Validation of the Edinburgh Postnatal Depression Scale and prevalence of postnatal depression at two months postpartum in a sample of Greek mothers

The EPDS has been validated as a screening instrument for postnatal depression in numerous communities over the last 20 years. Absence of a validation study for the Greek population has limited significantly its use in Greece. A community sample of 109 women was recruited on the second day postpartum in the two largest maternity hospitals in Athens. Ninety‐five women consented to participate and to complete the EPDS, the Beck Depression Inventory (BDI), the 28‐item General Health Questionnaire (GHQ), and the 26‐item WHO‐Quality of Life (WHO‐QOL). Of them, 81 consented to be reassessed 2 months later. At that time, in addition to the baseline questionnaires, the Structured Clinical Interview for DSM‐III‐R (SCID), non‐patient version, was conducted in order to establish psychiatric diagnosis of major and minor depression. The clinical diagnosis was used to test the criterion validity of the EPDS, and the GHQ, BDI and WHO‐QOL scores were used to assess the concurrent validity of the EPDS. Cronbach's alpha coefficient was used to measure the internal consistency of the scales. A cut‐off point of 11/12 on the EPDS showed optimum Receiver Operating Characteristics. The SCID showed that 12.4% of the subjects met criteria for depression at two months postpartum.     

Evaluation of Post Partum Depression in a Tertiary Hospital

Objective

To evaluate the association of different factors with postpartum depression.

Methods

A prospective study conducted in the Department of Obstetrics and Gynecology, Medical College, Kolkata. Six thousand patients, 4–7 days postpartum, were interrogated using Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic factors (age, parity, literacy, socioeconomic status, marital status and family structure), history of psychiatric disorder and abuse, mode of delivery and obstetric outcome were recorded. The results were analyzed statistically using Chi-square test.

Results

Incidence of PPD was 25%. Significant association of PPD was seen with poor socioeconomic group (P < 0.05), literacy (P < 0.001), nuclear family structure (P < 0.05), single mother (P < 0.001), past history of psychiatric illness (P < 0.001), history of abuse (P < 0.05), and poor obstetric outcome (P < 0.001). Age, parity and method of delivery showed no association.

Conclusion

EPDS should be used routinely to screen for PPD among high risk cases.     

A randomized clinical trial of exercise to alleviate postpartum depressed mood

Objective. To evaluate whether a 12-week home-based exercise program is more effective than usual care for alleviating depressive symptomology in the postpartum.

Methods. Eighty-eight women experiencing postpartum depressed mood were randomly assigned to a 12-week home-based exercise program or usual care. Outcomes assessed immediately post-treatment and 3-months post-treatment were the Hamilton Rating Scale for Depression (HAM-D) and Edinburgh Postnatal Depression Scale (EPDS).

Results. In the intention-to-treat analysis, the effect of the intervention on EPDS did not change from 3 to 6 months evaluations, but was modified by the baseline EPDS score, with subjects with greater depression at baseline (EPDS > 13) in the intervention group having a significantly lower postbaseline EPDS score compared with the usual care group (mean difference 4.06 points, 95%CI 1.51–6.61, p < 0.001). After adjusting for baseline HAM-D, subjects in the intervention group had a significantly lower HAM-D score at post-treatment compared with subjects in the usual care group (mean difference 1.83 points, 95%CI 0.24–3.41, p = 0.02). The difference in HAM-D became non-significant at 3-months post-treatment.

Conclusions. Home-based exercise is a feasible nonpharmacological intervention with the potential to alleviate postpartum depressive symptoms, especially in women with higher initial depressed mood scores as measured by the EPDS. These findings may guide the design of future exercise clinical trials with postpartum depressed women.     

