Neonates in the Intensive Care Unit: Maternal Health-Related Quality of Life and Depression After Term and Preterm Births

Effects of home-based integrated sensory stimulation program to preterm infants on parents' depression and anxiety: a randomized controlled trial

BACKGROUND

Preterm parents face higher risks of postpartum depression and anxiety, affecting bonding and infant development. Sensory stimulation shows promise, but its long-term impact on parental mental health needs further study.

OBJECTIVES

This study aimed to evaluate whether a home-based integrated sensory stimulation program, administered to preterm infants by their parents, could alleviate parental mental health issues and enhance maternal bonding and parenting competence.

METHODS

The program, including tactile, auditory, visual, gustatory, and olfactory stimuli, was assessed in a block-randomized controlled trial from November 2018 to January 2020. A total of 200 parents of preterm infants were recruited, and the intervention continued at home until the infants reached six months corrected age. Parents' depression and anxiety were assessed using validated scales at baseline, and at first, third, and sixth month follow-ups.

RESULTS

The intervention group included 98 parents, and the control group comprised 102 parents. At the six-month follow-up, the intervention group demonstrated significant improvements in maternal depression, state anxiety, and trait anxiety compared to the control group. In the mixed linear model, the intervention was associated with reductions in maternal trait anxiety (d =-2.18; 95% CI: -4.30, -0.06), paternal trait anxiety (d =-3.37; 95% CI: -5.62, -1.11) and state anxiety (d =-4.63; 95% CI: -7.00, -2.26).

CONCLUSION

The home-based integrated sensory stimulation program, when provided by parents to preterm infants, was effective in improving parents' mental health and can serve as an alternative treatment for postpartum depression and anxiety in parents of preterm infants at home.

Association between adverse perinatal events and postpartum depressive symptoms in a North American prospective preconception cohort study

BACKGROUND

Identifying risk factors for postpartum depression (PPD) is critical to inform early intervention efforts. This study investigated the impact of adverse perinatal events on PPD.

METHODS

We analyzed data from the Pregnancy Study Online (PRESTO), a North American prospective preconception cohort study. Participants (N = 3559) aged 21-45 years completed questionnaires at preconception, during pregnancy, and postpartum. PPD was assessed at six months postpartum using the Edinburgh Postnatal Depression Scale (EPDS). We fit generalized linear models to estimate risk ratios (RRs) and 95 % confidence intervals (CIs) for the associations of adverse perinatal events (preterm birth; birth size for gestational age; infant birthweight; and NICU admission) with PPD (EPDS score ≥ 13), adjusting for confounders including preconception mental health.

RESULTS

A total of 9.8 % reported PPD. Preterm birth (i.e., <37 weeks gestational age; RR = 1.30; 95 % CI: 0.92, 1.82), particularly spontaneous preterm birth (RR = 1.38; 95 % CI: 0.90, 2.10), very preterm birth (<34 weeks; RR = 1.88; 95 % CI: 1.04, 3.35), very low infant birthweight (i.e., <1500 g; RR = 1.67, 95 % CI: 0.77, 3.60), and NICU admission (RR = 1.15; 95 % CI: 0.86, 1.55) were associated with increased PPD risk. Stratified analyses indicated preterm birth was more strongly associated with PPD among parous participants and participants with a history of mental health diagnoses.

CONCLUSION

Adverse perinatal events were associated with an increased risk of PPD at 6 months postpartum. Early identification and management of depressive symptoms in those who have experienced adverse perinatal events are crucial for improving both parental and infant health outcomes.

Maternal postpartum mental health negatively affects infants' health related quality of life

OBJECTIVES

To assess the association of early and late postpartum maternal mental health with infants' health related quality of life (HRQoL).

METHODS

The study was embedded within the POST-UP trial (n = 1843). Infants' HRQoL was assessed with the Infant and Toddler Quality of Life Questionnaire Short Form-47 at ages 1 month (1 m), and 12 m. Maternal mental health regarded postpartum depression (PPD), measured with the Edinburgh Postnatal Depression Scale at 1 m and 6 m (early/late), and postpartum anxiety (PPA) with the short version of the state form of the Spielberger State-Trait Anxiety inventory at 1 m and 12 m (early/late). We used linear regression analyses.

RESULTS

Early and late PPD and PPA were negatively associated with infants' HRQoL at ages 1 m and 12 m. The negative associations with infants' HRQoL at 1 m were most pronounced for the domain infant temperament (standardized regression coefficient, (95% confidence interval)): -0.30 (-0.34; -0.25), and -0.37 (-0.41; -0.32) for PPD and PPA respectively, and weakest for the domain bodily pain: -0.14 (-0.19; -0.09), and -0.22 (-0.26; -0.17) for PPD and PPA respectively. The negative associations of early postpartum maternal health with infants' HRQoL at age 12 months were less pronounced. Moreover, associations with infants' HRQol were weaker for late than for early PPD and PPA.

LIMITATION

Usage of maternal proxy reports for assessing infant HRQoL.

CONCLUSION

Postpartum maternal mental health is negatively associated with infants' HRQoL at age 1 m and 12 m. This confirms the need for regular screening of maternal mental health in the postpartum period.

