Trajectory and Determinants of Quality of Life Among Postpartum Women

BACKGROUND

The postpartum period is a critical phase in which postpartum women experience dynamic changes in their physiology, psychology, and family status.

OBJECTIVE

This study investigated the changes in women's quality of life (QoL) during the first, third, and sixth months of the postpartum period and their associated factors.

METHODS

A single-group repeated-measure design was used to collect data from 282 postpartum women recruited from a regional hospital in Taiwan. We used the brief World Health Organization Quality of Life scale, Social Support Scale, and Edinburgh Postnatal Depression Scale to assess postpartum women's quality of life, social support, and postpartum depressive symptoms, respectively. The data were analyzed using trajectory analysis and generalized estimating equations.

RESULTS

The trajectory analysis indicated that postpartum women could be categorized into low, medium, and high QoL groups. Although the medium and high QoL groups maintained stable QoL levels, the low QoL group experienced a linear decrease in QoL over time. Moreover, the determinants of postpartum women's QoL were immigrant status, employment status, family type, social support, and postpartum depression.

CONCLUSIONS

Health care providers should assess these determinants of postpartum QoL in perinatal women to identify those at risk of low postpartum quality of life. Early assessment and intervention by health care providers could significantly improve the health status of women after childbirth.

The effect of perceived social support on postpartum stress: the mediating roles of marital satisfaction and maternal postnatal attachment

BACKGROUND

Multiple factors may be responsible for the development of postpartum stress, including perceived social support, marital satisfaction, and maternal postnatal attachment. However, the underlying mediation mechanisms remain unclear. This study examined the complex relationships between perceived social support and postpartum stress among Chinese women.

METHODS

A convenience sample comprising 406 postpartum women was recruited from six hospitals in Nantong, Jiangsu Province, China. The participants completed general survey questionnaires and were evaluated using the Maternal Postpartum Stress Scale, the Perceived Social Support Scale, the Maternal Postnatal Attachment Scale, and the Marital Satisfaction Scale. Furthermore, we evaluated the relationship between postpartum stress and the various influencing factors by performing a multiple linear regression analysis. The potential mediating roles of marital satisfaction and maternal and infant attachment in the association between perceived social support and postpartum stress were explored by performing a mediation analysis.

RESULTS

According to the multivariate regression analysis, perceived social support, marital satisfaction, and maternal postnatal attachment contributed to postpartum stress levels (P < 0.05). The mediation analysis revealed that marital satisfaction and maternal postnatal attachment played parallel mediating roles in the association between perceived social support and postpartum stress, and the mediating effect of marital satisfaction was - 0.1125 (95% confidence interval [CI]: -0.1784 to -0.0520), accounting for 33.20% of the total effect, and the mediating effect of maternal postnatal attachment was - 0.0847 (95% CI: -0.1304 to -0.0438), accounting for 25.00% of the total effect.

CONCLUSION

Our study revealed that perceived social support could influence postpartum stress not only through direct effect (41.80% of the total effect), but also through the indirect effect (mediation effect) of marital satisfaction and maternal postnatal attachment (58.20% of the total effect), suggesting that improving postpartum women's social support, enhancing maternal and infant attachment, and improving their marital satisfaction could help lower postpartum stress.

The global burden of perinatal common mental health disorders and substance use among migrant women: a systematic review and meta-analysis

BACKGROUND

There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants.

METHODS

In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291.

FINDINGS

18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I² 98·8%; τ² 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I² 96·8%; τ² 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I² 97·4%; τ² 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I² 96·6%; τ² 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner.

INTERPRETATION

One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants.

FUNDING

UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.

Measurement instruments for parental stress in the postpartum period: A scoping review

Background

Parenting stress is a particular type of stress that is conceptualized as a negative psychological response to the numerous obligations associated with raising children. Despite a considerable increase in research on parenting stress, little attention has been given to the ways parenting stress are measured.

Objectives

This scoping review aimed to provide an overview of available instruments measuring parental stress and to describe their psychometric properties.

Methods

We conducted a scoping review in accordance with international guidelines for scoping reviews. The main search strategy was searches in seven electronic databases. Pairs of reviewers selected relevant studies based on predetermined inclusion and exclusion criteria. Studies had to report one or more psychometric properties of an instrument measuring stress in parents with children 0–12 months. For each included study, we collected information relevant to the review question, guided by the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN). Finally, we collated, summarized, and reported the findings descriptively.

