A cross-sectional study of maternal-fetal attachment and perceived stress at the first antenatal visit.

ABSTRACT

Background

Maternal-fetal attachment (MFA) psychologically is well described. Suboptimal attachment may have negative consequences particularly if it is associated with unhealthy maternal behaviour that may potentially increase the risk of adverse pregnancy outcomes. The perception of stress or anxiety is also associated with potential adverse outcomes including preterm birth.     

Counseling and in-advance provision of levonorgestrel emergency contraceptive pills decrease the rate of unplanned pregnancy during breastfeeding: a randomized controlled trial

Objective: To evaluate the effect of counseling and in-advance provision of levonorgestrel emergency contraceptive pills (LNG-ECPs) during postpartum counseling on the incidence of occurrence of unplanned pregnancy during breastfeeding.

Materials and methods: The current study is an open-label, parallel, randomized controlled trial carried out in a university hospital in Egypt. All women who delivered and planning to birth-space and breastfeed for at least 1 year were approached for participation during a postpartum hospital stay. Eligible participants were randomly allocated to receive adequate lactational amenorrhea method (LAM) counseling Group 1 (LAM-only) or the above LAM counseling in addition to counseling and in advance provision of one packet of 0.75-mg LNG-ECPs Group 2 (LAM?+?EC). The two study groups were followed 6 months and the primary outcome was the unplanned pregnancy rate.

Results: The study included 2708 women randomized into two groups; LAM-only and LAM?+?EC groups. Demographic characteristics were homogenous between the groups at the time of recruitment. Unplanned pregnancy was significantly higher in LAM-only group 70 (5.3%) as compared with 5 (0.4%) in LAM-EC group (p?=?.0001). Also, 619 women (46.6%) used LNG-ECPs with minor side effects like nausea in 175 (28.3%) women, headache in 94 (15.2%) women, vomiting in 24 (3.9%) women.

Conclusion: In-advance counseling and provision of LNG-ECPs for those opt to use LAM during postpartum family planning counseling can decrease the rate of unplanned pregnancy during breastfeeding and increase the initiation of long-term use of contraception.     

The clinical outcomes of unplanned pregnancy in severely obese women

Objective: The objective of this study was to compare the clinical outcomes of unplanned pregnancies among severely obese women with those of planned pregnancies.

Methods: This prospective cohort study included severely obese women (Body Mass Index [BMI] ≥40.0?kg/m²) who delivered a baby weighing ≥500?g over 5 years 2009–2013 in a large university hospital. Maternal weight and height were measured and BMI was calculated at the first prenatal visit.

Results: Of the 650 women, the mean BMI was 43.8?kg/m², mean age was 31.6 years, and 30.0% (n?=?195) were nulliparous. Prenatal complications including gestational diabetes mellitus (GDM), hypertensive and thromboembolic disorders occurred in 56.6% (n?=?368). Compared with planned pregnancies (58.2%, n?=?378), those that were unplanned (41.8%, n?=?272) were associated with increased prepregnancy risk factors including essential hypertension (4.0% versus 1.6%, p?=?0.03) and depression (6.6% versus 3.2%, p?=?0.03). Unplanned pregnancy was associated with a higher macrosomia rate (birthweight?>?4.5?kg) compared with planned pregnancies (p?=?0.03). This was not explained by a higher GDM rate in unplanned pregnancies. Compared with planned pregnancies, unplanned pregnancies were not associated with increased adverse fetomaternal outcomes.

Conclusion: Despite increased prepregnancy risk factors, in severely obese women, unplanned pregnancies were not associated with increased prenatal complications or adverse pregnancy outcomes compared with planned pregnancies.     

Decision-making trajectories leading to termination of an unplanned pregnancy: specificities among adolescent and adult women

Objective: To describe the decision-making trajectories leading to termination of an unplanned pregnancy and to explore the differences according to women’s age.

Background: Although decision-making regarding abortion has been conceptualised as a multiphase event, the different trajectories leading to termination of an unplanned pregnancy remain unexplored.

