Journal of Psychosomatic Obstetrics & Gynecology最新文献

There are several factors that influence women's childbirth experience, and personal interactions with health professionals are of particular significance. The main objective of this study was to present the validation of an abbreviated form of an existing questionnaire on attitudes about childbirth in medical and nursing students. We used a sample of 512 perinatal medicine and nursing students who received the original 52-item CAVE-st questionnaire to obtain a shorter version with proper psychometric properties. We used Cronbach's alpha coefficient to evaluate the new version's internal consistency. The Kaiser- Meyer-Olkin test and the Barlett sphericity test were performed to assess the suitability of exploratory factor analysis (EFA). Subsequently, confirmatory factor analysis (CFA) was performed using structural equation models in a second sample of 139 medical students. We obtained a 15-item version with a Cronbach's alpha of 0.82. The EFA revealed a four-dimensional structure, similar to the full 52-item version. In the CFA the adjustment indexes showed good model fitness, RMSEA= 0.046 [CI 0.00-0.07]; CFI = 0.978. We can conclude that the 15-item version is a valid tool for evaluating the attitude of students toward childbirth, pointing out the matters that should be improved in their training to avoid obstetric trauma by the promotion of a positive experience in women during childbirth.

This narrative review explores the relationship between psychological stress and ovulatory disorders, focusing on the molecular mechanisms involved. Ovulation is regulated by the hypothalamus-pituitary-ovarian (HPO) axis, and disruptions in this axis can lead to ovulatory dysfunction. Chronic psychological stress affects the HPO axis, resulting in abnormalities in hypothalamus hormone secretion, pituitary hormone release, and ovarian function. These disruptions cause ovulation disorders and menstrual irregularities. The mechanisms by which psychological stress affects ovulation involve alterations in neuropeptides and hormones, activation of the hypothalamic-pituitary-adrenal (HPA) axis, impairment of follicular development, generation of oxidative stress, and the decline in ovarian reserve function. Understanding these mechanisms is crucial for developing interventions to restore reproductive health. Psychological interventions, such as cognitive-behavioral therapy, have shown promise in improving ovulation and pregnancy rates in women with ovulatory disorders. Further research is needed to explore the specific mechanisms of these interventions and optimize treatment strategies. Addressing psychological factors is essential in managing reproductive health and ovulatory disorders.

Objectives: To gain a deeper understanding of the real experiences and needs of the patients of Peutz-Jeghers syndrome (PJS) with fertility concerns.

Design: A qualitative study.

Methods: Phenomenological research and Semi-structured method were conducted with the patients of PJS (N = 16), and the interview data were analyzed using inductive content analysis strategies.

Results: 16 patients were interviewed, including 13 women and 3 men partners. We identified 5 themes, including: (i) Heritability of disease, (ii) Potential risks of reproduction; (iii) The difficulties in raising children; (iv) family and social support. (V) Need support from multiple sources.

Conclusion: The findings of this study demonstrate that patients with Peutz-Jeghers syndrome (PJS) who are of childbearing age experience various reproductive concerns and other manifestations. Therefore, it is essential to offer individualized psychological interventions for PJS patients at different psychological stages, with the support of healthcare professionals, family, and social networks.

Perinatal anxiety disorders (PAD) affect one in five pregnant/postpartum people and are associated with adverse maternal and child health outcomes. Effective treatment and prevention rely on early identification and management of risk factors. Our study fills a gap in literature about how maternal adverse childhood experiences (ACEs) relate to PAD during and beyond the postpartum period. Using longitudinal data from a population-based sample of mothers in Colorado, USA (N = 1116), we evaluated whether maternal ACEs predicted self-reported anxiety symptoms, measured six times between 3 and 36 months postpartum. A mixed mean model of anxiety was fit with ACEs as the predictor and maternal age, race, ethnicity, education, marital status, and parity as covariates. Controlling for sociodemographic covariates, mothers reporting four or more ACEs had significantly higher levels of anxiety than those reporting less than four ACEs (b = 0.84, 95% CI (0.53, 1.15), p<.001) over the three-year period. Mothers of younger age at time of birth (25-34 years vs. <24 years: b=-0.54, 95% CI (-1.00, -0.08), p=.02) and non-Hispanic ethnicity (b = 0.47, 95% CI (0.09, 0.85), p=.01) were also found to have higher anxiety over this period. Our findings support screening for and addressing maternal ACEs early in obstetric care and well-child visits through trauma-informed, strengths-based approaches that promote maternal, child, and intergenerational well-being.

