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Baumann S, Staudt A, Horesh D, Eberhard-Gran M, Garthus-Niegel S, Horsch A. Perineal tear and childbirth-related posttraumatic stress: A prospective cohort study. Acta Psychiatr Scand 2023. [PMID: 37550260 DOI: 10.1111/acps.13595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/03/2023] [Accepted: 07/15/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE Quantitative studies examining the occurrence of childbirth-related posttraumatic stress disorder (CB-PTSD) following severe perineal rupture are lacking. The objective of this population-based study was to investigate the prospective associations between the degree of perineal tear during childbirth and CB-PTSD symptoms, when adjusting for known covariates (maternal age, years of school education, premature birth, and parity). We hypothesized that women with different degrees of perineal tear will differ regarding (1) the level of CB-PTSD symptoms at 8 weeks and 2 years postpartum and (2) the rate of change in CB-PTSD symptoms from 8 weeks to 2 years postpartum. METHOD Secondary data analysis from the Akershus Birth Cohort, a large population-based prospective cohort study using self-report questionnaires and hospital record data. RESULTS The degree of perineal tear was significantly associated with CB-PTSD symptoms at 8 weeks and 2 years postpartum. However, the degree of perineal tear was not significantly associated with the change in CB-PTSD symptoms over time. Similar patterns were found for both total CB-PTSD symptoms as well as for avoidance and intrusion symptoms only. CONCLUSION Results seem to support a dose-response model, suggesting that the higher the severity of the perineal tear, the higher the posttraumatic morbidity.
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Affiliation(s)
- Sophie Baumann
- Faculty of Medicine, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Methods in Community Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Andreas Staudt
- Faculty of Medicine, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Methods in Community Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- Department of Psychiatry, NYU Grossman School of Medicine, New York City, New York, USA
| | - Malin Eberhard-Gran
- Women and Children's Division, Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Susan Garthus-Niegel
- Faculty of Medicine, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
- Faculty of Medicine, Medical School Hamburg, Institute for Systems Medicine (ISM), Hamburg, Germany
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Department Woman-mother-child, Lausanne University Hospital, Lausanne, Switzerland
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Staudt A, Baumann S, Horesh D, Eberhard-Gran M, Horsch A, Garthus-Niegel S. Predictors and comorbidity patterns of maternal birth-related posttraumatic stress symptoms: A Latent Class Analysis. Psychiatry Res 2023; 320:115038. [PMID: 36603381 DOI: 10.1016/j.psychres.2022.115038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/08/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
Birth-related posttraumatic stress symptoms (PTSS) place a significant burden on mothers and their families. The aim was to (1) identify differential profiles of maternal birth-related PTSS; (2) determine the predictive value of established risk factors; (3) examine comorbidity patterns related to depression and anxiety symptoms. As part of the Norwegian Ahus Birth Cohort, 2,088 (expectant) mothers completed self-report questionnaires from 17 weeks of gestation to 2 years postpartum. The Impact of Event Scale was used to assess PTSS 8 weeks after birth. Latent class analysis revealed four latent classes: a High birth-related PTSS class (4%), a Moderate birth-related PTSS class (16%) particularly characterized by endorsement of intrusion symptoms, a Mild birth-related PTSS class (47%), as well as a No birth-related PTSS class (33%). We found similar (younger age, worse subjective birth experience, higher fear of childbirth) and differential predictors (prior posttraumatic stress disorder, lower education, birth complications). Women classified with High, Moderate, or Mild birth-related PTSS showed higher depression and anxiety symptoms compared to women with No birth-related PTSS. A considerable number of mothers experienced birth-related PTSS, most on a subclinical level, but these women still showed signs of mental distress 2 years postpartum, calling for more universal prevention approaches.
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Affiliation(s)
- Andreas Staudt
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany; Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.
| | - Sophie Baumann
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany; Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel; Department of Psychiatry, NYU Grossman School of Medicine, New York, USA
| | - Malin Eberhard-Gran
- Norwegian Research Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland; Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany; Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
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Trinh NTH, Nordeng HME, Bandoli G, Palmsten K, Eberhard-Gran M, Lupattelli A. Antidepressant Fill and Dose Trajectories in Pregnant Women with Depression and/or Anxiety: A Norwegian Registry Linkage Study. Clin Epidemiol 2022; 14:1439-1451. [PMID: 36506004 PMCID: PMC9733444 DOI: 10.2147/clep.s379370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/18/2022] [Indexed: 12/08/2022] Open
Abstract
Background Few studies investigated longitudinal antidepressant exposure during pregnancy and included dosage in the assessment. Methods We conducted a nationwide, registry-linkage study in Norway using data on antidepressant prescription fills in pregnancies lasting ≥32 weeks in women with a delivery between 2009 and 2018 who had a depression/anxiety diagnosis and antidepressant fills prior to pregnancy. Information on antidepressant exposure by week (measured by filled prescriptions) and prescribed average daily dose was used in longitudinal k-means trajectory modelling for a 108-week time window from six months prior to pregnancy to one year after delivery. Factors associated with trajectory group membership were examined using multinomial logistic regression models. Results We included 8,460 pregnancies in 8,092 women. Four antidepressant fill trajectories were identified based on filled antidepressant prescriptions: two distinct discontinuing patterns, one at around the start of pregnancy (30.4%) and one around the end of pregnancy (33.8%); one continuing pattern (20.6%); and one interrupting pattern (15.2%). Using average usual daily dose, we identified low dose discontinuing (60.3%), medium dose reducing (20.6%) and high dose continuing (15.2%) patterns. The multinomial logistic regressions showed that the fill trajectory group membership was strongly associated with: antidepressant type and dose prior to pregnancy and co-medication prior to pregnancy, maternal age, marital status, parity, previous pregnancy loss, and pregnancy planning. Conclusion Longitudinal trajectory modelling revealed distinct antidepressant fill and dosage patterns in the period around pregnancy. Knowledge about factors associated with utilization trajectories might be useful for health-care personnel counselling women about antidepressant use in pregnancy.
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Affiliation(s)
- Nhung T H Trinh
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway,Correspondence: Nhung TH Trinh, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Post box 1068 Blindern, Oslo, 0316, Norway, Email
| | - Hedvig M E Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | | | - Malin Eberhard-Gran
- Norwegian Research Centre for Women’s Health, Women’s and Children’s Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
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Karalexi MA, Eberhard-Gran M, Valdimarsdóttir UA, Karlsson H, Munk-Olsen T, Skalkidou A. Perinatal mental health: how nordic data sources have contributed to existing evidence and future avenues to explore. Nord J Psychiatry 2022; 76:423-432. [PMID: 35057712 DOI: 10.1080/08039488.2021.1998616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Perinatal mental health disorders affect a significant number of women with debilitating and potentially life-threatening consequences. Researchers in Nordic countries have access to high quality, population-based data sources and the possibility to link data, and are thus uniquely positioned to fill current evidence gaps. We aimed to review how Nordic studies have contributed to existing evidence on perinatal mental health. METHODS We summarized examples of published evidence on perinatal mental health derived from large population-based longitudinal and register-based data from Denmark, Finland, Iceland, Norway and Sweden. RESULTS Nordic datasets, such as the Danish National Birth Cohort, the FinnBrain Birth Cohort Study, the Icelandic SAGA cohort, the Norwegian MoBa and ABC studies, as well as the Swedish BASIC and Mom2B studies facilitate the study of prevalence of perinatal mental disorders, and further provide opportunity to prospectively test etiological hypotheses, yielding comprehensive suggestions about the underlying causal mechanisms. The large sample size, extensive follow-up, multiple measurement points, large geographic coverage, biological sampling and the possibility to link data to national registries renders them unique. The use of novel approaches, such as the digital phenotyping data in the novel application-based Mom2B cohort recording even voice qualities and digital phenotyping, or the Danish study design paralleling a natural experiment are considered strengths of such research. CONCLUSIONS Nordic data sources have contributed substantially to the existing evidence, and can guide future work focused on the study of background, genetic and environmental factors to ultimately define vulnerable groups at risk for psychiatric disorders following childbirth.
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Affiliation(s)
- Maria A Karalexi
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Malin Eberhard-Gran
- Norwegian Research Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Unnur Anna Valdimarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Hasse Karlsson
- Department of Psychiatry and Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Trine Munk-Olsen
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alkistis Skalkidou
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Trinh NTH, Nordeng HME, Bandoli G, Eberhard-Gran M, Lupattelli A. Antidepressant and mental health care utilization in pregnant women with depression and/or anxiety: An interrupted time-series analysis. J Affect Disord 2022; 308:458-465. [PMID: 35461816 DOI: 10.1016/j.jad.2022.04.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about mental health care utilization patterns in pregnant women with depression/anxiety in Norway according to antidepressant fill trajectories in pregnancy. METHOD We conducted a registry-linkage cohort study of pregnancies within women having outpatient visit for depression/anxiety and antidepressant fills prior to pregnancy identified from four national registries of Norway (2009-2018). Number of consultations for depression/anxiety per 100 pregnancies as proxy of mental health care utilization was modelled using interrupted time-series analysis with first month into pregnancy and first month after delivery as interruption points. We investigated the time window spanning from six months prior to one year postpartum. Antidepressant fill trajectories in the corresponding time window were identified using longitudinal k-means trajectory modelling. RESULTS The cohort included 8460 pregnancies within 8062 women with depression/anxiety. We observed reduced mental health care utilization when pregnant women entered the course of pregnancy (negative slopes during pregnancy for psychiatric specialists and psychologists). The declines were observed for all antidepressant fill trajectories (i.e., discontinuers and continuers) except interrupters (i.e., discontinued then resumed treatment). We found increased mental health care utilization in the postpartum year, notably in interrupters (positive slopes in consultation rates with specialists of outpatient clinics and public-contracted psychiatrists). LIMITATIONS It was not possible to measure directly the use of psychosocial interventions and psychotherapy. CONCLUSIONS Pregnancy was associated with reduced mental health care utilization regardless of whether antidepressant treatment was maintained during pregnancy or not. Increases in mental health care utilization were observed in the postpartum year, especially in interrupters.
