Explanatory factors and levels of health-related quality of life among healthy pregnant women at midpregnancy: A cross-sectional study of The PregnActive Project

Gestational weight gain and daily life impact of pregnancy symptoms in healthy women: A multivariable analysis

OBJECTIVE

To study the relationship between gestational weight gain (GWG) and Daily Life Impact of Pregnancy Symptoms (DLIPS) scores.

METHODS

A multivariable analysis of a clinical trial (the Walking Preg_Project (WPP), ClinicalTrials.gov NCT03735381) was conducted. The cohort data concerning GWG across gestational trimesters (T1, T2 and T3) was categorized into adequate, excessive, and reduced based on published criteria. DLIPS was measured using the pregnancy symptoms inventory (PSI) a validated tool, across the gestational trimesters. Univariable and multivariable analyses were employed to assess the association between the GWG categories and DLIPS scores in each trimester of pregnancy estimating the β-coefficients and 95% confidence intervals (CI).

RESULTS

There were 221 participants in the cohort. DLIPS mean score in the overall sample and within adequate, excessive, and reduced GWG categories significantly increased across pregnancy (p < 0.005). DLIPS mean score was higher in the excessive GWG category compared to adequate and reduced GWG, in T1 and T2 (p = 0.035; p = 0.031, respectively). An excessive GWG at T1 [β-coefficient (95 % CI) = 3.88, (0.84, 6.93)] and T2 [β-coefficient (95 % CI) = 4.47 (1.24; 7.70)] was associated with higher DLIPS score compared to an adequate GWG.

CONCLUSION

The impact of pregnancy symptoms on daily life increased throughout pregnancy, overall. Excessive GWG was associated with daily life impact of pregnancy symptoms, particularly in the first and second trimester.

Health-Related Quality of Life Among Chinese Pregnant Women in the Third Trimester Based on Theory of Unpleasant Symptoms: A Complex Network Analysis

Health-related quality of life (HRQOL) is the result of complex interactions between many different factors. But few studies to date have explored the structure of HRQOL. This study aimed to investigate the complex inter-relationship between HRQOL and influencing factors using network analysis. In all, 624 Chinese pregnant women in third trimester were recruited through recruiting sampling. We used regularized network analysis to create a complex network. The relationship with mother-in-law was the most central node followed by relationship with partner. We found the comorbidity of anxiety and depressive symptoms using network analysis. Physical- and mental-related quality of life were a "bridge node" connecting psychological factors with physiologic factors. The present network analysis highlights the strong link between relationship with mother-in-law or partner and HRQOL, which is also a unique phenomenon under Chinese culture. This analysis provides key variables for future intervention or improvement of pregnant women' HRQOL.

Meeting physical activity guidelines and its association with health-related quality of life throughout pregnancy: the PregnActive project

Pregnancy is a unique period in women life, characterized by anatomical and metabolic variation that may affect health-related quality of life (HRQoL). Physical activity has the potential to positively influence HRQoL. The aim of this study is to analyze the association between the fulfillment of physical activity guidelines and HRQoL throughout pregnancy. Seventy-eight pregnant women were assessed at two time point through their pregnancy: at mid- and at later-pregnancy. Physical activity was objectively assessed by a multi-sensor monitor and pregnant women were categorized by the fulfillment of the minimum physical activity recommendations: at least 30 minutes/day on at least 5 days/week. Perceived mental health was evaluated by health-related quality of life and by psychological pregnancy symptoms, using the SF-36 and the Pregnancy Symptoms Inventory, respectively. T-Student Test and hierarchical multiple linear regressions analysis was developed. Pregnant women who fulfilled physical activity recommendations reported better mental HRQoL both at mid-pregnancy (p = 0.148) and later-pregnancy (p = 0.007). The number of days meeting minimum physical activity recommendations contributes to better mental HRQoL and together with depression and anxiety symptoms the model explain the 65% of the mental HRQoL at later pregnancy. Meeting the minimum physical activity recommendations is associated with better perceived health at both midpregnancy and later pregnancy. While mental HRQoL is explained by physical activity, physical HRQoL is explained by others factors such as age or pregnancy-related symptoms, but not by meeting the minimum physical activity recommendations.

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).

Assessment of physical fitness during pregnancy: validity and reliability of fitness tests, and relationship with maternal and neonatal health - a systematic review

Objectives

To systematically review studies evaluating one or more components of physical fitness (PF) in pregnant women, to answer two research questions: (1) What tests have been employed to assess PF in pregnant women? and (2) What is the validity and reliability of these tests and their relationship with maternal and neonatal health?

