Body image perception and social support as predictors of psychological distress among third trimester pregnant women in Nigeria.

BACKGROUND: Body image perception and social support during pregnancy can impact the psychological distress levels experienced by pregnant women. As a result, the purpose of this study was to examine the relationship between various components of social support and body image perception on psychological distress levels among pregnant women in their third trimester in Nigeria. METHOD: A cross-sectional study was conducted among 246 pregnant women who were in the third trimester and attending selected health care facilities in Ogbomoso, a semiurban city in Oyo State, Nigeria. Body image perception, social support, and psychological distress scales were used to collect the data. Data were analyzed and summarized using descriptive and inferential statistics (ANOVA and multiple regression), with significance set at p < 0.05. RESULTS: Regression analysis showed that 44% of the variation in psychological distress among pregnant women was explained by the background variables, marital status, body image perception, appraisal support, tangible support, belonging support, interaction between body image perception and appraisal support, belong support and tangible support. CONCLUSION: Intervention programs focusing on bolstering tangible support, belonging support and appraisal support are recommended at reducing the psychological distress due to body image perception among pregnant women at third trimester.

Depression in the Perinatal Period: Course and Outcome of Depression in the Period from the Last Trimester of Pregnancy to One Year after Delivery in Primiparous Mothers.

Background and Objectives: One of the most significant psychiatric problems in women is depression related to the perinatal period. Our study aims to determine the frequency and course of depressive symptomatology in the perinatal period with particular reference to objective rate and outcome of postpartum depression. Materials and Methods: One hundred and eighty-eight pregnant/postnatal women were included in a prospective, longitudinal, observational study during which the depressive symptomatology was estimated at the third trimester of pregnancy, and the first, sixth, and twelfth month' postpartum. All participants completed a semi-structured sociodemographic questionnaire constructed for research purposes, the Edinburgh Postnatal Depression Scale, Toronto Alexithymia Scale, Beck Anxiety Inventory, and The Mood Disorder Questionnaire at each time point. Postpartum depression diagnosis was confirmed by a trained and certified psychiatrist with long-standing experience. For a better understanding of the trajectory of depressive symptomatology and genuine postpartum depression, we classified depression into those with new-onset and those left over from the previous observation period. Results: In general, 48.9% of participants in the study were depressed at some point during the investigation. A total of 10.6% of women were depressed in the third trimester. The highest percentage of new-onset depression (25%) was in the first month after giving birth and was maintained for up to six months, after which the appearance was sporadic. Most of the postpartum depression resolved in the period from the first month to the sixth month after childbirth (20.7%). The episodes mainly had characteristics of unipolar depression. Conclusions: Our results imply that a new onset of depression is most intensive during the first six months, and after that, it is sporadic. Further studies are needed to explore whether all depressive symptomatology in the postnatal period is the same, or perhaps postpartum depression, classified in this way, has specific characteristics, etiology, and consequently different treatment and preventive options.

Maternal and infant outcomes during the COVID-19 pandemic: a retrospective study in Guangzhou, China.

In late December 2019, the COVID-19 pandemic caused a great threat to people's lives worldwide. As a special category of the population, pregnant women are vulnerable during emergencies. This study was designed to explore whether or not the COVID-19 pandemic has influenced maternal and infant outcomes. We collected maternal characteristics, laboratory results, condition in the third trimester, maternal outcome, fetal or neonatal outcomes, and characteristics of amniotic fluid, umbilical cord and placenta from pregnant women and fetals or newborns in the first affiliated hospital of Jinan university from 24 January to 31 March 2020 (peak period), chose the same types of data at the hospital during the same period in 2019 and 1 January-23 January 2020 (prior to the outbreak of COVID-19 in 2020) as a control. Our study focused on uncomplicated singleton pregnancies among women not infected by COVID-19. The results demonstrated that there was not an increase in adverse outcomes of pregnant women and newborns during the COVID-19 pandemic; This might be associated with the updated design of major epidemic prevention and control systems in Guangzhou, and the extension of pregnant women's rest time during the third trimester of pregnancy. Nevertheless, the survey showed an increased incidence rate of 25-hydroxyvitamin D and zinc deficiency in newborns during the epidemic, implying that pregnant women should participate in appropriate physical exercise, increase their exposure to outdoor sunlight and improve nutrition intake to ensure healthy newborns during the quarantine period. Our study has provided some guidance for maternal management during the COVID-19 pandemic.

