Effects of Contact with Stillborn Babies on Maternal Anxiety and Depression

Abstract: Background: Some guidelines encourage mothers to see and hold their babies after stillbirth, which might be traumatizing. The study objective was to investigate the effects of women seeing and holding their stillborn baby on the risk of anxiety and depression in a subsequent pregnancy and in the long term. Methods: Thirty‐seven organizations recruited women who had experienced stillbirth (N = 2,292 of whom 286 reported being pregnant). Anxiety and depressive symptoms were assessed by using the 25‐item Hopkins Symptom Check List. Results: Among nonpregnant women, seeing and holding their stillborn baby were associated with lower anxiety symptoms (OR 0.68, 95% CI 0.49–0.95) and a tendency toward fewer symptoms of depression (OR 0.72, 95% CI 0.51–1.02), compared with pregnant women. Participants who were pregnant also had less depressive symptomatology (OR 0.57, 95% CI 0.43–0.75), but more symptoms of anxiety if they had seen and held their baby (OR 3.79, 95% CI 1.42–10.1). Conclusions: Seeing and holding the baby are associated with fewer anxiety and depressive symptoms among mothers of stillborn babies than not doing so, although this beneficial effect may be temporarily reversed during a subsequent pregnancy. (BIRTH 35:4 December 2008)     

Unintended pregnancy is a risk factor for depressive symptoms among socio-economically disadvantaged women in rural Bangladesh

Background

Little is known about the relation between unwanted pregnancy and intention discordance and maternal mental health in low-income countries. The study aim was to evaluate maternal and paternal pregnancy intentions (and intention discordance) in relation to perinatal depressive symptoms among rural Bangladeshi women.

Methods

Data come from a population-based, community trial of married rural Bangladeshi women aged 13–44. We examined pregnancy intentions among couples and pregnancy-intention discordance, as reported by women at enrollment soon after pregnancy ascertainment, in relation to depressive symptoms in the third trimester of pregnancy (N?=?14,629) and six months postpartum (N?=?31,422). We calculated crude and adjusted risk ratios for prenatal and postnatal depressive symptoms by pregnancy intentions.

Results

In multivariable analyses, women with unwanted pregnancies were at higher risk of prenatal (Adj. RR?=?1.60, 95% CI: 1.37–1.87) and postnatal depressive symptoms (Adj. RR?=?1.32, 95% CI: 1.21–1.44) than women with wanted pregnancies. Women who perceived their husbands did not want the pregnancy also were at higher risk for prenatal (Adj. RR?=?1.42, 95% CI: 1.22–1.65) and postnatal depressive symptoms (Adj. RR?=?1.30, 95% CI: 1.19–1.41). Both parents not wanting the pregnancy was associated with prenatal and postnatal depressive symptoms (Adj. RR?=?1.34, 95% CI: 1.19–1.52; Adj. RR?=?1.13, 95% CI: 1.06–1.21, respectively), compared to when both parents wanted it. Adjusting for socio-demographic and pregnancy intention variables simultaneously, maternal intentions and pregnancy discordance were significantly related to prenatal depressive symptoms, and perception of paternal pregnancy unwantedness and couple pregnancy discordance, with postnatal depressive symptoms.

Conclusions

Maternal, paternal and discordant couple pregnancy intentions, as perceived by rural Bangladeshi women, are important risk factors for perinatal maternal depressive symptoms.

     

