Depression symptom prevalence and demographic risk factors among U.S. women during the first 2 years postpartum

OBJECTIVE: To examine differences in depression symptom rates and severity and factors associated with depression ratings. PARTICIPANTS: Cross-sectional sample of 1,359 American women who had delivered a single, live infant within the previous 2 years. DESIGN: Data were collected using the Edinburgh Postnatal Depression Scale online to screen for depression symptoms as part of Listening to Mothers, a national survey sponsored by Childbirth Connection of New York City and administered by Harris Interactive between May and June 2002. RESULTS: Evidence of continued mild and moderate-to-severe depression symptom rates throughout the first 2 years postpartum was found. Age, income, education, and employment had significant negative associations with depression symptom severity, and parity had a significant positive association with depression symptom severity. Race was not associated with depression symptom severity. CONCLUSIONS: Long-term screening for childbearing women is justified based on the study findings. The ease in survey administration suggests potential for online depression screening by health care providers and researchers. Furthermore, risk factors identified from this large-scale national survey, specifically young maternal age, low income, low education, not being employed full time, and multiparity, merit evaluation in clinical practice and future research.     

Physical activity during pregnancy and postpartum depressive symptoms

Objective

to examine the associations between total and domain-specific moderate-to-vigorous physical activity (MVPA) during pregnancy and postpartum depressive symptoms.

Design

a prospective cohort study.

Participants

data were obtained from 652 women recruited from prenatal clinics at University of North Carolina Hospitals during 2001–2005 for the Pregnancy, Infection, and Nutrition (PIN) Postpartum Study.

Measurements

MVPA measured at 17–22 and 27–30 weeks' gestation was investigated as a predictor of depressive symptoms assessed with the Edinburgh Postnatal Depression Scale at 3 months postpartum.

Findings

total MVPA was not associated with depressive symptoms when using either 17–22 weeks' gestation or 27–30 weeks' gestation MVPA measures. In general, there were minimal associations for domain-specific MVPA. The direction of associations between depressive symptoms and work, adult and child care, and outdoor household MVPAs differed by time of measurement.

Key conclusions

the association between physical activity and postpartum depressive symptoms may differ with the timing of assessment. Additional studies (i.e. with a larger sample of women or a sample of at-risk women) following women throughout pregnancy and postpartum are needed to explore differences in the influence of physical activity on depressive symptoms.

Implications for practice

assessment of potential risk factors for elevated depressive symptoms, such as participation levels in different types of physical activity, throughout pregnancy may assist in determining who may be susceptible to postpartum depression.     

Incidence of and risk factors for thromboembolism during pregnancy and postpartum: A 10-year nationwide population-based study

ObjectiveKnowledge of the incidence of pregnancy-related thromboembolism and its risk factors is clinically important because thromboembolism is the leading cause of maternal death. However, there are insufficient large population-based studies on this topic. The purpose of this study was to estimate the incidence of and identify the risk factors for thromboembolism during pregnancy and puerperium.Materials and methodsWe analyzed data from 2007 to 2016 using the Health Insurance Review and Assessment Service (HIRA) database. Women who gave birth in the Republic of Korea were identified. Thromboembolism was defined as the simultaneous presence of both the diagnostic and test codes. Risk factors for thromboembolism were identified using logistic regression.ResultsA total of 1,188 delivery episodes with thromboembolism were extracted from 4,243,393 delivery episodes. The incidence of thromboembolism was 0.28 per 1,000 deliveries, and it increased over the 10-year period. The incidence of antepartum thromboembolism was 0.1 per 1,000 deliveries (418 cases), and the incidence of postpartum thromboembolism was 0.18 per 1,000 deliveries (770 cases). Thromboembolism was associated with ovarian hyperstimulation syndrome, low socioeconomic status, multiple birth, cesarean birth, preeclampsia, postpartum hemorrhage, placenta previa, advanced maternal age, hyperemesis and primiparity. The factors associated with mortality from thromboembolism were cesarean birth and preterm premature rupture of membranes.ConclusionThe incidence of pregnancy-related thromboembolism increased over the 10-year study period. Low socioeconomic status, ovarian hyperstimulation syndrome, cesarean delivery and premature rupture of membranes were high-risk factors. This study provides an important reference for thromboprophylaxis for pregnancy-related thromboembolism.     