The mediating role of prenatal depression in adult attachment and maternal-fetal attachment in primigravida in the third trimester.

BACKGROUND: Prenatal depression and adult attachment are factors that affect the establishment of an intimate relationship between a mother and fetus. The study explored differences in prenatal depression and maternal-fetal attachment (MFA) scores between different types of adult attachment and the effects of maternal depression scores and attachment dimensions on maternal intimacy with the fetus. METHODS: The Edinburgh Postnatal Depression Scale (EPDS), Experience of Close Relationship (ECR) scale, Maternal Antenatal Attachment Scale (MAAS) and a general data scale were used to investigate 260 primigravida. An exploratory analysis was performed to analyze the effects of the depression score and adult attachment on MFA. RESULTS: The results showed that pregnant women with insecure attachment exhibited an increased prevalence of prenatal depression, lower total MFA scores, and lower MFA quality compared with those women with secure adult attachment. The explorative analysis showed that the depression scores mediated the relationship between adult attachment avoidance and MFA quality. CONCLUSIONS: Primigravida who had insecure adult attachment exhibited an increased prevalence of prenatal depression and lower MFA. Maternal depression and adult attachment may affect the emotional bond between a mother and fetus. This finding should be seriously considered, and timely intervention needs to take personality traits into consideration.

Maternal-fetal attachment in pregnant Italian women: multidimensional influences and the association with maternal caregiving in the infant's first year of life.

BACKGROUND: Maternal-Fetal Attachment (MFA) describes the cognitive-representational, emotional, and behavioral aspects of the mother-fetus relationship that develops during pregnancy. We present two studies conducted on pregnant Italian women. In Study I, we aimed to explore multifaceted associations of MFA with variables important for a healthy pregnancy (e.g., maternal mental health, the couple's relationship). In Study II, we investigated the predictive role of MFA on observed maternal caregiving during the first months of the infant's life. METHODS: In Study I, 113 pregnant Italian women were assessed on MFA (Maternal Antenatal Attachment Scale, MAAS), maternal depression (Beck Depression Inventory-II, BDI-II), maternal anxiety (State Trait Anxiety Inventory - State version, STAI), adjustment of the couple (Dyadic Adjustment Scale, DAS), and perceived parental care (The Parental Bonding Instrument, PBI). In Study II, 29 mother-infant pairs were followed up at 4 months to assess observational variables of maternal caregiving through the Emotional Availability Scale (EAS) and to test for an association with MFA in pregnancy. RESULTS: Study I showed a significant association between MFA and the quality of the couple relationship (ß = .49, P < .001) and between MFA and the recall of memories of care received in childhood (ß = .22, P = .025). Study II showed a predictive effect of MFA on maternal structuring observed during mother-infant interactions at 4 months of age (ß = 0.36, P = .046). CONCLUSION: The study points out relevant relationship contexts that might receive care and support throughout pregnancy to protect MFA. The findings also provide thoughtful insights on the role of MFA in early maternal caregiving, suggesting that MFA might be a candidate as one putative antecedent of mother-infant interaction processes.

Prenatal distress levels of pregnant women in Turkey and affecting factors: a multicentre study.

This study was conducted to determine prenatal distress levels of pregnant women from seven provinces of Turkey and factors affecting prenatal distress levels. The multicentre descriptive study included 2365 pregnant women who were in the twentieth gestational week and above. The data were collected using the pregnancy information form, prenatal distress questionnaire and spousal support scale. Descriptive statistics, Student's t-test, ANOVA and logistic regression were used to evaluate the data. The results of this study demonstrated that pregnant women's prenatal distress levels are affected by such factors as the region lived in, lack of spousal support and being a primary school graduate. Nurses should develop intervention strategies that involve the pregnant woman's spouse to reduce prenatal distress and the factors affecting prenatal distress.Impact statementWhat is already known on this subject? Prenatal distress can have significant effects on pregnancy, maternal health and human development across the lifespan.What the results of this study add? Spousal support could also have an effect on the psychological health of mothers.What the implications are of these findings for clinical practice and/or further research? Nurses and midwives monitor the pregnant women, and therefore, they should evaluate the prenatal distress levels in the prenatal period, plan intervention strategies for pregnant women with high stress levels and include the pregnant women's spouses in these intervention strategies.

