Journal of Psychosomatic Obstetrics & Gynecology最新文献

Purpose: The applicability of the Zung self-rating depression scale (SDS) in pregnancy is unknown. We aimed to identify redundant items and evaluate the Zung SDS's structural validity.

Method: Two samples of pregnant women were invited from two districts in Shanghai (Yangpu sample, n = 6468 and Huangpu sample, n = 402). The Yangpu sample was randomly split into YGroup1/2/3. Item's properties were evaluated via the item response theory in YGroup1. Exploratory and confirmatory factor analyses were correspondingly executed in YGroup2 and YGroup3. Those items with discrimination parameter (α) lower than 0.65 or factor loading smaller than 0.4 were deleted from the scale. The final structure was validated in the Huangpu sample.

Results: Items 4 (sleep), 7 (weight loss), 8 (constipation) and 9 (tachyarrhythmia) exhibited low discrimination power. Items 2 (diurnal variation), 5 (appetite), 10 (fatigue) and 19 (suicide idea) made a low contribution to all factors. A three-factor model was eventually constructed as cognitive (Items 14, 16, 17, 18 and 20), psychomotor (Items 6, 11 and 12) and affective (Items 1, 3, 13 and 15).

Conclusion: The Zung SDS needs modification before applied to pregnant women in China. The items describing the overlap symptoms of the physical change in pregnancy and mood disorder should be deleted.

Purpose of the study: to examine whether women's and men's infertility-related stress, and specifically its sexual concerns aspect, is related to their and their partner's sexual satisfaction.

Materials and methods: In a cross-sectional study, 94 couples experiencing infertility filled out the New Sexual Satisfaction Scale and Fertility Problem Inventory, which measures infertility-related stress with dimensions of social, sexual and relationship concerns, rejection of childfree lifestyle, and need for parenthood. Dyadic analyses were performed following the Actor-Partner Interdependence Model (APIM).

Results: The dyadic analysis revealed that women's and men's greater infertility-related stress contributed to their lower levels of sexual satisfaction (actor effect). Moreover, women's and men's greater sexual concerns (as the aspect of infertility-related stress) contributed to their own and their partner's lower levels of sexual satisfaction (actor and partner effect).

Conclusions: The findings suggest that both individual and relational processes are important in the association between the specific dimension of infertility-related stress and sexual satisfaction. These findings could guide the psychosocial support for couples experiencing infertility.

Background: Stress-induced pregnancy complications are thought to represent a significant cause of maternal morbidity and mortality; little is known regarding types of stress most predictive of adverse outcomes.

Methods: We used Utah PRAMs 2012-2014 data to evaluate links between preconception life stressors and prevalence of hypertensive disorders of pregnancy (HDP) and pre-term labor (PTB) (births <37 weeks gestational age, and very PTB <33 weeks). We categorized 12 specific stressful events into 4 groups: partner, traumatic, financial, and emotional. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated controlling for important sociodemographic, lifestyle, and pregnancy history factors.

Results: 4,378 mothers completed the survey. 26.6%, 12.2%, 32.2%, and 28.4% reported partner, traumatic, financial, and emotional-related stress. Reporting any of the 4-types of life stress was linked with increased prevalence of HDP (aPR: 1.46 [95% CI: 0.96, 2.22]) after adjusting for age, race/ethnicity, BMI, education, prior diagnosis of high blood pressure, and prior history of preterm labor. The strongest association was observed for financial stress (aPR: 1.50 [95% CI: 1.03, 2.18]). Financial stress was also associated with increased prevalence of very PTB (aPR: 1.61 [95% CI: 1.03, 2.51]) after adjustment.

Conclusion: Women reporting financial stress, including job loss, pay reduction, or difficulty paying bills, had increased prevalence of HDP and very PTB.

Objective: To identify the factors of postpartum depression among teen mothers.

