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JAMA Network Open May 2024An increasing body of evidence suggests equivalent if not improved postpartum outcomes of in-person group prenatal care compared with individual prenatal care. However,...
IMPORTANCE
An increasing body of evidence suggests equivalent if not improved postpartum outcomes of in-person group prenatal care compared with individual prenatal care. However, research is needed to evaluate outcomes of group multimodal prenatal care (GMPC), with groups delivered virtually in combination with individual in-person office appointments to collect vital signs and conduct other tests compared with individual multimodal prenatal care (IMPC) delivered through a combination of remotely delivered and in-person visits.
OBJECTIVE
To compare postpartum outcomes between GMPC and IMPC.
DESIGN, SETTING, AND PARTICIPANTS
A frequency-matched longitudinal cohort study was conducted at Kaiser Permanente Northern California, an integrated health care delivery system. Participants included 424 individuals who were pregnant (212 GMPC and 212 frequency-matched IMPC controls (matched on gestational age, race and ethnicity, insurance status, and maternal age) receiving prenatal care between August 17, 2020, and April 1, 2021. Participants completed a baseline survey before 14 weeks' gestation and a follow-up survey between 4 and 8 weeks post partum. Data analysis was performed from January 3, 2022, to March 4, 2024.
EXPOSURE
GMPC vs IMPC.
MAIN OUTCOME MEASURES
Validated instruments were used to ascertain postpartum psychosocial outcomes (stress, depression, anxiety) and perceived quality of prenatal care. Self-reported outcomes included behavioral outcomes (breastfeeding initiation, use of long-acting reversible contraception), satisfaction with prenatal care, and preparation for self and baby care after delivery. Primary analyses included all study participants in the final cohort. Three secondary dose-stratified analyses included individuals who attended at least 1 visit, 5 visits, and 70% of visits. Log-binomial regression and linear regression analyses were conducted.
RESULTS
The final analytic cohort of 390 participants (95.6% follow-up rate of 408 singleton live births) was racially and ethnically diverse: 98 (25.1%) Asian/Pacific Islander, 88 (22.6%) Hispanic, 17 (4.4%) non-Hispanic Black, 161 (41.3%) non-Hispanic White, and 26 (6.7%) multiracial participants; median age was 32 (IQR, 30-35) years. In the primary analysis, after adjustment, GMPC was associated with a 21% decreased risk of perceived stress (adjusted risk ratio [ARR], 0.79; 95% CI, 0.67-0.94) compared with IMPC. Findings were consistent in the dose-stratified analyses. There were no significant differences between GMPC and IMPC for other psychosocial outcomes. While in the primary analyses there was no significant group differences in perceived quality of prenatal care (mean difference [MD], 0.01; 95% CI, -0.12 to 0.15) and feeling prepared to take care of baby at home (ARR, 1.09; 95% CI, 0.96-1.23), the dose-stratified analyses documented higher perceived quality of prenatal care (MD, 0.16; 95% CI, 0.01-0.31) and preparation for taking care of baby at home (ARR, 1.27; 95% CI, 1.13-1.43) for GMPC among those attending 70% of visits. No significant differences were noted in patient overall satisfaction with prenatal care and feeling prepared for taking care of themselves after delivery.
CONCLUSIONS
In this cohort study, equivalent and, in some cases, better outcomes were observed for GMPC compared with IMPC. Health care systems implementing multimodal models of care may consider incorporating virtual group prenatal care as a prenatal care option for patients.
Topics: Humans; Female; Pregnancy; Adult; Prenatal Care; Longitudinal Studies; California; Postpartum Period; Cohort Studies
PubMed: 38771574
DOI: 10.1001/jamanetworkopen.2024.12280 -
Neuropsychiatric Disease and Treatment 2024To determine whether perioperative esketamine use decreases the risk of postpartum depression (PPD). (Review)
Review
PURPOSE
To determine whether perioperative esketamine use decreases the risk of postpartum depression (PPD).
METHODS
Online search of PubMed, Web of Science, and Embase was conducted to identify relevant studies. Key words for search included, but were not limited to, postpartum depression, esketamine, and clinical trials. The mean and standard deviation of the Edinburgh Postnatal Depression Scale (EPDS) scores were extracted from the studies as primary parameters.
