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Ďuríčeková B, Škodová Z, Bašková M. Risk factors associated with postpartum depression and PTSD after birth in a sample of Slovak women. Heliyon 2024; 10:e23560. [PMID: 38173480 PMCID: PMC10761800 DOI: 10.1016/j.heliyon.2023.e23560] [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: 09/19/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Background Pregnancy, childbirth and the postpartum period represent a unique experience in a woman's life that significantly changes their life. Methods The aim of the study is to analyse risk factors of postpartum depression and posttraumatic stress disorder symptoms after birth in a sample of women in Slovakia. Data from the INTERSECT project were collected, including 437 postpartum women (mean age 30.5 ± 4.8). Posttraumatic stress disorder was (PTSD) measured through the City BiTS questionnaire, postpartum depression (PPD) symptoms were detected using the Edinburgh Postnatal Depression Scale (EPDS) and birth satisfaction was measured by the Birth Satisfaction Scale- Revised (BSS-R). Results An increased risk for the development of PPD (the EPDS score >12.5) was found in 11.4 % of respondents, PTSD after birth was identified among 2.8 % of respondents. In the linear regression models, birth satisfaction (95%CI: 0,56; -0,19), subjective perception of birth (95%CI: 0,82; 1,63), previous trauma (95%CI: 0,27; 3,74), respect during birth (95%CI: 5,08; -0,45), and health complications of both mother (95%CI: 0,12; 2,81) and child (95%CI: 1,53; 1,84) were found significantly associated with the posttraumatic stress symptoms after birth (total explained variance 37 %). Subjective perception of birth as traumatic (95%CI: 0,82; 1,63), previous trauma in the anamnesis (95%CI: 0,27; 3,74) and respect during birth (95%CI: 5,08; -0,45) were significantly associated with the depression symptoms (total explained variance 15 %). Conclusion Subjective perception of birth, birth satisfaction, previous trauma in anamnesis as well as lack of respect during birth were found as crucial risk factors for both PPD and postpartum PTSD.
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Affiliation(s)
- Barbora Ďuríčeková
- Comenius University, Jessenius Faculty of Medicine, Department of Midwifery, Martin, Slovakia
| | - Zuzana Škodová
- Comenius University, Jessenius Faculty of Medicine, Department of Midwifery, Martin, Slovakia
| | - Martina Bašková
- Comenius University, Jessenius Faculty of Medicine, Department of Midwifery, Martin, Slovakia
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Punj P, Arora A, Shah R, Patil AN, Sikka P, Jain V, Suri V, Saini SS. Prospective assessment of mental and physical health of maternal near-miss women: A low-middle-income country's experience. J Family Med Prim Care 2023; 12:3387-3392. [PMID: 38361862 PMCID: PMC10866246 DOI: 10.4103/jfmpc.jfmpc_1319_23] [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: 08/12/2023] [Revised: 09/27/2023] [Accepted: 10/17/2023] [Indexed: 02/17/2024] Open
Abstract
Background Traumatic birth experience is an unaddressed arena, especially in Asian women, with several societal stigmas lingering around. Aim A study was undertaken to simultaneously assess the post-partum mental and physical health follow-up of maternal near-miss (MNM) women and compare it with women of uneventful deliveries. Materials and Methods The prospective cohort study enrolled 88 MNM women (case cohort) and 80 women with an uneventful peri-partum period (control cohort) at the same time. The participants were followed up with Edinburgh Postnatal Depression Scale (EDPS), PTSD Checklist - Civilian Version (PLC-C), and a 36-item short-form-survey form over 6 months after the delivery. Results The case group had higher mean EPDS and PLC-C scores, with poor quality of life (QOL) performance, compared to the control group at 6 weeks and 3 months, and 6 months follow-up (P < 0.05). At the sixth-week follow-up visit, the study observed that 28 (31.8%) women from the case group required a psychiatry consultation compared to the control group with only two (2.5%) participants (P < 0.001). At 3 months, an evident difference was noted on various QOL parameters, such as limitations due to physical health and emotional problems, energy fatigue, general health, and health change parameters between the two groups (P < 0.05). The difference persisted at 6-month follow-up as well for limitations due to physical health, energy fatigue, and general health parameters only (P < 0.05). Conclusion There is an urgent need for a multi-departmental collaborative approach at the hospital level and policy-making decisions at higher levels for the mental health of Asian women facing MNM events.
