Physical health after childbirth and maternal depression in the first 12 months post partum: Results of an Australian nulliparous pregnancy cohort study

Objectiveto investigate the relationship between maternal physical health problems and depressive symptoms in the first year after childbirth.Designprospective pregnancy cohort study.SettingMelbourne, Victoria, Australia.Population1507 nulliparous women.Methodswomen were recruited from six public hospitals between six and 24 weeks gestation. Written questionnaires were completed at recruitment and at three, six and 12 months post partum.Outcome measuresEdinburgh Postnatal Depression Scale (EPDS); standardised measures of urinary and faecal incontinence, a checklist of symptoms for other physical health problems.Resultsoverall, 16.1% of women reported depressive symptoms during the first 12 months post partum, with point prevalence at three, six and 12 months post partum of 6.9%, 8.8% and 7.8% respectively. The most commonly reported physical health problems in the first three months were tiredness (67%), back pain (47%), breast problems (37%), painful perineum (30%), and urinary incontinence (29%). Compared with women reporting 0–2 health problems in the first three months post partum, women reporting 5 or more health problems had a six-fold increase in likelihood of reporting concurrent depressive symptoms at three months post partum (Adjusted OR=6.69, 95% CI=3.0–15.0) and a three-fold increase in likelihood of reporting subsequent depressive symptoms at 6–12 months post partum (Adjusted OR=3.43, 95% CI 2.1–5.5).Conclusionspoor physical health in the early postnatal period is associated with poorer mental health throughout the first 12 months post partum. Early intervention to promote maternal mental health should incorporate assessment and intervention to address common postnatal physical health problems.     

Maternal characteristics and pregnancy outcomes among illicit drug-using women in an urban setting

Objective

To identify characteristics and pregnancy outcomes among pregnant illicit drug users living in an urban area, and to describe trends in drug use over an 8-year period.

Maternal birth weight in relation to plasma lipid concentrations in early pregnancy

OBJECTIVE: The purpose of this study was to determine the extent to which, if at all, maternal weight at birth is related to dyslipidemia during early pregnancy, which is a risk factor for preeclampsia. STUDY DESIGN: This hospital-based prospective cohort study included 1000 women who initiated prenatal care before 16 weeks of gestation. Participants provided information about their birth weight and other sociodemographic and reproductive covariates. Plasma triglyceride, high-density lipoprotein cholesterol, and total cholesterol concentrations were measured at approximately 13 weeks of gestation. beta coefficients and standard errors were estimated by multiple linear regression; odds ratios and 95% confidence intervals were estimated by logistic regression. RESULTS: Maternal birth weight was correlated negatively with triglycerides (r =-0.12; P =.001) and was correlated positively with high-density lipoprotein cholesterol (r =0.08; p =.02) but not statistically significantly related with total cholesterol (r =-0.004; P=.91). After adjusting for potential confounders, women who weighed <2500 g at birth had higher triglyceride and total cholesterol concentrations (beta=23.4 mg/dL [P<.001]; beta =2.6 mg/dL [P =.585], respectively) and lower high-density lipoprotein cholesterol concentrations (beta =-3.2 mg/dL; P=.105), when compared with women who weighed 3000 to 3499 g at birth. Women who were born small (<2500 g) and became overweight (body mass index, >or=25 kg/m(2)) in adulthood had less favorable lipid profiles than their counterparts who weighed >or=2500 g at birth and remained lean (body mass index, <25 kg/m(2)). CONCLUSION: Our findings suggest that factors that are related to growth in utero may help to predict the subsequent risk of altered lipid metabolism during pregnancy, which may, in turn, be causally related to the occurrence of preeclampsia.     

Physical activities (exercises or choreses) during pregnancy and mode of delivery in nulliparous women: A prospective cohort study

Objective

The aim of this study was to investigate changes in physical activities during pregnancy and the relationship between physical activity and unplanned caesarean sections (CSs).

