-
Journal of the American Heart... Jun 2024Adverse cardiovascular events during pregnancy (eg, preeclampsia) occur at higher rates among individuals with overweight or obesity (body mass index ≥25 kg/m) and...
Improvements in Maternal Cardiovascular Health Over the Perinatal Period Longitudinally Predict Lower Postpartum Psychological Distress Among Individuals Who Began Their Pregnancies With Overweight or Obesity.
BACKGROUND
Adverse cardiovascular events during pregnancy (eg, preeclampsia) occur at higher rates among individuals with overweight or obesity (body mass index ≥25 kg/m) and have been associated with postpartum depression. The present study examined whether changes in cardiovascular health (CVH) during the perinatal period, as defined by the American Heart Association's Life's Essential 8 framework, predicted postpartum psychological functioning among individuals with prepregnancy body mass index ≥25 kg/m.
METHODS AND RESULTS
Pregnant individuals (N = 226; mean ± SD age = 28.43 ± 5.4 years; mean body mass index = 34.17 ± 7.15 kg/m) were recruited at 12 to 20 weeks of gestation (mean, 15.64 ± 2.45 weeks) for a longitudinal study of health and well-being. Participants completed ratings of depression and perceived stress and reported on CVH behaviors (dietary intake, physical activity, nicotine exposure, and sleep) at baseline and at 6 months postpartum. Body mass index and CVH behaviors were used to calculate a composite CVH score at both time points. Linear regression analyses were performed to examine whether change in CVH related to postpartum symptom scores. Because sleep was measured in only a subset of participants (n = 114), analyses were conducted with and without sleep. Improved CVH was associated with lower postpartum depression (β = -0.18, <0.01) and perceived stress (β = -0.13, =0.02) scores. However, when including sleep, these relationships were no longer significant (all >0.4).
CONCLUSIONS
Improvements in CVH from early pregnancy to 6 months postpartum were associated with lower postpartum depressive symptoms and perceived stress but not when including sleep in the CVH metric, potentially due to the large reduction in sample size. These data suggest that intervening during pregnancy to promote CVH may improve postpartum psychological functioning among high-risk individuals.
PubMed: 38874183
DOI: 10.1161/JAHA.123.034153 -
Heliyon Jun 2024During the postpartum period, understanding women's well-being, specifically their Health-related Quality of Life (HRQoL), is vital for comprehensive healthcare.
BACKGROUND
During the postpartum period, understanding women's well-being, specifically their Health-related Quality of Life (HRQoL), is vital for comprehensive healthcare.
OBJECTIVES
Our study aims to explore the HRQoL and its associated factors in Moroccan women after vaginal birth (VB) and cesarean section (CS).
STUDY DESIGN
In this cross-sectional study we assessed the HRQoL and its associated factors among Moroccan women who gave birth at the provincial hospital center of Settat. We gathered data from 566 women, using the EQ-5D-5L instrument alongside questionnaires about socioeconomic and obstetrical aspects. The assessment was conducted utilizing the improved Relative to an Identified Distribution (RIDIT) approach, and we employed a multiple linear regression model to pinpoint the associated factors.
RESULTS
A total of 566 women were included in our study. Our results revealed that the HRQoL in women who underwent CS was significantly lower than in VB women (EQ-5D index score = 0.30 ± 0.28 vs 0.61 ± 0.31; p < 0.0001). Similarly, the CS reduced the EQ-VAS score (mean difference = -10.73 ± 3.78; p < 0.0001). The CS was associated negatively with problems in mobility (ARI = 55 % [42-67], p < 0.0001), autonomy (ARI = 67 % [57-80], p < 0.0001), and usual activities (ARI = 56 % [42-69], p < 0.0001). Also, CS was associated with pain/discomfort (ARI = 47 % [34-60], p < 0.0001) and anxiety/depression (ARI = 3 % [-5.8-12.6], p = 0.31). The women who had birth complications had the worst HRQoL (EQ-5D index score = 0.32) compared to those who had no complications (EQ-5D index score = 0.56). Likewise, women who had postpartum complications had the worst HRQoL (EQ-5D index score = 0.39 vs EQ-5D index score = 0.54).