Learning the Hard Way: Expectations and Experiences of Infant Feeding Support

Abstract: Background: Breastfeeding involves learning for women and their infants. For emotional, social, and developmental reasons this type of feeding is recommended for all newborn infants but for those in exceptional circumstances. The objective of this study was to gain a better understanding of what is needed in the early days to enable women to initiate and continue breastfeeding their infants. Methods: Data from a large-scale national survey of women’s experience of maternity care in England were analyzed using qualitative methods, focusing on the feeding-related responses. Results: A total of 2,966 women responded to the survey (62.7% response rate), 2,054 of whom wrote open text responses, 534 relating to infant feeding. The main themes identified were “the mismatch between women’s expectations and experiences” and “emotional reactions” at this time, “staff behavior and attitudes,” and “the organization of care and facilities.” Subthemes related to seeking help, conflicting advice, pressure to breastfeed, the nature of interactions with staff, and a lack of respect for women’s choices, wishes, previous experience, and knowledge. Conclusions: Many women who succeeded felt that they had “learned the hard way” and some of those who did not, felt they were perceived as “bad mothers” and women who had in some way “failed” at one of the earliest tasks of motherhood. What women perceived to be staff perceptions affected how they saw themselves and what they took away from their early experience of infant feeding. (BIRTH 39:1 March 2012)     

Does Supplementary Prenatal Nursing and Home Visitation Support Improve Resource Use in a Universal Health Care System? A Randomized Controlled Trial in Canada

ABSTRACT: Background: The addition of supplementary prenatal support may improve the health and well‐being of high‐risk women and families. The objective of this randomized controlled trial was to examine the impact of supplementary prenatal care on resource use among a community‐based population of pregnant women. Methods: Pregnant women from three urban maternity clinics were randomized (a) to current standard of physician care, (b) to current standard of care plus consultation with a nurse, or (c) to (b) plus consultation with a home visitor. Participants were 1,352 women who received 3 telephone interviews. The primary outcome was resource use (e.g., attended prenatal classes, used nutritional counseling). Results: Overall, those in the nurse intervention group were more likely to attend an “Early Bird” prenatal class and parenting classes, and to use nutrition counseling and agencies that assist with child care. Women provided with extra nursing and home visitation supports were more likely to use a written resource guide, nutrition counseling, and agencies that assist with child care. Among women at higher risk (e.g., language barriers, young maternal age, low income), the nurse intervention significantly increased use of early prenatal classes, whereas the nurse and home visitor intervention significantly increased use of the written resource guide and nutrition counseling. The intervention substantially increased the amount of information received on numerous pregnancy‐related topics but had little impact on resource use for mental health and poverty‐related needs. Among those with added support, resource use among low‐risk women was generally greater than among high‐risk women. Conclusions: Additional support provided by nurses, or nurses and home visitors, can successfully address informational needs and increase the likelihood that women will use existing community‐based resources. This finding was true even for high‐risk women, although this intervention did not reduce the difference in resource use between high‐ and low‐risk women. (BIRTH 33:3 September 2006)     

Systematic Review of the Literature on Postpartum Care: Effectiveness of Interventions for Smoking Relapse Prevention,Cessation, and Reduction in Postpartum Women

ABSTRACT: Background: Many women stop smoking during pregnancy and relapse again either later in the pregnancy or in the postpartum period. Smoking is harmful to mothers, and environmental tobacco smoke is harmful for children. This systematic review examined the published evidence for the effectiveness of postpartum interventions that prevent relapse (current persons who have stopped but start smoking again), improve cessation rates (current smokers who stop smoking), and reduce smoking (number of cigarettes smoked per day) in postpartum women. Methods: MEDLINE, CINAHL, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postpartum women. The initial literature search was done in 1999 and enhanced in 2003 and 2005. Randomized controlled trials that examined relapse prevention, smoking cessation, or smoking reduction interventions in the postpartum period were reviewed in this report. Data were extracted in a systematic manner, and the quality of each study was reviewed. Results: Five papers were published based on three trials for which data were extracted and summarized. Our review of these trials showed no statistically significant benefits of advice materials and counseling interventions in hospital (Vancouver), pediatricians’ offices (Portland), or child health centers (Stockholm) on relapse prevention, cessation rates, or smoking reduction in the postpartum period. Although the interventions had little effect on the major smoking outcomes, some positive attitudinal and knowledge changes were reported. Conclusion: This review found no evidence from the randomized controlled trial literature to date to support implementing postpartum smoking cessation interventions, such as providing advice materials and counseling, insofar as they were delivered in the trials reviewed. (BIRTH 34:4 December 2007)     