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Affiliation(s)
- Pankhuri Punj
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Aashima Arora
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Ruchita Shah
- Department of Psychiatry, PGIMER, Chandigarh, India
| | - Amol N. Patil
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Vanita Jain
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
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Ginter N, Takács L, Boon MJM, Verhoeven CJM, Dahlen HG, Peters LL. The Impact of Mode of Birth on Childbirth-Related Post Traumatic Stress Symptoms beyond 6 Months Postpartum: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148830. [PMID: 35886682 PMCID: PMC9316477 DOI: 10.3390/ijerph19148830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 02/05/2023]
Abstract
(1) Background: A traumatic birth can lead to the development of childbirth-related posttraumatic stress symptoms or disorder (CB-PTS/D). Literature has identified the risk factors for developing CB-PTS/D within the first six months postpartum thoroughly. However, the impact of mode of birth on CB-PTS/D beyond 6 months postpartum is scarcely studied. (2) Methods: A systematic search of the literature was conducted in the databases PubMed, Embase and CINAHL and PRISMA guidelines were followed. Studies were included if they reported the impact of mode of birth on CB-PTS/D beyond 6 months postpartum. (3) Results: In total, 26 quantitative and 2 qualitative studies were included. In the quantitative studies the percentage of women with CB-PTS/D ranged from 0.7% to 42% (between six months and five years postpartum). Compared with vaginal birth, operative vaginal birth, and emergency caesarean section were associated with CB-PTS/D beyond 6 months postpartum. Qualitative studies revealed that some women were suffering from CB-PTS/D as long as 18 years after birth. (4) Conclusions: Long- term screening of women for PTSD in the postnatal period could be beneficial. More research is needed on models of care that help prevent CB-PTS/D, identifying women at risk and factors that maintain CB-PTS/D beyond 6 months postpartum.
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Affiliation(s)
- Nicole Ginter
- Department of General Practice & Elderly Medicine, Section Midwifery Science, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.J.M.B.); (L.L.P.)
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
- Correspondence:
| | - Lea Takács
- Department of Psychology, Faculty of Arts, Charles University, 116 42 Prague, Czech Republic;
| | - Martine J. M. Boon
- Department of General Practice & Elderly Medicine, Section Midwifery Science, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.J.M.B.); (L.L.P.)
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
| | - Corine J. M. Verhoeven
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, 5504 DB Veldhoven, The Netherlands
| | - Hannah G. Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia;
| | - Lilian L. Peters
- Department of General Practice & Elderly Medicine, Section Midwifery Science, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.J.M.B.); (L.L.P.)
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia;
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Gómez-Baya D, Gómez-Gómez I, Domínguez-Salas S, Rodríguez-Domínguez C, Motrico E. The influence of lifestyles to cope with stress over mental health in pregnant and postpartum women during the COVID-19 pandemic. CURRENT PSYCHOLOGY 2022; 42:1-20. [PMID: 35729900 PMCID: PMC9200375 DOI: 10.1007/s12144-022-03287-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/23/2022]
Abstract
The COVID-19 pandemic affected daily life routines and lifestyles of pregnant and postpartum women and increased their stress and risk of suffering from mental health problems. The aim of this study was to analyse which sociodemographic variables, COVID-19 exposure variables and lifestyles to cope with stress variables predicted anxiety, depression, and PTSD symptoms in pregnant and postpartum women during the COVID-19 pandemic. A cross-sectional design was performed with a sample of 3356 Spanish women participating in the Riseup-PPD-COVID-19 study. These participants completed an online survey composed of measures of anxiety (GAD-7), depression (EPDS), and PTSD related to COVID-19 (Checklist DSM-5), as well as demographics, exposure to COVID-19, and lifestyles to cope with stress. Regarding results, 47.2% showed depression and a third reported anxiety, whereas moderate scores were observed in PTSD symptoms. The most commonly used strategies to cope with stress in the COVID-19 pandemic were talking with friends and family and increasing time with social networks. Better results in mental health were associated with coping strategies such as talking with family and friends or participating in family activities, physical activity, sleeping well at night, eating healthier, and increasing personal care. Furthermore, poor results in mental health were observed in those participants who increased time with screens, ate fast food, reported substance use, and talked more frequently with health professionals. More symptoms were also observed in younger women, primiparous women, and those who reported more exposure to COVID-19. The results underline the need to strengthen the mental health of pregnant and postpartum women. Trial registration: ClinicalTrials.gov Identifier: NCT04595123.