Trends and risk factors of stillbirth in New Jersey 1997–2005

Introduction: The purpose of this study was to examine the trends in the rates of stillbirth by race and ethnicity and to determine the risk factors of stillbirth. Methods: We used New Jersey data (1997–2005) for live births and fetal deaths. Cox proportional hazards model was used to estimate the risk of stillbirth associated with maternal risk factors and pregnancy complications. Results: The rate of stillbirth was 4.4/1000 total births (3.4 for white and 7.9 for black non-Hispanics and 4.4 for Hispanics/1000 total births). The rates of stillbirth decreased from 3.8 in 1997 to 2.7/1000 total births in 2005 for white non-Hispanics but remained unchanged for other race/ethnicity groups. Adjusted relative risks for the risk factors associated with stillbirth were 1.3 (95% CI, 1.2–1.4) for maternal age ≥ 35 years, 1.9 (95% CI, 1.7–2.1) for black non-Hispanics, 2.8 (95% CI, 2.4–3.3) for no prenatal care, 40.2 (95% CI, 36.9–43.9) for placental abruption, 5.3 (95% CI, 3.4–8.2) for eclampsia, 3.5 (95% CI, 2.8–4.3) for diabetes mellitus and 1.7 (95% CI, 1.3–2.2) for preeclampsia. Conclusion: There was a decline in the rate of stillbirth but there were persistent racial disparities with the highest rates of stillbirth for black non-Hispanics.     

Maternal Perception of Fetal Activity and Late Stillbirth Risk: Findings from the Auckland Stillbirth Study

Abstract: Background: Maternal perception of decreased fetal movements has been associated with adverse pregnancy outcomes, including stillbirth. Little is known about other aspects of perceived fetal activity. The objective of this study was to explore the relationship between maternal perception of fetal activity and late stillbirth (≥ 28 wk gestation) risk. Methods: Participants were women with a singleton, late stillbirth without congenital abnormality, born between July 2006 and June 2009 in Auckland, New Zealand. Two control women with ongoing pregnancies were randomly selected at the same gestation at which the stillbirth occurred. Detailed demographic and fetal movement data were collected by way of interview in the first few weeks after the stillbirth, or at the equivalent gestation for control women. Results: A total of 155/215 (72%) women who experienced a stillbirth and 310/429 (72%) control group women consented to participate in the study. Maternal perception of increased strength and frequency of fetal movements, fetal hiccups, and frequent vigorous fetal activity were all associated with a reduced risk of late stillbirth. In contrast, perception of decreased strength of fetal movement was associated with a more than twofold increased risk of late stillbirth (aOR: 2.37; 95% CI: 1.29–4.35). A single episode of vigorous fetal activity was associated with an almost sevenfold increase in late stillbirth risk (aOR: 6.81; 95% CI: 3.01–15.41) compared with no unusually vigorous activity. Conclusions: Our study suggests that maternal perception of increasing fetal activity throughout the last 3 months of pregnancy is a sign of fetal well‐being, whereas perception of reduced fetal movements is associated with increased risk of late stillbirth. (BIRTH 38:4 December 2011)     

The Relationship Between Depressive/Anxiety Symptoms During Pregnancy/Postpartum and Sexual Life Decline after Delivery

IntroductionSeveral factors have been found to be independently associated with decline in sexual activity after delivery. However, the association between depression in pregnancy/postpartum and sexual problems is less clear.AimTo prospectively evaluate the relationship between depressive/anxiety symptoms (DAS) during the perinatal period and sexual life in the postpartum period.MethodsA prospective cohort study conducted between May 2005 and March 2007 included 831 pregnant women recruited from primary care clinics of the public sector in São Paulo, Brazil. Four groups with DAS during antenatal and postpartum periods were identified using the Self Report Questionnaire (SRQ‐20): absence of both antenatal and postpartum DAS; presence of antenatal DAS only; presence of postpartum DAS only; and presence of both antenatal and postpartum DAS. The primary outcome was perception of sexual life decline (SLD) before and after pregnancy/delivery. Crude and adjusted risk ratios (RR), with 95% confidence intervals (95% CI), were calculated using Poisson regression to examine the associations between DAS and SLD.Main Outcome MeasureThe main outcome measure of this study is the perception of SLD before and after pregnancy/delivery.ResultsSLD occurred in 21.1% of the cohort. In the multivariable analysis, the following variables were independently associated with SLD: DAS during both pregnancy and postpartum (RR: 3.17 [95% CI: 2.18–4.59]); DAS during only the postpartum period (RR: 3.45 [95% CI: 2.39–4.98]); a previous miscarriage (RR: 1.54 [95% CI: 1.06–2.23]); and maternal age (RR: 2.11 [95% CI: 1.22–3.65]).ConclusionsPostpartum women with DAS have an increased likelihood for SLD up to 18 months after delivery. Efforts to improve the rates of recognition and treatment of perinatal depression/anxiety in primary care settings have the potential to preserve sexual functioning for low‐income mothers.     

