The Stirling Antenatal Anxiety Scale (SAAS): Turkish validity and reliability study.

AIMS: To examine the psychometric properties of the Stirling Antenatal Anxiety Scale (SAAS), developed by Sinesi et al., which assesses the level of anxiety of pregnant women in the prenatal period, in the Turkish culture, and to conduct a validity and reliability study. METHODS: This study had a methodological approach, with a cross-sectional and descriptive research design. Reporting was in accordance with the STROBE checklist. The sample included 160 pregnant women who were followed up in the maternity outpatient clinics of a public hospital and a private hospital in Istanbul. Data were collected face-to-face using a personal information form, the Turkish version of the SAAS, and the Generalized Anxiety Disorder-7 scale between June and August 2023. In the data analysis, validity analyses were performed with content and construct validity and multiple fit indices for confirmatory factor analysis. Item-total score analysis was conducted using Cronbach's alpha coefficient and Pearson's correlation analysis to assess reliability. Descriptive and reliability analyses were undertaken using SPSS v.28.0.1.0, and validity analyses were performed using SPSS AMOS v.26.0.0.0. FINDINGS: Based on expert opinions on the items in the Turkish version of the SAAS, the content validity ratio was 0.96. The decision was made to exclude Item 9 from the Turkish version because the item factor load was low. The Turkish version had a single factor, as did the original version. The Cronbach alpha coefficient was 0.87, so the Turkish version was determined to have high reliability. CONCLUSION: The Turkish version of the SAAS, originally produced in English, has high levels of validity and reliability. In addition, it is short and easy to apply in clinical and research settings. As such, the Turkish version of the SAAS is recommended for use to evaluate the level of anxiety in pregnant women.

Antenatal anxiety symptoms outperform antenatal depression symptoms and suicidal ideation as a risk factor for postpartum suicidal ideation.

BACKGROUND AND OBJECTIVES: Suicidal ideation (SI) during the postpartum phase is linked with suicide, a leading cause of death during this period. Antenatal depression and anxiety symptoms have both been linked with increased risk for postpartum SI. However, research aimed at examining the relative contributions of antenatal anxiety and depression symptoms towards postpartum SI remains nascent. In this study, we investigated the relative contribution of antenatal anxiety symptoms, depression symptoms, and SI towards postpartum SI. DESIGN: These data are from a longitudinal study in which American mothers were assessed during pregnancy and again at six- to eight weeks postpartum. METHODS: Data were analyzed using correlations and logistic regression models. RESULTS: Antenatal anxiety symptoms and antenatal depression symptoms were significantly correlated with postpartum SI. Results from a logistic regression model indicated that antenatal anxiety symptoms (T1; OR = 1.185 [1.125, 1.245], p = .004), but not antenatal depression symptoms (T1; OR = 1.018 [0.943, 1.093], p = .812) or antenatal SI (T1; OR = 1.58 [0.11, 22.29], p = 0.73), were significantly associated with postpartum SI. CONCLUSIONS: Antenatal anxiety symptoms, depression symptoms, and SI were positively associated with postpartum SI. When examined simultaneously, anxiety symptoms during the antenatal phase (but not depression symptoms or SI) predicted SI in the postpartum phase.

Bibliometric analysis of published articles on perinatal anxiety from 1920 to 2020.

INTRODUCTION: Trends and gaps in perinatal anxiety research remain unknown. The objective of this bibliometric review was to analyze the characteristics and trends in published research on perinatal anxiety to inform future research. METHODS: All published literature in Web of Science on perinatal anxiety from January 1, 1920 to December 31, 2020 were screened by two reviewers. VOSViewer was utilized to visualize linkages between publications. Bibliometric data were extracted from abstracts. RESULTS: The search strategy identified 4561 publications. After screening, 2203 publications related to perinatal anxiety were used for the visualization analysis. For the bibliometric data, 1534 publications had perinatal anxiety as a primary focus. There were 7910 different authors, over half named only once (55.5 %), from 63 countries. 495 journals were identified, with over half (56.0 %) publishing only one article. Most articles were published between 2011 and 2020 (75.9 %). In terms of perinatal timing, over half (54.2 %) published on antenatal anxiety. Only 6.0 % of studies reported on perinatal anxiety in fathers and 56.5 % also reported on perinatal depression. LIMITATIONS: Web of Science was solely used, and manual screening of each publication was required. CONCLUSION: This bibliometric analysis found: (1) perinatal anxiety is a growing field of research, with publications increasing over time; (2) there is variation in authors and journals; (3) over half of the publications focus on antenatal anxiety; (4) paternal anxiety is understudied; and (5) only 6 % of publications came from low and lower-middle income countries. Gaps related to maternal postnatal anxiety and paternal perinatal anxiety exist.

