Non-pharmacological interventions to reduce anxiety in pregnancy, labour and postpartum: A systematic review

Influenza vaccination hesitancy and related factors among pregnant and breastfeeding women: A cross-sectional study

Achieving safe influenza vaccination coverage among pregnant and breastfeeding women is a global health goal due to the potential risks of serious influenza for both mother and child. However, vaccine hesitancy remains a significant barrier to vaccination uptake. Since anxiety represents a determinant in vaccine decision-making, this study aimed to assess influenza vaccination hesitancy and anxiety levels in this population and to explore the association between women's characteristics, their reluctance, and anxiety levels. A multicentre, cross-sectional study was conducted between February and June 2022 using structured phone interviews to assess: (1) socio-demographics and clinical history; (2) anti-flu vaccination status, previous anti-flu vaccination, and Sars-CoV-2 infection history; (3) insights into influenza vaccination during pregnancy; (4) attitudes toward anti-flu vaccination, using the Vaccination Attitudes Examination (VAX) Scale; (5) anxiety levels, measured by the Self-Rating Anxiety Scale (SAS). Among the 387 participants, 22.8% were already vaccinated or expressed willingness to be vaccinated against influenza, and 54% had an anxiety disorder. While anxiety was not significantly associated with vaccine hesitancy, ongoing pregnancy emerged as an independent predictor of anxiety. Higher educational levels, ongoing pregnancy, already being vaccinated or willingness to get vaccinated, and being employed were associated with reduced vaccine hesitancy, while prior SARS-CoV-2 infection with increased hesitancy. Fear of unpredictable events and lack of healthcare professionals' recommendations emerged as reasons for vaccine reluctance. Given the low coverage rates, these findings highlight the need for health services to enhance vaccination efforts and provide clear recommendations to counter misinformation and ensure accurate vaccine safety information.

Does the Edinburgh Postnatal Depression Scale (EPDS) identify antenatal depression and antenatal anxiety disorders? A validation study in Singapore

OBJECTIVE

Research on the usage of the Edinburgh Postnatal Depression Scale (EPDS) to detect common antenatal mental disorders in pregnant women attending outpatient clinics in Singapore is limited. This study aimed to investigate the psychometric properties of the EPDS in screening for antenatal depression (AND) and anxiety disorders.

METHOD

250 pregnant women from two national public obstetric clinics were included. The EPDS and EPDS-3A were validated against the Mini International Neuropsychiatric Interview (MINI) by analyzing key parameters at different cutoffs and obtaining the receiver operating characteristic analysis. Multivariable analysis was used to identify possible risk factors of AND.

RESULTS

The prevalence of AND and anxiety disorders was 4.4 % and 3.3 %, respectively. The EPDS demonstrated strong psychometric performance in screening for both conditions, with an Area Under the Curve (AUC) of 0.927 for depression and 0.829 for anxiety. In contrast, the EPDS-3A was not recommended as a screening tool due to its relatively poor psychometric properties. For clinical applicability of AND screening using EPDS in a busy outpatient clinic, a cutoff >11 is recommended, followed by further assessment and tiered care based on needs. Being a member of minority ethnic group was the only risk factor identified for AND in our study population.

CONCLUSION

EPDS performs well in screening for antenatal depression and anxiety disorders; however, further assessment is important.

Effects of mindfulness yoga during pregnancy on psychological and pregnancy outcomes in multiparous women of advanced maternal age

BACKGROUND

Multiparous women of advanced maternal age are more susceptible to psychological stress.

OBJECTIVE

This study examined the impact of mindfulness yoga on psychological well-being (anxiety and sleep quality) and pregnancy outcomes (Apgar scores and adverse perinatal events) in aging multiparous women.

STUDY DESIGN

Participants meeting the criteria were randomly assigned to a control or a mindfulness yoga intervention group. The Chinese version of the Childbirth Attitudes Questionnaire, the Chinese version of the Pregnancy-Related Anxiety Questionnaire, and the Self-Rating Scale of Sleep were utilized to assess fear of childbirth, anxiety levels, and sleep quality, respectively. Maternal and neonatal outcomes, including vaginal delivery rates, labor analgesic use, duration of labor, postpartum bleeding volume, fetal anomaly rates, and Apgar scores, were analyzed.

RESULTS

A total of 148 multiparous women of advanced maternal age participated in the study. No significant differences in baseline characteristics were observed between the two groups. Participants in the mindfulness yoga group exhibited significantly lower scores on the C-CAQ, PRAQ, and SRSS scales compared to those in the control group. Additionally, higher vaginal delivery rates, reduced analgesic use, and shorter durations across all three stages of labor were observed in the mindfulness yoga group, contributing to an overall reduction in total labor duration. Neonatal outcomes demonstrated notable differences, with higher Apgar scores and lower incidences of adverse perinatal events in the mindfulness yoga group.

CONCLUSION

Engagement in mindfulness yoga during pregnancy may contribute to improved psychological well-being and enhanced pregnancy outcomes in older multiparous women.

A Google Trends analysis exploring public interest in common psychiatric conditions and non-pharmacological interventions

BACKGROUND AND OBJECTIVES

To use Google Trends for analyzing public interest in common psychiatric illnesses such as Depression, Anxiety, Bipolar Disorder, Post-traumatic Stress Disorder, and Obsessive-Compulsive Disorder, along with their various treatment modalities, in the United States over the past 10 years, in order to provide insights into emerging treatment modalities and their popularity among the population.

METHODOLOGY

A cross-sectional study was conducted from May 7 to June 6, 2024, using Google Trends data, specifically Relative Search Volume (RSV) from 2014 to 2023. Relative Search Volume is a metric provided by Google Trends, it is normalized to a scale of 0-100, where 100 represents the peak popularity of a search item within the selected time frame and location. Various psychological diseases and treatment modalities were searched individually, with all data and statistical analysis performed using Microsoft Excel and R v4.3.2.

RESULTS

The analysis revealed an overall increase in annual search interest for various mental health conditions, with Anxiety peaking in 2023 and Depression reaching its highest Relative Search Volume (RSV) in 2019. While Bipolar Disorder (BPD), Obsessive-Compulsive Disorder (OCD), and Post-Traumatic Stress Disorder (PTSD) also showed an upward trend, their increases were less pronounced. Additionally, search interest in therapeutic interventions, including Cognitive Behavioral Therapy (CBT), Psychotherapy, and Dialectical Behavioral Therapy (DBT), significantly increased from 2019 to 2023 compared to 2014-2018 (p < 0.05). In contrast, Electroconvulsive Therapy (ECT) had higher search frequency in the earlier period. These findings suggest a growing public interest in mental health conditions and evidence-based treatment options in recent years.

CONCLUSIONS

Limitations of this study include the use of Google Trends data, which relies on RSV rather than absolute search counts, which may not fully capture the extent of public interest. Additionally, the data cannot differentiate whether the searches were made by patients or healthcare professionals. However, the study's findings reflect a growing recognition and acceptance of diverse treatment approaches for mental health conditions, and concludes that while Google Trends is useful for analyzing public interest in psychiatric illnesses, further research is needed to ensure the reliability of the results.