Maternal bonding and risk of depression in late pregnancy: a survey of Italian nulliparous women

Objective: The aim of the study is to investigate the known risk factors of antenatal depression focusing on the woman’s intrapersonal and interpersonal characteristics, particularly her early experience of the parent–child relationship. Background: Starting from a psychodynamic view, where pregnancy is regarded as a period of normal maturational crisis which under unfavourable conditions may lead to psychopathological conditions, it may be important to outline which factors adversely affect the resolution of this phase. Methods: The study is a cross-sectional survey; a series of questionnaires were administered to a sample of Italian, nulliparous and low risk pregnant women to evaluate depression, anxiety, parental bonding and variables concerning the wellbeing of the woman including the quality of relationships with important people in her life. Results: Logistic regression analysis confirmed the role of several known risk factors of antenatal depression (i.e. concurrent anxiety, the presence of stressful events) and yielded two new findings: a relationship characterised by affectionless-control with the mother in childhood and having experienced a mother who had miscarried. Conclusion: The results underline the relevance of the early mother-daughter relationship in the pregnant woman’s intrapsychic reorganization of motherhood, emphasising the importance of preventive psychological management as part of prenatal care.     

The early detection of postpartum depression: midwives and nurses trial a checklist

OBJECTIVE: To evaluate the use of a standard pen-and-paper test versus the use of a checklist for the early identification of women at risk of postpartum depression and to investigate the experiences of nurses in using the checklist. DESIGN: A prospective cohort design using repeated measures. SETTING: The booking-in prenatal clinic at a regional hospital in Victoria, Australia, and the community-based postpartum maternal and child health service. PARTICIPANTS: 107 pregnant women over 20 years of age. MAIN MEASURES: Postpartum Depression Prediction Inventory (PDPI), Postpartum Depression Screening Scale (PDSS), Edinburgh Postnatal Depression Scale (EPDS), demographic questionnaire, and data on the outcome from the midwives and nurses. RESULTS: The PDPI identified 45% of the women at risk of depression during pregnancy and 30% postpartum. The PDSS and EPDS both identified the same 8 women (10%), who scored highly for depression at the 8-week postpartum health visit. Nurses provided 80% of the women with anticipatory guidance on postpartum depression in the prenatal period and 46% of women at the 8-week postpartum health visit. Nurse counseling or anticipatory guidance was provided for 60% of the women in the prenatal period. CONCLUSION: The PDPI was found to be a valuable checklist by many nurses involved in this research, particularly as a way of initiating open discussion with women about postpartum depression. It correlated strongly with both the PDSS and the EPDS, suggesting that it is useful as an inventory to identify women at risk of postpartum depression.     

Maternal burn-out: an exploratory study

Introduction: Maternal burn-out is a psychological, emotional and physiological condition resulting from the accumulation of various stressors characterised by a moderate but also a chronic and repetitive dimension. Little research has focused on this syndrome.

Objective: The current study aims to assess maternal burn-out rate and to identify factors associated with this state of exhaustion.

Method: 263 French mothers aged between 20 and 49 years answered five scales quantifying maternal burn-out, perceived social support, parental stress, depression and anxiety symptoms and history of postnatal depression.

Results: About 20% of mothers were affected by maternal burn-out. The main factors related to maternal burn-out were having a child perceived as difficult, history of postnatal depression, anxiety, satisfaction of a balance between professional and personal life and parental stress.

Conclusion: This research shows the need for further work on maternal burn-out to better understand and prevent this syndrome.     

Gestational weight gain and adverse pregnancy outcomes in a nulliparous cohort

Objective

Excessive gestational weight gain (GWG) is an important contributing factor to the obesity epidemic in women and is associated with pregnancy complications. We investigated the relationship between GWG and caesarean delivery in labour, large for gestational age (LGA), small for gestational age (SGA) infants and pregnancy-induced hypertension by maternal pre-pregnancy body mass index (BMI) in a contemporary nulliparous cohort.

