The association between pregnancy-specific anxiety and preterm birth: a cohort study

A qualitative examination of factors influencing pregnancy-related anxiety in Northern Ghana

INTRODUCTION

Despite high prevalence of anxiety among pregnant women in low- and -middle-income countries, research on context-specific conceptualisation, measurement, and predictors of pregnancy-related anxiety (PrA) is limited in these contexts. We explored local conceptualisations of factors influencing PrA in the Northern Region of Ghana.

METHODS

We conducted 15 focus group discussions with antenatal care seekers in the Mion District, Savelugu Municipality, and Tamale Metropolis of the Northern Region, in July and August 2021. Multistage stratified purposive sampling was used to select respondents (n = 108). The data were audio-recorded and transcribed, and then we conducted a thematic analysis of the data.

RESULTS

At the individual level, fear of anaemia; pre-existing health conditions; challenges with daily activities; and physical, emotional, and sexual abuses from spouses contributed to PrA. Health system failures resulting in unexpected out-of-pocket payments, negative health worker attitudes, diagnostic errors, constraints on birth preparation and birth process, and potential adverse birth outcomes were understood as driving PrA. Socio-cultural factors influencing PrA comprised beliefs and practices around baby naming/outdooring ceremonies, fear of spiritual attacks, social construction of gender roles, and contextual factors such as transportation challenges.

CONCLUSION

Pregnant women in the region understood, experienced, and could identify perceived predictors of PrA. To address PrA, we recommend that mental health services should be integrated into the basic package of antenatal care and rural health services should be improved. Perceived predictors of PrA identified here could be included in the design of a context-specific PrA measure for use in the region.

Association between low ambient temperature during pregnancy and adverse birth outcomes: A systematic review and meta-analysis

BACKGROUND

Extreme temperature events, including extreme cold, are becoming more frequent worldwide, which might be harmful to pregnant women and cause adverse birth outcomes. We aimed to investigate the association between exposure to low ambient temperature in pregnant women and adverse birth outcomes, such as preterm birth, low birth weight, and stillbirth, and to summarize the evidence herein.

METHODS

Relevant studies were searched in PubMed, Cochrane, and Embase electronic databases until November 2021. Studies involving low ambient temperature, preterm birth, birth weight, and stillbirth were included. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses were followed to conduct this study risk of bias and methods for data synthesis.

RESULTS

A total of 34 studies were included. First, pregnant women exposed to low ambient temperature had an increased risk of preterm birth (risk ratio [RR] 1.08; 95% confidence interval [CI] 1.04-1.13). Subgroup analyses revealed that exposure during late pregnancy was more likely to induce preterm birth. In addition, only pregnant women exposed to <1st percentile of the mean temperature suffered increased risk of preterm birth. Moreover, pregnant women living in medium or hot areas were more prone to have preterm births than those in cold areas when exposed to low ambient temperatures. Asians and Blacks were more susceptible to low ambient temperatures than Caucasians. Second, pregnant women exposed to low ambient temperature had an increased risk of low birth weight (RR 1.07; 95% CI 1.03-1.12). Third, pregnant women had an increased risk of stillbirth while exposed to low ambient temperature during the entire pregnancy (RR 4.63; 95% CI 3.99-5.38).

CONCLUSIONS

Exposure to low ambient temperature during pregnancy increases the risk of adverse birth outcomes. Pregnant women should avoid exposure to extremely low ambient temperature (<1st percentile of the mean temperature), especially in their late pregnancy. This study could provide clues for preventing adverse outcomes from meteorological factors.

REGISTRATION

No. CRD42021259776 at PROSPERO ( https://www.crd.york.ac.uk/PROSPERO/ ).

Paternal pregnancy-related anxiety: Systematic review of men's concerns and experiences during their partners' pregnancies

BACKGROUND

Up to 25 % of expectant parents experience anxiety symptoms. Pregnancy-related anxiety is characterised by concerns and worries specific to pregnancy, childbirth, and the transition to parenthood. While pregnancy-related anxiety is well-researched in women, the exact nature of this construct in men is unclear. The purpose of the current review was to examine men's concerns, worries, and fears during pregnancy and gain an understanding of their experiences during pregnancy.

METHODS

An integrative review design was adopted, using thematic content analysis to synthesise findings from quantitative and qualitative studies. Quality appraisal of the quantitative studies used the AXIS appraisal tool. The Critical Appraisal Skills Program (CASP) checklist was used for the qualitative studies.

