Persian couples' experiences of depressive symptoms and health-related quality of life in the pre- and perinatal period

Embedding Physical Activity Guidance During Pregnancy and in Postpartum Care: 'This Mum Moves' Enhances Professional Practice of Midwives and Health Visitors

INTRODUCTION

The benefits of physical activity during pregnancy and after childbirth are well established, yet many health care professionals do not feel well equipped to provide physical activity guidance to these populations. As such, the objectives of this study were to explore the immediate and longer term effects of training on health care professionals' ability to provide physical activity guidance to pregnant women and new mothers (mums).

METHODS

Midwives and health visitors from 5 locations in the United Kingdom were provided with training on the Chief Medical Officers' physical activity guidelines for pregnancy and after childbirth (n = 393). Midwives and health visitors attended training to become This Mum Moves Ambassadors, then disseminated education to colleagues through a cascade training model. Changes in knowledge, confidence, and professional practice were assessed by survey before and immediately after training (n = 247), and follow-up surveys were completed 3 (n = 35) and 6 (n = 34) months posttraining.

RESULTS

At all posttraining time points, health care professionals reported a significant increase in their confidence to communicate about physical activity (P < .001). The reported frequency of having conversations about physical activity increased significantly 3 and 6 months following training compared with baseline (pregnant women, P = .017; new mums, P = .005). There were changes in the types of advice and resources offered by health care professionals and an overall increase in health care professionals' own reported physical activity levels.

DISCUSSION

The This Mum Moves cascade approach to delivering training in physical activity guidelines improved reported knowledge, confidence and professional practice of midwives and health visitors, both immediately following and 3 and 6 months after training.

The impact of New Families home visiting program on first-time mothers' quality of life and its association with social support: a non-randomized controlled study

BACKGROUND

The transition to motherhood is characterized by physical, psychological, social, and relational changes. Quality of life (QoL) changes substantially during this transition. Higher QoL is associated with social support, essential for coping with the challenges and changes of becoming a mother. An early universal home visiting program (New Families) is developed to strengthen and support families. The study aims to evaluate the impact of New Families on first-time mothers' QoL and to investigate the association between their QoL, social support, and selected possible predictive factors.

METHODS

A prospective non-randomized controlled study with parallel group design. Child Health Services in five city districts of Oslo were matched in intervention and control groups. First-time mothers were allocated based on the residential area and assessed at pregnancy week 28 (N = 228), six weeks postpartum (N = 184), and three months postpartum (N = 167). Measures of the World Health Organization Quality of Life brief, Perinatal Infant Care Social Support Scale, and background variables were collected from October 2018 to June 2020. Multivariate linear regression models were applied to examine intervention impact and assess associations.

RESULTS

Our data did not reveal a significant association between New Families intervention and the QoL levels of first-time mothers at three months postpartum. Thus, we analyzed the whole sample together. Emotional support was significantly associated with higher QoL levels in the physical health (B = 0.19, 95%CI [0.04 to 0.34]) and social relationships (B = 0.40, 95%CI [0.20 to 0.60]) domains. Appraisal support was significantly associated with higher QoL levels in the psychological (B = 0.34, 95%CI [0.18 to 0.50]) and environment (B = 0.33, 95%CI [0.19 to 0.48]) domains. QoL levels in pregnancy were significantly associated with QoL levels postpartum, showing small to medium effect size (ES = 0.30 to 0.55), depending on the domain.

CONCLUSIONS

Further research, including qualitative interviews, could provide more insights into the impact of New Families on QoL. A positive association between QoL levels in pregnancy and postpartum suggests that postnatal interventions targeting improved QoL could potentially improve postpartum QoL. Emotional and appraisal support seems beneficial for first-time mothers' QoL and could be provided and facilitated by public health nurses.

TRIAL REGISTRATION

clinicaltrial.gov NCT04162626.

Quality of life in Norwegian pregnant women and men with pregnant partners, and association with perception of sleep and depressive symptoms: a cross-sectional study

BACKGROUND

Pregnant women and men with pregnant partners experience variations in quality of life (QoL) during pregnancy, a period characterized by physical, psychological, and social changes. Pregnancy is associated with reduced QoL, depressive symptoms, and sleep problems. This study aimed to: (1) determine whether Norwegian pregnant women and men with pregnant partners differed in QoL levels in the third trimester of pregnancy; (2) determine whether the relationship between perception of sleep and QoL is moderated by depressive symptoms, when analyzed separately in pregnant women and men with pregnant partners; and (3) determine whether selected possible predictive factors were associated with QoL when stratified by level of depressive symptoms, in pregnant women and men with pregnant partners separately.

