Anxiety symptoms and health-related quality of life in mainland Chinese pregnant women: a cross-sectional study

Validating the Quality Maternal and Newborn Care Framework Index: A Global Tool for Quality-of-Care Evaluations

BACKGROUND

Quality maternity care is known to improve a range of maternal and neonatal outcomes. The Lancet Series on Midwifery's Quality Maternal and Newborn Care (QMNC) Framework is a high-level synthesis of the global evidence on quality maternity care. Initial qualitative work demonstrated the Framework's adaptability in evaluating service user and provider perceptions of the quality of maternity care. However, evaluating services at scale requires a survey instrument. This paper reports the validation of the QMNC Framework index (QMNCFi), a five-part survey for the evaluation of maternity care across diverse settings.

METHODS

International online English language survey of women who had given birth in the previous year in Australia, Ghana, India and the United Kingdom (UK). It was distributed through service user networks (UK and Australia) and at postnatal clinics (Ghana and India). All forms were completed online. Test-retest was conducted to assess reliability.

RESULTS

Five hundred and forty mothers completed the survey (Australia 136; Ghana 131; India 153; UK 120). Construct validity: Cronbach's α in 12 of the survey's 13 sections ranged from 0.795 to 0.986; for the remaining section the alpha was 0.594. Reliability: 55 participants completed the QMNCFi a second time. Intraclass correlation coefficient results ranged from 0.657 to 0.939 across the 13 sections. Field researchers in Ghana and India reported that the survey was easily understood and completed.

CONCLUSION

This survey has shown that, across diverse contexts, the QMNCFi is a valid, reliable, and comprehensive tool for measuring service user perceptions of the quality of care over time.

Psychometric testing of Chinese version of screening tools (PASS) and GAD among perinatal population: hospital based evidence 2023

BACKGROUND

Anxiety disorders are increasing worldwide, untreated anxiety is linked to maternal and child health outcomes. The purpose of this study is to test psychometric properties of the Perinatal Anxiety Screening Scale (PASS) among Chinese women.

METHODS

The PASS was translated into Chinese following Beaton's intercultural debugging guide. A total of 494 women in the antenatal and postnatal phase participated ( 268 antenatal and 186 postnatal ) were recruited between March 2023 and July 2023 from two hospitals in Sichuan Province, China. The instruments included the demographic characteristics form, PASS, Edinburgh Postnatal Depression Scale (EPDS), and Generalized Anxiety Disorder-7 (GAD-7). The confirmatory factor analysis (CFA), internal consistency reliability and convergent validity were assessed.

RESULTS

The mean age of the participant was 31.67 years (SD = 3.78; range from 23 to 49). The CFA showed that four-factor model of the Chinese-PASS had an excellent fit to the data ( χ2 = 1481.2477; df = 425; χ2/df = 3.485; RMSEA = 0.071; CFI = 0.871; NNFI = 0.828; TLI = 0.859; and IFI = 0.871). The Cronbach's alpha coefficient of total scale was 0.950, and the split-half reliability of total scale was 0.907. The PASS significantly correlated with EPDS (r = 0.732) and GAD-7 (r = 0.763). The area under the ROC curve for PASS scores was 0.91 (SE = 0.01; 95% CI = 0.89-0.94). At cut-off score of ≥ 19.5, the sensitivity was 0.87. The area under the ROC curve for GAD-7 scores was 0.89 (SE = 0.02; 95% CI = 0.86-0.92). At cut-off score of ≥ 3.5, the sensitivity was 0.82.

CONCLUSIONS

The result of this study show that the Chinese-PASS had a reasonably adequate validity and reliability and can be used to screen for anxiety disorder among women during the perinatal period.

The effects of exercise on anxiety symptoms in women with gestational diabetes mellitus: a pilot study

PURPOSE

Anxiety is a common mental health issue during pregnancy. Moreover, women with gestational diabetes mellitus (GDM) seem to have to cope with higher levels of anxiety, being at higher risk for several health and mental complications. Women with GDM are recommended to undertake regular physical exercise to improve metabolic and reproductive outcomes. However, there are no specific guidelines for exercise in women with GDM and data on its relationship with mental health are scarce. The aim of this study was to investigate the effect of exercise on anxiety symptoms in pregnant women with GDM.

METHODS

The present non-randomized, open-label clinical trial was a pilot study intended to provide initial data on the effect of exercise on anxiety symptoms of pregnant women with GDM. Forty-three women were assigned to three the following three study groups, (a) Advice Group (n = 17), Walking Group (n = 14), and Mixed Exercise Group (n = 12), from GDM diagnosis to delivery.

RESULTS

Based on the Beck Anxiety Inventory (BAI) scores, all groups showed normal anxiety changes or mild anxiety levels pre- and post-intervention, ranging between 9.00 (1.00-32.00) (pre-intervention) and 7.5 (1.00-26.00) (post-intervention), but none experienced severe anxiety.