RESULTS

A comprehensive search of nine databases led to inclusion of 14 quantitative and 41 qualitative studies. Ten dimensions of paternal pregnancy-related anxiety were identified: childbirth concerns, attitudes towards childbirth, baby concerns, acceptance of pregnancy, partner concerns, relationship concerns, worry about self, transition to parenthood, attitudes towards health care professionals, and practical and financial concerns. The pregnancy transition was characterised by mixed emotions and conflicted experiences for fathers.

LIMITATIONS

Generalizability of review findings was limited by poor reporting of demographic information by many included studies, exclusion of studies not published in English, and focus on heterosexual relationships.

CONCLUSIONS

Expectant fathers may experience anxiety symptoms characterised by excessive worry across multiple domains of pregnancy-related concerns. Clinicians play an important role in identifying and supporting fathers with pregnancy-related anxiety and addressing the sense of exclusion often experienced by them.

Exploring social complexities of the COVID-19 pandemic on maternal anxiety: A mixed-methods observational cohort study

INTRODUCTION

The aim of this mixed-methods, small-scale observational cohort study was to examine if anxiety in pregnant women increased during the COVID-19 pandemic and to examine the subsequent impact on birth outcomes and psychological well-being. This research was conducted across two hospital sites in North London, with participation from 194 pregnant women.

METHODS

The GAD-7 questionnaire assessed for mild, moderate and high anxiety at one time point during the antenatal period and was repeated 6 weeks postnatally. Women with moderate to high scores on the GAD-7 were invited to participate in semi-structured interviews. The primary outcome measure was assessment of antenatal and postnatal anxiety. Secondary outcome measures assessed if women with moderate/high GAD-7 scores were more likely to develop a mental health condition during pregnancy, or up to 6 weeks postnatally, and if risk of preterm birth (<37 weeks gestation) and instrumental birth or cesarean section increased.

RESULTS

Pearson’s correlation indicated a positive and significant correlation between the COVID-19 pandemic, and increased self-reported antenatal GAD-7 anxiety scores (r=0.47, n=194, p<0.001). GAD-7 scores were higher during pregnancy compared to the postnatal period [t(193)=4.63; p=0.001; 95% CI: 0.87–2.16]. Logistic regression did not show an increased likelihood of preterm birth [χ²(1, n=184)=0.999; p=0.971] or instrumental/cesarean section birth in women who scored moderately to highly on the antenatal GAD-7 [χ²(1, n=184)=2.73; p=0.165]. Qualitative analysis was carried out within a social constructionist framework and identified the following themes: anxiety, maternity care, social impact, and coping.

CONCLUSIONS

Pregnant women self-reported an increase in antenatal anxiety during July 2020 to April 2021 of the COVID-19 pandemic. Moderate to high anxiety scores were not found to increase the likelihood of preterm birth and birth intervention or developing a mental health condition up to 6 weeks postnatally.

Screening for Pregnancy-Related Anxiety: Evaluation of the Pregnancy-Related Anxiety Scale-Screener Using Rasch Methodology

Pregnancy-related anxiety has been linked to many maternal and child-related negative outcomes. However, there is an absence of free, well-validated screeners for this condition. The Pregnancy-related Anxiety Scale-Screener (PrAS-Screener) was evaluated using robust Rasch methodology. This study also aimed to develop a shorter version to meet the need of settings governed by professional guidelines stipulating the use of brief instruments. Data from 400 pregnant women (M_age = 27.82, SD = 5.38) were subjected to Rasch analyses and the resulting Rasch models confirmed in a second sample (N = 400, M_age = 26.29, SD = 4.95). After minor modifications, the original 15-item PrAS-Screener demonstrated good fit, unidimensionality, excellent targeting, invariance, and internal consistency. After removal of items with content overlap, an 11-item version was developed, with this version showing good fit, unidimensionality, reasonable targeting, and sound internal consistency. The PrAS-Screeners show promise as psychometrically sound clinical scales for screening pregnancy-related anxiety.

Associations of physical activity, sedentary behavior and sleep duration with anxiety symptoms during pregnancy: An isotemporal substitution model

BACKGROUND

Studies have evidenced the close relationships between movement behavior [physical activity (PA), sedentary behavior (SB), and sleep duration)] and anxiety. Capturing 24 h of these maternal movement behaviors during pregnancy is necessary to understand their relationships.

METHODS

In a cross-sectional study design, a total of 946 prenatal women filled Pregnancy Physical Activity Questionnaire-Chinese version, Pregnancy-Related Anxiety Questionnaire, and 7-item Generalised Anxiety Disorders scale between May 2020 and April 2021. An Isotemporal Substitution Model was used to estimate the per-hour effects of replacing one behavior.