CONCLUSION
The results highlighted that mode of birth, childbirth complications, and postpartum complications are strongly associated with women's HRQoL. The EQ-5D-5L dimensions were affected after delivery. Hence, there is a requirement to create specialized initiatives for overseeing postpartum HRQoL, aiming to enhance the quality of maternal healthcare.
PubMed: 38873689
DOI: 10.1016/j.heliyon.2024.e32276 -
Philosophy, Ethics, and Humanities in... Jun 2024Gothic literature-a genre brimming with madness, supernaturalism, and psychological terror-offers innumerable case studies potentially representing how psychiatric...
Gothic literature-a genre brimming with madness, supernaturalism, and psychological terror-offers innumerable case studies potentially representing how psychiatric patients perceive their treatment from healthcare professionals. Charlotte Perkins Gilman's famous 1892 short story "The Yellow Wallpaper" offers a poignant example of this through its fictional narrator, a diarist many interpret to be suffering from postpartum depression. The fiction here does not stray far from reality: Gilman orchestrated her diarist's experience to mirror her own, as both real author and fictional character suffocated from a melancholy only made worse by their physicians' insistence on following the "Rest Cure." While this instruction to cease all work and activity was a prevalent depression treatment at the time, Gilman, through "The Yellow Wallpaper," reveals how the intervention ultimately harmed more than helped because it overlooked her-and, by extension, her fictional diarist's- unique needs and identities. Today, while the ineffective Rest Cure no longer exists, applying observations from "The Yellow Wallpaper" to clinical research calls attention to underrepresentation in treatment development, a costly problem that could be mitigated by mindful incorporation of intersectionality theory into study designs.
Topics: Humans; Biomedical Research; Medicine in Literature
PubMed: 38867305
DOI: 10.1186/s13010-024-00158-8 -
BMC Psychology Jun 2024Sleep is vital for maintaining individuals' physical and mental health and is particularly challenged during pregnancy. More than 70% of women during the gestational... (Randomized Controlled Trial)
Randomized Controlled Trial
Promoting sleep health during pregnancy for enhancing women's health: a longitudinal randomized controlled trial combining biological, physiological and psychological measures, Maternal Outcome after THERapy for Sleep (MOTHERS).
BACKGROUND
Sleep is vital for maintaining individuals' physical and mental health and is particularly challenged during pregnancy. More than 70% of women during the gestational period report insomnia symptoms. Sleep dysfunction in the peripartum increases the risk for a cascade of negative health outcomes during late pregnancy, birth, and postpartum. While psychological interventions are considered the first line treatment for sleep difficulties, they are still scarcely offered during pregnancy and there is a lack of longitudinal research combining psychological and physiological indices.
METHODS
The present protocol outlines a randomized controlled trial aimed at testing the long-term effectiveness of an automatized digitalized psychoeducational intervention for insomnia for expectant mothers complaining insomnia symptoms without comorbidity. Outcomes include physiological, hormonal, and subjective indices of maternal psychopathology, stress, and emotional processes, and sleep and wellbeing of the family system. The trial is part of a longitudinal study evaluating expectant mothers from early pregnancy (within the 15th gestational week) to 6-months postpartum through 6 observational phases: baseline (BSL), 6- and 12-weeks from BSL (FU1-FU2), 2-to-4 weeks after delivery (FU3), and 3- and 6-months after delivery (FU4-5). We plan to recruit 38 women without sleep difficulties (Group A) and 76 women with sleep difficulties (Group B). Group B will be randomly assigned to digital psychological control intervention (B1) or experimental psychoeducational intervention targeting insomnia (B2). At 3 time points, an ecological-momentary-assessment (EMA) design will be used to collect data on sleep and emotions (diaries), sleep-wake parameters (actigraphy) and stress reactivity (salivary cortisol). We will also test the DNA methylation of genes involved in the stress response as biomarkers of prenatal poor sleep. Information on partner's insomnia symptoms and new-borns' sleep will be collected at each stage.
