The effect of cognitive-behavioral counseling of pregnant women with the presence of a spouse on stress, anxiety, and postpartum depression

Preventing postpartum depression in pregnant women using an app-based health-promoting behaviors program (Pender's health promotion model): a randomized Controlled Trial

BACKGROUND

Depression is a prevalent mood disorder. Women face a heightened risk of depression during pregnancy and after childbirth, which can have negative consequences for both the mother and her family. It is essential to explore preventive strategies.

OBJECTIVE

To assess the impact of education focused on health-promoting behaviors in preventing postpartum depression (PPD) through social messaging among pregnant women.

METHODS

This randomized controlled trial study involved 108 non-depressed eligible pregnant women with a gestational age of 28-30 weeks during 2022-2023. Participants were randomly assigned to intervention and control groups using a block randomization method. The intervention group received virtual education based on health-promoting behaviors weekly over six sessions. The Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), and Health Promoting Lifestyle Profile II (HPLP II) questionnaires were utilized to evaluate outcomes. Data analysis was performed using SPSS software version 23, with a significance level set at P < 0.05.

RESULTS

The mean differences between the scores of EPDS, PHQ-9 and HPLP II before and after the intervention in two groups were - 4.85 (CI95%= -3.22, -6.48), -6.22 (CI95%= -4.43, -8.00) and 28.22 (CI95%= 23.41, 33.03), respectively, which were statistically significant (P < 0.001). The findings regarding the dimensions of health-promoting behaviors also indicated that all dimensions increased significantly in the intervention group. The greatest and least amount of change was observed in the physical activity dimension at 5.50 (CI95%= 4.31, 6.68) and in interpersonal relations at 3.48 (CI95%= 2.24, 4.72), respectively. The number needed to treat (NNT) for depression, based on the Edinburgh questionnaire six weeks postpartum was approximately 2.571, indicating that nearly one in two mothers who received education benefited.

CONCLUSION

The app-based health-promoting behaviors intervention-benefiting from not requiring in-person referrals and providing a common platform for communication-is effective in enhancing health-promoting behaviors, reducing depression scores and decreasing the frequency of PPD. In other words, this type of intervention led to the prevention of postpartum depression and the promotion of health-promoting behaviors among pregnant women.

REGISTRATION

The study was retrospectively registered with the IRCT Registry on 31/05/2024 (registration number: IRCT20221109056451N2).

Sexual function in pregnancy and postpartum: breaking the silence

BACKGROUND

Sexual function during pregnancy and the postpartum period is a complex component of maternal and couple health, and it's deeply influenced by an intricate interplay of physiological, psychological, childbirth, and relational factors.

AIM

This review seeks to explore the nuanced dynamics of sexual function during pregnancy and the postpartum period, shedding light on both the challenges and opportunities for enhancing maternal and couple sexual well-being.

METHODS

Drawing on a combination of existing scientific literature and extensive clinical experience, this expert opinion delves into the physiological transformations, psychological adjustments, and shifts in relational dynamics that accompany pregnancy and postpartum. It sheds light on the sexual experiences of partners and underscores the necessity of a holistic understanding of sexual health in this context.

OUTCOMES

The review offers an enhanced perspective on sexual function during pregnancy and postpartum and aims to contribute to a deeper and more nuanced understanding that can inform both clinical practice and future research.

RESULTS

The results highlight that pregnancy and postpartum phases influence sexual function, with fluctuations in sexual desire and activity resulting from changes in physiological, psychological, and relational factors. Women experience a decline in sexual function, particularly during the third trimester, with factors, such as hormonal changes, body image concerns, and partner dynamics shaping sexual experiences across pregnancy and postpartum stages.

CLINICAL IMPLICATIONS

A thorough understanding of sexual function throughout pregnancy and postpartum is critical for enhancing maternal and couple health and it creates pathways to more effective and compassionate care.

STRENGTHS AND LIMITATIONS

The strengths of this review include the integration of scientific literature with clinical experience to provide a holistic view of sexual function. However, the limitations are the reliance on cross-sectional studies and the scarcity of data on couple sexual functioning.

CONCLUSION

Understanding the interplay of physiological and anatomical changes, psychological factors, and partner dynamics is crucial in addressing sexual function during pregnancy and the postpartum period.

Effects of maternal posture and cognitive-behavioral interventions on labor outcomes in primigravidas with abnormal fetal head position: a randomized controlled clinical trial

OBJECTIVE

Fetal head malposition can result in neonatal and maternal complications. Fetal head malposition occurs frequently in labor. Appropriate and timely managements are required. Maternal posture and cognitive-behavioral interventions could improve labor outcomes in primigravidas with fetal head malposition.