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Affiliation(s)
- Nhung T H Trinh
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
| | - Hedvig M E Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway; Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Malin Eberhard-Gran
- Norwegian Research Centre for Women's Health, Women's and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
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Harris GME, Wood M, Eberhard-Gran M, Lundqvist C, Nordeng HME. Correction to: Patterns and predictors of analgesic use in pregnancy: a longitudinal drug utilization study with special focus on women with migraine. BMC Pregnancy Childbirth 2022; 22:300. [PMID: 35395733 PMCID: PMC8991970 DOI: 10.1186/s12884-022-04525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Gerd-Marie Eskerud Harris
- Pharmacoepidemiology & Drug Safety Research Group, Department of Pharmacy, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box. 1068, Blindern, 0316, Oslo, Norway.
| | - Mollie Wood
- Pharmacoepidemiology & Drug Safety Research Group, Department of Pharmacy, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box. 1068, Blindern, 0316, Oslo, Norway
| | - Malin Eberhard-Gran
- Department of Child Health, National Institute of Public Health, Oslo, Norway.,Health Services Research, Research Department, Akershus University Hospital and University of Oslo, Campus Ahus, Lørenskog, Norway
| | - Christofer Lundqvist
- Health Services Research, Research Department, Akershus University Hospital and University of Oslo, Campus Ahus, Lørenskog, Norway
| | - Hedvig Marie Egeland Nordeng
- Pharmacoepidemiology & Drug Safety Research Group, Department of Pharmacy, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box. 1068, Blindern, 0316, Oslo, Norway.,Department of Child Health, National Institute of Public Health, Oslo, Norway
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Eberhard-Gran M, Engelsen LY, Al-Zirqi I, Vangen S. Depressive symptoms and experiences of birthing mothers during COVID-19 pandemic. Tidsskr Nor Laegeforen 2022; 142:21-0450. [PMID: 35170925 DOI: 10.4045/tidsskr.21.0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND It is unclear how the COVID-19 pandemic has affected postnatal women in Norway. We therefore wanted to investigate their depressive symptoms and birthing experiences during the pandemic. MATERIAL AND METHOD In April 2021, a total of 3 642 postnatal women participated in an online survey. Depressive symptoms were measured using a short matrix version of the Edinburgh Postnatal Depression Scale (EPDS-4), and standardised questions about the ante-, peri- and post-natal periods were used to record birthing experiences. The questions were the same as those used ten years ago in the Ahus Birth Cohort study, which is the reference population here. The women were also asked questions related to the pandemic and mental health care. RESULTS Twenty-nine per cent of the mothers indicated that the pandemic had had a 'large' or 'very large' impact on their mental health. Thirty-two per cent reported high scores for depressive symptoms (EPDS-4 scores ≥ 6), while the corresponding figure in the reference population was 10 %. The proportion of mothers who were dissatisfied with their pregnancy experience was almost the same in both cohorts, while the proportion that reported poor care in the maternity ward during the pandemic was higher than for the reference population (34 % vs. 13 %). Of those who had mental health problems during the pandemic, 54 % stated that they had not received appropriate help. INTERPRETATION One in three postnatal women reported high scores for depressive symptoms during the pandemic. The study revealed significant dissatisfaction with the care provided in maternity wards and inadequate follow-up of the mothers' mental health.
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Madsen KB, Mægbæk ML, Thomsen NS, Liu X, Eberhard-Gran M, Skalkidou A, Bergink V, Munk-Olsen T. Pregnancy and postpartum psychiatric episodes in fathers: A population-based study on treatment incidence and prevalence. J Affect Disord 2022; 296:130-135. [PMID: 34601300 PMCID: PMC8595874 DOI: 10.1016/j.jad.2021.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND For women, the perinatal period confers an increased risk of severe psychiatric disorders, but similar evidence for fathers is lacking. We examined rates of first-time and recurrent psychiatric disorders in men before and after becoming fathers. METHODS A descriptive prospective study design was applied using information from the Danish National registers. Perinatal psychiatric episodes were assessed as incidence of first-time and prevalence (including recurrence) of recorded in- or outpatient admissions for any mental disorder and redeemed prescriptions for psychotropic medication in fathers to children born from January 1, 1998 until December 31, 2015. RESULTS We identified 929,415 births and 543,555 unique fathers. Incidence and prevalence proportions for paternal psychiatric in- and outpatient episodes showed an increasing trend over the perinatal period and were marginally higher postpartum compared to pregnancy; e.g., median incidence proportion for inpatient treatment during pregnancy was 0.07 (95% CI: 0.04; 0.07) and 0.10 (95% CI: 0.08; 0.11) postpartum per 1000 births. No difference between the periods was found for incidence of prescriptions for psychotropic medication. Psychiatric disorders in expecting and new fathers were mainly treated in primary care with cumulative incidence of prescriptions for psychotropic medication of 14.56 per 1000 births during the first year of fatherhood. LIMITATIONS We only capture fathers who actively sought and received treatment, and we consequently underestimate milder psychiatric episodes in expecting and new fathers. CONCLUSION Becoming a father did not appear to trigger a substantially increased risk of severe psychiatric disorders, as it has been observed for new mothers.
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Affiliation(s)
- Kathrine Bang Madsen
- National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Fuglesangs Allé 26, Building R, Aarhus 8210, Denmark; iPSYCH, the Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark.
| | - Merete Lund Mægbæk
- National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Denmark,iPSYCH, the Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Nete Stubkjær Thomsen
- National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Denmark,iPSYCH, the Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Xiaoqin Liu
- National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Denmark,iPSYCH, the Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Malin Eberhard-Gran
- Norwegian Research Centre for Women’s Health, Women and Children’s Division, Oslo University Hospital, Rikshospitalet, Oslo Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Veerle Bergink
- Department of Psychiatry and Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, NY, USA,Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Trine Munk-Olsen
- National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Denmark,iPSYCH, the Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
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Deforges C, Noël Y, Eberhard-Gran M, Garthus-Niegel S, Horsch A. Prenatal insomnia and childbirth-related PTSD symptoms: A prospective population-based cohort study. J Affect Disord 2021; 295:305-315. [PMID: 34488084 DOI: 10.1016/j.jad.2021.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Certain populations are at high risk of experiencing a traumatic event and developing post-traumatic stress disorder (PTSD). Yet, primary preventive interventions against PTSD are lacking. It is therefore crucial to identify pre-traumatic risk factors, which could be targeted with such interventions. Insomnia may be a good candidate, but studies on civilians are sparse. Furthermore, the mechanisms at stake in the relationship between pre-traumatic insomnia and PTSD symptoms are unclear. METHODS This prospective population-based cohort study (n = 1,610) examined the relationship between insomnia symptoms at 32 weeks of pregnancy and childbirth-related PTSD (CB-PTSD) symptoms at eight weeks postpartum. Postnatal insomnia symptoms, prenatal psychological symptoms (depression, anxiety, PTSD, fear of childbirth), subjective birth experience (SBE) and birth medical severity were included as covariates in the analyses, which were based on a Piecewise Structural Equation Modelling approach. RESULTS The relationship between prenatal insomnia and CB-PTSD symptoms was mediated by negative SBE and postnatal insomnia symptoms. All relationships involving insomnia symptoms had small or very small effect sizes. LIMITATIONS This study used self-report questionnaires. Postnatal insomnia and CB-PTSD symptoms were concurrently measured. CONCLUSION Prenatal insomnia symptoms may impair the ability to cope with a difficult birth experience and contribute to postnatal insomnia, a risk factor for CB-PTSD. Thus, prenatal insomnia symptoms may be a promising target for CB-PTSD primary preventive interventions, although other prenatal psychological symptoms could also be considered. Even beyond the perinatal context, future studies on pre-traumatic insomnia and PTSD should include post-traumatic insomnia as a covariate.
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Affiliation(s)
- Camille Deforges
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland.
| | - Yvonnick Noël
- Laboratory of Psychology, Cognition, Behavior and Communication, Univ Rennes, Rennes, France.
| | - Malin Eberhard-Gran
- Norwegian Research Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Susan Garthus-Niegel
- Department of Medicine, Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland; Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
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Høivik MS, Eberhard-Gran M, Wang CEA, Dørheim SK. Perinatal mental health around the world: priorities for research and service development in Norway. BJPsych Int 2021; 18:102-105. [PMID: 34747945 PMCID: PMC8554966 DOI: 10.1192/bji.2021.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/17/2020] [Accepted: 11/21/2020] [Indexed: 11/23/2022] Open
Abstract
Despite the country's generous social welfare systems, perinatal mental health problems are prevalent in Norway. National guidelines recommend that health services identify women with perinatal mental conditions, but systematic screening and clear treatment pathways are not nationally endorsed, neither are recommendations for evaluating and treating possible parent-infant interaction difficulties of affected mothers. There are no subspecialties in perinatal psychiatry or psychology, hence healthcare personnel often lack expertise about perinatal mental health. To safeguard the mental health of infants and parents, we need to establish systematic communication between primary healthcare professionals, as well as between primary- and secondary-level professionals.
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Affiliation(s)
- Magnhild Singstad Høivik
- Associate Professor, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) of Central Norway, Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Malin Eberhard-Gran
- Professor in Clinical Epidemiology and Health Services Research, Norwegian Research Centre for Women's Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Catharina Elisabeth Arfwedson Wang
- Professor of Clinical Psychology, Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Signe Karen Dørheim
- Consultant Psychiatrist, Sandnes District Psychiatric Centre, Division of Psychiatry, Stavanger University Hospital, Norway
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11
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Junge C, von Soest T, Seidler A, Eberhard-Gran M, Garthus-Niegel S. Severe recalled labor pain and elective cesarean section in a subsequent delivery: a cohort study of Norwegian parous women. Acta Obstet Gynecol Scand 2021; 100:1678-1687. [PMID: 34115883 DOI: 10.1111/aogs.14212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/12/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Some women keep on recalling intense labor pain experienced at childbirth to a degree that may negatively affect their life during the postpartum period or lead them to request a cesarean section (CS) in the subsequent delivery. This longitudinal study aimed to assess the impact of severe recalled labor pain from the previous birth on the preference for and delivery by an elective CS in the subsequent delivery. Furthermore, we investigated whether co-occurring maternal demographic, somatic and mental health factors related to the previous and subsequent delivery, explain parts of a potential association. MATERIAL AND METHODS The study sample comprised 1135 parous women from the Akershus Birth Cohort. Severe recalled labor pain was assessed on a numeric rating scale at pregnancy week 17, and at pregnancy week 32, the preference for an elective CS for the subsequent delivery was assessed. Information on actual delivery by elective CS in the subsequent delivery was retrieved from the electronic birth record. Logistic regression analyses were conducted to examine the impact of severe recalled labor pain on elective CS. RESULTS Severe recalled labor pain at the previous birth was associated with a preference for an elective CS (odds ratio [OR] 3.57, 95% confidence interval [CI] 2.25-5.67) and actual delivery by elective CS (OR 4.71, 95% CI 2.32-9.59). This association remained statistically significant for the preference for an elective CS (adjusted OR [aOR] 2.12, 95% CI 1.24-3.62) but diminished for delivery by elective CS (aOR 2.30, 95% CI 0.99-5.35) when adjusting for a variety of covariates. Factors related to previous childbirth such as number of years since previous birth, assisted vaginal delivery, anal sphincter lesions, overall birth experience and fear of childbirth were also linked to preference for and delivery by an elective CS. CONCLUSIONS Women with severe recalled labor pain were about twice as likely to prefer an elective CS compared with women without severe recalled pain. For actual delivery, the significant association with severe recalled pain diminished after adjustment for covariates. However, sample size was small and, irrespective of severe recalled labor pain, preference for an elective CS was statistically significantly associated with actual delivery by elective CS.
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Affiliation(s)
- Carolin Junge
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Tilmann von Soest
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Malin Eberhard-Gran
- Norwegian National Advisory Unit on Women's Health, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany.,Department of Medicine, Faculty of Medicine, Medical School Hamburg, Hamburg, Germany.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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Adler I, Weidner K, Eberhard-Gran M, Garthus-Niegel S. The Impact of Maternal Symptoms of Perinatal Insomnia on Social-emotional Child Development: A Population-based, 2-year Follow-up Study. Behav Sleep Med 2021; 19:303-317. [PMID: 32249601 DOI: 10.1080/15402002.2020.1746661] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background: Poor sleep quality is a common problem in pregnant women, however there is scarce research evidence regarding the association between maternal perinatal insomnia and later social-emotional child development.Participants: This study is part of the Akershus Birth Cohort, a longitudinal population-based study. Birth record and questionnaire data of 1,346 women were used.Methods: Maternal symptoms of insomnia were measured at pregnancy week 32 and at eight weeks postpartum and social-emotional child development was assessed at two years of child age. Correlational and multiple linear regression analyzes were performed.Results: Both, pre- and postnatal symptoms of insomnia were significantly correlated with poorer social-emotional child development two years later (r = 0.09, p < .01 and r = 0.13, p < .001). Adjusting for potential confounding factors, the prospective effect of maternal symptoms of perinatal insomnia on social-emotional child development remained significant in the multiple linear regression analyzes (β = 0.08, p < .01 and β = 0. 10, p < .01).Conclusions: We found a prospective effect of maternal symptoms of perinatal insomnia on social-emotional child development, highlighting the potential relevance of both pre- and postnatal maternal sleep for later social-emotional child development. Future studies ought to examine the bio-psycho-social mechanisms and implications of poor maternal sleep in the perinatal time in more detail.