Study design

Using 2009 Institute of Medicine guidelines, participants in the SCOPE study (from Cork, Ireland, Auckland, New Zealand and Adelaide, Australia) were classified into GWG categories (low, normal and high) according to pre-pregnancy BMI. Maternal characteristics and pregnancy outcomes were compared between weight gain categories. SGA and LGA were defined as <10th and >90th customised birthweight centile. Multivariable analysis adjusted for confounding factors that impact on GWG including BMI.

Results

Of 1950 participants, 17.2% (n = 335) achieved the recommended GWG, 8.6% (n = 167) had low and 74.3% (n = 1448) had high GWG. Women with high GWG had increased rates of LGA infants [adjusted OR 4.45 (95% CI 2.49–7.99)] and caesarean delivery in labour [aOR 1.46 (1.03–2.07)]. SGA was increased in women with low GWG [aOR 1.79 (1.06–3.00)].

Conclusion

Three quarters of participants had high GWG, which was associated with an independent risk of LGA infants and caesarean in labour. Low GWG was associated with SGA infants. These adverse outcomes are potentially modifiable by achievement of normal GWG, which should be an important focus of antenatal care.     

Thromboembolism and thrombophilia in pregnancy

Venous thromboembolism (VTE) is one of the leading causes of maternal mortality worldwide and is also the cause of significant maternal morbidity. This article discusses the risk factors for VTE in pregnancy, the management of the pregnant woman at risk both antenatally and post-partum, and the acute management of VTE when it occurs during pregnancy.The thrombophilias, both heritable and acquired, are becoming increasingly recognised as a cause of morbidity and mortality both within and outside pregnancy. There has been a recent increased interest in the thrombophilias and their link with recurrent miscarriage, preeclampsia, abruption and intrauterine growth restriction. The relationship between the thrombophilias and adverse pregnancy outcome is addressed in detail, with reference to the current literature available on this evolving subject.     

Alexithymia and postpartum anxiety and depression symptoms: a follow-up study in a pregnancy cohort

Abstract

Introduction: There is a lack of longitudinal studies assessing the significance of alexithymia on the emergence of mental illnesses. We aimed to evaluate the potential effect of alexithymia on postpartum anxiety and depression symptoms in a sample of parents to be.

Methods: In a pregnancy cohort, longitudinal data were available from three time points (gestational weeks 18?20, and 3 and 12 months postpartum) for 100 mothers and 65 fathers. The 20-item Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia, the State-Trait Anxiety Inventory (STAI) to evaluate anxiety symptoms and the Edinburgh Postnatal Depression Scale (EPDS) to assess depression. Linear regression analyses were used to estimate the effect of alexithymia on the symptom scale score changes from baseline.

Results: Both in mothers and fathers, the TAS-20 total score was significantly correlated with the STAI and EPDS scores at several time-points, with a higher TAS-20 score indicating more symptoms. In the regression analyses, the association of alexithymia with later symptoms became non-significant in mothers. However, in fathers, the TAS-20 score had a statistically significant effect on the increase of the STAI score at 3 months postpartum (p?=?0.006). For the separate TAS-20 subscales, difficulty identifying feelings had a significant effect on the increase of anxiety by 12 months postpartum (p?=?0.023) and difficulty describing feelings on the increase by 3 months postpartum (p?<?0.001).

Discussion: Although the setting did not facilitate the assessment of actual diagnoses regarding the anxiety and depression symptoms, alexithymia appears to have a significant effect on the increase of postpartum anxiety symptoms in fathers-to-be.     

Maternal obesity and pregnancy: a retrospective study

Objectives

to establish the incidence of obesity in the pregnant population in a large city in the North West of England, identify links between obesity and social deprivation, and compare outcomes of pregnancy in obese and non-obese women.