Method: A convenient sample of 120 teen mothers who were aged 15 to 19 years (M = 18.02, SD = 1.16) were recruited. Depression and its related factors were assessed with Edinburgh Postnatal Depression Scale, Eating Disorder Inventory (Body Dissatisfaction and Drive for Thinness subscales), Parental stress index (Parental distress and Parental-child dysfunctional interaction subscales), Frost Multidimensional Perfectionism Scale (parental criticism of parenting subscale) and Multidimensional Scale of Perceived Social Support. Both descriptive and analytical analyses were performed using Statistical Package for the Social Sciences (SPSS version 22).

Results: Results showed that 48% of sample had clinically high levels of depressive symptoms. Its associated factors were parental distress (β = .297, t = 3.378, p = .001), weight/shape disturbances (β = .217, t = 2.42, p = .017), economic income (β = -.210, t = -2.32, p = .022) and parental-child dysfunctional interaction (β = .20, t = 2.08, p = .03) among seven factors considered.

Conclusion: Regression analyses showed that parental distress, weight/shape disturbances, economic income and parental-child dysfunctional interaction predicted unique variance associated with depression level. These findings are discussed in light of future work and the persistent need to inform prevention and treatment programs for teen mothers.

Objectives: To investigate whether patients with polycystic ovary syndrome (PCOS) are at increased risk for incident schizophrenia and whether PCOS treatment (clomiphene, cyproterone, or metformin) affects the incidence of schizophrenia.

Methods: An overall of 7146 PCOS patients and 28,580 non-PCOS controls matched by age, index year, and Charlson Comorbidity Index (CCI) score were included between 2000 and 2012 and followed up until 2013 using a validated nationally representative sample from Taiwan. Participants newly diagnosed as schizophrenia were defined as incidents. Cox regression analysis was used to calculate the hazard ratio (HR) with a 95% confidence interval (CI) of the schizophrenia incidence rate between the two studied groups.

Results: PCOS patients were at increased risk of incident schizophrenia compared to non-PCOS controls after adjusting for age, CCI score, comorbidities, and different treatment options (0.49 versus 0.09 per 1000 person-years, HR: 6.93, 95% CI: 3.25-14.7). After adjusting for above-mentioned covariates, metformin treatment had a protective effect against the incident schizophrenia compared to non-users (HR: 0.16, 95% CI: 0.06-0.41). Also, treatment with clomiphene and cyproterone had only a limited impact on the incident schizophrenia.

Conclusion: This study shows PCOS patients are at increased risk of incident schizophrenia, and the metformin treatment has a protective effect against incident schizophrenia.

Objective: To analyze an association of eating disorders (EDs) to reproductive health outcomes among former adolescent psychiatric inpatients, hospitalized between the ages 13 and 17 years. The register-based follow-up information on psychiatric comorbidity and use of prescribed addictive psychotropic medication up to early adulthood were also explored.

Methods: A total of 31 (10.3%) women with a diagnosed ED were identified from the initial sample of 300 female adolescents, treated in psychiatric inpatient care between 2001 and 2006. The K-SADS-PL and EuropASI research instruments were used to gather information during the adolescent psychiatric hospitalization. The follow-up data for reproductive health outcomes and psychiatric comorbidity up to early adulthood were obtained from the national health care registers. Information on prescribed addictive psychotropic medication was provided by the Social Insurance Institution of Finland. In analyses, EDs were categorized into anorexia nervosa (AN) and other EDs (OED). AN accounted for 58.1% of all EDs. Of OEDs, the majority (69.1%) were bulimia.

Results: None of the women with AN, but 53.8% of those with OED had undergone medical abortions by early adulthood. Childbirths were emphasized in women with OED (61.5%) and a history of hospital-treated poisonings in women with AN (55.6%). High nicotine dependence in adolescence (30.8%) was a characteristic of women with OED.

Conclusion: Our study findings suggest that OED may expose affected women to various unfavorable reproductive health outcomes, particularly women with a history of psychiatric admissions. Recognizing the differences in young women with different subtypes of ED is important when discussing contraception and pregnancy.

