Sentimentos da mulher frente a gestação de alto risco / Sentimientos de la mujer frente al embarazo de alto riesgo / Women's feelings facing High-Risk pregnancy

Resumo Introdução: A gestação configura-se como um acontecimento único e memorável para a vida de uma mulher. A gravidez de alto risco é uma experiência estressante em razão dos riscos a que estão submetidos a mãe e o bebê e devido às mudanças que afetam negativamente o seu equilíbrio emocional. Objetivo: Identificar os sentimentos vivenciados pela gestante frente à gravidez de alto risco. Método: Descritivo e exploratório com abordagem qualitativa, com amostra por conveniência composta por mulheres com gestação de alto risco, selecionadas de acordo com a disponibilidade do serviço de internamento, até a saturação das entrevistas. A coleta dos dados foi realizada em um período de dois meses através de entrevistas guiadas por um roteiro. Os dados foram analisados por meio da técnica de análise de conteúdo segundo Minayo. Resultados: Fizeram parte 37 mulheres. Os resultados foram oeganizados nas categorias: Como se deu o diagnóstico de alto risco; Sentimentos ao descobrir que a gestação é/era de risco; Sentimentos em relação ao apoio familiar acerca da gestação de alto risco. Os sentimentos relatados pelas gestantes e puérperas que conviveram com a gravidez de alto risco, deixam evidentes os impactos que este evento traz não somente na saúde física sobretudo para a emocional, deixando as gestantes fragilizadas. Conclusão: Assim, o estudo nos permitiu perceber que os sentimentos vivenciados nesse processo podem interfir na vida dessas mulheres, e de forma negativa. Mas, que apesar dessa situação, estas expressam sentimentos ambíguos, pois mesmo com o risco gestacional, muitas mostram-se felizes pela dádiva de ser mãe.

Resumen Introducción: El embarazo se considera un evento único y memorable en la vida de una mujer. El embarazo de alto riesgo es una experiencia estresante debido a los riesgos a los que están expuestas tanto la madre como su bebé y a los cambios que afectan negativamente su equilibrio emocional. Objetivo: Identificar los sentimientos experimentados por las mujeres embarazadas frente a un embarazo de alto riesgo. Metodología: Descriptivo y exploratorio con enfoque cualitativo, con una muestra a conveniencia compuesta por mujeres con embarazos de alto riesgo, seleccionadas según la disponibilidad del servicio de hospitalización, hasta la saturación de las entrevistas. La recopilación de datos se llevó a cabo durante un período de dos meses a través de entrevistas guiadas. Los datos fueron analizados utilizando la técnica de análisis de contenido según Minayo. Resultados: Participaron 37 mujeres y los resultados se organizaron en las siguientes categorías: cómo se realizó el diagnóstico de alto riesgo; sentimientos al descubrir que el embarazo era de riesgo; sentimientos con respecto al apoyo familiar en relación con el embarazo de alto riesgo. Los sentimientos relatados por las mujeres embarazadas y posparto que vivieron un embarazo de alto riesgo evidencian los impactos que tiene este evento no solo en la salud física sino, especialmente, en el bienestar emocional, pues deja a las mujeres embarazadas en un estado de vulnerabilidad. Conclusión: El estudio nos permitió darnos cuenta de que los sentimientos experimentados en este proceso pueden interferir en la vida de estas mujeres de manera negativa. Sin embargo, a pesar de esta situación, muchas de ellas expresan sentimientos ambiguos, porque, incluso con el riesgo gestacional, están agradecidas por el regalo de la maternidad.

Abstract Introduction: Pregnancy is considered a unique and memorable event in a woman's life. High-risk pregnancy is a stressful experience due to the risks to which the mother and the baby are exposed, and due to the changes that negatively affect their emotional balance. Objective: To identify the feelings experienced by pregnant women facing high-risk pregnancy. Method: Descriptive and exploratory, employing a qualitative approach, the study featured a convenience sample of women with high-risk pregnancies, selected based on inpatient service availability, until interview saturation was achieved. Data collection was conducted over a two-month period through scripted interviews. Data analysis was performed utilizing Minayo's content analysis technique. Results: Thirty-seven women participated in the study. The results were categorized as follows: How the high-risk diagnosis was determined; Feelings upon discovering the pregnancy was high-risk; Feelings regarding family support regarding the high-risk pregnancy. The feelings reported by pregnant and postpartum women who experienced high-risk pregnancies clearly reveal the impacts this event has, not only on physical health, but especially on emotional well-being, leaving the pregnant women in a vulnerable state. Conclusion: The study allowed us to realize that the feelings experienced in this process can negatively interfere in the lives of these women. However, despite this situation, many of them express mixed feelings, because even with the gestational risk, they are grateful for the gift of motherhood.

Analysis of the anxiety level in high risk pregnancy based on the Beck Anxiety Inventory / Análise do nível de ansiedade na gestação de alto risco com base na escala Beck Anxiety Inventory

Abstract Objectives: to analyze the level of anxiety in high risk pregnant women admitted in the maternity ward of the Hospital Universitário Lauro Wanderley (HULW) of the Federal University of Paraíba. Methods: an observational, descriptive, cross-sectional study of quantitative character, with a sample composed of 100 pregnant women diagnosed as high risk interned at HULW. Data collection was performed using the Beck Anxiety Inventory (BAI), used to assess the level of anxiety the patient is in and the existing symptoms. For the statistical analysis, the Mann Whitney, Kruskal Wallis and Spearman correlation tests were used, considering p<0.05. Results: it was observed that 68% of pregnant women have moderate to high anxiety, with heat, fear of the worst happening, faster heartbeat, emotional instability and nervousness listed as the most common symptoms. The presence of an anxious condition was independent of maternal age, marital status or parity, however the gestational trimester, history of abortions and length of hospital stay were identified as risk factors for anxiety. Conclusion: pregnant women with a high risk diagnosis hospitalized at HULW presented anxiety, thus identifying the need for a multiprofessional support network, such as family assistance.

