Parents' depression and loneliness during pregnancy and respiratory infections in the offspring: A prospective birth cohort study

Loneliness in Pregnancy and Parenthood: Impacts, Outcomes, and Costs

Background: Becoming a parent has been highlighted as a period associated with increased risks for loneliness, with around one-third of parents reporting feeling lonely often or always. However, as most understanding of loneliness is based on elderly or student cohorts, further insights into the costs of parental loneliness is needed. Method: We conducted a literature review of impacts of loneliness in pregnancy and parenthood and present a synthesis of the health, social, societal, and economic costs. We draw on evidence about impacts and costs of loneliness in other cohorts to help provide a wider context to understand the impacts and costs and how parental loneliness differs from other populations. Results: Similar to literature with elderly cohorts, parental loneliness has impacts on health and wellbeing, such as depression in new parents and increased general practitioner (GP) visits in pregnancy. But also has intergenerational impacts via its association with poor mental health and social competence and increased respiratory tract infections in the child. Physical health impacts widely associated with loneliness in other cohorts have yet to be examined in parents. Loneliness in parents is likely to result in social withdrawal further isolating parents and wider societal and economic costs relating to absence from employment and informal caring roles. Conclusion: Parental loneliness has the potential for negative and pervasive impacts. As parental loneliness has wide ranging and intergenerational impacts it is important that a multi-sectoral perspective is used when examining its costs.

Maternal Social Loneliness Detection Using Passive Sensing Through Continuous Monitoring in Everyday Settings: Longitudinal Study

BACKGROUND

Maternal loneliness is associated with adverse physical and mental health outcomes for both the mother and her child. Detecting maternal loneliness noninvasively through wearable devices and passive sensing provides opportunities to prevent or reduce the impact of loneliness on the health and well-being of the mother and her child.

OBJECTIVE

The aim of this study is to use objective health data collected passively by a wearable device to predict maternal (social) loneliness during pregnancy and the postpartum period and identify the important objective physiological parameters in loneliness detection.

METHODS

We conducted a longitudinal study using smartwatches to continuously collect physiological data from 31 women during pregnancy and the postpartum period. The participants completed the University of California, Los Angeles (UCLA) loneliness questionnaire in gestational week 36 and again at 12 weeks post partum. Responses to this questionnaire and background information of the participants were collected through our customized cross-platform mobile app. We leveraged participants' smartwatch data from the 7 days before and the day of their completion of the UCLA questionnaire for loneliness prediction. We categorized the loneliness scores from the UCLA questionnaire as loneliness (scores≥12) and nonloneliness (scores<12). We developed decision tree and gradient-boosting models to predict loneliness. We evaluated the models by using leave-one-participant-out cross-validation. Moreover, we discussed the importance of extracted health parameters in our models for loneliness prediction.

RESULTS

The gradient boosting and decision tree models predicted maternal social loneliness with weighted F1-scores of 0.897 and 0.872, respectively. Our results also show that loneliness is highly associated with activity intensity and activity distribution during the day. In addition, resting heart rate (HR) and resting HR variability (HRV) were correlated with loneliness.

CONCLUSIONS

Our results show the potential benefit and feasibility of using passive sensing with a smartwatch to predict maternal loneliness. Our developed machine learning models achieved a high F1-score for loneliness prediction. We also show that intensity of activity, activity pattern, and resting HR and HRV are good predictors of loneliness. These results indicate the intervention opportunities made available by wearable devices and predictive models to improve maternal well-being through early detection of loneliness.

Association Between Maternal Health Status and Family Resilience: Results from a National Survey

OBJECTIVE

The relationship between maternal health and health outcome of offspring has been studied extensively. However, measures such as family resilience in the context of maternal health are not well understood. The objective of this study was to determine if overall maternal health status is associated with family resilience.

