Maternal depression and physical health problems in early pregnancy: Findings of an Australian nulliparous pregnancy cohort study

Objective

to investigate the relationship between physical health problems and depressive symptoms in early pregnancy.

Design

baseline questionnaire, prospective pregnancy cohort study.

Setting

six metropolitan public maternity hospitals in Victoria, Australia.

Participants

1507 nulliparous women recruited in early pregnancy.

Findings

nine per cent of women (131/1500) scored ≥13 on the EPDS indicating probable clinical depression in early pregnancy (mean gestation=15 weeks). The five most commonly reported physical health problems were as follows: exhaustion (86.9%), morning sickness (64.3%), back pain (45.6%), constipation (43.5%) and severe headaches or migraines (29.5%). Women scoring ≥13 on the EPDS reported a mean of six physical health problems compared with a mean of 3.5 among women scoring <13 on the EPDS. Women reporting five or more physical health problems had a three-fold increase in likelihood of reporting depressive symptoms (Adj OR=3.13, 95% CI 2.14–4.58) after adjusting for socio-demographic factors, including maternal age.

Conclusions

the findings from this large multi-centre study show that women experiencing a greater number of physical health problems are at increased risk of reporting depressive symptoms in early pregnancy.

Implications for practice

early detection and support for women experiencing physical and psychological health problems in pregnancy is an important aspect of antenatal care. The extent of co-morbid physical and psychological health problems underlines the need for comprehensive primary health care as an integral component of antenatal care.     

Maternal mortality from cardiac disease in Turkey: a population-based study

Objective: Population-based studies on maternal deaths in Turkey are rare. The aim of the present study was to analyze the cardiac causes of all maternal deaths in Turkey between 2007 and 2009. Materials and methods: In this retrospective study, case files of all pregnancy-associated deaths recorded in Turkey between 2007 and 2009 were reviewed. Records for all pregnancy-associated deaths were reviewed by five authors to identify 129 cases in which a cardiac disease seemed to be the reason. For each of the 129 cases, maternal age, gravidity, parity, antenatal care attendance, district of residence, year of death, mode of delivery, perinatal outcome, and clinical history preceding death were recorded. Results: During the study period, 779 maternal deaths were identified. Our estimate of the maternal mortality ratio (MMR) in 3-year period was 19.7 per 100,000 live births. The report lists 779 deaths, 411 direct and 285 indirect. Indirect obstetric causes of maternal death were primarily cardiac disorders and cerebrovascular diseases. Maternal mortality due to cardiac disease was 15.5% in 2007 and 18.4% in 2008. Valvular heart disease was the leading cause of maternal death from cardiac reasons (25.6%). Maternal mortality due to cardiac disease increased with age. Conclusion: The main cause of indirect maternal death has been cardiac disease in 3-year period.     

Maternal age and the likelihood of a maternal request for cesarean delivery: a 5-year population-based study

OBJECTIVE: The purpose of this study was to examine associations between maternal age and maternal request cesarean deliveries. STUDY DESIGN: Five-year population-based data from Taiwan (1997-2001) that covered 904,657 singleton deliveries without a clinical indication for cesarean delivery that were judged by the attending physician were subjected to multiple logistic regression, year-wise, to examine the association of maternal age with request cesarean delivery, adjusted for health care institutional characteristics. RESULTS: Request cesarean delivery rates steadily increased over the study period within each age group, disproportionately so among the 34+ age group. Women aged < 25 years were less likely than women aged 25 to 34 years (reference group) to request a cesarean delivery (odds ratio range, 0.67-0.88) and women aged 34+ were more likely than the reference group to have a request cesarean delivery (odds ratio range, 1.96-2.01), adjusted for health care institutional characteristics. CONCLUSION: Population-based data confirms the expectancy that request cesarean delivery propensity increases with maternal age.     

Maternal mortality surveillance in an inland Chinese province

Objectives

To evaluate the Chinese maternal mortality surveillance system in an inland province and identify how it can be improved.

Methods

The review process and Chinese Maternal Deaths Reporting Form were compared with standards recommended by the UK Confidential Enquiry into Maternal and Child Health using interviews with key personnel, field observations, and reports and audits from 2003-2005.

Results

The Chinese Maternal Deaths Reporting Form does not provide anonymity for the deceased woman, the health workers, or hospitals. The information collected is often insufficient to identify substandard care. The Review Committee was not multidisciplinary and the review was not confidential. The review findings were only available to the Review Committee.

Conclusion

Confidentiality should be a requirement in the maternal mortality surveillance system. The anonymous findings should be available to health workers, and be used to improve the system and inform the community about performance.     

Maternal mortality rates in the last eight years: A university hospital-based study from Turkey

Objective.?To analyze the cause of changing maternal mortality ratios (MMRs) in a tertiary women's health center in Turkey in the last eight years.