Methods: In this cross-sectional study, 422 women (248 adolescents, 174 adults) who had an abortion were recruited. Data were collected through self-report questionnaires at 16 Portuguese healthcare services.

Results: Eight decision-making trajectories leading to termination of an unplanned pregnancy were identified according to the sequence: consideration (or not) to continue the pregnancy, conceal (or not) the decision from the family, the main decision-maker, and reasons for abortion. The most frequent trajectory included women who did not consider its continuation, did not conceal the reproductive decision from their family, were the main decision-maker and referred as reasons for abortion ‘education/job would be more difficult to continue’. Adolescents more frequently not considering pregnancy continuation, not concealing the decision from their family and referred as reasons for abortion the prioritisation of their academic plans and immaturity; or considering its continuation, but were pressured into abortion by their parents. Adults more frequently (not) considering pregnancy continuation, concealed the decision from their family and reported economic reasons for abortion; or considering its continuation, but were pressured into abortion by their partners.

Conclusion: Our study may contribute to more informed intervention by healthcare providers involved in supporting women’s decisions, highlighting the need to promote an informed, weighted, developmentally adapted and free decision-making process.     

Maternal appraisals of risk,coping and prenatal attachment among women hospitalised with pregnancy complications

One goal of pregnancy is the development of maternal emotional attachment to the unborn baby, and this attachment has been shown to be related to later relationships and development. There are many factors which may hinder the development of prenatal attachment, including the presence of complications, hospitalisation, and anxiety. However, women's appraisals of risk may not be congruent with medical assessments of risk. The current study sought to model the relationships between risk (maternal perceptions and medical ratings), coping, psychological well‐being, and maternal–foetal attachment among 87 women hospitalised for pregnancy‐related complications. Analysis indicated that positive appraisal as a coping strategy mediates the relationship between maternal appraisals of risk and maternal–foetal attachment, and that medical ratings of risk were not predictive of maternal–foetal attachment. Awareness of the potential incongruence between patients' and health professionals' perceptions of risk is important within the clinical environment. The potential benefits of promoting positive appraisal in high‐risk pregnancy merit further research.     

Potential effects of chocolate on human pregnancy: a randomized controlled trial

Objective: This trial was undertaken to evaluate the effects of high-cocoa-content chocolate supplementation in pregnancy on several haematochemical and clinical parameters. The study had as reference population the pregnant women requesting an obstetric control at Outpatient Clinic of Obstetrics and Gynaecology of the S. Maria della Misericordia University Hospital, Perugia, Italy. Candidates who participated in this study were all Caucasian women aged 18–40 years, who had a single gestation pregnancy between 11th + 0 and 13th + 0 week gestational age. Methods: We conducted a single-center randomized controlled trial. The pregnant women selected were randomized into Group A, which received daily doses of 30 g of chocolate (70% cocoa), and Group B, which was free to increase their diet with other foods. Results: Ninety women were randomized. Significant difference was found between the two groups for diastolic blood pressure (p = 0.05), systolic (p < 0.0001) and levels of liver enzymes, with values lower in Group A than in Group B. Total cholesterol levels and weight gain in Group A did not increase more than in Group B. Conclusions: A modest daily intake of high-cocoa-content chocolate contributes to reduce blood pressure, glycemic and liver pattern during pregnancy without affecting the weight gain.     