Randomized Clinical Trial of an Aquatic Physical Exercise Program During Pregnancy

ObjectiveTo determine the effect of an aquatic physical exercise program performed during pregnancy on rate of intact perineum after childbirth.DesignRandomized clinical trial.SettingHealth centers in the metropolitan health district of Granada, Spain.ParticipantsA total of 129 pregnant women (control group [CG] = 64; aquatic exercise group [EG] = 65).MethodsThe intervention was an aquatic physical exercise program specifically designed for pregnant women (Study of Water Exercise During Pregnancy [SWEP] method). Participants were randomly assigned to the CG or EG by simple random sampling. Participants in the EG performed three sessions per week of physical exercises, which were led by the principal investigator. All participants received routine prenatal care. We evaluated status of the perineum after birth, including laceration and episiotomy rates. We also evaluated participants’ weight, body mass index (BMI) in the first and third trimesters, parity, the administration of anesthesia, and birth weight of the neonate as potential confounding variables.ResultsThe women in the EG had a greater rate of intact perineum than those in the CG (odds ratio [OR] = 13.54, 95% confidence interval [CI] [2.75, 66.56]). After adjusting for infant birth weight, the effect of the intervention on intact perineum was an OR of 8.57 (95% CI [1.85, 39.68]. Maternal weight gain did not influence the odds of intact perineum (OR = 1.072, 95% CI [0.896, 1.283]). Women who previously gave birth and followed the SWEP method had an OR of 10.197 (95% CI [2.190, 47.476] for an intact perineum. The administration of anesthesia and previous pregnancy also were associated with intact perineum (OR = 6.68, 95% CI [1.21, 36.84] and OR = 5.42, 95% CI [1.64, 17.89] respectively.ConclusionThe women who followed the SWEP method were significantly more likely to have intact perinea after childbirth.     

Women's Experiences of Participating in the Magpie Trial: A Postal Survey in the United Kingdom

Background: The Magpie Trial compared magnesium sulfate with placebo for women with preeclampsia. The objective of this study was to explore women's views and experiences of participating in the Magpie Trial in the United Kingdom. Methods: Postal questionnaires were sent to 771 women participants in the Magpie Trial to assess long‐term health of UK women and children. The questionnaire included three questions exploring women's experience of participating in the trial: (a) If time suddenly went backward, and you had to do it all over again, would you agree to participate in the Magpie Trial? (b) Please tell us if there was anything about the Magpie Trial that you think could have been done better; and (c) Please tell us if there was anything about the Magpie Trial, or your experience of joining the trial, that you think was particularly good. Results: Overall, 619 of the 771 women who were sent questionnaires returned them. In response to the three questions: (a) 58 percent (356) of women responded “definitely yes,” 27 percent (169) “probably yes,” 4 percent (23) “probably no,” 5 percent (33) “definitely no,” and 5 percent (34) “not sure.” No clear evidence was shown of a relationship with allocated treatment, although women who responded “probably or definitely no” were more likely to have had side effects from trial treatment. (b) Although 44 percent of women stated that nothing could have been done better, free text suggestions related to content of recruitment information, and its timing, and wanting to know treatment allocation and trial results. c) Women were generally extremely positive about being followed up and receiving trial results. Conclusions: Women were largely positive about participation in the trial and its follow‐up, but still reported ways they believed the study could have been improved, such as more information, given earlier, which also has implications for clinical care.     

Effect of an extended midwifery postnatal support programme on the duration of breast feeding: a randomised controlled trial

Objective

to evaluate the effects of an extended midwifery support (EMS) programme on the proportion of women who breast feed fully to six months.

Design

randomised controlled trial.

Setting

large public teaching hospital in Australia.

Participants

849 women who had given birth to a healthy, term, singleton baby and who wished to breast feed.

Intervention

participants were allocated at random to EMS, in which they were offered a one-to-one postnatal educational session and weekly home visits with additional telephone contact by a midwife until their baby was six weeks old; or standard postnatal midwifery support (SMS). Participants were stratified for parity and tertiary education.

Measurements

the main outcome measures were prevalence of full and any breast feeding at six months postpartum.