Assessing high-risk perinatal complications as risk factors for postpartum mood disorders

OBJECTIVES

Postpartum mood disorders affect approximately 20 % of postpartum women. This study examines the association between postpartum mood disorders and preeclampsia with severe features (SPE), postpartum hemorrhage (PPH), very/extremely preterm delivery (EPTD), and fetal congenital malformations (FCM).

METHODS

A retrospective chart review was conducted at a large southeastern quaternary academic hospital using ICD-10 codes for the four high-risk perinatal complications. Medical records included 3,652 cases and 750 normal patient comparisons (NPC). Inclusion criteria: 1) prenatal visit at the institution, 2) live delivery at the institution, 3) postpartum visit at the institution, and 4) completed Edinburgh Postnatal Depression Scale (EPDS) at postpartum visit. EPDS scores≥12 and EPDS-3A scores≥5 were considered positive for depression and anxiety symptoms, respectively.

RESULTS

Five cohorts were analyzed [NPC (n=200), SPE (n=150), PPH (n=153), EPTD (n=102), and FCM (n=200)]. Independent sample t-tests revealed significant differences in mean EPDS scores between NPC and EPTD (p<0.001) and FCM (p=0.014) and in mean EPDS-3A scores between NPC and EPTD (p<0.001) and PPH (p=0.011).

CONCLUSIONS

EPTD, FCM, and PPH are diagnoses associated with elevated EPDS and/or EPDS-3A scores. Increased mood surveillance in patients with these complications is warranted. Understanding the association of these conditions with increased depression and anxiety symptoms will allow for earlier identification and treatment of postpartum mood disorders.

Music mindfulness acutely modulates autonomic activity and improves psychological state in anxiety and depression

Introduction

Anxiety and depression reduce autonomic system activity, as measured by Heart Rate Variability (HRV), and exacerbate cardiac morbidity. Both music and mindfulness have been shown to increase HRV, and clinical approaches incorporating these interventions show promise as effective treatments for symptoms of anxiety and depression. Music mindfulness, which combines music listening with mindfulness activities, may provide unique and synergistic therapeutic benefits for stress management. However, to date, no studies have evaluated the physiological mechanisms underlying a community-based music mindfulness paradigm.

Methods

We used wearable technology to record electrocardiography and electroencephalography signals from participants with moderate symptoms of anxiety and depression during a community-based music mindfulness paradigm. We also assessed the impact of our music mindfulness session on participant's psychological state.

Results and discussion

We found that music mindfulness sessions acutely enhanced multiple measures of HRV and altered EEG power spectral density across various frequency bands in frontotemporal electrodes. Both live and virtual music mindfulness sessions also acutely reduced stress and altered participants' state of consciousness; however, only live sessions fostered social connection. Additionally, the physiological and psychological effects of music mindfulness varied based on participants' self-reported sex. Overall, our findings demonstrate that music mindfulness effectively engages autonomic and frontotemporal neural mechanisms, which may contribute to the treatment of anxiety and depression symptoms.

The effect of aromatherapy applied to pregnant women on sleep quality and fatigue level: A randomized clinical trial

INTRODUCTION

Sleep disturbances and fatigue can negatively impact pregnancy. The purpose of this study is to assess changes in sleep quality and fatigue levels pre- and post-aromatherapy intervention using lavender oil inhalation in pregnant women in the third trimester.

MATERIALS AND METHODS

The research was conducted in the gynecology and obstetrics outpatient clinic of a training and research hospital between October 2022 and March 2023. The study was designed as a randomized controlled experimental trial with a pretest-posttest control group. The sample consisted of a total of 74 pregnant women (37 intervention and 37 control). Aromatherapy with lavender oil was applied to pregnant women in the intervention group for one month using the "Inhalation Application Form." "Personal Information Form", "Visual Analog Scale (VAS)", "Pittsburg Sleep Quality Index (PSQI)" and " Visual Analogue Scale for Fatigue (VASF)" were used to collect data. Percentage distributions, chi-square significance test, t-test in independent groups, and Mann-Whitney U and Wilcoxon tests were used to evaluate the data.

RESULTS

In the study, the post-test PSQI score average of the pregnant women in the intervention group who received lavender oil inhalation was 4.10±1.36, it was 5.45±2.48 in the control group. The post-test fatigue score average of the pregnant women in the intervention group was 65.91±7.02, it was 75.40±10.79 in the control group. A statistically significant difference was found between the post-test PSQI and VAS-F total score averages of the pregnant women in the intervention and control groups (p < 0.05).

CONCLUSION

The study findings indicate that aromatherapy applied via inhalation to pregnant women improved sleep quality and reduced fatigue levels. According to these findings, lavender oil aromatherapy can be recommended to improve sleep quality and reduce fatigue levels in pregnant women during the third trimester.

Informational video impact before caesarean delivery on anxiety and satisfaction: a systematic review and meta-analysis

BACKGROUND

Anxiety prior to caesarean section can lead to a negative birth experience, which may affect different aspects of woman's life in the long term. Improving preoperative information may result in lower anxiety leading to a more positive birth experience. Thus, we aimed to evaluate the impact of informational video before planned caesarean delivery on maternal anxiety and satisfaction.

METHODS

Four different databases were searched from inception till March 2023. We selected randomised controlled trials (RCTs) that compared educational or informative videos about the aspects of the expected caesarean delivery process versus no preoperative information in the control group. No language restrictions were imposed. We used Revman software during performing our meta-analysis. Our main outcomes were preoperative and postoperative anxiety as well as maternal satisfaction post-procedure.

RESULTS

Six RCTs were retrieved with a total number of 702 patients. Informative video significantly reduced the anxiety level before caesarean delivery in comparison with the control group (MD = -4.21, 95% CI [-5.46, -2.95], p<0001). Moreover, the postoperative anxiety level was significantly improved in the informational video group (MD = -4.71, 95% CI [-7.06, -2.36],   p<0001). In addition, there was a significant improvement in maternal satisfaction score after caesarean delivery among the informational video group (p = 0.001).

CONCLUSIONS

Informational video prior to caesarean delivery decreases preoperative and postoperative anxiety levels with improvement in maternal post-procedure satisfaction. However, the existing evidence is limited by several shortcomings, chiefly small sample size. More trials with larger sample size are required to confirm our findings.

Effects of Yoga on Stress in Pregnant Women

During pregnancy, a woman's body undergoes physiological and metabolic changes to nourish the developing fetus. Every woman experiences pregnancy-related stress differently, with symptoms and difficulties ranging from mild to severe. However, various therapies are available to help reduce stress levels. The purpose of this study is to assess the impact of integrated yoga, which includes asanas and pranayama, on stress levels and physiological markers in pregnant women. The study is a prospective, randomized, controlled, single-blind trial with 2 parallel groups. The intervention group was provided with integrated yoga therapy, while the control group was given routine standard care from 18 to 22 weeks to 33-35 weeks of gestation. To measure the stress level, a standardized perceived stress scale was used, which has 10 items with stress scores ranging from 0 to 4, with a maximum score of 40. The average stress score was significantly lower in the intervention group ( P < .001) as well as normal physiological parameters when compared to the control group. Findings suggest that practicing yoga during pregnancy is safe and effective in reducing stress and preventing complications. Women who began yoga therapy during their second trimester reported a significant decrease in physiological parameters from baseline to post-intervention. However, further randomized controlled trials are necessary to determine the validity and usefulness of yoga therapy during pregnancy.

Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l'humeur, des troubles anxieux et des troubles connexes périnatals

BackgroundThe Canadian Network for Mood and Anxiety Treatments (CANMAT) publishes clinical practice guidelines for mood and anxiety disorders. This CANMAT guideline aims to provide comprehensive clinical guidance for the pregnancy and postpartum (perinatal) management of mood, anxiety and related disorders.MethodsCANMAT convened a core editorial group of interdisciplinary academic clinicians and persons with lived experience (PWLE), and 3 advisory panels of PWLE and perinatal health and perinatal mental health clinicians. We searched for systematic reviews of prevention and treatment interventions for perinatal depressive, bipolar, anxiety, obsessive-compulsive and post-traumatic stress disorders (January 2013-October 2023). We prioritized evidence from reviews of randomized controlled trials (RCTs), except for the perinatal safety of medications where reviews of large high-quality observational studies were prioritized due to the absence of RCT data. Targeted searches for individual studies were conducted when systematic reviews were limited or absent. Recommendations were organized by lines of treatment based on CANMAT-defined levels of evidence quality, supplemented by editorial group consensus to balance efficacy, safety, tolerability and feasibility considerations.ResultsThe guideline covers 10 clinical sections in a question-and-answer format that maps onto the patient care journey: case identification; organization and delivery of care; non-pharmacological (lifestyle, psychosocial, psychological), pharmacological, neuromodulation and complementary and alternative medicine interventions; high-risk clinical situations; and mental health of the father or co-parent. Equity, diversity and inclusion considerations are provided.ConclusionsThis guideline's detailed evidence-based recommendations provide clinicians with key information to promote the delivery of effective and safe perinatal mental healthcare. It is hoped that the guideline will serve as a valuable tool for clinicians in Canada and around the world to help optimize clinical outcomes in the area of perinatal mental health.

The impact of virtual reality on maternal anxiety, satisfaction, and fetal outcomes among pregnant women undergoing non-stress tests: A systematic review and meta-analysis of randomized controlled trials

We aimed to investigate the impact of virtual reality (VR) on maternal anxiety, satisfaction, and fetal physiological parameters during non-stress test (NST) in pregnant women. We conducted an extensive search across numerous databases to identify eligible studies from inception to April 2024. Researchers included randomized trials that compared VR intervention during NSTs in the third trimester with control groups. Data were analyzed through meta-analysis using Revman software. We identified four trials, encompassing 681 patients, that met the inclusion criteria. The VR group had significantly reduced anxiety levels and increased maternal satisfaction during NSTs. Furthermore, the VR group demonstrated higher basal fetal heart rate and more accelerations compared to the control group. Pregnant women in the VR group were also more likely to achieve a reactive NST, with a shorter duration of reactivity. Overall, VR use during NSTs effectively reduces maternal anxiety, enhances satisfaction, and improves fetal physiological parameters.

Sedative Effect of White Noise on Prefrontal Cortex Lobe: A Randomized Controlled Study Based on Functional Near-Infrared Spectroscopy

BACKGROUND

White noise has attracted widespread attention due to its potential effects on psychological and physiological states, particularly in promoting relaxation. The prefrontal cortex, a critical region of the brain responsible for higher cognitive functions and emotional regulation, may influence an individual's mental and physical health through its responses to external stimuli. Although previous research has investigated the calming effects of white noise, systematic studies on its specific impact on prefrontal cortex activity are still lacking. This study aims to explore the calming effects of white noise on the prefrontal cortex to elucidate its associated physiological mechanisms.

METHODS

In total, 103 healthy adult college students were recruited and randomly divided into four groups (fire, n = 24; wind, n = 27; rain, n = 27; and snow, n = 25), with each group exposed to the corresponding white noise for 3 min. Functional near-infrared spectroscopy (fNIRS) was used to evaluate excitability changes in the brain and changes in life signs and facial expressions were also measured.

RESULTS

The data of fNIRS were analyzed by paired sample t-test; in the wind group and the snow group, we found that the white noise can be effectively decreased the cortical excitability of related brain areas. The areas of reduced excitability were concentrated in the prefrontal cortex and pars triangularis of Broca's frontopolar area, while the concentration of oxyhemoglobin in these two area decreased from -0.159 to -0.107 µmol/L and from -0.139 to -0.096 µmol/L, respectively, both areas involved in relaxing and sedative modulation.

CONCLUSION

White noise can reduce the excitability of the prefrontal cortex and play a sedative effect. It may strengthen our understanding of how white noise is involved in neural modulation.

The effect of rose damascene extract on anxiety and sexual function of breastfeeding women: a randomized controlled trial

Background

Sexual dysfunction is prevalent among breastfeeding women.

Objective

This study was designed to evaluate the effect of Rose damascene extract on sexual function and anxiety of breastfeeding women.

Materials and methods

This was a randomized controlled trial. This study was conducted on 87 breastfeeding women who received either Rose damascene (n = 44) or placebo (n = 43) for eight weeks. The primary outcomes were sexual function and anxiety. A demographic questionnaire, and obstetric questionnaire, the Female Sexual Function Scale (FSFI), and the Spielberger questionnaire were used to collect the data. Chi-square test, independent t-test, and ANCOVA were used to analyze the data.

Results

In the intervention group, there was a significant increase in the scores of sexual desire, arousal, lubrication, orgasm, and sexual satisfaction, while the score of pain reduced significantly after eight weeks of intervention (p < 0.001). The mean total score of sexual function prior to the intervention was 19.61 ± 5.02 and 21.46 ± 3.08 in the intervention and control groups, respectively. After intervention, this score was improved in the intervention group compared to the control group (25.21 ± 1.62 vs. 21.82 ± 3, p < 0.001). The pre-intervention score of trait anxiety was 47.97 ± 4.68 and 48.44 ± 5.89 in the intervention and control groups, respectively, which was improved in the intervention group compared to the control group after intervention (51.63 ± 3.53 vs. 48.13 ± 5.57, p < 0.001). Although there was an improvement in the score of state anxiety in the intervention group compared to the control group, the difference was not statistically significant (43.31 ± 6.41 vs. 44.30 ± 8.87, p = 0.397).

Conclusion

Rose damascene could significantly improve the sexual functions of breastfeeding women. It also decreased the trait anxiety but failed to improve the state anxiety significantly. Using this herb is recommended to enhance sexual performance in breastfeeding women.

Clinical trial registration

https://www.irct.ir/trial/61375, identifier IRCT20211015052775N1.

The association of delivery during a war with the risk for postpartum depression, anxiety and impaired maternal-infant bonding, a prospective cohort study

OBJECTIVE

To examine the impact of war conditions on maternal mental health postpartum outcomes, specifically depression and anxiety, as well as on maternal-infant bonding (MIB).