RESULTS

Replacing moderate-to-vigorous PA(MVPA), light PA (LPA), or SB with sleep could reduce both general and pregnancy-specific anxiety (LPA, B = -0.61∼-0.37, P ≤ 0.01; MVPA, B = -0.35, P = 0.03; SB, B = -0.45∼-0.34, P ≤ 0.01). Replacing SB with MVPA could reduce pregnancy-specific anxiety in the group without adequate sleep duration (SB, B = -0.62,95%CI = -1.13∼-0.17). As for the types of PA, replacing household, occupational or inactivity PA with transportation PA or sleep duration reduced general anxiety (household PA: B = -0.51, 95%CI = -0.73∼-0.29, P < 0.001; occupational PA: B = -0.48, 95%CI = -0.69∼-0.27, P < 0.001; inactivity: B = -0.45, 95%CI = -0.68∼-0.24, P < 0.001). Replacing household PA, occupational PA, or inactivity with transport PA was associated with improved general anxiety (household: B = -0.33, 95%CI = -0.64∼-0.03, P = 0.29; occupational PA: B = -0.31, 95%CI = -0.62∼-0.003, P = 0.35; inactivity: B = -0.28, 95%CI = -0.56∼-0.01, P = 0.33).

LIMITATIONS

A cross-sectional study design and self-reported measurement limits the reliability of study.

CONCLUSION

Longer time spent in sleep and MVPA may mitigate the negative effects of SB on anxiety.

The effectiveness of sexual health counseling based on cognitive-behavioral therapy on sexual satisfaction and inefficient sexual beliefs of primigravida women

BACKGROUND

Pregnancy may change sex life, this period may be associated with decreased sex, and this is due to fear of miscarriage, nausea and vomiting, fear of harm to the fetus, fatigue, and fear of ruptured membranes. Midwives could help them to improve their sexual life during this period. One of the important approaches to improving sexual life during pregnancy is cognitive-behavioral therapy (CBT). This nonmedical approach could improve misconceptions about sex during pregnancy. The aim of this study was the effect of sexual health counseling based on CBT on sexual satisfaction and inefficient sexual beliefs of primigravida women.

MATERIALS AND METHODS

This was a randomized clinical trial study, the research population being 52 pregnant women who were randomly divided into groups, the experimental (26) and the control (26). Before the sexual health counseling based on CBT, the Sexual Satisfaction Questionnaire and the Inefficient Sexual Beliefs Questionnaire were filled by both the groups. These standard questionnaires were completed three times (before, immediately, and 4 weeks after intervention). After pretest, eight sexual health counseling sessions (90 min) were performed for the experimental group. The control group received routine care. Data analysis was performed by using descriptive statistics tests, ANOVA, and post hoc tests by Bonferroni method in SPSS version 22. P < 0.05 was considered statistically significant.

RESULTS

The mean score of inefficient sexual beliefs in the interventional group before intervention, immediately after the intervention, and 1 month later was obtained 22.85 ± 9.57, 12.92 ± 7.25, and 7.86 ± 13.88, respectively (P < 0.001). The mean score of sexual satisfaction before the study, immediately after the intervention, and 1 month later was 88.77 ± 11.89, 95.62 ± 9.27, and 94.65 ± 8.28, respectively, in the experimental group (P < 0.001).

CONCLUSION

Sexual health counseling based on CBT could reduce inefficient sexual beliefs and increase the sexual satisfaction of the primigravida women during pregnancy, but most participants preferred fewer sessions.

Tokophobia and Anxiety in Pregnant Women during the SARS-CoV-2 Pandemic in Poland-A Prospective Cross-Sectional Study

SARS-CoV-2 coronavirus emerged in the world at the end of 2019. The introduction of a number of restrictions had a significant effect on numerous aspects of human life with particular influence being exerted on pregnant women and their sense of security. The study aimed to assess the level of anxiety and its main determinants in women in the third trimester of pregnancy during the coronavirus pandemic. The study technique included the present purposely designed questionnaire, Labor Anxiety Questionnaire (KLPII), and the State-Trait Anxiety Inventory (STAI). The study was conducted in a group of 315 women in the third trimester of pregnancy. A total of 258 women (81.9%) completed the questionnaire in May 2020, and 57 of them (18.1%) completed it in October 2020. The overall analysis of the Labor Anxiety Questionnaire and the STAI inventory revealed a high level of anxiety, particularly situational anxiety, in pregnant women during the SARS-CoV-2 pandemic. The age and financial status of the women were the factors which contributed to the intensification of tokophobia. Women interviewed in October 2020 were characterized by higher tokophobia levels compared to the respondents included in May 2020. It seems justified to in-crease the vigilance in the diagnostics of possible mental disorders in the perinatal period during pandemic.