Gestational diabetes mellitus and quality of life during the third trimester of pregnancy.

PURPOSE: The primary aim of this study was to investigate the effect of gestational diabetes mellitus (GDM) on the quality of life (QoL) of pregnant women during the third trimester of pregnancy. The secondary aim was to compare the QoL of pregnant women with GDM according to their therapeutic approach. This is the first study of this kind conducted in Greece. METHODS: A case-control study with 62 pregnant women (31 with GDM and 31 with uncomplicated pregnancy), during the third trimester of pregnancy. QoL and Health Related QoL were studied with the use of three questionnaires (EQ-5D-5L, WHOQOL-BREF and ADDQoL). RESULTS: A decrease in the QoL was found in pregnant women with GDM compared with pregnant women with uncomplicated pregnancy (p < 0.05) regarding both social life and health scales. On the contrary, there was no difference in the QoL between pregnant women with GDM who followed different treatment approaches (diet or insulin). CONCLUSIONS: The diagnosis of GDM is associated with a reduction in the QoL of pregnant women during the third trimester of pregnancy, while the type of treatment does not seem to further affect it. More studies should be conducted so that the modifiers of this association can be clarified.

Experiences of pregnant women with a third trimester routine ultrasound - a qualitative study.

BACKGROUND: Studies showed that pregnant women generally value routine ultrasounds in the first two trimesters because these provide reassurance and a chance to see their unborn baby. This, in turn, might help to decrease maternal anxiety levels and increase the bond with the baby. However, it is unclear whether pregnant women hold the same positive views about a third trimester routine ultrasound, which is increasingly being used in the Netherlands as a screening tool to monitor fetal growth. The aim of this study was to explore pregnant women's experiences with a third trimester routine ultrasound. METHODS: We held semi-structured interviews with fifteen low-risk pregnant women who received a third trimester routine ultrasound in the context of the Dutch IUGR RIsk Selection (IRIS) study. The IRIS study is a nationwide cluster randomized controlled trial carried out among more than 13,000 women to examine the effectiveness of a third trimester routine ultrasound to monitor fetal growth. For the interviews, participants were purposively selected based on parity, age, ethnicity, and educational level. We performed thematic content analysis using MAXQDA. RESULTS: Most pregnant women appreciated a third trimester routine ultrasound because it provided them confirmation that their baby was fine and an extra opportunity to see their baby. At the same time they expressed that they already felt confident about the health of their baby, and did not feel that their bond with their baby had increased after the third trimester ultrasound. Women also reported that they were getting used to routine ultrasounds throughout their pregnancy, and that this increased their need for another one. CONCLUSIONS: Pregnant women seem to appreciate a third trimester routine ultrasound, but it does not seem to reduce anxiety or to improve bonding with their baby. Women's appreciation of a third trimester routine ultrasound might arise from getting used to routine ultrasounds throughout pregnancy. We recommend to examine the psychological impact of third trimester routine ultrasounds in future studies. Results should be taken into consideration when balancing the gains, which are as yet not clear, of introducing a third trimester routine ultrasound against unwanted side effects and costs.

Psychometric properties of the German version of the pregnancy-related anxiety questionnaire-revised 2 (PRAQ-R2) in the third trimester of pregnancy.

