Anxiety, depression and social support across pregnancy in women with a history of recurrent miscarriage: A prospective study

The prevalence of perceived stress and depression in women facing abortion and related obstetric and non-obstetric risk factors: a cross-sectional study

BACKGROUND

Available studies have limitations in identifying risk factors after abortion. Therefore, this study aimed to investigate the prevalence of perceived stress and depression in women facing abortion and to identify related obstetric and non-obstetric risk factors.

METHOD

This is a cross-sectional study that conducted from October 2023 to March 2024, involving 250 women seeking first-trimester abortions who visited the obstetrics emergency department at Amol hospitals. After obtaining informed consent, a questionnaire that includes demographic characteristics, perceived stress scale, Patient Health Questionnaire- 4, domestic violence questionnaire, 6-question marriage quality questionnaire, Medical Outcomes Social Support and Brief Resilience Scale were filled out. Data analyzed using descriptive statistics and logistic regression with a significance level of p < 0.05 in SPSS software version 23.

RESULT

The prevalence of high perceived stress and depressive symptoms was 18.8% and 15.6%, respectively. There was a significant relationship between depression and perceived stress (p = 0.029), as well as low social support (p = 0.034), history of previous abortion (p = 0.001), and social factors of abortion (p = 0.045) with perceived stress (p < 0.05). There was no significant relationship between other variables such as resilience, domestic violence, quality of marriage with perceived stress and depression (p > 0.05).

CONCLUSION

The prevalence of perceived stress and depression was not high in this women. Previous abortion history, low social support, and abortion for social reasons were the most important factors affecting perceived stress, which was also significantly associated with depression. The findings emphasize the importance of assessing the mental health of women seeking abortion, especially those with high-risk factors for Appropriate interventions.

Knights in shining armour and (M)others in life jackets: Women's experiences of advocating for care alone when suffering recurrent early pregnancy loss during the SARS-CoV-2 pandemic

BACKGROUND

Recurrent early pregnancy loss [rEPL] is a traumatic experience, marked by feelings such as grief and depression, and often anxiety. Despite this, the psychological consequences of rEPL are often overlooked, particularly when considering future reproductive health or approaching subsequent pregnancies. The SARS-CoV-2 pandemic led to significant reconfiguration of maternity care and a negative impact on the perinatal experience, but the specific impact on women's experience of rEPL has yet to be explored. This study aimed to examine the impact of changes to early pregnancy loss care and social restrictions during the pandemic on women's experience of rEPL.

METHODS

A qualitative interview study design was employed, with semi-structured interviews conducted virtually. A total of 16 women who had suffered two or more early pregnancy losses (≤ 14 weeks gestation) during the SARS-CoV-2 pandemic in the United Kingdom participated. Data were recorded, transcribed, and analysed by hand, following a Classical Grounded Theory Analysis, appropriate for cross-disciplinary health research.

RESULTS

Iterative and inductive analysis generated the theory 'Knights in Shining Armour and (M)others in Life Jackets', which describes women's experience of advocating for care alone, when suffering rEPL during the pandemic. This theory was derived from the way in which three emergent themes inter-related: (1) Dismantling Validation; (2) Preserving an Identity of Motherhood; and (3) Support Waning.

CONCLUSIONS

This study affirms recent findings of devalued maternity care during the pandemic, and magnification of pre-pandemic issues with EPL care, such as a lack of support or perceived empathy.

Analysis of the implementation value of abdominal B-ultrasound combined with cervical cerclage in the prevention and treatment of late recurrent spontaneous abortion

OBJECTIVE

To study the implementation value of abdominal B-ultrasound combined with cervical cerclage in the prevention and treatment of recurrent late abortion.

METHODS

From October 2020 to December 2023, 196 pregnant patients who had a history of late abortions at our institution were chosen. They were divided into groups based on the treatments used. In the observational team, 98 instances received abdominal B-ultrasound along with cervical cerclage, while 98 instances in the controlling team underwent traditional conservative treatment. Vaginal flora, inflammatory factor levels, labor outcomes, uterine artery parameters, and adverse effects were observed in both groups of pregnant women.