Introduction: This study aimed to examine important points of focus, trends, and depth of research on non-pharmacological interventions for the management of labor pain worldwide from a macro perspective and present an extensive definition of research fields regarding non-pharmacological interventions.

Methods: Bibliometric methods were used in this study. With comprehensive keyword lists, the Web of Science and PubMed databases were searched using different screening strategies for publications made until 25 February 2023.

Results: Studies on non-pharmacological interventions in the management of labor pain have continued to develop since 2003 with great momentum. In this study, the most productive country in research on non-pharmacological interventions was found to be Iran, while Australia, the USA, China, and the United Kingdom were the most notable ones in terms of collaboration. The most prevalently studied non-pharmacological interventions were hydrotherapy and acupuncture. The results of the co-word analysis revealed 5 main themes about this field of research.

Conclusion: The results of this study showed that interest in studies on non-pharmacological interventions in the management of labor pain has increased, the quality of research in the field is high, international collaboration is increasingly higher, and technological approaches have started to emerge in relevant studies.

Objective: To assess the impact of low-dose aspirin (LDA) on obstetrical outcomes through a meta-analysis of placebo-controlled randomized controlled trials (RCTs).

Methods: A systematic search of the PubMed, Cochrane Library, Web of Science and Embase databases from inception to January 2024 was conducted to identify studies exploring the role of aspirin on pregnancy, reporting obstetrical-related outcomes, including preterm birth (PTB, gestational age <37 weeks), small for gestational age (SGA), low birth weight (LBW, birthweight < 2500g), perinatal death (PND), admission to the neonatal intensive care unit (NICU), 5-min Apgar score < 7 and placental abruption. Relative risks (RRs) were estimated for the combined outcomes. Subgroup analyses were performed by risk for preeclampsia (PE), LDA dosage (<100 mg vs. ≥100 mg) and timing of onset (≤20 weeks vs. >20 weeks).

Results: Forty-seven studies involving 59,124 participants were included. Compared with placebo, LDA had a more significant effect on low-risk events such as SGA, PTB and LBW. Specifically, LDA significantly reduced the risk of SGA (RR = 0.91, 95% CI: 0.87-0.95), PTB (RR = 0.93, 95% CI: 0.89-0.97) and LBW (RR = 0.94, 95% CI: 0.89-0.99). For high-risk events, LDA significantly lowered the risk of NICU admission (RR = 0.93, 95% CI: 0.87-0.99). On the other hand, LDA can significantly increase the risk of placental abruption (RR = 1.72, 95% CI: 1.23-2.43). Subgroup analyses showed that LDA significantly reduced the risk of SGA (RR = 0.86, 95% CI: 0.77-0.97), PTB (RR = 0.93, 95% CI: 0.88-0.98) and PND (RR = 0.65, 95% CI: 0.48-0.88) in pregnant women at high risk of PE, whereas in healthy pregnant women LDA did not significantly improve obstetrical outcomes, but instead significantly increased the risk of placental abruption (RR = 5.56, 95% CI: 1.92-16.11). In pregnant women at high risk of PE, LDA administered at doses ≥100 mg significantly reduced the risk of SGA (RR = 0.77, 95% CI: 0.66-0.91) and PTB (RR = 0.56, 95% CI: 0.32-0.97), but did not have a statistically significant effect on reducing the risk of NICU, PND and LBW. LDA started at ≤20 weeks significantly reduced the risk of SGA (RR = 0.76, 95% CI: 0.65-0.89) and PTB (RR = 0.56, 95% CI: 0.32-0.97).

Conclusions: To sum up, LDA significantly improved neonatal outcomes in pregnant women at high risk of PE without elevating the risk of placental abruption. These findings support LDA's clinical application in pregnant women, although further research is needed to refine dosage and timing recommendations.

Pregnancy-specific anxiety (PSA) has been differentiated from general anxiety (GA) to better account for the heterogeneity of prenatal anxiety and possible measurement bias. A longitudinal study was conducted to determine the evolution of maternal anxiety symptoms during pregnancy, distinguishing PSA and GA, and the influence of maternal attachment A sample of 155 women (mean age 32.5, SD 3.88) were enrolled in their first trimester of pregnancy (T1) in one center and follow throughout their pregnancy. The Relationship Scales Questionnaire (RSQ), the State-Trait Anxiety Inventory (STAI), and the Pregnancy-Related Anxiety Questionnaire (PRAQ) were completed at T1, and, for the last two, at the second (T2) and third trimesters of pregnancy (T3). Multi-level model found significant decreases in the PRAQ total score and the STAI total score between T1 and T3, but only the PRAQ total score decreased from T1 to T2. Preoccupied maternal attachment was independently associated with higher PRAQ and STAI total scores at T1, T2, and T3. Considering the progressive decline of the levels of PSA and GA during pregnancy, interventions should focus on pregnant mothers with risk factors for a persisting course of anxiety such as preoccupied attachment.

