LBTQ parents' needs for support postpartum following a complicated birth: A matter of reproductive justice.

LBTQ people have increased risks of complications during birth, risks potentially driven by minority stress and increased levels of mental illness and fear of childbirth. With the aim of exploring reproductive injustices in postpartum care for LBTQ people, we analyzed qualitative interviews where 22 LBTQ birth and non-birth parents shared their experiences of support needs during the postpartum period after births where complications had arisen. Results point to the importance of providing an LBTQ safe space, which includes the need to feel safe regarding one's gender or sexual identity, by avoiding cisheteronormative assumptions and using inclusive language. In the context of recently experiencing birth complications, parents needed a space where they were able to focus on physical and mental healing. The results further show the need for validation of the non-birth parent and inclusive breast/chest-feeding support. Results emphasize the need for more psychosocial support around the birth experience, including better medical support and information during the whole process of childbirth.

Trauma-informed support after a complicated childbirth - An early intervention to reduce symptoms of post-traumatic stress, fear of childbirth and mental illness.

OBJECTIVE: Women who experience obstetric interventions and complications during childbirth have an increased risk of developing postnatal post-traumatic stress and mental illness. This study aimed to test the effect of a trauma-informed support programme based on psychological first aid (PFA) to reduce the mothers' symptoms of stress, fear of childbirth (FOC), anxiety and depression after a complicated childbirth. METHODS: The study population consisted of women ≥ 18 years old who had undergone a complicated childbirth (i.e. acute or emergency caesarean section, vacuum extraction, child in need of neonatal care, manual placenta removal, obstetric anal sphincter injury, shoulder dystocia or major haemorrhage (>1000 ml)). A total of 101 women participated in the study, of whom 43 received the intervention. Demographic questions and three self-assessment instruments measuring stress symptoms, FOC, anxiety and depression were answered one to three months after birth. RESULTS: The women in the intervention group scored significantly lower on the stress symptom scale, with a halved median score compared to the control group. There was no significant difference between the groups regarding FOC, depression and anxiety. CONCLUSION: Our results indicate that this PFA-based support programme might reduce post-traumatic stress symptoms in women who have gone through a complicated childbirth. With further studies in a larger population, this support programme has the potential to contribute to improved maternal care optimizing postnatal mental health.

Factors related to a positive childbirth experience - a cross-sectional study.

BACKGROUND/AIMS: Giving birth is a life-changing experience for women. Most previous studies have focused on risk factors for a negative childbirth experience. The primary aim of this study was to assess childbirth experience in a sample of postnatal Swedish women. The secondary aim was to analyse demographic and clinical determinants associated with a positive birth experience. DESIGN/METHODS: A digital survey including the instrument Childbirth Experience Questionnaire 2 (CEQ2) was answered by 619 women six to 16 weeks postpartum. Regression analyses were made assessing the impact that different factors had on the overall childbirth experience and the four subscales of CEQ2: Own Capacity, Perceived Safety, Professional Support and Participation. RESULTS: Overall, women were satisified with their birthing experience. Several factors contributed to a positive childbirth experience. Having a vaginal mode of birth (without vacuum extraction) together with not having ongoing mental health problems were the factors with the most influence on the total childbirth experience. Not having maternal complications postpartum and receiving much support from a trusted birth companion were two other important factors. CONCLUSION: Although Swedish women tend to express satisfaction with their childbirth experiences, there is a necessity to advocate for a childbirth approach that optimises the chance of giving birth vaginally rather than with vacuum extraction or acute caesarean section, and reduces the risk for complications whenever possible. During pregnancy, mental health problems should be appropriately addressed. Healthcare professionals could also more actively involve the birth companion in the birthing process and equip them with the necessary tools to effectively support birthing women.

Identification of depression and anxiety during pregnancy: A systematic review and meta-analysis of test accuracy.