Purpose: To describe the role of intuition for maternity care workers in deciding when a cesarean section should be advised during labor.

Material and methods: Focus group discussions with midwives and gynecologists, and nonparticipating observation at an obstetric ward.

Results: The decision about when to propose a cesarean section during labor is the result of interaction between objective and intuitive factors. Junior delivery ward workers report that they use more analytic reasoning for objective diagnosis of fetal distress, non-progressive labor, macrosomia or other indications for cesarean section; with increasing experience, however, non-analytic reasoning takes the overhand. Both consciously and unconsciously, other activities going on outside the individual delivery room seem to influence the decision. Out of the 50 deliveries observed, 38 births occurred through vaginal deliveries and 12 through cesarean sections. Maternity care workers clearly have "gut feelings" that the course of labor is moving toward a cesarean section. We were unable to detect any predictable pattern in the transition from gut feeling to decision.

Conclusion: Intuition plays a still not completely uncovered role in the decision to advise cesarean section during labor. The level of consciousness at which professionals use intuition or gut feeling and are aware of it in decision making is variable. Intuition or gut feelings seem to contribute more to the decision process as the level of experience increases.

Purpose: To evaluate whether severe postpartum hemorrhage (PPH) is a risk factor for posttraumatic stress disorder (PTSD). Severe PPH can be experienced as a traumatic event. PTSD leads to negative mental health effects. Knowing risk factors for PTSD during childbirth offers opportunities for early interventions, which may prevent the development of PTSD.

Materials and methods: In this prospective study, we compared two groups of participants; women with ≥2000 mL of blood loss (severe PPH, patients) and women with ≤500 mL of blood loss (controls). Participants were screened for PTSD using the PCL-5 four to six weeks after delivery. Positive screening was followed by the CAPS-5 to diagnose PTSD.

Results: We included 187 PPH patients and 121 controls. Median PCL-5 scores were higher for PPH patients (5.0) than controls (4.0, p = 0.005). Thirteen PPH patients (7.0%) and two controls (1.7%) scored ≥32 on the PCL-5, indicative of probable PTSD (OR 4.45, 95% CI 0.99-20.06, p = 0.035). Significant more PPH patients than controls met criteria for a clinical diagnosis of PTSD on the CAPS-5 (n = 10, 5.6% vs n = 0, 0.0%; p = 0.007).

Conclusions: There is a significant and clinically relevant increased risk for developing PTSD after severe PPH. Gynecologists and midwives are advised to screen for PTSD at postpartum follow-up visits to prevent long-term negative mental health effects.

Clinical trial registration: NL50273.100.14.

Objective: To prospectively investigate perinatal grief in women with pregnancy loss.

Methods: A total of 215 women (mean (SD) age: 30.7 (5.9) years) who experienced pregnancy loss were included. Data on sociodemographic, marital and obstetric characteristics and Perinatal Grief Scale (PGS) (first 48 h, 1 week, 1 month and 3 months after the loss) were recorded.

Results: Active grief scores were lower (p ranged  < .05 to <.01), while difficulty coping (p < .05 for each) and despair (p < .05 for each) scores were higher in the 3rd month as compared with prior assessments. All PGS scores at the 48 h and 3rd month assessments were significantly higher in assisted and planned pregnancies (p < .01 for each). Maternal age was positively correlated with 48 h active grief (r = 0.19, p < .001), despair (r = 0.13, p < .05) and total PGS (r = 0.13, p < .05) scores. Parity and the number of children were negatively correlated (r ranged from -0.35 to -0.20, p < .01 for each) with all PGS scores.

Conclusion: Our findings revealed decrease in active grief levels, whereas gradual increase in difficulty coping and despair in women with pregnancy loss within the first 3 months of losing a child. Our finding indicate association of older maternal age, primiparity, assisted and planned pregnancies with regular antenatal follow up with higher total PGS scores as well as active grief, difficulty coping and despair scores in women regardless of the time of assessment within 3 months after the pregnancy loss.