Journal of Psychosomatic Obstetrics & Gynecology最新文献

Objective: To explore the global burden of female infertility from 1990 to 2021 by examining trends in prevalence and years lived with disability (YLD).

Methods: Data from the Global Burden of Disease Study 2021 (GBD 2021) were analyzed with a focus on the prevalence and YLD of female infertility in women aged 15-49 years. Statistical models were used to estimate ASPRs and YLD across regions and countries.

Results: The global prevalence of female infertility was 110.1 million in 2021, with an age-standardized rate of 2,764.6 per 100,000 population. The YLD for infertility in 2021 was 601,134, which represented a 33.1% increase since 1990. Regionally, East Asia and Eastern Europe had the highest rates of infertility, whereas Australasia had the lowest rate.

Conclusions: The study highlights a significant rise in the burden of female infertility, particularly in high-income regions. Study findings emphasize the need for targeted public health strategies and healthcare interventions to address this growing issue.

Objective: Numerous studies have linked abortion to an elevated risk of suicide. One hypothesis is that this association is entirely incidental and most likely fully explained by preexisting mental illness. This hypothesis can be tested by examining women's own self-assessments of the degree, if any, that abortion and other pregnancy outcomes contributed to suicidal thoughts and behaviors.

Methods: A topic blind survey was distributed to 2829 American females 41-45 years of age. Respondents were asked about any history of attempted suicide(s) and reproductive histories. Grouped by reproductive history, respondents were then asked to rank on visual analog scales the degree, if any, to which their pregnancy outcome contributed to suicidal thoughts, self-destructive behaviors, and any attempted suicides.

Results: Aborting women were twice as likely to have attempted suicide compared to other women. Aborting women, especially those who underwent coerced or unwanted abortions, were significantly more likely to say their pregnancy outcomes directly contributed to suicidal thoughts and behaviors compared to women in all other groups.

Conclusions: The hypothesis that higher rates of suicide following abortion can be entirely explained by preexisting mental health problems is inconsistent with women's own self-assessments of the degree their abortions directly contributed to suicidal and self-destructive behaviors.

Objectives: Adverse Childhood Experiences (ACE) may be associated with unintended pregnancies (UPs). Our aim was to investigate whether there is an association between a history of ACE, type of ACE or number of ACE and the risk for UPs and if this risk is mediated by psychiatric vulnerabilities.

Study design: A cross-sectional study with participants recruited from the OLVG hospital was performed. Pregnant patients older than 18 years, literate in either Dutch or English were included. Patients with florid psychosis were excluded. ACEs were self-reported and assessed via the Childhood Trauma Questionnaire, pregnancy intention was extracted from the patient database and psychiatric vulnerability was self-reported. The association between ACE and UPs was analyzed by means of logistic regressions, followed by a mediation analysis with psychiatric vulnerability.

Results: A total of 269 participants, mostly with a university degree (66.5%) and with a mean age of 34 (SD 4.306) were included; 20.1% had at least one ACE and 22.3% had an UP. There was no significant association between UPs and a history of ACE regardless of the type and number of ACE.

Conclusions: Future studies should replicate our findings onf the associationimpact of ACEs and psychiatric vulnerabilities on pregnancy intention within a larger, and more representative sample.

Purpose: Whilst the antenatal period is well established as a period of increased vulnerability to mental health difficulties, restrictions resulting from COVID-19 lockdown in the UK are likely to have negatively affected psychosocial outcomes in these women.

Materials and Methods: This study aimed to describe prevalence rates of clinically relevant antenatal anxiety and depression, and explore whether psychosocial changes as a result of the pandemic were predictive of clinically relevant anxiety and depression. Antenatal women (N = 684) completed an online survey of psychosocial measures during the UK government's initial lockdown restrictions.

Results: Descriptive statistics indicate women experienced high levels of anxiety and depression and that changes resulting from restrictions were perceived negatively. Whilst 11.7% of women reported a current, clinical diagnosis of depression, 47.8% reported a score of ≥13 on the EPDS, indicating clinically relevant depression. Similarly, 18.7% of women reported a current, clinical diagnosis of anxiety, but 68.1% scored ≥40 on the STAI, indicating clinically relevant anxiety. After controlling for known demographic risk factors, only psychosocial change because of COVID-19 restrictions predicted clinically relevant anxiety (28%) and depression (27%).

Conclusions: This study highlights the importance of considering antenatal women as a high-priority group, and ensuring antenatal care remains accessible and uninterrupted in any future crises.

The diagnosis gestational trophoblastic disease (GTD) is known to have a significant psychological impact on women. Our objective was to provide insight in the psychological and physical consequences of women with GTD, while also reflecting on their coping strategies and their experiences of received care. A qualitative study was carried out using semi-structured interviews among women recently diagnosed with GTD. Interviews were audio-recorded, transcribed verbatim and analyzed using a thematic network approach. Eight interviews were analyzed. The abruptness of the diagnosis resulted in women feeling sad, uncertain and powerless. Coping strategies included seeking emotional support, accurate information, peer connections and distraction. Women were generally satisfied with care, emphasizing personalization, empathy, medical expertise and feeling heard as important aspects. They appreciated offered psychological support from specialized nurses. Nevertheless, aspects such as provided information, communication and logistical issues need improvement. The results of this study emphasize the importance of comprehensive patient information, the need for personalized psychological support and more frequent consultations at reference centers, while treatment is conducted locally.

Objective: This study evaluated the relationship between treatment for depression and anxiety in pregnancy and the risk of obesity.

Design: Multivariate logistic regression analysis, nested case control study design.