Climate change anxiety positively predicts antenatal distress in expectant female parents.

Clinical and subclinical levels of anxiety and depression are common experiences during pregnancy for expectant women; however, despite rising awareness of significant climate change anxiety around the world, the extent to which this particular type of anxiety may be contributing to overall antenatal psychological distress is currently unknown. Furthermore, the content of concerns that expectant women may have for their existing or future children remains unexplored. To address this gap in knowledge, 103 expectant Australian women completed standardised assessments of antenatal worry and depression, climate change anxiety, and perceived distance to climate change, and responded to several open-ended questions on concerns they had for their children. Results indicated that climate change anxiety accounted for significant percentages of variance in both antenatal worry and depression scores and, unexpectedly, neither child number nor perceived distance to climate change moderated these relationships. Content analysis of qualitative data highlighted the significant health-related anxieties for participants' children related to climate change (e.g., disease, exposure to extreme weather events, food/water insecurity). Given the escalating nature of climate change, further investigation of this relatively new stressor contributing to the experience of anxiety and distress, particularly in uniquely vulnerable groups such as expectant women, is urgently needed.

The Impact of Stress and Depression on the Outcome of Human Gestation.

Many researchers have reported on the high prevalence of anxiety and depression during pregnancy as well as the influence on delivery outcomes during the past decade. Preterm birth and premature labor, bleeding, higher frequency of cesarean section (CS), low birth weight, preeclampsia, stillbirth, miscarriage, NICU hospitalization, and a low Apgar score are the most commonly referenced outcomes assessed. Clarifying the relationship between exposure and result may help us to understand the risk factors and guide us to future clinical and research practices. The purpose of this narrative review is to search the following databases: PubMed, Research Gate, Scopus, Medline Plus, and present the most recent, comprehensive literature on the effects of stress and anxiety on pregnancy outcomes. Articles published from 01/01/2000 to 26/11/2022 were obtained from the previous databases. Anxiety and depression-related disorders are common nowadays, and they are frequently correlated with poor pregnancy outcomes. These problems are caused by a number of factors, including health social determinants, the individual obstetric situation, access to healthcare facilities, etc. The effects of each of these factors on birth outcomes range from major, such as preterm labor, congenital deformities, and low birth weight, to minor, such as mutations in the fetal epigenome. Both direct and indirect pathways of substantial interactions between depression, anxiety and stress, risk variables, and delivery problems were identified. Women's health practitioners and mental physicians must provide adequate support to these women in order to improve outcomes for both mothers and infants.

A prospective study of antepartum anxiety screening in patients with and without a history of spontaneous preterm birth.

