1
|
Bartholomew V, Hundley V, Clark CJ, Parris BA. The RETHINK Study: Could pain catastrophising explain why some women are more likely to attend hospital during the latent phase of labour. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 39:100941. [PMID: 38104503 DOI: 10.1016/j.srhc.2023.100941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To examine the prevalence of pain catastrophising and identify whether it impacts on the timing of hospital admission when in labour. METHODS A longitudinal cohort study. Nulliparous women, experiencing an uncomplicated pregnancy in England, were recruited between 25 and 33 weeks gestation. Participants completed two online questionnaires, (1) on recruitment, including the Pain Catastrophizing Scale (PCS) and the Wijma Delivery Expectancy Questionnaire (WDEQ-A) (2) at three weeks postnatal. RESULTS A total of 389 eligible participants entered the study. The percentage of women who were pain catastrophisers (PCS ≥ 20) was 28.1 %, while 7.6 % had a high pain catastrophising score (PCS ≥ 30). There was no association between pain catastrophising and the timing of hospital admission. The percentage of women reporting fear of childbirth (WDEQ-A score of ≥ 85) was 10.6 %. Fear of childbirth was highly associated with PCS scores (p <.001) at both the lower (≥20) and higher (≥30) thresholds. CONCLUSION Although not statistically significant, there was a tendency for women who pain catastrophise to present to hospital in the latent phase. The highly significant association between PCS and WDEQ-A scores has implications for the identification of these women and suggests that the PCS can be used as a screening tool to identify those women who have heightened fear around pain and who may also go on to develop clinically relevant fear of childbirth. Further studies are needed to confirm the acceptability of the PCS as a screening tool with women.
Collapse
Affiliation(s)
- V Bartholomew
- Centre for Midwifery & Women's Health, Bournemouth University, Faculty of Health and Social Sciences, Bournemouth Gateway Building, St Paul's Lane, Bournemouth BH8 8GP, United Kingdom.
| | - V Hundley
- Centre for Midwifery & Women's Health, Bournemouth University, Faculty of Health and Social Sciences, Bournemouth Gateway Building, St Paul's Lane, Bournemouth BH8 8GP, United Kingdom
| | - C J Clark
- Centre for Midwifery & Women's Health, Bournemouth University, Faculty of Health and Social Sciences, Bournemouth Gateway Building, St Paul's Lane, Bournemouth BH8 8GP, United Kingdom
| | - B A Parris
- Department of Psychology, Bournemouth University, Poole House P331, Talbot Campus, Fern Barrow, Poole BH12 5BB, United Kingdom
| |
Collapse
|
2
|
Lykins AD, Bonich M, Sundaraja C, Cosh S. Climate change anxiety positively predicts antenatal distress in expectant female parents. J Anxiety Disord 2024; 101:102801. [PMID: 38086278 DOI: 10.1016/j.janxdis.2023.102801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/26/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
Clinical and subclinical levels of anxiety and depression are common experiences during pregnancy for expectant women; however, despite rising awareness of significant climate change anxiety around the world, the extent to which this particular type of anxiety may be contributing to overall antenatal psychological distress is currently unknown. Furthermore, the content of concerns that expectant women may have for their existing or future children remains unexplored. To address this gap in knowledge, 103 expectant Australian women completed standardised assessments of antenatal worry and depression, climate change anxiety, and perceived distance to climate change, and responded to several open-ended questions on concerns they had for their children. Results indicated that climate change anxiety accounted for significant percentages of variance in both antenatal worry and depression scores and, unexpectedly, neither child number nor perceived distance to climate change moderated these relationships. Content analysis of qualitative data highlighted the significant health-related anxieties for participants' children related to climate change (e.g., disease, exposure to extreme weather events, food/water insecurity). Given the escalating nature of climate change, further investigation of this relatively new stressor contributing to the experience of anxiety and distress, particularly in uniquely vulnerable groups such as expectant women, is urgently needed.
Collapse
Affiliation(s)
- Amy D Lykins
- School of Psychology, University of New England, Armidale, New South Wales, Australia.
| | - Mary Bonich
- School of Psychology, University of New England, Armidale, New South Wales, Australia
| | - Cassandra Sundaraja
- School of Psychology, University of New England, Armidale, New South Wales, Australia
| | - Suzanne Cosh
- School of Psychology, University of New England, Armidale, New South Wales, Australia
| |
Collapse
|
3
|
Flink IK, Engström J, Vastamäki S, Vixner L, Engman L. Expecting the uncertain: The applicability of the intolerance of uncertainty model on fear of childbirth. J Psychosom Obstet Gynaecol 2023; 44:2243648. [PMID: 37593941 DOI: 10.1080/0167482x.2023.2243648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/19/2023] Open
Abstract
A considerable number of pregnant women experience fear of childbirth (FOC), characterized by worries and fear of the unpredictable. Despite this, the psychological processes in FOC have received notably little attention. The aim of this study was to advance the understanding by exploring the applicability of the Intolerance of Uncertainty (IU) model on FOC. Anonymous data was collected in a sample of pregnant women (N = 357) with varying levels of FOC. Analyses supported the associations between FOC and all proposed psychological processes: IU, negative problem orientation, positive beliefs about worry and avoidance of inner experiences. The exploration of potential mediators of the relation between IU and FOC revealed that, of the three processes from the model, only positive beliefs about worry were a mediator, and more specifically, a partial mediator between IU and FOC. These findings add to the theoretical understanding of FOC, by indicating that the role of IU may be similar to other conditions inflicted by worry and anxiety, which may inform treatment development.
Collapse
Affiliation(s)
- I K Flink
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | - J Engström
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | - S Vastamäki
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | - L Vixner
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - L Engman
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
- Behavioural Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
4
|
Lanssens D, Vandenberk T, Storms V, Thijs I, Grieten L, Bamelis L, Gyselaers W, Tang E, Luyten P. Changes in Intrapersonal Factors of Participants in the Pregnancy Remote Monitoring Study Who Are at Risk for Pregnancy-Induced Hypertension: Descriptive Quantitative Study. J Med Internet Res 2023; 25:e42686. [PMID: 37672324 PMCID: PMC10512113 DOI: 10.2196/42686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/25/2023] [Accepted: 06/23/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND The peripartum period, defined as the period from the beginning of the gestation until 1 year after the delivery, has long been shown to be potentially associated with increased levels of stress and anxiety with regard to one's transition to the status of parent and the accompanying parental tasks. Yet, no research to date has investigated changes in intrapersonal factors during the peripartum period in women at risk for pregnancy-induced hypertension (PIH). OBJECTIVE The aim of this study is to explore and describe changes in intrapersonal factors in participants at risk for PIH. METHODS We used an explorative design in which 3 questionnaires were sent by email to 110 participants the day following enrollment in the Pregnancy Remote Monitoring program for pregnant women at risk for PIH. Women were invited to complete the questionnaires at the beginning of their participation in the Pregnancy Remote Monitoring project (mostly at 14 weeks of gestation) and after approaching 32 weeks of gestational age (GA). The Generalized Anxiety Disorder-7 Scale (GAD-7) and the Patient Health Questionnaire-9 were used to assess anxiety and depression, and adaptation of the Pain Catastrophizing Scale was used to measure trait pain catastrophizing. RESULTS Scores were significantly higher at 32 weeks of GA than at the moment of enrollment (GAD-7 score=7, range 4-11 vs 5, range 3-8; P=.01; and Patient Health Questionnaire-9 score=6, range 4-10 vs 4, range 2-7; P<.001). The subscale scores of the Pain Catastrophizing Scale were all lower at 32 weeks of GA compared with 14 weeks of GA (rumination: 4, range 1-6 vs 5, range 2-9.5; P=.11; magnification: 3, range 1-5.5 vs 4, range 3-7; P=.04; and helplessness: 5, range 2-9 vs 6, range 3.5-12; P=.06). The proportion of women with a risk for depression (GAD-7 score >10) was 13.3% (10/75) at enrollment and had increased to 35.6% (26/75) at 32 weeks of GA. CONCLUSIONS This study shows that pregnant women at risk for PIH have higher levels of stress and anxiety at 32 weeks of GA than at the moment of enrollment. Further research is recommended to investigate potential strategies to help pregnant women at risk for PIH manage feelings of stress and anxiety. TRIAL REGISTRATION ClinicalTrials.gov NCT03246737; https://clinicaltrials.gov/study/NCT03246737.
Collapse
Affiliation(s)
- Dorien Lanssens
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty Medicine and Life Sciences, Department of Physiology, Hasselt University, Diepenbeek, Belgium
| | - Thijs Vandenberk
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Valerie Storms
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Inge Thijs
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Lars Grieten
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Lotte Bamelis
- Centre for Translational Psychological Research TRACE, Ziekenhuis Oost Liburg, Genk, Belgium
| | - Wilfried Gyselaers
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty Medicine and Life Sciences, Department of Physiology, Hasselt University, Diepenbeek, Belgium
| | - Eileen Tang
- Faculty of Psychology and Educational Sciences, KULeuven, Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KULeuven, Leuven, Belgium
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussel, Belgium
- Educational and Health Psychology, Research Department of Clinical, University College London, London, United Kingdom
| |
Collapse
|
5
|
Roosevelt L, Zielinski R, Seng J, Low LK. Measuring Fear of Childbirth Among a Diverse Population in the United States: A Revised Wijma Delivery Expectancy/Experience Scale (WDEQ-10). J Midwifery Womens Health 2023; 68:581-587. [PMID: 37221977 DOI: 10.1111/jmwh.13514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 03/22/2023] [Accepted: 03/31/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION The current gold standard instrument used to measure fear of childbirth is the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ). However, the existing scale is long, has translational challenges, and lacks data specific to experiences of a diverse population in the United States, making it challenging to assess how fear of childbirth impacts perinatal health care disparities. The objective of this study was to revise the WDEQ and analyze its reliability and validity for use in the United States. METHODS The questionnaire was revised using qualitative data from a previously published study of fear of childbirth within a racially, ethnically, and economically diverse group of pregnant or postpartum people in the United States. Psychometric properties were analyzed in terms of construct validity, reliability, and factor analysis from a group of 329 participants. RESULTS The revised and shortened 10 item WDEQ-10 comprises 3 subscales: fear of environmental factors, fear of death or injury, and fear of how they feel. The results indicate that the WDEQ-10 demonstrates good reliability and validity and confirmed the multidimensionality of fear of childbirth through a 3-factor solution. DISCUSSION The WDEQ-10 is a readable and accessible instrument that will allow health care providers and researchers to accurately measure complex components of how pregnant people experience fear of childbirth.