INTRODUCTION: Depression and anxiety are significant contributors to maternal perinatal morbidity and a range of negative child outcomes. This systematic review and meta-analysis aimed to review and assess the diagnostic test accuracy of selected screening tools (Edinburgh Postnatal Depression Scale [EPDS], EPDS-3A, Patient Health Questionnaire [PHQ-9]-, PHQ-2, Matthey Generic Mood Question [MGMQ], Generalized Anxiety Disorder scale [GAD-7], GAD-2, and the Whooley questions) used to identify women with antenatal depression or anxiety in Western countries. MATERIAL AND METHODS: On January 16, 2023, we searched 10 databases (CINAHL, Cochrane Library, CRD Database, Embase, Epistemonikos, International HTA Database, KSR Evidence, Ovid MEDLINE, PROSPERO and PsycINFO); the references of included studies were also screened. We included studies of any design that compared case-identification with a relevant screening tool to the outcome of a diagnostic interview based on the Diagnostic and Statistical Manual of Mental Disorders, fourth or fifth edition (DSM-IV or DSM-5), or the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Diagnoses of interest were major depressive disorder and anxiety disorders. Two authors independently screened abstracts and full-texts for relevance and evaluated the risk of bias using QUADAS-2. Data extraction was performed by one person and checked by another team member for accuracy. For synthesis, a bivariate model was used. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). REGISTRATION: PROSPERO CRD42021236333. RESULTS: We screened 8276 records for eligibility and included 16 original articles reporting on diagnostic test accuracy: 12 for the EPDS, one article each for the GAD-2, MGMQ, PHQ-9, PHQ-2, and Whooley questions, and no articles for the EPDS-3A or GAD-7. Most of the studies had moderate to high risk of bias. Ten of the EPDS articles provided data for synthesis at cutoffs ≥10 to ≥14 for diagnosing major depressive disorder. Cutoff ≥10 gave the optimal combined sensitivity (0.84, 95% confidence interval [CI]: 0.75-0.90) and specificity (0.87, 95% CI: 0.79-0.92). CONCLUSIONS: Findings from the meta-analysis suggest that the EPDS alone is not perfectly suitable for detection of major depressive disorder during pregnancy. Few studies have evaluated the other instruments, therefore, their usefulness for identification of women with depression and anxiety during pregnancy remains very uncertain. At present, case-identification with any tool may best serve as a complement to a broader dialogue between healthcare professionals and their patients.

Translation and validation of the Swedish version of the Birth Satisfaction Scale-Revised (BSS-R).

BACKGROUND: Optimizing women's childbirth experience is essential for development of quality mother infant relationships. The Birth Satisfaction Scale-Revised (BSS-R) can be used to measure birth satisfaction. AIM: The current investigation sought to translate and validate a Swedish version of the BSS-R. METHOD: Following translation, a comprehensive psychometric validation of the Swedish-BSS-R (SW-BSS-R) was carried out using a multi-model, cross-sectional, between- and within-subjects design. PARTICIPANTS: A total of 619 Swedish-speaking women participated, from which 591 completed SW-BSS-R and were eligible for analysis. DATA ANALYSIS: Discriminant, convergent, divergent and predictive validity, internal consistency, test-retest reliability, and factor structure were evaluated. RESULTS: The SW-BSS-R was found to have excellent psychometric properties and hence is a valid translation of the original UK(English)-BSS-R. Important insights into relationships between mode of birth, post-traumatic stress disorder (PTSD), and postnatal depression (PND) were observed. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The SW-BSS-R is a psychometrically valid translation of the original BSS-R and is suitable for use in a Swedish-speaking population of women. The study has also highlighted important dynamics between birth satisfaction and areas of significant clinical concern (i.e., mode of birth, PTSD and PND) in Sweden.

When complications arise during birth: LBTQ people's experiences of care.

OBJECTIVE: To explore the care experiences of lesbian, bisexual, transgender, and queer (LBTQ) people during births where complications have arisen. DESIGN: Data were collected through semi-structured interviews with self-identified LBTQ people who had experienced obstetrical and/or neonatal complications. SETTING: Interviews were conducted in Sweden. PARTICIPANTS: A total of 22 self-identified LBTQ people participated. 12 had experienced birth complications as the birth parent and ten as the non-birth parent. FINDINGS: Most participants had felt invalidated as an LBTQ family. Separation of the family due to complications elevated the number of hetero/cisnormative assumptions, as new encounters with healthcare professionals increased. Dealing with normative assumptions was particularly difficult in stressful and vulnerable situations. A majority of the birth parents experienced disrespectful treatment from healthcare professionals that violated their bodily integrity. Most participants experienced lack of vital information and emotional support, and expressed that the LBTQ identity made it harder to ask for help. CONCLUSIONS: Disrespectful treatment and deficiencies in care contributed to negative experiences when complications arose during birth. Trusting care relationships are important to protect the birth experience in case of complications. Validation of the LBTQ identity and access to emotional support for both birth and non-birth parents are crucial for preventing negative birth experiences. IMPLICATIONS FOR PRACTICE: To reduce minority stress and create conditions for a trusting relationship, healthcare professionals should specifically validate the LBTQ identity, strive for continuity of carer and zero separation of the LBTQ family. Healthcare professionals should make extensive efforts to transfer LBTQ related information between wards.