BACKGROUND: Maternal stress has been identified as one of the most common clinical phenotypes associated with preterm birth. The American College of Obstetricians and Gynecologists recommends anxiety screening at least once in the perinatal period. The prevalence of perinatal anxiety is challenged by the absence of formalized screening protocols and underreporting in high-risk populations, such as those with a history of adverse pregnancy outcomes. OBJECTIVE: This study administered a validated anxiety screening tool in a cohort of patients with and without a previous spontaneous preterm birth and compared differences in score and rate of a positive screen between groups. Moreover, this study evaluated perinatal outcomes associated with a positive screen and described a referral protocol involving evaluation by a perinatal mental health counselor and clinical diagnoses. A hypothesis was made that patients with a previous history of spontaneous preterm birth would have higher self-reported anxiety symptoms than controls and that those with recurrent preterm delivery at <35 weeks of gestation would have the highest anxiety screening scores. STUDY DESIGN: This was a prospective observational cohort study administering the Generalized Anxiety Disorder 7-item screen to patients enrolled in 2 prenatal care clinics at our institution. The preterm birth cohort consisted of patients with a history of spontaneous preterm labor, premature rupture of membranes, or cervical insufficiency compared with the control cohort without this history. Screening was initiated at entry to prenatal care or referral to our high-risk obstetrical clinic. The inclusion criteria included English- or Spanish-speaking patients and singleton pregnancy, and the exclusion criteria included pregnancies complicated by a major congenital anomaly, enrollment after 34 weeks of gestation, delivery at <20 weeks of gestation, and incomplete delivery data. Referral to a mental health counselor was offered to those with a Generalized Anxiety Disorder 7-item screen score of ≥10. Perinatal outcomes as a comparison between the Generalized Anxiety Disorder 7-item screen-positive group and Generalized Anxiety Disorder 7-item screen-negative group were performed with statistical methods, including the Student t test, chi-square test, and Wilcoxon rank-sum test, with a P value of <.05 to determine significance. RESULTS: Between September 2020 and December 2021, 1349 participants were analyzed, with 143 patients (11%) in the previous preterm birth cohort and 1206 (89%) patients in the control cohort. Patients with a history of preterm birth and subsequent delivery at ≤35 weeks of gestation in the study pregnancy had significantly higher Generalized Anxiety Disorder 7-item screen scores than controls with delivery after 35 weeks of gestation (median score: 4 [interquartile range, 1-9] vs 2 [interquartile range, 0-6], respectively; P=.006). Overall, 187 participants (14%) screened positive with significantly higher rates in the previous preterm birth group than in the control group (20% vs 13%; P=.036). Of note, 117 patients (63%) accepted a referral, and 32 patients (17%) with a positive screen were diagnosed with a perinatal mood disorder. CONCLUSION: Patients with recurrent preterm birth have higher self-reported anxiety using the Generalized Anxiety Disorder 7-item screen than controls. Of those with a positive screen, 17% were diagnosed with a perinatal mood disorder.

Epigenetic modifications appear in the human placenta following anxiety and depression during pregnancy.

INTRODUCTION: The future health of the offspring can be influenced by longstanding maternal anxiety and depression disorders during pregnancy. The present study aimed to explore the effect of psychiatric disorders during pregnancy on placental epigenetics. METHODS: We measured DNA methylation patterns in term-placentas of women either suffering longstanding anxiety and depression symptoms (Index group, with overt symptoms), or a healthy population (Control, none/only mild symptoms). Whole genome DNA methylation profiling was performed using the TruSeq® Methyl Capture EPIC Library Prep Kit (Illumina, San Diego, CA, USA) for library preparation and NGS technology for genomic DNA sequencing. RESULTS: The results of high-throughput DNA methylation analysis revealed that the Index group had differential DNA methylation at epigenome-wide significance (p < 0.05) in 226 genes in the placenta. Targeted enrichment analyses identified hypermethylation of genes associated with psychiatric disorders (BRINP1, PUM1), and ion homeostasis (COMMD1), among others. The ECM (extracellular matrix)-receptor interaction pathway was significantly dysregulated in the Index group compared to the Control. In addition, DNA methylation/mRNA integration analyses revealed that four genes with key roles in neurodevelopment and other important processes (EPB41L4B, BMPR2, KLHL18, and UBAP2) were dysregulated at both, DNA methylation and transcriptome levels in the Index group compared to Control. DISCUSSION: The presented results increase our understanding of how maternal psychiatric disorders may affect the newborn through placental differential epigenome, suggesting DNA methylation status as a biomarker when aiming to design new preventive techniques and interventions.

Early intervention to prevent adverse child emotional and behavioural development following maternal depression in pregnancy: study protocol for a randomised controlled trial.