Determinants of Pregnancy-Related Anxiety among Women Attending Antenatal Checkup at Public Health Institutions in Debre Markos Town, Ethiopia

BACKGROUND

Pregnancy-related anxiety has been associated with many pregnancy adverse outcomes including preterm birth, low birth weight, postpartum depression, and resulting in long-term sequels on the child's emotional, cognitive, and behavioral development. This study is aimed at assessing the magnitude of pregnancy-related anxiety and associated factors among pregnant women attending antenatal checkup at Debre Markos town public health institutions, Northwest Ethiopia.

METHODS

An institution-based cross-sectional study was conducted among 423 pregnant women at Debre Markos town, Northwest Ethiopia, from February 1^st to March 30^th, 2021. A systematic random sampling technique was used to select the study participants. Data were collected sing a structured, pretested, and interviewer-administered questionnaire. The collected data were entered with Epi-data version 4.6 and then exported to SPSS version 23. Both bivariable and multivariable logistic regression analyses were undertaken to identify significantly associated variables with pregnancy-related anxiety. The adjusted odds ratio (AOR) with its 95% confidence interval (CI) at a p value of ≤0.05 was used to claim statistical association.

RESULT

In this study, a total of 408 pregnant women participated, giving a 96.4% response rate. The prevalence of pregnancy-related anxiety was found to be 43.9% (95% CI: 39.5, 49.2). Having no formal education (AOR = 3.37; 95% CI: 1.32, 8.58), primigravida (AOR = 1.94; 95% CI: 1.17, 3.24), intimate partner violence (AOR = 2.88; 95% CI: 1.47, 5.64), and poor social support (AOR = 2.05; 95% CI: 1.18, 3.56) was significantly associated with pregnancy-related anxiety.

CONCLUSION

In this study, the prevalence of pregnancy-related anxiety was found to be high when compared to other study findings. The regional educational department should give emphasis for gender pedagogies which pay attention to the specific learning needs of girls. In addition, interventions on violence against women and social support for the women may reduce the problem.

Risk And Resilience Factors Influencing Postpartum Depression And Mother-Infant Bonding During COVID-19

Acute stress during pregnancy can have adverse effects on maternal health and increase the risk for postpartum depression and impaired mother-infant bonding. The COVID-19 pandemic represents an acute environmental stressor during which it is possible to explore risk and resilience factors that contribute to postpartum outcomes. To investigate prenatal risk and resilience factors as predictors of postpartum depression and impaired mother-infant bonding, this study recruited a diverse cohort of 833 pregnant women from an urban medical center in Philadelphia, Pennsylvania, and assessed them once during pregnancy in the early phase of the COVID-19 pandemic (April-July 2020) and again at approximately twelve weeks postpartum. Adverse childhood experiences, prenatal depression and anxiety, and COVID-19-related distress predicted a greater likelihood of postpartum depression. Prenatal depression was the only unique predictor of impaired maternal-infant bonding after postpartum depression was controlled for. Women reporting greater emotion regulation, self-reliance, and nonhostile relationships had healthier postpartum outcomes. Policies to increase the number of nonspecialty providers providing perinatal mental health services as well as reimbursement for integrated care and access to mental health screening and care are needed to improve lifelong outcomes for women and their children.

Mindfulness-based intervention in Chinese pregnant women with recurrent miscarriage: A non-randomized controlled study

OBJECTIVE

Pregnant women with recurrent miscarriage have high rates of anxiety and depression. Mindfulness-based interventions have shown benefits in improving mental health in diverse populations; however, few studies have explored their efficacy in pregnant women with recurrent miscarriage, which was investigated in the present study.

DESIGN

A nonrandomized controlled study was carried out from August 2019 to November 2020.

SETTING

The study was conducted at a regional teaching hospital in Guangzhou, China that provides leading care for recurrent miscarriage.

PARTICIPANTS

A total of 158 pregnant women with recurrent miscarriage were recruited and allocated to the intervention group (n = 79) or the control group (n = 79); 131 women completed the study.

INTERVENTION

The mindfulness-based intervention consisted of a 1-h education session and daily mindfulness exercises guided by audio recordings during hospitalization.