Joint observation in NICU (JOIN): A randomized controlled trial testing an early, one-session intervention during preterm care to improve perceived maternal self-efficacy and other mental health outcomes

BACKGROUND

Parents of preterm infants in the Neonatal Intensive Care Unit (NICU) environment may experience psychological distress, decreased perceived self-efficacy, and/or difficulties in establishing an adaptive parent-infant relationship. Early developmental care interventions to support the parental role and infant development are essential and their impact can be assessed by an improvement of parental self-efficacy perception. The aims were to assess the effects of an early intervention provided in the NICU (the Joint Observation) on maternal perceived self-efficacy compared to controls (primary outcome) and to compare maternal mental health measures (perceived stress, anxiety, and depression), perception of the parent-infant relationship, and maternal responsiveness (secondary outcomes).

METHODS

This study was a monocentric randomized controlled trial registered in clinicatrials.gov (NCT02736136), which aimed at testing a behavioural intervention compared with treatment-as-usual. Mothers of preterm neonates born 28 to 32 6/7 weeks gestation were randomly allocated to either the intervention or the control groups. Outcome measures consisted of self-report questionnaires completed by the mothers at 1 and 6 months after enrollment and assessing perceived self-efficacy, mental health, perception of the parent-infant relationship and responsiveness, as well as satisfaction with the intervention.

RESULTS

No statistically significant group effects were observed for perceived maternal self-efficacy or the secondary outcomes. Over time, perceived maternal self-efficacy increased for mothers in both groups, while anxiety and depression symptoms decreased. High satisfaction with the intervention was reported.

CONCLUSIONS

The joint observation was not associated with improved perceived maternal self-efficacy or other mental health outcomes, but may constitute an additional supportive measure offered to parents in a vulnerable situation during the NICU stay.

Long-term quality of life after obstetric intensive care unit admission: A cross-sectional cohort study

OBJECTIVE

To assess the long-term quality of life (QoL) after obstetric Intensive Care Unit (ICU) admission.

DESIGN

Cross-sectional survey study.

SETTING

Tertiary care centre.

POPULATION

Women admitted to the level 3 ICU during pregnancy or ≤6 weeks postpartum, between 2000 and 2015.

METHODS

Quality of life measures were compared with the population reference values. Associations with baseline ICU parameters were assessed with multivariable linear regression. Patient-reported outcome and experience measures (PROMs/PREMs) were described.

MAIN OUTCOME MEASURES

Quality of life according to the Linear Analogous Scale (LAS), the Satisfaction with Life Scale (SWLS) and the SF-36 questionnaire; PROMs/PREMs using the Pregnancy and Childbirth outcome set of the International Consortium for Health Outcomes Measurement.

RESULTS

Of all 265 obstetric ICU admissions, 230 were eligible and 94 (41%) were included (median follow-up time 14 years). The LAS (75.7 versus 78.7, p = 0.077) and SWLS (25.2 versus 26, p = 0.176) sum scores were not different from the population reference values. The SF-36 subdomains bodily pain (55.3 versus 73.9), general health (58.2 versus 73.9) and vitality (56.9 versus 69.1) were lower than the reference values (all p < 0.001). PROMs/PREMs were low in 46.2% for pain, 15.1% for depression, 11.8% for satisfaction with care and 52.7% for healthcare responsiveness. An indirect obstetric ICU admission diagnosis was independently associated with a reduced physical health score (B -1.7, 95% confidence interval [CI] -3.4 to -0.1) and severe neonatal morbidity with a reduced mental health score (B -6.6, 95% CI -11.3 to -1.8).

CONCLUSION

Obstetric ICU admission is associated with reductions in long-term physical health QoL and in some patients with mental health QoL. We suggest multidisciplinary rehabilitation and long-term psychosocial support.

Longitudinal risk of maternal hospitalization for mental illness following preterm birth

BACKGROUND

Preterm birth may affect maternal mental health, yet most studies focus on postpartum mental disorders only. We explored the relationship between preterm delivery and the long-term risk of maternal hospitalization for mental illness after pregnancy.

METHODS

We performed a longitudinal cohort study of 1,381,300 women who delivered between 1989 and 2021 in Quebec, Canada, and had no prior history of mental illness. The exposure was preterm birth, including extreme (<28 weeks), very (28-31 weeks), and moderate to late (32-36 weeks). The outcome was subsequent maternal hospitalization for depression, bipolar, psychotic, stress and anxiety, personality disorders, and self-harm up to 32 years later. We used adjusted Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between preterm birth and mental illness hospitalization.

RESULTS

Compared with term, women who delivered preterm had a higher rate of mental illness hospitalization (3.81 vs. 3.01 per 1000 person-years). Preterm birth was associated with any mental illness (HR 1.38, 95% CI 1.35-1.41), including depression (HR 1.37, 95% CI 1.32-1.41), psychotic disorders (HR 1.35, 95% CI 1.25-1.44), and stress and anxiety disorders (HR 1.42, 95% CI 1.38-1.46). Delivery at any preterm gestational age was associated with the risk of mental hospitalization, but risks were greatest around 34 weeks of gestation. Preterm birth was strongly associated with mental illness hospitalization within 2 years of pregnancy, although associations persisted throughout follow-up.

CONCLUSIONS

Women who deliver preterm may be at risk of mental disorders in the short and long term.