BACKGROUND: Substantial evidence indicates that maternal depression during pregnancy (i.e., antenatal depression) is associated not only with maternal wellbeing but also with child emotional and behavioural development. Children of antenatally depressed women are at risk of emotional and behavioural problems, including internalising problems (e.g., anxiety and depression) and externalising problems (e.g., attention problems), that may last at least to adolescence. These enduring effects also constitute an enormous economic cost. Despite the seriousness of this problem, until recently there existed very few controlled studies evaluating whether active psychological treatment for antenatal depression can prevent adverse child outcomes. Our previous pilot randomised controlled trial (RCT) exploring the effect of cognitive behavioural therapy (CBT) for antenatal depression on child outcomes showed promising results. We aim to assess whether treating antenatal depression with an evidence-based 8-week structured CBT program can prevent or ameliorate adverse child developmental outcomes at 2 years of age. METHODS: Pregnant women ≤ 30 weeks gestation diagnosed with a depressive disorder are recruited and randomised to CBT or treatment as usual (TAU). The target sample size is 230 and the primary outcome measure is the infant Internalising scale of the Child Behaviour Checklist (CBCL) at 24 months of age. Secondary infant outcome measures at 24 months are the Externalising scale of the CBCL and the motor and cognitive development subscales of the Ages & Stages Questionnaire (ASQ-3). Additional secondary outcome measures are subscales of the Revised Infant Behaviour Questionnaire (IBQ-R), ASQ-3 and the ASQ-Socio-Emotional (ASQ-SE) at 3 and 12 months of age and the quality of mother-infant interaction at 3 and 24 months. Maternal measures, including demographic data, depression diagnosis, depressive and anxiety symptoms, perceived stress and parenting stress, are collected across all time points. DISCUSSION: The trial is ongoing and recruitment was slowed due to the COVID-19 pandemic. If results suggest a beneficial effect of antenatal depression treatment on infant outcomes, the project could have repercussions for standard antenatal care, for maternal and infant health services and for preventing the intergenerational transmission of mental health disorders. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register: ACTRN12618001925235 Date Registered: 27 November 2018.

Prevalence of and relevant factors for depression and anxiety symptoms among pregnant women on the eastern seaboard of China in the post-COVID-19 era: a cross-sectional study.

BACKGROUND: Antenatal depression and anxiety symptoms may have negative consequences for both mothers and offspring, and upward trends in the prevalence of these symptoms were especially apparent during the COVID-19 epidemic. The purpose of this study was to evaluate the prevalence of and relevant factors influencing depressive and anxiety symptoms in Chinese pregnant women in the post-COVID-19 era. METHODS: We conducted an online survey of 1,963 pregnant women in Jiangsu Province, using a cross-sectional design, and collected their general demographic data. The nine-item Patient Health Questionnaire 9 (PHQ-9) was used to evaluate depression symptoms, and the seven-item Generalized Anxiety Disorder 7 (GAD-7) was used to measure anxiety symptoms. RESULTS: The prevalence of reported antenatal depressive symptoms, anxiety symptoms, and depression combined with anxiety symptoms was 25.2%, 27.9%, and 18.6%, respectively. Of the respondents, the prevalence of moderate to severe depression, and anxiety was 7.9% and 7.7%, respectively. Binary logistic regression analysis demonstrated that age, low level of education, rural area, unemployment, pregnancy complications, poor marital relationship, and fair household income were positively association with both depressive and anxiety symptoms (all P < 0.05). The proportion of women reporting anxiety symptoms in the third trimester was 1.91-fold higher than in first trimester. Parity was a relevant factor for depression and anxiety symptoms (all P < 0.05). CONCLUSIONS: In the post-COVID-19 era, the prevalence of depression and anxiety symptoms in pregnant women was higher than expected, and it is vital to establish hospital, community, and family psychological health screening systems based on relevant factors and enhance early preventive measures.

Role of antenatal anxiety in the relationship between maternal exposure to nitrogen dioxide and small for gestational age: A birth cohort study.

BACKGROUND: Both Nitrogen dioxide (NO2) exposure and antenatal anxiety have individually been associated with small for gestational age (SGA). Little is known, however, about whether there is effect modification of antenatal anxiety on NO2-related SGA. METHODS: The prospective birth cohort study included 1823 mother-newborn pairs in Guangzhou, China, from January 2017 to April 2020. Exposure to NO2 during the pre-conceptional and prenatal periods was estimated using an inverse distance weighted method. Antenatal anxiety was assessed by Trait Anxiety Inventory. SGA was determined by the Chinese gestational age- and sex-specific birthweight standards. Cox proportional hazards regression models was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for SGA as per 10 µg/m3 increase in NO2. Modifying effects of trait anxiety on NO2-related SGA were identified by stratified analyses, and three-dimensional response surface plots and two-dimensional heat maps. RESULTS: Each 10 µg/m3 increase in NO2 exposure during the third trimester was significantly associated with SGA risk among overall participants (HR = 1.221, 95 % CI: 1.014-1.471) and primipara (HR = 1.271, 95 % CI: 1.023-1.579). We found significant effect modification of anxiety level for NO2-related SGA in the third trimester (Pinteraction < 0.05). Pregnant women with higher levels of trait anxiety were more likely to deliver SGA newborns, particularly for those with high trait anxiety (HR = 1.781, 95 % CI: 1.007-2.945). Primiparous women were more susceptible. CONCLUSIONS: This study provides evidence that antenatal trait anxiety may modify the effects of maternal NO2 exposure on SGA risk. The third trimester could be a critical window of susceptibility.