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Affiliation(s)
- Ida Adler
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the TU Dresden, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the TU Dresden, Germany
| | - Malin Eberhard-Gran
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway.,HØKH, Research Centre, Akershus University Hospital, Norway
| | - Susan Garthus-Niegel
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the TU Dresden, Germany.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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13
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Osnes RS, Eberhard-Gran M, Follestad T, Kallestad H, Morken G, Roaldset JO. Mid-Pregnancy Insomnia and its Association with Perinatal Depressive Symptoms: A Prospective Cohort Study. Behav Sleep Med 2021; 19:285-302. [PMID: 32228307 DOI: 10.1080/15402002.2020.1743705] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective/Background: Insomnia and depression are disorders that affect many perinatal women and that often are interrelated. The present study aimed to examine concurrent and prospective associations between mid-pregnancy insomnia and depression during mid-pregnancy and 8 weeks postpartum. Furthermore, differences in depression and in the sleep-related characteristics insomnia, chronotype, and sleep efficiency were explored between the two time points (mid-pregnancy versus 8 weeks postpartum), and between primiparous and multiparous participants.Participants/Methods: The study was part of the Norwegian population-based Depression and Anxiety in the Perinatal Period (DAPP) prospective cohort study. Among 539 women that were recruited for participation when receiving a routine ultrasound examination, we analyzed data from hospital birth records and questionnaire responses from pregnancy week 17 and postpartum week 8. We used the Edinburgh Postnatal Depression Scale to measure depression. The Bergen Insomnia Scale, the reduced Horne-Östberg Morningness-Eveningness Questionnaire, and three questions from the Pittsburgh Sleep Quality Index were used to measure the sleep-related characteristics.Results: Mid-pregnancy insomnia was significantly associated with concurrent depression (p < .001), but not with postpartum depression (p = .288), in a linear mixed model with adjustment for several reproductive and psychosocial variables. Sleep efficiency was reduced from mid-pregnancy to postpartum (from 88% to 77%), and primiparous women reported less efficient sleep than multiparous women after childbirth.Conclusions: The results indicate that mid-pregnancy insomnia may be a marker for concurrent depression but not a predictor of postpartum depression. Future research should examine the extent to which treatment of insomnia from mid-pregnancy on reduces both perinatal insomnia and depression.
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Affiliation(s)
- Rannveig S Osnes
- Department of Psychiatry, Ålesund Hospital, Møre & Romsdal Hospital Trust, Ålesund, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Malin Eberhard-Gran
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway.,Department of Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Østmarka Department of Psychiatry, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Gunnar Morken
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Østmarka Department of Psychiatry, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - John Olav Roaldset
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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14
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Deforges C, Stuijfzand S, Noël Y, Robertson M, Breines Simonsen T, Eberhard-Gran M, Garthus-Niegel S, Horsch A. The relationship between early administration of morphine or nitrous oxide gas and PTSD symptom development. J Affect Disord 2021; 281:557-566. [PMID: 33421836 DOI: 10.1016/j.jad.2020.12.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Posttraumatic Stress Disorder (PTSD) is a debilitating mental health disorder. Certain drugs, such as morphine and nitrous oxide gas (N2O), are administered to individuals who just experienced a traumatic event (e.g., soldiers, injured civilians). It is therefore crucial to understand if they incidentally affect PTSD symptom development. Furthermore, such observations could pave the way for the development of pharmacological prevention strategies of PTSD. METHODS In this prospective population-based cohort study (n = 2,070), we examined the relationship between morphine or N2O administration during childbirth, and subsequent childbirth-related PTSD symptoms at eight weeks postpartum. Pain during labour, prior PTSD symptoms, and birth medical severity were included as covariates in the analyses. RESULTS In women who developed PTSD symptoms, N2O administration during childbirth predicted reduced PTSD symptom severity (p < .001, small to medium effect size). A similar tendency was observed for morphine, but was not significant (p < .065, null to small effect size). Both drugs predicted increased PTSD symptoms when combined with severe pain during labour. LIMITATIONS This study was observational, thus drug administration was not randomised. Additionally, PTSD symptoms were self-reported. CONCLUSIONS Peritraumatic N2O administration may reduce subsequent PTSD symptom severity and thus be a potential avenue for PTSD secondary prevention. This might also be the case for morphine. However, the role of severe peritraumatic pain in context of drug administration deserves further investigation.
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Affiliation(s)
- Camille Deforges
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland.
| | - Suzannah Stuijfzand
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland.
| | | | - Moira Robertson
- Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
| | - Tone Breines Simonsen
- HØKH - Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway; Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway.
| | - Malin Eberhard-Gran
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Women's Health, Women and Children's Division, Oslo University Hospital, Oslo, Norway.
| | - Susan Garthus-Niegel
- Department of Medicine, Medical School Hamburg, Hamburg, Germany; Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway; Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland; Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
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15
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Rosseland LA, Reme SE, Simonsen TB, Thoresen M, Nielsen CS, Eberhard-Gran M. Reply: Response to Letter to the Editor "Labor pain, birth experience and postpartum depression". Scand J Pain 2021; 20:861-863. [PMID: 32975207 DOI: 10.1515/sjpain-2020-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 09/01/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Silje Endresen Reme
- Department of Psychology, University of Oslo, Forskningsveien 3a, Oslo, 0373, Norway
| | - Tone Breines Simonsen
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
| | - Magne Thoresen
- Faculty of Medicine, Oslo Centre of Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | | | - Malin Eberhard-Gran
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
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16
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Rosseland LA, Reme SE, Simonsen TB, Thoresen M, Nielsen CS, Eberhard-Gran M. Corrigendum to: Are labor pain and birth experience associated with persistent pain and postpartum depression? A prospective cohort study. Scand J Pain 2020; 20:865. [PMID: 32892193 DOI: 10.1515/sjpain-2020-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silje Endresen Reme
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Tone Breines Simonsen
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
| | - Magne Thoresen
- Oslo Centre of Biostatistics and Epidemiology, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christopher Sivert Nielsen
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Chronic Diseases and Ageing, National Institute of Public Health, Oslo, Norway
| | - Malin Eberhard-Gran
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Department for Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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17
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Acharya RS, Tveter AT, Grotle M, Khadgi B, Koju R, Eberhard-Gran M, Stuge B. Cross-Cultural Adaptation and Validation of the Nepali Version of the Pelvic Girdle Questionnaire. J Manipulative Physiol Ther 2020; 43:257-265. [PMID: 32739042 DOI: 10.1016/j.jmpt.2019.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 04/04/2019] [Accepted: 04/07/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The purpose of this study was to translate, cross-culturally adapt, and assess the reliability and validity of the Pelvic Girdle Questionnaire (PGQ) in pregnant Nepalese women. METHODS The cross-cultural adaptation process was conducted according to the Guillemin guidelines. Reliability and validity were assessed using cross-sectional design. The participants responded to questionnaires of sociodemographics, the Nepali version of the PGQ, the Oswestry Disability Index, the Patient-Specific Functional Scale, the 5-item version of the Edinburgh Depression Scale, and the Numerical Pain Rating Scale. The internal consistency was assessed with Cronbach's alpha. The test-retest reliability was calculated using the intraclass correlation coefficient and smallest detectable change. Construct validity was assessed by testing 9 a priori hypotheses that examine correlations between the PGQ activity and symptom subscales, and also among the PGQ subscales and Oswestry Disability Index, Numerical Pain Rating Scale, Patient-Specific Functional Scale, and 5-item version of the Edinburgh Depression Scale. Spearman and Pearson's correlation were used to assess the correlations. RESULTS A sample of 111 pregnant women were included in the study. The Cronbach's alpha for the Nepali version of the total PGQ was good (α = 0.83), and the test-retest reliability was acceptable (ICC2.1, 0.72) with a measurement error of SDC95% 18.6 points. Seven of the 9 hypotheses found support, which confirms acceptable construct validity of the Nepali PGQ. CONCLUSION The Nepali version of the PGQ is a reliable and valid tool for assessing pelvic girdle pain in pregnant Nepalese women.
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Affiliation(s)
- Ranjeeta Shijagurumayum Acharya
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Kathmandu University Dhulikhel Hospital, Kavre, Nepal.
| | - Anne Therese Tveter
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Margreth Grotle
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; FORMI, Oslo University Hospital, Oslo, Norway
| | - Bimika Khadgi
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Kathmandu University Dhulikhel Hospital, Kavre, Nepal
| | - Rajendra Koju
- Department of Medicine, Kathmandu University School of Medical Sciences, Kathmandu University Dhulikhel Hospital, Kavre, Nepal
| | - Malin Eberhard-Gran
- Institute of Clinical Medicine, University of Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway; Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Britt Stuge
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
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18
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Osnes RS, Eberhard-Gran M, Follestad T, Kallestad H, Morken G, Roaldset JO. Mid-pregnancy insomnia is associated with concurrent and postpartum maternal anxiety and obsessive-compulsive symptoms: A prospective cohort study. J Affect Disord 2020; 266:319-326. [PMID: 32056894 DOI: 10.1016/j.jad.2020.01.140] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/04/2019] [Accepted: 01/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although many perinatal women are affected by anxiety, few studies have focused on perinatal anxiety and its potential triggers. The primary aim of this study was to examine concurrent and prospective associations between mid-pregnancy insomnia and perinatal anxiety. Furthermore, we compared psychosocial and reproductive characteristics between participants with and without mid-pregnancy insomnia and explored changes in the prevalence of obsessive-compulsive disorder (OCD) symptoms from mid-pregnancy to 8 weeks postpartum. METHODS This study was part of the Norwegian Depression and Anxiety in the Perinatal Period (DAPP) prospective, population-based, cohort study. We analyzed hospital birth records and questionnaire responses from pregnancy week 17 and postpartum week 8 (n = 530). The Bergen Insomnia Scale was used to measure insomnia and the Hopkins Symptom Checklist to measure anxiety. OCD symptoms were measured based on questions from the Mini-International Neuropsychiatric Interview. RESULTS Mid-pregnancy insomnia was significantly associated with both concurrent and postpartum anxiety in a linear mixed model adjusted for several potential confounders. Participants with mid-pregnancy insomnia had significantly higher levels of perinatal anxiety and postpartum OCD symptoms than participants with normal mid-pregnancy sleep. OCD symptoms affected more women after delivery than before (6.4% vs. 3.8% p = 0.034). LIMITATIONS Immigrants were underrepresented in our sample. CONCLUSION Our results suggest that mid-pregnancy insomnia is a marker for concurrent anxiety and predictor of postpartum anxiety. Future research should examine whether insomnia treatment starting in mid-pregnancy reduces both perinatal insomnia and anxiety. Health providers should also be aware that postpartum women have an increased risk of developing OCD symptoms.