Collapse
Affiliation(s)
- Lee Roosevelt
- School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Ruth Zielinski
- School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Julia Seng
- School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Lisa Kane Low
- School of Nursing, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
6
|
Priyadarshanie MN, Waas DA, Goonewardena S, Senaratna CV, Fernando S. Association of antenatal anxiety disorders with antenatal comorbidities and adverse pregnancy outcomes among clinic attendees at a tertiary-care hospital in Sri Lanka. Heliyon 2023; 9:e13900. [PMID: 36915536 PMCID: PMC10006716 DOI: 10.1016/j.heliyon.2023.e13900] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023] Open
Abstract
Purpose Evidence on the association between antenatal anxiety disorders (AADs) and adverse pregnancy outcomes with detection of AADs using the gold-standard is scarce despite being vital to make decisions on interventions. We aimed to determine this association in women attending tertiary-care antenatal clinics in Sri Lanka. Material and methods Presence/absence of AADs in a systematic random sample of 221 antenatal women attending routine antenatal clinics of a teaching hospital who participated in a questionnaire-validation study were confirmed by a psychiatrist. These women were followed up until the end of pregnancy. Information on antenatal comorbidities, adverse pregnancy outcomes was extracted from health records. The association between AADs with antenatal comorbidities and adverse pregnancy outcomes were reported using adjusted odds ratios (ORs) and 95%confidence intervals (CIs) generated from logistic regression models. Results Mean (±SD) age of the women was 30 (±5.8) years. AADs were diagnosed in 81 (37%) women. Compared to women without AADs, those who had AADs were more at risk of pregnancy-induced hypertension (OR 6.1; 95% CI 1.2-31.9), gestational diabetes mellitus (OR 12.6; 95% CI 1.5-107.2), preterm labour (OR 4.3; 95% CI 1.4-13.0), prolonged labour (OR 19.0; 95% CI 7.1-51.1), lower segment caesarean section (OR 4.7; 95% CI 2.5-8.7) and low birthweight (OR 11.2; 95% CI 4.8-26.3). All miscarriages, stillbirths and assisted labour occurred exclusively in those with AADs. Conclusions AADs are strongly associated with several adverse pregnancy outcomes. Causal pathways and effect of interventions for AADs must be explored in future research.
Collapse
Affiliation(s)
- M Nirmala Priyadarshanie
- Department of Nursing & Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka
| | - Dulshika A Waas
- Department of Psychiatry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Sampatha Goonewardena
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Chamara V Senaratna
- Non-Communicable Diseases Research Centre, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Sharaine Fernando
- Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| |
Collapse
|
7
|
San Martin Porter MA, Kisely S, Salom C, Betts KS, Alati R. Association between screening for antenatal depressive symptoms and delivery outcomes: The Born in Queensland Study. Aust N Z J Obstet Gynaecol 2022; 62:838-844. [PMID: 35451095 PMCID: PMC10084247 DOI: 10.1111/ajo.13534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/24/2022] [Accepted: 03/24/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Evidence shows that depressive symptoms during pregnancy increase the risk of an intervention during delivery (induction, the use of forceps or vacuum, and caesarean sections (CS)). Many women with depression during pregnancy are not identified and therefore will not receive appropriate follow up of their symptoms. We hypothesised that routine screening for depressive symptoms during pregnancy could reduce detrimental consequences of depressive symptoms on delivery outcomes. AIM We explored the association between screening for depressive symptoms during pregnancy and delivery outcomes. MATERIALS AND METHODS A cross-sectional analysis of state-wide administrative data sets. The population included all women who delivered a singleton in Queensland between the July and December of 2015. Logistic regression analyses were run in 27 501 women (93.1% of the total population) with information in all variables. The following were the main outcomes: onset of labour, CS, instrumental vaginal delivery, and all operative deliveries (including both CS and instrumental vaginal deliveries). RESULTS Women who completed the screening had increased odds of a spontaneous onset of labour (adjusted odds ratio (aOR) 1.18; 95% CI 1.09-1.27) and decreased odds of an operative delivery (instrumental or CS) (aOR 0.88; 95% CI 0.81-0.96). Among women who had a vaginal delivery, those who completed the screening had decreased odds of having an instrumental delivery (aOR 0.84; 95% CI 0.74-0.97). Sensitivity analyses in women who did not have a formal diagnosis of depression showed similar results. CONCLUSION Our findings suggest that screening may decrease interventions during delivery in women with depressive symptoms.
Collapse
Affiliation(s)
| | - Steve Kisely
- School of Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Caroline Salom
- Institute for Social Science Research, University of Queensland, Brisbane, Queensland, Australia.,Australian Research Council Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - Kim S Betts
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Rosa Alati
- Institute for Social Science Research, University of Queensland, Brisbane, Queensland, Australia.,School of Population Health, Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
8
|
Amegavluie REA, Ani-Amponsah M, Naab F. Women's experiences of surviving severe obstetric complications: a qualitative inquiry in southern Ghana. BMC Pregnancy Childbirth 2022; 22:212. [PMID: 35296276 PMCID: PMC8928636 DOI: 10.1186/s12884-022-04538-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/28/2022] [Indexed: 12/04/2022] Open
Abstract
Women who survive severe obstetric complications (SOC) have health and well-being issues even up to 1 year postpartum and have challenges in their quality-of-life (QoL). However, little is known about their predicaments. This study aimed to describe the impact of severe obstetric complications on women’s QoL and well-being after surviving severe obstetric complications. Using the WHO standards for near-miss, twelve (12) women who survived severe obstetric complications were recruited between January and March 2019. The study adopted a qualitative approach with an exploratory descriptive design to explore the experiences of women who survived SOC in Southern Ghana. The participants were purposively sampled and were interviewed face to face in their homes and healthcare facility after discharge from the Hospital. Recorded interviews were transcribed and analyzed. Two (2) major themes and nine (9) sub-themes emerged. The findings revealed that women who suffered SOC are unable to perform functional activities, have financial constraints, residual hypertension, signs and symptoms of anaemia, pain, and mostly have difficulty in sleeping due to fear of death when they fall asleep. Anxiety, sadness, and emotional trauma was a common phenomenon. The study findings offer insights and directions on measures to improve the care and QoL of women who have survived severe obstetric complications in Ghana.
Collapse
Affiliation(s)
| | - Mary Ani-Amponsah
- Maternal and Child Health Department, School of Nursing and Midwifery/ College of Health Sciences. University of Ghana, Legon, Ghana
| | - Florence Naab
- Maternal and Child Health Department, School of Nursing and Midwifery/ College of Health Sciences. University of Ghana, Legon, Ghana
| |
Collapse
|
9
|
Dual-Session Tokophobia Intervention, a Novel Ultrashort Cognitive Behavioral Therapy Protocol for Women Suffering From Tokophobia in the Third Term of Pregnancy. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
10
|
Fairbrother N, Collardeau F, Albert A, Stoll K. Screening for Perinatal Anxiety Using the Childbirth Fear Questionnaire: A New Measure of Fear of Childbirth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042223. [PMID: 35206412 PMCID: PMC8872365 DOI: 10.3390/ijerph19042223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/27/2022]
Abstract
Fear of childbirth affects as many as 20% of pregnant people, and has been associated with pregnancy termination, prolonged labour, increased risk of emergency and elective caesarean delivery, poor maternal mental health, and poor maternal-infant bonding. Currently available measures of fear of childbirth fail to fully capture pregnant people’s childbirth-related fears. The purpose of this research was to develop a new measure of fear of childbirth (the Childbirth Fear Questionnaire; CFQ) that would address the limitations of existing measures. The CFQ’s psychometric properties were evaluated through two studies. Participants for Study 1 were 643 pregnant people residing in Canada, the United States, and the United Kingdom, with a mean age of 29.0 (SD = 5.1) years, and 881 pregnant people residing in Canada, with a mean age of 32.9 (SD = 4.3) years for Study 2. In both studies, participants completed a set of questionnaires, including the CFQ, via an online survey. Exploratory factor analysis in Study 1 resulted in a 40-item, 9-factor scale, which was well supported in Study 2. Both studies provided evidence of high internal consistency and convergent and discriminant validity. Study 1 also provided evidence that the CFQ detects group differences between pregnant people across mode of delivery preference and parity. Study 2 added to findings from Study 1 by providing evidence for the dimensional structure of the construct of fear of childbirth, and measurement invariance across parity groups (i.e., the measurement model of the CFQ was generalizable across parity groups). Estimates of the psychometric properties of the CFQ across the two studies provided evidence that the CFQ is psychometrically sound, and currently the most comprehensive measure of fear of childbirth available. The CFQ covers a broad range of domains of fear of childbirth and can serve to identify specific fear domains to be targeted in treatment.
Collapse
Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Correspondence:
| | - Fanie Collardeau
- Department of Psychology, Faculty of Social Sciences, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Arianne Albert
- Women’s Health Research Institute, Vancouver, BC V6H 2N9, Canada;
| | - Kathrin Stoll
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| |
Collapse
|
11
|
Grundström H, Malmquist A, Ivarsson A, Torbjörnsson E, Walz M, Nieminen K. Fear of childbirth postpartum and its correlation with post-traumatic stress symptoms and quality of life among women with birth complications - a cross-sectional study. Arch Womens Ment Health 2022; 25:485-491. [PMID: 35230529 PMCID: PMC8921122 DOI: 10.1007/s00737-022-01219-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/22/2022] [Indexed: 12/03/2022]
Abstract
The primary aim of the study was to analyze differences in post-traumatic stress symptoms (PTSS) and quality of life (QoL) between women with and without severe fear of childbirth postpartum (PP FOC). The secondary aims were to analyze the correlation between PP FOC and PTSS, and PP FOC and QoL, in women undergoing complicated childbirth. This cross-sectional study was conducted in South-East Sweden. Women aged ≥ 18 years who had undergone complicated childbirth (i.e., acute or emergency cesarean section, vacuum extraction, child in need of neonatal care, manual placenta removal, sphincter rupture, shoulder dystocia, or hemorrhage ≥ 1000 ml) were invited. Seventy-six women answered demographic questions and three validated instruments measuring PP FOC, PTSS, and QoL. The study population was divided into two sub groups: severe PP FOC or no severe PP FOC. Statistical analyses were conducted using Mann-Whitney U-test, chi-square test or Fisher's exact test, and Spearman's rank-order correlation. Severe PP FOC was reported by 29% of the women, and 18% reported PTSS indicating post-traumatic stress disorder. Women with severe PP FOC reported significantly higher levels of PTSS, and significantly lower QoL in five dimensions: physical role functioning, emotional role functioning, energy/fatigue, emotional well-being, and social functioning. There was a positive significant correlation between level of PP FOC and PTSS. There were also significant negative correlations between level of PP FOC and most of the QoL dimensions. In conclusion, almost one-third of the women with complicated childbirth reported severe PP FOC, and almost one-fifth reported PTSS indicating post-traumatic stress disorder. PP FOC correlated with PTSS and deteriorated QoL.