RESULTS
The literature search identified 226 articles, of which 5 met the criteria and were enrolled in the study. In total, 886 patients in the studies were taken into analysis. The EPDS scores in the esketamine group were lower than those of the control group at the early stage of puerperium (WMD=-2.05, 95% CI: -3.77, -0.34, =0.019), whereas there was no significant difference at the middle and later stages (WMD=-1.41, 95% CI: -2.86, 0.04, =0.056). The sensitivity analyses indicated that the result for the early stage was stable, whereas it was unreliable for the middle and later stages. The results of the Egger's test indicated no publication bias.
CONCLUSION
Perioperative use of esketamine contributes to a lower risk of PPD at the early stage of puerperium but not at the middle and later stages. To further verify this conclusion, more high-quality studies are required.
PubMed: 38770534
DOI: 10.2147/NDT.S451930 -
Cureus Apr 2024Background Postpartum depression (PPD) is a significant public health concern globally characterized by a spectrum of mood disturbances ranging from mild mood swings to...
Background Postpartum depression (PPD) is a significant public health concern globally characterized by a spectrum of mood disturbances ranging from mild mood swings to severe depressive episodes initiating within four weeks post childbirth and potentially persisting up to 12 months. Besides affecting the mother, it also affects the mental health and development of the babies born to affected mothers. Despite its considerable burden and potential adverse effects on both maternal and child well-being, PPD often goes undetected and untreated. Materials and methods A cross-sectional study was conducted from January 2024 to March 2024 at a tertiary care center in Gorakhpur to assess PPD in 280 postpartum women. The Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10 was used to confirm depression. Data collection involved a pretested, structured questionnaire. Data were analyzed using SPSS version 22 (IBM Corp., Armonk, NY). A p-value < 0.05 was considered statistically significant. Results The prevalence of PPD was 12.14%. Age and education were significant sociodemographic risk factors (p < 0.05). In psychosocial factors, adverse life events (p < 0.001), wishing for a male child but giving birth to a female (p = 0.01), domestic violence (p = 0.005), relationship issues, an alcoholic spouse (p = 0.01), and poor in-law relations (p < 0.001) were found to be linked to PPD. Obstetric factors such as complicated antenatal history, physical illness, cesarean section, complicated intranatal history, and postpartum complications were also found to be important factors. Conclusion PPD affects many women, emphasizing the need for effective measures. Initiatives like the appointment of healthcare counselors and PPD screening programs in healthcare settings are essential to detect and support affected mothers.
PubMed: 38770470
DOI: 10.7759/cureus.58653 -
BMC Public Health May 2024Worldwide mothers are suffering from postpartum depression (PPD) which impairs mothers' well-being, children, and families, and leads to adverse outcomes for mothers and...
BACKGROUND
Worldwide mothers are suffering from postpartum depression (PPD) which impairs mothers' well-being, children, and families, and leads to adverse outcomes for mothers and their growing newborns. Low and middle-income countries have a higher prevalence of PPD and limited studies about it. This study assessed the percentage of Palestinian mothers experiencing PPD nationally, identified mothers at a higher risk of PPD, and studied the correlation between PPD and mistreatment during childbirth.
METHODS
The study is based on a secondary data analysis from a cross-sectional study in the occupied Palestinian territory (oPt). A total of 745 telephone-based interviews with mothers were done within 2-4 weeks post-childbirth. The Patient Health Questionnaire (PHQ-9) was used as a screening tool for PPD. The Statistical Package for Social Science (SPSS) was used for analyzing the data.
RESULTS
In the context of descriptive epidemiology, we observed that 12.6% of the selected Palestinian mothers experienced PPD, with a higher occurrence of PPD among mothers living in the Gaza Strip, a politically and economically unstable region in Palestine, compared to mothers living in the West Bank (Adjusted Odd Ratio (AOD: 2.2, Confidence Interval (CI): 1.4-3.44). Older mothers were two times more likely to develop PPD compared to young mothers (AOR: 2.03, CI: 1.070-3.84). Mothers who experienced disrespectful behaviors represented by any abuse, negligence, abandonment, ineffective communication, or poor pain management in childbirth settings were more likely to report PPD than those who were not exposed to the disrespect.
CONCLUSION
A notable percentage of Palestinian mothers were identified as experiencing PPD, especially among mothers who experienced mistreatment in childbirth settings. It is essential to support healthcare providers to improve their practices and attitudes to eliminate mistreatment and abusive behaviors of mothers during childbirth.