STUDY DESIGN

A prospective cohort study was performed on women who gave birth in a tertiary medical center during (October-November 2023) and before (March-May 2020) the Israel-Hamas War. All participants completed validated self-reported questionnaires: The Edinburgh Postnatal Depression Scale (EPDS ≥ 10), State-Trait Anxiety Inventory (STAI > 39) and the Postpartum Bonding Questionnaire (PBQ ≥ 26).

RESULTS

A total of 502 women were included in the study, with 230 delivering during the war and 272 delivered before. The rates of postpartum depression (PPD) were higher in women delivering during the war (26.6% vs. 12.4%, p < 0.001), while multivariable regression revealing a two-fold higher risk (adjusted OR 2.35, 95% CI 1.16-4.74, p = 0.017). The rate of postpartum anxiety (PPA) risk was also higher (34.3% vs 17.0%, p < 0.001), reaching a trend towards significance when accounting for other risk factors (adjusted OR 2.06, 95% CI 0.97-4.36, p = 0.058). Additionally, delivery during the war was associated with specific factors of impaired maternal-infant bonding (MIB), although it did not increase the overall impaired MIB (PBQ ≥ 26) (10.2 ± 14.1 vs 8.3 ± 6.9, p = 0.075).

CONCLUSION

The study revealed an increased risk of PPD, a marginally risk for PPA, and some aspects of impaired MIB among women delivering during the war. Maternal mental illness in the postpartum period has negative impacts on the entire family. Therefore, comprehensive screening and adequate resources should be provided for women delivering in war-conflict zones.

Development and Validation of the Midwifery Interventions Classification for a Salutogenic Approach to Maternity Care: A Delphi Study

Background/Objectives: This study aims to develop and validate a Midwifery Interventions Classification (MIC), which is an evidence-based, standardized taxonomy and classification of core midwifery interventions based on a salutogenic perspective for maternity care. Methods: This study described the consensus process up to the results regarding the validation of the MIC through a two-round Delphi survey involving three panels of stakeholders: Midwives, Healthcare Researchers, and Maternity Service Users. Results: The resulting MIC comprises 135 core midwifery interventions classified into Direct Midwifery care (n = 80 interventions), Indirect Midwifery Care (n = 43 interventions), and Community Midwifery Care (n = 12 interventions), reaching an overall consensus rate among experts equal to 87%. These interventions were, therefore, adapted specifically for the Italian midwifery care context, with potential for international transferability, implementation, and scalability. Conclusions: The MIC is pivotal to boosting quality improvement, education, and comparable data collection for research, sustaining midwives' role in promoting optimal health for women, newborns, and families at large.

Prenatal Telepsychological Intervention for Preventing Anxiety: A Study Protocol

Background: Anxiety is one of the most frequent disorders during the perinatal stage that is associated with adverse health effects in women and their babies. In spite of this, preventive interventions during this stage are scarce. A long-distance intervention carried out during pregnancy can be an effective and accessible resource to help improve women's emotional state. The objective of this study is to present and assess the effectiveness of a telepsychology cognitive-behavioral preventive intervention during pregnancy to manage anxiety. Methods: A random clinical trial will be carried out among pregnant women in Spain. The psychological intervention will take place via videoconference in seven weekly sessions, lasting one hour each, with groups of 6-8 pregnant women. Study outcomes will be collected via online questionnaires at five points in time: pre-intervention (baseline: t0), post-intervention (baseline: t1), follow-up at 1 month (t2), follow-up at 3 months (t3) and follow-up at 6 months (t4). The control group will receive usual pregnancy care (attendance at pregnancy follow-up consultations and information and answers to frequently asked questions provided by the midwife). Our primary hypothesis is that the intervention will decrease the frequency of women who present anxious symptomatology during pregnancy. The second objective is to analyze the effectiveness of this intervention to prevent depressive symptomatology during pregnancy, as well as postpartum anxiety and depressive symptomatology. The primary outcome measure is the difference in the mean anxiety score between the intervention and control groups assessed by the Edinburgh Depression Scale-Anxiety Subscale (EDS-3A), the State-Trait Anxiety Inventory (STAI) and Generalized Anxiety Disorder Screener (GAD-7) at the end of the intervention and at 1, 3 and 6 months postpartum. Generalized anxiety disorder (GAD) will be evaluated with the SCID clinical interview at the same time points. The secondary outcome will be determined by using the EPDS at the same time points. Conclusions: The results will determine whether a cognitive behavioral therapy applied via videoconference is well accepted by pregnant women, and if it is effective in preventing anxiety and emotional symptoms during the perinatal stage. If this intervention is an effective and useful resource among pregnant women, it can be implemented as a tool in Spanish healthcare.

Effect of music intervention on perinatal depressive symptoms: A meta-analysis

BACKGROUND

Little is known about the effect of music intervention on perinatal depressive symptoms (PDS), especially the effectiveness of specific aspects of the intervention. This meta-analysis aimed to evaluate the effectiveness of music intervention and explore the role of different intervention features.

METHODS

Six databases were searched from inception to May 21, 2024, to identify randomized controlled trials evaluating the effect of music intervention on PDS. The Cochrane Risk of Bias (RoB) 2.0 tool was used to assess RoB.

RESULTS

The meta-analysis of 10 studies including 988 participants showed that music intervention significantly improved PDS (standardized mean difference (SMD): 0.61, 95% confidence interval (CI): 0.91, -0.32), with statistical heterogeneity among the studies (I2 = 78%). Subgroup analysis showed significant effects on pregnant and postpartum women, and women with or without perinatal complications. Effects were also significant in low- and middle-income countries (SMD: 0.79, 95% CI: 1.16, -0.42), music medicine (SMD: 0.82, 95% CI: 1.17, -0.47), and total intervention length of less than 6 weeks (SMD: 0.85, 95% CI: 1.25, -0.45), but not in high-income countries, music therapy, or total intervention length of 6 weeks or more. Hospital intervention (SMD: 0.86, 95% CI: 1.41, -0.31) showed greater effects compared with home intervention and hospital combined with home intervention. Six studies had a high overall RoB and four had some concerns.

CONCLUSIONS

Music intervention is effective in alleviating PDS. Interventions in low- and middle-income countries, music medicine, total intervention length of less than 6 weeks, and hospital intervention may be advisable.

Evaluating the validity of ChatGPT responses on common obstetric issues: Potential clinical applications and implications

OBJECTIVE

To evaluate the quality of ChatGPT responses to common issues in obstetrics and assess its ability to provide reliable responses to pregnant individuals. The study aimed to examine the responses based on expert opinions using predetermined criteria, including "accuracy," "completeness," and "safety."

METHODS

We curated 15 common and potentially clinically significant questions that pregnant women are asking. Two native English-speaking women were asked to reframe the questions in their own words, and we employed the ChatGPT language model to generate responses to the questions. To evaluate the accuracy, completeness, and safety of the ChatGPT's generated responses, we developed a questionnaire with a scale of 1 to 5 that obstetrics and gynecology experts from different countries were invited to rate accordingly. The ratings were analyzed to evaluate the average level of agreement and percentage of positive ratings (≥4) for each criterion.