Racial and ethnic differences in factors associated with early postpartum depressive symptoms

OBJECTIVE: To explore racial differences in reporting of early postpartum depressive symptoms. To explore whether racial differences in early postpartum experience (such as mother's health status and social context) might account for racial differences in reported postpartum depressive symptoms. METHODS: This was a telephone survey of 655 white, African-American, and Hispanic mothers between 2 and 6 weeks postpartum. Mothers reported on demographic factors, physical symptoms, daily function, infant behaviors, social support, skills in managing infant and household, access, and trust in the medical system. We explored racial differences in report of early postpartum depressive symptoms using bivariate and multivariate statistics. RESULTS: African-American and Hispanic women more commonly reported postpartum depressive symptoms (43.9% and 46.8%, respectively) than white women (31.3%, P < .001). Similar factors (physical symptom burden, lack of social support, and lack of self-efficacy) were associated with early postpartum depressive symptoms in white, African-American, and Hispanic mothers. In a comprehensive model including other demographic factors, history of depression, physical symptoms, daily function, infant behavior, social support, skills in managing infant and household, access, and trust, the adjusted odds ratio for reported postpartum depressive symptoms remained elevated for African-American women at 2.16 (95% confidence interval 1.26-3.70) and Hispanic women at 1.89 (95% confidence interval 1.19-3.01) as compared with white women. CONCLUSION: African-American and Hispanic mothers are at higher risk for reporting early postpartum depressive symptoms as compared with white mothers. Factors associated with these symptoms are similar among African-American, Hispanic, and white mothers.     

Risk factors associated with a new pregnancy loss and perinatal outcomes in cases of recurrent miscarriage treated with lymphocyte immunotherapy

Objective: To assess the perinatal outcomes and risk factors for further pregnancy loss in patients with recurrent miscarriage treated with lymphocyte immunotherapy (LIT).

Methods: We performed a retrospective observational study of women with a history of two or more consecutive miscarriages who underwent LIT. All patients had undergone investigation of the etiology of the pregnancy losses according to a specific protocol. These etiologic factors were compared between those whose pregnancy outcome was successful and those who had a further miscarriage. The comparison between the groups was performed by Kruskal–Wallis, Fisher exact and Chi-square tests. Perinatal outcome data were collected for the successful pregnancies.

Results: One-hundred six patients were included. The mean number (±SD) of previous pregnancies, deliveries and miscarriages in all patients were 2.73?±?0.8, 0.19?±?0.4 and 2.54?±?0.6, respectively. A successful pregnancy outcome after lymphocyte therapy occurred in 82 patients (group I), while 24 (22.6%) sustained a further miscarriage (group II). There was no statistical difference in the genetic, anatomic and hormonal causes of miscarriage between the groups (p?>?0.05). Antinuclear (ANA) and antithyroglobulin (TgAb) autoantibodies occurred more frequently in group II (p?=?0.0010 and p?=?0.0024, respectively). Of those with successful pregnancies, 11 women (13.4%) had a preterm delivery. The mean birth weight was 3036.4?±?498.6?g.

Conclusion: In patients with recurrent miscarriage treated with LIT, the presence of ANA and TgAb was a risk factor for further pregnancy loss. Perinatal outcomes in those whose pregnancies continued were favorable.     

Perinatal risk factors and mode of delivery associated with mortality in very low birth weight infants

Objective: To investigate the association of perinatal risk factors including delivery mode with mortality in very low birthweight (VLBW) in a tertiary hospital setting.