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Affiliation(s)
- Rannveig S Osnes
- Department of Psychiatry, Ålesund Hospital, Møre & Romsdal Health Trust, Ålesund, Norway; Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Malin Eberhard-Gran
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway; Department of Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Østmarka Department of Psychiatry, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Gunnar Morken
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Østmarka Department of Psychiatry, St Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - John Olav Roaldset
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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19
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Shijagurumayum Acharya R, Tveter AT, Grotle M, Eberhard-Gran M, Stuge B. Prevalence and severity of low back- and pelvic girdle pain in pregnant Nepalese women. BMC Pregnancy Childbirth 2019; 19:247. [PMID: 31307421 PMCID: PMC6631866 DOI: 10.1186/s12884-019-2398-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 07/04/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Low back pain (LBP) and pelvic girdle pain (PGP) are commonly reported during pregnancy and are known to affect pregnant women's well-being. Still, these conditions are often considered to be a normal part of pregnancy. This study assesses the prevalence and severity of LBP and/or PGP among pregnant Nepalese women, as well as exploring factors associated with LBP and PGP. METHODS A cross-sectional study with successive recruitment of pregnant women was conducted at two district hospitals in Nepal from May 2016 to May 2017. The data was collected using self-reported questionnaires. Univariate and multivariate logistic regression were used to assess the associations between independent variables and LBP and/or PGP. RESULTS A total of 1284 pregnant women were included in the study. The reported prevalence of pregnancy-related LBP and/or PGP was 34%. Pain intensity was high with a mean score (standard deviation) of 6 (2). The median (25th-75th percentiles) disability scores according to the total Pelvic Girdle Questionnaire and Oswestry Disability Index were 20 (10-32) and 30 (21-38), respectively. Even though only 52% of the women believed that the pain would disappear after delivery, concern about LBP and/or PGP was reported to be low (median 2 (0-4) (Numeric Rating Scale 0-10)). In the final model for women with LBP and/or PGP the adjusted odds ratios were for body mass index (20-24, 25-30, > 30) 0.7 (95% confidence interval (CI), 0.44-1.21), 1.1 (95% CI, 0.66-1.83), and 1.5 (95% CI, 0.78-2.94) respectively, for pelvic organ prolapse symptoms 6.6 (95% CI, 4.93-8.95) and for women with educated husbands (primary or secondary, higher secondary or above) 1.1 (95% CI, 0.53-2.16) and 1.7 (95% CI, 0.84-3.47), respectively. CONCLUSIONS Pregnant Nepalese women commonly report LBP and/or PGP. The women experienced low disability despite severe pain intensity and poor beliefs in recovery after delivery.
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Affiliation(s)
- Ranjeeta Shijagurumayum Acharya
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Kathmandu University Dhulikhel Hospital, Kavre, Nepal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Anne Therese Tveter
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Margreth Grotle
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- FORMI, Oslo University Hospital, Oslo, Norway
| | - Malin Eberhard-Gran
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Department for Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Oslo, Eastern and Southern Norway Norway
| | - Britt Stuge
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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20
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Polte C, Junge C, von Soest T, Seidler A, Eberhard-Gran M, Garthus-Niegel S. Impact of Maternal Perinatal Anxiety on Social-Emotional Development of 2-Year-Olds, A Prospective Study of Norwegian Mothers and Their Offspring : The Impact of Perinatal Anxiety on Child Development. Matern Child Health J 2019; 23:386-396. [PMID: 30610530 DOI: 10.1007/s10995-018-2684-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction Anxiety in women is highly prevalent during pregnancy and in the postnatal period. Anxiety disorders in mothers have been linked to adverse outcomes in their children's development. However, large-scale prospective studies on this issue, covering both the prenatal and postnatal period with follow-up periods beyond the first year of life are scarce. Method In this prospective cohort study, data gathered from 1336 Norwegian women and their children were used. Maternal anxiety symptoms were measured at gestation week 17-19 and 32, as well as 8 weeks postpartum using the Symptom Check List. Child development problems were assessed at 2 years postpartum using the Ages & Stages Questionnaire: Social-Emotional. Logistic regressions were conducted to examine the association between maternal prenatal, postnatal, and perinatal anxiety and the risk of social-emotional development problems in 2-year-old children. Results Of all women, 8.2% experienced prenatal anxiety, 4.0% had postnatal anxiety, and 4.4% reported perinatal anxiety (i.e., anxiety in both the prenatal and postnatal period). 5.6% of the 2-year-olds showed problems in their social-emotional behavior. Child development problems were associated with maternal prenatal anxiety (Odds Ratio [OR] = 2.48, 95% CI 1.55-4.92), postnatal anxiety (OR 3.32, 95% CI 1.43-7.74), and anxiety both in the prenatal and postnatal period (OR 3.98, 95% CI 1.85-8.56). Adjusted for confounders, maternal anxiety continued to be a significant predictor of adverse child social-emotional development (postnatal anxiety: OR 2.46, 95% CI 1.01-5.97; perinatal anxiety: OR 2.40, 95% CI 1.03-5.59). Discussion Maternal postnatal anxiety and anxiety both during and after pregnancy are unique substantial predictors for problems in a 2-year-old's social-emotional development, even when controlled for confounders.
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Affiliation(s)
- Carolin Polte
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Carolin Junge
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | | | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Malin Eberhard-Gran
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway.,Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway.,Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Susan Garthus-Niegel
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Osnes RS, Roaldset JO, Follestad T, Eberhard-Gran M. Insomnia late in pregnancy is associated with perinatal anxiety: A longitudinal cohort study. J Affect Disord 2019; 248:155-165. [PMID: 30735852 DOI: 10.1016/j.jad.2019.01.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/09/2019] [Accepted: 01/20/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Postpartum anxiety (PPA) affects a substantial number of women. Despite increasing recognition of PPA, few studies have focused on perinatal anxiety and potential PPA triggers. Here we aimed to estimate the prevalence of perinatal anxiety disorders, and to explore the association between insomnia during late pregnancy and anxiety before and after childbirth. METHODS This study was part of the large population-based Akershus Birth Cohort. We analyzed data from the hospital's birth records and questionnaire responses from pregnancy weeks 17 and 32 and postpartum week 8 (n = 1563). Perinatal anxiety symptoms were measured using the Hopkins Symptom Check List. Anxiety disorder measurements were based on questions from the Mini-International Neuropsychiatric Interview. Insomnia was measured using the Bergen Insomnia Scale. RESULTS Among perinatal women, 10% reported symptoms of at least one anxiety disorder. The observed prevalence of obsessive-compulsive disorder was higher after delivery (4.2%) than during pregnancy (2.5%). Multiple regression analysis, with adjustment for several psychosocial and reproductive variables, indicated that insomnia during pregnancy was significantly associated with postpartum anxiety symptoms. However, this association was markedly weakened when depression variables were included in the analysis, indicating that gestational insomnia may also be a marker for a mood disorder. LIMITATIONS Immigrant and single women were underrepresented in our sample. CONCLUSIONS Our results suggest that anxiety disorders are prevalent during the perinatal period. Moreover, insomnia during pregnancy is associated with perinatal anxiety. Health professionals should be aware that women with gestational insomnia may have an increased risk of mood and anxiety disorders.
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Affiliation(s)
- Rannveig S Osnes
- Department of Psychiatry, Ålesund Hospital, Møre & Romsdal Health Trust, Ålesund, Norway; Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - John Olav Roaldset
- Department of Psychiatry, Ålesund Hospital, Møre & Romsdal Health Trust, Ålesund, Norway; Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Malin Eberhard-Gran
- HØKH, Research Unit, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway; Department for Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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Adler I, Weidner K, Eberhard-Gran M, Garthus-Niegel S. Der Einfluss von prä- und postpartaler mütterlicher Schlafqualität auf die Kindesentwicklung: eine 2-Jahres-Follow-up-Studie. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1678364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- I Adler
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Dresden
| | - K Weidner
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Dresden
| | - M Eberhard-Gran
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - S Garthus-Niegel
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Dresden
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Kjeldgaard HK, Vikanes Å, Benth JŠ, Junge C, Garthus-Niegel S, Eberhard-Gran M. The association between the degree of nausea in pregnancy and subsequent posttraumatic stress. Arch Womens Ment Health 2019; 22:493-501. [PMID: 30225528 PMCID: PMC6647437 DOI: 10.1007/s00737-018-0909-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/27/2018] [Indexed: 12/27/2022]
Abstract
Hyperemesis gravidarum (HG) is a pregnancy condition characterised by severe nausea and vomiting during early pregnancy. The experience of HG is for many women a traumatic event. Few studies have investigated a possible association between HG and birth-related posttraumatic stress. The objective of the current study was to assess whether HG increases the risk of birth-related posttraumatic stress symptoms (PTSS). This was a population-based pregnancy cohort study using data from the Akershus Birth Cohort Study (ABC study). A linear mixed model was used to estimate the association between the degree of nausea (no nausea (n = 574), mild nausea (n = 813), severe nausea (n = 522) and HG (hospitalised due to nausea, n = 20)) and PTSS score at 8 weeks and 2 years after birth. At 8 weeks postpartum, women with HG had higher PTSS scores compared to women with no nausea (p = 0.008), women with mild nausea (p = 0.019) and women with severe nausea (p = 0.027). After 2 years, women with HG had higher PTSS scores compared to women with no nausea (p = 0.038). Women with HG had higher PTSS scores following childbirth compared to women with less pronounced symptoms or no nausea at all. After 2 years, women with HG still had higher PTSS scores compared to women with no nausea. Although the overall differences in PTSS scores were small, the results may still be of clinical relevance.
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Affiliation(s)
- Helena Kames Kjeldgaard
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway.
| | - Åse Vikanes
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway ,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Carolin Junge
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway ,Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway ,Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Malin Eberhard-Gran
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway ,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway ,Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
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Eberhard-Gran M. M. Eberhard-Gran svarer. Tidsskriftet 2019; 139:19-0019. [DOI: 10.4045/tidsskr.19.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Junge C, von Soest T, Weidner K, Seidler A, Eberhard-Gran M, Garthus-Niegel S. Labor pain in women with and without severe fear of childbirth: A population-based, longitudinal study. Birth 2018; 45:469-477. [PMID: 29630751 DOI: 10.1111/birt.12349] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND This prospective study aims to investigate whether severe fear of childbirth increases pain perceptions during birth and whether co-occurring maternal health and birth factors as well as length and weight of the child explain the association. METHODS The study sample comprised women with a vaginal delivery and was drawn from the Akershus Birth Cohort. Data from the hospital birth's record and questionnaires at weeks 17-19 and 32 of pregnancy and 8 weeks postpartum were used (n = 1649). Analysis of variance and analysis of covariance were conducted to examine whether ratings of labor pain differed significantly between women with and without severe fear of childbirth and which factors explained the difference. RESULTS Women with severe fear of childbirth experienced significantly more labor pain than women without severe fear of childbirth (P < .01). However, when controlling for symptoms of maternal depression and anxiety, use of epidural/spinal anesthetic or nitrous oxide gas, and menstrual pain, this difference was no longer significant (P = .09). DISCUSSION Although the results show that labor pain is related to multiple physiological and psychological factors in a complex manner, symptoms of maternal depression and anxiety seem to play a central role for the experience of labor pain, and should therefore be focused on by health practitioners.