BACKGROUND: Pregnancy-related anxiety (PrA) has been identified as a construct distinct from general stress and anxiety with a negative impact on birth and child outcomes. Validated instruments with good psychometric properties to assess pregnancy-related anxiety in German-speaking expectant mothers are still lacking. The Pregnancy-Related Anxiety Questionnaire revised for its use independent of parity (PRAQ-R2) assesses fear of giving birth (FoGB), worries of bearing a physically or mentally handicapped child (WaHC) and concerns about own appearance (CoA). The aim of this study was to investigate the psychometric properties of the PRAQ-R2 in a German sample of pregnant women in their third pregnancy trimester. METHODS: The PRAQ-R2 and several questionnaires measuring different forms of anxiety as well as depressive symptoms and perceived general self-efficacy were administered cross-sectionally in a sample of nulliparous and parous women (N = 360) in the third trimester of pregnancy. RESULTS: Reliability was satisfactory to excellent for the PRAQ-R2 total scale (Cronbach's α = .85) and the subscales (α = .77 to .90). Confirmatory and exploratory factor analysis confirmed the three-factorial structure of the instrument. The three factors together explained 68% of variance. Construct validity was confirmed by positive low- to moderate-sized correlations of the PRAQ-R2 total score and the subscales with measurements of anxiety and depression and by negative low correlations with general self-efficacy. CONCLUSIONS: The German version of the PRAQ-R2 is a valid and feasible measurement for pregnancy-related anxiety for research and clinical practice.

Association between social and family support and antenatal depression: a hospital-based study in Chengdu, China.

BACKGROUND: Antenatal depression (AD) is considered as one of the major health burdens and has adverse effects on the outcome of expectant mothers and newborns. The present study aims to investigate the prevalence of antenatal depression (AD), and to explore the potential risk factors of AD among pregnant women in Chengdu, including personal background, related social factors, family factors and cognitive factors. METHODS: The prospective nested case-control study included pregnant women who were in their second pregnancy and attended prenatal care at three tertiary hospitals and one regional hospital in Chengdu, China, between March 2015 and May 2016. Self-designed questionnaires were given to participants in their second and third trimesters to collect information on clinical and demographic characteristics, and a modified edition of Edinburgh Postnatal Depression Scale (EPDS) were used to measure AD. The logistic regression was applicated in analyses. RESULTS: A total of 996 pregnant women were included in analysis. Ninety-three women suffered from AD symptoms only in their second trimester, 96 only in their third trimester, and 107 displayed persistent depression in both trimesters. In the univariate analyses, age and marital relationships were linked with AD occurrence in both second and third trimester. In addition, increasing age, full-time job, higher education level, and no gender preference of spouse were associated with reduced persistent depression. Multivariate analysis showed that gender preference and marital relationship were the potential risk factors of persistent depression. CONCLUSIONS: Age, marital relationship relationships, with parents-in-law, the negative recognition of this pregnancy and husband's gender preference were found as risk factors of AD occurrence in some specific trimester. Gender preference of husbands and marital relationships were independently associated with persistent depression. These findings suggest that stronger family support can help improve mental health of pregnant women.

Screening of depression in overweight and obese pregnant women and its predictors.

AIM: The aim of this study was to investigate the screening result of depression and its predictors in overweight and obese pregnant women in second and third trimester of pregnancy. METHODS: The present cross-sectional study was carried out on 232 overweight or obese pregnant women older than 18 years in the second and third trimesters of pregnancy. Edinburgh Postnatal Depression Scale questionnaire, the International Physical Activity Questionnaire and the Food Record were used. Independent t-test, Man-Whitney U, Pearson and Spearman correlation test, independent t-test, one-way analysis of variance and, multivariate linear regression were applied for data analysis using spss 21. RESULTS: The results of the study showed that the mean (standard deviation) score of depression was 10.1 (4.4), and it was similar in both overweight and obese women (P = 0.784). Median (quartile 25-75) of physical activity was 891.0 (495.0-1336.0) metabolic equivalent of task -min/week. The total physical activity in obese women was statistically higher than overweight ones (P = 0.032). In linear regression model, the variables of parity, body mass index, physical activity education, protein, fat, oleic acid, monounsaturated fatty acids, potassium, magnesium, and zinc were the strong predictors of depression, and along with the others explained the 80% of variances. CONCLUSION: Considering the fact that nearly one-third of overweight and obese women in the present study were positive for depression screening, it is important to pay attention to strong predictors of depression in these women.