CONCLUSION

In the present study, a trend of self-selected pace walking to reduce the BAI scores was identified since the Walking Groups had lower scores after the intervention. However, this trend did not reach statistical significance. Brisk walking (30-45 min) three times per week may produce positive changes in both the treatment plan and the anxiety state of women with GDM. Moreover, the study confirms that routine medical care, counseling, and support by an interdisciplinary team are protective against anxiety in women with GDM.

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.

Decisional conflict, anxiety, and social support among Chinese pregnant women making further prenatal testing decisions

OBJECTIVE

This study aimed to examine decisional conflict and identify its predictors in Chinese pregnant women who were making decisions about further prenatal testing after receiving a screening result of high-risk for Down syndrome.

METHOD

A cross-sectional study was conducted from September 2020 to July 2021 in Guangzhou, China. Two-hundred and sixty pregnant women receiving a screening result of high-risk for Down syndrome completed a questionnaire comprising the Decisional Conflict Scale, Self-rating Anxiety Scale, and Social Support Rating Scale.

RESULTS

The mean decisional conflict score was 28.8 ± 13.6, representing a moderate level. Advanced age (≥35 years), having a religious belief, not knowing about non-invasive or invasive prenatal testing, choosing NIPT for further prenatal testing, high levels of anxiety, and low levels of social support were significant predictors of decisional conflict, explaining 28.4% of its variance (F = 18.115, p < 0.001).

CONCLUSIONS

The results highlighted the necessity of assessing patients' decisional conflict and providing adequate interventions along the prenatal care trajectory. The results also showed that providing good support has an essential value for women by relieving their decisional conflict.

Barriers to professional psychological help among pregnant women in China: a qualitative study

BACKGROUND

Pregnant women face significant physiological and psychological stressors, which can lead to mental health issues such as anxiety and depression. Despite the importance of professional psychological assistance, many pregnant women in China do not seek help due to various barriers. This study aims to explore the experiences and challenges of pregnant women in seeking psychological help in China through qualitative methods.

METHODS

Purposive sampling was employed to select 20 pregnant women from a Class III Type A hospital in Hainan. Semi-structured in-depth interviews were conducted from July to August 2023, focusing on psychological states, help-seeking experiences, encountered challenges, and suggestions for improving psychological support. Colaizzi's 7-step method was used to synthesize the themes.

RESULTS

We distilled five themes: (1) Psychological conditions during pregnancy, which includes stress and emotional fluctuations and anticipations of postpartum challenges; (2) Barriers to seeking help, underscored by societal misconceptions, limited professional access, and varied familial support; (3) Sources of psychological stress, highlighting physical changes, familial and work pressures, and societal expectations; (4) Expectations for psychological assistance, emphasizing the need for professional understanding and societal awareness; (5) Impact of psychological issues on daily life, such as decreased work efficiency and affected social activities.

CONCLUSION

Pregnant women in China confront significant psychological stress and face multiple barriers in accessing help. There is an urgent need for personalized and professional psychological services for pregnant women. Addressing barriers such as societal stigma and poor accessibility, along with increasing public awareness and improving mental health services, is crucial. These findings provide a foundation for developing effective psychological support strategies aimed at enhancing the mental health of pregnant women in China.

Prevalence of Perinatal Anxiety and Related Disorders in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Importance

Anxiety disorders are associated with poor maternal and neonatal outcomes. Women in low- and middle-income countries (LMICs) are thought to be disproportionally burdened by these disorders, yet their prevalence is unclear.

Objective

To conduct a systematic review and meta-analysis to determine the prevalence of 6 anxiety and related disorders among perinatal women in LMICs.

Data Sources

Embase, MEDLINE, PsycINFO, Cochrane Library, CINAHL, and Web of Science databases were searched from inception until September 7, 2023.

Study Selection

Studies conducted in World Bank-defined LMICs and reporting prevalence of generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder, posttraumatic stress disorder, panic disorder, or adjustment disorder during the perinatal period (conception to 12 months post partum) using a validated method were included.

Data Extraction and Synthesis

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Study eligibility, extracted data, and risk of bias of included studies were assessed by 2 independent reviewers. Random-effects meta-analysis was used to estimate pooled point prevalence. Subgroup analyses were performed by specific anxiety disorder.

Main Outcomes and Measures

Main outcomes were prevalence estimates of each anxiety disorder, measured as percentage point estimates and corresponding 95% CIs.

Results

At total of 10 617 studies were identified, 203 of which met the inclusion criteria and reported the outcomes of 212 318 women from 33 LMICs. Generalized anxiety disorder was the most reported (184 studies [90.6%]) and most prevalent disorder at 22.2% (95% CI, 19.4%-25.0%; n = 173 553). Posttraumatic stress disorder was the second most prevalent (8.3%; 95% CI, 5.0%-12.2%; 33 studies; n = 22 452). Adjustment disorder was least prevalent (2.9%; 95% CI, 0.0%-14.1%; 2 studies; n = 475). The prevalence of generalized anxiety varied by country income status, with the highest prevalence among lower-middle-income countries (27.6%; 95% CI, 21.6%-33.9%; 59 studies; n = 25 109), followed by low-income (24.0%; 95% CI, 15.3%-33.8%; 11 studies; n = 4961) and upper-middle-income (19.1%; 95% CI, 16.0%-22.4%; 110 studies; n = 138 496) countries.