METHODS

A randomized controlled clinical trial was performed between January and December 2022 (Chinese Clinical Trial Registry, ChiCTR2100049359). Eligible primigravidas were randomly assigned into four groups. Group A received traditional perinatal care. Group B, C, and D received posture management, posture management with music therapy, and posture management with video education, respectively, in addition to traditional perinatal care. The maternal postures referred to place pregnant women in certain positions (lateral, lateral-prone, hands and knees, open knee-chest) to change the anatomical structure of pelvis, thus, to facilitate the fetal downward movement and birth. Maternal and neonatal outcomes were recorded and compared.

RESULTS

A total of 136 primigravidas were included, with 34, 35, 34, and 33 women in group A, B, C, and D, respectively. The incidences of cesarean section were lower in groups B, C, and D than that in group A (5.7%, 2.9%, and 3.0% versus 20.6%, p < 0.05). The fetal position correction rates at the time of full dilation of cervix were higher in groups B, C, and D than that in group A (66.7%, 63.6%, 68.8% versus 27.6%, p < 0.05). Primigravidas in groups B, C, and D had better experiences and a lower anxiety level than those in group A (p < 0.001). The four groups had no statistically significant differences in the total labor duration, operative vaginal delivery, umbilical artery blood pH, and neonatal Apgar scores.

CONCLUSION

Fetal head malposition could happen in primigravidas. Maternal posture management and cognitive-behavioral interventions during labor could improve labor outcomes in primigravidas with fetal head malposition.

Comparing the effect of haptonomy and CBT-based counseling on childbirth experience and postpartum depression of women with high fear of childbirth: A randomized clinical trial

BACKGROUND

Fear of childbirth (FOC) leads to the perception of more pain and a negative childbirth experience. Negative childbirth experience is related to postpartum depression. This study aimed to compare the effect of haptonomy and cognitive-behavioral therapy (CBT) on the childbirth experience and postpartum depression of women with high FOC.

MATERIALS AND METHODS

This randomized controlled trial was performed on 99 primigravida women referred to health centers in Tabriz, Iran, from January to August 2022. Participants with Wijma score above 65 were assigned into three groups using block randomization. One of the intervention groups (n = 33) received eight sessions of CBT from gestational age of 24-28 weeks and the other group (n = 33) received haptonomy during five sessions once a week. The control group (n = 33) received routine care. The data were collected using the Edinburgh Postpartum Depression Scale, and childbirth experiences questionnaire version 2.0 and were analyzed using ANOVA and ANCOVA.

RESULTS

The mean score of childbirth experience in the CBT and haptonomy groups was 70.67 (13.70) and 70.63 (14.48), respectively, which was more than that in the control group 61.63 (14.11) (P = 0.01). However, no statistically significant difference was observed between the intervention groups (P = 1.000). There wasn't significant difference in the mean score of postpartum depression among CBT 7.59 (3.03), haptonomy 7.47 (4.49), and control 9.71 (3.05) groups (P = 0.09).

CONCLUSIONS

Both CBT and haptonomy improved the childbirth experience, but did not affect postpartum depression. Considering the lack of significant difference between the CBT and haptonomy intervention groups in terms of childbirth experience and given that haptonomy intervention is employed by midwives with no need for CBT counseling skills and can be presented in fewer sessions than CBT, it can be used as a preferred intervention approach by midwives in the care of pregnant women with FOC to improve the childbirth experience.

Etiology and incidence of postpartum depression among birthing women in the scenario of pandemics, geopolitical conflicts and natural disasters: a systematic review

Postpartum depression (PPD) is classified under postpartum psychiatric disorders and initiates soon after birthing, eliciting neuropsychological and behavioral deficits in mothers and offspring. Globally, PPD is estimated to be associated with 130-190 per 1000 birthing. The severity and incidences of PPD have aggravated in the recent years due to the several unfavorable environmental and geopolitical circumstances. The purpose of this systematic review hence is to explore the contributions of recent circumstances on the pathogenesis and incidence of PPD. The search, selection and retrieval of the articles published during the last three years were systematically performed. The results from the primary studies indicate that unfavorable contemporary socio-geopolitical and environmental circumstances (e.g. Covid-19 pandemic, political conflicts/wars, and natural calamities; such as floods and earthquakes) detrimentally affect PPD etiology. A combination of socio-economic and psychological factors, including perceived lack of support and anxiousness about the future may contribute to drastic aggravation of PPD incidences. Finally, we outline some of the potential treatment regimens (e.g. inter-personal psycho- and art-based therapies) that may prove to be effective in amelioration of PPD-linked symptoms in birthing women, either alone or in complementation with traditional pharmacological interventions. We propose these psychological and art-based intervention strategies may beneficially counteract the negative influences of the unfortunate recent events across multiple cultures, societies and geographical regions.