Cannabis Use in Pregnancy in British Columbia and Selected Birth Outcomes

ObjectiveThis study sought to determine the association between cannabis use in pregnancy and stillbirth, small for gestational age (SGA) (<10th percentile), and spontaneous preterm birth (<37 weeks).MethodsThe study used abstracted obstetrical and neonatal medical records for deliveries in British Columbia from April 1, 2008 to March 31, 2016 that were contained in the Perinatal Data Registry of Perinatal Services British Columbia. Chi-square tests were conducted to compare maternal sociodemographic characteristics by cannabis use. Logistic regression was conducted to determine the association between cannabis use and SGA and spontaneous preterm births. Cox proportional hazards regression modelling was used to identify the association between cannabis use and stillbirth. Secondary analyses were conducted to ascertain differences by timing of stillbirth (Canadian Task Force Classification II-2).ResultsMaternal cannabis use has increased in British Columbia over the past decade. Pregnant women who use cannabis are younger and more likely to use alcohol, tobacco, and illicit substances and to have a history of mental illness. Using cannabis in pregnancy was associated with a 47% increased risk of SGA (adjusted OR 1.47; 95% CI 1.33–1.61), a 27% increased risk of spontaneous preterm birth (adjusted OR 1.27; 95% CI 1.14–1.42), and a 184% increased risk of intrapartum stillbirth (adjusted HR [aHR] 2.84; 95% CI 1.18–6.82). The association between cannabis use in pregnancy and overall stillbirth and antepartum stillbirth did not reach statistical significance, but it had comparable point estimates to other outcomes (aHR 1.38; 95% CI 0.95–1.99 and aHR 1.34; 95% CI 0.88–2.06, respectively).ConclusionCannabis use in pregnancy is associated with SGA, spontaneous preterm birth, and intrapartum stillbirth.     

Long-term outcomes for mothers who have or have not held their stillborn baby

Objectives

to investigate long-term outcomes of mothers who have or have not held their stillborn baby, and predictors of having held the baby.

Design

postal questionnaires.

Setting

a nation-wide cohort study of mothers who gave birth to a singleton stillborn baby in Sweden in 1991.

Participants

314 out of 380 women answered the questionnaire and 309 reported whether or not they had held their baby.

Measurements

scales measuring anxiety, depression and well-being.

Findings

126 (68%) mothers of 185 babies stillborn after 37 gestational weeks had held their baby and 82 (68%) mothers of 120 babies stillborn at gestational weeks 28–37 had also done so. Compared with mothers who agreed completely with the statement that staff gave enough support to hold the baby, mothers who did not agree were less likely to have held their baby [relative risk (RR) 4.1; 95% confidence interval (CI) 2.7–6.1], and mothers with a low level of education were less likely to have held their baby than mothers with a higher level of education (RR 2.2; 95% CI 1.3–3.8). Mothers who had not held their babies born after 37 gestational weeks had an increased risk of headache (RR 4.3; 95% CI 1.1–16.5), and they were less satisfied with their sleep (RR 2.7; 95% CI 1.5–5.0). The increased risk of long-term outcomes associated with not holding, compared with holding, a stillborn baby were less pronounced for women who gave birth at gestational week 28–37 compared with women who gave birth after 37 gestational weeks.

Key conclusions

in this cohort, we found an overall beneficial effect of having held a stillborn baby born after 37 gestational weeks, whereas findings for having held a stillborn baby born at gestational weeks 28–37 are uncertain. The attitude of staff influenced whether or not the mother held her stillborn baby.

Implications for practice

if the mother is guided by staff in a sensitive way to hold her stillborn term baby, the experience will possibly be beneficial for her in the long term.     

