Trajectories and Predictors of Symptoms of Depression in Chinese Women From Early Pregnancy to the Early Postpartum Period

ObjectiveTo explore the trajectories and predictors of symptoms of depression in Chinese women from early pregnancy to 3 months after birth.DesignProspective cohort study.SettingSeveral maternal and child health care institutions and obstetric departments of general hospitals in Beijing, Jiangsu, Hunan, Sichuan, Shandong, Guangdong, and Shanxi provinces in China.ParticipantsChinese women (N = 667) during pregnancy and the postpartum period.MethodsFrom August 2019 to June 2020, participants from several tertiary hospitals in China who completed at least three measurements during early pregnancy to 3 months after birth (from time point 1 to time point 5) were included for data analysis. We used the self-administered basic information questionnaire and the Edinburgh Postnatal Depression Scale for follow-up. We used Mplus version 8.3 to construct the growth mixture modeling and SPSS version 25.0 to carry out logistic regression analysis.ResultsWe found three potential trajectories of symptoms of depression during pregnancy and the postpartum period: the down-then-up healthy group (Class 1, 68.5%), steady-growth moderate-risk group (Class 2, 27.5%), and up-then-down high-risk group (Class 3, 4.0%). Multinomial logistic regression analysis showed that being pregnant for the first time, being a company employee, being less satisfied with the living environment, and the occurrence of negative life events were significant predictors of the Class 2 trajectory, whereas younger age, being less satisfied with food, and the occurrence of negative life events were predictors of the Class 3 trajectory.ConclusionThe trajectories of symptoms of depression during pregnancy and the postpartum period among Chinese women showed significant group heterogeneity. The trajectory categories were influenced not only by demographics and pregnancy-related factors but also by maternal subjective feelings.     

Universal Postpartum Mental Health Screening for Parents of Newborns With Prenatally Diagnosed Birth Defects

Objective

To describe the implementation of a nurse-led project to screen parents for depression and traumatic stress in the postpartum period after visiting their newborns in the NICU.

Comfort and Satisfaction Among Women Who Used Different Options for Analgesia During Labor and Birth

ObjectiveTo determine if comfort and satisfaction with the birth experience differed among women who used nitrous oxide (N₂O), epidural analgesia, or no analgesia during labor and birth.DesignNonexperimental, cross-sectional, between-subjects.SettingMaternity care units in three U.S. Midwest hospitals from June to October 2019.ParticipantsA total of 84 women with spontaneous vaginal birth at term gestation (≥37 weeks).MethodsWomen were grouped according to self-selected pain management method: N₂O and oxygen (50%/50% mixture) only (n = 28), epidural analgesia (may have been in combination with other analgesia options; n = 28), or no analgesia (n = 28). We collected data within 6 hours after childbirth using the Birth Satisfaction Scale–Revised and the researcher-modified Childbirth Comfort Questionnaire. We analyzed data for differences in comfort and satisfaction scores among the three groups of women using analysis of variance.ResultsWe found no statistically significant differences related to comfort during labor and birth among women who used N₂O only, epidural analgesia, or no analgesia during labor and birth, F(2, 81) = 1.11, p = .34. We also found no statistically significant differences related to satisfaction with the birth experience among women who used N₂O only, epidural analgesia, or no analgesia during labor and birth, F(2, 81) = .084, p = .92.ConclusionOur finding of no statistically significant differences in comfort and satisfaction with the birth experience across groups highlights the need to present comprehensive pain management options to women for labor and birth, such as N₂O.     

Physical Activity Prior to and During Pregnancy and Risk of Postpartum Depressive Symptoms

Objective: To examine the relationship between physical activity before and during the last trimester of pregnancy and postpartum depressive symptoms.
Design: Secondary analysis of data from the 2004 and 2005 Pregnancy Risk Assessment Monitoring System.
Settings: Mailed questionnaire or telephone interview of new mothers in North Carolina.
Patients/Participants: Female residents of North Carolina, ages 18 to 45 ( n =2,169), who had given birth to a live infant in the past 2 to 6 months.
Methods: Information on physical activity and depressive symptoms was self-reported. Logistic regression was used to examine the physical activity-depressive symptom associations while controlling for confounding variables.
Results: After adjustment for confounders, there were no statistically significant associations between being physically active before and/or during pregnancy and feeling depressed or "down." However, participants who were physically active both prepregnancy and during the last trimester had decreased odds of having little interest or pleasure compared with participants who were not physically active, after adjustment for age and marital status (odds ratio =0.66, 95% confidence interval: 0.49, 0.87).
Conclusion: Although regular physical activity is recommended for healthy women during pregnancy, additional studies are needed to investigate the physical activity-depressive symptoms association. If confirmed in other studies, physical activity may be an additional option for women who want to ease postpartum depressive symptoms.     