Findings

there was no difference between the groups at six months postpartum for either full breast feeding [EMS 43.3% versus SMS 42.5%, relative risk (RR) 1.02, 95% confidence interval (CI) 0.87–1.19] or any breast feeding (EMS 63.9% versus SMS 67.9%, RR 0.94, 95%CI 0.85–1.04).

Conclusions

the EMS programme did not succeed in improving breast-feeding rates in a setting where there was high initiation of breast feeding. Breast-feeding rates were high but still fell short of national goals.

Implications for practice

continuing research of programmes designed to promote breast feeding is required in view of the advantages of breast feeding for all mothers and babies.     

The identification of severity ranges for the Edinburgh Postnatal Depression Scale

Objective: The present study established severity cut-off scores for the Edinburgh Postnatal Depression Scale (EPDS) based on a widely used depression symptom severity measure, the Beck Depression Inventory (BDI).

Background: The EPDS is a widely used screening tool to identify clinically significant levels of depression in postpartum women. Traditionally, an EPDS cut-off score is used to identify probable depression. This dichotomisation of postpartum women into depressed vs. non-depressed groups fails to account for valuable information regarding the variability in symptom severity among those in the depressed group. The identification of depression severity ranges (e.g. mild, moderate or severe) for the EPDS would provide incremental information regarding level of depression, which in turn, could inform treatment referrals.

Methods: A sample of 1516 postpartum women completed the EPDS and the BDI. Equipercentile linking was used to develop concordance between EPDS and BDI scores, and severity ranges were established by identifying EPDS scores that corresponded to established severity ranges on the BDI.

Results: The following severity ranges were established for the EPDS: none or minimal depression (0–6), mild depression (7–13), moderate depression (14–19), and severe depression (19–30).

Conclusion: Postpartum women experience a wide range of depression severity. The establishment of severity ranges for EPDS scores may guide treatment referrals. Although the study sample size was large, only a limited number of women scored in the severe range of depression symptoms. Replication in a larger sample of depressed women is an important direction for future research.     

中国孕妇宫颈环扎术疗效评价的Meta分析

目的:评价中国孕妇行宫颈环扎术的疗效。方法:检索维普中文科技期刊数据库、万方数据库、中国生物医学文献数据库和中国期刊全文数据库,收集关于宫颈环扎术的RCT研究,进行文献筛选和质量评价,采用RevMan4.2.10软件进行Meta分析。结果:共纳入9篇文献,文献质量评价均为C级。Meta分析结果显示:宫颈环扎术组新生儿存活率(OR=5.21,95%CI2.81～9.64,P<0.00001)、平均分娩孕周(WMD=3.36,95%CI2.40～4.32,P<0.00001)、平均延长孕周(WMD=2.76,95%CI2.59～2.93,P<0.00001)、新生儿体重(WMD=616.81,95%CI74.48～1159.14,P=0.03)均优于对照组(期待疗法或药物治疗)。结论:宫颈环扎术在增加新生儿存活率及体重、延长孕周等方面明显优于期待疗法或药物治疗。     

The large loop excision of the transformation zone cut or blend thermal artefact study: a randomized controlled trial

The objective of this randomized controlled trial was to determine whether the pure cut setting results in less thermal artefact than the traditional blend setting when performing a large loop excision of the transformation zone (LLETZ). Forty-nine consenting women were randomized to undergo an LLETZ procedure using either the pure cut or the blend setting. Two histopathologists, who were blind to the randomization, examined the specimens and then graded and measured the degree of thermal artefact. No significant difference was noted at the epithelial margin. At the deep stromal margins, in the blend group, the mean thickness of thermal artefact was 0.382 mm (95% CI, 0.350-0.414) and in the cut group 0.325 mm (95% CI, 0.297-0.353). This was statistically significant. No significant difference was detected in terms of grading of thermal artefact, the presence of dysplasia at the specimen margins, or in positive follow-up smears. Although there was less thermal artefact at the deep stromal margin, cautery at this margin does not generally interfere with pathological assessment of the specimen and the pure cut setting does not produce a clinically significant decrease in the degree of thermal artefact.