Assessment of maternal posttraumatic stress disorder following childbirth: Psychometric properties of the Swedish version of City Birth Trauma Scale.

OBJECTIVE: City Birth Trauma Scale (City BiTS) is an instrument designed to evaluate and diagnose postpartum posttraumatic stress disorder (PTSD) according to the 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). No validated Swedish instrument exists to measure postpartum PTSD according to DSM-5. Therefore, the primary aim of this study was to assess the psychometric properties of the Swedish version of the City BiTS (City BiTS-Swe) and to examine the latent factor structure of postpartum PTSD. The secondary aim was to report the Swedish prevalence of PTSD following childbirth. METHOD: A total of 619 women, who had given birth at five clinics in the past 6-16 weeks, completed an online version of City BiTS-Swe and the Edinburgh Postnatal Depression Scale (EPDS). Additionally, sociodemographic and medical data were collected. A second questionnaire was answered by 110 women to examine reliability over time. RESULTS: The confirmatory factor analysis using the two-factor model gave best fit to the data. We found a high internal consistency (α = .89-.87) and good test-retest reliability (ICC = 0.53-0.90). Divergent reliability with EPDS showed significant correlations with satisfying results for the subscale birth-related symptoms (r = .41). We also found discriminant validity concerning mode of birth, parity, gestational age, mental illness, history of traumatic childbirth, and history of traumatic event as expected. The prevalence of PTSD was 3.8%. CONCLUSIONS: The City BiTS-Swe is a valid and reliable instrument to assess and diagnose PTSD following childbirth. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Fear of childbirth and mental health among lesbian, bisexual, transgender and queer people: a cross-sectional study.

Background: Most studies of fear of childbirth (FOC) are conducted on heterosexual cisgender pregnant populations of birth-giving parents. Among lesbian and bisexual women, as well as transgender and queer people (LBTQ), minority stress can add an extra layer to FOC. Gender binary and cisnormative assumptions leave it to the patient to educate and navigate healthcare providers, which can increase mental health problems.Objective: The aim of this study is to compare FOC and mental illness among expecting birth-giving parents and their partners in an LBTQ population.Materials and methods: This cross-sectional study recruited 80 self-identified pregnant LBTQ persons and their 54 non-pregnant partners at a LBTQ specialized antenatal clinic in a large Swedish city of over one million inhabitants. The survey included socio-demographic characteristics, sexual and gender orientation, obstetric history, previous mental health, previous trauma exposure and measures of FOC and mental health.Results: Levels of FOC were significantly higher for the pregnant participants (median W-DEQ 67.5) than for partners (median W-DEQ 60.0). The proportion of severe FOC was higher for pregnant participants (20.3%) than for partners (9.4%), although this difference was not statistically significant. Mental illness was significantly associated with FOC.Conclusion: The results add valuable information to our understanding of the specific needs of pregnant LBTQ people and their partners and may help us to develop healthcare in the future.

Supporting women's reproductive capabilities in the context of childbirth: Empirical validation of a midwifery theory synthesis.