Design

A systematic review.

Data sources

PubMed and Web of Science.

Eligibility criteria

Original English or Spanish full-text articles in a group of healthy pregnant women which at least one component of PF was assessed (field based or laboratory tests).

Results

A total of 149 articles containing a sum of 191 fitness tests were included. Among the 191 fitness tests, 99 (ie, 52%) assessed cardiorespiratory fitness through 75 different protocols, 28 (15%) assessed muscular fitness through 16 different protocols, 14 (7%) assessed flexibility through 13 different protocols, 45 (24%) assessed balance through 40 different protocols, 2 assessed speed with the same protocol and 3 were multidimensional tests using one protocol. A total of 19 articles with 23 tests (13%) assessed either validity (n=4), reliability (n=6) or the relationship of PF with maternal and neonatal health (n=16).

Conclusion

Physical fitness has been assessed through a wide variety of protocols, mostly lacking validity and reliability data, and no consensus exists on the most suitable fitness tests to be performed during pregnancy.

PROSPERO registration number

CRD42018117554.

The Quality of Life among Women with Pre-eclampsia: A Pilot Descriptive Study

Introduction: Preeclampsia is a severe life event that has the potential to alter a woman's quality of life. This study sought to determine the quality of life among women with preeclampsia. Method: This study uses a descriptive study. Using total sampling methods, participants diagnosed and hospitalized with preeclampsia were invited to complete a survey about their demographics and the Quality of Life Instrument for Chronic Disease - Hypertension (QLICD-HY) Questionnaire. Results: 35 eligible participants with mean age of 33.2±5.83 were included in the present study. In Indonesia, most women with pre-eclampsia have a high quality of life. The sub-analysis found that many women with pre-eclampsia have a high quality of life in all domains (physical, psychological, and social). Age, education, occupation, family income, pregnancy stage, gravida, and medication adherence had a significant relationship with quality of life (p< 0.05). Conclusion: Women with preeclampsia generally describe a high quality of life. Nonetheless, there is still improvement to be made in preventing and treating preeclampsia patients to optimize quality of life. Keyword: Preeclampsia; pregnancy; quality of life  

Impact of Systematic Holistic Nursing Combined with Narrative Nursing Intervention for Patients with Advanced Gastric Cancer on Complications and Negative Emotions

Objective

The aim of this study is to evaluate the influence of systemic holistic nursing combined with narrative nursing on the postoperative complications and negative emotions in patients with advanced gastric cancer.

Methods

A total of 120 patients with advanced gastric cancer admitted to our hospital between February 2020 and February 2021 were recruited and assigned to receive systemic holistic nursing combined with narrative nursing (experimental group) or systemic holistic nursing (control group) according to order of admission, with 60 cases in each group. The outcome measures included the incidence of postoperative complications, negative emotion score, quality of life score, self-efficacy score, self-care ability score, and nursing satisfaction.

Results

The experimental group had a significantly lower incidence of complications and lower negative emotion scores than the control group (P < 0.001). Systemic holistic nursing plus narrative nursing resulted in significantly higher life scores, self-efficacy scores, and self-care ability scores in the experimental group after nursing than in the control group (P < 0.001). Patients of the experimental groups were more satisfied with the nursing in contrast to those in the control group (P < 0.001).

Conclusion

Systematic holistic nursing plus narrative nursing alleviates the negative emotions of patients, improves their self-efficacy scores, lowers the incidence of complications, and enhances quality of life.

Health-Related Quality of Life of HIV-Positive and HIV-Negative Pregnant Women in an Impoverished Area: Cross-sectional Study

Background

Liangshan prefecture of Sichuan province was an impoverished mountainous area in China, where the annual number of HIV-positive pregnant women accounted for approximately 10% of China’s total population in the decades before 2020. In general, pregnant women living here are likely to be physically and mentally different from those in other places.

Objective

This study aims to explore the health-related quality of life (HRQoL) of pregnant women living with HIV in an impoverished area.

Methods

From December 2018 to January 2019, HIV-positive and HIV-negative parturients within 18 months after delivery were recruited in Liangshan Prefecture, Sichuan Province. Questionnaires were designed to collect their demographic data, while the EuroQol 5-Dimension, 3-Level questionnaire was used to measure their HRQoL when they were in the second trimester from 4 to 6 months of pregnancy, and their quantitative health scores were converted to corresponding healthy utility values by using the Chinese Utility Value Integral System (time trade-off coefficient).