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Affiliation(s)
- Carolin Junge
- Norwegian Institute of Public Health, Oslo, Norway.,Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Malin Eberhard-Gran
- Norwegian Institute of Public Health, Oslo, Norway.,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Susan Garthus-Niegel
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
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Garthus-Niegel S, Horsch A, Bickle Graz M, Martini J, von Soest T, Weidner K, Eberhard-Gran M. The prospective relationship between postpartum PTSD and child sleep: A 2-year follow-up study. J Affect Disord 2018; 241:71-79. [PMID: 30098473 DOI: 10.1016/j.jad.2018.07.067] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/11/2018] [Accepted: 07/22/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The main aim of this study was to examine the prospective impact of maternal postpartum PTSD on several standardized child sleep variables two years postpartum in a large, population-based cohort of mothers. Moreover, we investigated the influence of numerous potential confounding maternal and child factors. Finally, we tested potential reverse temporal associations between child sleep eight weeks postpartum and maternal PTSD symptoms two years postpartum. METHODS This study is part of the population-based Akershus Birth Cohort, a prospective cohort study at Akershus University Hospital, Norway. Data from the hospital's birth record, from questionnaires at 17 weeks gestation, eight weeks and two years postpartum were used. At two years postpartum, 39% of the original participants could be retained, resulting in a study population of n = 1480. All child sleep variables significantly correlated with postpartum PTSD symptoms were entered into multiple linear regression analyses, adjusting for confounding factors. RESULTS Postpartum PTSD symptoms were related to all child sleep variables, except daytime sleep duration. When all significant confounding factors were included into multivariate regression analyses, postpartum PTSD symptoms remained a significant predictor for number and duration of night wakings (β = 0.10 and β = 0.08, respectively), duration of settling time (β = 0.10), and maternal rating of their child's sleep problems (β = 0.12, all p<.01. Child sleep at eight weeks postpartum was not significantly related to maternal sleep two years postpartum when controlling for postpartum PTSD at eight weeks. LIMITATIONS Child outcomes were based on maternal reporting and might be influenced by maternal mental health. CONCLUSIONS Our results showed for the first time that maternal postpartum PTSD symptoms were prospectively associated with less favorable child sleep, thus increasing the risk of developmental or behavioral problems through an indirect, but treatable pathway. Early detection and treatment of maternal postpartum PTSD may prevent or improve sleep problems and long-term child development.
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Affiliation(s)
- Susan Garthus-Niegel
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine,Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; Department of Child Health, Norwegian Institute of Public Health, P.O. box 222 Skøyen, 0213 Oslo, Norway.
| | - Antje Horsch
- Department Woman-Mother-Child, Faculty of Biology and Medicine, Lausanne University Hospital, Rue du Bugnon 21, CH-1011 Lausanne, Switzerland; Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, Lausanne University and Lausanne University Hospital, Rue du Bugnon 21, CH-1011 Lausanne, Switzerland
| | - Myriam Bickle Graz
- Department Woman-Mother-Child, Faculty of Biology and Medicine, Lausanne University Hospital, Rue du Bugnon 21, CH-1011 Lausanne, Switzerland
| | - Julia Martini
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Tilmann von Soest
- Department of Psychology, University of Oslo, P.O. box 1094, Blindern, 0317 Oslo, Norway
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine,Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Malin Eberhard-Gran
- Department of Child Health, Norwegian Institute of Public Health, P.O. box 222 Skøyen, 0213 Oslo, Norway; HØKH, Research Centre, Akershus University Hospital, P.O. box 1000, 1478 Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, P.O. box 1171, Blindern, 0318 Oslo, Norway
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Shakeel N, Sletner L, Falk RS, Slinning K, Martinsen EW, Jenum AK, Eberhard-Gran M. Prevalence of postpartum depressive symptoms in a multiethnic population and the role of ethnicity and integration. J Affect Disord 2018; 241:49-58. [PMID: 30096592 DOI: 10.1016/j.jad.2018.07.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/11/2018] [Accepted: 07/22/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Postpartum depression (PPD) may have adverse effects on both mother and child. The aims were to determine the prevalence of postpartum depressive symptoms, PPDS, identify associations with ethnicity and with the level of social integration. METHOD Population-based, prospective cohort study of 643 pregnant women (58% ethnic minorities) attending primary antenatal care in Oslo. Questionnaires regarding demographics and health issues were collected through interviews. PPDS was defined as a sum score ≥ 10 by the Edinburgh Postnatal Depression Scale, used as the main outcome in logistic regression analyses, first with ethnicity, second with level of integration as main explanatory factors. RESULTS The prevalence of PPDS was higher in ethnic minorities 12.7% (95% CI: 9.31-16.09) than in Western Europeans 4.8% (2.26-7.34). Adverse life events, lack of social support and depressive symptoms during the index pregnancy were other significant risk factors. Western European with PPDS were more likely to have had depressive symptoms also during pregnancy than women from ethnic minorities (72.2% versus 33.3%, p = 0.041). When replacing ethnicity with integration, a low level of integration was independently associated with PPDS (2.1 (1.11-3.95)). LIMITATIONS Cases with PPDS were limited. Heterogeneity in the ethnic groups is a concern. CONCLUSION Both point prevalence and new onset of PPDS was higher among ethnic minorities than among Western Europeans. Low level of integration was associated with PPDS. Our findings suggest that clinicians should be aware of the increased risk of new cases of PPDS among ethnic minorities compared to Western European women and offer evidence-based care accordingly.
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Affiliation(s)
- Nilam Shakeel
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Norway.
| | - Line Sletner
- Department of Pediatrics and Adolescents Medicine, Akershus University Hospital, Lørenskog, Norway.
| | - Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Norway.
| | - Kari Slinning
- Center for Child and Adolescent Mental Health Eastern and Southern Norway (R.BUP Oslo), Norway.
| | - Egil W Martinsen
- Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Norway.
| | - Malin Eberhard-Gran
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway; Health Services Research Centre, Akershus University Hospital, Lørenskog; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway.
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Achary RS, Tveter AT, Grotle M, Khadgi B, Eberhard-Gran M, Braekken IH, Stuge B. Pelvic Floor Muscle Training Program in Pregnant Nepalese Women- A Feasibility Study. Nepal J Obstet Gynaecol 2018. [DOI: 10.3126/njog.v13i2.21911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aims: Obstetric Fistula is one of the common pelvic floor dysfunctions that affects the women’s quality of life. PFMT is recommended as first line treatment for prevention and treatment of pelvic floor dysfunctions. There is lack of knowledge on the feasibility of performing a PFMT program in pregnant Nepalese women. The aim was to develop a Pelvic floor muscle training (PFMT) program and to assess the feasibility of the program by assessing attendance to antenatal follow-up visits and adherence to PFMT.
Methods: The PFMT program included development of education material (video, leaflet, and poster) and PFMT in different positions. Pregnant women (before 16 weeks of gestation) visiting Dhulikhel Hospital were recruited consecutively. Sociodemographic factors, pregnancy history, symptoms of urinary incontinence, pelvic organ prolapse and depression questionnaires were collected at first and last visit. Number of antenatal follow-up visits, exercise diary records and motivation questions for performing PFMT were also collected.Compliers were defined as women attending four or more PFMT antenatal follow-up visits.
Results: Two hundred and fifty three pregnant women with mean age25 (Standard deviation, (SD) 4) years and mean gestation weeks of 10(SD 3) were included. In total, 164 (65%) participants complied with the PFMT program and 89 (35%) did not comply.Eight percent of the women reported not doing PFMT and approximately 20% women over-reported to have performed PFMT.
Conclusions: More than half of the women completed the PFMT program. Adherence to PFMT had inconsistent results.
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Garthus-Niegel S, Horsch A, Handtke E, von Soest T, Ayers S, Weidner K, Eberhard-Gran M. The Impact of Postpartum Posttraumatic Stress and Depression Symptoms on Couples' Relationship Satisfaction: A Population-Based Prospective Study. Front Psychol 2018; 9:1728. [PMID: 30283380 PMCID: PMC6157399 DOI: 10.3389/fpsyg.2018.01728] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 08/27/2018] [Indexed: 11/13/2022] Open
Abstract
The couple relationship is of particular importance in the transition to parenthood and in the early childhood years because it is related to the well-being and mental health of partners, children, and the family. One factor that may substantially influence relationship quality and couple satisfaction after childbirth is the woman’s experience of birth. Approximately 2–4% of women develop posttraumatic stress disorder (PTSD) after childbirth, with potentially wide-ranging negative consequences for the women themselves and their families. To date, some qualitative studies have explored the influence of postpartum PTSD on couple relationship satisfaction. However, quantitative studies are sparse, with mixed results and methodological limitations. We hypothesized that postpartum PTSD will be prospectively associated with low couple relationship satisfaction, even when taking into account a variety of potential confounding variables, and that the effect of postpartum PTSD symptoms on couple relationship satisfaction will be mediated by postpartum depression symptoms. This study is based on data from the Akershus Birth Cohort study, a prospective cohort study. Information from hospital records and questionnaires completed at 17 weeks gestational age, as well as at 8 weeks and 2 years postpartum were used (n = 1480). PTSD symptoms were measured by the Impact of Event Scale and couple relationship satisfaction was assessed using a modified version of the Mehrabians Marital Satisfaction Scale. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale. Data were analyzed using bivariate correlations, multivariate regression analyses, and mediation analyses. Postpartum PTSD symptoms were prospectively related to low couple relationship satisfaction at 2 years postpartum, even when controlling for a considerable number of background factors. When including postpartum depression symptoms as predictor in the analyses, the effect of postpartum PTSD was no longer significant. Moreover, more detailed analyses showed that postpartum depression symptoms acted as a significant mediator, fully explaining the association of postpartum PTSD with couples’ relationship satisfaction. Early detection of couples’ relationship problems and the provision of professional help, particularly in high-risk couples may not only improve the quality of the couple relationship but also improve parenting and promote positive child outcomes.