OBJECTIVE: To conduct an empirical validation of the theoretical model of midwifery care suggested by Peters et al. (2020). DESIGN: A qualitative deductive methodology was used to validate the theoretical model of aims and objectives of midwifery care. The existing model was validated for midwifery care before, during and after childbirth by interviewing women who had reported high satisfaction with childbirth and low fear of childbirth postpartum. SETTING: Data were collected via interviews with women who had given birth from January to March 2018 at a middle-sized hospital in south-east Sweden. PARTICIPANTS: Swedish-speaking women aged ≥ 18 years, were invited by midwives to participate at a postpartum maternal healthcare ward, and they received oral and written information. They filled in a demographic questionnaire, a grading of their birth experience on a 0-10 numeric rating scale (NRS) and the Wijma Delivery Experience Questionnaire Version B (W-DEQ B). We used ≥7 as the cut-off for high satisfaction with childbirth (NRS), and a sum score ≤60 for low fear of childbirth (W-DEQ B). Of 172 women, 28 were eligible, of whom 20 were interviewed 8-13 months postpartum. The interviews were analysed using qualitative content analysis with a directed approach. FINDINGS: All of the model's levels and their aspects were found in the interviews. All women had experienced a trusting relationship, including individual and woman-centred care, communication, choice and continuity, prompt attention and an empathic attitude. A majority described midwifery in terms of promoting security, and almost all had experienced aspects of personal control. The objective of midwifery care, described as the facilitation of women's reproductive capabilities, was described as being met by half of the women. The importance of pep talks and coaching was emphasized, and partner support could be added to the model. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Our findings indicate that the theoretical model proposed by Peters et al. (2020) is mainly applicable to midwifery care of women reporting high satisfaction with their birth experience and low postpartum fear of childbirth. Our findings suggest that this model may serve as a clarification of the unique objective of midwifery care, and could be used by midwives in daily clinical work and in midwifery education programs.

Fear of childbirth postpartum and its correlation with post-traumatic stress symptoms and quality of life among women with birth complications - a cross-sectional study.

The primary aim of the study was to analyze differences in post-traumatic stress symptoms (PTSS) and quality of life (QoL) between women with and without severe fear of childbirth postpartum (PP FOC). The secondary aims were to analyze the correlation between PP FOC and PTSS, and PP FOC and QoL, in women undergoing complicated childbirth. This cross-sectional study was conducted in South-East Sweden. Women aged ≥ 18 years who had undergone complicated childbirth (i.e., acute or emergency cesarean section, vacuum extraction, child in need of neonatal care, manual placenta removal, sphincter rupture, shoulder dystocia, or hemorrhage ≥ 1000 ml) were invited. Seventy-six women answered demographic questions and three validated instruments measuring PP FOC, PTSS, and QoL. The study population was divided into two sub groups: severe PP FOC or no severe PP FOC. Statistical analyses were conducted using Mann-Whitney U-test, chi-square test or Fisher's exact test, and Spearman's rank-order correlation. Severe PP FOC was reported by 29% of the women, and 18% reported PTSS indicating post-traumatic stress disorder. Women with severe PP FOC reported significantly higher levels of PTSS, and significantly lower QoL in five dimensions: physical role functioning, emotional role functioning, energy/fatigue, emotional well-being, and social functioning. There was a positive significant correlation between level of PP FOC and PTSS. There were also significant negative correlations between level of PP FOC and most of the QoL dimensions. In conclusion, almost one-third of the women with complicated childbirth reported severe PP FOC, and almost one-fifth reported PTSS indicating post-traumatic stress disorder. PP FOC correlated with PTSS and deteriorated QoL.

How norms concerning maternity, femininity and cisgender increase stress among lesbians, bisexual women and transgender people with a fear of childbirth.

OBJECTIVE: To explore and describe norms concerning maternity, femininity and cisgender in lesbian and bisexual women and transgender people (LBT) assigned female at birth, with an expressed fear of childbirth (FOC). DESIGN: Semi-structured interviews were conducted with self-identified LBT people with an expressed FOC. PARTICIPANTS: 17 self-identified LBT people participated. 15 had an expressed FOC, and two were non-afraid partners. FINDINGS: Participants described how their FOC was related to ideals of "the primal woman", including ideals of a natural birth. They also described stress in relation to expectations of gaining a feminine-coded body during pregnancy and of being related to as feminine women. KEY CONCLUSIONS: Maternity ideals, and the ideal of the "natural" birth, can be particularly stressful on those who fear childbirth. Norms concerning femininity and cisgender can contribute to FOC among those who do not comfortably conform with feminine body ideals or feminine gender expressions. IMPLICATION FOR PRACTICE: Treatments of FOC must be designed to acknowledge whether and how norms concerning maternity, femininity and cisgender affect the individual's FOC.

Negotiating who gives birth and the influence of fear of childbirth: Lesbians, bisexual women and transgender people in parenting relationships.