Collapse
Affiliation(s)
- Hanna Grundström
- Department of Obstetrics and Gynecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Anna Malmquist
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Alice Ivarsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elin Torbjörnsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Malin Walz
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Katri Nieminen
- Department of Obstetrics and Gynecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
12
|
Jones H, Seaborne M, Cowley L, Odd D, Paranjothy S, Akbari A, Brophy S. Population birth outcomes in 2020 and experiences of expectant mothers during the COVID-19 pandemic: A 'born in Wales' mixed methods study using routine data. PLoS One 2022; 17:e0267176. [PMID: 35609019 PMCID: PMC9129046 DOI: 10.1371/journal.pone.0267176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pregnancy can be a stressful time and the COVID-19 pandemic has affected all aspects of life. This study aims to investigate the pandemic impact on pregnancy experience, rates of primary childhood immunisations and the differences in birth outcomes in during 2020 to those of previous years. METHODS Self-reported pregnancy experience: 215 expectant mothers (aged 16+) in Wales completed an online survey about their experiences of pregnancy during the pandemic. The qualitative survey data was analysed using codebook thematic analysis. Population-level birth outcomes in Wales: Stillbirths, prematurity, birth weight and Caesarean section births before (2016-2019) and during (2020) the pandemic were compared using anonymised individual-level, population-scale routine data held in the Secure Anonymised Information Linkage (SAIL) Databank. Uptake of the first three scheduled primary childhood immunisations were compared between 2019 and 2020. FINDINGS The pandemic had a negative impact on the mental health of 71% of survey respondents, who reported anxiety, stress and loneliness; this was associated with attending scans without their partner, giving birth alone, and minimal contact with midwives. There was no significant difference in annual outcomes including gestation and birth weight, stillbirths, and Caesarean sections for infants born in 2020 compared to 2016-2019. There was an increase in late term births (≥42 weeks gestation) during the first lockdown (OR: 1.28, p = 0.019) and a decrease in moderate to late preterm births (32-36 weeks gestation) during the second lockdown (OR: 0.74, p = 0.001). Fewer babies were born in 2020 (N = 29,031) compared to 2016-2019 (average N = 32,582). All babies received their immunisations in 2020, but there were minor delays in the timings of immunisations. Those due at 8-weeks were 8% less likely to be on time (within 28-days) and at 16-weeks, they were 19% less likely to be on time. INTERPRETATION Whilst the pandemic had a negative impact on mothers' experiences of pregnancy. Population-level data suggests that this did not translate to adverse birth outcomes for babies born during the pandemic.
Collapse
Affiliation(s)
- Hope Jones
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, United Kingdom
- * E-mail:
| | - Mike Seaborne
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, United Kingdom
| | - Laura Cowley
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, United Kingdom
- Research and Evaluation Division, Knowledge Directorate, Public Health Wales, Cardiff, Wales, United Kingdom
| | - David Odd
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Shantini Paranjothy
- Centre for Health Data Science, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Ashley Akbari
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea, Wales, United Kingdom
| | - Sinead Brophy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, United Kingdom
| |
Collapse
|
13
|
Sanni KR, Eeva E, Noora SM, Laura KS, Linnea K, Hasse K. The influence of maternal psychological distress on the mode of birth and duration of labor: findings from the FinnBrain Birth Cohort Study. Arch Womens Ment Health 2022; 25:463-472. [PMID: 35150311 PMCID: PMC8921080 DOI: 10.1007/s00737-022-01212-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022]
Abstract
Antepartum depression, general anxiety symptoms, and pregnancy-related anxiety have been recognized to affect pregnancy outcomes. Systematic reviews on these associations lack consistent findings, which is why further research is required. We examined the associations between psychological distress, mode of birth, epidural analgesia, and duration of labor. Data from 3619 women with singleton pregnancies, from the population-based FinnBrain Birth Cohort Study were analyzed. Maternal psychological distress was measured during pregnancy at 24 and 34 weeks, using the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2) and its subscale "Fear of Giving Birth" (FOC), the anxiety subscale of the Symptom Checklist-90 (SCL-90) and the Edinburgh Postnatal Depression Scale (EPDS). Mode of birth, epidural analgesia, and labor duration were obtained from the Finnish Medical Birth Register. Maternal psychological distress, when captured with PRAQ-R2, FOC, and SCL-90, increased the likelihood of women having an elective cesarean section (OR: 1.04, 95% CI 1.01-1.06, p = .003; OR: 1.13, 95% CI 1.07-1.20, p < .001; OR: 1.06, 95% CI 1.03-1.10, p = .001), but no association was detected for instrumental delivery or emergency cesarean section. A rise in both the PRAQ-R2, and FOC measurements increased the likelihood of an epidural analgesia (OR: 1.02, 95% CI 1.01-1.03, p = .003; OR: 1.09, 95% CI 1.05-1.12, p < .001) and predicted longer second stage of labor (OR: 1.01, 95% CI 1.00-1.01, p = .023; OR: 1.03, 95% CI 1.02-1.05, p < .001). EPDS did not predict any of the analyzed outcomes. The results indicate that maternal anxiety symptoms (measured using PRAQ-R2, FOC, and SCL-90) are associated with elective cesarean section. Psychological distress increases the use of epidural analgesia, but is not associated with complicated vaginal birth.
Collapse
Affiliation(s)
- Kuuri-Riutta Sanni
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Lemminkäisenkatu 3a, Building: Teutori, 20014, Turku, Finland.
| | - Ekholm Eeva
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Lemminkäisenkatu 3a, Building: Teutori, 20014 Turku, Finland ,Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | - Scheinin M. Noora
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Lemminkäisenkatu 3a, Building: Teutori, 20014 Turku, Finland ,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Korhonen S. Laura
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Lemminkäisenkatu 3a, Building: Teutori, 20014 Turku, Finland ,Department of Paediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Karlsson Linnea
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Lemminkäisenkatu 3a, Building: Teutori, 20014 Turku, Finland ,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland ,Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - Karlsson Hasse
- Department of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku, Lemminkäisenkatu 3a, Building: Teutori, 20014 Turku, Finland ,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland ,Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| |
Collapse
|
14
|
Reynolds KA, Pankratz L, Cameron EE, Roos LE, Giesbrecht GF, Lebel C, Tomfohr-Madsen LM. Pregnancy during the COVID-19 pandemic: a qualitative examination of ways of coping. Arch Womens Ment Health 2022; 25:1137-1148. [PMID: 36443483 PMCID: PMC9707189 DOI: 10.1007/s00737-022-01277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic and related public health restrictions have impacted the mental health and coping strategies of many population groups, including people who are pregnant. Our study sought to explore the ways that pregnant people described coping with stressors associated with the pandemic. N = 5879 pregnant individuals completed the pan-Canadian Pregnancy During the COVID-19 Pandemic Survey between April and December 2020. We used descriptive statistics to quantify sociodemographic characteristics and thematic analysis (Braun & Clarke, 2006, 2019) to analyze n = 3316 open-ended text responses to the question "Can you tell us what things you are doing to cope with the COVID-19 pandemic?" The average age of participants was 32 years (SD = 4.4), with the majority identifying as White (83.6%), female (99.7%), married (61.5%), having completed post-secondary education (90.0%), and working full-time (75.4%). We categorized participant responses into two overarching thematic dimensions: (1) ways of coping and (2) coping challenges. Ways of coping included the following main themes: (1) taking care of oneself, (2) connecting socially, (3) engaging in pandemic-specific coping strategies, (4) keeping busy, (5) taking care of others, (6) creating a sense of normalcy, (7) changing perspectives, and (8) practicing spirituality. Coping challenges included the following: (1) the perception of coping poorly, (2) loss of coping methods, (3) managing frontline or essential work, and (4) worries about the future. Findings highlight important implications for targeted prenatal supports delivered remotely, including opportunities for social support, prenatal care, and mental health strategies.
Collapse
Affiliation(s)
- Kristin A. Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba Canada ,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba Canada
| | - Lily Pankratz
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba Canada
| | - Emily E. Cameron
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba Canada
| | - Leslie E. Roos
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba Canada
| | - Gerald F. Giesbrecht
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta Canada
| | - Catherine Lebel
- Department of Radiology, University of Calgary, Calgary, Alberta Canada
| | | |
Collapse
|
15
|
Zochowski MK, Kolenic GE, Zivin K, Tilea A, Admon LK, Hall SV, Advincula A, Dalton VK. Trends In Primary Cesarean Section Rates Among Women With And Without Perinatal Mood And Anxiety Disorders. Health Aff (Millwood) 2021; 40:1585-1591. [PMID: 34606349 DOI: 10.1377/hlthaff.2021.00780] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Reducing the rate of cesarean sections among women considered at low risk for delivery by that method is a goal of Healthy People 2030. Prior research suggests that perinatal mood and anxiety disorders increase the risk for cesarean section, but data are limited. This cross-sectional study of commercially insured women examined the relationship between perinatal depression and anxiety disorders and primary (first-time) cesarean section rates, using administrative claims data for US in-hospital deliveries from the period 2008-17. Of the 360,225 delivery hospitalizations among 317,802 unique women, 24.0 percent included a delivery by primary cesarean section, and 3.1 percent carried a diagnosis of depression, anxiety, or both made during the index pregnancy. Using an adjusted generalized estimating equation, we found that the predicted probability of primary cesarean section was 3.5 percentage points higher, on average, among women with these disorders compared with those without them. Our findings confirm the importance of pursuing research to identify mechanisms by which perinatal depression and anxiety disorders increase the risk for primary caesarean section among women otherwise considered at low risk for delivery by that method, as well as effective interventions.
Collapse
Affiliation(s)
- Melissa K Zochowski
- Melissa K. Zochowski is a research specialist in the Department of Psychiatry, University of Michigan, in Ann Arbor, Michigan
| | - Giselle E Kolenic
- Giselle E. Kolenic is a statistician in the Department of Obstetrics and Gynecology, University of Michigan
| | - Kara Zivin
- Kara Zivin is a professor in the Department of Psychiatry, University of Michigan, a research career scientist at the Veterans Affairs Ann Arbor Healthcare System, and a senior health researcher at Mathematica, all in Ann Arbor, Michigan
| | - Anca Tilea
- Anca Tilea is a data and analytics manager in the Department of Obstetrics and Gynecology, University of Michigan
| | - Lindsay K Admon
- Lindsay K. Admon is an assistant professor in the Department of Obstetrics and Gynecology, University of Michigan
| | - Stephanie V Hall
- Stephanie V. Hall is a doctoral student in the Department of Psychiatry, University of Michigan
| | - Agatha Advincula
- Agatha Advincula is a student intern, Benjamin Franklin Scholars, University of Pennsylvania, in Philadelphia, Pennsylvania
| | - Vanessa K Dalton
- Vanessa K. Dalton is a professor in the Department of Obstetrics and Gynecology, University of Michigan
| |
Collapse
|
16
|
Postpartum Depression, Complications During Pregnancy, and Offspring Behavior Problems in Early Childhood. CHILD & YOUTH CARE FORUM 2021. [DOI: 10.1007/s10566-021-09630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
A model of risk for perinatal posttraumatic stress symptoms. Arch Womens Ment Health 2021; 24:259-270. [PMID: 32995950 DOI: 10.1007/s00737-020-01068-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
Existing research suggests that childbirth may be a significant trigger of posttraumatic stress symptoms (PTSS). The current study examined whether subjective birthing experiences and objective childbirth characteristics mediated the association between predisposing psychosocial factors measured during pregnancy (e.g., fear of childbirth, history of trauma, and social support) and PTSS during the postpartum period. Women were recruited during pregnancy from a large Midwestern hospital. Symptoms of posttraumatic stress, obsessive compulsive disorder (OCD), and depression, as well as PTSS-related risk factors, including social support, lifetime trauma exposure, fear of childbirth, subjective perceptions, and objective characteristics of childbirth, were measured during pregnancy and 4, 8, and 12 weeks postpartum. A path model revealed that subjective perceptions of childbirth mediated the association between fear of childbirth and PTSS at 4 weeks postpartum. Objective childbirth characteristics mediated the association between fear of childbirth and PTSS at 8 weeks postpartum, and there was a direct association between fear of childbirth and PTSS. Subjective perceptions of childbirth also mediated the effect of fear of childbirth on PTSS at 4 weeks postpartum when controlling for OCD symptoms. Further, the direct effect of fear of childbirth on PTSS at 8 weeks postpartum remained significant when controlling for OCD symptoms. The current study emphasizes the importance of fear of childbirth and subjective and objective birthing experiences in predicting postpartum psychopathology. Future research should examine these models in diverse and at-risk samples. Valid assessments and effective interventions for perinatal PTSS should be explored.