RESULTS

Of the 42 experts invited, 20 responded to the questionnaire. The combined score for all responses yielded a mean rating of 4, with 75% of responses receiving a positive rating (≥4). While examining specific criteria, the ChatGPT responses were better for the accuracy criterion, with a mean rating of 4.2 and 80% of the questions received a positive rating. The responses scored less for the completeness criterion, with a mean rating of 3.8 and 46.7% of questions received a positive rating. For safety, the mean rating was 3.9 and 53.3% of questions received a positive rating. There was no response with an average negative rating below three.

CONCLUSION

This study demonstrates promising results regarding potential use of ChatGPT's in providing accurate responses to obstetric clinical questions posed by pregnant women. However, it is crucial to exercise caution when addressing inquiries concerning the safety of the fetus or the mother.

Nursing interventions for the proposed nursing diagnosis of puerperal fatigue: An integrative review

INTRODUCTION

The postpartum period is considered a phase of many physiological and hormonal changes that affect the individual. Fatigue is something present and can influence the postpartum woman in a negative way. In this way, the nurse has an essential role, and the nursing process can be used to establish an efficient care plan.

OBJECTIVE

To present the main nursing interventions and activities of the nursing diagnosis (ND) fatigue (00093) in individuals/people in the immediate postpartum period obtained through an integrative literature review and correlate with the proposed ND puerperal fatigue/excessive burden of fatigue in the postpartum period.

METHODS

Integrative literature review, carried out in the databases Cochrane, Scopus and Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science (WoS), Virtual Health Library (VHL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL), following rigorous methodological standards.

RESULTS

Six articles were included that identified the main nursing interventions related to the proposed ND puerperal fatigue.

CONCLUSIONS

The integrative review highlighted the main nursing interventions and activities, and this study will be the basis for the next stages of the validation process for the ND puerperal fatigue/excessive fatigue in the postpartum period.

IMPLICATIONS FOR NURSING PRACTICE

This work can help nurses in clinical practice establish an efficient care plan through the most accurate nursing interventions and thus improve the quality of nursing services.

State-trait anxiety levels and vital signs of pregnant women following intervention with virtual reality during the nonstress test: A randomized controlled trial

BACKGROUND

Pregnant women often experience anxiety due to pregnancy, negatively impacting their and their fetus' health. Non-pharmacological interventions, such as virtual reality (VR), could reduce anxiety levels, potentially impacting non-stress tests or the physiological responses of the pregnant woman and the fetus.

METHODS

A randomized clinical trial conducted between February and December 2022 involved 286 term pregnant women. They were divided into a VR intervention group (146 women) and a control group (140 women). The intervention consisted of 20 min of 3D glasses with images and sounds during a third-trimester nonstress test. Anxiety was measured using the Spielberg State-Trait Anxiety Inventory (STAI), alongside physiological parameters.

RESULTS

The VR group exhibited lower anxiety levels compared to controls (STAI score: Rosenthal's r: -0.54, p = 0.01; state anxiety: Rosenthal's r: -0.40, p = 0.001; trait anxiety: Rosenthal's r: -0.41, p = 0.001). Within the VR group, there was a significant reduction in trait anxiety (Rosenthal's r, 1.27; p < 0.001) and total anxiety (Rosenthal's r, 1.63; p < 0.001) post-intervention, along with decreased systolic blood pressure (p < 0.001), diastolic blood pressure (p < 0.001), and maternal heart rate (p = 0.02).

LIMITATIONS

Future research could explore additional pregnancy-related variables, such as postpartum anxiety.

CONCLUSIONS

The results confirm that the use of VR is beneficial for pregnant women and their fetuses, as it decreases anxiety levels, and improves physiological parameters such as blood pressure and maternal heart rate during the nonstress test. VR is a technique that is easy to integrate into the healthcare system due to its non-invasive and non-pharmacological nature.

The Effects of MBSR Programme on Prenatal Comfort and Fetal Health Anxiety in Pregnant Women

OBJECTIVE

This study was conducted to examine the effect of the online Mindfulness-Based Stress Reduction (MBSR) programme applied to pregnant women on their prenatal comfort and foetal anxiety levels.

MATERIAL AND METHOD

This randomised controlled study was conducted between July and October 2022, with 89 pregnant women registered in a Family Health Centre of Adiyaman, located in the Southeastern Anatolia region of Turkey. In the study, a total of eight sessions of MBSR programme, one session per week for eight weeks, were applied to the pregnant women in the experimental group. Data of the study was collected with the 'Personal Information Form', 'Prenatal Comfort Scale (PCS)', and 'Fetal Health Anxiety Inventory (FHAI)'. Descriptive statistics, chi-square test, and t-test for independent and dependent samples were utilised in the analysis of the data.

RESULTS

It has been determined that the PCS total mean score after the intervention is 58.91 ± 7.18 in the experimental group and 50.56 ± 15.78 in the control group; the post-test FHAI total mean score is 4.52 ± 1.66 in the experimental group and 9.76 ± 5.00 in the control group, and the difference between the groups is statistically significant (p < 0.001).

CONCLUSION

It has been determined that the MBSR programme applied to pregnant women has increased the prenatal comfort levels of pregnant women and has decreased foetal health anxieties. In line with these results, it is recommended that the MBSR programme may be used as an alternative method to relieve pregnant women.

Digital Training for Nurses and Midwives to Improve Treatment for Women with Postpartum Depression and Protect Neonates: A Dynamic Bibliometric Review Analysis

The high prevalence of postpartum depression makes it necessary for midwives and nurses to implement prenatal interventions for expectant mothers. The current study aims to investigate and highlight the importance of the digital training of nurses in order to help women mitigate the symptoms of postpartum depression and protect infants. To approach this, we conducted a bibliometric analysis to address the study's main objective. Articles were retrieved from the Scopus database for the timeframe 2000-2023. Data analysis was conducted using the statistical programming language R (version R-4.4.) and the bibliometric software VOSviewer (version 1.6.20) and Biblioshiny (version 4.1.4), focused on year, journal, and country. For this investigation, we selected a total of 31 MeSH keywords and sub-headings that exhibited significant frequencies. We consistently used six significant clusters of MeSH keywords. We obtained a total of 585 articles from the Scopus database that were major contributors to the field of PPD, as evidenced by their extensive publication of research articles and their influential role in the domain. The studies included a thorough analysis of depression research, the use of scales for diagnosing and screening PPD, psychological studies related to PPD, and the exploration of causes, mechanisms, outcomes, and genetic factors. Our study's results demonstrate a steady and significant increase in the availability of information on PPD. Importantly, the novelty of the current study lies in highlighting the need for a transition in the ways in which nurses and midwives are trained to mitigate postpartum disease by integrating emerging technologies into their practices. The knowledge provided here has the potential to serve as a foundation for future advancements in obstetric psychology, both presently and in the future.

Effect of Reflexology on Pain, Fatigue, Sleep Quality, and Lactation in Postpartum Primiparous Women After Cesarean Delivery: A Randomized Controlled Trial

BACKGROUND

Mothers commonly experience pain, fatigue, sleep disruption, and breastfeeding problems after cesarean delivery. To date, no follow-up study has examined all of these variables to evaluate the utility of reflexology in reducing these problems and supporting breastfeeding.