MEASUREMENTS AND FINDINGS

Study outcomes included perceived stress measured with the Perceived Stress Scale; symptoms of anxiety and depression measured with the Self-rating Anxiety Scale and Edinburgh Postnatal Depression Scale, respectively; and positive and negative affect measured with the Positive Affect and Negative Affect Scale - Revised, respectively. Compared to the control group, participants in the intervention group showed significant decreases in perceived stress, depression symptoms, and negative affect and an increase in positive affect after the intervention. Anxiety increased significantly in the control group during the study but remained unchanged in the intervention group.

KEY CONCLUSIONS

A mindfulness-based intervention can reduce psychological symptoms and improve mental health in pregnant women with recurrent miscarriage.

IMPLICATIONS FOR PRACTICE

A mindfulness-based intervention should be incorporated into routine care to help improve the mental health of pregnant women with recurrent miscarriage.

Interactive relations between maternal prenatal stress, fetal brain connectivity, and gestational age at delivery

Studies reporting significant associations between maternal prenatal stress and child outcomes are frequently confounded by correlates of prenatal stress that influence the postnatal rearing environment. The major objective of this study is to identify whether maternal prenatal stress is associated with variation in human brain functional connectivity prior to birth. We utilized fetal fMRI in 118 fetuses [48 female; mean age 32.9 weeks (SD = 3.87)] to evaluate this association and further addressed whether fetal neural differences were related to maternal health behaviors, social support, or birth outcomes. Community detection was used to empirically define networks and enrichment was used to isolate differential within- or between-network connectivity effects. Significance for χ2 enrichment was determined by randomly permuting the subject pairing of fetal brain connectivity and maternal stress values 10,000 times. Mixtures modelling was used to test whether fetal neural differences were related to maternal health behaviors, social support, or birth outcomes. Increased maternal prenatal negative affect/stress was associated with alterations in fetal frontoparietal, striatal, and temporoparietal connectivity (β = 0.82, p < 0.001). Follow-up analysis demonstrated that these associations were stronger in women with better health behaviors, more positive interpersonal support, and lower overall stress (β = 0.16, p = 0.02). Additionally, magnitude of stress-related differences in neural connectivity was marginally correlated with younger gestational age at delivery (β = -0.18, p = 0.05). This is the first evidence that negative affect/stress during pregnancy is reflected in functional network differences in the human brain in utero, and also provides information about how positive interpersonal and health behaviors could mitigate prenatal brain programming.

Pregnancy and work stress: investigation of factors relating stress level of pregnant working women in Indonesia

OBJECTIVE

To identify factors related to the stress levels among pregnant women in Indonesia.

METHOD

The study was used cross sectional design. The participants were 92 pregnant women who worked at a footwear manufacturer at Banten, Indonesia. Half of the participants worked less than 40h per week and the other half worked 40h or more per week. A test instrument to measure stress in pregnant women was developed and conducted in this study. Dependent and independent factors were analyzed by the chi-square test.

RESULTS

Our results showed that 59.78% of respondents had their gestational age was more than 31 weeks; 53.00% of workers experienced moderate stress; and as many 53.26% of respondents experienced a high workload.

CONCLUSIONS

Our conclusion confirmed gestational age, workload, and working time related with work stress level of pregnant women significantly.

Australian massage therapists' views and practices related to preconception, pregnancy and the early postpartum period

BACKGROUND AND PURPOSE

Massage is commonly used by the Australian public and is often sought by expectant mothers. Despite its popularity there is no regulatory body to enforce minimum educational standards, guidelines or evidence-based best practice for massage therapists. The aim of this paper is to critically examine the views and practices of massage therapists who offer preconception, antenatal or postnatal massage.

MATERIALS AND METHODS

An online survey was administered to Australian massage therapists who provide massage in the preconception, antenatal or postnatal periods.

RESULTS

Ninety-nine therapists completed the survey. The majority of respondents had received training in pregnancy massage (n = 72; 72.7%) only. The most confident respondents were those that had both training and experience.

CONCLUSION

There are potential gaps in training for massage therapists including up-to-date curriculum and a fragmentation around industry training requirements for pregnancy massage, which may impact on the safety and benefits of pregnancy massage.

COVID-19-related anxiety and concerns expressed by pregnant and postpartum women-a survey among obstetricians

This paper from India describes anxieties that pregnant and postpartum women reported to obstetricians during the COVID-19 pandemic. Of the 118 obstetricians who responded to an online survey, most had been contacted for concerns about hospital visits (72.65%), methods of protection (60.17%), the safety of the infant (52.14%), anxieties related to social media messages (40.68%) and contracting the infection (39.83%). Obstetricians felt the need for resources such as videos, websites and counselling skills to handle COVID-related anxiety among perinatal women.