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Affiliation(s)
- Diego Gómez-Baya
- Department of Social, Developmental and Educational Psychology, Universidad de Huelva, Huelva, Spain
| | - Irene Gómez-Gómez
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Seville Spain
| | - Sara Domínguez-Salas
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Seville Spain
| | | | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Seville Spain
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Paternal and maternal long-term psychological outcomes after uterine artery embolization for severe post-partum hemorrhage. Sci Rep 2021; 11:13990. [PMID: 34234162 PMCID: PMC8263630 DOI: 10.1038/s41598-021-92847-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/15/2021] [Indexed: 02/02/2023] Open
Abstract
This study intend to compare the long-term psychological impact (depression, post-traumatic stress disorder) on both partners between patients that underwent uterine artery embolization (UAE) for post-partum hemorrhage (PPH) and uneventful deliveries. Women who experienced severe PPH treated by UAE in our institution between 2003 and 2013 were identified in our obstetrical database. These cases were matched to controls with uneventful deliveries. Matching criteria were maternal age, parity, ethnicity, year of delivery, birthweight, gestational age and mode of delivery. Patients and their partners completed validated questionnaires measuring post-traumatic stress (TSQ), as well as depression symptoms (MINI). A total of 63 cases of PPH and 189 matched controls (1:3) participated in a study exploring gynecological and obstetrical outcomes. With a mean of 8 years post-index delivery, patients after PPH showed increased risk of depression (p = 0.015) and post-traumatic stress disorder (22.2% versus 4.8%, p < 0.005) compared to controls. PPH remains strongly associated with post-traumatic stress disorder, even after adjustment for depression (adjusted odds ratio 5.1; 95% confidence intervals 1.5–17.5). Similarly, partners of patients with PPH showed a propensity to depression (p = 0.029) and post-traumatic stress disorder (11.5% versus 1.5%, p = 0.019). In conclusion, both women and their partners are at increased risk of long-term psychological adverse outcomes after PPH. Couples may benefit from psychological support.
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von Rosen IEW, Shiekh RM, Mchome B, Chunsen W, Khan KS, Rasch V, Linde DS. Quality of life after maternal near miss: A systematic review. Acta Obstet Gynecol Scand 2021; 100:704-714. [PMID: 33599289 DOI: 10.1111/aogs.14128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Maternal near miss is a major global health issue; approximately 7 million women worldwide experience it each year. Maternal near miss can have several different health consequences and can affect the women's quality of life, yet little is known about the size and magnitude of this association. The aim of this study was to assess the evidence of the association between women who have experienced maternal near miss and quality of life and women who had an uncomplicated pregnancy and delivery. MATERIAL AND METHODS Cochrane library, Embase, CINAHL, Web of Science, MEDLINE, Scopus and PubMed were searched for published studies. Studies were selected according to the PECO model (population, exposure, control and outcome) and were included if they investigated quality of life as an outcome after maternal near miss among women of all ages with no limitation on country or time (up to June 2020). Maternal near miss was defined as a life-threatening condition arising from complications related to pregnancy and/or childbirth. The quality of the studies was assessed according to the Newcastle-Ottawa scale and a Forest plot was constructed based on quality of life outcomes and study quality. PROSPERO registration number: CRD42020169232. RESULTS Fifteen studies were included in the review with a total of 31 558 women. Quality of life was reported in various ways, and 25 different confounders were controlled for. Compared with women who did not experience maternal near miss, women exposed to maternal near miss had an overall lower quality of life (n = 2/2), had poorer mental (n = 6/10) and social health (n = 2/3), and maternal near miss had negative economic consequences (n = 4/4). Maternal near miss was not associated with sexual dysfunction (n = 1/5). Ten of 15 studies were assessed as being of poor quality. CONCLUSIONS Evidence shows that maternal near miss is negatively associated with various aspects of quality of life. This highlights the importance of addressing the adverse effects associated with maternal near miss and follow up maternal near miss after discharge. Quality of life is a multidimensional concept that is assessed in various ways, and the literature on the field is heterogeneous. More high-quality studies are needed.