Maternal and Neonatal Hair Cortisol Levels and Psychological Stress Are Associated With Onset of Secretory Activation of Human Milk Production.

BACKGROUND: Several factors can influence the production of mothers' own milk. PURPOSE: To assess the influence of maternal psychological stress, maternal cortisol levels, and neonatal hair cortisol levels on timing of secretory activation. METHODS: A prospective study was conducted at 2 public health centers in Andalusia, Spain. Participants were 60 pregnant women and their 60 neonates. Hair cortisol levels and psychological stress (pregnancy-specific stress [Prenatal Distress Questionnaire, PDQ] and perceived stress [Perceived Stress Scale, PSS]) were evaluated during the third trimester and the postpartum period. This study was part of the GESTASTRESS cohort study on the effects of stress during pregnancy. RESULTS: Higher PDQ and PSS scores (P < .05) in the third trimester were associated with later onset of secretory activation. Higher postpartum maternal hair cortisol levels were associated with a delayed secretory activation of mother's own milk (P < .05). IMPLICATIONS FOR RESEARCH: Future studies should look at the influence of psychological stress and cortisol levels on hormones involved in mother's own milk production. IMPLICATIONS FOR PRACTICE: Neonatal nurses and other healthcare providers should be familiar with levels of neonates' exposure to maternal prenatal stress prior to birth.

The effect of maternal depression and anxiety on labour and the well-being of the newborn.

Maternal symptomatology during pregnancy represents a significant risk factor for women and children. The main focus of this paper is to jointly investigate the role of maternal depression and anxiety during pregnancy on the well-being of the newborn, through their influences on the clinical aspects of labour. A longitudinal study was conducted on 167 pregnant women (Mage=32.07, SD = 4.50) recruited in the third trimester of gestation. The data was collected at two different times: the socio-demographical data and prenatal anxiety and depression were assessed at T1 (31-32 week of gestation); the clinical data on childbirth (duration of labour, administration of oxytocin and epidural analgesia) and the Apgar index of the newborn were registered at T2 (the day of childbirth). A structural equation modeling was performed using the MPLUS statistical programme. The results showed that a maternal psychopathological symptomatology during pregnancy constitutes a significant risk factor for the well-being of the newborn. In particular, both prenatal anxiety and depression negatively affect the clinical aspects of the labour experience and, indirectly, the Apgar index. The limitations, strengths, and theoretical and clinical implications are discussed. Impact statement What is already known on this subject? Depression and anxiety during pregnancy can negatively affect the well-being of women, the experience of labour and delivery, and birth outcomes. All of these aspects are documented in literature, however, they are usually analysed independently. What do the results of this study add? This is the first study that analyses all of the above psychological and clinical variables together, testing a theoretical model where prenatal anxiety and depression influence the newborn's Apgar index, through the clinical aspects of labour. The outcomes highlight the role that depressive and anxiety symptoms during pregnancy and the labour experience play on the newborn's wellbeing. What are the implications of these findings for clinical practice and/or further research? Overall, our data confirms the importance of putting a new light on maternal psychological symptoms during pregnancy and birth experience, considering them as complex human processes in which psychological and physical aspects are highly interconnected, influencing maternal and newborn well-being. Our results highlight how important it is that, when approaching the delivery experience, healthcare professionals pay attention not only to the physical condition of pregnant women and newborns, but also to the psychological condition of women, given the impact this can have on delivery and, therefore, on the baby's wellbeing.

Maternal depressive symptomatology during pregnancy is a risk factor affecting newborn's health: a longitudinal study.

Background: Depression symptomatology in pregnant women is a condition that represents an important risk factor for the health of both women and children. Objectives: The aim of this study was to investigate the influence of women's depression symptomatology on the clinical aspects of their delivery, both directly and indirectly, through mothers' prenatal attachment to their unborn children. Moreover, we analysed whether these aspects affect the well-being of the newborn, assessed through the Apgar score. Methods: A longitudinal design was carried out on a total of 203 pregnant women. At weeks 31-32 of gestation, women filled out the Beck Depression Inventory and the Prenatal Attachment Inventory. The day of childbirth, hospital healthcare staff registered the clinical data of childbirth. Results: A woman's depressive symptomatology negatively affects prenatal attachment to her unborn child and positively affects the clinical aspects of the delivery, both directly and mediated by the quality of prenatal attachment. Moreover, the Apgar score was negatively influenced by the clinical aspects of the delivery and, indirectly, by the depressive symptomatology. Conclusion: Depressive symptomatology during pregnancy has negative outcomes, affecting the delivery experience of women, the first emotional bond with the child, and the well-being of the newborn.