Results

A total of 250 pregnant women (133 HIV-positive and 117 HIV-negative) were enrolled in the study. Among them, 55 (41.35%) and 75 (64.10%) of HIV-positive and HIV-negative pregnant women self-reported full health (healthy state 11111), respectively. The median health utility value of the 250 pregnant women was 0.961 (IQR –0.046 to 0.961), and those of the HIV-positive and HIV-negative pregnant women were 0.875 (0.424-0.961) and 0.961 (IQR –0.046 to 0.961), respectively. We observed a significant difference only in the dimension of anxiety or depression between the two groups (P=.002) and no significant difference in the distribution of health utility indices between the two groups in terms of maternal age, education level, occupation, annual household income, prenatal care visits, family size, and medical insurance category. Multivariate ordinal logistic regression analysis showed that age (odds ratio [OR] 0.62, P<.05) and prenatal care visit (OR 0.29, P<.01) were independent risk factors for health status.

Conclusions

Most pregnant women self-reported satisfactory HRQoL in this impoverished mountainous area. HIV-negative pregnant women had an edge over HIV-positive pregnant women, and there were significant differences in anxiety or depression dimensions between the two groups.

The associations of pregnancy-related symptoms with health-related quality of life at midpregnancy: the PregnActive project

AIM

To analyze the associations between the wide range of pregnancy-related symptoms and health-related quality of life.

MATERIAL AND METHODS

A cross-sectional study was developed among 155 healthy low-risk pregnant women, aged 18-45 years, participated in the study at midpregnancy. Health-related quality of life and pregnancy symptoms were assessed using the Medical Outcome Study 36-item short form questionnaire and the Pregnancy Symptoms Inventory, respectively. Simple correlations, hierarchical linear regressions and standard multiple regressions were performed.

RESULTS

Significant correlations, after adjusting for sociodemographic and anthropometric characteristics, were found between five pregnancy-related symptoms and physical component of health-related quality of life and between thirteen pregnancy-related symptoms and mental component. However, when all pregnancy symptoms were entered simultaneously into a multiple regression model, back pain and shortness of breath on the physical components, and feeling depressed and anxiety on the mental component were the main explanatory factors of health-related quality of life.

CONCLUSION

Among the wide range of pregnancy-related symptoms, back pain, hip or pelvic pain, shortness of breath, and feeling depressed and anxiety are the main symptoms affecting the physical and the mental components of health-related quality of life, respectively. An early detection of the pregnancy-related symptoms that may affect health-related quality of life enables early interventions aimed at ameliorating their negative impact on health-related quality of life and daily living activities at midpregnancy.

Quality of life and the related factors in early postnatal women in Malawi

OBJECTIVE

To explore the quality of life (QOL) and related factors in early postnatal women.

DESIGN

A descriptive, cross-sectional study.

SETTING

Liwonde, Malawi.

PARTICIPANTS

Women who underwent a normal vaginal birth (N = 173) were included from August to September 2018.

MEASUREMENTS

The QOL of participants was assessed using a World Health Organization QOL instrument. Demographic, obstetric, and health variables were collected using a structured questionnaire. Childbirth fear and depression were respectively assessed using the Wijma Delivery Experience Questionnaire and the Edinburgh Postnatal Depression Scale. A multiple linear regression was used to examine factors associated with the QOL.

RESULTS

The mean age of participants was 29 (standard deviation 6.7) years. The overall QOL and health were satisfactory. The mean score of the QOL was highest in the psychological health and social relationships domains, followed by the environmental and physical health domains. A higher educational level was negatively related to the physical health of QOL (p ≤ 0.01), with physician care positively related (p = 0.01). The employment status was positively related to psychological health and the environmental QOL (p ≤ 0.01). Furthermore, a higher income, and physician care were positively related to the environmental QOL (p ≤ 0.05). High levels of childbirth fear and depressive symptoms were negatively related to all domains of the QOL (p ≤ 0.05), except for the social relationships domain.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

The physical health QOL was lower in postnatal mothers in Malawi. Measures to improve physical health aspects and address women's fears and depressive symptoms during postpartum care are warranted. The findings should alert the health providers of the importance of assessing and improving women's physical health and psychological well-being during postpartum care.

Measuring perinatal and postpartum quality of life of women and associated factors in semi-urban Bangladesh

PURPOSE

The objective of this study was to measure the health-related quality of life (HRQoL) among pregnant women in the perinatal and postpartum periods and determine influencing factors that predict their HRQoL.

