The Perceived Health Needs of Primiparous Mothers Referring to Primary Health Care Centers: A Qualitative Study

The effectiveness of Parentbot - a digital healthcare assistant - on parenting outcomes: A randomized controlled trial

BACKGROUND

Transitioning to parenthood is a stressful period that makes parents more prone to depression and anxiety. Mobile application-based interventions and chatbots could improve parents' well-being across the perinatal period. Hence, the Parentbot - a Digital healthcare Assistant was developed to support parents across the perinatal period.

OBJECTIVE

To evaluate the effectiveness of the Parentbot - a Digital healthcare Assistant in improving parenting self-efficacy (primary outcome), stress, depression, anxiety, social support, parent-child bonding, and parenting satisfaction (secondary outcomes) among parents across the perinatal period.

METHODS

A two-group pre-test and repeated post-test randomized controlled trial was used where 118 heterosexual couples (118 mothers and 118 fathers) were recruited from a public tertiary hospital in Singapore. Couples were randomly assigned to the intervention group receiving the Parentbot - a Digital healthcare Assistant and standardized care (59 couples) and a control group receiving the standard care only (59 couples). Data collection occurred at baseline (>24 weeks of gestation - age of viability in Singapore) and at one month (post-test 1) and three months (post-test 2) postpartum. Linear mixed models were used to compare parental outcomes between groups and a linear mixed model with repeated measures was used to analyze within-group differences. General linear models were used to conduct subgroup analyses of mothers and fathers between groups.

RESULTS

After adjusting for baseline values and sociodemographic covariates, parents in the intervention group had higher parenting self-efficacy compared to the control group at one-month postpartum (mean difference = 1.22, 95 % CI: 0.06 to 2.39, p = 0.04; Cohen standardized effect size = 0.14), and mothers had lower state-anxiety compared to the control group at three-months postpartum (mean difference = -2.21, 95 % CI: -4.18 to -0.24, p = 0.03; Cohen standardized effect size = -0.22). Non-statistically significant differences between groups were reported for the other parental outcomes.

CONCLUSIONS

This study showed that the Parentbot - a Digital healthcare Assistant is feasible and promising in supporting parents especially enhancing their self-efficacy across the perinatal period. The lack of statistical significance in most outcomes showed that further evaluation of the intervention is required among varied populations of parents across different cultural and geographical contexts. The intervention could be enhanced to support more diverse groups of parents including single parents, parents with high-risk pregnancies and infants with medical complications, and parents with limited English language skills. Future trials could explore the cost-effectiveness of such interventions and investigate infant outcomes for a more comprehensive assessment of mobile application-based perinatal interventions.

TRIAL REGISTRATION

Clinicaltrails.gov (NCT05463926).

Infants born to first-time mothers with a refugee background faced an increased risk of regulatory problems

AIM

This study investigated the association between mothers' migration background and infant regulatory problems and analysed the mediating role of maternal mental health. We also explored whether the child's sex, parity and length of residence moderated the effect of a maternal migrant background.

METHODS

Child health surveillance data from the Danish home visiting programme were used. Community health nurses followed infants from birth to 12 months of age. The source population comprised 103 813 infants born between 1 January 2008 and 31 December 2018. The final sample comprised 62 964 infants, including 3.4% with a refugee background. A maternal migrant background was the primary exposure. The results are presented as risk ratios (RR) and 95% confidence intervals (CI).

RESULTS

A maternal refugee background increased the risk of regulatory problems in offspring (RR 1.34, 95% CI: 1.18-1.51). The effect was partially mediated by maternal postpartum mental health concerns. The association between maternal refugee background and infant regulatory problems was more pronounced in first-time mothers (RR 1.80, 95% CI: 1.51-2.15).

CONCLUSION

The risk of infant regulatory problems was higher in the first-born children of refugee mothers. First-time refugee parents may need tailored support to identify mental health needs and infants with regulatory problems.

Perceptions of primiparous women diagnosed with gestational diabetes mellitus: A descriptive qualitative study

OBJECTIVE

To understand the perceptions of primiparous women recently diagnosed with Gestational Diabetes Mellitus (GDM) in Singapore.

DESIGN

A descriptive qualitative study design.

SETTING

An outpatient women's health clinic in a tertiary hospital in Singapore.

PARTICIPANTS

Twelve English-speaking primiparous women (aged 27-44 years old) who were diagnosed with GDM were recruited via purposive sampling to participate in this study.

METHODS

Face-to-face interviews were carried out with study participants in a private room at the outpatient clinic from December 2019 to May 2021. All interviews were audio-recorded and transcribed verbatim on the same day. Data analysis was guided by Braun and Clarke's thematic analysis framework.

FINDINGS

Four main themes were identified from this study's findings: (1) Life leading to GDM: A 'hint' that something was wrong, (2) Reactions to diagnosis: Shock or acceptance, (3) Learning to cope: Facing internal and external challenges, and (4) Living with GDM: A way forward.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Primiparous women with GDM require comprehensive informational, practical, and emotional support to help them manage and accept their condition. Healthcare providers are encouraged to provide individualised and holistic care to these women using a humanistic approach. Accessible online educational resources and peer support services could be considered. Public campaigns to increase the general public's awareness of GDM would also allow future women and their families to be more familiar with the condition and hence more prepared to cope with it.

Effectiveness of psychological interventions in preventing postpartum depression in non-depressed women: a systematic review and meta-analysis of randomized controlled trials

Postpartum depression (PPD) is one of the most common disorders following childbirth. This systematic review and meta-analysis (SR/MA) aimed to assess the effectiveness of psychological interventions in preventing PPD in non-depressed women. PRISMA guidelines were followed. MEDLINE (Ovid and PubMed), PsycINFO, Web of Science, Scopus, CINAHL, CENTRAL, OpenGrey, Australian New Zealand Clinical Trial Registry and clinicaltrial.gov were searched. Randomized controlled trials (RCTs) conducted with pregnant or postpartum (up to 12 months) women who were non-depressed at baseline were selected. The outcomes were the incidence of PPD and/or the reduction of postpartum depressive symptoms. The standardized mean difference (SMD) using random-effect models was calculated. Sensitivity, sub-group and meta-regression analyses were performed. 17 RCTs were included in the SR and 15 in the MA, representing 4958 participants from four continents. The pooled SMD was -0.175 [95% confidence interval (CI) -0.266 to -0.083; p < 0.001] and sensitivity analyses confirmed the robustness of this result. Heterogeneity was low (I2 = 21.20%) and was fully explained by a meta-regression model including one variable (previous deliveries). The meta-regression model and MA stratified by previous deliveries indicated that interventions focused on primiparous women are more effective. There was no evidence of publication bias. Few RCTs had an overall low risk of bias. According to GRADE, the quality of evidence was moderate. Psychological interventions have very little effectiveness in preventing PPD in non-depressed women, although this effectiveness is greater in interventions focused on primiparous women. Further RCTs with a low risk of bias and more effective interventions are needed.