DISCUSSION
The proposed protocol aims at testing an easily accessible evidence-based psychoeducational intervention for expectant mothers to help them improving sleep, health, and wellbeing in the peripartum. The results could improve the understanding and management of sleep difficulties and peripartum depression.
TRIAL REGISTRATION
The study protocol has been registered on 22 April 2024 with ClinicalTrials.gov Protocol Registration and Results System (PRS), ID: NCT06379074.
PROTOCOL VERSION
April 23, 2024.
Topics: Humans; Female; Pregnancy; Sleep Initiation and Maintenance Disorders; Longitudinal Studies; Adult; Mothers; Pregnancy Complications; Women's Health; Postpartum Period
PubMed: 38858743
DOI: 10.1186/s40359-024-01827-1 -
Frontiers in Global Women's Health 2024Postpartum depression affects nearly a quarter of women up to a year after childbirth. Although it is treatable, significant barriers to help-seeking prevent women from...
Postpartum depression affects nearly a quarter of women up to a year after childbirth. Although it is treatable, significant barriers to help-seeking prevent women from being treated. This paper assesses key literature on the barriers for help-seeking among women with postpartum depression. The barriers identified have been mapped onto the socio-ecological model in addition to potential recommendations that professionals can use to address barriers on individual, interpersonal, organizational, community and societal levels. The recommendations provided are meant to serve as leverage points for professionals in efforts to create appropriate support and interventions. As such, this paper serves as a mapping tool for healthcare and public health professionals to assess obstacles to women's help-seeking and to guide multi-pronged interventions on various levels of the socio-ecological model that may increase help-seeking among women with postpartum depression. Holistically and comprehensively providing support to women will require significant effort throughout all sectors of society as opposed to isolated, siloed interventions.
PubMed: 38855482
DOI: 10.3389/fgwh.2024.1335437 -
MedRxiv : the Preprint Server For... May 2024Postpartum depression (PPD) represents a major contributor to postpartum morbidity and mortality. Beyond efforts at routine screening, risk stratification models could...
OBJECTIVE
Postpartum depression (PPD) represents a major contributor to postpartum morbidity and mortality. Beyond efforts at routine screening, risk stratification models could enable more targeted interventions in settings with limited resources. Thus, we aimed to develop and estimate the performance of a generalizable risk stratification model for PPD in patients without a history of depression using information collected as part of routine clinical care.
METHODS
We performed a retrospective cohort study of all individuals who delivered between 2017 and 2022 in one of two large academic medical centers and six community hospitals. An elastic net model was constructed and externally validated to predict PPD using sociodemographic factors, medical history, and prenatal depression screening information, all of which was known before discharge from the delivery hospitalization.
RESULTS
The cohort included 29,168 individuals; 2,703 (9.3%) met at least one criterion for postpartum depression in the 6 months following delivery. In the external validation data, the model had good discrimination and remained well-calibrated: area under the receiver operating characteristic curve 0.721 (95% CI: 0.707-0.734), Brier calibration score 0.088 (95% CI: 0.084 - 0.092). At a specificity of 90%, the positive predictive value was 28.0% (95% CI: 26.0-30.1%), and the negative predictive value was 92.2% (95% CI: 91.8-92.7%).
CONCLUSIONS
These findings demonstrate that a simple machine-learning model can be used to stratify the risk for PPD before delivery hospitalization discharge. This tool could help identify patients within a practice at the highest risk and facilitate individualized postpartum care planning regarding the prevention of, screening for, and management of PPD at the start of the postpartum period and potentially the onset of symptoms.
PubMed: 38854098
DOI: 10.1101/2024.05.27.24307973 -
Lipids in Health and Disease Jun 2024Exposure to different concentration levels of fatty acids (FAs) may have an impact on depression. However, previous studies using individual FAs may not reflect the...
BACKGROUND
Exposure to different concentration levels of fatty acids (FAs) may have an impact on depression. However, previous studies using individual FAs may not reflect the performance of mixtures of various FAs, and the associations of FA patterns with depression remain unclear.