METHODS

Using the 2016 National Survey of Children's Health, a nationally representative survey of parents/guardians of children ages 0-17, we evaluated the association of overall maternal health status with measures of family resilience. The analysis was performed using descriptive and multivariable analyses. The study adjusted for current health insurance status, family structure of child's household, income level, highest education of adult in household, child race, primary household language, children with special health care needs, emotional support, neighborhood support, parental aggravation, and adverse childhood experiences.

RESULTS

Compared to mothers who reported their physical health to be good, mothers who had a very good/excellent physical health status reported significantly higher adjusted rates for family resilience measures [Adjusted Odds Ratio (AOR) 0.741, 95% Confidence Interval (CI) (0.640, 0.859); p < 0.001]. Results suggested also that mothers whose mental health was very good/excellent were more likely to exhibit greater family resilience as compared to those that were good [(AOR) 0.452, 95% (CI) (0.390, 0.525); p < 0.001] or poor/fair [(AOR) 0.283, 95% (CI) (0.223, 0.360); p < 0.001].

CONCLUSION

Our findings suggest that maternal mental and physical health may contribute to how families respond to adversity. Our findings highlight the importance of evaluating interventions that target both physical and mental aspects of maternal health status to better the resilience of the family unit. In the healthcare setting, maternal health services should ensure early detection and prevention of chronic conditions beyond obstetric care and detection and treatment of mental health.

Loneliness in pregnant and postpartum people and parents of children aged 5 years or younger: a scoping review

BACKGROUND

Despite evidence that loneliness increases during times of transition, and that the incidence of loneliness is highest in young adults, loneliness during pregnancy and new parenthood has not been developed as a program of research. Because loneliness research has primarily focused on older adults and other high-risk populations, the concept of loneliness and its effects on this population are not well understood, leaving a gap in our understanding of the psychosocial needs and health risks of loneliness on pregnant people and new parents. A scoping review has been completed in order to map and synthesize the literature on loneliness experienced during pregnancy and the first 5 years of parenthood prior to the COVID-19 pandemic.

METHODS

To address the aim of this review, a wide net was cast in order to detect experiences of perinatal or parental loneliness and/or instances where loneliness was measured in this population. Among the inclusion criteria were loneliness in people who were pregnant, who were parents in the postpartum period, or who had children aged 5 years or younger. A search for literature was conducted in December 2020 using nine databases: MEDLINE (Ovid), EMBASE (Elsevier), SCOPUS (Elsevier), Cochrane Library including CENTRAL (Wiley), CINAHL (Ebscohost), PsycINFO (Ebscohost), Dissertations & Theses Global (ProQuest) and Sociological Abstracts (ProQuest), and the Web of Science Core Collection (Clarivate).

RESULTS

Perinatal and parental loneliness studies are limited and have rarely been targeted and developed through a program of research. Loneliness inquiry in this population was frequently studied in relation to other concepts of interest (e.g., postpartum depression). Alternatively, the importance of loneliness emerged from study participants as relevant to the research topic during qualitative inquiry. Across studies, the prevalence of loneliness ranged from 32 to 100%. Loneliness was commonly experienced alongside parenting difficulties, with parents feeling as though they were alone in their struggles.

CONCLUSIONS

As loneliness has been called a sensitive indicator of mental wellbeing, we believe screening will help healthcare professionals identify common difficulties and early signs of depression experienced during pregnancy and parenthood.

SYSTEMATIC REVIEW REGISTRATION

The protocol is available on Open Science Framework at DOI 10.17605/OSF.IO/BFVPZ.

The effect of loneliness and social support on the course of major depressive disorder among adults aged 50 years and older: A longitudinal study

BACKGROUND

Previous research indicates that social support, loneliness, and major depressive disorder (MDD) are interrelated. Little is known about the potential pathways among these factors, in particular in the case of adults aged 50 years and older and suffering from MDD. The objective was to investigate whether loneliness mediates the association between low social support and recurrent episodes of MDD.