RESEARCH AIM

This study aimed to determine the effect of foot reflexology performed in the postpartum period on pain, fatigue, sleep quality, and lactation in primiparous women who underwent cesarean delivery.

METHODS

This is a two-arm, parallel-group randomized controlled trial. Data were collected between January 1, 2020, and January 31, 2021, with a sample of 80 women who were randomly assigned to the reflexology (n = 40) and control (n = 40) groups. The reflexology group received 40 minutes of foot reflexology once a week for 8 weeks. The primary outcomes of the study were pain, fatigue, sleep quality, and breastfeeding efficacy.

RESULTS

Pain scores in the reflexology group decreased by 90.9% in week 1, 90.2% in week 2, and 59.8% in week 3 compared to the control group. Pain resolved at week 4 in the reflexology group and week 7 in the control group. The reflexology group showed a 36.9% decrease in fatigue level, a 48.0% increase in energy level, a 70.7% increase in sleep quality, and a 20.2% increase in breastfeeding efficacy compared to the control group (p < 0.05).

CONCLUSIONS

Foot reflexology reduces postpartum symptoms and positively affects breastfeeding and can be used safely in postnatal care practices.

The effect of virtual reality and music on anxiety, non-stress test parameters, and satisfaction of high-risk pregnant women undergoing non-stress tests: Randomized controlled trial

BACKGROUND

Prenatal tests cause high-risk pregnant women to experience high anxiety levels.

AIM

This paper investigated the effect of Virtual Reality (VR) and music on anxiety, non-stress test parameters, and satisfaction of high-risk pregnant women undergoing non-stress tests (NSTs).

METHODS

This was a randomized controlled trial. The sample consisted of 102 participants randomized into three groups (VR = 34, music = 34, and control = 34). Maternal anxiety was assessed using the Spielberger State-Trait Anxiety Inventory-S (STAI-S) before and after NSTs. Satisfaction was evaluated using the Visual Analogue Scale (VAS) after NSTs. NST parameters were evaluated after NSTs. The findings were reported based on the Consolidated Standards of Reporting Trials (CONSORT).

RESULTS

The VR and music groups had significantly lower mean posttest STAI-S scores than the control group (p <.05). There was no significant difference in NST findings (reactive/nonreactive) between the groups (p >.05). The VR group had a significantly shorter reactive NST duration than the control group (p <.05). The VR and music groups had significantly higher mean VAS-satisfaction scores than the control group (p <.05) CONCLUSION: Virtual reality and music during NSTs help high-risk pregnant women experience less anxiety and satisfy them more with the procedure. We recommend that obstetric midwives and nurses use these low-cost, simple, and noninvasive methods to reduce anxiety in high-risk pregnant women during prenatal testing.

Brief Assessment of Patient Phenotype to Explain Variability in Postsurgical Pain and Opioid Consumption after Cesarean Delivery: Performance of a Novel Brief Questionnaire Compared to Long Questionnaires

BACKGROUND

Understanding factors that explain why some women experience greater postoperative pain and consume more opioids after cesarean delivery is crucial to building an evidence base for personalized prevention. Comprehensive psychosocial assessment with validated questionnaires in the preoperative period can be time-consuming. A three-item questionnaire has shown promise as a simpler tool to be integrated into clinical practice, but its brevity may limit the ability to explain heterogeneity in psychosocial pain modulators among individuals. This study compared the explanatory ability of three models: (1) the 3-item questionnaire, (2) a 58-item questionnaire (long) including validated questionnaires (e.g., Brief Pain Inventory, Patient Reported Outcome Measurement Information System [PROMIS]) plus the 3-item questionnaire, and (3) a novel 19-item questionnaire (brief) assessing several psychosocial factors plus the 3-item questionnaire. Additionally, this study explored the utility of adding a pragmatic quantitative sensory test to models.

METHODS

In this prospective, observational study, 545 women undergoing cesarean delivery completed questionnaires presurgery. Pain during local anesthetic skin wheal before spinal placement served as a pragmatic quantitative sensory test. Postoperatively, pain and opioid consumption were assessed. Linear regression analysis assessed model fit and the association of model items with pain and opioid consumption during the 48 h after surgery.

RESULTS

A modest amount of variability was explained by each of the three models for postoperative pain and opioid consumption. Both the brief and long questionnaire models performed better than the three-item questionnaire but were themselves statistically indistinguishable. Items that were independently associated with pain and opioid consumption included anticipated postsurgical pain medication requirement, surgical anxiety, poor sleep, pre-existing pain, and catastrophic thinking about pain. The quantitative sensory test was itself independently associated with pain across models but only modestly improved models for postoperative pain.

CONCLUSIONS

The brief questionnaire may be more clinically feasible than longer validated questionnaires, while still performing better and integrating a more comprehensive psychosocial assessment than the three-item questionnaire.

EDITOR’S PERSPECTIVE

Regulated Expiratory Methods During Childbirth Process: A Randomized Controlled Trial

OBJECTIVES

To evaluate the impact of a regulated expiratory method (REM) on the childbirth process.

METHODS

This was a randomized trial. Study population included all first-time mothers with a spontaneous onset of labour, at an early stage, and a fetus in cephalic presentation with a normal weight for gestational age. The evaluated intervention was REM based on the use of a specific device. The primary outcome was the cesarean delivery rate. Secondary outcomes included first and second stages of labour times, rates of spontaneous and instrumental vaginal births, and pain scores. Subjective qualitative outcomes related to childbirth experience were evaluated via 2 interviews conducted with the parturient and the midwife responsible for her delivery. Intention-to-treat analysis was employed to compare the 2 groups.

RESULTS

The reduction in primary cesarean rates between the 2 groups was not significant (26.7% in control group vs. 18.3% in intervention group; P = 0.274). However, REM allowed for a significant reduction in second stage (P = 0.039) and pushing effort times (P = 0.003). According to midwives, REM had a significant positive impact on parturients' breathing (P < 0.0001) and pushing effort intensity (P = 0.041). It facilitated communication with the parturient (P = 0.002). Moreover, the evaluated method had a significant positive impact on patient's childbirth experience.

CONCLUSIONS

Although the reduction in immediate cesarean rates was not significant, REM has the potential to shorten labour duration, improve pain management, and ultimately improve maternal childbirth experience.

The effects of yoga-based interventions on postnatal mental health and well-being: A systematic review

Background

The postnatal period is a critical time for maternal mental health, presenting unique challenges and vulnerabilities. Identifying effective and accessible strategies to improve postnatal mental health and well-being is therefore crucial and could have substantial benefits for both mothers and babies, alongside broader implications for healthcare systems. Yoga is a potential intervention that has demonstrated notable benefits; however, a gap exists in systematically evaluating the existing literature on postnatal yoga-based interventions. This systematic review addresses this, aiming to comprehensively assess the impact of postnatal yoga on maternal mental health and well-being.