Contraception and pregnancy then and now: Examining the experiences of a cohort of mid-age Australian women

Background: More than 50% of women who have an unplanned pregnancy report using a contraceptive method. Since the launch of the pill 50 years ago, a number of cross-sectional surveys have examined contraceptive use in the Australian context. There is, however, little data on contraceptive use and efficacy over a woman's reproductive years.
Aim: To determine the pattern of contraceptive use of Australian women over their reproductive lifespan, with particular emphasis on the relationship between contraceptive use and pregnancy.
Method: One thousand women from the mid-age cohort of the Australian Women's Longitudinal Study were invited to participate in the Family Planning survey by completing a questionnaire about their reproductive histories.
Results: Completed questionnaires were received for 812 women. The contraceptive pill was the most commonly ever used contraceptive method at 94% and also the most commonly used method prior to all pregnancies. Contraceptive failure increased with increasing gravidity; 11.4% with the first pregnancy to 23.0% with the fourth pregnancy, while 28.8% of the respondents reported an 'accidental' pregnancy due to stopping contraception for reasons such as concern about long-term effects and media stories.
Conclusions: While surveys indicate that 66–70% of Australian women use a contraceptive method, more than half of unplanned pregnancies apparently occur in women using contraception. The modern Australian woman, in common with her predecessors, still faces significant challenges in her fertility management. This survey provides a longitudinal perspective on contraceptive use in relation to pregnancy and highlights the issue of efficacy of contraceptives in real-life situations.     

Safety of a physical therapy protocol for women with preeclampsia: a randomized controlled feasibility trial

Objective: To assess the feasibility and safety of a physiotherapy protocol applied to pregnant women with preeclampsia. Methods: Randomized, controlled, single-blind feasibility study, with 24 hospitalized pregnant women with preeclampsia. The intervention group received one session of the physiotherapy. The control group remained under the routine care of the hospital. The primary outcomes were Doppler velocimetry, cardiotocography, and maternal–fetal hemodynamics. Secondary outcomes were pain and anxiety assessed before and after the interventions. A mixed effects linear regression model was used, and the data were compared with the level of significance at 5%. Results: The baseline characteristics of the participants were homogeneous between groups. Resistance index of the Middle Cerebral Artery (MAC) and Umbilical Artery (UA) and cardiotocography did not change significantly. The systolic blood pressure (SBP) increased 4.90 mmHg in the control group and 0.22 mmHg in the intervention group. The diastolic blood pressure (DBP) increased 1.34 mmHg in the control group and decreased 0.40 mmHg in the intervention group. The middle bood pressure (MBP) increased 4.66 mmHg in the control group while there was a decrease of 0.09 mmHg in the intervention group, without statistical difference. Heart rate (HR) decreased 0.94 bpm in the control group; whereas, in the intervention group, there was an increase of 6.30 bpm. The pain reduced clinically 2 points after the intervention. The anxiety reduced clinically in both the groups (?1.26 in the intervention group and ?2.17 in the control group). Conclusion: The protocol applied in the intervention group is feasible and safe for both mother and fetus. Both groups showed clinical reduction in the levels of anxiety; whereas, pain was clinically reduced in the intervention group.     

The effect of lifestyle-based education to women and their husbands on the anxiety and depression during pregnancy: a randomized controlled trial

Objective: The aim of this study was to determine the effect of lifestyle-based education to women and their husbands on anxiety and depression during pregnancy.

Method: This controlled trial was conducted on 189 pregnant women. Participants were allocated into three groups through block randomization. In the first intervention group, both women and their husbands, and in the second one, only women received the lifestyle-based education. In the control group, women received only the routine care. Edinburgh depression and Spielberger anxiety questionnaires were completed at baseline and 8 weeks after it.

Results: Compared to the control group, significant reductions were observed in the scores of depression (adjusted difference: ?4.7; 95% CI: ?5.9 to ?3.4), state anxiety (?8.1; ?11.3 to ?4.9) and trait anxiety (?8.3; ?11.9 to ?5.0) in the first intervention group, and in the scores of depression (?2.9; ?4.1 to ?1.6), state anxiety (?4.3; ?7.5 to ?1.1) and trait anxiety (?5.5; 95% CI: ?8.7 to ?2.3) in the second intervention group. Comparing the two intervention groups, mean scores of depression and state anxiety were significantly lower in the first group.

Conclusion: Results suggested the positive effect of lifestyle education to women and their husbands on depression and anxiety during pregnancy.     

