Mental health of pregnant women during the SARS-CoV-2 pandemic in France: Evolution of self-perceived psychological state during the first lockdown, and anxiety frequency two months after the lockdown ended.

Previous pandemics and related lockdowns have had a deleterious impact on pregnant women's mental health. We studied the impact of the SARS-CoV-2/Covid-19 pandemic and France's first lockdown on pregnant women's mental health. A cross-sectional study was conducted in July 2020 using a web-questionnaire completed by 500 adult women who were pregnant during the first lockdown in France (March-May 2020). Questions focused on their self-perceived psychological state and affects they felt before and during the lockdown and anxiety symptomatology (HAD) two months after it ended. A robust variance Poisson regression model was used to estimate adjusted prevalence ratios (aPR) for anxiety and self-perceived psychological state evolution. One in five respondents (21.1%) reported psychological deterioration during lockdown. Associated determinants were: i) little or no social support (self-perceived) (aRP = 1.77, 95%CI[1.18-2.66]), ii) increased workload (1.65, [1.02-2.66]), and iii) poor/moderate knowledge about SARS-CoV-2 transmission (1.60, [1.09-2.35]). Seven percent of women reporting psychological deterioration had access to professional psychological support during lockdown, while 19% did not despite wanting it. Women reported heightened powerlessness (60.3%), frustration (64%) and fear (59.2%) during lockdown. One in seven respondents (14.2%, 95%CI[10.9-18.2]) had anxiety symptoms. Determinants associated: i) at least one pregnancy-related pathology (aPR = 1.82, 95%CI[1.15-2.88]), ii) overweightness or obesity (1.61, [1.07-2.43]), iii) one child under the age of six years in the household during the lockdown (3.26, [1.24-8.53]), iv) little or no social support (self-perceived) during the lockdown (1.66, [1.07-2.58]), v) friend or relatives diagnosed with Covid-19 or with symptoms of the disease (1.66; [1.06-2.60]), vi) no access to medication for psychological distress (2.86, [1.74-4.71]), and vii) unsuccessfully seeking exchanges with healthcare professionals about their pregnancy during the pandemic (1.66, [1.08-2.55]). Our results can guide prevention and support policies for pregnant women during pandemics, current or future, with or without lockdowns. Preventing perinatal mental health problems is essential to ensure a supportive environment for the child's development.

Children and Adolescents Psychological Distress Scale During COVID-19 Pandemic: Validation of a Psychometric Instrument (CONFEADO Study).

Aim and Object Purpose of the Study: In March 2020, the WHO declared a pandemic (COVID-19) due to the SARS-CoV-2 virus. In France, school closures and lockdowns were implemented. In this unprecedented context for French adolescents and children, the CONFEADO study surveyed children aged 9 to 18 years to assess their mental health, psychological distress, and resilience during and after the lockdown in relation to their living and housing conditions. To assess psychological distress, a psychometric tool (Children and Adolescent Psychological Distress Scale-CAPDS-10) was specifically designed for the research. This article presents the psychometric validity of the CAPDS-10. Methods: This cross-sectional study collected data from June 9 to September 14, 2020, from children and adolescents (9 to 18 years of age) via an online questionnaire after sending it to a large network of partners. Psychological distress, resilience, and trait anxiety were assessed using the CAPDS-10, the Child and Youth Resilience Measure (CYRM), and the State-Trait Anxiety Inventory for Children (STAIC). The CAPDS-10 measured perceived psychological distress in the most recent 2 weeks (primary endpoint). The predictive power of the CAPDS-10 was determined by statistical analysis. We proceeded to a confirmatory factor analysis to validate the scale at a clinical level. We carried out a psychometric validation with a step to verify the uni-dimensionality of the scale (PCA analysis) and the calculation of convergent and divergent validity, correlation coefficient between items and subscales, Cronbach's alpha for reliability, determination of a cut-off score for the AUROC index. Results: Three thousand and forty eight children and adolescents completed the CAPDS-10. Analysis confirmed a three-factor model (anxiety, depression, and aggressive behavior) (RMSEA = 0.072 [0.067; 0.077], CFI = 0.954), with a correlation coefficient between items >0.4. PCA analysis concluded that the scale is unidimensional. Reliability was satisfactory with Cronbach's alpha coefficients >0.7 (0.86). In addition, prediction was good with an AUROC index equal to 0.73 and a threshold score for severe distress greater than or equal to 19. Conclusion: The CAPDS-10 measures psychological distress over the most recent 2-week period with good psychometric qualities. It could be used in crisis or prevention contexts in the general population or in clinical settings.