Collapse
|
18
|
Ghasemi S, Rayyani M, Farokhzadian J. General health and self-efficacy for health practices of pregnant women: is it important for motherhood? J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01094-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
19
|
Jradi H, Alfarhan T, Alsuraimi A. Validation of the Arabic version of the Perinatal Anxiety Screening Scale (PASS) among antenatal and postnatal women. BMC Pregnancy Childbirth 2020; 20:758. [PMID: 33276746 PMCID: PMC7716415 DOI: 10.1186/s12884-020-03451-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety among women in the perinatal period is common. Assessing the severity of perinatal anxiety will help monitor the progress of the patient through the stages of anxiety and facilitated the treatment. This study assesses the validity and reliability of the "Perinatal Anxiety Screening Scale" (PASS) in the Arabic language. METHODS The PASS was translated into Arabic. Two hundred seventeen women in the antenatal and postnatal phase participated (92 antenatal and 125 postnatal) answered to PASS, GHQ12, EPDS-10, and DASS-21. Content validity, factor analysis, internal consistency, and test retest reliability were assessed. RESULTS Content Validity Index (CVI) and Content Validity Ratio (CVR) were .88 and 0.79; respectively. The scale loaded on four components: acute anxiety, social anxiety, and dissociation; specific fears and trauma; general anxiety and adjustment; and perfectionism and control. Cronbach's Alpha value for the scale was 0.78 and test retest correlation coefficient was 0.94. PASS significantly correlated with EPDS-10 (rho=0.46), GHQ-12(rho=0.58), the three components of DASS-21 (0.47, 0.50, and 0.43; respectively), and experiencing adverse life events. CONCLUSION The Arabic translated version of the PASS showed reasonably adequate validity and reliability and can be used to screen for anxiety disorder among women in the perinatal phase.
Collapse
Affiliation(s)
- Hoda Jradi
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. .,College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Mail code 2350, 11426, Riyadh, Saudi Arabia.
| | - Thikrayat Alfarhan
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Mail code 2350, 11426, Riyadh, Saudi Arabia
| | - Anas Alsuraimi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| |
Collapse
|
20
|
Chan CY, Lee AM, Koh YW, Tang CSK. Validation of the Chinese version of the Pregnancy-related Anxiety Questionnaire-Revised (PRAQ-R) and its distinction from general anxiety and depression in pregnant women. J Psychosom Obstet Gynaecol 2020; 41:215-223. [PMID: 31290358 DOI: 10.1080/0167482x.2019.1639042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objective: This study aims to evaluate the reliability and validity of the translated Chinese-Cantonese version of the Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R) in a sample of pregnant women in Hong Kong, China. It also aims to determine whether pregnancy-related anxiety changes significantly across trimesters and if it is differentiated from general anxiety and depression.Method: This study adopts a prospective longitudinal design with a quantitative approach. A consecutive sample of 186 Chinese pregnant women from hospitals in Hong Kong are assessed using the translated Chinese-Cantonese version of the PRAQ-R and other standardized instruments at three time points during the first to third trimester.Results: A confirmatory factor analysis revealed a three-factor structure of the Chinese-Cantonese version of the PRAQ-R, including fear of giving birth, fear of bearing a physically or mentally handicapped child, and concern about one's appearance. The internal consistency was excellent (α = 0.88 to 0.91) for all of the items in the PRAQ-R across the three trimesters. The average variance extract (AVE) and composite reliability (CR) for each factor were greater than the recommended level of CR > 0.70 and AVE > 0.50. Multiple regression analyses showed that a combination of general anxiety and depression explained a small proportion of the variance (10-29%) in the PRAQ-R subscales during the three trimesters.Conclusions: The Chinese-Cantonese version of the PRAQ-R has good validity and reliability, and the results provide evidence of its relevance for Chinese pregnant women with pregnancy-related anxiety in Hong Kong. The finding also shows that pregnancy-related anxiety is a relatively distinctive form of anxiety that is different from general anxiety and depression.
Collapse
Affiliation(s)
- Chui Yi Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,The Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of Higher Education, Hong Kong, China
| | - Antoinette Marie Lee
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Yee Woen Koh
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Center for Family and Population Research, National University of Singapore, Singapore, Singapore
| | | |
Collapse
|
21
|
Bangma M, Kazemier BM, Papatsonis DNM, Van der Zaag-Loonen HJ, Paarlberg KM. The association between depressive symptoms during pregnancy and post-delivery fear of childbirth; a prospective study. J Reprod Infant Psychol 2020; 38:367-377. [PMID: 32393062 DOI: 10.1080/02646838.2020.1753031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Fear of childbirth is an important reason for a caesarean section on request. OBJECTIVE To assess the association between depressive symptoms during pregnancy and post-delivery fear of childbirth (PFOC). METHODS We prospectively studied pregnant women from two hospitals in the Netherlands. Women completed the Edinburgh Depression Scale (EPDS), the Wijma Delivery Experience Questionnaire (W-DEQ B) and questions concerning risk factors. Depressive symptoms were assessed at baseline and six weeks post-delivery. PFOC was assessed six weeks post-delivery. Baseline characteristics and pregnancy outcomes were compared between women with and without a depression at baseline. The association between depression and PFOC was assessed with multivariable logistic regression analysis. RESULTS 245 women participated in this study. At baseline 11% suffered from depressive symptoms. There were no differences in pregnancy outcomes. Women with depressive symptoms more often suffered from depressive symptoms six weeks post-delivery (adjusted OR 4.9, 95% CI 1.4-17). PFOC six weeks post-delivery was present in 11%. Women with depression were at increased risk of PFOC six weeks post-delivery (adjusted OR 9.2, 95% CI 2.6-32). CONCLUSION This study shows that women with depression at baseline are at increased risk for depression and PFOC six weeks post-delivery.
Collapse
Affiliation(s)
- Meike Bangma
- Department of Obstetrics and Gynaecology, Amphia Teaching Hospital Breda , Breda, The Netherlands
| | - Brenda M Kazemier
- Department of Obstetrics and Gynaecology, Gelre Hospitals Apeldoorn Location , Apeldoorn, The Netherlands.,Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam , Amsterdam, The Netherlands
| | - Dimitri N M Papatsonis
- Department of Obstetrics and Gynaecology, Amphia Teaching Hospital Breda , Breda, The Netherlands
| | | | - K Marieke Paarlberg
- Department of Obstetrics and Gynaecology, Gelre Hospitals Apeldoorn Location , Apeldoorn, The Netherlands
| |
Collapse
|
22
|
KARATAŞ BARAN G, ŞAHİN S, ÖZTAŞ D, DEMİR P, DESTİCİOĞLU R. Gebelerin algılanan stres düzeylerinin ve stres nedenlerinin değerlendirilmesi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.633534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
23
|
Finnbogadóttir H, Baird K, Thies-Lagergren L. Birth outcomes in a Swedish population of women reporting a history of violence including domestic violence during pregnancy: a longitudinal cohort study. BMC Pregnancy Childbirth 2020; 20:183. [PMID: 32216780 PMCID: PMC7098079 DOI: 10.1186/s12884-020-02864-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/09/2020] [Indexed: 11/26/2022] Open
Abstract
Background Victimisation of women is encountered in all countries across the world, it damages the mental and physical health of women. During pregnancy and the postpartum period, women are at a greater risk of experiencing violence from an intimate partner. The aim of this study was to explore childbirth outcomes in a Swedish population of women reporting a history of violence including domestic violence during pregnancy. Methods A longitudinal cohort design was used. In total, 1939 pregnant women ≥18 years were recruited to answer two questionnaires, both questionnaires were administered in the early and late stages of their pregnancy. The available dataset included birth records of 1694 mothers who gave birth between June 2012 and April 2014. Statistical analyses included descriptive statistics, T-test and bivariate logistic regression. Results Of 1694 mothers 38.7% (n = 656) reported a history of violence and 2% (n = 34) also experienced domestic violence during pregnancy. Women who were single, living apart from their partner, unemployed, smoked and faced financial distress were at a higher risk of experiencing violence (p = 0.001). They also had significant low scores on the SOC-scale and high EDS-scores ≥13 (p = 0.001) when compared to women without a history of violence (p = 0.001). Having a history of violence increased the woman’s risk of undergoing a caesarean section (OR 1.33, 95% CI 1.02–1.70). A history of emotional abuse also significantly increased the risk of having a caesarean section irrespective of whether it was a planned or an emergency caesarean section (OR 1.50, 95% CI 1.09–2.06). Infants born to a mother who reported a history of violence, were at significant risk of being born premature < 37 weeks of gestation compared to infants born by mothers with no history of violence (p = 0,049). Conclusions A history of violence and/or exclusively a history of emotional abuse has a negative impact on childbirth outcomes including caesarean section and premature birth. Therefore, early identification of a history of or ongoing violence is crucial to provide women with extra support which may have positive impact on her birth outcomes.