Scoping Review of the Associations Between Perinatal Substance Use and Perinatal Depression and Anxiety

ObjectiveTo evaluate published literature on the associations between perinatal substance use (PSU), perinatal depression and anxiety (PDA), and known maternal–newborn outcomes.Data SourcesWe conducted a systematic search of health-related databases, including PubMed, CINAHL, MEDLINE, and Embase. Search terms included maternal mental health, substance use, postpartum, opioid, alcohol, methamphetamine, addiction, dependence, pregnancy, depression, and anxiety.Study SelectionWe included English-language, peer-reviewed reports of primary research and systematic reviews that were published between 2010 and 2020 and focused on PSU and PDA. We excluded commentaries, nonsystematic reviews, and articles on maternal mental health other than PDA. Fourteen of 379 articles met the inclusion criteria.Data ExtractionWe used the Joanna Briggs Institute Review Guidelines to guide extraction of the following data: author(s), year of publication, type of study, country of origin, study sample, targeted substance(s), mental health, key findings, and recommendation(s).Data SynthesisIn studies of PSU, researchers identified a strong association with PDA. Likewise, researchers investigating PDA found a strong association with PSU. Findings from these articles suggest an increasing risk for PSU with increasing severity of PDA, depending on the specific substances of use. Findings also indicated that women with polysubstance use have greater odds for comorbid perinatal mental health conditions. A relationship between PSU and PDA and adverse newborn outcomes, such as low birth weight, was found.ConclusionThere is a paucity of published research on co-occurring PSU and PDA. However, polysubstance use appears to be associated with the greatest risk for PDA. It is essential to address PSU and PDA together to better understand the effects on maternal and infant outcomes.     

Research Recommendations on the Effects of Postpartum Depression and Pain on Infant Care and Development

Postpartum depression is one of the most common complications of childbirth, and another is pain. A growing body of research shows that the severity and duration of postpartum pain can increase a woman’s risk for postpartum depression. Postpartum depression and pain negatively affect maternal well-being, and postpartum depression has been associated with adverse outcomes in children. However, there is a dearth of information about the effects of postpartum depression and pain on infant care and development. The objectives of this commentary were to highlight the need to address this gap in the literature, offer a preliminary conceptual model to advance the field, and ignite new lines of inquiry to inform infant care and development.     

Prenatal Depressive Symptoms and Postpartum Sexual Risk Among Young Urban Women of Color

Study ObjectiveTo determine whether prenatal depressive symptoms are associated with postpartum sexual risk among young, urban women of color.DesignParticipants completed surveys during their second trimester of pregnancy and at 1 year postpartum. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression Scale, excluding somatic items because women were pregnant. Logistic and linear regression models adjusted for known predictors of sexual risk and baseline outcome variables were used to assess whether prenatal depressive symptoms make an independent contribution to sexual risk over time.SettingFourteen community health centers and hospitals in New York City.ParticipantsThe participants included 757 predominantly black and Latina (91%, n = 692) pregnant teens and young women aged 14-21 years.Interventions and Main Outcome MeasuresThe main outcome measures were number of sex partners, condom use, exposure to high-risk sex partners, diagnosis of a sexually transmitted disease, and repeat pregnancy.ResultsHigh levels of prenatal depressive symptoms were significantly associated with increased number of sex partners (β = 0.17; standard error, 0.08), decreased condom use (β = −7.16; standard error, 3.08), and greater likelihood of having had sex with a high-risk partner (odds ratio = 1.84; 95% confidence interval, 1.26-2.70), and repeat pregnancy (odds ratio = 1.72; 95% confidence interval, 1.09-2.72), among participants who were sexually active (all P < .05). Prenatal depressive symptoms were not associated with whether participants engaged in postpartum sexual activity or sexually transmitted disease incidence.ConclusionScreening and treatment for depression should be available routinely to women at risk for antenatal depression.     

Establishment of a Community Advisory Board to Address Postpartum Depression Among Indigenous Women

In this article, we describe the process of establishing an academically and tribally supported community advisory board (CAB) to guide and inform community-engaged research about postpartum depression (PPD) among Indigenous women. Using a community-based participatory research framework, we created a CAB with stakeholders from the Chickasaw Nation because they are well situated to inform a research agenda about PPD in Indigenous women. We developed CAB roles, goals, and responsibilities; established processes for compensation and recognition; identified and recruited potential members; and conducted meetings to build rapport, brainstorm, receive feedback, and invite discussion of topics related to PPD that have been deemed important by the tribe (October 2021 through June 2022). The CAB defined specific roles, goals, and responsibilities for the academic–community partnership, including assumptions, expectations, and confidentiality. We used a standing agenda item to recognize member achievements. Members of the CAB represented many tribal departments and professional disciplines. We use a CAB framework to evaluate our process and to provide recommendations for future research and policymaking.     