Umbilical artery Doppler in relation to placental pathology and FV Leiden in pregnant women and their offspring

Abstract

Objective: Abnormal umbilical artery blood flow has been implicated in pregnancy complications and fetal demise. Its relation to histopathological changes in the placenta and to maternal or fetal thrombophilia is less well understood. The aim of this study was to evaluate the relation between umbilical artery Doppler findings, placental histopathology, and maternal and fetal coagulation factor V Leiden (FVL) status.

Methods: Two previous studies on FVL in pregnancy made the placentas of 25 women with maternal FVL carriership and 43 randomly selected non-carriers available for a histopathological examination. Umbilical artery Doppler velocimetry was performed on 54 women in late pregnancy.

Results: Abnormal umbilical artery Doppler velocimetry was associated with an approximately sevenfold increased risk of fetoplacental thrombotic vasculopathy (odds ratio [OR]: 7.5, 95% confidence intervals [CI]: 1.3–44.3), ischemic lesions (OR: 7.5, 95% CI: 1.2–46.1) and fetal carriership of FVL (OR: 8.2, 95% CI: 1.5–43.5), but not maternal FVL. Fetal FVL carriership was also associated with a sevenfold increased risk of ischemic lesions (OR: 6.7, 95% CI: 1.3–35).

Conclusions: Our results indicate that the fetal – not the maternal – FVL carriership matters regarding the umbilical artery blood flow and placental pathology, which might explain some of the heterogeneity of studies.     

A prospective study of postpartum depression in 17 648 parturients

Abstract

Objective: To assess perinatal antecedents to postpartum depression (PPD).

Methods: This was a prospective population-based, observational study of women screened for symptoms of depression using the Edinburgh Postnatal Depression Scale (EPDS) with scores ≥13 referred for psychiatric evaluation. Obstetric and neonatal outcomes were analyzed using univariable and multivariable analysis for associations with postpartum depressive symptoms.

Results: Of 25?050 women delivered, 17?648 (71%) completed EPDS questionnaires with 1106 (6.3%) scoring ≥13. Perinatal complications most associated with EPDS scores ≥13 included major malformation (adjusted OR 1.5; 95% CI, 1.1–2.3), neonatal death (adjusted OR 5.8; 95% CI, 2.9–11.4), stillbirth (adjusted OR 9.4; 95% CI, 6.0–14.8), and necrotizing enterocolitis (adjusted OR 21.7; 95% CI, 1.9–244.3). A total of 238 (22%) women kept their psychiatric referral appointment, and 111 (47%) were diagnosed with PPD. Perinatal factors were also found to be significantly associated with PPD.

Conclusions: PPD is significantly increased in women with adverse pregnancy outcomes, especially involving the infant.     

Fear of an Intimate Partner and Women’s Health in Early Pregnancy: Findings from the Maternal Health Study

ABSTRACT: Background: Intimate partner violence affects 1 in 4 women at some stage in their lives. Exposure to violence has short‐ and long‐term consequences for women themselves and their children. The objective of this study was to examine associations between fear of an intimate partner and maternal physical and psychological morbidity in early pregnancy. Method: This paper reports baseline measures from a prospective pregnancy cohort study of 1,507 nulliparous women recruited at six public hospitals in Melbourne, Australia. Results: The study showed that 18.7 percent (280/1,497) of women reported being afraid of an intimate partner at some stage in their lives; 3.1 percent (47/1,497) were afraid in early pregnancy and 15.6 percent (233/1,497) had been afraid before but not during the current pregnancy. Compared with women who had never been afraid of an intimate partner, women who reported being afraid of an intimate partner in early pregnancy (≤ 24 wk gestation) were at increased risk of urinary incontinence (adjusted OR = 1.64, 95% CI 0.9–3.1), fecal incontinence (adjusted OR = 3.32, 95% CI 1.2–9.2), vaginal bleeding (adjusted OR = 2.84, 95% CI 1.5–5.5), anxiety (adjusted OR = 10.22, 95% CI 5.0–21.2), and depression (adjusted OR = 4.43, 95% CI 2.1–9.7). Women afraid of an intimate partner before but not during pregnancy experienced a similar pattern of morbidity. Conclusions: Women afraid of an intimate partner both before and during pregnancy have poorer physical and psychological health in early pregnancy. (BIRTH 35:4 December 2008)     