METHODS
We conducted the cross-sectional analysis in 792 adults aged 18 and older with available serum FAs and depression screening data in the National Health and Nutrition Examination Survey (NHANES) 2011-2012. The serum concentrations of thirty FAs were measured using gas chromatography-mass spectrometry and their percentage compositions were subsequently calculated. Depression was defined as the Patient Health Questionnaire-9 score ≥ 10. We employed principal component analysis to derive serum FA patterns. We examined the association between these patterns and depression in the overall population and various subgroups through survey-weighted logistic regression.
RESULTS
Four distinct patterns of serum FAs were identified: 'high eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA); low docosatetraenoic acid (DTA) and docosapentaenoic acid (DPA) n-6', 'high long-chain saturated FA and long chain FA', 'low median-chain saturated FA and myristoleic acid' and 'low capric acid and lauric acid; high gamma-linolenic acid (GLA) and stearidonic acid (SDA)' pattern. Individuals in the high tertile of 'high EPA and DHA; low DTA and DPA n-6' pattern score had 0.46 (95% CI: 0.22, 0.93) lower odds of developing depression compared to individuals in the lowest tertile after adjusting for confounders such as age, sex, physical activity and total energy intake, etc. The odds ratio (OR) of depression was increased in the population with the highest tertile of 'low capric acid and lauric acid; high GLA and SDA' pattern (OR: 2.45, 95% CI: 1.24, 4.83). In subgroup analyses, we observed that the association between 'high EPA and DHA; low DTA and DPA n-6' and depression persisted among specific demographic and lifestyle subgroups, including females, non-Mexican Americans, non-obese, those aged over 60 years, smokers and drinkers. Similarly, 'low capric acid and lauric acid; high GLA and SDA' showed stable associations in female, non-Mexican Americans and smokers.
CONCLUSIONS
Serum FA patterns are associated with depression, and their relationships vary across sex, race, BMI, age, smoking and drinking subgroups, highlighting the importance of considering specific FA patterns within these demographic and lifestyle categories. Utilization of combined FA administration may serve as a mitigation measure against depression in these specific populations.
Topics: Humans; Female; Male; Depression; Adult; Middle Aged; Fatty Acids; Nutrition Surveys; Cross-Sectional Studies; United States; Decanoic Acids; Eicosapentaenoic Acid; Aged; Fatty Acids, Unsaturated; Young Adult; Adolescent; Principal Component Analysis
PubMed: 38851716
DOI: 10.1186/s12944-024-02142-9 -
Discover Mental Health Jun 2024Postpartum depression and anxiety are major public health concerns that affect 3-39% of women after childbearing and can adversely affect maternal and child health. Most...
Prevalence and predictors of postpartum depression and generalized anxiety symptoms among women who delivered at a tertiary hospital in Mwanza Tanzania: a cross-sectional study.
BACKGROUND
Postpartum depression and anxiety are major public health concerns that affect 3-39% of women after childbearing and can adversely affect maternal and child health. Most studies have investigated postpartum depression and anxiety and their associated factors among women 4-12 weeks after delivery. There is a scarcity of research among women immediately after delivery from low- and middle-income countries, the gap this study aimed to fill.
METHODS
A descriptive cross-sectional study was conducted among 386 postpartum women within one week after delivery. The Edinburg Postnatal Depression Scale was used to assess depressive symptoms and the Generalized Anxiety Disorder - 7 scale was used to screen for symptoms of generalized anxiety disorder. Participants were systematically selected from the postnatal wards and interviewed by trained research assistants from November 2019 to March 2020.
RESULTS
Using standard cut points, the prevalence of depressive and anxiety symptoms was 25.39%, and 37.31% respectively. Having a baby with a weight of 2.5 kgs or more and having partner support were associated with decreased odds of both depression and anxiety symptoms. In contrast, complications during delivery, caesarian section, marital status, and partner violence, were associated with increased odds of depressive and anxiety symptoms post-delivery.