Collapse
Affiliation(s)
- Hafrún Finnbogadóttir
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
| | - Kathleen Baird
- School of Nursing and Midwifery, Transforming Maternity Care Collaborative, Griffith University, & Gold Coast University Hospital, Griffith, Australia
| | - Li Thies-Lagergren
- The Department of Health Science: Midwifery research - reproductive, perinatal and sexual health, Health Science Center, Lund University, Lund, Sweden
| |
Collapse
|
24
|
Abrar A, Fairbrother N, Smith AP, Skoll A, Albert AYK. Anxiety among women experiencing medically complicated pregnancy: A systematic review and meta-analysis. Birth 2020; 47:13-20. [PMID: 31222840 DOI: 10.1111/birt.12443] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Symptoms of anxiety are common among pregnant and postpartum women, and 15%-20% of pregnancies are affected by medical complications. Despite this, little is known about the relationship of medical complications in pregnancy and women's experience of anxiety. The purpose of this research was to conduct a systematic review and meta-analysis of differences in anxiety symptom severity among women experiencing a medically complicated versus a medically uncomplicated pregnancy. METHODS This work was guided by the PRISMA reporting process. Electronic databases MEDLINE and PsycINFO were searched to identify studies that met the inclusion criteria. An adaptation of the Newcastle-Ottawa Quality Assessment Scale for case-control studies was used to perform a quality assessment review. A random-effects meta-analysis was used to calculate the estimated average standardized mean differences. RESULTS Based on the five studies which met our inclusion criteria, findings provide evidence of higher levels of anxiety symptoms among pregnant women experiencing a medically complicated versus a medically uncomplicated pregnancy. Despite considerable heterogeneity, all mean difference estimates are in the direction of greater anxiety in the high-risk groups. CONCLUSIONS Women experiencing a medically complex pregnancy report higher levels of anxiety symptoms compared to women experiencing a medically uncomplicated pregnancy.
Collapse
Affiliation(s)
- Ambar Abrar
- Social Dimensions of Health Program, The University of Victoria, Victoria, British Columbia, Canada
| | - Nichole Fairbrother
- Department of Psychiatry and Island Medical Program, The University of British Columbia, Vancouver, British Columbia, Canada
| | - André P Smith
- Department of Sociology, The University of Victoria, Victoria, British Columbia, Canada
| | - Amanda Skoll
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Arianne Y K Albert
- Women's Health Research Institute, British Columbia's Women's Hospital and Health Centre and Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
25
|
Muche AA, Olayemi OO, Gete YK. Effects of gestational diabetes mellitus on risk of adverse maternal outcomes: a prospective cohort study in Northwest Ethiopia. BMC Pregnancy Childbirth 2020; 20:73. [PMID: 32013909 PMCID: PMC6998275 DOI: 10.1186/s12884-020-2759-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background Gestational diabetes mellitus is a leading medical condition woman encounter during pregnancy with serious short- and long-term consequences for maternal morbidity. However, limited evidence was available on potential impacts of gestational diabetes mellitus using updated international diagnostic criteria on adverse maternal outcomes. Therefore, this study aimed to assess the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes in Northwest Ethiopia. Methods A prospective cohort study was conducted among pregnant women followed from pregnancy to delivery. Gestational diabetes mellitus status was determined by using a two-hour 75 g oral glucose tolerance test and based on updated international diagnostic criteria. Multivariable log-binomial model was used to examine the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes. Results A total of 694 women completed the follow-up and included in the analysis. Women with gestational diabetes mellitus had a higher risk of composite adverse maternal outcome (ARR=1.58, 95% CI: 1.22, 2.04), caesarean delivery (ARR=1.67; 95%: 1.15, 2.44), pregnancy induced hypertension (ARR= 3.32; 95%: 1.55, 7.11), premature rupture of membranes (ARR= 1.83; 95%: 1.02, 3.27), antepartum hemorrhage (ARR= 2.10; 95%: 1.11, 3.98) and postpartum hemorrhage (ARR= 4.85; 95%:2.28, 10.30) compared to women without gestational diabetes mellitus. Conclusions Gestational diabetes mellitus increased the risk of adverse maternal outcomes. This implies that maternal care and intervention strategies relating to women with gestational diabetes mellitus should be strengthened.
Collapse
Affiliation(s)
- Achenef Asmamaw Muche
- Department of Obstetrics and Gynecology, Pan African University Life and Earth Sciences Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria. .,Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Oladapo O Olayemi
- Department of Obstetrics and Gynecology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Yigzaw Kebede Gete
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
26
|
McQuire C, Daniel R, Hurt L, Kemp A, Paranjothy S. The causal web of foetal alcohol spectrum disorders: a review and causal diagram. Eur Child Adolesc Psychiatry 2020; 29:575-594. [PMID: 30648224 PMCID: PMC7250957 DOI: 10.1007/s00787-018-1264-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/05/2018] [Indexed: 12/21/2022]
Abstract
Foetal alcohol spectrum disorders (FASDs) are a leading cause of developmental disability. Prenatal alcohol use is the sole necessary cause of FASD, but it is not always sufficient. Multiple factors influence a child's susceptibility to FASD following prenatal alcohol exposure. Much of the FASD risk factor literature has been limited to discussions of association, rather than causation. While knowledge of predictor variables is important for identifying who is most at risk of FASD and for targeting interventions, causal knowledge is important for identifying effective mechanisms for prevention and intervention programmes. We conducted a systematic search and narrative synthesis of the evidence and used this to create a causal diagram (directed acyclic graph; DAG) to describe the causal pathways to FASD. Our results show that the aetiology of FASD is multifaceted and complex. FASD risk is determined by a range of lifestyle, sociodemographic, maternal, social, gestational, and genetic factors. The causal diagram that we present in this review provides a comprehensive summary of causal risk factors for FASD and can be used as a tool to inform data collection and statistical modelling strategies to minimise bias in future studies of FASD.
Collapse
Affiliation(s)
- Cheryl McQuire
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - R. Daniel
- Division of Population Medicine, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - L. Hurt
- Division of Population Medicine, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - A. Kemp
- Division of Population Medicine, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - S. Paranjothy
- Division of Population Medicine, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| |
Collapse
|
27
|
Dere SS, Varotariya JK, Ghildiyal RP, Sharma SA, Kaur DMS. Antenatal preparedness for motherhood and its association with antenatal anxiety and depression in first time pregnant women from India. Ind Psychiatry J 2019; 28:255-261. [PMID: 33223720 PMCID: PMC7659993 DOI: 10.4103/ipj.ipj_66_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 04/26/2020] [Accepted: 06/04/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS Pregnancy is a developmental period demanding special adjustments. Psychologically, pregnancy can be associated with positive preparedness in some and fear of childbirth or doubts of mothering role in others. Anxiety and depression during pregnancy can have negative implications on its outcome. The current study aims to provide insight into factors influencing maternal preparedness for motherhood. METHODOLOGY Hundred first time pregnant women were enrolled after written informed consent and ethical approval. The Pregnancy Experiences Scale-Brief Version was used to study maternal rating of uplifts and hassles experiences specific to pregnancy, indicating affective valence toward the pregnancy. Pregnancy-Related Anxiety Questionnaire (PRAQ-R) helped to identify pregnancy-specific anxiety and depressive symptoms were screened using Whooley's Questions. Data were analyzed using Microsoft Excel 15.30 (170107). RESULTS The mean age of the women was 23.1 years. More than half of the pregnancies were unplanned, and the mean duration of pregnancy was 6.8 months. The positive experience was reported more than a negative experience. Negative valence increased in the presence of psychosocial stressors. On PRAQ-R, anxiety symptoms were reported by 52% of the patients, especially high on the domain of "fear of giving birth" and increased with trimester. Depressive symptoms were reported by 23% of the women. CONCLUSION Advanced gestation, presence of stressors, past psychiatric illness, ANC complications, and the presence of anxiety/depression influence maternal preparedness for motherhood. There is a need of sensitizing the doctors, nurses, health-care workers, and relatives regarding screening, referral of unmet psychological needs of pregnant women to help new mothers to adjust with their motherhood positively.
Collapse
Affiliation(s)
| | - Jagdish K Varotariya
- Department of Psychiatry, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Rakesh P Ghildiyal
- Department of Psychiatry, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Sunil A Sharma
- Department of Obstetrics and Gynaecology, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | | |
Collapse
|
28
|
Sun Y, Huang K, Hu Y, Yan S, Xu Y, Zhu P, Tao F. Pregnancy-specific anxiety and elective cesarean section in primiparas: A cohort study in China. PLoS One 2019; 14:e0216870. [PMID: 31091276 PMCID: PMC6519904 DOI: 10.1371/journal.pone.0216870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/30/2019] [Indexed: 01/17/2023] Open
Abstract
The purpose of this study was to investigate the association between pregnancy-specific anxiety and elective cesarean section, and identify the critical period in which pregnancy-specific anxiety will affect the elective cesarean section. Primiparous women in the 1st trimester of pregnancy were invited to participate in the cohort. General information on maternal socio-demographic characteristics and environmental exposure were collected using questionnaires. Pregnancy-specific anxiety was assessed by using pregnancy-specific anxiety questionnaire in the 1st, 2nd and 3rd trimester, respectively. Delivery modes and pregnancy complications were abstracted from medical notes. Structural equation modeling (SEM) was adopted to examine the relationship between pregnancy-specific anxiety and elective cesarean section. Results indicated the overall elective cesarean section rate in this study was 45%. Among 1 874 pregnant women, 30.9% women experienced anxiety at least once during pregnancy, and 6.9% women suffered from anxiety in all three trimesters. Anxiety in the 2nd trimester was a significant predictor for elective cesarean section. Young maternal age and low educational level had indirect effects on women’s choice of elective caesarean section through affecting pregnancy-specific anxiety. More attention should be paid to maternal psychological problems, and professional counseling needs to be strengthened to protect women from pregnancy-specific anxiety.
Collapse
Affiliation(s)
- Yuanfang Sun
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui Province, China
- * E-mail:
| | - Yabin Hu
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health Center, Ma'anshan, China
| | - Yeqing Xu
- Ma'anshan Maternal and Child Health Center, Ma'anshan, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui Province, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui Province, China
| |
Collapse
|
29
|
Rutherford JN, Asiodu IV, Liese KL. Reintegrating modern birth practice within ancient birth process: What high cesarean rates ignore about physiologic birth. Am J Hum Biol 2019. [DOI: 10.1002/ajhb.23229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Julienne N. Rutherford
- Department of Women, Children, and Family Health Science; College of Nursing, University of Illinois at Chicago; Chicago Illinois
| | | | - Kylea L. Liese
- Department of Women, Children, and Family Health Science; College of Nursing, University of Illinois at Chicago; Chicago Illinois
| |
Collapse
|
30
|
Smorti M, Ponti L, Tani F. The effect of maternal depression and anxiety on labour and the well-being of the newborn. J OBSTET GYNAECOL 2019; 39:492-497. [DOI: 10.1080/01443615.2018.1536697] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Martina Smorti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Lucia Ponti
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Franca Tani
- Department of Health Sciences, University of Florence, Florence, Italy
| |
Collapse
|
31
|
Ternström E, Hildingsson I, Haines H, Karlström A, Sundin Ö, Ekdahl J, Segeblad B, Larsson B, Rondung E, Rubertsson C. A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth - A study protocol. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 13:75-82. [PMID: 28844361 DOI: 10.1016/j.srhc.2017.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/04/2017] [Accepted: 06/13/2017] [Indexed: 11/25/2022]
Abstract
Fear of birth is a concern that requires evidence based treatment. The aim of this study is to present the protocol of a randomized controlled multi-center trial to compare internet-based cognitive therapy with counseling as standard care for pregnant women reporting fear of birth. Participants will be recruited in mid-pregnancy. Women who score 60 or above on the Fear of Birth Scale will be offered to participate in this study. Data will be collected by questionnaires including validated instruments at baseline and follow-ups at gestational weeks 30 and 36, two months and one year after birth. The primary outcome will be level of fear of birth measured with the Fear of Birth Scale at 36 weeks of gestation. Secondary outcome measures are level of fear of birth at two months and one year after giving birth, preferences for mode of birth, requests for elective cesarean section, compliance and satisfaction with treatment and birth outcomes. A power calculation based on a 20% reduction of fear implies that approximately 200 will be included in the trial. The study outlined in this protocol will be the first randomized controlled trial comparing internet-based cognitive therapy with counseling for women reporting fear of birth. An effective treatment may result in better overall health for women with fear of birth and a reduction in cesarean sections for non-medical reasons. Evidence regarding treatment options of fear of birth will also provide a greater choice for women.