Risk of Fetal Death Associated With Maternal Drug Dependence and Placental Abruption: A Population-Based Study

ObjectiveSubstance use in pregnancy is associated with placental abruption, but the risk of fetal death independent of abruption remains undetermined. Our objective was to examine the effect of maternal drug dependence on placental abruption and on fetal death in association with abruption and independent of it.MethodsTo examine placental abruption and fetal death, we performed a retrospective population-based study of 1 854 463 consecutive deliveries of liveborn and stillborn infants occurring between January 1, 1995 and March 31, 2001, using the Canadian Institute for Health Information Discharge Abstract Database.ResultsMaternal drug dependence was associated with a tripling of the risk of placental abruption in singleton pregnancies (adjusted odds ratio [OR] 3.1; 95% confidence intervals [CI] 2.6–3.7), but not in multiple gestations (adjusted OR 0.88; 95% CI 0.12–6.4). Maternal drug dependence was associated with an increased risk of fetal death independent of abruption (adjusted OR 1.6: 95% CI 1.1–2.2) in singleton pregnancies, but not in multiples. Risk of fetal death was increased with placental abruption in both singleton and multiple gestations, even after controlling for drug dependence adjusted OR 11.4 in singleton pregnancy; 95% CI 10.6–12.2, and 3.4 in multiple pregnancy; 95% CI 2.4–4.9).ConclusionMaternal drug use is associated with an increased risk of intrauterine fetal death independent of placental abruption. In singleton pregnancies, maternal drug dependence is associated with an increased risk of placental abruption.     

Severe Maternal Morbidity and Maternal Mortality Associated with Assisted Reproductive Technology

ObjectiveTo assess the association between use of assisted reproductive technologies (ART) and severe maternal morbidity and maternal mortality (SMM).MethodsWe carried out a cohort study that included all hospital deliveries at ≥20 weeks gestation in Canada (excluding Québec) between April 2009 and March 2018. Outcomes of interest included composite SMM and SMM types (e.g., severe preeclampsia, HELLP syndrome, and eclampsia; severe hemorrhage; acute renal failure). Multivariable regression was used to estimate crude and adjusted rate ratios (RR and aRR) and 95% confidence intervals (CI).ResultsThe study included 2 535 056 women, of whom 72 023 (2.8%) delivered following the use of ART. The composite SMM rate for women who used ART was 34.7 per 1000 deliveries (95% CI 33.0–36.0) versus 11.5 per 1000 deliveries (95% CI 11.4–11.6) for women who did not use ART (RR 3.01; 95% CI 2.89–3.14). ART use was associated with SMM types such as severe preeclampsia, HELLP syndrome, and eclampsia (RR 3.50; 95% CI 3.27–3.73), severe hemorrhage (RR 3.58, 95% CI 3.27–3.92), and acute renal failure (RR 6.79; 95% CI 5.78–7.98). Associations between ART and composite SMM were attenuated but remained elevated after adjusting for maternal characteristics (aRR 2.34; 95% CI 2.24–2.45). Women who used ART and had a multi-fetal pregnancy had a 4.7 times higher rate of composite SMM compared with women who did not use ART and delivered singletons.ConclusionWomen who deliver following the use of ART have increased risks of SMM and require counselling that includes mention of the lower risks of SMM associated with ART-conceived singleton pregnancy.     

Second-trimester maternal serum alpha-fetoprotein and risk of adverse pregnancy outcome(1)