CONCLUSION
There was a high prevalence of postpartum depression and anxiety symptoms among the study participants in the first week post-delivery, with delivery complications and outcome and psychosocial supports identified as associated factors for depression and anxiety symptoms. These findings highlight the need for early screening to identify those at risk for appropriate intervention.
PubMed: 38849688
DOI: 10.1007/s44192-024-00074-5 -
Alternative Therapies in Health and... Jun 2024This study investigated the impact of the use of a family-based delivery room on primiparous women's clinical outcomes and psychological well-being during childbirth. It...
Comparison of Clinical Outcomes and Postpartum Psychological Status Scores in Primiparous Women Delivered with Family Members in a Family-Based Room vs Women Delivered in a General Ward.
BACKGROUND
This study investigated the impact of the use of a family-based delivery room on primiparous women's clinical outcomes and psychological well-being during childbirth. It addressed the growing interest in family-centered care and assessed the effectiveness of a family-based room in providing a supportive environment for delivery.
OBJECTIVE
We aimed to compare the clinical outcomes and postpartum scores regarding the psychological status of primiparous women who delivered with their families in a home-based labor ward and women who delivered in a general labor ward.
METHODS
In this retrospective study, 158 primiparous women, recruited between October 2021 and July 2022, were categorized into 2 groups based on their choice of delivery room: a family group (n=77) and a general group (n=81). Baseline data, indicators related to maternal role adjustment, pregnancy outcomes, psychological status, self-efficacy and quality of life (QoL) data were collected and compared between the 2 groups.
RESULTS
More women in the family group were well- and generally adapted than in the general group, and fewer were poorly adapted than in the general group (P < .05). There were more spontaneous deliveries in the family group than in the general group, and fewer cesarean deliveries, postpartum hemorrhages and cases of neonatal asphyxia than in the general group; lower postpartum Numerical Rating Scale (NRS) scores and higher Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores than in the general group, with notably better pregnancy outcomes in the family group (P < .05). Postpartum State Anxiety Inventory (S-AI) and Edinburgh Postnatal Depression Scale (EPDS) scores in the family group (50.25±1.58 and 8.02±0.35, respectively) were remarkably lower than in the general group (59.89±1.98 and 9.84±0.69, respectively) (P < .05). The family group exhibited a postpartum score of self-efficacy higher compared with the general group (P < .05). The QoL score in the family group was noticeably higher than in the general group (P < .05). The time of colostrum secretion in the family group was significantly earlier compared with the control group, and milk production within 48 hours postpartum was significantly higher in the family group (P < .05).
CONCLUSION
The family-based delivery room model significantly enhanced maternal role adaptation, increased the rate of spontaneous delivery, reduced the risk for cesarean conversion and diminished adverse maternal and infant outcomes. In addition, it substantially improved postpartum psychological status and positively influenced maternal self-efficacy and QoL. These findings hold significant reference value for maternal care practices.
PubMed: 38836737
DOI: No ID Found -
Neonatology Today Apr 2024The COVID-19 pandemic posed challenges to measuring mother-infant interactions, a critical outcome for many interventions to support mothers with postpartum depression...
PURPOSE
The COVID-19 pandemic posed challenges to measuring mother-infant interactions, a critical outcome for many interventions to support mothers with postpartum depression symptoms and their new infants. The current study describes the process and lessons learned from implementing a remote assessment of mother-infant interactions during the pandemic.
DESCRIPTION
At the onset of the COVID-19 pandemic, we pivoted from in-person to using two different strategies to remotely assess mother-infant interactions: (1) participants independently recorded and uploaded videos of free-play with their child; and (2) research team conducted a live-video recording of the free-play.
ASSESSMENT
We found initial barriers including technical and video quality issues but overall, a remote option could increase enrollment and retention rates in a sample of postpartum women across various racial/ethnic groups and economic levels.
CONCLUSION
Our experiences in conducting remote assessments with postpartum women add to growing evidence for the feasibility and validity of remote visits. This showed how our methods can be implemented in future research and in practice with postpartum mothers and their infants.
PubMed: 38836047
DOI: No ID Found