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Affiliation(s)
- Susan Garthus-Niegel
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität, Dresden, Germany.,Department of Child Health, Norwegian Institute of Public Health, Nydalen, Norway
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.,Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Handtke
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität, Dresden, Germany
| | | | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, United Kingdom
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität, Dresden, Germany
| | - Malin Eberhard-Gran
- Department of Child Health, Norwegian Institute of Public Health, Nydalen, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine Campus Ahus, University of Oslo, Oslo, Norway
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Preis H, Benyamini Y, Eberhard-Gran M, Garthus-Niegel S. Childbirth preferences and related fears - comparison between Norway and Israel. BMC Pregnancy Childbirth 2018; 18:362. [PMID: 30185162 PMCID: PMC6126000 DOI: 10.1186/s12884-018-1997-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/28/2018] [Indexed: 12/13/2022] Open
Abstract
Background Fear of childbirth (FOC) could have significant impact on women’s childbearing choices and experience. Culture affects the way women conceptualize childbirth, influencing the fears and expectations they may hold in relation to it. In the current study, we examined differences in childbirth preferences of cesarean section and use of epidural analgesia between Norwegian and Israeli pregnant women. Later, we used the Norwegian six-factor solution of the widely-used Wijma Delivery Expectancy Questionnaire (W-DEQ-A) to compare levels of the different FOC factors. Finally, we investigated differences in the associations between FOC and childbirth preferences between the two countries. Methods Secondary analysis of two large surveys. Women from Israel (n = 490) and Norway (n = 2918) were recruited during prenatal check-ups in community clinics and a university hospital. At around 32 weeks of gestation, all participants filled out questionnaires, including the W-DEQ-A. Statistical analysis included exploratory factor analysis, confirmatory factor analysis, M/ANOVA, Spearman’s Rho and Fisher’s Z tests for the significance of the difference between independent correlations. Results The Norwegian six-factor solution of the W-DEQ fit well with the Israeli data. Norwegian women were more concerned about loneliness, feeling less self-efficacy, negatively appraising birth, and lacking positive anticipation. Israeli women were more concerned about negative outcomes for the child and experienced greater general fear and fear of pain. Norwegian women preferred more cesarean sections compared to Israeli women, who preferred more epidural use than Norwegians. FOC factors were more strongly related to childbirth preferences among Norwegians. Conclusions Cultural differences between Israel and Norway are reflected by the differences seen in the levels of fear reported across the six factors. In Israel, birth culture is very medicalized, motherhood is highly revered, and there is an emphasis on having “perfect babies”. In contrast, Norwegian women have fewer children, and birth is considered more natural. This could explain why Israeli women were more concerned that their child might be harmed during birth, while Norwegian women were more concerned with the physical and emotional expectations of birth. Electronic supplementary material The online version of this article (10.1186/s12884-018-1997-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heidi Preis
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Malin Eberhard-Gran
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Susan Garthus-Niegel
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway. .,Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Germany, Dresden, Germany.
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Shakeel N, Richardsen KR, Martinsen EW, Eberhard-Gran M, Slinning K, Jenum AK. Physical activity in pregnancy and postpartum depressive symptoms in a multiethnic cohort. J Affect Disord 2018; 236:93-100. [PMID: 29723768 DOI: 10.1016/j.jad.2018.04.081] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/06/2018] [Accepted: 04/14/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is strong evidence that postpartum depression is associated with adverse health effects in the mother and infant. Few studies have explored associations between physical activity in pregnancy and postpartum depression. We aimed to investigate whether physical activity during pregnancy was inversely associated with postpartum depressive symptoms, PPDS in a multiethnic sample. METHOD Population-based, prospective cohort of 643 pregnant women (58% ethnic minorities) attending primary antenatal care from early pregnancy to postpartum in Oslo between 2008 and 2010. Data on demographics and health outcomes were collected during standardized interviews. PPDS was defined by a sum score ≥10 from the Edinburgh Postnatal Depression Scale (EPDS), 3 months after birth. Physical activity was recorded with Sense Wear™ Pro3 Armband (SWA) in gestational week 28 and defined as moderate-to-vigorous intensity physical activity (MVPA) accumulated in bouts ≥10 min. RESULTS Women who accumulated ≥150 MVPA minutes/week had significantly lower risk (OR = 0.2, 95% CI: 0.06-0.90), for PPDS compared to those who did not accumulate any minutes/week of MVPA, adjusted for ethnic minority background, depressive symptoms in the index pregnancy and self-reported pelvic girdle syndrome. The results for MVPA persisted in the sub-sample of ethnic minority women. LIMITATIONS Numbers of cases with PPDS were limited. The SWA does not measure water activities. Due to missing data for SWA we used multiple imputations. CONCLUSION Women meeting the physical activity recommendation (>150 MVPA min/week) during pregnancy have a lower risk of PPDS compared to women who are not active during pregnancy.
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Affiliation(s)
- Nilam Shakeel
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Norway.
| | - Kåre Rønn Richardsen
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Norway.
| | - Egil W Martinsen
- Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Malin Eberhard-Gran
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway; Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway.
| | - Kari Slinning
- Center for Child and Adolescent Mental Health Eastern and Southern Norway (R.BUP Oslo), Norway.
| | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Norway.
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Garthus-Niegel S, Horsch A, Ayers S, Junge-Hoffmeister J, Weidner K, Eberhard-Gran M. The influence of postpartum PTSD on breastfeeding: A longitudinal population-based study. Birth 2018; 45:193-201. [PMID: 29265443 DOI: 10.1111/birt.12328] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND In most Western countries, breastfeeding rates are lower than what is recommended by the World Health Organization. Depression has been shown to influence breastfeeding outcomes; however, there is very little research on the role of postpartum posttraumatic stress disorder (PTSD). This study examined to what extent maternal postpartum PTSD predicted breastfeeding initiation, exclusive breastfeeding during the first 6 months, and continuation up to 1 and 2 years. METHODS The study is part of the large, population-based Akershus Birth Cohort. Data from the hospital's birth record and questionnaire data from 8 weeks and 2 years postpartum were used (n = 1480). All breastfeeding variables significantly correlated with postpartum PTSD were entered into stepwise logistic regression analyses. RESULTS Although most mothers (97.1%) initiated breastfeeding, considerably fewer adhered to the World Health Organization's breastfeeding guidelines about exclusive breastfeeding during the first 6 months (13.4%) or continued breastfeeding for 12 or 24 months postpartum (37.7% and 4.2%, respectively). Even after adjustment for important confounding variables, maternal postpartum PTSD was significantly associated with not initiating breastfeeding (aOR 5.98 [95% CI 1.79-19.97]). Postpartum PTSD was also significantly related to not continuing breastfeeding up to 12 months, although this association did not hold after adjusting for confounding variables. CONCLUSION Identifying women at risk of not initiating breastfeeding is crucial to prevent a negative influence on infant development and the development of the mother-infant bond. Early screening and treatment of women at risk of developing postpartum PTSD might be a way forward.
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Affiliation(s)
- Susan Garthus-Niegel
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany.,Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Antje Horsch
- Department Woman-Mother-Child, University Hospital Lausanne, Lausanne, Switzerland.,Institute of Higher Education in Healthcare Research (IUFRS), University of Lausanne, Lausanne, Switzerland
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Juliane Junge-Hoffmeister
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
| | - Malin Eberhard-Gran
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway.,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
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Chortatos A, Iversen PO, Haugen M, Eberhard-Gran M, Bjelland EK, Veierød MB. Nausea and vomiting in pregnancy - association with pelvic girdle pain during pregnancy and 4-6 months post-partum. BMC Pregnancy Childbirth 2018; 18:137. [PMID: 29739355 PMCID: PMC5941485 DOI: 10.1186/s12884-018-1764-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background To better understand previous associations reported regarding nausea and vomiting in pregnancy (NVP) and pelvic girdle pain (PGP), an investigation into timing of symptom onset for NVP and PGP in pregnancy, as well as the association of NVP with PGP 4-6 months post-partum was performed. We hypothesised that women with NVP symptoms would be most susceptible to experiencing persistence of PGP post-partum. Methods Fifty two thousand six hundred seventy-eight pregnancies from the Norwegian Mother and Child Cohort Study were analysed regarding nausea, vomiting, pelvic girdle pain, and health outcome data collected from questionnaires answered between gestation weeks 15, 20, 30, and 6 months post-partum. Logistic regression was used. Results Women experiencing NVP and PGP together (6.9%) were heaviest in the sample, youngest at menarche and had highest proportion with education ≤12 years. The primiparous women in this group had the lowest timespan from menarche to pregnancy. Women with nausea alone (NP) and NVP had higher odds of PGP 4-6 months post-partum (adjusted odds ratio, aOR = 2.14, 95% CI 1.70–2.71, and aOR = 2.83, 95% CI 2.25–3.57, respectively), compared to symptom-free women. NP/NVP symptoms appeared early in the first trimester, while PGP symptoms appeared later in pregnancy. Women with longer durations of nausea and/or vomiting had a higher proportion of PGP compared to shorter duration women. Conclusions Women with NP and NVP had increased odds of PGP 4-6 months post-partum, and women with a long duration of nausea and/or vomiting had a higher proportion of PGP than women with shorter duration, both during pregnancy and 4-6 months post-partum. This finding suggests a synergistic relationship between NP/NVP and PGP. Electronic supplementary material The online version of this article (10.1186/s12884-018-1764-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arthur Chortatos
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, PO Box 1122, Blindern, N-0317, Oslo, Norway. .,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, N-0317, Oslo, Norway.
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, N-0317, Oslo, Norway.,Department of Hematology, Oslo University Hospital, PO Box 4950, Nydalen, N-0424, Oslo, Norway
| | - Margaretha Haugen
- Domain for Infection Control and Environmental Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway
| | - Malin Eberhard-Gran
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, PO Box 1000, N-1478, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Elisabeth Krefting Bjelland
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403, Oslo, Norway.,Department of Obstetrics and Gynecology, Akershus University Hospital, PO Box 1000, N-1478, Lørenskog, Norway
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, PO Box 1122, Blindern, N-0317, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, N-0317, Oslo, Norway
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Petrovski BÉ, Vetvik KG, Lundqvist C, Eberhard-Gran M. Characteristics of menstrual versus non-menstrual migraine during pregnancy: a longitudinal population-based study. J Headache Pain 2018; 19:27. [PMID: 29611008 PMCID: PMC5880793 DOI: 10.1186/s10194-018-0853-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/12/2018] [Indexed: 01/03/2023] Open
Abstract
Background Migraine is a common headache disorder that affects mostly women. In half of these, migraine is menstrually associated, and ranges from completely asymptomatic to frequent pain throughout pregnancy. Methods The aim of the study was to define the pattern (frequency, intensity, analgesics use) of migrainous headaches among women with and without menstural migraine (MM) during pregnancy, and define how hormonally-related factors affect its intensity. Results The analysis was based upon data from 280 women, 18.6% of them having a self-reported MM. Women with MM described a higher headache intensity during early pregnancy and postpartum compared those without MM, but both groups showed improvement during the second half of pregnancy and directly after delivery. Hormonal factors and pre-menstrual syndrome had no effect upon headache frequency, but may affect headache intensity. Conclusions Individual treatment plan is necessary for women with migrainous headaches during pregnancy, especially for those suffering highest symptoms load.
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Affiliation(s)
- Beáta Éva Petrovski
- Health Services Research Centre, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Oslo, Norway. .,Faculty of Dentistry, University of Oslo, Geitmyrsveien 69, 0455, Oslo, Norway.
| | - Kjersti G Vetvik
- Department of Neurology, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Oslo, Norway
| | - Christofer Lundqvist
- Health Services Research Centre, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Oslo, Norway.,Department of Neurology, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Oslo, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Post Box 1000, 1478, Lørenskog, Norway
| | - Malin Eberhard-Gran
- Health Services Research Centre, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Oslo, Norway.,Department of Neurology, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Oslo, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Post Box 1000, 1478, Lørenskog, Norway.,Domain for Mental and Physical Health, Norwegian Institute of Public Health, Lovisenberggata 6-8, 0456, Oslo, Norway
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Sitras V, Šaltytė Benth J, Eberhard-Gran M. Obstetric and psychological characteristics of women choosing epidural analgesia during labour: A cohort study. PLoS One 2017; 12:e0186564. [PMID: 29045499 PMCID: PMC5646833 DOI: 10.1371/journal.pone.0186564] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/12/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the obstetric and psychological characteristics of women who opt to use epidural analgesia (EDA) during labour and the impact of participating in labour preparation courses on women's decisions to use EDA. DESIGN Longitudinal cohort study. SETTING Akershus University Hospital, Norway. POPULATION 2596 women with singleton pregnancies and intended vaginal delivery. METHODS Data were collected using two self-completed questionnaires at pregnancy weeks 17 and 32. Fear of childbirth was assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ). Symptoms of anxiety were measured by the Hopkins Symptom Check List (SCL-25) and depression by the Edinburgh Postnatal Depression Scale (EPDS). Obstetric and socio-demographic information was retrieved from birth records at the maternity ward. MAIN OUTCOME MEASURE Preference for EDA was indicated by the questionnaire item "I would prefer an epidural regardless" on a 4-point scale (1 = highly agree, 4 = highly disagree) at pregnancy week 32. RESULTS Twenty-one percent of the women (540/2596) answered that they would choose EDA as the only alternative method of analgesia during labour. Counselling for fear of childbirth [OR 3.23 (95%CI 2.12; 4.92)] and W-DEQ sum score ≥ 85 [OR 2.95 (95%CI 2.06; 4.23)] were significantly (p<0.001) associated with choice of EDA. Participation in labour preparation courses was significantly (p = 0.008) associated with a reduction of intended use of EDA during labour [OR 0.67 (95%CI 0.49; 0.90)]. CONCLUSION Fear of childbirth is significantly associated with women's choice of EDA during labour. On the other hand, women that participate in labour preparation courses would rather consider other methods of analgesia during labour.