Conclusions and Relevance

These findings suggest that 1 in 5 women living in LMICs experience anxiety disorders during pregnancy and post partum. Targeted action is needed to reduce this high burden.

Prevalence of perinatal anxiety and its determinants in mainland China: A systematic review and meta-analysis

BACKGROUND

Perinatal anxiety is among the most common mental health conditions that have a huge negative impact both on mothers and their children. This study aimed to establish summary estimates of the prevalence of perinatal anxiety and its influencing factors in Mainland China.

METHODS

A systematic search was carried out from nine major English and Chinese electronic databases to identify studies published up to August 20, 2022 with data on the prevalence of perinatal anxiety. Two reviewers conducted data extraction and quality assessment. Meta-analysis was performed using a random-effects model. Subgroup and meta-regression analyses were performed when possible.

RESULTS

271 studies representing 369,477 women were included in the study. Pooled prevalence of perinatal anxiety was 17.4 % (95 % CI: 16.2 % to 18.7 %), with prenatal anxiety 17.4 % (95%CI: 16.1 % to 18.8 %) and postpartum anxiety 17.5 % (95%CI: 13.5 % to 22.4 %). However, the overall estimates presented substantial heterogeneity (I² = 98.93 %). Qualitative summaries demonstrated some main potential risk factors of perinatal anxiety such as women with abnormal pregnancy-labor history, poor health status, pregnancy complications, and unplanned pregnancies, and some potential protective factors such as high family income, good social support, good interpersonal relationships, and history of multiple deliveries.

LIMITATION

Very large heterogeneity among studies was observed in meta-synthesis, and all included studies used self-report scales to identify anxiety rather than diagnostic interviews.

CONCLUSION

Varying degrees of perinatal anxiety is prevalent among Chinese women. Screening and evidence-based interventions are urgent and necessary to address this public concern and promote their health and well-being.

Can we hit prenatal depression and anxiety through HIIT? The effectiveness of online high intensity interval training in pregnant women during the COVID-19 pandemic: a randomized controlled trial

BACKGROUND

In recent years high intensity interval training (HIIT) has grown in popularity. However, it rarely represents training interventions in experimental studies in pregnant populations. Therefore, in this study we aimed to assess changes in depressive symptoms, fear of childbirth, fear of Covid-19 and quality of life after an 8-week supervised online HIIT program, compared to an educational (self-performed physical activity) program.

METHODS

We conducted a randomized control trial among 54 Caucasian women in uncomplicated, singleton pregnancy (age 32 ± 4 years, 22 ± 4 week of gestation; mean ± SD). There were 34 women in the experimental group, who participated in an 8-week high intensity interval training program (HIIT group). The comparative group was constituted of 20 pregnant women who attended 8-week educational program (EDU group).

RESULTS

The most important finding was that mental health improved somewhat in both groups after the intervention, but only the HIIT group improved statistically significantly. The positive trends in lowering the severity of depressive symptoms, fear of childbirth, and fear of Covid-19 were observed in both groups. However, the positive response to the intervention was stronger in the EDU group. As a secondary outcome, there was a significant decrease in cardiorespiratory fitness level in the EDU group, while the HIIT group maintained unchanged level of maximal oxygen uptake.

CONCLUSIONS

HIIT seems to be beneficial for women with uncomplicated pregnancies to maintain adequate quality of life and mental health. However, more research is needed to determine the effectiveness of prenatal HIIT in pregnant women in various psychological conditions.

TRIAL REGISTRATION

We conducted this study in Poland, in 2021. It was approved by the Bioethics Commission at the District Medical Chamber in Gdansk (KB-8/21). The full study protocol was registered in ClinicalTrials.gov (NCT05009433).

Incidence and correlates of insomnia and its impact on health-related quality of life among Chinese pregnant women: a cross-sectional study

OBJECTIVE

The aims of this study were to examine the incidence and correlates of insomnia and its impact on health-related quality of life among Chinese pregnant women.

METHOD

A cross-sectional study was performed from November 2018 to April 2019 in a university-affiliated general hospital in Guangzhou, China. Seven hundred and seventeen pregnant women completed the 36-item Short-Form Health Survey (SF-36), the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), and the obstetric and sociodemographic data sheet.

FINDINGS

24.3% of the pregnant women suffered from insomnia. Compared with women without insomnia, those with insomnia had a significantly lower health-related quality of life during pregnancy. Maternal age, educational level, occupation, economic status, insurance coverage, gestational age, the woman's relationship with her mother-in-law and anxiety were significantly associated with insomnia among pregnant women.

CONCLUSION

The incidence of insomnia among pregnant women is high, and insomnia is negatively correlated with health-related quality of life. Appropriate measures and practical therapeutic programmes should be provided to prevent the adverse effects of insomnia in pregnant women with advanced maternal age, lower education, lower economic status, unemployment, lack of insurance coverage, unsatisfied with their relationships with their mothers-in-law, and suffering from anxiety symptoms, especially in the third trimester.