Manual rotation to decrease operative delivery in posterior or transverse positions.

OBJECTIVE: To assess the effect of a policy of manual rotation on the mode of delivery of fetuses in posterior or transverse positions at full dilatation. METHODS: This was a prospective study to compare two policies of management for posterior and transverse positions in two different hospitals (Hospital 1: no manual rotation and Hospital 2: manual rotation). We used univariable and multivariable analyses to study the association between the management policy for posterior and transverse positions at full dilatation in these hospitals and maternal and neonatal outcomes. The principal end point was operative delivery (ie, cesarean or instrumental vaginal delivery). All factors associated with the risk of operative delivery in the univariable analysis (P<.1) were included in the logistic regression models. We then specifically studied whether manual rotation was independently associated with a reduction in operative deliveries. RESULTS: The rate of posterior or transverse positions at full dilatation was 15.9% (n=111) in Hospital 1 and 15.3% (n=220) in Hospital 2 (P=.75). Of the 172 attempts of manual rotation in Hospital 2, 155 (90.1%) were successful. The rate of operative delivery was significantly lower in Hospital 2, which performed manual rotations (23.2% compared with 38.7% in Hospital 1, adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.28-0.95). After multivariable analysis, manual rotation remained significantly associated with a reduction in the risk of operative delivery (adjusted OR 0.45, 95% CI 0.25-0.85). Five-minute Apgar score and arterial pH at birth were similar in the two hospitals. CONCLUSION: For fetuses in posterior or transverse positions at full dilatation, a strategy of manual rotation is associated with a reduction in the rate of operative delivery. LEVEL OF EVIDENCE: III.

Induction of labor and risk of postpartum hemorrhage in low risk parturients.

OBJECTIVE: Labor induction is an increasingly common procedure, even among women at low risk, although evidence to assess its risks remains sparse. Our objective was to assess the association between induction of labor and postpartum hemorrhage (PPH) in low-risk parturients, globally and according to its indications and methods. METHOD: Population-based case-control study of low-risk women who gave birth in 106 French maternity units between December 2004 and November 2006, including 4450 women with PPH, 1125 of them severe, and 1744 controls. Indications for labor induction were standard or non-standard, according to national guidelines. Induction methods were oxytocin or prostaglandins. Multilevel multivariable logistic regression modelling was used to test the independent association between induction and PPH, quantified as odds ratios. RESULTS: After adjustment for all potential confounders, labor induction was associated with a significantly higher risk of PPH (adjusted odds ratio, AOR1.22, 95%CI 1.04-1.42). This excess risk was found for induction with both oxytocin (AOR 1.52, 95%CI 1.19-1.93 for all and 1.57, 95%CI 1.11-2.20 for severe PPH) and prostaglandins (AOR 1.21, 95%CI 0.97-1.51 for all and 1.42, 95%CI 1.04-1.94 for severe PPH). Standard indicated induction was significantly associated with PPH (AOR1.28, 95%CI 1.06-1.55) while no significant association was found for non-standard indicated inductions. CONCLUSION: Even in low risk women, induction of labor, regardless of the method used, is associated with a higher risk of PPH than spontaneous labor. However, there was no excess risk of PPH in women who underwent induction of labor for non-standard indications. This raises the hypothesis that the higher risk of PPH associated with labor induction may be limited to unfavorable obstetrical situations.