RESULTS

Comparing the detection of vaginal flora between the two groups, the difference was not statistically significant (P > 0.05); the detection values of WBC, neutrophil percentage and neutrophil absolute value in the observation group were lower than those in the control group (P < 0.05). The recurrent late abortion rate (4.08%) and premature delivery rate (16.33%) were lower than those of the control group, and the full-term delivery rate (79.59%) and total fetal survival rate (93.88%) were higher than those of the control group, and the difference was statistically significant (P < 0.05). The resistance index (RI) and pulsatility index (PI) of pregnant women with abortion were higher than those of live birth pregnant women. The RI and PI of group A (pregnant women with recurrent late abortion) at 7, 12, 24 and 32 weeks of gestation were also higher than those of group B (pregnant women without recurrent late abortion), and the difference was statistically significant (P < 0.05). At 7 weeks of gestation, there was no statistical difference between the observation and control groups in terms of RI and PI (P > 0.05)0.12 By 32 weeks of gestation, the RI and PI were lower in the observation group than in the control group (P < 0.05)0.13 In the observation group, the RI and PI were lower than in the control group (P < 0.05). The incidence of gestational hypertension, gestational diabetes mellitus, and eclampsia were significantly lower in the observation group compared to the control group (P < 0.05).

CONCLUSION

Abdominal ultrasound combined with cervical cerclage reduces the risk of miscarriage by improving the hemodynamic status of the uterus and placenta, and also optimizes the pregnancy environment by reducing the inflammatory response in the uterine cavity, which has important clinical applications in the prevention and treatment of late recurrent spontaneous abortion.

Anxiety, depression, and perceived wellbeing in antenatal women at risk of preterm birth: a retrospective cohort study

Introduction

Women identified at risk for preterm may be vulnerable to developing mental health difficulties due to the increased likelihood of poor pregnancy outcome and uncertainty surrounding their delivery. Formal assessment of mental wellbeing in specialist preterm birth clinics is not routinely offered, but may offer the opportunity for early intervention.

Methods

We aimed to investigate if demographic characteristics and obstetric risk factors were associated with psychological wellbeing in women at risk of preterm birth. We explored associations between mental wellbeing and risk factors for preterm birth using hierarchical regression analyses.

Results

When demographic variables were considered alone, high body mass index (BMI) was significantly associated with anxiety (p = .026), however became non-significant when obstetric risk factors were also considered. Previous late miscarriage was associated with high anxiety (p = .049). Lower maternal age at estimated date of delivery (p = .019) and non-European ethnic heritage (p = .029) were significantly associated with depression. High maternal BMI (p < .001), being of any other non-European ethnic heritage (p = .043), currently smoking (p = .002), and previous spontaneous preterm birth (p = .017) were associated with lower perceived wellbeing.

Discussion

The results of this study highlight the importance of routinely monitoring mental health in women with relevant risk factors, particularly if they are already at risk of preterm birth.

Recurrent Pregnancy Loss: Immunological aetiologies and associations with mental health

Recurrent pregnancy loss (RPL) is an obstetric condition estimated to affect 2-4% of childbearing individuals globally. Due to its varied nature, medical societies globally differ in their diagnostic criteria. Its aetiologies are numerous, ranging from anatomic abnormalities to endocrine and immunological factors. Autoimmune factors can attribute to approximately 20% of cases and include dysregulation of immune cells, cytokine production and antiphospholipid syndrome. Treatment pathways vary by aetiology; however, many cases remain unexplained, adding an additional level of complexity to this condition. Due to its recurrent nature, this type of pregnancy loss has profound impacts on mental health during subsequent pregnancies. While some aspects of RPL have been widely investigated, there continues to be a gap in research, such as its impacts on non-birthing parents and specific sociodemographic groups.

Assisted reproductive technology and physical activity among Chinese pregnant women at high risk for gestational diabetes mellitus in early pregnancy: A cross-sectional study

Currently, the number of pregnant women at high risk for gestational diabetes mellitus (GDM) and using assisted reproductive technology (ART) is increasing. The present study aims to explore the relationship between ART and physical activity in Chinese pregnant women at high risk for GDM in early pregnancy. A cross-sectional study was conducted in a regional teaching hospital in Guangzhou, China, between July 2022 and March 2023. Three hundred fifty-five pregnant women at high risk for GDM in early pregnancy completed the Chinese version of the Pregnant Physical Activity Questionnaire (PPAQ), the Pregnancy Physical Activity Knowledge Scale, the Pregnancy Physical Activity Self-Efficacy Scale, the Pregnancy Physical Activity Social Support Scale, and a sociodemographic and obstetric characteristics data sheet. Compared to women who conceived naturally, women who used ART were more likely to be 35 years or older, unemployed, primigravidae, and to have intentionally planned their pregnancies. Women who used ART had significantly lower levels of physical activity and self-efficacy compared to their counterparts who conceived naturally. Over half (55.6%) of women who used ART reported being physically inactive, and those with lower self-efficacy, as well as the unemployed, were significantly more likely to be inactive. Physical inactivity is a critical clinical issue among women who use ART, especially in the context of GDM risk. Future research should develop and test physical activity programs, including enhancing physical activity self-efficacy for women who use ART. Patient or public contribution: In this study, survey questionnaires were completed by participants among Chinese pregnant women at high risk for GDM in early pregnancy.