METHODS

The study was conducted among pregnant women who live in a semi-urban area of Chandpur, Bangladesh. A total of 465 women were recruited. The EuroQoL 5-Dimension 3-Level (EQ-5D-3L) and EuroQoL visual analog scale (EQ-VAS) instruments were used to measure the HRQoL of participants. Two-sample mean test (t test) was performed to examine the changes in HRQoL between the perinatal and postnatal periods of the same individuals. Multivariate linear regression was employed to identify the factors influencing HRQoL during the two periods.

RESULTS

Overall, the HRQoL scores improved significantly from the perinatal (0.49) to postpartum (0.86) period. Approximately 58% of women experienced moderate or extreme levels of health problems during the perinatal period regardless of their health status. However, most women had significantly improved health status in the postpartum period. Gestational weight gain and recommended postnatal care were significantly associated with improved HRQoL. Factors that negatively influenced changes in HRQoL included adolescent motherhood, caesarean delivery, inadequate antenatal care consultations and living in a poor household, during both the perinatal and postpartum periods.

CONCLUSIONS

Overall health status is found to be poor among women during the perinatal period compared with the postpartum period. The study indicates that interventions to address the influencing factors are needed to ensure better quality of life for women both pre- and post-birth. Community-based initiatives, such as awareness building, might address negative factors and subsequently improve health status and reduce adverse health outcomes related to pregnancy and postnatal care.

Associations of 24-hours activity composition with adiposity and cardiorespiratory fitness: The PregnActive project

AIM

This study examined the associations of activity behaviors composition (sleep, sedentary time, light and moderate-to-vigorous physical activity) with adiposity and cardiorespiratory fitness, and how isotemporal reallocations of time between activity behaviors are associated with differences in adiposity and cardiorespiratory fitness.

METHODS

A cross-sectional study was conducted in 130 women during midpregnancy. Activity behaviors, conceptualized as a 24-hours composition, were objectively assessed by multi-sensor monitors. Skinfold thickness, fat mass index, and body mass index were calculated as indicators of adiposity. Cardiorespiratory fitness was assessed using a 6-minute walk test. Log-ratio multiple linear regression models and compositional isotemporal substitutions were used to analyze the associations and estimated differences in outcomes.

RESULTS

The activity composition was significantly associated with adiposity indicators (all P < .001) and cardiorespiratory fitness (P values from .025 to <.001) during midpregnancy. The isotemporal substitutions were asymmetrical, showing the highest estimated differences in adiposity (8.7%, 0.80 kg/m² , for fat mass index; 6.0%, 2.65 mm, for the sum of skinfold thickness; and 3.8%, 1.02 kg/m² , for body mass index) and cardiorespiratory fitness (3.0%, 1.00 mL/kg min) when 30 minutes of moderate-to-vigorous physical activity was reallocated by sedentary time.

CONCLUSION

The activity composition was associated with adiposity and the cardiorespiratory fitness levels during midpregnancy, with moderate-to-vigorous physical activity being the leading activity behavior. The most unfavorable differences in adiposity and cardiorespiratory fitness were found when moderate-to-vigorous physical activity was replaced by another behavior, mainly sedentary time, reinforcing the importance of at least maintaining moderate-to-vigorous physical activity during pregnancy.

Women's Quality of Life at 6 Weeks Postpartum: Influence of the Discomfort Present in the Puerperium

Background: Discomfort during the puerperium period is very frequent in the lives of women but the influence of this discomfort on the women’s quality of life has been little studied. The objective of this study is to establish the association between discomfort and frequent problems of women in the puerperium and their quality of life score. Methods: A cross-sectional study on postpartum Spanish women was performed. Women older than 18 years and who had had a live birth were included. Less than 1% of women refused to participate in the study. Data were collected on socio-demographic, obstetric and newborn variables, on maternal problems/ discomfort in the postnatal period and on parameters that are quality of life indicators. An ad hoc online questionnaire which included the SF-36 Health Survey was used. Crude mean difference (cMD) and adjusted mean difference (aMD) were calculated through multiple linear regression. Results: 2990 women participated in the study. The greater problems causing quality of life loss were depressive symptoms (aMD = −12.40, CI 95%: −10.79, −14.01), lactation problems (aMD = −4.30, CI 95%: −2.97, −5.63), problems for sexual intercourse after childbirth (aMD = −6.34, CI 95%: −5.07, −7.60) and urinary incontinence (aMD = −4.97, CI 95%: −6.30, −3.65), among others. These have been detected as risk factors that affect the quality of life of the postpartum woman. Conclusions: The discomfort and problems manifested in the 6 weeks after childbirth have an influence that deeply affects the quality of life of postpartum women.