METHODS

We used data from a cohort of the Spanish general population interviewed at three time-points over a 7-year period. We included 404 individuals aged 50+ suffering from MDD in the baseline assessment. A 12-month major depressive episode was assessed with the Composite International Diagnostic Interview (CIDI) at each interview. The University of California, Los Angeles Loneliness Scale was used to measure loneliness, whereas social support was assessed through the Oslo Social Support Scale. We tested cross-lagged and autoregressive longitudinal associations using structural equation modeling.

RESULTS

We identified two significant longitudinal mediation patterns: lower social support predicted higher subsequent levels of loneliness (Coef. = -0.16; p < .05), which in turn predicted an increase in MDD recurrence (Coef. = 0.05; p < .05).

CONCLUSIONS

Interventions focused on promoting social support among older adults suffering from MDD may decrease feelings of loneliness and prevent recurrent episodes of MDD.

Psychosocial health in pregnancy and postpartum among women living with - and without HIV and non-pregnant women living with HIV living in the Nordic countries - Results from a longitudinal survey study

BACKGROUND

The success of antiretroviral therapy has normalized pregnancy among women living with HIV (WWH) with a very low risk of perinatal transmission of HIV. Despite these advances, WWH still face complex medical and psychosocial issues during pregnancy and postpartum. The aim of this study was to assess differences in psychosocial health outcomes between pregnant WWH, non-pregnant WWH, and pregnant women without HIV, and further identify factors associated with probable depression in the third trimester and postpartum.

METHODS

In a longitudinal survey study, participants were included from sites in Denmark, Finland, and Sweden during 2019-2020. Data was collected in the 3rd trimester, 3 and 6 months postpartum using standardized questionnaires assessing depression, perceived stress, loneliness, and social support. Mixed regression models were used to assess changes over time within and between groups. Logistic regression models were used to identify factors associated with depression in pregnancy and postpartum.

RESULTS

A total of 47 pregnant WWH, 75 non-pregnant WWH, and 147 pregnant women without HIV were included. The prevalence of depression was high among both pregnant and non-pregnant WWH. There was no significant difference between pregnant and non-pregnant WWH in depression scores, perceived stress scores, or social support scores at any time point. Compared to pregnant women without HIV, pregnant WWH reported worse outcomes on all psychosocial scales. Social support and loneliness were associated with an increased odds of depressive symptoms in the adjusted analysis.

CONCLUSIONS

A high burden of adverse psychosocial outcomes was observed in both pregnant and non-pregnant women living with HIV compared to pregnant women without HIV. Loneliness and inadequate social support were associated with increased odds of depression in pregnancy and should be a focus in future support interventions.

Parental mental health, socioeconomic position and the risk of asthma in children-a nationwide Danish register study

Background

Parental mental illness affects child health. However, less is known about the impact of different severities of maternal depression and anxiety as well as other mental health conditions. The objective of this study was to examine the impact of different severities of maternal and paternal mental health conditions on child asthma.

Methods

This nationwide, register-based cohort study included all children in Denmark born from 2000 to 2014. Exposure was parental mental health conditions categorized in three severities: minor (treated at primary care settings), moderate (all ICD-10 F-diagnoses given at psychiatric hospital) and severe (diagnoses of severe mental illness). The children were followed from their third to sixth birthday. Child asthma was identified by prescribed medication and hospital-based diagnoses. Incidence rate ratios were calculated using negative binomial regression analyses.

Results

The analyses included 925 288 children; 26% of the mothers and 16% of the fathers were classified with a mental health condition. Exposed children were more likely to have asthma (10.6–12.0%) compared with unexposed children (8.5–9.0%). The three severities of mental health conditions of the mother and the father increased the risk of child asthma, most evident for maternal exposure. Additive interaction between maternal mental health conditions and disadvantaged socioeconomic position was found.

Conclusion

We found an increased risk of asthma in exposed children, highest for maternal exposure. Not only moderate and severe, but also minor mental health conditions increased the risk of child asthma. The combination of mental health condition and disadvantaged socioeconomic position for mothers revealed a relative excess risk.