Effect of empiric intravenous intralipid therapy on pregnancy outcome in women with unexplained recurrent implantation failure undergoing intracytoplasmic sperm injection-embryo transfer cycle: a randomized controlled trial

Abstract

To evaluate the effect of empiric intralipid infusion therapy on pregnancy outcomes for patients with unexplained recurrent implantation failure (RIF) undergoing intracytoplasmic sperm injection (ICSI). A total of 142 patients with a history of unexplained RIF (3 or more cycles) were included in this randomized controlled trial. Patients were randomized into two groups, study group (n?=?71) and control group (n?=?71). The study group received intralipid 20% infusion on the day of embryo transfer (ET) and a second dose on the day of pregnancy test. The clinical pregnancy rate in the study group was 36.6% (n?=?26) compared to 28.2% (n?=?20) in the control group (OR 1.47, CI 0.72–2.98, p?=?.282). The live birth rate in the study group was 18.3% (n?=?13) and 14.1% (n?=?10) in the control group (OR 1.37, CI 0.55–3.36, p=.49). No side effects of intralipid therapy were reported in the study period. There was improvement in the pregnancy rate among women with unexplained RIF who received empiric intralipid infusion therapy; however, this improvement did not reach statistical significance.     

Maternal-fetal attachment in pregnant women who use illicit drugs

OBJECTIVE: To explore cognitive, affective, and altruistic dimensions of maternal-fetal attachment in pregnant women who use illicit drugs. DESIGN: Content analysis with deductive and inductive coding methods was used to uncover common themes in each dimension of attachment. SETTING: A prenatal clinic of a tertiary medical center in the northeastern United States. PARTICIPANTS: Forty pregnant women. Inclusion criteria were the following: used illicit drugs after the last menstrual period, had felt fetal movement, and could read and speak English. Women in methadone treatment programs were excluded. RESULTS: Knowing the baby's characteristics and health through fetal movement, acknowledging the fetus as an individual with physical and emotional functions, and knowing the baby by relating the fetus to self and family members are the three major themes in cognitive attachment. Themes in affective attachment include mixing strong affection with guilt and viewing fetal movement as visual and tactile enjoyment but also discomfort. Common themes with conflicting feelings were salient in altruistic attachment, including feeling uncomfortable versus feeling worthwhile, viewing being pregnant as an incentive for lifestyle changes, battling with substance use and concern for fetal health, and alternating between uncertainty and hope in preparing for the baby's arrival. CONCLUSION: Maternal-fetal attachment is not a phenomenon that is present or absent, but a struggle manifested by guilt, concern, and uncertainty. Without proper treatment and counseling, many women struggle between illicit drug use and development of maternal-fetal attachment.     

Effect of regular exercise on blood pressure in normotensive pregnant women. A randomized controlled trial

Objective: To evaluate the effect of regular exercise on maternal arterial blood pressure (BP) at rest and during uphill walking, in healthy former inactive pregnant women. Methods: A single-blind, single-center, randomized controlled trial including 61 out of 105 healthy, inactive nulliparous pregnant women, initially enrolled in a controlled trial studying the effect of 12 weeks of aerobic exercise (60 min 2/week) on maternal weight gain. Primary outcome was the mean adjusted difference in change in resting systolic and diastolic BP from baseline to after intervention. Secondary outcome was the mean adjusted difference in change in systolic BP during uphill treadmill walking at critical power. Measurements were performed prior to the intervention (gestation week 17.6 ± 4.2) and after the intervention (gestation week 36.5 ± 0.9). Results: At baseline, resting systolic and diastolic BP was 115/66 ± 12/7 and 115/67 ± 10/9 mmHg in the exercise (n = 35) and control group (n = 26), respectively. After the intervention, resting systolic BP was 112 ± 8 mmHg in the exercise group and 119 ± 14 mmHg in the control group, giving a between-group difference of 7.5 mmHg (95% CI 1.5 to 12.6, p = 0.013). Diastolic BP was 71 ± 9 and 76 ± 8 mmHg, with a between-group difference of 3.9 mmHg (95% CI ?0.07 to 7.8, p = 0.054). During uphill treadmill walking at critical power, the between-group difference in systolic and diastolic BP was 5.9 mmHg (95% CI ?4.4 to 16.1, p = 0.254) and 5.5 mmHg (95% CI –0.2 to 11.1, p = 0.059), respectively. Conclusions: Aerobic exercise reduced resting systolic BP in healthy former inactive pregnant women.     