Collapse
Affiliation(s)
- Elin Ternström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Health Science, Mid Sweden University, Sundsvall, Sweden.
| | - Helen Haines
- Rural Health Academic Centre, University of Melbourne, Victoria, Australia.
| | - Annika Karlström
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, Östersund, Sweden.
| | - Johanna Ekdahl
- Department of Psychology, Mid Sweden University, Östersund, Sweden.
| | | | - Birgitta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Research and Development Centre, Sundsvall Hospital, Sundsvall, Sweden.
| | - Elisabet Rondung
- Department of Psychology, Mid Sweden University, Östersund, Sweden.
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
32
|
Finnbogadóttir H, Mellgren C. The degree of suffering among pregnant women with a history of violence, help-seeking, and police reporting. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 13:23-28. [PMID: 28844354 DOI: 10.1016/j.srhc.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 04/13/2017] [Accepted: 05/23/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To explore the degree of self-reported suffering following violent incidents and the prevalence of police reporting as well as other help-seeking behaviour among women in early pregnancy with history of violence. STUDY DESIGN A cross-sectional design. 1939 pregnant women≥18years were recruited prospectively between March 2012 and September 2013 in south-west Sweden. Of those, 761 (39.5%) reported having a history of violence, and they comprised the cohort investigated in the present study. Descriptive statistics, Chi-square analysis, and T-test were used for the statistical calculations. RESULTS More than four of five women (80.5%) having a history of emotional abuse (n=374), more than half (52.4%) having history of physical abuse (n=561), and almost three of four (70.6%) who experienced sexual abuse (n=302) reported in the early second trimester of their pregnancy that they still suffered from their experience. Of those women who had experienced emotional, physical, and sexual abuse, 10.5%, 25.1%, and 18.0%, respectively, had never disclosed their experiences to anyone. At most, a quarter of the abused women had reported a violent incident to the police. CONCLUSIONS All midwives and other actors who meet women with experience of abuse need to have increased knowledge about the long-term consequences of all types of abuse. Increased routine questioning of pregnant women about history of violence would help to prevent experiences of violence from affecting pregnancy and childbirth negatively and facilitate the provision of help and support.
Collapse
Affiliation(s)
- Hafrún Finnbogadóttir
- Faculty of Health and Society, Department of Care Science, Malmö University, Sweden.
| | - Caroline Mellgren
- Faculty of Health and Society, Department of Criminology, Malmö University, Sweden.
| |
Collapse
|
33
|
Koelewijn JM, Sluijs AM, Vrijkotte TGM. Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study. BMJ Open 2017; 7:e013413. [PMID: 28490549 PMCID: PMC5623367 DOI: 10.1136/bmjopen-2016-013413] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The rate of interventions during childbirth has increased dramatically during the last decades. Maternal anxiety might play a role in the progress of the labour process and interventions during labour. This study aimed to identify associations between anxiety in the first half of pregnancy and the birth process, including any interventions required during labour. In addition, differences in the associations by parity and ethnicity were explored. DESIGN Prospective cohort study. SETTING Primary care midwifery practices and secondary/tertiary care obstetric practices in Amsterdam, participating in the multiethnic ABCD (Amsterdam Born Children and their Development) study (participation rate 96%; response 8266/12 373 (67%)). PARTICIPANTS Included were women with singletons, alive at labour start, with a gestational age ≥24 weeks (n=6443). INDEPENDENT VARIABLE General anxiety (State-Trait Anxiety Inventory state) and pregnancy-related anxiety (Pregnancy-Related Anxieties Questionnaire (PRAQ)) were self-reported in the first half of pregnancy. OUTCOMES Associations between both forms of anxiety and several indicators of the birth process were analysed. Subgroup analyses were performed for parity and ethnicity. RESULTS The prevalence of high general anxiety (State-Trait Anxiety Inventory score ≥43) and pregnancy-related anxiety (PRAQ score ≥P90) were 30.9% and 11.0%, respectively. After adjustment, in nulliparae, both general anxiety and pregnancy-related anxiety were associated with pain relief and/or sedation (OR for general anxiety 1.23; 95% CI 1.02 to 1.48; OR for pregnancy-related anxiety 1.45; 95% CI 1.14 to 1.85). In multiparae, general anxiety was associated with induction of labour (OR 1.53; 95% CI 1.16 to 2.03) and pregnancy-related anxiety was associated with primary caesarean section (OR 1.66; 95% CI 1.02 to 2.70). Associations were largely similar for all ethnicities. CONCLUSIONS High levels of general and pregnancy-related anxiety in early pregnancy contribute modestly to more interventions during the birth process with similar associations between ethnic groups, but with some differences between nulliparae and multiparae.
Collapse
Affiliation(s)
- Johanna Maria Koelewijn
- Sanquin Research and Landsteiner Laboratory, Department of Experimental Immunohematology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Marie Sluijs
- Department of Obstetrics and Gynecology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
34
|
Parsa P, Saeedzadeh N, Roshanaei G, Shobeiri F, Hakemzadeh F. The Effect of Entonox on Labour Pain Relief among Nulliparous Women: A Randomized Controlled Trial. J Clin Diagn Res 2017; 11:QC08-QC11. [PMID: 28511452 PMCID: PMC5427378 DOI: 10.7860/jcdr/2017/21611.9362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 11/19/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Labour pain is one of the most severe pain in humans. Fear of labour pain is the most dreadful reason for Caesarean Section (CS). Entonox (a mixture of nitrous oxide+oxygen) is a safe inhalational analgesia during labour pain. AIM This study investigated the effect of entonox on pain relief and length of labour in nulliparous women. MATERIALS AND METHODS A clinical trial study was conducted among 120 nulliparous women (60 in intervention and 60 in control group) in 2015 in Atieh Hospital, Hamadan city, Iran. The women were chosen randomly to receive either entonox in the intervention group or oxygen in the control group. For the intervention group, entonox inhalation was introduced at the initiation of pain at each contraction. entonox gas was administrated via a face-mask. This enabled the women to breathe fresh gas in each inspiration. In the control group the oxygen inhalation was given with occurrence of pain at each contraction too. In both groups, the gas administration continued until the end of contraction pain with the patient finally breathing room air. Pain using Visual Analogue Scale (VAS), duration of labour and side effects were compared in two groups. RESULTS The mean age of women was 25.69 (SD=4.83). There were significant differences between two groups on labour pain at the first, second, third and fourth hours after intervention (p<0.05). Duration of labour in the intervention group (64.80 minutes) was significantly shorter than the control group (98.33 minutes) (p<0.05). There were no significant differences between the two groups on women's blood pressure and neonatal Apgar score. Only dizziness was slightly higher in the intervention group compared to the control group (p<0.05). CONCLUSION Entonox provides significant pain relief and it can quickly be implemented during painful labour.
Collapse
Affiliation(s)
- Parisa Parsa
- Associate Professor, Department of Mother and Child Health, Chronic Diseases (home care) Research Center of Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nafiseh Saeedzadeh
- Master of Science in Consultation of Midwifery, Department of Midwifery, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ghodratallah Roshanaei
- Associate Professor, Department of Statistics, Faculty of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatameh Shobeiri
- Associate Professor, Department of Midwifery, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Faryar Hakemzadeh
- Anaesthesiologist, Department of Anaesthesiology, Atieh Hospital, Hamadan, Iran
| |
Collapse
|
35
|
Rondung E, Thomtén J, Sundin Ö. Psychological perspectives on fear of childbirth. J Anxiety Disord 2016; 44:80-91. [PMID: 27788373 DOI: 10.1016/j.janxdis.2016.10.007] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 08/22/2016] [Accepted: 10/13/2016] [Indexed: 11/27/2022]
Abstract
The objective of this narrative review was to examine the literature on fear of childbirth from a psychological perspective, addressing the specificity of childbirth fear, the pathways of fear acquisition, and the physiological, cognitive and behavioral aspects of fear. Systematic procedures for literature search, inclusion and exclusion left 86 original research papers for analysis. Findings summarize the body of knowledge for each area of interest, as well as the number of studies addressing each theme. Overall, few studies adopt a clear-cut psychological perspective, leaving the psychological mechanisms of childbirth fear largely unexplored. Although methodological limitations make conclusions difficult, results give a hint of etiological diversity and possible psychological mechanisms commonly described as transdiagnostic features in anxiety. Systematic investigations of psychological mechanisms, longitudinal studies exploring possible vicious circles of fear, and studies comparing psychological characteristics within the group of women fearing childbirth are identified as research areas of high priority.
Collapse
Affiliation(s)
- Elisabet Rondung
- Department of Psychology, Mid Sweden University, 831 40 Östersund, Sweden.
| | - Johanna Thomtén
- Department of Psychology, Mid Sweden University, 831 40 Östersund, Sweden.
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, 831 40 Östersund, Sweden.
| |
Collapse
|
36
|
Martini J, Asselmann E, Einsle F, Strehle J, Wittchen HU. A prospective-longitudinal study on the association of anxiety disorders prior to pregnancy and pregnancy- and child-related fears. J Anxiety Disord 2016; 40:58-66. [PMID: 27115070 DOI: 10.1016/j.janxdis.2016.04.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 01/27/2023]
Abstract
This study aimed to investigate the relation between anxiety disorders prior to pregnancy and specific pregnancy- and child-related fears during pregnancy and after delivery. 306 expectant mothers were interviewed regarding anxiety (and depressive) disorders prior to pregnancy and pregnancy- and child-related fears (e.g. fear of labor pain, fear of infant injury) using the Composite International Diagnostic Interview for Women (CIDI-V). Pregnancy- and child-related fears were particularly pronounced in women with multiple anxiety disorders and women with comorbid anxiety and depressive disorders prior to pregnancy. Further analyses revealed associations between particular anxiety disorders and specific pregnancy- and child-related fears. Results remained stable when considering potential confounders such as maternal age, education, marital status, parity, prior abortion and preterm delivery or low birth weight. Our study suggests that especially women with multiple anxiety and/or comorbid depressive disorders may benefit from early targeted interventions to prevent an escalation of anxiety and fears over the peripartum period.