Association between depression and antibiotic use: analysis of population-based National Health Insurance claims data

BACKGROUND

Frequent exposure to antibiotic treatments may increase the risk of antibiotic resistance, which may threaten the effectiveness of future antibiotic treatments. Thus, it is important to identify the preventable risks in terms of antibiotic use. This study assessed the association between major depressive disorder (MDD) and antibiotic use by comparing the likelihood and extent of antibiotic use between patients with and without MDD.

METHODS

This retrospective cross-sectional study utilized the National Patients Sample data from the 2017 Health Insurance Review and Assessment Service. We analyzed 16,950 patients with MDD, defined as those with at least two claims records stating a primary diagnosis of MDD (International Classification of Diseases, 10th revision codes F32-33) and 67,800 patients without MDD (1:4 propensity-score matched control group). Antibiotic use was compared between the patients with and without MDD based on three variables: the presence of antibiotic prescriptions, total prescription days of antibiotics per year, and total medication costs of antibiotics per year.

RESULTS

The adjusted odds ratio obtained by multivariate regression analysis for the presence of prescription of antibiotics was 1.31 (95% confidence interval [CI]: 1.25-1.36). In the negative binomial model, the number of prescription days was 1.25 times (95% CI: 1.23-1.28) higher in patients with MDD than in those without MDD. Generalized linear model analysis showed a 1.39-fold (95% CI: 1.36-1.43) higher cost of antibiotic prescription in patients with MDD than in those without MDD.

CONCLUSIONS

Our results suggest a potential association between MDD and the prescription of antibiotics, implying that patients with MDD are relatively vulnerable to infections. It is important to prevent as well as closely monitor the occurrence of infections when managing patients with MDD.

Social network size, loneliness, physical functioning and depressive symptoms among older adults: Examining reciprocal associations in four waves of the Longitudinal Aging Study Amsterdam (LASA)

INTRODUCTION

Previous research indicates that social isolation, loneliness, physical dysfunction and depressive symptoms are interrelated factors, little is known about the potential pathways among them. The aim of the study is to analyse simultaneously reciprocal relationships that could exist between the four factors to clarify potential mediation effects.

METHODS

Within a large representative sample of older people in the Longitudinal Aging Study Amsterdam (LASA), participants aged 75 and over were followed up over a period of 11 years (four waves). We tested cross-lagged and autoregressive longitudinal associations of social network size, loneliness, physical functioning and depressive symptoms using structural equation modelling (SEM).

RESULTS

Several statistically significant cross-lagged associations were found: decreasing physical functioning (Coef. = -0.03; p < 0.05), as well as social network size (Coef. = -0.02; p < 0.05), predicted higher levels of loneliness, which predicted an increase in depressive symptoms (Coef. = 0.17; p < 0.05) and further reduction of social network (Coef. = -0.20; p < 0.05). Decreasing physical functioning also predicted an increase in depressive symptoms (Coef. = -0.08; p < 0.05). All autoregressive associations were statistically significant.

CONCLUSION

Interventions focused on promoting social activities among older adults after negative life events, such as loss of social contacts or declining physical function, may alleviate feelings of loneliness and act as mental health protector.

Maternal Mental Disorders and Pediatric Infectious Diseases: A Retrospective Cohort Study

BACKGROUND

Maternal stress and depression are associated with infections in offspring, but there is a paucity of data for other mental disorders.

METHODS

We conducted a retrospective cohort study of 832,290 children born between 2006 and 2016 in hospitals of Quebec, Canada. We identified maternal mental disorders before and during pregnancy, and admissions for otitis media, pneumonia, infectious enteritis and other infections in children before 13 years of age. We used Cox proportional hazards regression to estimate hazard ratios (HRs) with 95% confidence intervals (CI) for the association between maternal mental disorders and the risk of pediatric infectious diseases, adjusted for maternal age, comorbidity, socioeconomic disadvantage, and other confounders.