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Affiliation(s)
- Ida E W von Rosen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Rayan M Shiekh
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bariki Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Wu Chunsen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, CIBER of Epidemiology and Public Health (CIBERESP), Granada, Spain
| | - Vibeke Rasch
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ditte S Linde
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
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7
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Factors Associated with Postpartum Post-Traumatic Stress Disorder (PTSD) Following Obstetric Violence: A Cross-Sectional Study. J Pers Med 2021; 11:jpm11050338. [PMID: 33923164 PMCID: PMC8145360 DOI: 10.3390/jpm11050338] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
To determine the association between experiencing obstetric violence and the incidence of postpartum post-traumatic stress disorder (PTSD). A cross-sectional study with puerperal women was conducted in Spain following ethical approval. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) was administered online. Sociodemographic, clinical, and obstetric violence variables and the risk of dichotomized PTSD (low/high) were studied by bivariate and multivariate analysis with binary logistic regression. 955 women were invited to participate. 53 women refused to participate, three did not complete all survey questions and, finally, 899 women were included. The risk of PTSD (score ≥ 19) using the PPQ was 12.7% (114). The mean score was 9.10 points (SD = 8.52). Risk factors identified were having a delivery plan that was not respected (aOR: 2.85, 95% CI 1.56–5.21), elective caesarean delivery (aOR: 2.53, 95% CI 1.02–2.26), emergency caesarean section (aOR: 3.58, 95% CI 1.83–6.99), admission of the newborn to the neonatal intermediate care unit (aOR: 4.95, 95% CI 2.36–10.36), admission to the intensive care unit (aOR: 2.25, 95% CI 1.02–4.97), formula feeding on discharge (aOR: 3.57, 95% CI 1.32–9.62), verbal obstetric violence (aOR: 5.07, 95% CI 2.98–8.63), and psycho-affective obstetric violence (aOR: 2.61, 95% CI 1.45–4.67). Various clinical practices were identified with the risk of PTSD, highlighting various types of obstetric violence. Partner support and early breastfeeding were identified as protective factors. Sensitizing professionals is essential to prevent the risk of PTSD.
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Cyr S, Guo DX, Marcil MJ, Dupont P, Jobidon L, Benrimoh D, Guertin MC, Brouillette J. Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 69:81-93. [PMID: 33582645 DOI: 10.1016/j.genhosppsych.2021.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE PTSD is increasingly recognized following medical traumas although is highly heterogeneous. It is difficult to judge which medical contexts have the most traumatic potential and where to concentrate further research and clinical attention for prevention, early detection and treatment. The objective of this study was to compare PTSD prevalence in different medical populations. METHODS A systematic review of the literature on PTSD following medical traumas was conducted as well as a meta-analysis with final pooled result and 95% confidence intervals presented. A meta-regression was used to investigate the impact of potential effect modifiers (PTSD severity, age, sex, timeline) on study effect size between prevalence studies. RESULTS From 3278 abstracts, the authors extracted 292 studies reporting prevalence. Using clinician-administered reports, the highest 24 month or longer PTSD prevalence was found for intraoperative awareness (18.5% [95% CI=5.1%-36.6%]) and the lowest was found for epilepsy (4.5% [95% CI=0.2%-12.6%]). In the overall effect of the meta-regression, only medical events or procedures emerged as significant (p = 0.006) CONCLUSION: This review provides clinicians with greater awareness of medical contexts most associated with PTSD, which may assist them in the decision to engage in more frequent, earlier screening and referral to mental health services.