Association of antenatal anxiety with adverse pregnancy outcomes: A prospective hospital-based study.

Background: Anxiety is common in pregnant women. Many studies have shown association of antenatal anxiety with adverse pregnancy outcomes, though the results are conflicting. Further, there are very limited studies on the subject reported from India, due to which, the data is limited. Hence this study was undertaken. Materials and Methods: Two hundred randomly selected consenting registered pregnant women reporting for antenatal follow up during third trimester of pregnancy were included in the study. Hindi version of Perinatal Anxiety Screening scale (PASS) was used to assess anxiety. Edinburgh Postnatal Depression rating Scale (EPDS) was used to assess comorbid depression. These women were followed up in the post-natal period to assess pregnancy outcomes. Chi-square test, Analysis of Variance (ANOVA) and correlation coefficients were calculated. Results: Analysis was done for 195 subjects. Most women (48.7%) were between 26 and 30 yrs of age. Primigravidas comprised 11.3 % of total study sample. Mean anxiety score was 23.6 (range 5-80). Adverse pregnancy outcomes were noted in 99 women; however anxiety scores in this group were not different from the group without adverse outcomes. No significant group differences were found with respect to PASS or EPDS scores. None of the women were found to have a syndromal anxiety disorder. Conclusions: Antenatal anxiety was not found to be associated with adverse pregnancy outcomes. This finding is contrary to the results obtained in earlier studies. More enquiry is needed into this area to replicate the results with clarity in larger samples, in Indian context.

Biological Mechanisms in Pregnant Women With Anxiety (Happy Mother-Healthy Baby Supplement Study): Protocol for a Longitudinal Mixed Methods Observational Study.

BACKGROUND: Anxiety and depression are common in the perinatal period and negatively affect the health of the mother and baby. Our group has developed "Happy Mother-Healthy Baby" (HMHB), a cognitive behavioral therapy-based psychosocial intervention to address risk factors specific to anxiety during pregnancy in low- and middle-income countries (LMICs). OBJECTIVE: The purpose of this study is to examine biological mechanisms that may be linked to perinatal anxiety in conjunction with a randomized controlled trial of HMHB in Pakistan. METHODS: We are recruiting 120 pregnant women from the Holy Family Hospital, a public facility in Rawalpindi, Pakistan. Participants are assessed for at least mild anxiety symptoms using the Hospital Anxiety and Depression Scale (ie, a score ≥8 on the anxiety scale is necessary for inclusion in the anxiety groups and <8 for inclusion in the healthy control group). Women who meet the criteria for an anxiety group are randomized into either the HMHB intervention group or an enhanced usual care (EUC) control group. Participants receive HMHB or EUC throughout pregnancy and undergo blood draws at 4 time points (baseline, second trimester, third trimester, and 6 weeks post partum). We will assess peripheral cytokine concentrations using a multiplex assay and hormone concentrations using gas chromatography and mass spectrometry. The statistical analysis will use generalized linear models and mixed effects models to assess the relationships across time among anxiety, immune dysregulation, and hormone levels, and to assess whether these biological factors mediate the relationship between anxiety and birth and child development outcomes. RESULTS: Recruitment started on October 20, 2020, and data collection was completed on August 31, 2022. The start date for recruitment for this biological supplement study was delayed by approximately half a year due to the COVID-19 pandemic. The trial was registered at ClinicalTrials.gov (NCT03880032) on September 22, 2020. The last blood samples were shipped to the United States on September 24, 2022, where they will be processed for analysis. CONCLUSIONS: This study is an important addition to the HMHB randomized controlled trial of an intervention for antenatal anxiety. The intervention itself makes use of nonspecialist providers and, if effective, will represent an important new tool for the treatment of antenatal anxiety in LMICs. Our biological substudy is one of the first attempts to link biological mechanisms to antenatal anxiety in an LMIC in the context of a psychosocial intervention, and our findings have the potential to significantly advance our knowledge of the biological pathways of perinatal mental illness and treatment efficacy. TRIAL REGISTRATION: ClinicalTrials.gov NCT03880032; https://clinicaltrials.gov/ct2/show/NCT03880032. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43193.