Methods

Six databases were searched using keywords "yoga", "yogic", "postnatal", "postpartum", "perinatal", "maternal", "mother*". Articles were considered if they were quantitative and evaluated a yoga or yoga-based intervention in postnatal samples. Study outcomes were extracted and synthesised descriptively. A quality assessment of studies was also conducted.

Findings

Of the 383 non-duplicated records that were identified, nine met criteria for full-text review. Only 6 met the inclusion criteria and so were included in the review. Across the 6 studies within this review, data from 377 adult women were included and looked at the outcomes of women in the USA, Northern Ireland, Taiwan and Turkey. The findings of the studies suggest that taking part in postnatal yoga is associated with decreased symptoms of depression, an increase in psychological well-being and quality of life.

Key conclusions

Yoga-based interventions may offer a promising and effective intervention for maternal mental health and well-being. However, due to the limited number of studies, and a lack of consistency in study design and measures, more high-quality research is required to establish these effects and explore the potential benefits on other aspects of maternal well-being and infant outcomes.

The use of hydrotherapy in the first stage of labour: A systematic review and meta-analysis

AIM

To explore the effect of hydrotherapy applied in the first stage of labour on the health of mother and newborn.

METHODS

This systematic review and meta-analysis was carried out by following PRISMA. The studies were obtained by scanning EBSCO, PubMed, Science Direct, Ovid, Web of Science and Scopus electronic databases. Twenty studies published between 2013 and 2023 were included.

RESULTS

The total sample size of the studies was 8254 (hydrotherapy: 2953, control: 5301). Meta-analyses showed that the perception of pain decreased, comfort level and vaginal birth rate were higher and assisted vaginal birth rate and APGAR scores in the first minute were lower in women who underwent hydrotherapy. There was no difference between groups in terms of the duration of the first and second stage of labour, episiotomy, perineal trauma, intrapartum and postpartum bleeding amounts, use of pain medication and labour augmentations, APGAR scores in the fifth minute, positive neonatal bacterial culture and neonatal intensive care unit need.

CONCLUSION

This study revealed that the results that hydrotherapy decreased the perception of pain and assisted birth, increased the rate of vaginal birth and comfort level and did not adversely affect the health of the mother and baby during the birth process.

Effect of cognitive behavior therapy training and psychological nursing on the midwifery process in the delivery room

BACKGROUND

The severe physical and psychological impact of pain on the physical and mental health of women during labor leads to increased risks and complications during childbirth, presenting a major public health concern. Some studies have shown that cognitive behavioral therapy (CBT) has a positive effect on maternal psychology during delivery, reducing stress and shortening labor time. Thus, CBT training for mothers and delivery room staff may be beneficial in minimizing complications and adverse effects during natural birth.

AIM

To investigate the clinical effects of CBT training and psychological care during delivery, and their therapeutic effects on women in labor.

METHODS

This study used a retrospective analysis and included 140 mothers admitted to the maternity ward between January 2021 and January 2023. The study subjects were randomized into two groups: control (n = 70) and observation (n = 70). Routine care, CBT training, and psychological care were provided to mothers in both groups. Psychological status scores, delivery time, and satisfaction with care pre- and post-delivery were compared, and the incidence of complications after receiving care was analyzed between the two groups.

RESULTS

Although the psychological state of both groups improved significantly in the late stages of labor, the psychological state scores of the mothers in the observation group were significantly lower than those of the mothers in the control group (P < 0.05). The duration of labor and incidence of complications in the observation group were significantly lower than those in the control group (P < 0.05). The mothers in the observation group were significantly more satisfied with nursing care during the course of labor than those in the control group (P < 0.05).

CONCLUSION

CBT training and psychological care for mothers in the midwifery process can effectively improve anxiety and depression, shorten labor duration, reduce postnatal complications, and improve nursing satisfaction and nurse-patient relationships. Its clinical application is effective and has popularization value, providing a new way to protect maternal mental health.

Non-pharmacological interventions for the management of perinatal anxiety in primary care: a meta-review of systematic reviews

BACKGROUND

Perinatal anxiety (PNA), anxiety that occurs during pregnancy and/or up to 12 months postpartum, is estimated to affect up to 21% of women, and may impact negatively on mothers, children, and their families. The National Institute for Health and Care Excellence (NICE) has called for further research around non-pharmacological interventions in primary care for PNA.

AIM

To summarise the available international evidence on non-pharmacological interventions for women with PNA in a primary care population.

DESIGN & SETTING

A meta-review of systematic reviews (SRs) with narrative synthesis was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance.

METHOD

Systematic literature searches were conducted in 11 health-related databases up to June 2022. Titles, abstracts, and full-text articles were dual-screened against pre-defined eligibility criteria. A variety of study designs were included. Data were extracted about study participants, intervention design, and context. Quality appraisal was performed using the AMSTAR 2 tool (A MeaSurement Tool to Assess systematic Reviews). A patient and public involvement group informed and contributed towards this meta-review.

RESULTS

Twenty-four SRs were included in the meta-review. Interventions were grouped into the following six categories for analysis purposes: psychological therapies; mind-body activities; emotional support from healthcare professionals (HCPs); peer support; educational activities; and alternative or complementary therapies.

CONCLUSION

In addition to pharmacological and psychological therapies, this meta-review has demonstrated that there are many more options available for women to choose from that might be effective to manage their PNA. Evidence gaps are present in several intervention categories. Primary care clinicians and commissioners should endeavour to provide patients with a choice of these management options, promoting individual choice and patient-centred care.

Understanding and Fostering Mental Health and Well-Being among University Faculty: A Narrative Review

In recent years, there has been increasing recognition of mental health concerns in academia, with stress, burnout, anxiety, and depression being reported among faculty members. The demanding work environment, the need to balance personal and professional duties, and the constant pressure of productivity while navigating multiple tasks of teaching, research, mentorship, professional development, and service all impact the mental health and overall well-being of faculty. Higher education institutions have structurally changed as has the research landscape. These changes as well as faculty-specific and student-specific factors coupled to the effect of the COVID-19 pandemic have led to profound effects on the mental health of academics. This paper is a narrative review of the pertinent literature describing faculty mental health and well-being. It summarizes the available evidence on factors influencing faculty mental health and shows the prevalence of anxiety, depression, stress, and burnout among faculty from various academic fields and along the whole academic ladder. Using a suggested framework that collates the efforts of leaders and faculty, the paper concludes by exploring strategies that promote work-life balance among academics and suggesting effective interventions to improve their mental health outcomes.

Bornyl acetate: A promising agent in phytomedicine for inflammation and immune modulation

BACKGROUND

Bornyl acetate (BA), as a bicyclic monoterpene, is an active volatile component widely found in plants across the globe. BA can be used as essence and food flavor agent and is widely used in perfumes and food additives. It remains a key component in several proprietary Chinese medicines.

PURPOSE

This review summarized the pharmacological activity and research prospects of BA, making it the first of its kind to do so. Our aim is to provide a valuable resource for those pursuing research on BA.

METHODS

Databases including PubMed, Web of Science, and CNKI were used based on search formula "(bornyl acetate) NOT (review)" from 1967 to 2022. For the relevant knowledge of TCM, we quoted Chinese literature. Articles related to agriculture, industry, and economics were excluded.