Methods: Medical records of 241 live-born VLBW infants (≤1500?g) were retrospectively reviewed. Details of maternal, obstetrical, perinatal risk factors and their associations with infant mortality were evaluated.

Results: The overall infant mortality rate was 23.2%. Mortality was significantly higher for infants born at ≤27 gestational weeks and with a birthweight of ≤750?g (p?=?0.000 and p?=?0.000, respectively), showing a steep decrease thereafter. On ROC analysis, a cut off of 26.5 weeks was determined for mortality with a sensitivity of 57.1% and a specificity of 90.3% (area under the curve?=?0.792, 95% CI: 0.719–0.866). On multivariate regression analysis, gestational week at birth, birthweight, antenatal steroid treatment and pathologic Doppler ultrasound findings were found as independent risk factors for mortality.

Conclusions: Gestational week at birth, birthweight and antenatal steroid treatment remain the most important perinatal risk factors for infant mortality in VLBW infants. Mode of delivery does not seem to be associated with mortality when adjusted for other perinatal risk factors.     

Hypertension during pregnancy in South Australia, part 2: risk factors for adverse maternal and/or perinatal outcome - results of multivariable analysis

OBJECTIVE: To identify factors associated with adverse pregnancy outcomes among women with hypertension during pregnancy. DESIGN: A population-based retrospective multivariable analysis using the South Australian perinatal data collection. METHODS: Perinatal data on 70,386 singleton births in 1998-2001 were used in multivariable analyses on three groups: all women combined, all hypertensive women and women with pregnancy hypertension only, in order to identify independent risk factors for requirement for level II/III care, preterm birth, small for gestational age (SGA) birth and maternal length of stay greater than 7 days. RESULTS: The risks for the four morbidities were all increased among women with hypertension compared with normotensive women. Those with pre-existing hypertension had the lowest risk (with odds ratios (OR) 1.26-2.90). Pregnancy hypertension held the intermediate position (OR 1.52-5.70), while superimposed pre-eclampsia was associated with the highest risk (OR 2.00-8.75). Among women with hypertension, Aboriginality, older maternal age, nulliparity and pre-existing or gestational diabetes increased the risk for level II/III nursery care, preterm birth and prolonged hospital stay. Smokers had shorter stays, which may be related to their decreased risk of having a Caesarean section or operative vaginal delivery. Asian women, Aboriginal women, smokers and unemployed women had an increased risk for having an SGA baby, while women with pre-existing or gestational diabetes had a reduced risk. CONCLUSIONS: Among hypertensive pregnant women, nulliparity, older maternal age, Aboriginality, unemployment and diabetes are independent risk factors for one or more major adverse pregnancy outcomes. Smoking does not always worsen the outcome for hypertensive women except for SGA births.     

Anxiety symptoms during pregnancy and postpartum

This cross-sectional study compared the distribution of anxiety symptoms among pregnant, non-pregnant, and postpartum women of lower socioeconomic status. Participants were 807 women who were pregnant (24–36 weeks), postpartum (2–8 weeks), or not pregnant. Anxiety and depressive symptoms were assessed by the state-trait anxiety index and the Beck depression inventory, respectively. English and Spanish versions of the instrument were available. Group differences in anxiety were evaluated using analysis of variance. Multivariate regression was performed to evaluate differences in anxiety while controlling for marital status, education, race/ethnicity, employment, cohabitation, income, parity, history of depression/anxiety, and depressive symptoms. Anxiety scores were lower among postpartum women relative to pregnant and non-pregnant women (both P < 0.001), who did not differ (P = 0.99). After controlling for depressive symptoms and patient characteristics, anxiety remained lowest among postpartum women. Additionally, history of depression/anxiety and depressive symptoms were significant predictors of anxiety in the multivariate analysis. Comparatively low anxiety and depressive symptoms were observed among women who were 2–8 weeks postpartum. Anxiety symptoms that occur postpartum may not appear until later in the postpartum period.     