OBJECTIVE: To determine the risk of adverse pregnancy outcome by maternal serum alpha-fetoprotein (MSAFP) level. METHODS: We followed 77,149 pregnant women and their infants from MSAFP screening in the 15th to 20th week of gestation until 1 year after birth. Information on pregnancy outcome was obtained from national registries. The relative risks (RRs) and 95% confidence intervals (CIs) for adverse pregnancy outcome were estimated according to the level of MSAFP, with adjustment for confounders. RESULTS: A total of 638 pregnancies resulted in spontaneous abortion, 289 in stillbirth, and 437 in infant death. Compared with women with MSAFP levels at 0.75-1.24 multiples of the median (MoM), those with MSAFP levels greater than or equal to 2.5 MoM had an increased risk of spontaneous abortion (RR 12.5; 95% CI 9.7, 16.1), preterm birth (RR 4.8; 95% CI 4.1, 5.5), small for gestational age (RR 2.8; 95% CI 2.4, 3.2), low birth weight (RR 5.8; 95% CI 5.0, 6.6), and infant death (RR 1.9; 95% CI 1.2, 2.8). Women with MSAFP levels below 0.25 MoM had an increased risk of spontaneous abortion (RR 15.1; 95% CI 9.3, 24.8), preterm birth (RR 2.2; 95% CI 1.3, 3.8), and stillbirth (RR 4.0; 95% CI 1.0, 16.0); those with levels less than 0.5 MoM had an increased risk of infant death (RR 1.9; 95% CI 1.2, 3.0). The increased risk of infant death remained after the subtraction of recognized conditions associated with extreme MSAFP values. CONCLUSION: Pregnant women with extreme MSAFP values in the second trimester have an increased risk of fetal and infant deaths. Obstet Gynecol 2001;97:277-82.     

Adverse perinatal outcomes among interracial couples in the United States

OBJECTIVE: We examined the association between parental race and stillbirth and adverse perinatal and infant outcomes. METHODS: We conducted a retrospective cohort analysis using the 1995-2001 linked birth and infant death files that are composed of live births and fetal and infant deaths in the United States. The study included singleton births delivered at 20 or more weeks of gestation with a fetus weighing 500 g or more (N = 21,005,786). Parental race was categorized as mother white-father white, mother white-father black, mother black-father white, and mother black-father black. Multivariable logistic regression analysis was performed to examine the association between parental race and risks of stillbirth (at > or = 20 weeks), small for gestational age (defined as birth weight < 5th and < 10th percentile for gestational age), and early neonatal (< 7 days), late neonatal (7-27 days), and postneonatal (28-364 days) mortality. All analyses were adjusted for the confounding effects of maternal age, education, trimester at which prenatal care began, parity, marital status, and smoking during pregnancy. RESULTS: Although risks varied across parental race categories, stillbirth was associated with a higher-than-expected risk for interracial couples: mother white-father black, relative risk (RR) 1.17 (95% confidence interval [CI] 1.10-1.26) and mother black-father white, RR 1.37 (95% CI 1.21-1.54) compared with mother white-father white parents. The RR for stillbirth was even higher among mother black-father black parents (RR 1.67, 95% CI 1.62-1.72). The overall patterns of association for small for gestational age births (< 5th and < 10th percentile) and early neonatal mortality were similar to those seen for stillbirth. CONCLUSION: There is an increased risk of adverse perinatal outcomes for interracial couples, including stillbirth, small for gestational age infants, and neonatal mortality. LEVEL OF EVIDENCE: II-2.     

Birthweight in pregnant women with protein S deficiency treated with low-molecular-weight heparin: a retrospective cohort study

Objective: To determine the risk of small-for-gestational-age (SGA) and intrauterine growth retardation (IUGR) in pregnant women with protein S (PS) deficiency who received low-molecular-weight heparin (LMWH).

Methods: Retrospective cohort study of pregnant women seen from January 2002 to December 2011. The study cohort comprised a total of 328 patients with PS deficiency, who received prophylactic enoxaparin during pregnancy. The control cohort included 11 884 pregnant women without significant past medical history. The risk of SGA and IUGR was calculated as odds ratio. Multivariate regression analysis over the entire reference population was performed determining the risk of both SGA and IUGR by adjusting for maternal age, first delivery, maternal underweight status, pre-eclampsia, other treated thrombophilias or history of recurrent abortion.

Results: The SGA rates in the PS deficiency and control cohorts were 10.7% and 8.5%, respectively (p?>?0.05). There was no increased risk of SGA (unadjusted OR?=?1.28, 95% confidence interval [CI] 0.9–1.83; adjusted OR?=?1.35, 95% CI 0.91–2.01). The IUGR rate was 2.7% in pregnant women with PS deficiency versus 4.1% in the control group (p?>?0.05). Also, we did not find a significant risk of IUGR (OR?=?0.66; 95% CI 0.34–1.28; adjusted OR?=?0.843; 95% CI 0.42–1.70).