Materials and methods.?Charts of patients seen between 1998 and 2005 were retrospectively reviewed. Statistical analysis was performed using the Chi-square test. The results were accepted to be significant when the p value was <0.05.

Results.?During this period, 27 pregnancy-related deaths were identified via hospital death records. The MMR was found to have decreased in rate by approximately 50% from 822.2/100 000 live births in the previous report including the years 1978–1997 to 412.0/100 000 during the last eight years (p < 0.01). Pregnancy-induced hypertension was still the most frequent cause of maternal death. The decrease in MMR was due to the decrease in the ratio of maternal infection (26.4% in 1978–1997 to 7.4% in 1998–2005, p < 0.01).

Conclusion.?Although treatment in the antenatal care and health service has decreased maternal deaths, it was discovered that the MMR has not reached the optimum levels found in developed countries in the last eight years. Also the percentage of direct obstetric deaths (with the exception of those caused by infection) showed no change and was similar to that found in the previous report (1978–1997).     

Maternal age is associated with embryo splitting after single embryo transfer: a retrospective cohort study

PurposeTo determine whether maternal age has an impact on monozygotic twinning (MZT) rates in women undergoing single embryo transfer (SET).MethodsThis is a retrospective cohort study analyzed for the incidence of MZT of all clinical pregnancies after a single embryo transfer was carried out between 2014 and 2018. The effect of different assisted reproductive technology (ART) parameters on the incidence of MZT was evaluated.ResultsThere were a total of 8459 cycles resulting in pregnancy during the study period. Of these pregnancies, 8236 were singletons and 223 were MZT. The preterm birth rate, miscarriage rate, and cesarean section rate were higher in MZT. Birth weight and gestational age at delivery were lower and smaller. In the univariate analysis, the risk of MZT was decreased with frozen embryo transfer (ET). A nonlinear relationship was observed between maternal age and MZT. A negative relationship between maternal age and MZT was observed in the patients’ age ≥ 36 years.ConclusionAdvanced maternal age was associated with a lower rate of MZT. A threshold female age of 36 years existed for lower MZT.     

Longitudinal study of perinatal maternal stress,depressive symptoms and anxiety

Objectives

to understand the trends in, and relationships between, maternal stress, depressive symptoms and anxiety in pregnancy and post partum.

Design

a prospective longitudinal survey study was undertaken to explore maternal psychological distress throughout the perinatal period. The participants were recruited after 24 completed weeks of gestation, and were followed-up monthly until one month post partum (four surveys in total).

Setting

participants were recruited from a single hospital in southern Taiwan, and asked to complete questionnaires in the hospital waiting area.

Participants

inclusion criteria were: age ≥18 years, able to read and write Chinese, ≥24 weeks of gestation, singleton pregnancy and no pregnancy complications (including a diagnosis of antenatal depression or anxiety disorder). In total, 197 women completed all four surveys (response rate 74.62%).

Measurements and findings

stress was measured with the 10-item Perceived Stress Scale, depressive symptoms were measured with the Center for Epidemiologic Studies' Depression scale, and anxiety was measured with the Zung Self-reported Anxiety Scale. Participants were followed-up at four time points: T1 (25–29 gestational weeks), T2 (30–34 gestational weeks), T3 (>34 gestational weeks) and T4 (4–6 weeks post partum). Appointments for data collection were made in accordance with the participants' antenatal and postnatal check-ups. The three types of maternal distress had different courses of change throughout the perinatal period, as levels of depressive symptoms remained unchanged, anxiety levels increased as gestation advanced but declined after birth, and stress decreased gradually during pregnancy but returned to the T1 level after birth. There was a low to high degree of correlation in maternal stress, depressive symptoms and anxiety in pregnancy and post partum.

Key conclusions

around one-quarter of the study participants had depressive symptoms during pregnancy and post partum. Stress and anxiety showed opposing courses during the perinatal period. Regardless of the trend, maternal mental distress returned to the T1 level after birth.

Implications for practice

effective survey questionnaires are suggested for use as primary screening for possible psychological distress among pregnant and post partum women. It is suggested that health care professionals involved in obstetrics and midwifery should pay attention to the psychological needs of pre- and postnatal women, provide women with sufficient information about their mental well-being, and make appropriate and timely referrals to psychiatric or psychological care.     

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.     

Maternal diet and breastfeeding duration of infants after NICU hospitalization in Greece: a cohort study

Objectives: To investigate the role of maternal diet, personal characteristics and willingness to breastfeed on breastfeeding duration of hospitalized neonates as well as to evaluate the mothers’ dietetic intake based on the national recommendations.