METHODS

A cross-sectional study conducted between October 2018 and January 2020 included 228 pregnant women and 197 men with pregnant partners in the third trimester of pregnancy. The age range was 22-50 years. QoL was assessed using the World Health Organization Quality of Life Questionnaire brief version, depressive symptoms using the Edinburgh Postnatal Depression Scale, and perception of sleep by a single item. Data were analyzed in SPSS version 28 using descriptive statistics, the PROCESS macro for moderation analyses, and multivariate linear regression. The level of statistical significance was p < 0.05.

RESULTS

Pregnant women reported significantly lower QoL scores on the physical health and psychological domains than the men with pregnant partners. Our data did not reveal any moderating effect of depressive symptoms on the relationship between the perception of sleep and QoL. Depressive symptoms in the pregnant women were found to be a significant predictor of lower QoL in all domains. In the men with pregnant partners, getting enough sleep was a significant predictor of higher QoL in all domains. In the pregnant women without depressive symptoms, higher QoL in the physical health domain was significantly associated with the perception of getting enough sleep.

CONCLUSION

Women in the final trimester of pregnancy experience poor QoL compared to the men with pregnant partners. Pregnant women with depressive symptoms have lower QoL compared to those without depressive symptoms. The perception of getting enough sleep was associated with better QoL.

Insomnia and sleep quality among women during the perinatal period

Background

Insomnia is the most common sleep disorder affecting sleep quality and quality of life among women during the perinatal period. The aim of the study is to study the frequency of insomnia and sleep quality among perinatal women and their effect on quality of life: 131 participants; 64 perinatal and 67 control groups from the outpatient clinics of Suez Canal University Hospital, Ismailia, Egypt. DSM-5 criteria were used to diagnose insomnia. Sleep quality was assessed using PSQI, and SF-36 questionnaire was used for assessment of health-related quality of life.

Results

Insomnia was statistically significant higher among the perinatal group than the control; 28.1% and 10.4%, respectively (P < 0.05). The perinatal women had poor sleep quality as compared with the control group with a higher mean global PSQI score; 8.02 ± 2.97 and 4.97 ± 2.45, respectively (P < 0.05). The quality of life in the perinatal group was lower than the control group with scores of 54.96 ± 14.63 versus 62.34 ± 14.63, respectively.

Conclusions

Insomnia and poor sleep quality are found in higher frequency in perinatal women than their counterpart control. The study also showed a significant impact of these changes on maternal HRQoL.

Prevalence of prenatal and postpartum depression in fathers: A comprehensive meta-analysis of observational surveys

BACKGROUND

Increasing attention has been paid to maternal prenatal and postpartum depressive symptoms (depression thereafter), but little is known about the prevalence of paternal prenatal and postpartum depression. To fill this gap, the current study meta-analyzed the worldwide prevalence of prenatal and postpartum depression in fathers.

METHODS

Studies that reported paternal depression occurring between the first trimester and the first postpartum year were identified by searching both international (PubMed, PsycINFO, Web of Science and EMBASE) and Chinese (WanFang and CNKI) databases between their inception date and July 1, 2018. A random-effects model was used to calculate pooled estimates and 95% confidence intervals.

RESULTS

Forty-seven studies with 20,728 subjects were included in the meta-analysis. The prevalence of prenatal depression in fathers was 9.76% in all three trimesters, 13.59% in the first, 11.31% in the second and 10.12% in the third trimester. The prevalence of postpartum depression was 8.75% within a whole year, 8.98% within one-month, 7.82% between one- and three months, 9.23% between three months and six months and 8.40% between six months to twelve months after child-birth. The prevalence of paternal postpartum depression was moderated by year of publication, study area, age of fathers of ≥18 years, quality assessment score and mean age (all P<0.05).

CONCLUSIONS

This meta-analysis found that the prevalence of prenatal and postpartum depression in fathers was relatively common. Regular screening, effective prevention and appropriate treatment need to be implemented in this population.