Conclusions: In women with PS deficiency treated with LMWH, the risk of SGA and IUGR is similar to the one found in healthy pregnant women.     

Perceived Discrimination and Depressive Symptoms,Smoking, and Recent Alcohol Use in Pregnancy

Abstract: Background: Perceived discrimination is associated with poor mental health and health‐compromising behaviors in a range of vulnerable populations, but this link has not been assessed among pregnant women. We aimed to determine whether perceived discrimination was associated with these important targets of maternal health care among low‐income pregnant women. Methods: Face‐to‐face interviews were conducted in English or Spanish with 4,454 multiethnic, low‐income, inner‐city women at their first prenatal visit at public health centers in Philadelphia, Penn, USA, from 1999 to 2004. Perceived chronic everyday discrimination (moderate and high levels) in addition to experiences of major discrimination, depressive symptomatology (CES‐D ≥ 23), smoking in pregnancy (current), and recent alcohol use (12 months before pregnancy) were assessed by patients’ self‐report. Results: Moderate everyday discrimination was reported by 873 (20%) women, high everyday discrimination by 238 (5%) women, and an experience of major discrimination by 789 (18%) women. Everyday discrimination was independently associated with depressive symptomatology (moderate = prevalence ratio [PR] of 1.58, 95% CI: 1.38–1.79; high = PR of 1.82, 95% CI: 1.49–2.21); smoking (moderate = PR of 1.19, 95% CI: 1.05–1.36; high = PR of 1.41, 95% CI: 1.15–1.74); and recent alcohol use (moderate = PR of 1.23, 95% CI: 1.12–1.36). However, major discrimination was not independently associated with these outcomes. Conclusions: This study demonstrated that perceived chronic everyday discrimination, but not major discrimination, was associated with depressive symptoms and health‐compromising behaviors independent of potential confounders, including race and ethnicity, among pregnant low‐income women. (BIRTH 37:2 June 2010)     

Thicker endometrial linings are associated with better IVF outcomes: a cohort of 6331 women

Abstract

Our objective was to determine if a correlation exists between endometrial thickness measured on the day of ovulation trigger during an in vitro fertilization (IVF) cycle and pregnancy outcomes among non-cancelled cycles. We performed a retrospective cohort study looking at 6331 women undergoing their first, fresh autologous IVF cycle from 1 May 2004 to 31 December 2012 at Boston IVF (Waltham, MA). Our primary outcome was the risk ratio (RR) of live birth and positive β-hCG. We found that thicker endometrial linings were associated with positive β-hCG and live birth rates. For each additional millimetre of endometrial thickness, we found a statistically significant increased risk of positive β-hCG (adjusted RR: 1.14; 95% CI: 1.09–1.18) and live birth (RR: 1.08; 95% CI: 1.05–1.11). There was no association between endometrial thickness and miscarriage (RR: 0.99; 95% CI: 0.91–1.07). Similar results were seen when categorizing endometrial thickness. Compared with an endometrial thickness >7 to <11?mm, the likelihood of a live birth was significantly higher for an endometrial thickness ≥11?mm (adjusted RR: 1.23; 95% CI: 1.11–1.37) and significantly lower for the ≤7?mm group (adjusted RR: 0.64; 95% CI: 0.45–0.90). In conclusion, thicker endometrial linings were associated with increased pregnancy and live birth rates.     