Design

retrospective cohort study using maternal records.

Setting

largest maternity hospital in Europe.

Participants

8176 women who gave birth at the study hospital in 2006.

Findings

data showed that 17.7% of women were clinically obese. Obesity rates increased with advancing age. The incidence of pre-eclampsia, gestational diabetes, induction of labour, caesarean section and fetal macrosomia was significantly higher amongst the obese population. No relationship was found between obesity and social deprivation.

Conclusions

this study ascertained the exact incidence of maternal obesity in the local area and showed the increased risks associated with obesity and pregnancy.

Implications for practice

this study supports the need for a shared-care approach to antenatal care and that obese women should give birth in consultant-led units. The support of a named midwife should be available to these women throughout the childbearing experience, and preconception care advocated.     

Australian midwives' knowledge of antenatal and postpartum depression: a national survey

Introduction: Emotional care provided by midwives may improve health and well‐being; reduce stress, trauma, and depressive symptoms; and enhance maternal outcomes in childbearing women. The provision of intrapartum and postpartum emotional care can be challenging and requires a good knowledge base for the provider to screen and assist distressed women. This study assessed Australian midwives’ levels of knowledge and learning needs regarding antenatal depression and postpartum depression. Methods: Eight hundred and fifteen members of the Australian College of Midwives completed a postal survey, which consisted of 20 items drawn from the literature and the National Baseline Survey—Health Professional Knowledge Questionnaire. Results: On average, respondents correctly answered 62.9% of items related to antenatal depression and 70.7% of questions about postpartum depression. Many midwives were unable to identify the risk factors (70.6%) or prevalence of antenatal depression (49.6%). Nearly all (98.3%) respondents underestimated the percentage of antenatally depressed women that attempts suicide. Significant percentages of midwives did not correctly identify the incidence (44.4%), onset period (71%), and treatment options (32%) associated with postpartum depression. About half did not understand the use of antidepressant medications (48.6%) and incorrectly reported that the Edinburgh Postnatal Depression Scale was a suitable instrument to assess symptoms of psychotic depression (43.8%). Discussion: There are key knowledge deficits relating to onset of, assessment of, and treatment for depressive symptoms during the antenatal and postpartum periods. There is a need for continuing professional education to improve midwives’ knowledge and competency in the assessment and care of women suffering depression.     

Maternal and perinatal outcome in pregnancies complicated with hypertensive disorder of pregnancy: a seven year experience of a tertiary care center

Objective: The aim of the study was to determine the risk factors, prevalance, epidemiological parameters and maternal-perinatal outcome in pregnant women with hypertensive disorder. Materials and methods: A retrospective analysis was undertaken on 255 consecutive cases of hypertensive disorder in pregnancy who were managed at Kocaeli University, School of Medicine, Department of Obstetrics and Gynecology from June 1997 to November 2004. Demographic data involving age, parity, gestational week, clinical and laboratory findings were recorded from the medical files. Additionally delivery route, indications of cesarean section, fetal and maternal complications were determined. Statistical analysis was performed by SPSS programme using Kruskal Wallis nonparametric test, ANOVA (Analysis of variance) and chi-square tests. Results: Of 5,155 deliveries in our clinic during the defined period, 438 cases (8.49%) were managed as hypertensive disorder of pregnancy. Medical records of 255 cases could be avaliable. Of 255 cases, 138 patients (54.11%) were found to have severe preeclampsia while 88 cases (34.50%) were diagnosed as mild preeclampsia. Twenty-nine patients (11.37%) were suffering from chronic hypertension. Of 138 severely preeclamptic cases, 28 cases (11%) had eclamptic convulsion and another 28 patients (11%) were demonstrated to have HELLP syndrome. Intrauterine growth restriction, oligohydramnios, placental ablation were the obstetric complications in 75 (29.4%), 49 (19.2%), 19 (7.5%) cases, respectively. Additionally multiple pregnancy and gestational diabetes mellitus were noted in 5.9% (n:15) and 3.9% (n:10) of the patients. Delivery route was vaginal in 105 patients (41.2%) while 150 patients (58.8%) underwent cesarean section with the most frequent indication to be fetal distress in 69 cases (46%). Cesarean section rate seemed to be the lowest (48.3%) in chronic hypertensive women while the highest (63.8%) in severe preeclamptic patients. Maternal mortality occured in 3 cases (1.2%) and all of those cases were complicated with HELLP syndrome. Intracranial bleeding was the cause of maternal death in one case while the other two cases were lost due to acute renal failure and disseminated intravascular coagulation, respectively. Intrauterine fetal demise was recorded in 24 cases on admission. Ten fetuses died during the intrapartum period. Mean gestational age and birth weight were 28±3.5 and 1000±416 g, respectively in this group. In these ten women, five cases were diagnosed as HELLP syndrome, two were severely preeclamptic and three were eclamptic. Perinatal mortality rate was found to be 144/1,000 births Conclusion: Hypertensive disorder of pregnancy is associated with increased risk of maternal-perinatal adverse outcome. The complications of severe preeclampsia and eclampsia could be prevented by more widespread use of prenatal care, education of primary medical care personnel, prompt diagnosis of high-risk patients and timely referral to tertiary medical centers.     