Results

From 2164 unique record, 64 studies from 24 countries were included. They described 15 instruments, of which four were generic and eleven parental-specific self-administered instruments. Only two studies examined parental stress among fathers. Eleven of the studies were validation studies, but they only described seven of the 15 instruments. Internal consistency was the only information provided by 73.4% of the included studies. None of the instruments had information on all measurement properties as per the COSMIN criteria, and there was no information about measurement error, responsiveness, or interpretability for any of the 15 instruments.

Discussion

There are presently 15 instruments with some associated psychometric information being used to measure parental stress among parents with young children, but the amount of information on the instruments’ psychometric properties is slight. There is a need for further research.

Women's trajectories of postpartum depression and social support: A repeated-measures study with implications for evidence-based practice

BACKGROUND

Postpartum depression is one of the most common psychological disorders of women after childbirth. Despite the importance of social support as an influencing factor, there have been few studies on the trends and characteristics of social support as it relates to postpartum depression.

AIMS

To explore the trends in postpartum depression and social support, to cross-analyze the correlation between the postpartum depression trajectory and the social support trajectory, and to investigate predictors of changes in postpartum depression trajectories.

METHODS

A prospective repeated-measure study and convenience sampling were used to recruit 230 women at 1, 3, and 6 months after childbirth. Structured questionnaires were used for data collection. Trajectory analysis was used to explore the trajectories of postpartum depression and social support during the 6 months after childbirth, and polynomial logistic regression was used to explore predictors of the trajectory of postpartum depression.

RESULTS

Postpartum depression was at its most serious in the third month after childbirth, showing patterns of low-risk, moderate-risk, and high-risk trajectories. Social support also showed low, moderate, and high patterns, and the trajectory of postpartum depression was significantly related to the trajectory of social support. The predictors of moderate-risk and high-risk postpartum depression were also found in this study.

LINKING EVIDENCE TO ACTION

Postpartum mental health education and online learning systems should be used to increase social support for women after childbirth and reduce the incidence of postpartum depression.

The impact of prenatal depression and diabetes management self-efficacy on postpartum stress and depression in women with gestational diabetes mellitus

AIMS

The study aimed to examine the impact of prenatal depression and diabetes management self-efficacy on postpartum stress and postpartum depression in women with gestational diabetes mellitus.

BACKGROUND

Poor perinatal mental health is linked to various adverse pregnancy outcomes in women with gestational diabetes mellitus.

DESIGNS

A predictive study design and the guidelines for the STROBE checklist were used for the study.

METHODS

A total of 119 pregnant women with a positive 75 g-glucose challenge test were recruited at a medical centre. The Taiwanese depression questionnaire (TDQ), the diabetes management self-efficacy scale (DMSES) and the Hung postpartum stress scale (Hung PSS) were used for data collection at the 24th week of pregnancy and the first week after childbirth.

RESULTS

Diabetes management self-efficacy was correlated with postpartum stress in women with gestational diabetes mellitus. Moreover, prenatal depression was a predictor of postpartum stress and postpartum depression, respectively, in women with gestational diabetes mellitus.

CONCLUSIONS

Healthcare providers should assess those women's diabetes management self-efficacy and mood status during prenatal visits and offer the needed intervention to reduce the levels of postpartum stress and postpartum depression of those women after childbirth.

RELEVANCE TO CLINICAL PRACTICE

A holistic care approach integrated diabetic care and mental health for women with gestational diabetes mellitus in a timely manner is warranted to promote perinatal mental health in women with gestational diabetes mellitus.

Labor Analgesia reduces the risk of postpartum depression: A cohort study

Background

Postpartum depression (PPD) is a frequent mental disorder after delivery. In China, most parturients give birth with the assistance of labor analgesia (LA) or by cesarean section (CS); however, it is still unclear whether these two approaches reveal different effects on PPD.

Methods

One hundred and ninety-eight patients with single pregnancy at full term were allocated to receive either group LA or group CS. Maternal and neonatal variables in the perinatal period were recorded. Multivariate logistical regression analysis was conducted to evaluate the associated factors of PPD.