The Mediating Role of Physical Activity Self-Efficacy in Predicting Moderate-Intensity Physical Activity in Pregnant People at High Risk for Gestational Diabetes

INTRODUCTION

Gestational diabetes mellitus (GDM) is a common medical complication in pregnancy. Moderate-intensity physical activity during pregnancy can lower the risk of GDM. However, the relationship between moderate-intensity physical activity and correlated factors among pregnant people at high risk for GDM remains unknown.

METHODS

A cross-sectional study was conducted in China. Two hundred fifty-two participants completed the Pregnancy Physical Activity Questionnaire, Pregnancy Physical Activity Self-Efficacy Scale, Physical Activity Knowledge Questionnaire, Physical Activity Social Support Scale, 7-item Generalized Anxiety Disorder Scale, Edinburgh Postnatal Depression Scale, and a sociodemographic data sheet. Structural equation modeling was used to explore the direct and indirect associations between the study variables.

RESULTS

A total of 51.6% of the participants did not meet the current physical activity guidelines. Only physical activity self-efficacy was significantly correlated with moderate-intensity physical activity. Physical activity self-efficacy mediated the relationship between moderate-intensity physical activity and knowledge of physical activity, social support for physical activity, and anxiety symptoms. Furthermore, knowledge of physical activity was also associated with improved moderate-intensity physical activity mediated by reduced anxiety symptoms and increased physical activity self-efficacy.

CONCLUSION

Our study revealed a high prevalence of not meeting current physical activity guidelines among pregnant people at high risk for GDM. Physical activity self-efficacy played an important mediating role in predicting moderate-intensity physical activity. Future studies should focus on enhancing self-efficacy to improve moderate-intensity physical activity for pregnant people at high risk for GDM.

Global research trends in sexual health care: A bibliometric and visualized study

No Patient or Public Contribution, because the relevant data of this article comes from the literature database.

PURPOSE

The present study aimed to investigate the trends and research status of sexual healthcare.

METHODS

We searched the Web of Science database for relevant articles concerning sexual healthcare, published between 2009 and 31 December 2022. Data collected include: the number of publications, authors, journals, countries, institutions, keywords. VOSviewer and CiteSpace were used to conduct the bibliometric study and visualise the analysis.

RESULTS

A total of 1450 publications were included. The number of publications on sexual healthcare shows a fluctuating upward trend, and a stable core group of authors has been formed. The Journal of Clinical Nursing published the most articles on sexual healthcare (140 publications). The United States of America published the most articles (723, 49.86%). The research institution with the highest number of publications is the University of São Paulo. According to the keyword, timeline view and prominence mapping analysis, we believe that 'Female sexual health', 'HIV', 'LGBT' and 'Sexual Healthcare Services' may be new research hotspots in the field of sexual healthcare.

CONCLUSION

This study describes the research status of sexual healthcare research over the past 14 years. The findings of this study can provide helpful reference and guidance for the development trend and research direction of sexual healthcare.

Development and internal validation of a clinical prediction model for spontaneous abortion risk in early pregnancy

OBJECTIVE

This study aimed to develop and internally validate a prediction model for estimating the risk of spontaneous abortion in early pregnancy.

METHODS

This prospective cohort study included 9,895 pregnant women who received prenatal care at a maternal health facility in China from January 2021 to December 2022. Data on demographics, medical history, lifestyle factors, and mental health were collected. A multivariable logistic regression analysis was performed to develop the prediction model with spontaneous abortion as the outcome. The model was internally validated using bootstrapping techniques, and its discrimination and calibration were assessed.

RESULTS

The spontaneous abortion rate was 5.95% (589/9,895) 1. The final prediction model included nine variables: maternal age, history of embryonic arrest, thyroid dysfunction, polycystic ovary syndrome, assisted reproduction, exposure to pollution, recent home renovation, depression score, and stress score 1. The model showed good discrimination with a C-statistic of 0.88 (95% CI 0.87‒0.90) 1, and its calibration was adequate based on the Hosmer-Lemeshow test (p = 0.27).

CONCLUSIONS

The prediction model demonstrated good performance in estimating spontaneous abortion risk in early pregnancy based on demographic, clinical, and psychosocial factors. Further external validation is recommended before clinical application.