Topics: Humans; Female; Depression, Postpartum; Adult; Cross-Sectional Studies; Prevalence; Risk Factors; Middle East; Arabs; Young Adult; Surveys and Questionnaires; Adolescent; Parturition; Pregnancy; Mothers
PubMed: 38769541
DOI: 10.1186/s12889-024-18829-8 -
Psychiatry and Clinical... Sep 2023The aim of this study is to investigate the validity and reliability of the Turkish version of the Attitudes Toward Motherhood Scale. Attitudes Toward Motherhood Scale...
BACKGROUND
The aim of this study is to investigate the validity and reliability of the Turkish version of the Attitudes Toward Motherhood Scale. Attitudes Toward Motherhood Scale was developed by Sockol et al to evaluate cognitive distortions and attitudes toward motherhood during pregnancy and the postpartum period.
METHODS
The sample of this study consisted of 223 pregnant women and 138 postpartum women. A Sociodemographic Data Form, the Edinburgh Postnatal Depression Scale, and Attitudes Toward Motherhood Scale were used to collect data from the participants.
RESULTS
Cronbach's alpha coefficient for internal consistency was 0.868 for the entire sample, 0.877 during pregnancy, and 0.828 for the postpartum period. Factor analysis revealed that the 3-factor structure explained 68.93% of the variance. Pearson's correlation coefficient was calculated as 0.901 for the test-retest correlation analysis after 3 weeks ( < .001). There was a positive correlation between Attitudes Toward Motherhood Scale and Edinburgh Postnatal Depression Scale.
CONCLUSION
The results of this study revealed that the validity and reliability of the Turkish version of the Attitudes Toward Motherhood Scale were satisfactory.
PubMed: 38765307
DOI: 10.5152/pcp.2023.22571 -
Scientific Reports May 2024Associations between depressive symptoms and breastfeeding are well documented. However, evidence is lacking for subdivisions of feeding styles, namely exclusive...
Associations between depressive symptoms and breastfeeding are well documented. However, evidence is lacking for subdivisions of feeding styles, namely exclusive breastfeeding, exclusive formula feeding and a mixed feeding style (breastfeeding and formula feeding). In addition, studies examining associations between mother-child-bonding and breastfeeding have yielded mixed results. The aim of this study is to provide a more profound understanding of the different feeding styles and their associations with maternal mental health and mother-child-bonding. Data from 307 women were collected longitudinally in person (prenatally) and by telephone (3 months postnatally) using validated self-report measures, and analyzed using correlational analyses, unpaired group comparisons and regression analyses. Our results from a multinomial regression analysis revealed that impaired mother-child-bonding was positively associated with mixed feeding style (p = .003) and depressive symptoms prenatal were positively associated with exclusive formula feeding (p = .013). Further studies could investigate whether information about the underlying reasons we found for mixed feeding, such as insufficient weight gain of the child or the feeling that the child is unsatiated, could help prevent impaired mother-child-bonding. Overall, the results of this study have promising new implications for research and practice, regarding at-risk populations and implications for preventive measures regarding postpartum depression and an impaired mother-child-bonding.
Topics: Humans; Breast Feeding; Female; Mother-Child Relations; Adult; Depression, Postpartum; Depression; Infant Formula; Infant; Object Attachment; Mothers; Longitudinal Studies; Infant, Newborn; Pregnancy; Bottle Feeding
PubMed: 38763963
DOI: 10.1038/s41598-024-62168-y -
BMC Pregnancy and Childbirth May 2024
PubMed: 38760768
DOI: 10.1186/s12884-024-06576-y -
Psychoneuroendocrinology Aug 2024Allopregnanolone (ALLO) is a metabolite of progesterone and a neuroactive steroid hormone. As a positive allosteric modulator of gamma-aminobutyric acid (GABA)...
BACKGROUND
Allopregnanolone (ALLO) is a metabolite of progesterone and a neuroactive steroid hormone. As a positive allosteric modulator of gamma-aminobutyric acid (GABA) receptors, ALLO seems to have antidepressant and anxiolytic effects, and was therefore approved as a specific medication for the treatment of postpartum depression in 2019. Despite the growing number of publications investigating ALLO levels, results on the biological and psychological correlates in the peripartum period remain inconsistent, possibly due to methodological challenges regarding measurement. To date, however, there is no systematic review examining the correlates, concentrations, and challenges in measuring ALLO in peripartum women.
METHOD
A systematic literature search of PubMed and PsycINFO was conducted in August 2023. Original research articles that measured ALLO concentrations in peripartum women were included. Reports were excluded if they were not original research, included non-human subjects, did not include peripartum women, did not include ALLO measurement as an outcome, included (pharmacological) interventions, constituted method validations, or used the same cohort as another study.