Postpartum Physical Symptoms in New Mothers: Their Relationship to Functional Limitations and Emotional Well‐being

ABSTRACT: Background: Postpartum physical health problems are common and have been understudied. The purpose of this investigation was to explore the associations among reported physical symptoms, functional limitations, and emotional well‐being of postpartum women. Methods: The study included data from interviews conducted at 9 to 12 months postpartum from 1,323 women who had received prenatal care at nine community health centers located in Philadelphia, Pennsylvania, United States, between February 2000 and November 2002. Emotional well‐being was assessed with the Center for Epidemiological Studies Depression Scale and perceived emotional health. Functional limitations measures were related to child care, daily activities (housework and shopping), and employment. A summary measure of postpartum morbidity burden was constructed from a checklist of potential health problems typically associated with the postpartum period, such as backaches, abdominal pain, and dyspareunia. Results: More than two‐thirds (69%) of the women reported experiencing at least one physical health problem since childbirth. Forty‐five percent reported at least one problem of moderate or major (as opposed to minor) severity and 20 percent reported at least one problem of major severity. The presence, severity, and cumulative morbidity burden associated with postpartum health problems were consistently correlated with reports of one or more functional limitations and measures of emotional well‐being including depressive symptomatology. Conclusions: Although physical problems typically associated with the postpartum period are often regarded as transient or comparatively minor, they are strongly related both to women’s functional impairment and to poor emotional health. Careful assessment of the physical, functional, and emotional health status of women in the year after childbirth may improve the quality of postpartum care. (BIRTH 35:3 September 2008)     

Smoking Status and Symptoms of Depression During and After Pregnancy Among Low-Income Women

ObjectiveTo describe the point prevalence rates, relapse rates, smoking status, and symptoms of depression and to examine the relationship between smoking status and symptoms of depression from early pregnancy to 12 months after childbirth among low-income women.DesignSecondary data analysis.SettingData from the national Nurse-Family Partnership program.ParticipantsWomen who were enrolled in the national Nurse-Family Partnership program between 2011 and 2016 with histories of smoking 3 months before pregnancy (N = 1,554).MethodsWe used smoking status and Edinburgh Postnatal Depression Scale scores in early pregnancy, late pregnancy, and 12 months after childbirth to identify point prevalence rates, relapse rates, smoking status, and symptoms of depression. We used chi-square and additional analyses to examine the relationship between smoking status and symptoms of depression.ResultsThe prevalence of smoking was 30.12% (n = 468) in early pregnancy, 24.39% (n = 379) in late pregnancy, and 50.58% (n = 786) 12 months after childbirth. Prevalence rates of a positive depression screening result were 30.31% (n = 471), 20.46% (n = 318), and 18.08% (n = 281), respectively. Smoking relapse rates were 2.45% (n = 38) during the third trimester and 27.86% (n = 433) at 12 months after childbirth. Eight distinct patterns of smoking and depression were identified. Women who smoked were significantly more likely to also have positive depression screening results during the third trimester and at 12 months after childbirth compared with nonsmoking women (OR = 1.37, 95% confidence interval [1.04, 1.81] and OR = 1.93, 95% confidence interval [1.47, 2.51], respectively).ConclusionPrevalence rates of smoking, relapse, and positive depression screening results were great in this sample of low-income women during and after pregnancy. Pivotal time points exist where the trajectory of smoking and depression screening patterns may change. It is important for smoking cessation interventions to incorporate mental health assessment and treatment.     

Antenatal Depressive Symptoms and Preterm Birth: A Prospective Study of a Swedish National Sample

Abstract: Background: Preterm birth is the principal risk factor for neonatal morbidity and mortality. The objective of this study was to investigate the association between antenatal depressive symptoms and preterm birth. Methods: The study included a national sample of 2,904 pregnant women who were recruited at their first booked visit to antenatal clinics in Sweden. Data on depressive symptoms, and sociodemographic and reproductive background were collected by questionnaires. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS). The average length of gestation at the time for completion of the questionnaire was 16 weeks. Data on gestational length were extracted from the Swedish Medical Birth Register. Multiple logistic regression analyses were conducted to estimate the risk of preterm birth associated with antenatal depressive symptoms. Results: The presence of antenatal depressive symptoms above a cutoff score of 12 or higher on the EPDS increased the risk for preterm birth (OR: 1.56; 95% CI: 1.03–2.35). Being of age 35 years and over, being a primipara, and having experienced a previous miscarriage were also shown to be significant predictors in a multivariate model. Conclusion: Pregnant women reporting antenatal depressive symptoms are at elevated risk of preterm birth. (BIRTH 38:1 March 2011)