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Affiliation(s)
- Vasilis Sitras
- Department of Obstetrics and Gynaecology, Akershus University Hospital, Oslo, Norway
- Department of Fetal Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Malin Eberhard-Gran
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
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Harris GME, Wood M, Eberhard-Gran M, Lundqvist C, Nordeng H. Patterns and predictors of analgesic use in pregnancy: a longitudinal drug utilization study with special focus on women with migraine. BMC Pregnancy Childbirth 2017; 17:224. [PMID: 28705177 PMCID: PMC5512742 DOI: 10.1186/s12884-017-1399-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 07/02/2017] [Indexed: 12/03/2022] Open
Abstract
Background Few studies have investigated the drug utilization patterns and factors predicting drug use in pregnant women with migraine. This longitudinal drug utilization study aimed to describe patterns of analgesic use in a sample of Norwegian pregnant women according to their migraine history, and to identify predictors for analgesic use among these women. Methods Pregnant women giving birth at Akershus University Hospital between 2008 and 2010 were recruited at ultrasound examination in gestational week 17. Data were collected by questionnaires in gestational weeks 17 and 32, and at 8 weeks postpartum, and linked to birth records. Women were grouped into four categories according to migraine history: no migraine history, previous migraine history, recent migraine history (within 1 year prior to pregnancy) and migraine in pregnancy. Patterns of use of analgesics were analyzed descriptively. Multivariable logistic regression was used to identify factors predicting analgesic use. Results Out of 1981 women, 5.0% reported having migraine in pregnancy, 13.2% had a recent history of migraine, 11.5% had a previous history of migraine, and 68.8% reported no history of migraine. Analgesic use declined during pregnancy. Many women switched from triptans and non-steroidal anti-inflammatory drugs to paracetamol, which constituted most of the analgesic use. Factors associated with analgesic use included recent migraine history (OR 1.6, 95% CI 1.2–2.2), more severe headache intensity (OR 1.3, 95% CI 1.3–1.4), smoking (OR 1.9, 95% CI 1.1–3.3) and multiparity (OR 1.4, 95% CI 1.1–1.7). Conclusions Women with migraine stop or switch medications during pregnancy. Analgesic use in pregnancy is affected by migraine characteristics and intensity, and also by socio-demographic factors. Clinicians should bear this in mind when giving advice on adequate management of migraine in pregnancy and safe analgesic use. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1399-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gerd-Marie Eskerud Harris
- Pharmacoepidemiology & Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box. 1068, Blindern, 0316, Oslo, Norway.
| | - Mollie Wood
- Pharmacoepidemiology & Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box. 1068, Blindern, 0316, Oslo, Norway
| | - Malin Eberhard-Gran
- Department of Child Health, National Institute of Public Health, Oslo, Norway.,Health Services Research, Research Department, Akershus University Hospital and University of Oslo, Campus Ahus, Lørenskog, Norway
| | - Christofer Lundqvist
- Health Services Research, Research Department, Akershus University Hospital and University of Oslo, Campus Ahus, Lørenskog, Norway
| | - Hedvig Nordeng
- Pharmacoepidemiology & Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box. 1068, Blindern, 0316, Oslo, Norway.,Department of Child Health, National Institute of Public Health, Oslo, Norway
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Garthus-Niegel S, Ayers S, Weidner K, Soest T, Eberhard-Gran M. Auswirkungen postpartaler posttraumatischer Belastungsstörungen auf die Entwicklung des Kindes: eine populationsbasierte 2-Jahres-Follow-up-Studie. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1598129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- S Garthus-Niegel
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Medizinische Akademie Carl Gustav Carus Dresden
| | - S Ayers
- City University London, Great Britain
| | - K Weidner
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Medizinische Akademie Carl Gustav Carus Dresden
| | - T Soest
- University of Oslo, Oslo, Norway
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Junge C, Garthus-Niegel S, Soest T, Weidner K, Eberhard-Gran M. Der Einfluss von Geburtsangst auf das Erleben von Geburtsschmerzen: eine bevölkerungsbezogene Kohortenstudie. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1598122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- C Junge
- Institut und Poliklinik für Arbeits-und Sozialmedizin, Medizinische Akademie Carl Gustav Carus Dresden
| | - S Garthus-Niegel
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Medizinische Akademie Carl Gustav Carus Dresden
| | - T Soest
- Department of psychology, University of Oslo, Oslo, Norway
| | - K Weidner
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Medizinische Akademie Carl Gustav Carus Dresden
| | - M Eberhard-Gran
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
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Sivertsen B, Petrie KJ, Skogen JC, Hysing M, Eberhard-Gran M. Insomnia before and after childbirth: The risk of developing postpartum pain-A longitudinal population-based study. Eur J Obstet Gynecol Reprod Biol 2017; 210:348-354. [PMID: 28126668 DOI: 10.1016/j.ejogrb.2017.01.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/16/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine if insomnia before and after childbirth predicts the development of postpartum bodily pain. METHODS This study is part of a longitudinal cohort study, the Akershus Birth Cohort Study, which targeted all women giving birth at Akershus University Hospital in Norway. The current sample is comprised of 1480 women who participated at all three time points, yielding a participation rate of 32% of the 4662 women who originally consented to participate. The Bergen Insomnia Scale (BIS) was used to measure insomnia and a latent profile analysis (LPA) was used to identify subsets of women who shared a similar pattern of responses on the BIS-scale across the three time points. Pain was measured using the bodily pain scale, derived from the Primary Care Evaluation of Mental Disorders (PRIME-MD) and symptoms of depression were measured by the Edinburgh Postnatal Depression Scale (EPDS). RESULTS Using a latent profile analysis a three class model showed the best fit and identified one major group (55.6%) with a low BIS scores across all three time points, one group with intermediate BIS scores (32.9%), and a smaller group (11.5%) with higher BIS scores across all three times. The chronic high insomnia group had a 2.8-fold increased risk of reporting high levels of bodily pain. The chronic intermediate group was associated with a 2.2-fold increased risk of bodily pain at two years postpartum. Adjusting for demographics and lifestyle behaviors did not reduce any of the associations, while adjusting for depression significantly attenuated the associations. Additional adjustment for pain at eight weeks postpartum further reduced the magnitude of the associations, but both chronic intermediate insomnia and chronic high insomnia remained strongly associated with the onset of bodily pain in the fully adjusted models (RR=1.75, 95% CI: 1.37-2.23) and RR=1.63, 95% CI: 1.15-2.32, respectively). CONCLUSIONS The high prevalence of insomnia among women during and after childbirth, in combination with the strong prospective association with impaired physical health, emphasizes the importance of adequately identifying, preventing and treating insomnia for this population.
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Affiliation(s)
- Børge Sivertsen
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 973 Sentrum, 5808 Bergen, Norway; The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, P.O. Box 7810, N-5020 Bergen, Norway; Department of Psychiatry, Helse Fonna HF, P.O. Box 2170, N-5504 Haugesund, Norway.
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland 1142, New Zealand
| | - Jens Christoffer Skogen
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 973 Sentrum, 5808 Bergen, Norway; The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, P.O. Box 7810, N-5020 Bergen, Norway; Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
| | - Mari Hysing
- The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, P.O. Box 7810, N-5020 Bergen, Norway
| | - Malin Eberhard-Gran
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 973 Sentrum, 5808 Bergen, Norway; Health Services Research Center, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
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Kjeldgaard HK, Eberhard-Gran M, Benth JŠ, Vikanes ÅV. Hyperemesis gravidarum and the risk of emotional distress during and after pregnancy. Arch Womens Ment Health 2017; 20:747-756. [PMID: 28842762 PMCID: PMC5691116 DOI: 10.1007/s00737-017-0770-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 08/07/2017] [Indexed: 12/11/2022]
Abstract
Hyperemesis gravidarum (HG) is a pregnancy condition characterised by severe nausea and vomiting. Previous studies have shown an association between HG and depressive symptoms during pregnancy, but little is known about the risk of maternal psychological distress following an HG pregnancy. The objective of the current study was therefore to assess the association between HG and emotional distress during and after pregnancy. This was a population-based pregnancy cohort study using data from the Norwegian Mother and Child Cohort Study. A total of 851/92,947 (0.9%) had HG. Emotional distress was measured by the Hopkins Symptom Checklist (SCL-5) in gestational weeks 17 and 32 and 6 and 18 months postpartum. The generalised estimating equations model was estimated for assessing time trends in emotional distress. Adjustments were made for previous HG, lifetime history of depression, maternal age, parity, BMI, smoking before pregnancy, physical activity, length of education, and pelvic girdle pain. Women with HG had higher odds for emotional distress than women without HG at the 17th (p < 0.001) and 32nd gestational weeks (p = 0.001) in addition to 6 months postpartum (p = 0.005) but not 18 months postpartum (p = 0.430). Adjusted odds for emotional distress varied significantly over time for women with and without HG (p = 0.035). Women with HG were more likely to report emotional distress compared to women without HG during pregnancy and 6 months postpartum, but the difference between the groups disappeared 18 months after birth. The results suggest that the increased risk of developing emotional distress may primarily be a consequence of HG.
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Affiliation(s)
- Helena Kames Kjeldgaard
- HØKH, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Norway.
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway.
| | - Malin Eberhard-Gran
- HØKH, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jūratė Šaltytė Benth
- HØKH, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
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Kjeldgaard HK, Eberhard-Gran M, Benth JŠ, Nordeng H, Vikanes ÅV. History of depression and risk of hyperemesis gravidarum: a population-based cohort study. Arch Womens Ment Health 2017; 20:397-404. [PMID: 28064341 PMCID: PMC5423929 DOI: 10.1007/s00737-016-0713-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/26/2016] [Indexed: 12/27/2022]
Abstract
Hyperemesis gravidarum (HG) is a pregnancy condition characterised by debilitating nausea and vomiting. HG has been associated with depression during pregnancy but the direction of the association remains unclear. The aim of this study was to assess whether previous depression is associated with HG. This is a population-based pregnancy cohort study using data from The Norwegian Mother and Child Cohort Study. The study reviewed 731 pregnancies with HG and 81,055 pregnancies without. Logistic regression analyses were performed to examine the association between a lifetime history of depression and hyperemesis gravidarum. Odds ratios were adjusted for symptoms of current depression, maternal age, parity, body mass index, smoking, sex of the child, education and pelvic girdle pain. A lifetime history of depression was associated with higher odds for hyperemesis gravidarum (aOR = 1.49, 95% CI (1.23; 1.79)). Two thirds of women with hyperemesis gravidarum had neither a history of depression nor symptoms of current depression, and 1.2% of women with a history of depression developed HG. A lifetime history of depression increased the risk of HG. However, given the fact that only 1.2% of women with a history of depression developed HG and that the majority of women with HG had no symptoms of depression, depression does not seem to be a main driver in the aetiology of HG.