Prenatal and perinatal risk factors of schizophrenia

Schizophrenia could be considered the most severe of all psychiatric disorders. It shows a heterogeneous clinical picture and presents an etiopathogenesis that is not cleared sufficiently. Even if the etiopathogenesis remains a puzzle, there is a scientific consensus that it is an expression of interaction between genotype and environmental factors. In the present article, following a study of literature and the accumulated evidence, the role of prenatal and perinatal factors in the development of schizophrenia will be revised and synthesized. We think that better knowledge of the risk factors could be helpful not only for better comprehension of the pathogenesis but especially to optimize interventions for prevention of the disorder.     

Avoidable risk factors in perinatal deaths: a perinatal audit in South Australia

OBJECTIVES: To analyse risk factors of perinatal death, with an emphasis on potentially avoidable risk factors, and differences in the frequency of suboptimal care factors between maternity units with different levels of care. METHODS: Six hundred and eight pregnancies (2001-2005) in South Australia resulting in perinatal death were described and compared to 86 623 live birth pregnancies. RESULTS: Two hundred and seventy cases (44.4%) were found to have one or more avoidable maternal risk factors, 31 cases (5.1%) had a risk factor relating access to care, while 68 cases (11.2%) were associated with deficiencies in professional care. One hundred and four women (17.1% of cases) presented too late for timely medical care: 85% of these did have a sufficient number of antenatal visits. The following independent maternal risk factors for perinatal death were found: assisted reproductive technology (adjusted odds ratio (AOR) 3.16), preterm labour (AOR 22.05), antepartum haemorrhage (APH) abruption (AOR 6.40), APH other/unknown cause (AOR 2.19), intrauterine growth restriction (AOR 3.94), cervical incompetence (AOR 8.89), threatened miscarriage (AOR 1.89), pre-existing hypertension (AOR 1.72), psychiatric disorder (AOR 1.85) and minimal antenatal care (AOR 2.89). The most commonly found professional care deficiency in cases was the failure to act on or recognise high-risk pregnancies/complications, found in 49 cases (8.1%). CONCLUSION: Further improvements in perinatal mortality may be achieved by greater emphasis on the importance of antenatal care and educating women to recognise signs and symptoms that require professional assessment. Education of maternity care providers may benefit from a further focus on how to recognise and/or manage high-risk pregnancies.     

产后出血危险因素及高危评分系统临床价值研究

目的 探讨发生产后出血的危险因素,以及建立产后出血高危评分系统和风险预测方程的临床应用价值。方法 选择2008年12月至2009年12月在福建省妇幼保健院进行系统产前检查并住院分娩的212例产后出血患者作为病例组,采用1∶2病例对照研究方法选择同期住院分娩未发生产后出血的424例产妇作为对照组;采用单因素分析筛选产后出血高危因素。在全国产后出血防治协作组拟定“产后出血预测评分表”（简称“评分表”）基础上,用筛选出的高危因素建立较全面的“产后出血高危评分系统”（简称“评分系统”）。通过受试者工作特性（receiver–operating characteristics,ROC）曲线下面积（AUC）评价并比较评分表和评分系统工作效能。结果 产后出血发生率为3.07%,其中严重产后出血发生率为15.56%。产后出血危险因素有孕妇年龄、产次、人工流产史、孕早期体重指数（BMI）、产前宫底高度、双胎或多胎妊娠、产前血小板计数（PLT）、前置胎盘、妊娠期高血压疾病、妊娠合并子宫肌瘤、胎儿腹围、羊水过多、分娩方式、子宫切口延裂、产道裂伤、第一产程异常、第三产程延长、胎盘粘连或植入、新生儿体重。用评分系统评分,若总评分≥6分或产前评分≥4分者发生产后出血危险性明显增加。评分表预测产后出血的ROC曲线AUC为0.657,评分系统评估产后出血的AUC为0.805。产后出血风险预测方程为：Z=1-1/［1+exp(-3.216+0.482×产前评分+0.452×产时产后评分)］或Z=1-1/［1+exp(-3.187+0.469×总评分)］;严重产后出血风险预测方程为：Z=1-1/［1+exp(-3.715+0.146×总评分)］。结论　产后出血发生与孕妇及胎儿因素、妊娠并发症及合并症、产程等均密切相关。评分系统总评分≥6分者或产前评分≥4分者应纳入产后出血重点监护范围。评分系统与评分表相比有较强预测产后出血的效能。     