RESULTS

The incidence of pediatric infection hospitalization was higher for maternal mental disorders compared with no disorder (66.1 vs. 41.1 cases per 1000 person-years). Maternal mental disorders were associated with 1.38 times the risk of otitis media (95% CI: 1.35-1.42), 1.89 times the risk of bronchitis (95% CI: 1.68-2.12), and 1.65 times the risk of infectious enteritis in offspring (95% CI: 1.57-1.74). Stress and anxiety disorders (HR 1.49, 95% CI: 1.46-1.53) and personality disorders (HR 1.55, 95% CI: 1.49-1.61) were more strongly associated with the risk of pediatric infection hospitalization than other maternal mental disorders. Associations were prominent in the first year of life and weakened with age.

CONCLUSIONS

Maternal mental disorders are risk factors for infectious disease hospitalization in offspring. Women with mental disorders may benefit from psychosocial support to reduce the risk of serious infections in their children.

Effect of perinatal depression on risk of adverse infant health outcomes in mother-infant dyads in Gondar town: a causal analysis

BACKGROUND

Approximately one-third of pregnant and postnatal women in Ethiopia experience depression posing a substantial health burden for these women and their families. Although associations between postnatal depression and worse infant health have been observed, there have been no studies to date assessing the causal effects of perinatal depression on infant health in Ethiopia. We applied longitudinal data and recently developed causal inference methods that reduce the risk of bias to estimate associations between perinatal depression and infant diarrhea, Acute Respiratory Infection (ARI), and malnutrition in Gondar Town, Ethiopia.

METHODS

A cohort of 866 mother-infant dyads were followed from infant birth for 6 months and the cumulative incidence of ARI, diarrhea, and malnutrition were assessed. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess the presence of maternal depression, the Integrated Management of Newborn and Childhood Illnesses (IMNCI) guidelines were used to identify infant ARI and diarrhea, and the mid upper arm circumference (MUAC) was used to identify infant malnutrition. The risk difference (RD) due to maternal depression for each outcome was estimated using targeted maximum likelihood estimation (TMLE), a doubly robust causal inference method used to reduce bias in observational studies.

RESULTS

The cumulative incidence of diarrhea, ARI and malnutrition during 6-month follow-up was 17.0% (95%CI: 14.5, 19.6), 21.6% (95%CI: 18.89, 24.49), and 14.4% (95%CI: 12.2, 16.9), respectively. There was no association between antenatal depression and ARI (RD = - 1.3%; 95%CI: - 21.0, 18.5), diarrhea (RD = 0.8%; 95%CI: - 9.2, 10.9), or malnutrition (RD = -7.3%; 95%CI: - 22.0, 21.8). Similarly, postnatal depression was not associated with diarrhea (RD = -2.4%; 95%CI: - 9.6, 4.9), ARI (RD = - 3.2%; 95%CI: - 12.4, 5.9), or malnutrition (RD = 0.9%; 95%CI: - 7.6, 9.5).

CONCLUSION

There was no evidence for an association between perinatal depression and the risk of infant diarrhea, ARI, and malnutrition amongst women in Gondar Town. Previous reports suggesting increased risks resulting from maternal depression may be due to unobserved confounding.

Associations Between Social Network Characteristics and Loneliness During Pregnancy in a Sample of Predominantly African American, Largely Publicly-Insured Women

OBJECTIVES

Most research evaluating relationships between social network attributes and loneliness have focused on older adult and adolescent networks. The present study examines the relationships between social network size (number of relationships), social network density (whether named relationships are connected to one another) and maternal loneliness during pregnancy.

METHODS

Eligible women were enrolled at the time of their dating ultrasound (between 8 and 12 weeks of gestation). Interested women provided written consent and completed demographic, social network and loneliness measures. Participants completed the same surveys in their third trimester. Mixed-regression models, adjusted for age, race, ethnicity, and insurance type, were used to assess the relationship between social network size, network density, and loneliness.