Effect of acupuncture on nausea of pregnancy: a randomized, controlled trial

OBJECTIVE: To compare acupuncture with sham (placebo) acupuncture for treatment of nausea of pregnancy. METHODS: In a subject- and observer-masked, randomized, controlled trial in the maternity unit at Exeter Hospital, we gave 55 women between 6 and 10 weeks' gestation genuine, traditional-style acupuncture or sham treatment with a cocktail stick on three or four occasions over 3 weeks. The main outcome measure was nausea score, as determined by subject report on a visual analogue scale in a daily diary. Anxiety and depression also were assessed. RESULTS: Nausea scores decreased from a median of 85.5 (interquartile range 71.25-89.75) to 47.5 (interquartile range 29.25-69.5) in the acupuncture group and from 87.0 (interquartile range 73.0-90.0) to 48.0 (interquartile range 14.0-80.0) in the sham treatment group. There was strong evidence of a time effect (P <.001) but no evidence of a group effect (P =.9) or a group-time interaction (P =.8). Similarly, there was evidence of time effects in scores for anxiety and depression but no group differences. The study had a power of 95% to detect significant differences in nausea scores. CONCLUSION: Acupuncture was as effective in treating nausea of pregnancy as a sham procedure.     

Psychometric properties of the attachment style questionnaire in Swedish pregnant women: short and full versions

Objectives: (i) To evaluate the reliability and factor structure of the Attachment Style Questionnaire – Short Form (ASQ-SF) for use in pregnant women and (ii) to compare the reliability and factor structure of the short- and full version-ASQ among pregnant women.

Background: Adult attachment insecurity is currently included as a major risk factor in studies of perinatal health. None of the self-report measures with a Swedish translation have been psychometrically evaluated in a pregnant cohort.

Methods: A population-based cohort of 1631 pregnant women answered the ASQ in late pregnancy. Internal consistency (item-subscale correlations, Cronbach’s α, and α if item deleted) was evaluated for the seven available subscales. Confirmatory factor analysis (CFA) was run to examine the factor structure of the short form compared with the full-version. Test–retest correlations were assessed in a subgroup (n = 48).

Results: All mean item-subscale correlations for the ASQ-SF were > 0.30. Cronbach’s α’s for ASQ-SF dimensions were as follows: Avoidance (0.87); Anxiety (0.89); Discomfort with Closeness (0.85); Relationships as Secondary (0.54); Confidence (0.83); Need for Approval (0.76); and Preoccupation with Relationships (0.77). No item removal substantively increased subscale α’s. The CFA demonstrated better model fit for the ASQ-SF than for the full-version ASQ, while other reliability measures were similar. Test–retest correlations ranged from 0.65 to 0.84.

Conclusion: The ASQ-SF showed similar psychometric properties in pregnant women as in the general population and had good reliability, but the optimal factor structure needs to be studied further. Results support the usage of the ASQ-SF in pregnant cohorts.     

A clinical carepath for obese pregnant women: a pragmatic pilot cluster randomized controlled trial

Abstract

Objectives: Obese women are at increased risks for complications during pregnancy, birth, and in their infants. Although guidelines have been established for the clinical care of obese pregnant women, management is sometimes suboptimal. Our goal was to determine the feasibility of implementing and testing a clinical carepath for obese pregnant women compared to standard care, in a pilot cluster randomized controlled trial (RCT).