Collapse
Affiliation(s)
- Julia Martini
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Faculty of Medicine of the Technische Universität Dresden, Department of Child and Adolescent Psychiatry, Schubertstraße 42, 01307 Dresden, Germany.
| | - Eva Asselmann
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
| | - Franziska Einsle
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; SRH Fachhochschule für Gesundheit Gera, Neue Straße 28-30, 07548 Gera, Germany.
| | - Jens Strehle
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
| |
Collapse
|
37
|
Petit AC, Eutrope J, Thierry A, Bednarek N, Aupetit L, Saad S, Vulliez L, Sibertin-Blanc D, Nezelof S, Rolland AC. Mother's Emotional and Posttraumatic Reactions after a Preterm Birth: The Mother-Infant Interaction Is at Stake 12 Months after Birth. PLoS One 2016; 11:e0151091. [PMID: 27022953 PMCID: PMC4811536 DOI: 10.1371/journal.pone.0151091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/22/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Very preterm infants are known to be at risk of developmental disabilities and behavioural disorders. This condition is supposed to alter mother-infant interactions. Here we hypothesize that the parental coping with the very preterm birth may greatly influence mother-infant interactions. METHODS 100 dyads were included in 3 university hospitals in France. Preterm babies at higher risk of neurodevelopmental sequelae (PRI>10) were excluded to target the maternal determinants of mother-infant interaction. We report the follow-up of this cohort during 1 year after very preterm birth, with regular assessment of infant somatic state, mother psychological state and the assessment of mother-infant interaction at 12 months by validated scales (mPPQ, HADS, EPDS, PRI, DDST and PIPE). RESULTS We show that the intensity of post-traumatic reaction of the mother 6 months after birth is negatively correlated with the quality of mother-infant interaction at 12 months. Moreover, the anxious and depressive symptoms of the mother 6 and 12 months after birth are also correlated with the quality of mother-infant interaction at 12 months. By contrast, this interaction is not influenced by the initial affective state of the mother in the 2 weeks following birth. In this particular population of infants at low risk of sequelae, we also show that the quality of mother-infant interaction is not correlated with the assessment of the infant in the neonatal period but is correlated with the fine motor skills of the baby 12 months after birth. CONCLUSIONS This study suggests that mothers' psychological condition has to be monitored during the first year of very preterm infants' follow-up. It also suggests that parental interventions have to be proposed when a post-traumatic, anxious or depressive reaction is suspected.
Collapse
Affiliation(s)
- Anne-Cécile Petit
- CHU Reims, Hôpital Robert Debré, Service de Psychothérapie de l’Enfant et de l’Adolescent, Reims, France
| | - Julien Eutrope
- CHU Reims, Hôpital Robert Debré, Service de Psychothérapie de l’Enfant et de l’Adolescent, Reims, France
| | - Aurore Thierry
- CHU Reims, Hôpital Robert Debré, Unité d’aide méthodologique, Reims, France
| | - Nathalie Bednarek
- CHU Reims, American-Memorial-Hospital, Service de réanimation néonatale et néonatologie, Reims, France
| | | | - Stéphanie Saad
- CHU Nancy, Centre psychothérapique de Nancy, Service de pédopsychiatrie, Laxou, France
| | - Lauriane Vulliez
- CHU de Besançon, Hôpital Saint Jacques, Service de psychiatrie de l’enfant et de l’adolescent, Besançon, France
| | - Daniel Sibertin-Blanc
- CHU Nancy, Centre psychothérapique de Nancy, Service de pédopsychiatrie, Laxou, France
| | - Sylvie Nezelof
- CHU de Besançon, Hôpital Saint Jacques, Service de psychiatrie de l’enfant et de l’adolescent, Besançon, France
| | - Anne-Catherine Rolland
- CHU Reims, Hôpital Robert Debré, Service de Psychothérapie de l’Enfant et de l’Adolescent, Reims, France
| |
Collapse
|
38
|
Roosevelt L, Low LK. Exploring Fear of Childbirth in the United States Through a Qualitative Assessment of the Wijma Delivery Expectancy Questionnaire. J Obstet Gynecol Neonatal Nurs 2015; 45:28-38. [PMID: 26815796 DOI: 10.1016/j.jogn.2015.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To explore women's experiences while completing the Wijma Delivery Expectancy Questionnaire (W-DEQ), an instrument used to measure fear of childbirth, and to analyze the readability and applicability of the instrument within a diverse population of women in the United States. DESIGN Qualitative descriptive study using focus groups with women who were pregnant or had given birth in the last 5 years. SETTING Urban health center in the Detroit metropolitan area. PARTICIPANTS Participants included 22 women who participated in three focus groups. METHODS Focus groups were used to collect data, which were analyzed using content analysis. The Fry Readability Graph, in computer form, was used to rate the readability of the instrument. RESULTS Women in the focus groups identified many themes that were consistent with previous research. However, the women indicated many new factors that contributed to their fear that were previously unidentified by the W-DEQ, including fear of abandonment by their clinicians and fear of how the structure of the maternity care system affects care during childbirth. CONCLUSION The findings from the focus groups challenge the utility and appropriateness of the W-DEQ for use as a screening tool to identify women who are pregnant and experiencing FOC in a U.S.
Collapse
|
39
|
Detecting the severity of perinatal anxiety with the Perinatal Anxiety Screening Scale (PASS). J Affect Disord 2015; 186:18-25. [PMID: 26226429 DOI: 10.1016/j.jad.2015.07.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/29/2015] [Accepted: 07/08/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Perinatal Anxiety Screening Scale (PASS; Somerville et al., 2014) reliably identifies perinatal women at risk of problematic anxiety when a clinical cut-off score of 26 is used. This study aimed to identify a severity continuum of anxiety symptoms with the PASS to enhance screening, treatment and research for perinatal anxiety. METHODS Antenatal and postnatal women (n=410) recruited from the antenatal clinics and mental health services at an obstetric hospital completed the Edinburgh Postnatal Depression Scale (EPDS), the Depression, Anxiety and Stress Scale (DASS-21), the Spielberg State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory II (BDI), and the PASS. The women referred to mental health services were assessed to determine anxiety diagnoses via a diagnostic interview conducted by an experienced mental health professional from the Department of Psychological Medicine - King Edward Memorial Hospital. Three normative groups for the PASS, namely minimal anxiety, mild-moderate anxiety, and severe anxiety, were identified based on the severity of anxiety indicated on the standardised scales and anxiety diagnoses. RESULTS Two cut-off points for the normative groups were calculated using the Jacobson-Truax method (Jacobson and Truax, 1991) resulting in three severity ranges: 'minimal anxiety'; 'mild-moderate anxiety'; and 'severe anxiety'. LIMITATIONS The most frequent diagnoses in the study sample were adjustment disorder, mixed anxiety and depression, generalised anxiety, and post-traumatic stress disorder. This may limit the generalisability of the severity range results to other anxiety diagnoses including obsessive compulsive disorder and specific phobia. CONCLUSIONS Severity ranges for the PASS add value to having a clinically validated cut-off score in the detection and monitoring of problematic perinatal anxiety. The PASS can now be used to identify risk of an anxiety disorder and the severity ranges can indicate developing risk for early referrals for further assessments, prioritisation of access to resources and tracking of clinically significant deterioration, improvement or stability in anxiety over time.
Collapse
|
40
|
Bayrampour H, Salmon C, Vinturache A, Tough S. Effect of depressive and anxiety symptoms during pregnancy on risk of obstetric interventions. J Obstet Gynaecol Res 2015; 41:1040-8. [PMID: 25772686 DOI: 10.1111/jog.12683] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/29/2014] [Indexed: 11/30/2022]
Abstract
AIM The effect of prenatal mental health on the risk of obstetric interventions is unclear. The present study examined the associations between depressive and anxiety symptoms in the second and third trimesters and mode of delivery, epidural use and labor induction in a large community-based pregnancy cohort, in Alberta, Canada. MATERIAL AND METHODS Women who had singleton pregnancies, delivered in hospital, and had medical data were selected (n = 2825). Obstetric intervention data were obtained from the medical records, and depressive and anxiety symptoms were measured by the Edinburgh Postnatal Depression Scale and the Spielberger State Anxiety Inventory. Data were evaluated with multivariate multinomial and logistic regression analyses using a hierarchical modeling. RESULTS After accounting for factors known to increase the risk of each intervention, including demographic variables, smoking, hospital site, gestational age, previous history of cesarean delivery, prepregnancy body mass index, assisted conception, and antepartum risk score, the only mental health variable associated with obstetric interventions was depressive symptoms in the third trimester, which increased the risk of emergency cesarean delivery (adjusted odds ratio, 2.04; 95% confidence interval, 1.26-3.29). No associations were found between antenatal depressive and anxiety symptoms and other obstetric interventions. CONCLUSION The present findings support an association between depressive symptoms and adverse obstetric outcomes and suggest that anxiety and depression may have different effects on obstetric outcomes. Understanding the mechanism in which depression increases the risk of emergency cesarean birth needs further research.
Collapse
Affiliation(s)
- Hamideh Bayrampour
- Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Charleen Salmon
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Angela Vinturache
- Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Tough
- Department of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
41
|
Verly-Miguel MVB, Farias DR, Pinto TDJP, Lepsch J, Nardi AE, Kac G. Serum docosahexaenoic acid (DHA) is inversely associated with anxiety disorders in early pregnancy. J Anxiety Disord 2015; 30:34-40. [PMID: 25591045 DOI: 10.1016/j.janxdis.2014.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/05/2014] [Accepted: 12/06/2014] [Indexed: 10/24/2022]
Abstract
Little is known about the association between polyunsaturated fatty acids (PUFAs) and anxiety disorders during pregnancy. We evaluated this association at the first pregnancy trimester in 228 women. The study endpoint was the diagnosis of any anxiety disorder assessed by the Mini International Neuropsychiatric Interview. The independent variables were the serum concentrations of total n-3 and fractions (18:2, 20:5, 22:5, 22:6), total n-6 and fractions (18:2, 18:3, 20:2, 20:3, 20:4, 22:4, 22:5) and the n-6/n-3 ratio PUFAs. The prevalence of any anxiety disorders was 25%. The first tertile of the docosahexaenoic acid (DHA, 22:6 n-3) distribution represented 1.95 (95% CI: 1.00-3.77) higher chance of having an anxiety disorder diagnosis, compared to those in the second and third tertiles after adjusting the analyses for parity, family income, early pregnancy BMI and gestational age at the blood sampling. Serum concentrations of DHA were inversely associated with the occurrence of early pregnancy anxiety disorders.