Psychological changes among women with recurrent pregnancy loss during the COVID-19 period in northeastern China: a cross-sectional study

Background

It aimed to investigate the prevalence of anxiety and depression in recurrent pregnancy loss (RPL) women and the related factors in Northeastern China during the Coronavirus disease 2019 (COVID-19) pandemic.

Methods

From March to June 2021, we conducted an electronic questionnaire survey of 267 RPL women who attended the recurrent pregnancy loss clinic at Shengjing Hospital of China Medical University. The State-Trait Anxiety Inventory (STAI), Beck Depression Inventory-II (BDI-II), Perceived Stress Scale (PSS), and Medical Outcomes Study Social Support Survey (MOS-SSS-C) were used to screen for anxiety, depression, stress, and social support. Logistic regression was used to explore the related factors of anxiety and depression.

Results

RPL women had severe psychological problems during the pandemic: 56.6% showed state anxiety or trait anxiety, 26.6% showed high levels of stress, and 13.1% showed depression. Economic pressure caused by COVID-19, and high stress were common related factors for anxiety and depression. The interval since last miscarriage <6 months, worse mood changes due to COVID-19, and concerns about COVID-19 were associated with anxiety. A history of pregnancy loss >14 weeks was associated with depression. While adequate social support and actively seeking health help were protective factors for trait anxiety. And identifying the etiology was a protective factor for depression.

Conclusion

The study revealed the prevalence of anxiety, depression, and the associated factors in RPL women during COVID-19. More attention should be paid to the psychology of RPL women and adequate social support should be provided.

Internet addiction and depression among Chinese adolescents: anxiety as a mediator and social support as a moderator

This study constructed a moderated mediation model to investigate the mediating effect of anxiety and the moderating effect of social support between Internet addiction and depression. A sample of 17 058 middle school students in one district of Chengdu were selected. The Internet Addiction Test (IAT), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and Social Support Scale for adolescents were used to investigate their Internet addiction, anxiety, depression and social support. The descriptive statistics and Spearman correlation analysis were performed with SPSS 25.0. An SPSS macro process was used to analyze the data from complex models that contained mediators and moderators. The results show that adolescents with Internet addiction are more likely to suffer from depression. Anxiety partially mediated the relations between Internet addiction and depression. Social support moderated both direct and indirect pathways leading from Internet addiction to depression, and these two effects were stronger for adolescents with low social support than for those with high social support. It will be possible for researchers to gain a better understanding of the conditions, pathways, and effects of Internet addiction on depression in adolescents through the results of this study.

Longitudinal study of the relationship between number of prior miscarriages or stillbirths and changes in quality of life of pregnant women: the Japan Environment and Children's Study (JECS)

BACKGROUND

Although a history of miscarriage or stillbirth has been reported to negatively affect quality of life (QOL) during the subsequent pregnancy, the association between the number of previous miscarriages or stillbirths and QOL, as well as trends in QOL during pregnancy, has not been clarified. This study sought to determine this association during early and mid- to late pregnancy.

METHODS

Data from 82,013 pregnant women who participated in the Japan Environment and Children's Study (JECS) from January 2011 to March 2014 were analyzed. In early and mid/late pregnancy, participants completed questionnaires and QOL was assessed using the Physical and Mental Component Summary (PCS and MCS, respectively) scores from the 8-item Short-Form Health Survey (SF-8). The pregnant women were divided into four groups according to number of previous miscarriages or stillbirths (0, 1, 2, and ≥ 3), and the PCS and MCS scores in early pregnancy and mid/late pregnancy were compared between group 0 and groups 1, 2, and ≥ 3. Generalized linear mixed models were used for analysis.

RESULTS

PCS score in early pregnancy was lower in group 1 (β =  - 0.29, 95% confidence interval [CI] - 0.42 to - 0.15), group 2 (β =  - 0.45, 95% CI - 0.73 to - 0.18), and group ≥ 3 (β =  - 0.87, 95% CI - 1.39 to - 0.35) than in group 0. Group 1 and group ≥ 3 showed a trend for increased PCS score during pregnancy (β = 0.22, 95% CI 0.07 to 0.37 and β = 0.75, 95% CI 0.18 to 1.33, respectively) compared with group 0.

CONCLUSIONS

PCS score in early pregnancy was lower with a more frequent history of miscarriage or stillbirth. However, in terms of changes in QOL during pregnancy, pregnant women with a history of miscarriage or stillbirth showed greater increases in PCS score during mid/late pregnancy than pregnant women with no history of miscarriage or stillbirth.