Traversing mental health disorders during pregnancy: Lebanese women's experiences of antepartum depression and anxiety.

INTRODUCTION: Over the past few years, Lebanon-a developing country-has faced a plethora of economic and political challenges, with more than half of the general population presenting depressive and anxiety symptoms. However, when it comes to maternal mental health during pregnancy, the last examination in Lebanon dates far back to 2005. Our study's aim was to help delineate the factors associated with Lebanese women's mental health disorders during pregnancy, namely antepartum depression and anxiety. METHODS: We launched a cross-sectional study among Lebanese pregnant women (age ≥ 18 years) between June and July 2021, during the COVID-19 lockdown (N = 433). RESULTS: In total, 87.8% of the participants experienced depression (mild to severe), where severe depression was observed in 7.9%. In addition, 70.3% had a significant level of anxiety. Increased pregnancy-specific hassles (beta = 0.93), being Muslim compared to Christians (beta = 3.19), being afraid of an existing aggressor (beta = 8.75), urinary tract infections (beta = 2.02), and higher gestational age (beta = 0.07) were significantly associated with higher depression, whereas higher physical activity index (beta = - 0.09) and increased disordered eating attitudes during pregnancy (beta = - 0.27) were significantly associated with less depression, all accounting for 60.4% of the model's variance. Additionally, increased pregnancy-specific hassles (beta = 0.54), being Muslim compared to Christians (beta = 2.42), urinary tract infections (beta = 1.72), and having been emotionally or physically abused (beta = 1.19) were significantly associated with higher levels of anxiety and could predict 49% of the total variance. CONCLUSION: Our study has suggested the existence of factors that have additive effects in potentiating the risk for depression and anxiety among Lebanese pregnant women, namely cultural beliefs, pregnancy-related distress, medical complications during pregnancy, and a history of abuse. Therefore, it would be judicious to implement screening programs targeting pregnant women at risk for antepartum depression and anxiety. In addition, high rates of prenatal depression and anxiety were detected among our sample, supporting that recognizing and treating maternal mental health disorders should be prioritized during antenatal care in Lebanon.

Midwifery Acupuncturists' Management of Antenatal Anxiety and Depression: Data from a Survey in Aotearoa (New Zealand).

Objective: The goal of this research was to explore how New Zealand midwifery acupuncturists manage mild-to-moderate antenatal anxiety and depression (AAD). Materials and Methods: A survey (Surveymonkey®) on midwives' perceptions of acupuncture for treating AAD was distributed late in 2019 to midwives who completed a Certificate in Midwifery Acupuncture. Data were collected on referrals and on acupuncture and complementary and alternative medicine use for AAD and associated symptoms of concern (SoC), such as low-back and pelvic pain (LBPP), sleep issues, stress, other pain, and pregnancy issues. Descriptive analysis was used to report data. Results: Of 119 midwives, 66 responded (55.5%). For AAD and SoC, midwives mostly referred patients to general practitioners and counselors, and administered acupuncture themselves. Acupuncture was most accessed for LBPP (n = 38; 70.4%), sleep (n = 31; 57.4%), anxiety (n = 27; 50.0%); stress (n = 26; 48.1%), and other pain (n = 20, 37.0%). Massage was second most-accessed for LBPP (n = 36; 66.7%), sleep (n = 25; 46.3%), and stress (n = 24; 44.4%). For depression, treatments were herbs (n = 16; 29.6%), homeopathy (n = 14; 25.9%), and acupuncture and massage (both n = 13; 24.1%). Acupuncture was most used for other pregnancy issues: birth preparation (n = 44, 88.0%); assisted labor induction (n = 43; 86.0%): nausea and vomiting (n = 43; 86.0%); breech (n = 37; 74.0%); and headaches/migraines (n = 29; 58.0%). Conclusion: Acupuncture is commonly used by midwife acupuncturists in New Zealand to treat a range of pregnancy issues, including anxiety, SoC for AAD, and other pregnancy issues. Further research would be beneficial.