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Affiliation(s)
- Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - De Xuan Guo
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Joëlle Marcil
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Patrice Dupont
- Health Sciences Library, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Jobidon
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - David Benrimoh
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal, Montreal, Quebec, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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Andreucci CB, Filippi V, Cecatti JG. Women's well-being and functioning after evidence-based antenatal care: a protocol for a systematic review of intervention studies. BMJ Open 2021; 11:e042667. [PMID: 33550253 PMCID: PMC7925906 DOI: 10.1136/bmjopen-2020-042667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The 2016 WHO antenatal guidelines propose evidence-based recommendations to improve maternal outcomes. We aim to complement these recommendations by describing and estimating the effects of the interventions recommended by WHO on maternal well-being or functioning. METHODS AND ANALYSIS We will conduct a systematic review of experimental and quasi-experimental studies evaluating women's well-being or functioning following the implementation of evidence-based antenatal interventions, published in peer-reviewed journals through a 15-year interval (2005-2020). The lead reviewer will screen all records identified at MEDLINE, EMBASE, CINAHL Plus, LILACS and SciELO. Two other reviewers will control screening strategy quality. Quality and risk of bias will be assessed using a specially designed instrument. Data synthesis will consider the instruments applied, how often they were used, conditions/interventions for positive or negative effects documented, statistical measures used to document effectiveness and how results were presented. A random-effects meta-analysis comparing frequently used instruments may be conducted. ETHICS AND DISSEMINATION The study will be a systematic review with no human beings' involvement, therefore not requiring ethical approval. Findings will be disseminated through peer-reviewed publication and scientific events. PROSPERO REGISTRATION NUMBER CRD42019143436.
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Affiliation(s)
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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10
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Long-Term High Risk of Postpartum Post-Traumatic Stress Disorder (PTSD) and Associated Factors. J Clin Med 2021; 10:jcm10030488. [PMID: 33573115 PMCID: PMC7866544 DOI: 10.3390/jcm10030488] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/20/2022] Open
Abstract
Postpartum post-traumatic stress disorder (PTSD) is not a specific process but can last for months and may manifest itself during any subsequent pregnancies or even become chronic. This study aimed to determine the factors associated with long-term PTSD symptoms one year after delivery. A cross-sectional study was conducted on 1301 Spanish puerperal women. Data were collected on sociodemographic, obstetric, and neonatal variables. The Perinatal Post-Traumatic Stress Disorder Questionnaire (PPQ) was administered online through midwives’ associations across Spain. Crude odds ratio (OR) and adjusted odds ratio (aOR) and their 95% confidence intervals were calculated. A PPQ score ≥ 19 (high-risk) was recorded for 13.1% (171) of the participants. Identified risk factors were not respecting a birth plan (aOR = 1.89 (95% CI 1.21–2.94)), formula-feeding of the baby at discharge (aOR = 2.50 (95% CI 1.20–5.17)), postpartum surgical intervention (aOR = 2.23 (95% CI 1.02–4.85)), hospital readmission (aOR = 3.45 (95% CI 1.21–9.84)), as well as verbal obstetric violence (aOR = 3.73 (95% CI 2.52–5.53)) and psycho-affective obstetric violence (aOR = 3.98 (95% CI 2.48–6.39)). During childbirth, some clinical practices, such as formula-feeding of the newborn at discharge or types of obstetric violence towards the mother, were associated with a higher risk of PTSD symptoms one year after delivery.