RESULTS
The literature search yielded 234 articles, and two articles were identified from other sources. After full-text screening, 19 articles (N = 1401) met the inclusion criteria, of which seven focused on biological correlates of ALLO and 12 on mood correlates. Of the latter, six found no association between ALLO and mood, four found a negative association, and two found a positive association. Overall, the results show an increase in ALLO levels during pregnancy and a decrease after birth, with levels then remaining low until six months postpartum. ALLO was most commonly measured in blood plasma and by gas chromatography-mass spectrometry (GC-MS). A significant matrix effect was found for blood serum and a significant method effect for radioimmunoassays (RIAs). A significant effect of time of measurement was found.
CONCLUSION
ALLO measurement shows method and matrix effects. ALLO levels are higher when measured in serum compared to in plasma, and when measured using RIA compared to other methods. Time of measurement, study design, and standardization of measurement also influence the reliability of measurement and the interpretation of results.
Topics: Humans; Pregnanolone; Female; Peripartum Period; Pregnancy; Depression, Postpartum; Adult
PubMed: 38759520
DOI: 10.1016/j.psyneuen.2024.107081 -
Medicine May 2024The perinatal period is crucial for both mother and newborn, and mental health, including prenatal and postpartum depression (PPD), is a significant aspect. Screening... (Observational Study)
Observational Study
The perinatal period is crucial for both mother and newborn, and mental health, including prenatal and postpartum depression (PPD), is a significant aspect. Screening for these disorders allows for early treatment and helps prevent risks to both mother and child. This prospective cohort study was carried out at University Hospital Obstetrics in Damascus City. The first phase was during the third trimester of pregnancy and the second phase involved a follow-up assessment after 6 weeks of delivery. The Arabic-validated version of the Edinburgh Postnatal Depression Scale questionnaire (EPDS) was used. A cutoff of 13 or higher was used to determine the presence of probable depression in both assessments. Of 347 pregnant women, 38.6% had prenatal depression (PND). 295 patients have achieved the second assessment, of which 30.2% had PPD. Furthermore, 42.6% who had PND developed PPD on follow-up. Binary logistic regression indicated that PND was predicted by non-Syrian nationality, paternal absence, poor financial status, number of previous pregnancies, and a history of depression independent of pregnancy. PPD was predicted by a history of PPD, and work status. Findings underscore potential value of early screening for depressive symptoms as a predictive measure. It is recommended that women with a history of depression receive heightened attention and care, irrespective of the timing of their depressive episodes.
Topics: Humans; Female; Pregnancy; Depression, Postpartum; Prospective Studies; Adult; Hospitals, University; Pregnancy Complications; Depression; Psychiatric Status Rating Scales; Young Adult; Risk Factors
PubMed: 38758898
DOI: 10.1097/MD.0000000000038170 -
Frontiers in Public Health 2024Postpartum depression (PPD) is the most common mental illness affecting women after childbirth, and working mothers may be faced with unique challenges. This study aimed...
BACKGROUND
Postpartum depression (PPD) is the most common mental illness affecting women after childbirth, and working mothers may be faced with unique challenges. This study aimed to examine the depression status among working postpartum women in 1 year of childbirth and explore the relationship between occupational factors and PPD in urban Beijing, China.
METHODS
A cross-sectional survey of 554 postpartum women was conducted among ten community health service centers in six urban districts of Beijing, China. Sociodemographic, occupational, childbirth and postpartum information were collected. Depression status was obtained using the Edinburgh Postnatal Depression Scale. Prevalence of postpartum depression (PPD) was assessed in relation to occupational characteristics, and influencing factors were analyzed through logistic regression.
RESULTS
Of the postpartum women, 29.42% met the criteria for depression. PPD prevalence was significantly higher among women employed in commercial enterprises (39.81%). The analysis of influencing factors showed that age, family or personal monthly income, maternity leave, feeding methods, and postpartum care affected the psychological health of occupational women after childbirth.
CONCLUSION
PPD prevalence is notably elevated among women employed in commercial enterprises, and specific risk factors contribute to its occurrence. These findings highlight the need for targeted interventions to address these risk factors and prevent PPD in this population.
Topics: Humans; Female; Cross-Sectional Studies; Adult; Risk Factors; Depression, Postpartum; Women, Working; Beijing; Prevalence; Surveys and Questionnaires; China; Young Adult
PubMed: 38756876
DOI: 10.3389/fpubh.2024.1346583