Association of antenatal anxiety disorders with antenatal comorbidities and adverse pregnancy outcomes among clinic attendees at a tertiary-care hospital in Sri Lanka.

Purpose: Evidence on the association between antenatal anxiety disorders (AADs) and adverse pregnancy outcomes with detection of AADs using the gold-standard is scarce despite being vital to make decisions on interventions. We aimed to determine this association in women attending tertiary-care antenatal clinics in Sri Lanka. Material and methods: Presence/absence of AADs in a systematic random sample of 221 antenatal women attending routine antenatal clinics of a teaching hospital who participated in a questionnaire-validation study were confirmed by a psychiatrist. These women were followed up until the end of pregnancy. Information on antenatal comorbidities, adverse pregnancy outcomes was extracted from health records. The association between AADs with antenatal comorbidities and adverse pregnancy outcomes were reported using adjusted odds ratios (ORs) and 95%confidence intervals (CIs) generated from logistic regression models. Results: Mean (±SD) age of the women was 30 (±5.8) years. AADs were diagnosed in 81 (37%) women. Compared to women without AADs, those who had AADs were more at risk of pregnancy-induced hypertension (OR 6.1; 95% CI 1.2-31.9), gestational diabetes mellitus (OR 12.6; 95% CI 1.5-107.2), preterm labour (OR 4.3; 95% CI 1.4-13.0), prolonged labour (OR 19.0; 95% CI 7.1-51.1), lower segment caesarean section (OR 4.7; 95% CI 2.5-8.7) and low birthweight (OR 11.2; 95% CI 4.8-26.3). All miscarriages, stillbirths and assisted labour occurred exclusively in those with AADs. Conclusions: AADs are strongly associated with several adverse pregnancy outcomes. Causal pathways and effect of interventions for AADs must be explored in future research.

Antenatal depression and anxiety in Indian women: A systematic review.

There is good evidence to suggest that high prevalence of depression and anxiety in the postpartum period. However, very few studies have focused on antenatal depression and anxiety disorders and their associated risk factors. Further, there are only a handful of studies from India on common antenatal mental health disorders. With this background, we reviewed the existing evidence on antenatal depression and anxiety from the studies conducted in Indian pregnant women during the antenatal period and to explore the associated risk factors. All the major databases were searched systematically for English language studies on prevalence and risk factors for antenatal depression and anxiety in Indian pregnant females, published during the period January 2000 to May 2022. Quality assessment of studies was done with the modified version of Newcastle Ottawa Scale for cross-sectional studies. We found the overall prevalence of antenatal depression was ranged from 3.8% to 65% and antenatal anxiety from 13 to 55%. The most relevant risk factors associated with antenatal depression and anxiety during pregnancy were preference to have a male child, intimate partner violence, history of abortions, marital conflict, poor relationship with the husband/in-laws and lack of social support. To conclude, the systematic review suggests that depressive and anxiety disorders are quite common in Indian pregnant women in antepartum period with varying prevalence depending on various settings and scales used. Steps should be taken to promote obstetricians for regular mental health screening during the antenatal visits and prompt referral to mental health professionals when suspected.

Contributions of COVID-19 Pandemic-Related Stressors to Racial and Ethnic Disparities in Mental Health During Pregnancy.