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Ferreira EC, Costa ML, Pacagnella RC, Silveira C, Andreucci CB, Zanardi DMT, Santos JP, Angelini CR, Souza RT, Parpinelli MA, Sousa MH, Cecatti JG. Multidimensional assessment of women after severe maternal morbidity: the COMMAG cohort study. BMJ Open 2020; 10:e041138. [PMID: 33303455 PMCID: PMC7733206 DOI: 10.1136/bmjopen-2020-041138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To perform a multidimensional assessment of women who experienced severe maternal morbidity (SMM) and its short-term and medium-term impact on the lives and health of women and their children. DESIGN A retrospective cohort study. SETTING A tertiary maternity hospital from the southeast region of Brazil. PARTICIPANTS The exposed population was selected from intensive care unit admissions if presenting any diagnostic criteria for SMM. Controls were randomly selected among women without SMM admitted to the same maternity and same time of childbirth. PRIMARY AND SECONDARY OUTCOME VARIABLES Validated tools were applied, addressing post-traumatic stress disorder (PTSD) and quality of life (SF-36) by phone, and then general and reproductive health, functioning (WHO Disability Assessment Schedule), sexual function (Female Sexual Function Index (FSFI)), substance abuse (Alcohol, Smoking and Substance Involvement Screening Test 2.0) and growth/development (Denver Developmental Screening Test) of children born in the index pregnancy in a face-to-face interview. RESULTS All instruments were applied to 638 women (315 had SMM; 323 were controls, with the assessment of 264 and 307 children, respectively). SF-36 score was significantly lower in the SMM group, while PTSD score was similar between groups. Women who had SMM became more frequently sterile, had more abnormal clinical conditions after the index pregnancy and a higher score for altered functioning, while proportions of FSFI score or any drug use were similar between groups. Furthermore, children from the SMM group were more likely to have weight (threefold) and height (1.5 fold) for age deficits and also impaired development (1.5-fold). CONCLUSION SMM impairs some aspects of the lives of women and their children. The focus should be directed towards monitoring these women and their children after birth, ensuring accessibility to health services and reducing short-term and medium-term repercussions on physical, reproductive and psychosocial health.
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Affiliation(s)
- Elton C Ferreira
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Carla Silveira
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Carla B Andreucci
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | | | - Juliana P Santos
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Carina R Angelini
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Mary A Parpinelli
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | - Maria Helena Sousa
- Department of Statistics, Faculdade de Medicina de Jundiai, Jundiai, Brazil
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Mental Health and Quality of Life of Women One Year after Maternal Near-Miss in Low and Middle-Income Countries: The Case of Zanzibar, Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239034. [PMID: 33287466 PMCID: PMC7730062 DOI: 10.3390/ijerph17239034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/06/2020] [Accepted: 11/20/2020] [Indexed: 11/17/2022]
Abstract
Women who experienced a maternal near-miss are at risk of mental health complications and lower quality of life, but long-term consequences are largely unknown. The aim of this study is to assess whether mental health symptoms and quality of life change over time and to examine associations with risk factors among post-partum women. In this cohort study, women with maternal near-miss were matched to women without or with mild complications at Mnazi Mmoja Hospital in Zanzibar. Depressive and post-traumatic stress disorder symptoms, and quality of life were measured at three, six, and twelve-months follow-up. A linear mixed-effects model was used for data analysis. Postpartum women in Zanzibar reported low levels of depressive and post-traumatic stress disorder symptoms. While depressive symptoms and quality of life trajectories were similar among women with and without maternal near-miss, differences for trajectories of post-traumatic stress disorder symptoms and physical quality of life were found. Social support, perinatal loss, and intercurrent illness were strongly associated with both depressive symptoms and quality of life in this group of Islamic women. These findings suggest that social support, embedded in the cultural context, should be considered in helping women cope with mental health issues in the aftermath of severe maternal complications.
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Abstract
Post-traumatic stress disorder (PTSD) accompanies miscarriage, intrauterine fetal demise, and preterm birth. Levels of PTSD may be higher for women who experience acute, life-threatening events during labor and delivery. Severe maternal morbidities or near misses for maternal death disproportionately impact African American, Hispanic, American Indian, and women in rural communities. Expanding research demonstrates association between severe maternal morbidity or near-miss events and PTSD. Multiple preceding conditions and intrapartum and postpartum events place women at higher risk for PTSD. Postpartum evaluation provides an opportunity for PTSD screening. Untreated perinatal PTSD impacts long-term maternal and child health and contributes to health disparities.
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Postpartum psychoactive substance abuse after severe maternal morbidity. Int J Gynaecol Obstet 2019; 147:368-374. [DOI: 10.1002/ijgo.12967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 06/23/2019] [Accepted: 09/06/2019] [Indexed: 11/07/2022]
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