RESULTS

BA showed rich pharmacological activities: It inhibits the NF-κB signal pathway via affecting the phosphorylation of IKB and the production of IKKs, inhibits the MAPK signal pathway via inhibiting the phosphorylation of ERK, JNK, and p38, down-regulates pro-inflammatory cytokines such as TNF-α, IL-1β, IL-6, up-regulates IL-11, reduces NO production, regulates immune response via up-regulating CD86⁺, decreases catecholamine secretion, and reduces tau protein phosphorylation. In addition to the pharmacological activities of BA, its toxicity and pharmacokinetics were also discussed in this paper.

CONCLUSION

BA has promising pharmacological properties, especially anti-inflammatory and immunomodulatory effects. It also has sedative properties and potential for use in aromatherapy. Compared to traditional NSAIDs, it has a more favorable safety profile while maintaining efficacy. BA has potential for developing novel drugs for treating various conditions.

Pain Severity and Pain Interference in Late Pregnancy: An Analysis of Biopsychosocial Factors Among Women Scheduled for Cesarean Delivery

OBJECTIVE

Pain is a variably experienced symptom during pregnancy, and women scheduled for cesarean delivery, an increasingly common procedure, are a relatively understudied group who might be at higher pain risk. Although biopsychosocial factors are known to modulate many types of chronic pain, their contribution to late pregnancy pain has not been comprehensively studied. We aimed to identify biopsychosocial factors associated with greater pain severity and interference during the last week of pregnancy.

METHODS

In this prospective, observational study, 662 pregnant women scheduled for cesarean delivery provided demographic and clinical information and completed validated psychological and pain assessments. Multivariable hierarchical linear regressions assessed independent associations of demographic, clinical, and psychological characteristics with pain severity and pain interference during the last week of pregnancy.

RESULTS

Women in the study had a mean age of 34 years, and 73% identified as White, 11% as African American, 10% as Hispanic/Latina, and 6% as Asian. Most women (66%) were scheduled for repeat cesarean delivery. Significant independent predictors of worse pain outcomes included identifying as African American or Hispanic/Latina and having greater depression, sleep disturbance, and pain catastrophizing. Exploratory analyses showed that women scheduled for primary (versus repeat) cesarean delivery reported higher levels of anxiety and pain catastrophizing.

CONCLUSIONS

Independent of demographic or clinical factors, psychological factors, including depression, sleep disturbance, and pain catastrophizing, conferred a greater risk of late pregnancy pain. These findings suggest that women at higher risk of pain during late pregnancy could benefit from earlier nonpharmacological interventions that concurrently focus on psychological and pain symptoms.

Does telecounseling reduce anxiety and depression during pregnancy? A randomized controlled trial

OBJECTIVE

This study aims to examine the effect of telecounseling in reducing the anxiety and depression experienced by pregnant women.

METHOD

This randomized control trial was conducted on 100 pregnant women (50 in each intervention and control group). The intervention group received telecounseling with regard to the mother and the fetus as needed between 08:00 h and 20:00 h for 6 weeks at home. The control group received only routine care. Anxiety and depression levels were evaluated at the beginning and end of the study using the Hospital Anxiety Depression Scale.

RESULTS

Anxiety and depression levels were found to be lower in the intervention group than in the control group (p<0.001). In the control group, the anxiety score increased from 5.62 to 7.16, and the depression score increased from 4.92 to 5.76 without any intervention (p<0.001).

CONCLUSION

This study shows that telecounseling may have an effect on reducing the level of anxiety and depression of pregnant women.

What is the evidence for efficacy of advance care planning in improving patient outcomes? A systematic review of randomised controlled trials

Objectives

To conduct an up-to-date systematic review of all randomised controlled trials assessing efficacy of advance care planning (ACP) in improving patient outcomes, healthcare use/costs and documentation.

Design

Narrative synthesis conducted for randomised controlled trials. We searched electronic databases (MEDLINE/PubMed, Embase and Cochrane databases) for English-language randomised or cluster randomised controlled trials on 11 May 2020 and updated it on 12 May 2021 using the same search strategy. Two reviewers independently extracted data and assessed methodological quality. Disagreements were resolved by consensus or a third reviewer.

Results

We reviewed 132 eligible trials published between 1992 and May 2021; 64% were high-quality. We categorised study outcomes as patient (distal and proximal), healthcare use and process outcomes. There was mixed evidence that ACP interventions improved distal patient outcomes including end-of-life care consistent with preferences (25%; 3/12 with improvement), quality of life (0/14 studies), mental health (21%; 4/19) and home deaths (25%; 1/4), or that it reduced healthcare use/costs (18%; 4/22 studies). However, we found more consistent evidence that ACP interventions improve proximal patient outcomes including quality of patient–physician communication (68%; 13/19), preference for comfort care (70%; 16/23), decisional conflict (64%; 9/14) and patient-caregiver congruence in preference (82%; 18/22) and that it improved ACP documentation (a process outcome; 63%; 34/54).

Conclusion

This review provides the most comprehensive evidence to date regarding the efficacy of ACP on key patient outcomes and healthcare use/costs. Findings suggest a need to rethink the main purpose and outcomes of ACP.

PROSPERO registration number

CRD42020184080.

Current Resources for Evidence-Based Practice, March 2022

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of systemic racism and its effect on maternal health in the United States and commentaries on reviews focused on barriers and facilitators to HPV vaccination and delayed cord clamping in preterm infants.

Effect of non-pharmacological interventions on anxiety, depression, sleep quality, and pain after orthopedic surgery: A protocol for systematic review and network meta-analysis

BACKGROUND

Patients after orthopedic surgery often experience the pain, anxiety, depression, and sleep disturbances, which can be greatly reduced by non-pharmacologic interventions as alternative therapies. Randomized controlled trials of nonpharmacologic interventions for anxiety, depression, sleep quality, and pain in patients after orthopedic surgery have been reported, but the results may be conflicting. Evidence to determine the optimal non-pharmacological intervention with a high efficacy is limited. This study aims to assess the effects of non-pharmacologic interventions on the bone anxiety, depression, sleep quality, and pain in patients after orthopedic surgery through a network meta-analysis, thus providing guidance in clinical application.

METHODS

A systematic search of randomized controlled trials reporting the effects of non-pharmacological interventions on anxiety, depression, sleep quality and pain after orthopedic surgery published before October 2021 will be searched in Wanfang, VIP Information Chinese Journal Service Platform, China National Knowledge Infrastructure, Chinese BioMedicine Literature Database, Pubmed, Embase, Cochrane, and Web of science. Two reviewers will be independently responsible for study selection, quality appraisal, and data extraction. Stata 14.0 software will be used to perform the network meta-analysis.

RESULTS

The findings of this research will be reported in a recognized journal.

CONCLUSION

This meta-analysis will provide the stronger evidence for non-pharmacological interventions on alleviating bone anxiety, depression, sleep quality, and pain in patients after orthopedic surgery, which will help clinicians and decision makers in their choices.Open Science Framework registration number: DOI 10.17605/OSF.IO/2SCBD.