The influence of interpregnancy interval on the subsequent risk of stillbirth and early neonatal death

OBJECTIVE: To study whether interpregnancy interval is associated with increased risks of stillbirth and early neonatal death and whether this possible association is confounded by maternal characteristics and previous reproductive history. METHODS: In a Swedish nationwide study of 410,021 women's first and second singleton deliveries between 1983 and 1997, we investigated the influence of interpregnancy interval on the subsequent risks of stillbirth and early neonatal death. Odds ratios (ORs) with 95% confidence intervals (CIs) estimated using unconditional logistic regression were adjusted for maternal characteristics and previous pregnancy outcome categorized into stillbirth, early neonatal death, preterm, or small for gestational age delivery. RESULTS: Compared with interpregnancy intervals between 12 and 35 months, very short interpregnancy intervals (0-3 months) were, in the univariate analyses, associated with increased risks of stillbirth and early neonatal death (crude OR 1.9; 95% CI 1.3, 2.7; and 1.8; 1.2, 2.8, respectively). However, after adjusting for maternal characteristics and previous reproductive history, women with interpregnancy intervals of 0 to 3 months were not at increased risks of stillbirth (adjusted OR 1.3; 95% CI 0.8, 2.1) or early neonatal death (adjusted OR 0.9; 95% CI 0.5, 1.6). Women with interpregnancy intervals of 72 months and longer were at increased risk of stillbirth (adjusted OR 1.5; 95% CI 1.1, 2.1) and possibly early neonatal death (adjusted OR 1.3; 95% CI 0.9, 2.1). CONCLUSION: Short interpregnancy intervals appear not to be causally associated with increased risk of stillbirth and early neonatal death, whereas long interpregnancy intervals were associated with increased risk of stillbirth and possibly early neonatal death.     

Fish oil supplementation improves pregnancy outcomes and size of the newborn: a meta-analysis of 21 randomized controlled trials

Objective: To observe the effects of fish oil on related pregnancy outcomes.

Methods: A systematic search of the Medline, EMBASE and Cochrane’s library databases was conducted for the randomized controlled trials published till February 2015 that compared the effects of fish oil supplementation with a control diet in women during pregnancy.

Results: Twenty-one studies comprising 10?802 pregnant women were included. Dietary fish oil was associated with a 5.8-day increase in gestational age of the newborn, a 22% reduced risk for early preterm delivery (risk ratio [RR]?=?0.78, 95% CI: 0.64–0.95, p?=?0.01) and a 10% reduction in preterm delivery (RR?=?0.90, 95% CI 0.81–1.00, p?=?0.05). Fish oil supplementation was associated with higher infantile birth weight (51.23?g), birth length (0.28?cm) and head circumference (0.09?cm), and a 23% lower risk of low birth weight. No benefit from fish oil supplementation was found with regard to risk of intrauterine growth restriction or stillbirth.

Conclusions: Dietary fish oil during pregnancy was associated with reduced risk of preterm delivery and improved size of the newborn. Fish oil during pregnancy may be an effective prophylactic for preterm delivery.     

The clinical utility of maternal self-reported personal and familial psychiatric history in identifying women at risk for postpartum depression

BACKGROUND: To determine whether maternal self-reported data on personal and family psychiatric history would significantly predict postpartum depressive symptomatology at 8 weeks postpartum and to examine which of these variables were the most predictive for inclusion in an obstetrical clinical assessment aimed at early identification of postpartum depression. METHODS: As part of a longitudinal study, a population-based sample of 622 women completed mailed questionnaires at 1 and 8 weeks postpartum. RESULTS: At 8 weeks postpartum, mothers who indicated that they had any personal psychiatric history were almost four times more likely to exhibit depressive symptomatology (Edinburgh Postnatal Depression Scale score > 9) than those with no previous mental health difficulties (odds ratio [OR] 3.65, 95% CI 2.30-5.82). Any family psychiatric history was not a significant risk factor. Variables most predictive of depressive symptomatology at 8 weeks, explaining 42% of the variance, included: maternal antenatal depression (OR 3.77, p=0.03), maternal history of postpartum depression (OR 2.21, p=0.02), and Edinburgh Postnatal Depression Scale score >9 at 1 week postpartum (OR 18.23, p<0.001). CONCLUSIONS: The results suggest that maternal variables, particularly those related to the index and past pregnancies, not family psychiatric history, are the best predictors of postpartum depressive symptoms. These findings highlight the importance of assessing symptoms of depression and anxiety during pregnancy and the early postpartum period, in order to facilitate timely identification of women at risk for developing postpartum depression.