Results

The incidence of PPD in group LA was lower than in group CS. Besides, eight factors were found to be potential predictors of PPD. Multivariate logistic model showed that LA was a protective factor against PPD. However, high family income and Edinburgh postnatal depression scale (EPDS) scores at 3 days postpartum were associated with an increased risk of PPD.

Conclusion

LA could reduce the incidence of PPD in women with single pregnancy at full term. Family income and EPDS scores in the early postpartum period were also related with PPD. Large sample size studies are needed to verify the impact of LA on the psychological states of postpartum women.

A systematic review of prevalence and risk factors of postpartum depression in Chinese immigrant women

BACKGROUND

As the number of immigrants grows, the health of Chinese immigrant women, especially their perinatal health, has gradually attracted public attention. Our review has two main purposes. First, estimate the prevalence of postpartum depressive symptoms in Chinese immigrant women, and then determine risk factors for postpartum depressive symptoms among these women.

METHODS

The following databases: MEDLINE, Embase, Scopus, Web of Science, PsycINFO and PubMed were used in literature search from their commencements until November 21st 2017. The Joanna Briggs Institute (JBI) Critical Appraisal instruments were used to evaluate the quality of the article. Four studies met the inclusion criteria, contributed to our review and meta-analysis.

RESULT

The prevalence of postpartum depression is high in Chinese immigrant women. Risk factors for postpartum depression in Chinese immigrant women were defined as lack of social support, unstable economic status, and acculturation.

CONCLUSION

There have been few studies on postpartum depression among Chinese immigrant women. Existing studies have shown a high prevalence of postpartum depression in Chinese immigrant women. Moreover, there is an urgent need for studies on postpartum depression among Chinese immigrant women informing better understanding, programs of care and improving the perinatal health status of Chinese immigrant women.

Vietnamese Immigrant Women&apos;s Experience of Maternity after Childbirth

PURPOSE

To understand the meaning and essence of Vietnamese migrant women's maternal experience after childbirth.

METHODS

A phenomenological methodology was used for this study. Study participants were six Vietnamese marriage migrant women who had experience of childbirth in Korea. Data collection period was from February 1 through November 4, 2016. Data were collected through in-depth interview and analyzed with the Giorgi method.

RESULTS

As a result of study, six main meanings and 12 themes were produced. The six main meanings produced in this study were 'childbirth realized in the double difficulty', 'concerned health between the ở cữ and the sanhujori', 'tired body with hard parenting', 'crowding regret for international marriage after childbirth', 'Grateful partner becoming the prop', and 'Growing maternal instinct by moving the mind and body in a foreign country'.

CONCLUSION

Consideration for postnatal care is necessary from Vietnamese marriage migrant women's viewpoint. Systematic education programs that can improve nursing capability of medical personnel for multicultured clinical practice with development of a postnatal care program suited to multiculture are also necessary.

Effectiveness of Psychosocial and Educational Prenatal and Postnatal Care Interventions for Married Immigrant Women in Korea: Systematic Review and Meta-analysis

The rapid influx of married immigrant women from low-income Asian countries is a concern in South Korea, Japan, and Taiwan. In South Korea, 1 in 10 couples includes a Korean man and a migrant woman, increasing the need for prenatal and postnatal care interventions. Studies published in English or Korean after 2000 were retrieved from 8 databases and reviewed via a systematic review and meta-analysis of the effectiveness of prenatal and postnatal psychosocial and educational interventions in Korea. Of 3583 records, 10 studies (1 randomized controlled trial [RCT] and 9 non-RCTs) involving 408 married immigrant women fulfilled the inclusion criteria. A meta-analysis of the non-RCTs showed that prenatal and postnatal care interventions were effective in improving family support, knowledge regarding self-care management and infant rearing, and self-efficacy regarding self-care management and infant rearing. Subgroup analysis showed that interventions involving husbands and individualized care were most effective. This study illustrated the extent to which strategies are needed for developing prenatal and postnatal care interventions for married immigrant women. Further studies should explore other factors and identify the most important factor for improving the effectiveness of such interventions. Robust study designs published in peer-reviewed journals are required for examining the effectiveness of these interventions.