孕产妇危重事件发生率及防控策略研究进展

过去孕产妇死亡率是衡量一个国家或地区妇女健康状况和社会经济发展的重要指标之一。2019年美国疾病控制中心收集全国孕产妇死亡信息得出结论:如果采取行动,多达一半的孕产妇死亡是可预防的。随着2000年联合国“千年发展目标”的提出以及各国对孕产妇健康的重视,孕产妇死亡已经成为极低概率事件,而孕产妇危重事件发生率(severe maternal morbidity,SMM)已成为比孕产妇死亡率更常见和有用的产科护理指标。在美国,约50名经历SMM孕产妇中发生1例死亡。虽然孕产妇死亡率历来是孕产妇结局的关键指标,SMM的流行情况却可以为围生期健康提供更全面的信息,也是监测孕产妇结局的一种方法。同时,SMM通常是孕产妇死亡的先兆,作为导致孕产妇死亡的动态过程和前期指标,SMM对强化孕产妇管理、降低孕产妇死亡率有重要意义。许多国家开始将SMM作为评价产科质量的重要指标之一。防控SMM,除了常规策略外,避免医疗相关的延迟,使用孕产妇早期预警触发工具(MEWT)有重要临床价值。     

Maternal Adjustment and Maternal Attitudes in Adolescent and Adult Pregnant Women

Study ObjectiveThis study analyzes differences between adolescent and adult pregnant women and the contribution of maternal age to maternal adjustment and maternal attitudes during pregnancy.Design, Setting, and ParticipantsA sample of 398 Portuguese pregnant women (111 younger than 19 years) was recruited in a Portuguese Maternity Hospital and completed the Maternal Adjustment and Maternal Attitudes Questionnaire between the 24^th and 36^th weeks of gestation.Main Outcome MeasuresMaternal Adjustment and Maternal Attitudes Questionnaire¹ResultsAdolescent pregnant women show lower maternal adjustment (poorer body image and worse marital relationship) and poorer maternal attitudes (more negative attitudes to sex) than adult pregnant women. When controlling for socio-demographics, age at pregnancy predicts poorer body image and more negative attitudes to sex, but not a worse marital relationship, more somatic symptoms or negative attitudes to pregnancy and the baby. A worse marital relationship was better predicted by living without the partner, and more somatic symptoms and negative attitudes to pregnancy and the baby was predicted by higher education.ConclusionAdolescent pregnant women show lower maternal adjustment and poorer maternal attitudes than adult pregnant women according to socio-demographics and unfavorable developmental circumstances.