International Fitness Scale-IFIS: Validity and association with health-related quality of life in pregnant women

This study aimed (a) to examine the construct validity of the International Fitness Scale (IFIS) to discriminate between different objectively measured physical fitness levels in pregnant women and (b) to assess the extent to which IFIS is able to discriminate between pregnant women with different levels of health-related quality of life (HRQoL). A total of 159 pregnant women were involved in the GESTAtion and FITness project: 106 pregnant women (mean age 32.7, SD 4.4 years) were included. Self-reported physical fitness-that is, cardiorespiratory fitness, muscular strength, flexibility, and overall fitness-was assessed with the IFIS. Physical fitness was objectively measured using the Bruce test, the handgrip strength test and the back-scratch test. The HRQoL was assessed with the 36-item Short Form Health Survey (SF-36). Higher self-reported physical fitness measured with IFIS was associated with higher objectively measured physical fitness (P < .05). There was a linear association so that higher self-reported physical fitness (ie, IFIS; regardless of the fitness component) was related to greater General Health dimension scores (P < .05). Moreover, higher self-reported physical fitness (all components except muscular strength) was associated with better Physical Functioning, lower Bodily Pain and higher Vitality scores (ie, SF-36 components). This linear trend was not seen for objectively measured physical fitness. The results of this study suggest that IFIS might be a useful tool for identifying pregnant women with low or very low physical fitness and with low quality of life health-related. Further research should elucidate whether IFIS can identify women with pregnancy complications before it can be implemented in clinical practice.

The humanistic burden of postpartum depression: a systematic literature review

OBJECTIVE

Postpartum depression (PPD) is the most common medical complication of childbirth. PPD can be disabling, with potential negative effects on maternal health-related quality-of-life (HRQoL) as well as on children and partners. The objective of this study was to systematically review and summarize recently published literature describing the humanistic burden of PPD on affected women, their children, and partners.

METHODS

Databases including Embase, MEDLINE, and PsycINFO, as well as conference proceedings were searched for keywords related to PPD. Searches were initially conducted in February 2017 and restricted to the prior 5 years for databases and the prior 2 years for conference proceedings. Searches were updated in February 2018. Two researchers independently reviewed 1154 unique records according to pre-defined inclusion and exclusion screening criteria.

RESULTS

Forty-eight studies were identified; over 40 studies assessed the effects of PPD on children of affected mothers, with many demonstrating a negative association with elements of parenting and childhood development. Furthermore, five studies that evaluated the effects of PPD symptoms on partners suggested that certain aspects of their relationships were negatively affected. Partners of affected women also experienced greater levels of their own stress, anxiety, and depression compared with partners of women without PPD symptoms. Despite limited data on HRQoL among women with PPD symptoms (four studies), a negative impact on physical and mental sub-scales was observed.

CONCLUSIONS

Findings suggest that PPD symptoms have a substantial humanistic burden on affected mothers as well as on their children and partners.

Dyadic coping, marital adjustment and quality of life in couples during pregnancy: an actor-partner approach

Objective: This study aimed to examine the impact of dyadic coping on the quality of life of couples during pregnancy and to explore the potential mediating role of marital adjustment on this association.Background: According to the systemic transactional model, pregnancy can be characterised as a situation of dyadic stress because it affects both members of the couple. However, the impact of dyadic coping on couples' quality of life during pregnancy is unexplored. Also, the potential mediating role of marital adjustment on this association remains understudied.Methods: Participants were 320 pregnant women and their partners (N = 640) who completed the Dyadic Coping Inventory, the Dyadic Adjustment Scale and the World Health Organisation Quality of Life instrument. Data were analysed using the actor-partner interdependence mediation model.Results: Results showed that there was an intrapersonal indirect effect of dyadic coping on quality of life through marital adjustment. Moreover, an interpersonal indirect effect was found with fathers' dyadic coping being associated with mothers' quality of life through mothers' marital adjustment.Conclusions: These findings highlight the importance of assessing dyadic coping strategies of couples during pregnancy and targeting them in the psychological support offered to couples as a way of improving their marital adjustment, and consequently, their quality of life.

High risk of depression, anxiety, and poor quality of life among experienced fathers, but not mothers: A prospective longitudinal study

BACKGROUND

Mental distress patterns in first-time or experienced mothers and fathers during the transition to parenthood have been inadequately studied. This longitudinal study thus investigated changes in depression, anxiety, and health-related quality of life in both parents from early pregnancy until 1 year postpartum. Parity effects were specifically examined.