Collapse
Affiliation(s)
| | - Dayana Rodrigues Farias
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, RJ, Brazil; Graduate Program in Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, RJ, Brazil
| | - Thatiana de Jesus Pereira Pinto
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, RJ, Brazil; Graduate Program in Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, RJ, Brazil
| | - Jaqueline Lepsch
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, RJ, Brazil; Graduate Program in Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, RJ, Brazil
| | - Antonio Egidio Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry, School of Medicine, Federal University of Rio de Janeiro, RJ, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
42
|
Darwin Z, McGowan L, Edozien LC. Antenatal mental health referrals: review of local clinical practice and pregnant women's experiences in England. Midwifery 2014; 31:e17-22. [PMID: 25467596 DOI: 10.1016/j.midw.2014.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/29/2014] [Accepted: 11/03/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE to investigate (i) the consistency and completeness of mental health assessment documented at hospital booking; (ii) the subsequent management of pregnant women identified as experiencing, or at risk of, mental health problems; and (iii) women's experiences of the mental health referral process. DESIGN mixed methods cohort study SETTING large, inner-city hospital in the north of England PARTICIPANTS women (n=191) booking at their first formal antenatal appointment; mean gestational age at booking 13 weeks. METHODS women self-completed the routine mental health assessment in the clinical handheld maternity notes, followed by a research pack. Documentation of mental health assessment (including assessment of depression symptoms using the Whooley and Arroll questions, and mental health history), mental health referrals and their management were obtained from women's health records following birth. Longitudinal semi-structured interviews were conducted with a purposive sub-sample of 22 women during and after pregnancy. FINDINGS documentation of responses to the Whooley and Arroll questions was limited to the handheld notes and symptoms were not routinely monitored using these questions, even for women identified as possible cases of depression. The common focus of referrals was on the women's previous mental health history rather than current depression symptoms, assessed using the Whooley questions. Women referred to a Mental Health Specialist Midwife for further support were triaged based on the written referral and few met eligibility criteria. Although some women initially viewed the referral as offering a 'safety net', analysis of health records and subsequent interviews with women both indicated that communication regarding the management of referrals was inadequate and women tended not to hear back about the outcome of their referral. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE mental health assessment was introduced without ensuring that identified needs would be managed consistently. Care pathways and practices need to encompass identification, subsequent referral and management of mental ill-health, and ensure effective communication with patients and between health professionals.
Collapse
Affiliation(s)
- Zoe Darwin
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK.
| | - Linda McGowan
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
| | - Leroy C Edozien
- Manchester Academic Health Science Centre, University of Manchester, St Mary's Hospital, Manchester M13 9WL, UK
| |
Collapse
|
43
|
Somerville S, Dedman K, Hagan R, Oxnam E, Wettinger M, Byrne S, Coo S, Doherty D, Page AC. The Perinatal Anxiety Screening Scale: development and preliminary validation. Arch Womens Ment Health 2014; 17:443-54. [PMID: 24699796 DOI: 10.1007/s00737-014-0425-8] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
Abstract
The purpose of this study is to develop a scale (Perinatal Anxiety Screening Scale, PASS) to screen for a broad range of problematic anxiety symptoms which is sensitive to how anxiety presents in perinatal women and is suitable to use in a variety of settings including antenatal clinics, inpatient and outpatient hospital and mental health treatment settings. Women who attended a tertiary obstetric hospital in the state of Western Australia antenatally or postpartum (n = 437) completed the PASS and other commonly used measures of depression and anxiety. Factor analysis was used to examine factor structure, and ROC analysis was used to evaluate performance as a screening tool. The PASS was significantly correlated with other measures of depression and anxiety. Principal component analyses (PCA) suggested a four-factor structure addressing symptoms of (1) acute anxiety and adjustment, (2) general worry and specific fears, (3) perfectionism, control and trauma and (4) social anxiety. The four subscales and total scale demonstrated high to excellent reliabilities. At the optimal cutoff score for detecting anxiety as determined by ROC analyses, the PASS identified 68 % of women with a diagnosed anxiety disorder. This was compared to the EPDS anxiety subscale which detected 36 % of anxiety disorders. The PASS is an acceptable, valid and useful screening tool for the identification of risk of significant anxiety in women in the perinatal period.
Collapse
Affiliation(s)
- Susanne Somerville
- Department of Psychological Medicine, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, WA, 6008, Australia,
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Doyle O, McGlanaghy E, Palamaro-Munsell E, McAuliffe F. Home based educational intervention to improve perinatal outcomes for a disadvantaged community: A randomised control trial. Eur J Obstet Gynecol Reprod Biol 2014; 180:162-7. [DOI: 10.1016/j.ejogrb.2014.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 05/27/2014] [Accepted: 06/13/2014] [Indexed: 10/25/2022]
|
45
|
Maclean E. What to expect when you're expecting? Representations of birth in British newspapers. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/bjom.2014.22.8.580] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Emily Maclean
- Student Midwife King's College London Florence Nightingale School of Nursing and Midwifery Guy's and St Thomas' NHS Foundation Trust
| |
Collapse
|
46
|
Newham JJ, Wittkowski A, Hurley J, Aplin JD, Westwood M. Effects of antenatal yoga on maternal anxiety and depression: a randomized controlled trial. Depress Anxiety 2014; 31:631-40. [PMID: 24788589 DOI: 10.1002/da.22268] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/27/2014] [Accepted: 03/01/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Antenatal depression and anxiety are associated with adverse obstetric and mental health outcomes, yet practicable nonpharmacological therapies, particularly for the latter, are lacking. Yoga incorporates relaxation and breathing techniques with postures that can be customized for pregnant women. This study tested the efficacy of yoga as an intervention for reducing maternal anxiety during pregnancy. METHODS Fifty-nine primiparous, low-risk pregnant women completed questionnaires assessing state (State Trait Anxiety Inventory; STAI-State), trait (STAI-Trait), and pregnancy-specific anxiety (Wijma Delivery Expectancy Questionnaire; WDEQ) and depression (Edinburgh Postnatal Depression Scale; EPDS) before randomization (baseline) to either an 8-week course of antenatal yoga or treatment-as-usual (TAU); both groups repeated the questionnaires at follow-up. The yoga group also completed pre- and postsession state anxiety and stress hormone assessments at both the first and last session of the 8-week course. RESULTS A single session of yoga reduced both subjective and physiological measures of state anxiety (STAI-S and cortisol); and this class-induced reduction in anxiety remained at the final session of the intervention. Multiple linear regression analyses identified allocation to yoga as predictive of greater reduction in WDEQ scores (B = -9.59; BCa 95% CI = -18.25 to -0.43; P = .014; d = -0.57), while allocation to TAU was predictive of significantly increased elevation in EPDS scores (B = -3.06; BCa 95% CI = -5.9 to -0.17; P = .042; d = -0.5). No significant differences were observed in state or trait anxiety scores between baseline and follow-up. CONCLUSION Antenatal yoga seems to be useful for reducing women's anxieties toward childbirth and preventing increases in depressive symptomatology.
Collapse
Affiliation(s)
- James J Newham
- Maternal and Fetal Health Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Maternal and Fetal Health Research Centre, Manchester Academic Health Sciences Centre, St Mary's Hospital Central Manchester Universities NHS Foundation Trust, Manchester, UK
| | | | | | | | | |
Collapse
|
47
|
Poor marital support associate with anxiety and worries during pregnancy in Greek pregnant women. Midwifery 2014; 30:628-35. [DOI: 10.1016/j.midw.2013.10.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 10/08/2013] [Accepted: 10/13/2013] [Indexed: 01/21/2023]
|
48
|
Dutch midwives' behavioural intentions of antenatal management of maternal distress and factors influencing these intentions: An exploratory survey. Midwifery 2014; 30:234-41. [DOI: 10.1016/j.midw.2013.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/25/2013] [Accepted: 06/13/2013] [Indexed: 11/23/2022]
|
49
|
No association between antenatal common mental disorders in low-obstetric risk women and adverse birth outcomes in their offspring: results from the CDS study in Ghana and Côte D'Ivoire. PLoS One 2013; 8:e80711. [PMID: 24260460 PMCID: PMC3832471 DOI: 10.1371/journal.pone.0080711] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/05/2013] [Indexed: 12/19/2022] Open
Abstract
Background Evidence linking common mental disorders (CMD) in pregnant women to adverse birth outcomes is inconsistent, and studies often failed to control for pregnancy complications. This study aimed to explore the association between antenatal depression and anxiety symptoms and birth outcomes in a low-obstetric risk sample of mother/child dyads in Ghana and Côte d’Ivoire. Methods In 2010-2011, a prospective cohort of 1030 women in their third trimester in Ghana and Côte d’Ivoire was enrolled. Depression and anxiety were assessed in the third trimester using the Patient Health Questionnaire depression module and the 7-item Generalized Anxiety Disorder scale. 719 mother/child dyads were included in the analysis. We constructed multivariate regression models to estimate the association between CMD and low birth weight (LBW), and preterm birth (PTB) to control for potential confounders. Results The prevalence of depression and anxiety symptoms were 28.9% and 14.2% respectively. The mean birth weight was 3172.1g (SD 440.6) and the prevalence of LBW was 1.7%. The mean gestational age was 39.6 weeks and the proportion of PTB was 4%. Multivariate linear regression revealed no significant association between maternal depression (B=52.2, 95% CI -18.2 122.6, p=0.15) or anxiety (B=17.1, 95% CI -74.6 108.7, p=0.72) and birth weight. Yet, low socio-economic status, female sex of the child, and younger maternal age were associated with lower birth weight. Multivariate logistic regression suggested no significant association between maternal depression (OR: 2.1, 95% CI 0.8 5.6, p=0.15) or anxiety (OR: 1.8, 95% CI 0.6 5.5, p=0.29) with PTB. Conclusions Our data suggests that depression and/or anxiety in the 3rd trimester of pregnancy are not independent predictors of adverse birth outcomes in low obstetric risk women. The role of pregnancy complications as confounders or effect modifiers in studies of maternal CMD and their impact on birth outcomes should be investigated.
Collapse
|
50
|
Reck C, Zimmer K, Dubber S, Zipser B, Schlehe B, Gawlik S. The influence of general anxiety and childbirth-specific anxiety on birth outcome. Arch Womens Ment Health 2013; 16:363-9. [PMID: 23558948 DOI: 10.1007/s00737-013-0344-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 03/17/2013] [Indexed: 11/25/2022]
Abstract
In the present study, we examined a German sample to determine whether anxiety symptoms during pregnancy had an impact on the duration and method of childbirth. Data of N = 88 women recruited at the Heidelberg University Hospital were used in the analyses. Prepartum anxiety symptoms were assessed with the State-Trait Anxiety Inventory (STAI, general anxiety) and the Pregnancy Related Anxiety Questionnaire (PRAQ-R, pregnancy-specific anxiety). Obstetric outcome was taken from birth records and operationalized by two parameters: the total duration of birth (dilation and fetal expulsion) and the incidence of pregnancy or birth-related interventions (ventouse, planned, and unplanned Cesarean section). The data show that childbirth-specific anxiety assessed by the PRAQ-R is an important predictor of total birth duration. In contrast, general anxiety measured by the STAI had no effect. The incidence of birth intervention was explained by parity. Anxiety, however, had no predictive value. In addition to medical factors, childbirth-specific anxiety during pregnancy plays an important role in the process of childbirth. The findings of the present study point to the need of implementing psychological interventions to reduce childbirth-specific anxiety and thereby positively influencing birth outcome.
Collapse
Affiliation(s)
- C Reck
- General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany,
| | | | | | | | | | | |
Collapse
|