RESULTS

A total of 94 pregnant women (mean age = 23.77, 70.2% Black, 87.2% public insurance) completed baseline study measures, and 60 participants completed both assessment time points. Completers and non-completers did not differ on key characteristics. Social network density, but not social network size, predicted maternal loneliness ([Formula: see text]= - 1.27, 95% CI - 2.53, - 0.01, p = 0.0489) in the first and third trimester.

CONCLUSIONS

These findings indicate that pregnant women's social network density may be more intimately related to feelings of loneliness than the objective number of relationships. This knowledge can begin to inform the design of supportive approaches to improve women's health.

Loneliness in pregnant and postpartum people and parents of children aged 5 years or younger: a scoping review protocol

BACKGROUND

The experience of loneliness during pregnancy and in new parenthood has not been targeted and developed as a program of research, despite evidence indicating that the incidence of loneliness is highest in those aged 16 to 24 and that loneliness rises during transitional periods. The scarcity of parenthood-loneliness inquiries leaves a gap in our understanding of new parenthood and its effects on the health and well-being of parents and their children. Here, a scoping review protocol will be presented to address this gap. The objective of this study will be to summarize the current knowledge of loneliness experienced during pregnancy and by parents during the postpartum period through the first 5 years of the child's life.

METHODS

A scoping review protocol was designed following Arksey and O'Malley's framework. We will include all types of literature in English, including all study designs, reviews, opinion articles, dissertations, reports, books, and grey literature. To be considered for inclusion, sources should focus on loneliness in pregnant persons, postpartum people, and parents of children 5 years or younger. We will search the following electronic databases (from inception onwards): MEDLINE, EMBASE, CINAHL Complete, Cochrane Library, PsycINFO, Dissertations & Theses Global, Sociological Abstracts, Scopus, and Web of Science. Grey literature will be identified searching the British governmental website gov.uk, the Jo Cox Commission on Loneliness, the Campaign to End Loneliness, and the British Red Cross's Action on Loneliness websites. Two reviewers, working independently of each other, will screen the titles and abstracts of the articles returned by the searches, then screen the selected full-text articles, and extract data. A third reviewer will cast the deciding vote in case no consensus is reached. Results will be given in the narrative form, mapped, and illustrated.

DISCUSSION

This scoping review will capture the state of the current literature on loneliness in pregnancy and new parenthood. Results will be published in a peer-reviewed journal. We anticipate that the study will identify gaps and make recommendations for future areas of study and related interventions. The protocol is available on Open Science Framework at DOI 10.17605/OSF.IO/BFVPZ.

Perinatal Depression of Exposed Maternal Women in the COVID-19 Pandemic in Wuhan, China

Objective: This study aims to investigate perinatal depression in women who gave birth during the COVID-19 pandemic in Wuhan, and to evaluate the effect of the pandemic on perinatal depression prevalence. Methods: A cross-sectional investigation was conducted into women hospitalized for delivery in Hubei Maternity and Child Healthcare Hospital from December 31, 2019 to March 22, 2020, a period which encompasses the entire time frame of the COVID-19 pandemic in Wuhan. The Edinburgh Postnatal Depression Scale (EPDS) was adopted to evaluate perinatal depression status. A Chi-square test and logistic regression model were utilized for data analysis. Results: A total of 2,883 participants were included, 33.71% of whom were found to suffer from depressive symptoms. In detail, 27.02%, 5.24%, and 1.46% were designated as having mild, moderate, and severe depressive symptoms, respectively. The perinatal depression prevalence increased as the COVID-19 pandemic worsened. Compared to the period from December 31, 2019 to January 12, 2020, perinatal depression risk significantly decreased within the 3 weeks of March 2-22, 2020 (1st week: OR = 0.39, 95% CI: 0.20, 0.78; 2nd week: OR = 0.35, 95% CI: 0.17, 0.73; and 3rd week: OR = 0.48, 95% CI: 0.25, 0.94); and the postnatal depression risk significantly rose within the four weeks of January 27-February 23, 2020 (1st week: OR = 1.78, 95% CI: 1.18, 2.68; 2nd week: OR = 2.03, 95% CI: 1.35, 3.04; 3rd week: OR = 1.48, 95% CI: 1.02, 2.14; and 4th week: OR = 1.73, 95% CI: 1.20, 2.48). Conclusion: The dynamic change of perinatal depression was associated with the progression of the COVID-19 pandemic among new mothers who were exposed to the pandemic. An elevated risk of postnatal depression was also observed during the COVID-19 pandemic.