The risk factors of progestational anxiety, depression, and sleep disturbance in women with recurrent pregnancy loss: A cross-sectional study in China

Background

The risk factors of progestational anxiety, depression, and sleep disturbance in women with a history of recurrent pregnancy loss (RPL) remain controversial, additional study is needed to investigate the incidence and risk factors of progestational anxiety, depression, and sleep quality in RPL women.

Methods

A cross-sectional study was conducted among 663 non-pregnant RPL women in Northeast China from October 2019 to July 2022. We assessed the state of anxiety, depression, and sleep quality before pregnancy using structured questionnaires, including sociodemographic characteristics, state-trait anxiety scale (STAI), center for epidemiological survey, depression scale (CES-D), Pittsburgh sleep quality index (PSQI), and symptom self-rating scale (SCL-90). Logistic regression was used to evaluate the association between sleep quality and anxiety, depression. Pearson’s correlation was used to evaluate the correlation between anxiety and depression. Multivariate logistic regression analysis was used to find the risk factors of depression symptoms. The receiver operating characteristic curve (ROC) was used to evaluate the predictive value of the model.

Results

The incidence of state anxiety, trait anxiety, depression, and sleep disturbance in RPL women were 60.3, 51.7, 33.9, and 31.2%, respectively. The level of anxiety and depression in RPL women varied at different stages of treatment. In a longitudinal study (25 pairs), we found the level of state anxiety and trait anxiety were significantly lower after the cause was identified. Sleep disturbance is positively correlated with anxiety and depression. Logistic regression showed that the number of miscarriages ≥4 (Odds ratio (OR) = 2.268, 95%CI 1.300–3.956), Low household family income (OR = 1.613, 95%CI 1.036–2.513/OR = 2.361, 95%CI 1.095–5.092), interval since last miscarriage &lt;6 months (OR = 2.154, 95%CI 1.246–3.726) and sleep disturbance (OR = 5.523, 95%CI 3.542–8.614) were associated with the occurrence of depressive symptoms. At the same time, anxiety can be used as a predictor of depression.

Conclusion

Recurrent pregnancy loss women have a certain degree of anxiety, depression, and sleep disturbance. Education level, interval since the last miscarriage &lt;6 months, and sleep disturbance are risk factors for anxiety and depression. A history of pregnancy loss after 14 weeks and no living birth are also closely related to anxiety. Therefore, it is necessary to pay close attention to the psychological state of RPL women and provide appropriate psychosocial support to reduce the occurrence of negative emotions.

Psychologic Sequelae in Early Pregnancy Complications

Early pregnancy complications, including miscarriage, ectopic pregnancies, and hyperemesis gravidarum, are common discomforts accounting for about 15% to 20% of all pregnancies. A proportion of women with early pregnancy complications will experience short- and long-term psychologic sequelae in the aftermath of pregnancy complications, including anxiety, depression, and post-traumatic stress disorder (PTSD) which are the most commonly reported psychologic reactions. This review will focus on the course and impact of these psychologic sequelae in early pregnancy complications, and the noninvasive interventions to improve mental health are also briefly discussed.

Social connectedness as a determinant of mental health: A scoping review

Public health and epidemiologic research have established that social connectedness promotes overall health. Yet there have been no recent reviews of findings from research examining social connectedness as a determinant of mental health. The goal of this review was to evaluate recent longitudinal research probing the effects of social connectedness on depression and anxiety symptoms and diagnoses in the general population. A scoping review was performed of PubMed and PsychInfo databases from January 2015 to December 2021 following PRISMA-ScR guidelines using a defined search strategy. The search yielded 66 unique studies. In research with other than pregnant women, 83% (19 of 23) studies reported that social support benefited symptoms of depression with the remaining 17% (5 of 23) reporting minimal or no evidence that lower levels of social support predict depression at follow-up. In research with pregnant women, 83% (24 of 29 studies) found that low social support increased postpartum depressive symptoms. Among 8 of 9 studies that focused on loneliness, feeling lonely at baseline was related to adverse outcomes at follow-up including higher risks of major depressive disorder, depressive symptom severity, generalized anxiety disorder, and lower levels of physical activity. In 5 of 8 reports, smaller social network size predicted depressive symptoms or disorder at follow-up. In summary, most recent relevant longitudinal studies have demonstrated that social connectedness protects adults in the general population from depressive symptoms and disorders. The results, which were largely consistent across settings, exposure measures, and populations, support efforts to improve clinical detection of high-risk patients, including adults with low social support and elevated loneliness.