Objective: This study aimed to investigate the association between depressive symptoms and pregnancy losses, as well as the moderating effects of demographic variables, including age, income level and ethnicity.

Methods: Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) questionnaire, with key variables such as "loss of interest," "feeling down," and "sleep disturbances." Weighted linear regression models evaluated the relationship between depressive symptoms and pregnancy losses, while interaction analyses explored the moderating effects of demographic factors.

Results: The findings revealed a significant positive association between depressive symptoms and pregnancy losses. Severe symptoms, particularly "thoughts of self-harm" (p = .013), were strongly linked to multiple losses. Other symptoms such as "feeling down" (p < .001) and "feeling bad about oneself" (p < .001) were also significantly associated. The association was most pronounced among women aged 35-50. Additionally, the effect of depressive symptoms was more significant among low-income and minority women, suggesting socioeconomic and cultural factors play a role.

Conclusions: Depression, especially major depression, is significantly associated with an increased number of pregnancy losses, particularly among women aged 35-50. Socioeconomic and cultural factors are influential, highlighting the need for targeted interventions in high-risk groups.

Importance: The first-trimester anomaly scan (FTAS) has the potential to detect major congenital anomalies in an early stage of pregnancy. Due to this potential early detection, there is a trend to introduce FTAS in regular care. Data regarding the impact of FTAS on the patient's perspective are limited.

Objective: To provide an overview of the literature assessing the impact of the FTAS on health-related quality of life (HRQoL) and healthcare costs.

Evidence acquisition: Literature search was performed in Embase, PubMed, Medline Ovid, Cochrane Library database, Web-of-Science, and Google Scholar were searched. All studies that reported the performance of a nuchal translucency measurement with a basic fetal assessment HRQoL or healthcare costs of FTAS were included. Studies solely describing screening of chromosomal anomalies were excluded. Three authors independently screened the studies and extracted the data. Results were combined using descriptive analysis. PROSPERO registration number: CRD42016045190.

Results: The search yielded 3242 articles and 16 were included. Thirteen articles (7045 pregnancies) examined the relationship between FTAS and HRQoL. Anxiety scores were raised temporarily before FTAS and returned to early pregnancy baseline following the absence of anomalies. Depression scores did not change significantly as a result of FTAS. Three articles studied healthcare costs. These studies, published before 2005, found a combination of FTAS and second-trimester anomaly scan (STAS) resulted in an increased amount of detected anomalies when compared to a STAS-only regimen. However, the combination would also be more costly.

Conclusions: Women experience anxiety in anticipation of the FTAS result and following a reassuring FTAS result, anxiety returns to the baseline level. FTAS seems to be a reassuring experience. The included studies on costs showed the addition of FTAS is likely to increase the number of detected anomalies against an increase in healthcare costs per pregnancy.Review registration: PROSPERO CRD42016045190.

Objective: In China, there is a unique type of second marriage (SM) family where the woman is remarried, and the man is experiencing his first marriage. Additionally, the woman is older than the man. Therefore, these families experience many challenges: psychological, emotional, and societal pressure. Such family is a typical sample for studying sociocultural and psychological stress influencing on outcome of assisted reproductive technology (ART). This study aimed to investigate the impact of social psychological stress on the live birth outcomes AR.

Methods: In this retrospective cohort, second marriage (SM) families who visited the Second Hospital of Hebei Medical University reproductive center between January 2012 to December 2022 were screened, and 561s marriage families (the SM group) with 5600 first marriage (FM) families (the FM group) were included undergoing their first ART cycles. The primary outcome of this study was the live birth rate (LBR).

Results: The live birth rate (LBR) of SM group (30.7%) is lower than that of the FM group (43.6%) (p < 0.01). After adjustment by logistic regression, the second marriage group (OR = 1.269, 95%CI 1.031-1.562, p = 0.025) were independent factors associated with the outcome of live birth. After propensity score matching (PSM), the live birth rate of SM group (28.7%) is lower than the FM group (35.9%) (0 = 0.011).

Conclusion: The SM family experience higher levels of social and psychological pressure, which lead to lower level of LBR than FM family.