Perceived Stress and Associated Factors Among Pregnant Women Attending Antenatal Care in Urban Thailand.

BACKGROUND: Perceived stress during pregnancy is associated with adverse obstetric outcomes. Antenatal perceived stress is still unaware and under-diagnosed during routine antenatal care. There has not yet been a study of prevalence and associated factors among pregnant women living in urban areas in Thailand. Understanding antenatal perceived stress is important to improve maternal and neonatal outcomes. OBJECTIVE: To identify the prevalence, associated factors, and predictive factors of perceived stress in pregnant women living in an urban area. MATERIALS AND METHODS: This cross-sectional study was conducted from December 1, 2019 to February 29, 2020 among pregnant women attending antenatal care at the Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Bangkok, Thailand. The participants were interviewed using a structured questionnaire which included demographic data, obstetric data, serious life event data, and a Thai language version of the 10-item Perceived Stress Scale (T-PSS-10) to assess perceived stress symptoms. RESULTS: Of a total 403 pregnant women, the prevalence of perceived stress symptoms in antenatal pregnant women was 23.6%. Perceived stress symptoms were significantly associated with divorce (p=0.001), separation from spouse (p=0.005), physical or psychological trauma from family (p=0.005), marital conflict (p<0.001), and family conflict (p<0.001). Results from multiple logistic regression found that significant predictive factors for perceived stress symptoms in pregnant women were marital conflict (AOR 3.10, 95% CI 1.74-5.52, p<0.001) and family conflict (AOR 3.24, 95% CI 1.59-6.60, p=0.001). CONCLUSION: This study demonstrated that the prevalence of perceived stress symptoms in pregnant women living in an urban area in Thailand was 23.6%. Perceived stress symptoms were significantly associated with divorce, separation from spouse, physical or psychological trauma from family, marital conflict, and family conflict. Predictive factors for perceived stress symptoms were marital conflict and family conflict.

Prevalence and Associated Factors of Antenatal Depressive Symptoms in Pregnant Women Living in an Urban Area of Thailand.

BACKGROUND: Depression is a major public health problem in middle- and low-income countries. Depression in pregnancy has adverse effects on obstetric outcomes. Maternal depression remains under-recognized, under-diagnosed and undertreated in Thailand. Antenatal screening of depression is an important strategy to improve maternal and neonatal outcomes. This problem has rarely been investigated in Thailand, especially in urban areas. OBJECTIVE: To discover the prevalence, associated factors, and predictive factors of depression in pregnant women living in an urban area. MATERIALS AND METHODS: This cross-sectional study of 402 pregnant women was conducted during antenatal care at the Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, from 10 September to 31 November 2019. The participants were interviewed using a structured questionnaire that included a demographic profile, obstetric conditions, socio-cultural characteristics, and a Thai language version of the Center for Epidemiologic Studies-Depression Scale to assess depressive symptoms. RESULTS: Among a total 402 pregnant women, the prevalence of depressive symptoms in pregnant women in an urban area was 18.9%. Depressive symptoms in pregnant women were significantly associated with divorce (p < 0.001), low family income (p < 0.03), financial insufficiency (p < 0.001), extended family (p < 0.001), history of previous abortion (p = 0.033), history of previous pregnancy complications (p = 0.044), current alcohol use (p = 0.03), current tobacco use (p = 0.009), current substance abuse (p = 0.002), marital conflict (p < 0.001), and family conflict (p < 0.001). The significant factors predicting depression in pregnant women were extended family (AOR 3.0, 95% CI 1.59-5.51, p=0.001) and marital conflict (AOR 4.7, 95% CI 2.37-9.11, p<0.001). CONCLUSION: This study revealed that the prevalence of depressive symptoms in pregnant women living in an urban area in Thailand was 18.9%. The significant associated factors of depressive symptoms were divorce, low family income, financial insufficiency, extended family, previous abortion, previous pregnancy complications, current alcohol use, current tobacco use, current substance abuse, marital conflict, and family conflict. Extended family and marital conflict were significant predictive factors for antenatal depressive symptoms.

The Effect of Perceived Stress During Pregnancy on Preterm Birth.

BACKGROUND: Preterm birth is one of the most common problems in pregnancy globally, often leading to neonatal death. The rate of preterm birth is increasing every year. The etiology of preterm birth is multifactorial; preventable maternal psychosocial stress is one of the causes of preterm birth. There has not yet been a report of maternal psychosocial stress and preterm birth in Thailand. This study aimed to explore the relationship between maternal perceived stress and preterm birth. OBJECTIVE: To study the effects of maternal perceived stress on preterm birth. PATIENTS AND METHODS: An unmatched case-control study was conducted in postpartum women, between January 17, 2019, and September 30, 2019, at the Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital. A total of 200 participants were enrolled and divided into case and control groups in a 1:1 ratio. The case group consisted of postpartum women with preterm birth and the control group consisted of consecutive postpartum women with term birth. Perceived stress was measured by using the Thai Perceived Stress Scale-10 (T-PSS-10). RESULTS: Maternal perceived stress during pregnancy was significantly greater in preterm birth compared with term birth in both means score (19.43±4.48 vs 14.08±4.06, p<0.001) and moderate to high stress level (92 vs 51, p<0.001). Perceived stress score and stress level were significant predictive factors for preterm birth (AOR 1.31, 95% CI 1.20-1.44, P < 0.001 and AOR 8.66, 95% CI 3.64-20.63, P < 0.001, respectively). CONCLUSION: Maternal perceived stress during pregnancy was statistically greater in preterm birth. Perceived stress score and stress level were significant predictive factors for preterm birth.