Setting: Births occurring 2008-2022 at an outer-suburban, lower socioeconomic maternity hospital in Australia. Population: 75,308 eligible births. Main outcome measures: BMI ≥ 30 (obesity), BMI ≥ 35 (severe obesity/obesity class II and III).

Results: In this analysis, we found an adjusted OR of 1.56 of BMI ≥ 30, p < .000 with CI (1.35-1.80) in women taking antidepressants in pregnancy, OR 1.56 of BMI ≥ 35, p < .000, CI (1.31-1.84). Within this dataset, a cohort of 7559 women with a history or current diagnosis of depression or anxiety were found; adjusted OR of 1.40 of BMI ≥ 30, p < .000, CI (1.22-1.60) in women within this group taking antidepressants. Rates of severe obesity were similar in this cohort, BMI ≥ 35; OR 1.39, p < .000; CI 1.18-1.62).

Conclusions: These results suggest an increase in rates of obesity in women taking antidepressants in pregnancy not accounted for by other risks for obesity which might accrue from current mental ill-health or other cohort effects such as genetic vulnerability or lifestyle factors. This outcome is important in relation to the care of pregnant women with depression and anxiety. In view of current high rates of prescribing of antidepressants in pregnancy and the postpartum, this research may help inform clinician decision-making for women at risk of obesity in pregnancy.

The aim of this study was to apply complexity theory to explain and understand how risk factors combined in complex ways, eventually leading to a high prevalence of depressive symptoms among pregnant women. We also aimed to evaluate whether depressive symptoms affected delivery approach. The study had a longitudinal design and was conducted between May and September 2017. A total of 481 pregnant women were recruited to participate and completed closed-end surveys at two distinct times: during prenatal care at the hospital after 26 weeks of pregnancy and 1 to 4 weeks after delivery. This study identified eleven different pathways that led to an increase in depressive symptoms. Each pathway differentiated the effects of different influencing factors. Among the 481 pregnant women, 128 (26.6%) had cesarean deliveries without medical indications. Although depressive symptoms could affect delivery approach, it was not the most important factor. Surprisingly, the first production emerged as the key factor determining delivery mode. This study was innovative in that it examined which factors and which combinations of factors were necessary for the development of depressive symptoms. Additionally, this study provided a better understanding of the mechanisms underlying the choice of cesarean section without medical indications.

Background: This study aims to examine whether the Edinburgh Postnatal Depression Scale (EPDS), excluding the self-harm item (EPDS-9), performs as effectively as the full EPDS in identifying depression among perinatal women.

Methods: A total of 3571 pregnant women and 3850 postpartum women participated in this observational study. Participants who scored ≥ 9 on the EPDS underwent further diagnostic evaluations by a clinical psychologist and/or psychiatrist.

Results: The EPDS-9 and full EPDS demonstrated a near-perfect correlation in both the antepartum (r = 0.996) and postpartum (r = 0.998) cohorts. EPDS-9 showed exceptional precision in identifying depression as screened by the full EPDS at cutoff points ranging 9-14, with areas under the curve ≥0.998. The sensitivity of EPDS-9 and full EPDS to detect depression that requires psychotropic medications was poor. The highest accuracy for both versions was at a cutoff score of 9: sensitivity of 0.579 for the full EPDS and 0.526 for the EPDS-9. At the cutoff point of 9, EPDS-9 performed adequately in predicting the response of the participants to the self-harm item.

Conclusion: The EPDS-9 represents a solid and effective replacement for the full EPDS in clinical settings. If the presence of suicidal thoughts needs to be assessed, specialized scales should be used.

This study aims to explore the correlation between different social support patterns and perinatal mental health, and the mediating role of social trust in this. A cross-sectional survey was conducted in Jiangsu, China, with a sample size of 1705 pregnant respondents. Latent class analysis (LCA) was utilized to identify various social support patterns, while a multiple regression model was employed to analyze the mediating effect of social trust on the relationship between social support patterns and perinatal mental health. The study found four distinct social support patterns among the respondents: primary relationship-centric support, overall weak support, primary-secondary relationship-balanced support, and overall strong support. In the relationship between social support patterns and perinatal mental health, social trust played both a partial and full mediating role. The findings indicate that a social support system that enhances maternal trust and promotes honest disclosure of symptoms can effectively promote perinatal mental health.

Poor perinatal mental health is associated with deleterious effects and individuals with low socioeconomic status (SES) are at elevated risk. Fortifying multi-level resources of low-SES pregnant individuals to boost their well-being is a crucial step toward achieving equity in perinatal health. The purpose of this project was to explore what patterns of resources supported well-being among low-SES pregnant individuals in Colorado. In a prospective mixed methods cohort study, 23 low-SES pregnant individuals completed surveys and interviews. Participants were separated into 3 subgroups based on their overall Warwick-Edinburgh Mental Well-being Scale (WEMWBS) score and interviewed to identify multi-level resources that supported their well-being. Our analysis was framed by Self-Determination Theory which contends that three universal basic psychological needs are required for individuals to function in a healthy manner: autonomy, competence, and relatedness. We extrapolated resources that promoted perinatal competence, autonomy, and relatedness from the high well-being group. Perinatal-related knowledge (construct related to competence); mindfulness and intended pregnancy (constructs related to autonomy); and emotional, informational, and friend support, social capital, and connection to nature (constructs related to relatedness) were identified as the resources more frequently endorsed in the high well-being group. Targeting interventions to fortify specific multi-level resources that support the autonomy, competence, and relatedness of pregnant individuals facing socioeconomic disadvantage is a crucial step toward achieving equity in perinatal health.