Can we identify risk factors during pregnancy for thrombo-embolic events during the puerperium and later in life?

Objectives: To investigate parturients at risk to develop venous thrombo-embolic events (VTE) in the puerperium or later in life, during a follow-up of more than a decade and compare risk factors for VTE during the puerperium with VTE later in life.

Methods: A nested case–control study was conducted to profile parturients at risk for VTE and a secondary analysis to compare risk factors for VTE during or after puerperium. We used a cohort of 95?257 women who gave birth between the years 1988 and 1998.

Results: Independent risk factors to develop VTE were peripartum hysterectomy, stillbirth, cesarean delivery (CD), obesity, pregnancy-related hypertension, grandmultiparity and advanced maternal age. Women undergoing CD and those receiving blood transfusion were more likely to develop early versus late VTE (OR?=?2.0, 95% CI?=?1.15–3.5 and OR?=?11.0, 95% CI?=?2.25–55.5; respectively). Patients that encountered VTE during the puerperium had more pulmonary emboli and less deep vein thrombosis, compared with the late VTE group (p?Conclusions: Maternal age, grandmultiparity, pregnancy-related hypertension, CD, obesity, stillbirth and peripartum hysterectomy are independent risk factors for the development of VTE. CD and blood transfusion were predictive of early versus late VTE.     

Pharmacological prophylaxis of postpartum exacerbation in depressive and anxiety symptoms: a retrospective study

The aim of this study was to investigate the efficacy of prophylactic treatment with antidepressants for the prevention of postpartum exacerbation in depressive or anxiety symptoms. The study included data on 33 patients who were followed from pregnancy to the postpartum period at the Department of Psychiatry of a university Hospital. Psychiatric diagnoses were determined by means of a structured clinical interview. The severity of depressive and anxiety symptoms were assessed by means of Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A), respectively. Prophylactic treatment was initiated within the first 3 days after the delivery. The patients were assessed again with HAM-D and HAM-A at 4-week postpartum. Postpartum prophylaxis was carried out with administration of sertraline at 50?mg/day (n?=?7, 21.2%), paroxetine at 20?mg/day (n?=?24, 72.7%), and escitalopram at 10?mg/day (n?=?2, 6.1%). Statistical analyses indicated that the mean HAM-D and HAM-A scores before (9.45?±?7.01 and 10.09?±?6.42, respectively) and after (9.09?±?6.65 and 9.54?±?5.97, respectively) the delivery were not significant. Results of the present study suggest that prophylactic use of antidepressants following parturition may be useful in the prevention of postpartum exacerbation of symptoms in women with depression or anxiety disorders.     

Substance use during pregnancy: risk factors and obstetric and perinatal outcomes in South Australia