BACKGROUND: Fear of childbirth (FOC) may affect family planning in lesbian, bisexual and transgender (LBT) couples with two potential carriers of a pregnancy. FOC has previously been researched in heterosexual women, while experiences of LBT people have remained unattended. The choice of birth-giving partner in same-sex couples has gained some attention in previous research, but the potential complexities of the decision have not been studied. AIM: The aim is to explore how LBT people negotiate the question of who gives birth, in couples with two potential birth parents, and where one or both partners have a pronounced FOC. METHODS: Seventeen self-identified LBT people were interviewed about their expectancies and experiences of pregnancy and childbirth. Data were analysed following a six-step thematic analysis. RESULTS: FOC was negotiated as one of many aspects that contributed to the decision of who would be the birth-giving partner. Several participants decided to become pregnant despite their fears, due to a desire to be the genetic parent. Others negotiated with their partner about who was least vulnerable, which led some of them to become pregnant despite FOC. Still other participants decided to refrain from pregnancy, due to FOC, and were delighted that their partner would give birth. Several participants described their partner's birth-giving as a traumatic experience for them, sometimes also when the birth did not require any obstetric interventions. The partner's experience was in some cases not addressed in postnatal care. CONCLUSIONS: It is important that healthcare staff address both partners' prenatal expectancies and postnatal experiences.

Minority stress adds an additional layer to fear of childbirth in lesbian and bisexual women, and transgender people.

OBJECTIVE: To explore and describe thoughts about and experiences of pregnancy, childbirth and reproductive healthcare in lesbian and bisexual women and transgender people (LBT) with an expressed fear of childbirth (FOC). DESIGN: Data were collected through semi-structured interviews with self-identified LBTs with an expressed FOC. PARTICIPANTS: 17 self-identified LBTs participated. 15 had an expressed FOC, and two were non-afraid partners. FINDINGS: Participants' fears were similar to those previously described in research on FOC, e.g., fear of pain, injury, blood, death of the child or of the parent. However, minority stress, including fear and experiences of prejudicial treatment, in maternity care and at delivery wards add an additional layer to the fear of childbirth. KEY CONCLUSIONS: LBTs with FOC are a particularly vulnerable group of patients, whose needs must be addressed in healthcare. IMPLICATION FOR PRACTICE: The findings call attention to the need for LBT-competent treatment prior to, and throughout pregnancy and childbirth. In the most vulnerable patients, caregivers must work extensively to build trust, in order to explore and reduce FOC.

Severe fear of childbirth indicates high perinatal costs for Swedish women giving birth to their first child.

INTRODUCTION: The objective of this study was to calculate costs associated with severe fear of childbirth (FOC) during pregnancy and peripartum by comparing two groups of women expecting their first child and attending an ordinary antenatal program; one with low FOC and one with severe FOC. MATERIAL AND METHODS: In a prospective case-control cohort study one group with low FOC [Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) sum score ≤60, n = 107] and one with severe FOC (W-DEQ ≥85, n = 43) were followed up till 3 months postpartum and included in the analysis. Medical records were assessed and medical parameters were mapped. Mean costs for healthcare consumption and sick leave during pregnancy were calculated and compared. RESULTS: When means were compared between the groups, the group with severe FOC had more visits for psychosocial reasons (p = 0.001) and more hours on sick leave (p = 0.03) during pregnancy, and stayed longer at the maternity ward (p = 0.04). They also more seldom had normal spontaneous deliveries (p = 0.03), and more often had an elective cesarean section on maternal request (p = 0.02). Postpartum, they more often than the group with low FOC paid visits to the maternity clinic because of complications (p = 0.001) and to the antenatal unit because of adverse childbirth experiences (p = 0.001). The costs for handling women with severe FOC was 38% higher than those for women with low FOC. CONCLUSION: Women with severe FOC generate considerably higher perinatal costs than women with low FOC when handled in care as usual.

Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth-a randomized controlled trial.

