Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: a prospective cross-sectional descriptive multicentred study.

OBJECTIVE: To assess the prevalence of anxiety and depression and their associated risk factors throughout the pregnancy and postpartum process using a new screening for the early detection of mental health problems. DESIGN: A prospective cross-sectional descriptive multicentred study. Participants were consecutively enrolled at ≥ 12 weeks' gestation and followed at three different time points: at 12-14 weeks of pregnancy, at 29-30 weeks of pregnancy, and 4-6 weeks postpartum. All women completed a mental screening at week 12-14 of pregnancy consisting of two questions from the Generalised Anxiety Disorder Scale (GAD-2) and the two Whooley questions. If this screening was positive, the woman completed the Edinburgh Postnatal Depression Scale (EPDS). SETTING: Seven primary care centres coordinated by a Gynaecology and Obstetrics Department in the city of Terrassa (Barcelona) in northern Spain. PARTICIPANTS: Pregnant women (N = 335, age 18-45 years), in their first trimester of pregnancy, and receiving prenatal care in the public health system between July 2018 and July 2020. FINDINGS: The most relevant factors associated with positive screening for antenatal depression or anxiety during pregnancy, that appear after the first trimester of pregnancy, are systematically repeated throughout the pregnancy, and are maintained in the postpartum period were: a history of previous depression, previous anxiety, abuse, and marital problems. In weeks 12-14 early risk factors for positive depression and anxiety screening and positive EPDS were: age, smoking, educational level, employment status, previous psychological/psychiatric history and treatment, suicide in the family environment, voluntary termination of pregnancy and current planned pregnancy, living with a partner and partner's income. In weeks 29-30 risk factors were: being a skilled worker, a history of previous depression or anxiety, and marital problems. In weeks 4-6 postpartum, risk factors were: age, a history of previous depression or anxiety or psychological/psychiatric treatment, type of treatment, having been mistreated, and marital problems. CONCLUSIONS: Early screening for anxiety and depression in pregnancy may enable the creation of more effective healthcare pathways, by acting long before mental health problems in pregnant women worsen or by preventing their onset. Assessment of anxiety and depression symptoms before and after childbirth and emotional support needs to be incorporated into routine practice.

Study protocol for improving mental health during pregnancy: a randomized controlled low-intensity m-health intervention by midwives at primary care centers.

BACKGROUND: Pregnancy-related anxiety and depression has received considerable attention worldwide. Mental health problems in pregnant women already since early weeks of gestation may have important consequences to the fetus. The necessity for more effective health care pathways, including some early interventions that reduce the overall burden of the childbearing situation appears a key factor for a successful birth and care of the baby. The few studies focalized in interventions, are focused on delivery and postpartum, without taking into account the whole maternity process. Current literature recommends the use of interventions based on new technologies for the treatment of mood disorders, already during the prenatal period. There have been scarce well-designed intervention studies that test technological low-intensity interventions by midwives to address pregnant women's mental health, diminishing anxiety and depression during pregnancy. METHODS/DESIGN: Adult pregnant women (weeks 12-14 of gestation) will be recruited and screened from different primary care centers in Catalonia, Spain. Women who pass the initial mental screening will be randomly allocated to the relaxation virtual reality intervention or control group. The intervention aims to improve mental state of pregnant women during pregnancy, work through breathing, mindfulness and muscle relaxation techniques. Women in the control group will receive standard care offered by the public funded maternity services in Catalonia. The primary outcome measures will include the Edinburg Postnatal Depression (EPDS), State Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90), and the Cambridge Worry Scale (CWS) instruments. Secondary outcome measures will include the Temperament and Character Inventory-Revised (TCI-R) and the Whooley and Generalized Anxiety Disorder-2 (GAD-2) questions. Routinary pregnancy monitoring measures will be also evaluated. DISCUSSION: This study aims to test the efficacy of a low-intensity, midwife-led e-health intervention based on new technologies to work on women's anxiety and depression during pregnancy. We hypothesize that low-intensity mental health intervention during pregnancy, using an e-health (virtual reality) as a support tool, will be effective in reducing of anxiety, depressive symptoms, and improving satisfaction with pregnancy follow-up. TRIAL REGISTRATION: Clinical Trials ID NCT05756205.

Evolución y cambios de la sexualidad durante la gestación: visión de la mujer embarazada / Evolution and changes of women's sexual life during pregnancy: insight of the pregnant woman

Objetivo: Determinar la percepción de las gestantes sobre la evolución de su sexualidad. Método: Estudio multicéntrico, observacional, descriptivo, longitudinal, con seguimiento prospectivo en tres visitas programadas: al inicio del embarazo y en cada trimestre. Participaron nueve centros del Programa de Atención a la Salud Sexual y Reproductiva (PASSIR) del Vallès (Barcelona) entre 2009 y 2011. Se utilizó un cuestionario de elaboración propia, con cuatro secciones (tres de diseño propio y una adaptada del cuestionario Female Sexual Function Index [FSFI]) y 35 ítems. Para las variables cuantitativas se utilizó una escala del 1 al 10. Resultados: La muestra del estudio fue 213 gestantes. La edad media fue de 31 años. El 54% de las mujeres eran primíparas. El 100% tenía pareja estable y el 25% había sufrido algún aborto previo. Se puntuó el deseo de tener un hijo con una media de 7,91 puntos. El 86% experimentó variaciones en su sexualidad. El deseo disminuyó de una puntuación de 3,93 al inicio hasta otra de 2,75 al final (p <0,001), la frecuencia de las relaciones sexuales pasó de 2,37 veces semanales al inicio a 1,26 al final (p <0,001), y la satisfacción con la sexualidad se redujo desde los 7,03 puntos iniciales hasta los 4,28 puntos finales. Estos cambios se atribuyeron a las molestias físicas (60% en el tercer trimestre) y al temor a dañar al feto (23%). Conclusiones: La sexualidad experimenta importantes alteraciones durante el embarazo, relacionadas con los cambios físicos y psicológicos propios de la gestación y con el temor a dañar al feto. Este estudio proporciona un instrumento de trabajo a los profesionales sanitarios para abordar la sexualidad dentro de la práctica clínica (AU)

Objective: To analyze the perception of pregnant women on the evolution of their sex life during pregnancy. Method: A multicenter cross-sectional questionnaire-based study with prospective follow-up in three scheduled visits: early pregnancy and in each trimester from 2009 to 2011 in nine Sexual and Reproductive Health Centres Within (Barcelona). A questionnaire with four sections was designed: three ad hoc sections and our adapted version of the Female Sexual Function Index (FSFI) to pregnancy for the fourth section was used. Variables were scored on a scale of 1 to 10. Results: There were 213 pregnant women recruited. The average age was 31 years old. 54% were primiparous, 100% had stable partner and 25% had had a previous abortion. The desire to have a child was scored, on average, with 7.91 points. By the third trimester, 86% had observed variations in their sexuality. The desire domain in the FSFI score decreased during pregnancy: from 3.93 at baseline to 2.75 in the third trimester (p < 0.001). The frequency of sexual relations also decreased from 2.37 times/week prior to pregnancy to 1.26 times/week in the third trimester (p < 0.001). Satisfaction with sexuality also changed significantly ranging from 7.03 points at the beginning to 4.28 points at the end. Regarding the reasons for the changes in sexuality, physical discomfort prevailed (60% in the third trimester) as well as fear to harm the fetus (23%). Conclusions: Sexuality undergoes major alterations during pregnancy related to physical and psychological changes and fear to harm the fetus. This study provides a working tool for healthcare professionals to address sexuality in clinical practice (AU)