Methods: A pragmatic pilot cluster RCT was conducted, randomly allocating eight clinics to the carepath or standard care for obese pregnant women. Women were eligible if they had a pre-pregnancy body mass index (BMI) of ≥30?kg/m² and a viable singleton <21?weeks. The primary outcomes were the feasibility of conducting a full-scale cluster RCT (defined as >80%: randomization of clinics, use in eligible women, and completeness of follow-up) and of the intervention (defined as >80%: compliance with each step in the carepath and recommendation of the carepath by clinicians to a colleague).

Results: All eight approached clinics agreed to participate and were randomized. Half of the intervention clinics used the carepath, resulting in <80% uptake of eligible women. High follow-up (99.5%) was achieved, in 188 of 189 women. The carepath was feasible for numerous guideline-directed recommendations for screening, but less so for counseling topics. When the carepath was used in the majority of women, all clinicians, most of whom were midwives, reported they would recommend it to a colleague. The intervention group had significantly higher overall adherence to the guideline recommendations compared to control (relative risk: 1.71, 95% confidence interval: 1.57–1.87).

Conclusions: In this pragmatic pilot cluster RCT, a guideline-directed clinical carepath improved some aspects of care of obese pregnant women and was recommended by clinicians, particularly midwives. A cluster RCT may not be feasible in a mix of obstetric and midwifery clinics, but may be feasible in midwifery clinics.     

Effect of auricular acupressure on postpartum blues: A randomized sham controlled trial

AimTo investigate the effect of auricular acupressure on the severity of postpartum blues.MethodsA randomized sham controlled trial was conducted from February to November 2021, with 74 participants who were randomly allocated into two groups of either routine care + auricular acupressure (n = 37), or routine care + sham control (n = 37). Vacaria seeds with special non-latex adhesives were used to perform auricular acupressure on seven ear acupoints. There were two intervention sessions with an interval of five days. In the sham group, special non-latex adhesives without vacaria seeds were attached in the same acupoints as the intervention group. Severity of postpartum blues, fatigue, maternal-infant attachment, and postpartum depression were assessed.ResultsAuricular acupressure was associated with significant effect in reduction of postpartum blues on 10th and 15th days after childbirth (SMD = −2.77 and −2.15 respectively), postpartum depression on the 21st day after childbirth (SMD = −0.74), and maternal fatigue on 10th, 15th and 21st days after childbirth (SMD = −2.07, −1.30 and −1.32, respectively). Also, maternal-infant attachment was increased significantly on the 21st day after childbirth (SMD = 1.95).ConclusionAuricular acupressure was effective in reducing postpartum blues and depression, reducing maternal fatigue, and increasing maternal-infant attachment in the short-term after childbirth.Trial registrationRegistered prospectively in Iranian Registry of Clinical Trials (ID: IRCT20180218038789N2).     

Severity of drug use, initiation of prenatal care, and maternal-fetal attachment in pregnant marijuana and cocaine/heroin users

OBJECTIVE: To compare the severity of drug use, initiation of prenatal care, and maternal-fetal attachment between pregnant marijuana and cocaine/heroin users. DESIGN: A cross-sectional design. SETTING: A prenatal clinic of a medical center in the northeast of the United States. PARTICIPANTS: 19 marijuana, 17 cocaine, and 4 heroin users. Cocaine and heroin users were combined in one group. MAIN OUTCOME MEASURES: The Severity of Drug Use Questionnaire containing 11 questions of withdrawal, dependence, and medical, legal, and interpersonal issues was used to assess the severity of drug use. Initiation of prenatal care was obtained from the chart and was calculated by weeks of gestation when care began. Cranley's Maternal-Fetal Attachment Scale measured maternal-fetal attachment. RESULTS: Pregnant cocaine/heroin users were 6 years older, had experienced more pregnancies, had higher drug severity scores, and initiated prenatal care later than marijuana users. No significant difference in maternal-fetal attachment was found. CONCLUSION: Interventions to help especially cocaine/heroin users initiate early prenatal care and reduce severity of drug use are indicated.