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Affiliation(s)
- Helena Kames Kjeldgaard
- Health Services Research Unit, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Norway. .,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway.
| | - Malin Eberhard-Gran
- Health Services Research Unit, Akershus University Hospital, Post Box 1000, 1478 Lørenskog, Norway ,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway ,Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Health Services Research Unit, Akershus University Hospital, Post Box 1000, 1478 Lørenskog, Norway ,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Hedvig Nordeng
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway ,PharmacoEpidemiology & Drug Safety Research Group, Department of Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway
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Garthus-Niegel S, Ayers S, Martini J, von Soest T, Eberhard-Gran M. The impact of postpartum post-traumatic stress disorder symptoms on child development: a population-based, 2-year follow-up study. Psychol Med 2017; 47:161-170. [PMID: 27682188 DOI: 10.1017/s003329171600235x] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Against the background of very limited evidence, the present study aimed to prospectively examine the impact of maternal postpartum post-traumatic stress disorder (PTSD) symptoms on four important areas of child development, i.e. gross motor, fine motor, communication and social-emotional development. METHOD This study is part of the large, population-based Akershus Birth Cohort. Data from the hospital's birth record as well as questionnaire data from 8 weeks and 2 years postpartum were used (n = 1472). The domains of child development that were significantly correlated with PTSD symptoms were entered into regression analyses. Interaction analyses were run to test whether the influence of postpartum PTSD symptoms on child development was moderated by child sex or infant temperament. RESULTS Postpartum PTSD symptoms had a prospective relationship with poor child social-emotional development 2 years later. This relationship remained significant even when adjusting for confounders such as maternal depression and anxiety or infant temperament. Both child sex and infant temperament moderated the association between maternal PTSD symptoms and child social-emotional development, i.e. with increasing maternal PTSD symptom load, boys and children with a difficult temperament were shown to have comparatively higher levels of social-emotional problems. CONCLUSIONS Examining four different domains of child development, we found a prospective impact of postpartum PTSD symptoms on children's social-emotional development at 2 years of age. Our findings suggest that both boys and children with an early difficult temperament may be particularly susceptible to the adverse impact of postpartum PTSD symptoms. Additional studies are needed to further investigate the mechanisms at work.
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Affiliation(s)
- S Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine,TU Dresden,Faculty of Medicine,Fetscherstr. 74,01307 Dresden,Germany
| | - S Ayers
- Centre for Maternal and Child Health,School of Health Sciences,City University London,London,UK
| | - J Martini
- Department of Child and Adolescent Psychiatry,TU Dresden,Faculty of Medicine,Schubertstr. 42,01307 Dresden,Germany
| | - T von Soest
- Department of Psychology,University of Oslo,Oslo,Norway
| | - M Eberhard-Gran
- Department of Child Health,Norwegian Institute of Public Health,Oslo,Norway
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Abstract
In this longitudinal population study, the aims were to study associations of mode of delivery with new onset of pelvic pain and changes in pelvic pain scores up to 7 to 18 months after childbirth. We included 20,248 participants enrolled in the Norwegian Mother and Child Cohort Study (1999-2008) without preexisting pelvic pain in pregnancy. Data were obtained by 4 self-administered questionnaires and linked to the Medical Birth Registry of Norway. A total of 4.5% of the women reported new onset of pelvic pain 0 to 3 months postpartum. Compared to unassisted vaginal delivery, operative vaginal delivery was associated with increased odds of pelvic pain (adjusted odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.06-1.59). Planned and emergency cesarean deliveries were associated with reduced odds of pelvic pain (adjusted OR: 0.48; 95% CI: 0.31-0.74 and adjusted OR: 0.65; 95% CI: 0.49-0.87, respectively). Planned cesarean delivery, young maternal age, and low Symptom Checklist-8 scores were associated with low pelvic pain scores after childbirth. A history of pain was the only factor associated with increased pelvic pain scores over time (P = 0.047). We conclude that new onset of pelvic pain after childbirth was not commonly reported, particularly following cesarean delivery. Overall, pelvic pain scores were rather low at all time points and women with a history of pain reported increased pelvic pain scores over time. Hence, clinicians should follow up women with pelvic pain after a difficult childbirth experience, particularly if they have a history of pain.
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Affiliation(s)
- Elisabeth Krefting Bjelland
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway Domain for Mental and Physical Health, Norwegian Institute of Public Health, Norway Department of Public Health and Caring Sciences, Uppsala University, Sweden Norwegian National Advisory Unit on Women's Health, Division of Women and Children, Oslo University Hospital Rikshospitalet, Norway Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway
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Rognmo K, Sivertsen B, Eberhard-Gran M. Self-reported short sleep duration and insomnia symptoms as predictors of post-pregnancy weight change: Results from a cohort study. ACTA ACUST UNITED AC 2016; 12:465-474. [PMID: 27634975 DOI: 10.1177/1745505716668871] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/27/2016] [Accepted: 08/09/2016] [Indexed: 11/17/2022]
Abstract
This study aims to investigate whether change in sleep duration and insomnia symptoms in the postpartum period is related to change in body mass index from before to 2 years after pregnancy. This study is based on self-report data from a Norwegian cohort, the AHUS Birth Cohort Study. Data were collected at 8 weeks (T1) and 2 years (T2) postpartum. Data from 812 women were analyzed. The results showed that only women with symptoms of insomnia at both T1 and T2 (persistent symptoms) had a greater increase in body mass index compared to women with no insomnia symptoms at T1 or T2.The results indicate that persistent insomnia symptoms are related to a greater increase in body mass index.
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Affiliation(s)
- Kamilla Rognmo
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Børge Sivertsen
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.,Uni Research Health, Bergen, Norway.,Department of Psychiatry, Helse Fonna HF, Haugesund, Norway
| | - Malin Eberhard-Gran
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.,Health Services Research Center, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway
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Junge C, Garthus-Niegel S, Slinning K, Polte C, Simonsen TB, Eberhard-Gran M. The Impact of Perinatal Depression on Children’s Social-Emotional Development: A Longitudinal Study. Matern Child Health J 2016; 21:607-615. [DOI: 10.1007/s10995-016-2146-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Personality may influence sleep in perinatal women. A follow-up study was conducted among 3,752 pregnant, then postpartum women at Akershus University Hospital, Norway. The Big Five personality dimensions were measured by the Mini-International Personality Item Pool in week 17 of pregnancy. Insomnia was measured by the Bergen Insomnia Scale in pregnancy week 32 and 8 weeks postpartum, along with self-reported sleep times. The Edinburgh Postnatal Depression Scale measured depression, and the Hopkins Symptom Checklist measured anxiety. Adjusted for current anxiety, depression, and demographic variables, the personality traits Neuroticism and Agreeableness were associated with insomnia in pregnancy. No personality traits were associated with postpartum insomnia. Extraversion was associated with longer postpartum sleep duration and better sleep efficiency, and Agreeableness with shorter sleep duration.
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Affiliation(s)
- Signe K Dørheim
- a MoodNet Research Group Division of Psychiatry , Stavanger University Hospital
| | - Susan Garthus-Niegel
- b Division of Mental Health Norwegian Institute of Public Health ;,c Institute and Outpatient Clinics of Occupational and Social Medicine TU Dresden , Faculty of Medicine
| | - Bjørn Bjorvatn
- d Norwegian Competence Center for Sleep Disorders Haukeland University Hospital.,e Department of Global Public Health and Primary Care University of Bergen
| | - Malin Eberhard-Gran
- b Division of Mental Health Norwegian Institute of Public Health ;,f Health Services Research Center Akershus University Hospital.,g Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo
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Harris GME, Wood M, Eberhard-Gran M, Nordeng HM. Patterns of analgesic use in pregnant women with migraine – A drug utilization study based on data from the Akershus Birth Cohort Study. Reprod Toxicol 2016. [DOI: 10.1016/j.reprotox.2016.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hysing M, Sivertsen B, Garthus-Niegel S, Eberhard-Gran M. Pediatric sleep problems and social-emotional problems. A population-based study. Infant Behav Dev 2016; 42:111-8. [DOI: 10.1016/j.infbeh.2015.12.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/15/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
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Kvalevaag AL, Ramchandani PG, Hove O, Eberhard-Gran M, Assmus J, Havik OE, Sivertsen B, Biringer E. Parents' Prenatal Mental Health and Emotional, Behavioral and Social Development in Their Children. Child Psychiatry Hum Dev 2015; 46:874-83. [PMID: 25504529 DOI: 10.1007/s10578-014-0527-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examines the association between expectant parents' psychological distress and children's development at 36 months old. This is a prospective population study based on the Norwegian Mother and Child Cohort Study, N = 31,663. Logistic regression models were used to assess whether high scores (cutoff ≥ 2.00) on the symptom checklist-5 in parents predicted higher levels (cutoff ≥ 90 percentile) of developmental problems in their children. The risk of emotional and behavioral problems were significantly increased in children when both parents were affected by psychological distress during pregnancy, fully adjusted OR 2.35 (95% CI 1.36, 4.07) and OR 2.65 (96% CI 1.564.48), respectively. The risk was higher when mothers reported high level of psychological distress than when only the fathers did, but the risk of emotional difficulties in children was highest when both parents presented high levels of psychological distress, indicating an additive effect of parental psychological distress.
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Affiliation(s)
- Anne Lise Kvalevaag
- Department of Psychiatry, Helse Fonna HF, P.O. Box 2170, 5504, Haugesund, Norway.
| | - Paul G Ramchandani
- Academic Unit of Child and Adolescent Psychiatry, 3rd Floor QEQM Building, Imperial College, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Oddbjørn Hove
- Department of Psychiatry, Helse Fonna HF, P.O. Box 2170, 5504, Haugesund, Norway
| | - Malin Eberhard-Gran
- Division of Mental Health, Norwegian Institute of Public Health, Nydalen, P.O. Box 4404, 0403, Oslo, Norway.,Health Services Research Center, Akershus University Hospital, Lørenskog, Norway
| | - Jörg Assmus
- Center for Clinical Research, Haukeland University Hospital, 5021, Bergen, Norway
| | - Odd E Havik
- Department of Clinical Psychology, University of Bergen, Christiesgt. 12, 5020, Bergen, Norway
| | - Børge Sivertsen
- Department of Psychiatry, Helse Fonna HF, P.O. Box 2170, 5504, Haugesund, Norway.,Division of Mental Health, Norwegian Institute of Public Health, Kalfarveien 31, 5018, Bergen, Norway.,Department of Psychiatry, Uni Health, Uni Research, Bergen, Norway
| | - Eva Biringer
- Department of Psychiatry, Helse Fonna HF, P.O. Box 2170, 5504, Haugesund, Norway
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