Methods: A sample of 161 pregnant women from Athens, Greece was followed up during pregnancy, labor and the first 40 weeks of lactation. The participants attended breastfeeding classes and were interviewed regarding their nutritional habits, personal characteristics and breastfeeding intention. A multivariable logistic regression, adjusted for maternal age, smoking, weeks of gestation, body mass index, mode of delivery was conducted in order to estimate the adjusted odds ratios of breastfeeding for at least 6 months for consuming additional serves of fruit or vegetables from the recommended by the national guidelines.

Results: The adjusted odds ratios for breastfeeding at 6 months was 2.15 (p?=?0.05) for women consumed ≥3.5 servings of fruits/day. Moreover, the participants reported low conformity with the national dietetic guidelines.

Conclusions: Mothers who consumed the recommended by the NDG fruit servings/day breast-fed their hospitalized newborns for a longer period. Despite the fact that our participants were highly motivated and willing to breast-feed, we argue that this relationship is highly unlikely to be biological.     

Eclampsia: Maternal and neonatal outcomes

The objective of our study is to define the maternal and neonatal outcomes associated with eclampsia. This retrospective cohort study was performed using the Consortium on Safe Labor, database from 12 clinical centers, including 19 hospitals, from 2002–2008. All patients admitted with a diagnosis of eclampsia or seizure in labor and delivery or postpartum were included in the analysis. Patients with history of seizure disorder were excluded. Maternal and neonatal outcomes were compared to outcomes of women with preeclampsia and their neonates. Statistical analyses were performed using SAS. Chi square and t-test were used for categorical and continuous variables, respectively. Logistic regression and general linear regression were used to calculate odds ratios and 95% confidence intervals. p < 0.05 was considered significant. The eclampsia prevalence was 0.08% (n = 191) in our population; the preeclampsia cohort had 7012 women. There were significantly more eclamptic women (49%) delivered by cesarean section, as compared to preeclamptic women (36%), OR 1.7 (1.28–2.28). These women were more likely to have an ICU admission OR 12.9 (7.0–23.7). The mean gestational ages and birthweights were lower in the neonates of the eclampsia group. A multivariate analysis revealed that low cord arterial pH, low 5 min Apgar score, respiratory distress syndrome OR 5.5, (1.11–27.66) and seizures OR 10.3 (3.12–33.68), p < 0.05, were significantly elevated in the eclampsia cohort. The prevalence of eclampsia in our contemporary obstetrics population was 0.08%. Both mothers as well as neonates of eclamptics are at significant risk for complications due to their illness.     

Maternal laboratory stress influences fetal neurobehavior: Cortisol does not provide all answers

Objective.?Maternal stress can have an impact on pregnancy. However, effects on fetal neurobehavior are not well understood. In this study, the effect of laboratory stress on maternal psychoneuroendocrinological response and on fetal neurobehavior was studied. Serum cortisol as a potential underlying mechanism was measured.

Methods.?Twenty-seven women made a single 1.5-h visit in their third trimester. The laboratory stressor involved an arithmetic task. Associations between maternal laboratory stress response and fetal neurobehavior were analyzed by studying 19 maternal–fetal dyads with high signal quality cardiotocograms.

Results.?Stress exposure changed participants stress perception (p?<?0.0001). However, only half of the participants (responders) had an HPA-axis response. Fetuses responded to the stress exposure depending on their mothers' stress response: (i) there was a fetal heart rate (FHR) group effect at the level of trend (p?=?0.06). Fetuses of responders had higher HR levels 20?min after the exposure (p?=?0.043), (ii) there were interaction (p?=?0.026) and group effects at the level of trend (p?=?0.078) found for FHR short-term variation (STV). Fetuses of responders had lower FHR STV 20?min after stress exposure (p?=?0.007). Cortisol as a potential underlying mechanism only seemed to be associated with short- and long-term variation of FHR.

Conclusions.?An activation of the maternal stress-system could result in a child being born having a history of responding to maternal stress.     

Maternal mortality in southern israel

Summary Between 1969 and 1991 there were 166,410 births in Southern Israel with 13 maternal deaths (7.8/100,000). In the Jewish population there were 119,130 deliveries with 7 maternal deaths (5.9/100,000), and the Bedouins had 47,280 deliveries with 6 maternal deaths (12.7/100,000). Prenatal care was an important preventive factor. 7 maternal deaths occurred among 151,088 women who had received prenatal care (4.6/100,000), whereas 6 such deaths occurred among 15,322 without prenatal care (39.1/100,000) (P value 0.0005). Ten of the 13 women who died were over 24 years old. Eight of the 13 patients were multiparous. Live births occurred in 6 patients and stillbirths in 5 patients. Hemorrhage, preeclampsiaeclampsia and pulmonary embolism were the leading causes of maternal death.