Background: This study aimed to identify racial and ethnic disparities in prenatal mental health and identify COVID-19 pandemic-related health/healthcare and economic contributors to these disparities, using an established framework for disparity investigation. Methods: This cross-sectional study includes 10,930 pregnant people at Kaiser Permanente Northern California who completed an online survey between June 22, 2020 and April 28, 2021 on COVID-19 pandemic-related health/healthcare and economic stressors, depression, and anxiety. Self-reported race and ethnicity were extracted from electronic health records. Weighted analyses were used to evaluate the association between racial and ethnic category and prenatal depression and anxiety; the prevalence of each stressor by race and ethnicity; and the relationship between each stressor and prenatal depression and anxiety in each racial and ethnic category. Results: The sample was 22% Asian, 3% Black, 20% Hispanic, 5% Other/Multiracial/Unknown, and 49% White. Compared to White people, Black and Hispanic people had a higher prevalence of prenatal depression (aPR: 1.85, 95% CI: 1.45, 2.35 and aPR: 1.17, 95% CI: 1.00, 1.37, respectively) and anxiety (aPR: 1.71, 95% CI: 1.34, 2.18 and aPR: 1.10, 95% CI: 0.94, 1.29, respectively). Compared to White people, Black and Hispanic people had a higher prevalence of moderate/severe distress due to changes in prenatal care (24 vs. 34 and 31%), and food insecurity (9 vs. 31 and 24%). Among Black and Hispanic people, distress due to changes in prenatal care was associated with a greater prevalence of prenatal depression (aPR: 2.27, 95% CI: 1.41, 3.64 and aPR: 2.76, 95% CI: 2.12, 3.58, respectively) and prenatal anxiety (aPR: 3.00, 95% CI: 1.85, 4.84 and aPR: 2.82, 95% CI: 2.15, 3.71, respectively). Additionally, among Hispanic people, high-risk employment and food insecurity were associated with a greater prevalence of prenatal depression and anxiety. Conclusions: This study identified racial and ethnic disparities in mental health for pregnant Black and Hispanic people. Distress due to prenatal care changes contributed to the observed disparities in prenatal depression and anxiety for Black and Hispanic people and food insecurity additionally contributed to the observed disparities for Hispanic people. Addressing distress due to changes to prenatal care and food insecurity specifically in Black and Hispanic people may help reduce the high burden of poor mental health and reduce observed disparities in these communities.

Anxiety, depression and marital satisfaction in women with hyperemesis gravidarum: A comparative cross-sectional study in Hospital Tengku Ampuan Rahimah, Klang, Malaysia.

INTRODUCTION: Hyperemesis Gravidarum (HG) is a severe form of vomiting that occurs among pregnant mothers. Due to the nature of HG, pregnant mothers may feel fatigued and burdened by it and questions have been raised about the emergence of psychiatric illness during this period of vulnerability. METHODS: A comparative cross-sectional study using Hospital Anxiety and Depression Scale (HADS), M.I.N.I (MINI International Neuropsychiatric Interview) and ENRICH- EMS (Evaluation and Nurturing Relationship Issues, Communication and Happiness - Marital Satisfaction Scale) were performed in a group of 112 pregnant women. RESULTS: There were no differences in the prevalence rate of any anxiety disorder among the patient with HG vs comparative group (9% vs 3%, P > 0.05) and depressive disorder in women with HG vs comparative group (16% vs 8%, P > 0.05) respectively. There were associations between HG and gravida, past history of miscarriage, and gestational diabetes (P < 0.05). After adjustment, only past history of gestational diabetes was associated with HG as a protective factor (AOR 0.034 95% CI 0.002-0.181; P = 0.0014). We found that women in the HG group tended to score statistically significantly higher than the comparison group for depressive symptoms in the HADS Depression subscale (P = 0.041). DISCUSSION: We found no convincing association between HG and anxiety disorder, depressive disorder, and marital satisfaction, but women with HG statistically significantly reported more depressive symptoms than women who were not diagnosed with HG. Psychiatric evaluation should be considered for women with HG.

A new scale for fear of childbirth: the Fear of Childbirth Questionnaire (FCQ).

OBJECTIVE: To create a clear and acceptable measure of fear of childbirth with satisfactory content validity for use with English-speaking women in the UK. BACKGROUND: Fear of childbirth (FOC) can have a significant impact on a woman's view of her pregnancy, birth and her recovery post birth. Early identification is paramount to ensure that women's needs are recognised so that appropriately tailored care can be provided in pregnancy. Availability of reliable and valid measures to assess FOC in an English-speaking population are sparse, mainly due to issues with definitions of FOC or cultural sensitivity after translation. Recent research from phase one of the Fear of Childbirth study (FOCUS), has established key elements for FOC in an English-speaking UK population, and allows for a culturally sensitive measure of FOC to be developed. The aim was to ensure inclusion of all ten FOC elements and to attend to guidance from women in phase two of the FOCUS study about what would ensure clarity and acceptability. METHOD: A multidisciplinary team developed items in accordance with FOCUS. The measure was then piloted with one reviewer and further refined by the team of perinatal researchers. RESULTS: The FCQ is a new 20-item fear of childbirth questionnaire, which has been developed and is grounded in fears reported by women in the UK. CONCLUSION: A new tool to measure FOC in an English-speaking UK population with good content validity has undergone a preliminary phase of development and now needs testing for reliability and other forms of validity.