The aim of this study was to analyse the effects of trauma-focused guided Internet-based cognitive behaviour therapy for relieving posttraumatic stress disorder (PTSD) symptoms following childbirth, a problem that about 3% women encounter postpartum. Following inclusion, 56 traumatized women were randomized to either treatment or to a waiting list control group. Primary outcome measures were the Traumatic Event Scale (TES) and Impact of Event Scale-Reversed (IES-R). Secondary measures were Beck depression inventory II, Patient Health Questionnaire (PHQ-9), Beck Anxiety Inventory, Quality Of Life Inventory and the EuroQol 5 Dimensions. The treatment was guided by a clinician and lasted eight weeks and comprised eight modules of written text. The between-group effect size (ES) was d = .82 (p < .0001) for the IES-R. The ES for the TES was small (d = .36) and not statistically significant (p = .09). A small between-group ES (d = .20; p = .02) was found for the PHQ-9. The results from pre- to post-treatment showed large within-group ESs for PTSD symptoms in the treatment group both on the TES (d = 1.42) and the IES-R (d = 1.30), but smaller ESs in the control group from inclusion to after deferred treatment (TES, d = .80; IES-R d = .45). In both groups, the treatment had positive effects on comorbid depression and anxiety, and in the treatment group also on quality of life. The results need to be verified in larger trials. Further studies are also needed to examine long-term effects.

Treatment of nulliparous women with severe fear of childbirth via the Internet: a feasibility study.

OBJECTIVE: The aim of the present study was to test the feasibility of Internet interventions among nulliparous women suffering from severe fear of childbirth (FOC) by means of an Internet-delivered therapist-supported self-help program based on cognitive behavioral therapy (ICBT). DESIGN: Prospective, longitudinal cohort study. SETTING: A feasibility study of an ICBT program for the treatment of severe FOC in pregnant women. SAMPLE: Twenty-eight Swedish-speaking nulliparous women with severe FOC recruited via a project home page from January 2012 to December 2013. METHODS: The main components of the ICBT program for the treatment of severe FOC comprised psycho-education, breathing retraining, cognitive restructuring, imaginary exposure, in vivo exposure and relapse prevention. The study participants were anonymously self-recruited over the Internet, interviewed by telephone and then enrolled. All participants were offered 8 weeks of treatment via the Internet. Participants reported their homework weekly, submitted measurements of their fear and received feedback from a therapist via a secure online contact management system. MAIN OUTCOME MEASURES: Level of FOC measured with the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ A) during screening at enrollment and weekly during the treatment (W-DEQ version A), and after the delivery (W-DEQ version B). RESULTS: A statistically significant (p < 0.0005) decrease of FOC [W-DEQ sum score decreased pre to post-therapy, with a large effect size (Cohen's d = 0.95)]. CONCLUSIONS: The results of this feasibility study suggest that ICBT has potential in the treatment of severe FOC during pregnancy in motivated nulliparous women. The results need to be confirmed by randomized controlled studies.

Women's fear of childbirth and preference for cesarean section--a cross-sectional study at various stages of pregnancy in Sweden.

OBJECTIVE: To investigate Swedish women's level of antenatal fear of childbirth at various gestational ages, and factors associated with intense fear and with preference for cesarean section. DESIGN: A cross-sectional study. SETTING: All antenatal clinics in four geographical areas. SAMPLE: Thousand six hundred and thirty-five pregnant women at various gestational ages recruited during September-October 2006. METHOD: A questionnaire completed at the antenatal clinic. The women reported their appraisal of the approaching delivery according to the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). MAIN OUTCOME MEASURES: The level of fear of childbirth and preferred mode of delivery. RESULTS: Mean W-DEQ score was 62.8. The prevalence of intense fear of childbirth (W-DEQ score > or =85) was 15.8% and very intense fear (tocophobia) (W-DEQ score > or =100) 5.7%. Nulliparous women had a higher mean score than parous women, but more parous women reported an intense fear. Preference for cesarean section was associated with fear of childbirth (OR 11.79, 6.1-22.59 for nulliparous and OR 8.32, 4.36-15.85 for parous women) and for parous women also with a previous cesarean section (OR 18.54, 9.55-35.97), or an instrumental vaginal delivery (OR 2.34, 1.02-5.34). The level of fear of childbirth was not associated with the gestational age. CONCLUSIONS: When a woman requests a cesarean section, both primary fear of birth and traumatic childbirth experiences need to be considered and dealt with. The W-DEQ can be used at any time during pregnancy in order to identify pregnant women who suffer from intense fear of childbirth.

Cytokine mapping of sera from women with preeclampsia and normal pregnancies.