[Behaviour and attitudes towards the sexuality of the pregnant woman during the last trimester. Phenomenological study]. / Comportamiento y actitud frente a la sexualidad de la mujer embarazada durante el último trimestre. Estudio fenomenológico.

OBJECTIVE: To explore the life experiences on sexual relationships in the third trimester of pregnancy in primiparous women. DESIGN: Phenomenological qualitative study, SITE: Cáceres (Extremadura). PARTICIPANTS: Primiparous women in the third trimester of their pregnancy. METHODS: We use theoretical sampling, was conducted on pregnant primiparous. The study included 15 participants. The data was collected using in-depth interviews, that were voiced recorded and later transcribed. The analysis was made using Giorgi's proposal. RESULTS: The results show three main points. Fear of doing damage, mediated by the obstetric history and the desire to have the long-awaited child. Exploring new routes: forms of sexual expression are modified by the physical changes, the fears, and the mobility. Highlighting the importance of other displays of affection and love (kisses and caresses). The Sex Taboo: lack of information against sexuality during pregnancy is still common. CONCLUSIONS: Women in the third trimester of their pregnancy put aside their sexual appetite and that of their partners, and concentrate in the wellbeing of their new born baby. It highlights the role of the mother before the couple. The more desired and difficult the pregnancy has been, the more the sexual life is reduced. The Health Professionals must advise and inform the couples with an open-minded attitude.

Anxiety and depressive symptoms, and stress biomarkers in pregnant women after in vitro fertilization: a prospective cohort study.