Recall accuracy of weekly automated surveys of health care utilization and infectious disease symptoms among infants over the first year of life

Automated surveys, by interactive voice response (IVR) or email, are increasingly used for clinical research. Although convenient and inexpensive, they have uncertain validity. We sought to assess the accuracy of longitudinally-collected automated survey responses compared to medical records. Using data collected from a well-characterized, prospective birth cohort over the first year of life, we examined concordance between guardians' reports of their infants' health care visits ascertained by weekly automated survey (IVR or email) and those identified by medical chart review. Among 180 survey-visit pairs, concordance was 51%, with no change as number of visits per baby increased. Accuracy of recall was higher by email compared to IVR (61 vs. 43%; adjusted OR = 2.5 95% CI: 1.3-4.8), did not vary by health care encounter type (hospitalization: 50%, ER: 64%, urgent care: 44%, primary care: 52%; p = 0.75), but was higher for fever (77%, adjusted OR = 5.1 95%CI: 1.5-17.7) and respiratory illness (58%, adjusted OR = 2.9 95%CI: 1.5-5.8) than for other diagnoses. For the 75 mothers in these encounters, 69% recalled at least one visit; among 41 mothers with two or more visits, 85% recalled at least one visit. Predictors of accurate reporting by mothers after adjusting for illness in the baby included increased age and increased years of education (age per year, β = 0.05, p = 0.03; education per year, β = 0.08, p = 0.04). Additional strategies beyond use of automated surveys are needed to ascertain accurate health care utilization in longitudinal cohort studies, particularly in healthy populations with little motivation for accurate reporting.

Study protocol: becoming and being a mother living with HIV - a multicentre longitudinal mixed methods study among pregnant women living with HIV, non-pregnant women living with HIV and pregnant women not living with HIV in a high-income setting (the 2B MOM study)

INTRODUCTION

The success of combination antiretroviral therapy has decreased the risk of perinatal HIV transmission and normalised pregnancy in women living with HIV (WLWH). Despite these advances, WLWH still face complex medical and psychosocial issues during pregnancy and postpartum, and there is a gap of knowledge on the experiences of becoming and being a mother living with HIV in today's context. The overall aim of this study is to investigate psychosocial outcomes and experiences of WLWH in Scandinavia during pregnancy and early motherhood.

METHODS AND ANALYSIS

This is a multicentre longitudinal convergent mixed methods study consisting of a quantitative survey study, a qualitative interview study and a mixed methods analysis. The survey study aims to examine psychosocial outcomes of WLWH across the pregnancy - postpartum trajectory. Participants are pregnant WLWH living in Scandinavia. Two control groups of HIV-negative pregnant women and non-pregnant WLWH are also included. Data is collected in the third trimester, 3 and 6 months postpartum using standardised questionnaires. Statistical analysis will assess changes over time and identify predictors of adverse outcomes. The interview study seeks to understand experiences of pregnancy and becoming a mother while living with HIV. Pregnant WLWH who are enrolled in the survey study will be asked to participate in individual interviews in the third trimester and 6 months postpartum. Data will be analysed using narrative analysis. The survey and interview results will be merged in a mixed methods analysis to assess confirmation, expansion or discordance between the data sets.

ETHICS AND DISSEMINATION

Approval from the Danish Data Protection Agency (VD-2018-253), and the Finnish and Swedish Ethics Committees have been obtained (HUS/1330/2019 and Dnr: 2019-04451, respectively). Study results will be disseminated to patient organisations, through publications in peer-reviewed journals and at scientific conferences.