OBJECTIVE: To determine the prevalence of self-reported substance use during pregnancy in South Australia, the characteristics of substance users, their obstetric outcomes and the perinatal outcomes of their babies. METHODS: Multivariable logistic regression with STATA statistical software was undertaken using the South Australian perinatal data collection 1998-2002. An audit was conducted on every fifth case coded as substance use to identify the actual substances used. RESULTS: Substance use was reported by women in 707 of 89 080 confinements (0.8%). Marijuana (38.9%), methadone (29.9%), amphetamines (14.6%) and heroin (12.5%) were most commonly reported, with polydrug use among 18.8% of the women audited. Substance users were more likely than non-users to be smokers, to have a psychiatric condition, to be single, indigenous, of lower socio-economic status and living in the metropolitan area. The outcome models had poor predictive powers. Substance use was associated with increased risks for placental abruption (OR 2.53) and antepartum haemorrhage from other causes (OR 1.41). The exposed babies had increased risks for preterm birth (OR 2.63), small for gestational age (OR 1.79), congenital abnormalities (1.52), nursery stays longer than 7 days (OR 4.07), stillbirth (OR 2.54) and neonatal death (OR 2.92). CONCLUSIONS: Substance use in pregnancy is associated with increased risks for antepartum haemorrhage and poor perinatal outcomes. However, only a small amount of the variance in outcomes can be explained by the substance use alone. Recent initiatives to improve identification and support of women exposed to adverse health, psychosocial and lifestyle factors will need evaluation.     

The role of perinatal and intrapartum risk factors in the etiologyof cerebral palsy in term deliveries in a Turkish population

Objective.?To investigate the relationship between cerebral palsy (CP) and perinatal and intrapartum risk factors and markers of birth asphyxia.

Methods.?This was a retrospective case–control study of 101 children with CP and 308 controls who were born at the Zeynep Kamil Hospital between 1990 and 2000. The roles of possible perinatal and intrapartum risk factors were investigated in CP development. Chi-square tests, Fisher's exact tests, Student t-tests, and regression analysis were used for statistical analysis (p < 0.05).

Results.?The only significant perinatal risk factor was neonatal weight of <2500 grams. The CP rate in the presence of solely intrapartum risk factors was estimated as 24.7% (n = 25). In 39.6% of cases, no risk factor could be identified. When regression analysis was performed, the following factors were significant: decreased beat-to-beat variability on electronic fetal monitoring (EFM) (p = 0.02), an Apgar score of <7 at 1 and 5 minutes (p = 0.02), and the necessity for neonatal intensive care unit admission (p < 0.0001).

Conclusion.?Intrapartum risk factors were significantly more frequent in the CP group (p < 0.01). An increased cesarean section rate could not prevent CP, suggesting that the hypoxic insult that causes CP might be of chronic onset. The development of diagnostic tests to detect non-reassuring fetal status in its intrauterine life and interventions at appropriate times may decrease the CP rate.     

Uterine rupture: risk factors and pregnancy outcome

OBJECTIVES: This study aimed at determining risk factors and pregnancy outcome in women with uterine rupture. STUDY DESIGN: We conducted a population-based study, comparing all singleton deliveries with and without uterine rupture between 1988 and 1999. RESULTS: Uterus rupture occurred in 0.035% (n=42) of all deliveries included in the study (n=117,685). Independent risk factors for uterine rupture in a multivariable analysis were as follows: previous cesarean section (odds ratio [OR]=6.0, 95% CI 3.2-11.4), malpresentation (OR=5.4, 95% CI 2.7-10.5), and dystocia during the second stage of labor (OR=13.7, 95% CI 6.4-29.3). Women with uterine rupture had more episodes of postpartum hemorrhage (50.0% vs 0.4%, P<.01), received more packed cell transfusions (54.8% vs 1.5%, P<.01), and required more hysterectomies (26.2% vs 0.04%, P<.01). Newborn infants delivered after uterine rupture were more frequently graded Apgar scores lower than 5 at 5 minutes and had higher rates of perinatal mortality when compared with those without rupture (10.3% vs 0.3%, P<.01; 19.0% vs 1.4%, P<.01, respectively). CONCLUSION: Uterine rupture, associated with previous cesarean section, malpresentation, and second-stage dystocia, is a major risk factor for maternal morbidity and neonatal mortality. Thus, a repeated cesarean delivery should be considered among parturients with a previous uterine scar, whose labor failed to progress.