STUDY QUESTION: Does in vitro fertilization (IVF) affect the course of anxiety and depressive symptoms as well as physiological stress from pregnancy to postpartum period? SUMMARY ANSWER: IVF mothers have more anxiety symptoms and higher stress biomarker levels but fewer depression symptoms than natural conception mothers at the third trimester of pregnancy, but these differences are negligible during postpartum period. WHAT IS KNOWN ALREADY: Cross-sectional studies have found an association between IVF and high stress levels during the prenatal period. There is, however, no follow-up study about the IVF effect on the mental health status from pregnancy to postpartum, adopting simultaneous measurement of self-reported symptoms and stress biomarkers. STUDY DESIGN, SIZE, DURATION: This is a prospective cohort study. A total of 243 eligible women were recruited during the third trimester of pregnancy (60 women after successful IVF and 183 who conceived naturally). The recruitment was performed during a 12-month period, and the follow-up was carried out until 3 months after delivery. PARTICIPANTS/MATERIALS, SETTING, METHODS: This study was performed in the Division of Obstetrics in a regional referral center. The State scale of the State-Trait Anxiety Inventory (STAI-S) and the Beck Depression Inventory-Sort Form (BDI/SF) were used as anxiety and depression indicators, respectively; salivary cortisol and α-amylase levels as stress biomarkers. Anxiety, depression and stress biomarkers were measured at the third trimester of pregnancy (T1), at 48 h after birth (T2) and at 3 months after birth (T3). Associations with IVF were assessed using ordinal mixed models for anxiety and depressive symptoms and linear quantile models for stress biomarkers. MAIN RESULTS AND THE ROLE OF CHANCE: Relative to natural conception mothers, IVF mothers had higher STAI-S scores at T1 (P = 0.016, odds ratio (OR) = 2.46), and this difference remained steady from T1 to T2 (P = 0.37, OR = 0.70) and from T2 to T3 (P = 0.36, OR = 0.69). In the case of depressive symptoms, the IVF group obtained lower BDI/SF scores at T1 (P < 0.001, OR = 0.192). This difference was apparently reduced from T1 to T2 (P = 0.072, OR = 2.21) and remained constant from T2 to T3 (P = 0.107, OR = 2.09). It is important to note that whereas the mean BDI/SF score was not clinically significant for any group (it was lower than the cut-off 4), the mean STAI-S score of the IVF group at T1 was so (it was higher than the cut-off 19). As for stress biomarkers, IVF mothers had higher cortisol levels at T1 (P = 0.043, Δlog(cortisol) = 0.88) compared to natural conceptions. From T1 to T2 cortisol levels of both groups increased at the relatively same rate (P = 0.81, Δlog(cortisol) = -0.16). However, the progressions tended to be different from T2 to T3, with IVF mothers exhibiting a sharp decrease in cortisol levels (P = 0.059, Δlog(cortisol) = -0.94), while natural conceptions value remained steady. In the case of α-amylase, there were no statistically significant differences between both groups at T1 (P = 0.7, Δlog(α-amylase) = -0.095). On the contrary, while IVF mothers showed sustained α-amylase levels across the time, the progression was different in the natural conception group, who showed a decrease in α-amylase levels from T1 to T2 (P = 0.049, Δlog(α-amylase) = 0.596) and a non-significant increase from T2 to T3 (P = 0.53, Δlog(α-amylase) = -0.283). LIMITATIONS REASON FOR CAUTION: Since this follow-up study has been carried out from the third trimester of pregnancy, the findings cannot be generalized to extremely preterm births. WIDER IMPLICATIONS OF THE FINDINGS: IVF women may have lower depressive symptoms for being pregnant. However, due to the potential pregnancy complications associated with IVF, they may have higher physiological stress and clinically significant anxiety at the third trimester of pregnancy but not during postpartum. Taking into account that both prenatal high maternal cortisol levels and prenatal clinically significant anxiety increase the risk of disturbance in the fetal neurodevelopment, psychological therapy should be extended during pregnancy in IVF women. STUDY FUNDING/COMPETING INTEREST(S): MV funded by FIS PI17/0131 grant from the Instituto de Salud Carlos III (ISCIII) and RETICS funded by the PN 2018-2011, and the European Regional Development Fund, reference RD16/0022/0001; AG-B funded by a 'Juan Rodés' Grant (JR17/00003) from the ISCIII. CC-P funded by a 'Miguel Servet I' Grant (CP16/00082) from the ISCIII. Authors declare no competing interests.

Demographic, psychosocial and clinical factors associated with postpartum depression in Kenyan women.

BACKGROUND: Few longitudinal studies have examined associations between risk factors during pregnancy and mental health outcomes during the postpartum period. We used a cohort study design to estimate the prevalence, incidence and correlates of significant postpartum depressive symptoms in Kenyan women. METHODS: We recruited adult women residing in an urban, resource-poor setting and attending maternal and child health clinics in two public hospitals in Nairobi, Kenya. A translated Kiswahili Edinburgh Postpartum Depression Scale was used to screen for depressive symptoms at baseline assessment in the 3rd trimester and follow up assessment at 6-10 weeks postpartum. Information was collected on potential demographic, psychosocial and clinical risk variables. Potential risk factors for postpartum depression were evaluated using multivariate logistic regression analysis. RESULTS: Out of the 171 women who were followed up at 6-10 weeks postpartum, 18.7% (95% CI: 13.3-25.5) were found to have postpartum depression using an EPDS cut off of 10. In multivariate analyses, the odds of having postpartum depression was increased more than seven-fold in the presence of conflict with partner (OR = 7.52, 95% CI: 2.65-23.13). The association between antepartum and postpartum depression was quite strong but did not reach statistical significance (OR = 3.37, 95% CI: 0.98-11.64). CONCLUSIONS: The high prevalence of significant postnatal depressive symptoms among Kenyan women underscores the need for addressing this public health burden. Depression screening and psychosocial support interventions that address partner conflict resolution should be offered as part of maternal health care.

Associations between social capital and maternal depression: results from a follow-up study in China.