Birth Preparedness and Complication Readiness Practices Among Pregnant Adolescents in Bangkok, Thailand.

BACKGROUND: Reducing the maternal mortality ratio is one of the United Nations Sustainable Development Goals. These maternal deaths are preventable with appropriate management and care. Birth preparedness and complication readiness (BPCR) is a strategy to make prompt decisions to seek care from skilled birth attendants, resulting in reduced maternal and neonatal mortality. Despite high global rates of adolescent pregnancy, there has not yet been a study of BPCR status and associated factors among pregnant adolescents. OBJECTIVE: To assess the proportion of, and associated factors for, good BPCR in adolescent pregnant women attending antenatal clinic in an urban tertiary care hospital. MATERIALS AND METHODS: This cross-sectional survey was conducted among adolescent pregnant women attending antenatal clinic at the Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Thailand, from September 1st, 2018 to March 31st, 2019. A total of 134 adolescent pregnant women were recruited. The participants and their parents or legal guardians were informed of the study process at the antenatal clinic before their parents or legal guardians, granted written consent on their behalf. The participants were interviewed using the BPCR index, which was adapted from the John Hopkins Program for International Education in Gynecology and Obstetrics. RESULTS: The proportion of good BPCR in adolescent pregnant women in an urban tertiary care hospital was 78.4%. The most mentioned aspect of BPCR was planning to give birth with a skilled provider (92.5%). The significant associated factor for good BPCR was the number of ANC ≥ 4 (odds ratio 3.2, 95% CI 1.13-9.05, p=0.023). CONCLUSION: This study demonstrated that the proportion of good BPCR among adolescent pregnant women attending an urban tertiary care hospital was high. The associated factor of good BPCR was the number of ANC ≥ 4.

Birth preparedness and complication readiness among pregnant women attending antenatal care at the Faculty of Medicine Vajira Hospital, Thailand.

BACKGROUND: Maternal and neonatal mortality is a major health problem in developing countries. Birth preparedness and complication readiness (BPCR) is a strategy to encourage pregnant women to make prompt decisions to seek care from skilled birth attendants. Reports of good BPCR vary depending on study setting and population. Most studies of BPCR have been conducted in developing countries, BPCR status and associated factors in Thailand are currently unknown. OBJECTIVE: To discover the proportion of good BPCR (at least four BPCR indicators), associated factors and predictive factors for good BPCR in pregnant women attending antenatal clinic. MATERIALS AND METHODS: This cross-sectional study was conducted among pregnant women attending the antenatal clinic at the Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Thailand, from May 1 to December 31, 2017. The participants were interviewed using the BPCR index developed by the John Hopkins Program for International Education in Gynecology and Obstetrics. RESULTS: Of a total 672 pregnant women, the proportion of good BPCR was 78.6%. The association between baseline characteristics with BPCR status revealed that the good BPCR group was significantly associated with adult pregnancy, married, high education, being employed, high income, extended family, multiparity, first antenatal visit ≤12 weeks and average distance to the hospital >2 hours. Results from multiple logistic regression found that significant predictive factors for good BPCR were a diploma or a bachelor's degree (ORadj 2.09, 95% CI 1.19-3.69, P=0.010), income more than 10,000 baht (ORadj 2.63, 95% CI 1.37-5.05, P=0.004), extended family (ORadj 2.32, 95% CI 1.41-3.82, P=0.001) and multiparity (ORadj 1.56, 95% CI 1.01-2.42, P=0.047). CONCLUSION: This study demonstrated that the proportion of good BPCR among pregnant women attending antenatal care was high. Associated factors of good BPCR were adult pregnancy, married status, high education, employed, high income, extended family, multiparity, first antenatal visit at ≤12 weeks and long-distance transportation. Predictive factors for good BPCR were high education, high income, multiparity and extended family.

Effects of immediate postpartum contraceptive counseling on long-acting reversible contraceptive use in adolescents.

BACKGROUND: Adolescent pregnancy is a global public health problem, particularly repeated pregnancy. The best strategy to lower prevalence of adolescent pregnancy and repeated pregnancy is promoting highly effective long-acting contraceptive methods along with special counseling programs. Long-acting reversible contraception (LARC) is the ideal contraceptive of choice for adolescents. It is not known whether immediate postpartum contraceptive counseling increases postpartum LARC use in adolescents. OBJECTIVE: To compare LARC use between immediate and conventional postpartum contraceptive counseling and discover predictive factors of postpartum LARC use. MATERIALS AND METHODS: This prospective, randomized controlled trial was conducted among postpartum adolescents at Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, from 1 July 2016 to 31 March 2017. The participants were assigned to receive immediate postpartum contraceptive counseling or conventional postpartum contraceptive counseling. The primary outcome was postpartum LARC use. The secondary outcome was predictive factors for LARC use in postpartum adolescents. RESULTS: Of the 233 postpartum adolescents, postpartum LARC use was 87 of 118 (73.7%) in the immediate postpartum counseling group and 49 of 115 (42.6%) in the conventional postpartum counseling group (odds ratio 3.780, 95% CI 2.18-6.57, p<0.001). A significant predictive factor for LARC use in postpartum adolescents was immediate postpartum counseling (odds ratio 3.67, 95% CI 2.10-6.41, p<0.001). CONCLUSION: Immediate postpartum contraceptive counseling led to a significant increase in postpartum use of LARC in adolescents, when compared with conventional (4-6 weeks) postpartum contraceptive counseling. Adolescent mothers who received immediate postpartum counseling were 3.67 times more likely to use LARC than those who received conventional postpartum counseling.