METHODS

In total, 531 pregnant women and their partners were recruited in Taiwan during early prenatal visits from 2011 to 2015, with five follow-ups from midpregnancy to 1 year postpartum. The participants' self-reported data were collected and analyzed using generalized estimating equation models.

RESULTS

Maternal mental distress levels were highest at 1 month postpartum. During postpartum periods, depression scores increased and social relations domain scores decreased in men. Although mental distress levels were higher in mothers than in fathers, parity evidently affected men. Experienced fathers were independently associated with a 70% higher risk of perinatal depression (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.2-2.3) and anxiety (OR = 1.7, 95% CI = 1.2-2.6). Experienced fathers also exhibited significantly lower perinatal scores than first-time fathers in the physical health and social relations domains.

LIMITATIONS

Selection of both parents in metropolitan areas with higher socioeconomic status may restrict the generalizability of our findings.

CONCLUSIONS

In addition to maternal mental distress during the transition to parenthood, we highlighted experienced fathers' psychological difficulties throughout perinatal periods. Such trends may indicate unsatisfied needs and could guide timely intervention to prevent adverse consequences.

Factors influencing the quality of life of pregnant women: a systematic review

Background

Pregnancy is a period of transition with important physical and emotional changes. Even in uncomplicated pregnancies, these changes can affect the quality of life (QOL) of pregnant women, affecting both maternal and infant health. The objectives of this study were to describe the quality of life during uncomplicated pregnancy and to assess its associated socio-demographic, physical and psychological factors in developed countries.

Methods

A systematic review was performed according to the PRISMA guidelines. Searches were made in PubMed, EMBASE and BDSP (Public Health Database). Two independent reviewers extracted the data. Countries with a human development index over 0.7 were selected. The quality of the articles was evaluated on the basis of the STROBE criteria.

Results

In total, thirty-seven articles were included. While the physical component of QOL decreased throughout pregnancy, the mental component was stable and even showed an improvement during pregnancy. Main factors associated with better QOL were mean maternal age, primiparity, early gestational age, the absence of social and economic problems, having family and friends, doing physical exercise, feeling happiness at being pregnant and being optimistic. Main factors associated with poorer QOL were medically assisted reproduction, complications before or during pregnancy, obesity, nausea and vomiting, epigastralgia, back pain, smoking during the months prior to conception, a history of alcohol dependence, sleep difficulties, stress, anxiety, depression during pregnancy and sexual or domestic violence.

Conclusions

Health-related quality of life refers to the subjective assessment of patients regarding the physical, mental and social dimensions of well-being. Improving the quality of life of pregnant women requires better identification of their difficulties and guidance which offers assistance whenever possible.

Stress, Depressive Symptoms, and Maternal Self-Efficacy in First-Time Mothers: Modelling and Predicting Change across the First Six Months of Motherhood

BACKGROUND

First-time mothers commonly experience stress and depressive symptoms in the postpartum period. Maternal self-efficacy has been shown to be an important protective factor against these experiences; however, research on the dynamic nature of stress, depressive symptoms, and maternal self-efficacy is limited. The aim of this study was to document changes in these psychological factors among first-time mothers, and determine how early maternal self-efficacy perceptions may predict change in stress and depressive symptoms over the first 6 months postpartum.

METHODS

Sixty first-time Australian mothers were recruited during their third trimester of pregnancy. Participants completed a baseline survey during the third trimester of pregnancy (M = 32.87 weeks, SD = 2.62 weeks), and subsequently reported stress, depressive symptoms, and maternal self-efficacy every 3 weeks postpartum for 6 months. Latent growth curve modelling was used to estimate participants' change over time for stress and depressive symptoms.

RESULTS

First-time mothers' stress and depressive symptoms peaked, and maternal self-efficacy was weakest, at 3 weeks postpartum. Maternal self-efficacy at 3 weeks postpartum was a significant (negative) predictor of 3-week levels of, and also (positively) predicted later reductions in, stress.

CONCLUSION

Future interventions aimed at bolstering early maternal self-efficacy may protect against postpartum stress for first-time mothers.

Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis

This review aims to examine the prevalence and incidence of postpartum depression among healthy mothers without prior history of depression including postpartum depression and who gave birth to healthy full-term infants. A systematic search of ClinicalTrials.gov, CINAHL, EMBASE, PsycINFO, and PubMed was performed for English articles from the inception of the database to November 2017, as well as a manual search of the reference lists of the included articles, and an expert panel was consulted. Across 15,895 articles, 58 articles (N = 37,294 women) were included in the review. The incidence of postpartum depression was 12% [95% CI 0.04-0.20] while the overall prevalence of depression was 17% [95% CI 0.15-0.20] among healthy mothers without a prior history of depression. Prevalence was similar regardless of the type of diagnostic tool used; however, there were statistical differences in the prevalence between different geographical regions, with the Middle-East having the highest prevalence (26%, 95% CI 0.13-0.39) and Europe having the lowest (8%, 95% CI 0.05-0.11). There was no statistical difference in prevalence between different screening time points, but an increasing prevalence was observed beyond six months postpartum. Intervention studies often neglect healthy mothers. This review reports a similar prevalence rate of postpartum depression among mothers without history of depression when compared to mothers with history of depression. Thus, future studies should place equal emphasis on this neglected group of mothers so that targeted interventions and follow-ups can be introduced at appropriate time points.

Review of the prevalence of postnatal depression across cultures

The purpose of this review was to examine articles related to recent epidemiological evidence of the prevalence of maternal postnatal depression (PND) across different countries and cultures and to identify specific epidemiological studies that have been carried out exclusively in Malaysia on the prevalence of maternal PND. The review was undertaken in two stages, an initial review and an updated review. At both stages systematic literature searches of online databases were performed to identify articles on the prevalence of maternal PND. A total of 124 articles concerning research conducted in more than 50 countries were included in the final analysis. There were wide variations in the screening instruments and diagnostic tools used although the Edinburgh Postnatal Depression Scale (EPDS) was the most common instrument applied to identify PND. The prevalence of maternal PND ranged from 4.0% to 63.9%, with Japan and America recording the lowest and highest rates, respectively. Within continents, a wide variation in reported prevalence was also found. The reported rates of maternal PND in Malaysia were much higher than that previously documented with a range of 6.8–27.3%. This review indicated that the widely cited prevalence of maternal PND of 10–15% underestimates rates of PND worldwide. The reasons for this variability may not be fully explained by review methods. Future studies should evaluate the nature of women's PND experiences across cultures to explain these wide variations.

Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries

BACKGROUND

Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD and a meta-regression to identify economic, health, social, or policy factors associated with national PPD prevalence.

METHODS

We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence.

FINDINGS

291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7% (95% confidence interval: 16.6-18.8%), with significant heterogeneity across nations (Q = 16,823, p = 0.000, I2 = 98%), ranging from 3% (2-5%) in Singapore to 38% (35-41%) in Chile. Nations with significantly higher rates of income inequality (R2 = 41%), maternal mortality (R2 = 19%), infant mortality (R2 = 16%), or women of childbearing age working ≥40 h a week (R2 = 31%) have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence.

INTERPRETATION

The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.

Evaluation of the quality of life of pregnant women from 2005 to 2015

Over the past two decades, quality of life has become an essential preoccupation in the care of patients. Many measuring instruments are available to assess physical, psychological and social quality of life. These tools allow healthcare professionals to determine the best quality of their patients. However, the quality of life for the pregnant woman seems to be little studied. This article presents the results of a bibliographic review of publications between 2005 and 2015 - referenced in PUBMED and COCHRANE - on the quality of life of pregnant women giving birth after the 22nd week of amenorrhea. The articles were selected by a reading committee. 195 publications responding to keywords were identified. 75 articles on the problem were selected. The main countries that have published on this subject are Iran (n=11) and Brazil (n=9). France ranks 17th with only one publication. 74% of articles deal with quality of life for pathological pregnancies (gestational or pre-existing pathologies). 23 pathologies were identified, mainly depression (20% of items). This review reveals a growing global interest in quality of life in pregnant women. However, few studies evaluate the impact of care in terms of quality of life in pregnant women, contrary to the recommendations of different health authorities. Finally, the analysis of the various articles shows that, in general, few measurements are made to evaluate the quality of life, not requiring a standardized curve of quality of life during pregnancy. There is thus a significant lack of data to establish a standardized curve for the quality of life of pregnant women, which allows a simple comparison of quality of life measures according to the different clinical management.