, respectively. This review was registered on PROSPERO (reference: CRD42020167903).

Results

We included 34 studies (with 27,379 women). Meta-analysis of Adjusted Odds Ratios (AOR) found that Intimate partner violence (AOR 2.48, 95% CI 1.41–4.33), unplanned pregnancy (AOR 1.53, 95% CI 1.28–1.83), male gender preference (AOR 3.06, 95% CI 1.40–6.72) and poor relationship with in-laws (AOR 2.69, 95% CI 1.25–5.80) were significantly associated with antenatal depression/anxiety.

Conclusion

The review identified a complex range of social determinants of antenatal depression and anxiety in Bangladesh, India and Pakistan. Screening tools to identify pregnant women at high risk should be integrated within antenatal care to prevent adverse outcomes. Knowledge of these social determinants will inform the development of such screening tools and interventions.

Factors associated with pregnancy-related anxiety among pregnant women attending antenatal care follow-up at Bedelle general hospital and Metu Karl comprehensive specialized hospital, Southwest Ethiopia

Pregnancy-related anxiety (PRA) is an anxiety related to the pregnancy, involving labor and delivery, the well-being of the fetus/infant and the mother, the availability of quality of healthcare resources, and the capacity to parent. There is scarcity of study conducted on magnitude of Pregnancy-related anxiety and its associated factors among pregnant women in Ethiopia. The main objective of this research was to assess factors associated with Pregnancy-related anxiety among pregnant women attending ANC follow-up at Bedelle general and Metu Karl comprehensive specialized hospitals, Southwest Ethiopia. A hospital-based cross-sectional study design was used among pregnant women attending ANC follow-up. Data were collected from 406 sampled pregnant women who were selected through a systematic random sampling technique. Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R2) was used to measure the outcome variable. The collected data were analyzed using Statistical Package for Social Sciences (SPSS) version 26. Logistic regression analyses were done to identify factors associated with Pregnancy-related anxiety and significance level set at p < 0.05. The overall prevalence of PRA in this study was 32.7%. Unwanted pregnancy AOR = 2.77, 95% CI [1.71, 4.54], high perceived stress AOR = 2.39, 95% CI [1.54, 3.62], young age AOR = 2.14, 95% CI [1.49, 2.83], depression AOR = 2.09, 95% CI [1.39, 2.89], low income AOR = 2.01, 95% CI [1.29, 3.14], and poor social support AOR = 1.79, 95% CI [1.14, 3.37] were significantly associated with Pregnancy-related anxiety. The findings of this study showed that the prevalence of Pregnancy-related anxiety was high in the study area and positively associated with young age, low income, poor social support, high perceived stress, depression, and unwanted pregnancy. This finding suggests that clinicians should integrate screening for Pregnancy-related anxiety into clinical standards, more efforts should be made in the future to reduce the anxiety among pregnant women who had an unwanted pregnancy, young women, and poor social support. Also, it is good to encourage the pregnant mother to enhance their social connectedness by creating a self-help group, and increasing early identification of mental health problems throughout their daily ANC follow-up.

Complications after interval postpartum intrauterine device insertion

BACKGROUND:

In the United States, up to 57% of women report resumption of sexual activity by the 6 week postpartum visit. Effective contraception should be addressed and provided at that time, to avoid unintended pregnancies and optimize interpregnancy intervals. Long-acting reversible contraceptives are the most effective forms of reversible contraception and are increasingly popular during the postpartum period. However, timing of postpartum intrauterine device (IUD) placement varies among providers and many delay insertion due to concerns for uterine perforation or expulsion of the IUD.

OBJECTIVE:

This study aimed to evaluate uterine perforation and expulsion rates with IUD insertion at 4–8 weeks postpartum vs 9–36 weeks postpartum.

STUDY DESIGN:

We performed a retrospective cohort study using the Kaiser Permanente Southern California electronic medical record from 2010 to 2016. We calculated the proportion of perforations and expulsions with IUD insertion at 4–8 weeks vs 9–36 weeks postpartum. Our primary outcome was the perforation rate. Secondarily, we evaluated the expulsion rate. For our minimum sample size calculation, to detect a difference of 0.5% in the perforation rate, with a baseline perforation rate of 0.5% for the 9–36 week postpartum IUD placement group, 80% power, and 5% alpha error rate, we would need at least 4221 participants per group, 8442 in total.

RESULTS:

A total of 24,959 patients met inclusion criteria (n=13,180 in the 4–8 week group, n=11,777 in the 9–36 week group). Of 430 patients with a confirmed complication, 157 uterine perforations and 273 IUD expulsions were identified. Perforation rates were significantly higher with placement at 4–8 weeks than at 9–36 weeks (0.78% vs 0.46%; P=.001). After adjusting for race and ethnicity, breastfeeding, IUD type, provider type, parity, most recent delivery, and body mass index, the odds of perforation remained higher with placement at 4–8 weeks than at 9–36 weeks (adjusted odds ratio, 1.92; 95% confidence interval, 1.28–2.89). Our Kaplan-Meier survival curve showed that the risk of uterine perforation remained elevated until approximately 22–23 weeks postpartum. Expulsion rates were similar between the 2 groups (1.02 vs 1.17; P=.52).

CONCLUSION:

Uterine perforation after interval postpartum IUD insertion is greater at 4–8 weeks than at 9–36 weeks, although perforation rates remain low at <1%. Expulsion rates did not differ between the groups. Because overall rates of uterine perforation are low, women can safely be offered IUDs at any interval beyond 4 weeks with minimal concern for perforation.