INTRODUCTION: Preeclampsia is a pregnancy-specific syndrome. The immune system in preeclampsia is changed with an increased innate activity and there is a hypothesis of a shift towards Th1-type immunity. The aim of this study was to determine a spectrum of soluble immunological factors denoting different aspects of immune activation in third trimester sera from women with preeclampsia (N=15) and compare with levels in sera from normal pregnant women (N=15). MATERIAL AND METHODS: IL-1beta, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12 p40, IL-13, IL-15, IL-17, IFN-alpha, IFN-gamma, TNF-alpha, GM-CSF, MIP-lalpha, MIP-1beta, MCP-1, eotaxin and RANTES were measured in serum using multiplex bead arrays. The levels of soluble CD14 and soluble IL-4 receptor were measured by enzyme-linked immunoassay (ELISA). RESULTS: Preeclamptic women had significantly increased levels of circulating IL-6 (p=0.002), IL-8 (p=0.003) and soluble IL-4R (p=0.037), compared to women with normal pregnancies. CONCLUSION: This study supports the hypothesis of increased inflammatory responses in preeclampsia, illustrated by the increased levels of IL-6 and IL-8. The finding of increased levels of soluble IL-4 receptor is an intriguing finding with several interpretations, which may partly support the hypothesis of a Th1 shift in preeclampsia.

Indications of an altered immune balance in preeclampsia: a decrease in in vitro secretion of IL-5 and IL-10 from blood mononuclear cells and in blood basophil counts compared with normal pregnancy.

It has been suggested that maladaptation of the maternal immune response during pregnancy might be a causal factor for preeclampsia. This study was designed to examine the systemic immune status at both the innate level and the adaptive level in pregnancies complicated by preeclampsia (n=15) and normal pregnancies (n=15). Spontaneous and in vitro-induced secretion of IL-5, IL-6, IL-10, IL-12, IL-13 and TNF-alpha, in response to paternal blood cells and the vaccination antigens purified protein derivate of tuberculin (PPD) and tetanus toxoid (TT), was detected in cell culture supernatants from blood mononuclear cells by ELISA. Preeclamptic women showed reduced numbers of basophil granulocytes in the blood (p=0.004) and lower spontaneous secretion of IL-5 from blood mononuclear cells (p=0.016). In addition, paternal antigen-induced secretion of IL-10 was decreased in preeclampsia compared with normal pregnancy (p=0.012). No further differences between preeclampsia and normal pregnancy were found for any stimuli or cytokines. The present findings of reduced basophil numbers and lower spontaneous in vitro secretion of IL-5 in preeclampsia compared with normal pregnancy indicate a decrease in systemic Th2 immunity in preeclampsia. Furthermore, the decrease in paternal antigen-induced secretion of the immunosuppressive cytokine IL-10 in preeclampsia indicates a fetus-specific decrease in immunosuppression mediated by blood mononuclear cells. Whether these systemic changes are a cause or a consequence of preeclampsia remains to be elucidated.

Systemic Th1/Th2 cytokine responses to paternal and vaccination antigens in preeclampsia: no differences compared with normal pregnancy.

PROBLEM: A Th1-shift has been suggested to be involved in the pathogenesis of preeclampsia. This study was designed to compare Th1/Th2 related cytokine secretion in blood between women with preeclampsia (n = 15) and normal pregnancies (n = 15), using a high-sensitivity technique for cytokine detection. METHODS OF STUDY: Spontaneous as well as 'fetus-specific' and recall antigen-specific (purified protein derivate of Mycobacterium tuberculosis, tetanus toxoid and lipopolysaccharide) secretion of interferon-gamma, interleukin (IL)-4, IL-10 and IL-12 in peripheral blood mononuclear cells (PBMC) was detected by enzyme-linked immunosorbent spot-forming cell assay (ELISPOT). Fetus-specific secretion was induced by stimulation with paternal PBMC in a mixed leukocyte culture assay. RESULTS: All cytokines were secreted by PBMCs both from women with preeclampsia and women with normal pregnancies. No differences in the number of cytokine-secreting cells were found between the two groups. CONCLUSIONS: No evidence was found for a shift in the systemic Th1/Th2 responses, in preeclampsia compared with normal pregnancy. This does, however, not exclude differences in the local immune responses related to the fetoplacental unit.