BACKGROUND: This study aims to investigate the association between social capital (SC) and depressive symptoms among Chinese primiparas at different time-points from their late pregnancy to postpartum. METHODS: A total of 450 primiparas were recruited for the current study. The assessments were conducted at three different time-points: T1 - while the participants were recruited at their 30-36 weeks of pregnancy in the antenatal clinic in the maternity hospital in Zhejiang, China; T2 - at their 2nd or 3rd days in the wards after delivery; T3 - at week 6 to 8 after the delivery in the postpartum examination clinic. SC was measured by the 29-item SC scale; while depressive symptoms were measured by the Edinburgh Postnatal Depression Scale. The relationships between SC and depressive symptoms were explored separately at each of the three time-points. RESULTS: The prevalence of depression among the primiparas was 25% at T1, 13.5% at T2 and 20.8% at T3, respectively. However, the score of SC and its components at three time-points followed an opposite 'V' direction, with the highest score at T2, following by T3 and T1. At T1, the analysis suggested that depressive symptoms among the primiparas were negatively correlated with their social trust and social network levels. At T2, only social trust was negatively associated with depression. While at T3, it is social trust and social participations that were significantly negatively associated with depression. CONCLUSIONS: SC was associated with depression at all three time-points during and after pregnancy. More attention should be given to SC in the maternal health promotion programs of community pregnancy health care management.

Prospective associations between recalled parental bonding and perinatal depression: a cohort study in urban and rural Turkey.

PURPOSE: Recalled experiences of parental bonding may be important in the aetiology of perinatal depression. We hypothesized that lower recalled parental bonding would be associated with perinatal depression. METHOD: In a cohort study of perinatal depression in Turkey, 677 women were recruited in their third trimester. Parental Bonding Inventory (PBI) scores at baseline were investigated as predictors of depression on the Edinburgh Postnatal Depression Scale (EPDS) at 4, 14 and 21 months after childbirth in mothers without depression at baseline. RESULTS: Poor parental bonding scores, apart from paternal control and overprotection, were independently associated with antenatal depression. Incident postnatal depression at 4 months was predicted by parental overprotection, at 14 months by parental care and overprotection, and at 21 months by paternal control and overprotection. CONCLUSIONS: Less satisfactory parenting recalled in the antenatal period was an independent predictor of postnatal depression; however, the different bonding subscales varied as predictors according to the timing of the depression assessment after childbirth.

Antenatal depressive symptoms and perinatal complications: a prospective study in rural Ethiopia.

BACKGROUND: Antenatal depressive symptoms affect around 12.3% of women in in low and middle income countries (LMICs) and data are accumulating about associations with adverse outcomes for mother and child. Studies from rural, low-income country community samples are limited. This paper aims to investigate whether antenatal depressive symptoms predict perinatal complications in a rural Ethiopia setting. METHODS: A population-based prospective study was conducted in Sodo district, southern Ethiopia. A total of 1240 women recruited in the second and third trimesters of pregnancy were followed up until 4 to 12 weeks postpartum. Antenatal depressive symptoms were assessed using a locally validated version of the Patient Health Questionnaire (PHQ-9) that at a cut-off score of five or more indicates probable depression. Self-report of perinatal complications, categorised as maternal and neonatal were collected by using structured interviewer administered questionnaires at a median of eight weeks post-partum. Multivariate analysis was conducted to examine the association between antenatal depressive symptoms and self-reported perinatal complications. RESULT: A total of 28.7% of women had antenatal depressive symptoms (PHQ-9 score ≥ 5). Women with antenatal depressive symptoms had more than twice the odds of self-reported complications in pregnancy (OR=2.44, 95% CI: 1.84, 3.23), labour (OR= 1.84 95% CI: 1.34, 2.53) and the postpartum period (OR=1.70, 95% CI: 1.23, 2.35) compared to women without these symptoms. There was no association between antenatal depressive symptoms and pregnancy loss or neonatal death. CONCLUSION: Antenatal depressive symptoms are associated prospectively with self-reports of perinatal complications. Further research is necessary to further confirm these findings in a rural and poor context using objective measures of complications and investigating whether early detection and treatment of depressive symptoms reduces these complications.