Effects of Prenatal Stress on Behavior, Cognition, and Psychopathology: A Comprehensive Review

Prenatal stress is increasingly recognized as a significant factor impacting an individual's life from the beginning. This comprehensive review explores the intricate relationship between prenatal stress and its effects on behaviour, cognition, and psychopathology. Key findings reveal that prenatal stress can lead to a wide range of adverse outcomes in offspring, including neurodevelopmental disorders, emotional dysregulation, cognitive deficits, mood disorders, and an increased risk of psychopathological conditions. These effects' mechanisms involve epigenetic modifications, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, neurodevelopmental alterations, inflammatory processes, and changes in brain structure and function. Moreover, moderating factors such as maternal stress levels, maternal mental health, socioeconomic status, social support, and early-life adversity can significantly influence the impact of prenatal stress. The review also discusses intervention and prevention strategies, emphasizing the importance of prenatal stress reduction programs, maternal mental health support, nutritional interventions, and targeted early interventions for at-risk populations. These findings have substantial implications for public health and clinical practice, highlighting the need for a holistic approach to prenatal care that prioritizes maternal well-being and mitigates the lasting effects of prenatal stress. Addressing this critical issue promises healthier generations and stronger communities in the future.

Development and Validation of Safe Motherhood-Accessible Resilience Training (SM-ART) Intervention to Improve Perinatal Mental Health

Perinatal mental health issues in women can lead to a variety of health complications for both mother and child. Building resilience can strengthen coping mechanisms for pregnant women to improve their mental health and protect themselves and their children. The study aims to develop and validate the contextual and cultural appropriateness of the Safe Motherhood-Accessible Resilience Training (SM-ART) intervention for pregnant women in Pakistan. A three-phase approach was used to develop and validate an intervention that promotes resilience in pregnant women. Phase I comprised a needs assessment with stakeholders (pregnant women and key informants) to elicit opinions regarding module content. In Phase II, an intervention to build resilience was developed with the help of a literature review and formative assessment findings, and Phase III involved the validation of the intervention by eight mental health experts. The experts assessed the Content Validity Index (CVI) of the SM-ART intervention on a self-developed checklist. The resultant SM-ART intervention consists of six modules with strong to perfect CVI scores for each of the modules. Qualitative responses endorsed the strengths of the intervention as having innovative and engaging activities, contextual and cultural relevance, and a detailed, comprehensive facilitator guide. SM-ART was successfully developed and validated and is now ready for testing to promote the resilience of pregnant women at risk of perinatal mental illness.

Pregnant women's experiences of well-being in high-risk pregnancy: A qualitative study

BACKGROUND

Physical changes in high-risk pregnancy (HRP) can lead to changes in mood and social relationships and negative effects on women's well-being. Individuals in different sociocultural contexts have different perceptions of well-being. Yet, there is limited information about perceptions of well-being in HRP. This study aimed to explore the Iranian women's experiences of well-being in HRP.

MATERIALS AND METHODS

This qualitative study was conducted in 2019-2020 through directed content analysis based on the conceptual framework of well-being in HRP. Participants were 26 women with HRP purposively recruited from public and private healthcare settings in Mashhad, Iran. Face-to-face semistructured interviews were held for data collection until data saturation. Data were analyzed through directed content analysis proposed by Elo and kyngäs (2008) and were managed using the MAXQDA (v. 10) program.

RESULTS

Well-being in HRP had seven attributes in the five main dimensions of physical, mental-emotional, social, marital, and spiritual well-being. The seven attributes of well-being in HRP were controlled physical conditions, controlled mood, emotions, and affections, perceived threat, self-efficacy, and competence for multiple role performance, maintained social relationships, meaning seeking and relationship with the Creator, and positive marital relationships.

CONCLUSION

The present study provide an in-depth understanding about well-being in the Iranian women with HRP. It is a complex and multidimensional concept with physical, mental-emotional, social, marital, and spiritual dimensions. Comprehensive multicomponent interventions are needed to promote well-being among women with HRP and designed the guidelines to provide woman-centered care.