Resumo Objetivos: analisar o nível de ansiedade em gestantes de alto risco internadas na maternidade do Hospital Universitário Lauro Wanderley (HULW) da Universidade Federal da Paraíba. Métodos: estudo observacional, descritivo, transversal de caráter quantitativo, com amostra composta por 100 gestantes com diagnóstico de alto risco internadas no HULW. A coleta de dados foi realizada por meio do Inventário de Ansiedade de Beck (BAI), utilizado para avaliar o nível de ansiedade do paciente e os sintomas existentes. Para a análise estatística, foram utilizados os testes de Mann Whitney, Kruskal Wallis e correlação de Spearman, considerando p<0,05. Resultados: observou-se que 68% das gestantes apresentam ansiedade moderada a alta, com calor, medo do pior acontecer, batimento cardíaco acelerado, instabilidade emocional e nervosismo listados como os sintomas mais comuns. A presença de ansiedade foi independente da idade materna, estado civil ou paridade, porém o trimestre gestacional, história de aborto e tempo de internação foram identificados como fatores de risco para ansiedade. Conclusão: gestantes com diagnóstico de alto risco internadas no HULW apresentaram ansiedade, identificando-se a necessidade de uma rede de apoio multiprofssional, como o atendimento familiar.

Risk of depression in pregnancy among pregnant women undergoing high-risk prenatal care.

OBJECTIVE: to identify the risk of depression in pregnancy among pregnant women undergoing follow-up in high-risk prenatal care, to assess the factors associated with higher risk of depression in pregnancy and to compare the risk of depression in each gestational trimester. METHOD: this is a descriptive, correlational, cross-sectional study, conducted with 151 pregnant women in prenatal care in a high-risk pregnancy outpatient clinic at a university hospital in the state of São Paulo, Brazil. Data were collected through an online form. Chi-square and Fisher's exact tests were performed. After the bivariate analysis, the variables were included in the logistic regression model. In the final model, the Odds Ratio was calculated. RESULTS: 118 (78.1%) pregnant women had a higher risk of depression during pregnancy, which was higher in the first trimester, but without statistical significance. The number of pregnancies (OR = 0.32) and marital status (OR = 0.07) remained significantly associated with higher risk of depression during pregnancy as protective factors. CONCLUSION: the results elucidate the importance of screening for depression risk and the significant need to improve access to effective interventions for preventing prenatal depression and promoting mental health.

The impact of Covid-19 restrictions on depressive symptoms in low-risk and high-risk pregnant women: a cross-sectional study before and during pandemic.

BACKGROUND: The COVID-19 social restrictions have increased the risk for depression compared to the previous period in Italian women with Low-Risk Pregnancy (LRP). lLess is known about the impact of COVID-19 restrictions on High-Risk Pregnancy (HRP). This study aimed: 1) to explore levels of depression in women who become pregnant before and during COVID-19 pandemic, distinguishing between LRP and HRP; 2) to analyze the impact of COVID-19 restrictions on pregnancy experience in LRP and HRP. METHODS: A before-during COVID-19 pandemic cross-sectional study was carried out on 155 pregnant women (Mean age = 34.18), between 23 and 32 weeks of gestation. 77 women were recruited before COVID-19 pandemic (51.9% LRP; 48.1% HRP) and 78 women were recruited during COVID-19 pandemic (51.3% LRP; 48.7% HRP). HRP group was enrolled during hospitalization for high-risk pregnancy. Participants filled out Edinburgh Postnatal Depression Scale. Moreover, only COVID-19 group answered an open-ended question about the impact of restriction on pregnancy experience. RESULTS: HRP women reported higher levels of depressive symptoms than LRP. No difference emerged for COVID (before/during) but an interaction effect between COVID-19 and obstetric condition was found. The qualitative results showed the impact of restrictions on emotions and concerns. CONCLUSION: Respect to the previous period, LRP women during COVID-19 presented an increased risk for depressive symptoms than HRP. The HRP women during COVID-19 seemed to use hospitalization as a resource to find a social support network with other pregnant women and to be reassured on the clinical ongoing of pregnancy.

The effect of stress management training on perceived stress, anxiety and hopelessness levels of women with high-risk pregnancy.

The aim of this study was to investigate the effect of stress management training on the perceived stress, anxiety and hopelessness levels of women with high-risk pregnancy. The sample of this experimental study consisted of 206 high-risk pregnant women (intervention = 103; control = 103). Data were collected using a Personal Information Form, the Perceived Stress Scale, the Beck Hopelessness Scale and the State-Trait Anxiety Inventory. In the second follow-up after the training, there was a statistically significant difference amongst the Perceived Stress Scale, Beck Hopelessness Scale and State-Trait Anxiety Inventory mean scores in the intervention and control groups (p < .05). Perceived stress scores of the control group who did not receive training during discharge increased. The state and trait anxiety scores and hopelessness scores of the intervention group received training decreased compared with the control group.IMPACT STATEMENTWhat is already known on this subject? Mental problems such as anxiety and stress are more common in high-risk pregnancies compared with healthy pregnancies.What do the results of this study add? After the training 51.4% of women in the intervention group, 75.7% of women in the control group had stress. The state and trait anxiety and hopelessness scores of the intervention group having training decreased compared to the control group.What are the implications of these findings for clinical practice and/or further research? Health professionals should provide stress management training in high-risk pregnant women to reducing perceived stress, anxiety and hopelessness levels.

Effects of Mediterranean Diet or Mindfulness-Based Stress Reduction on Prevention of Small-for-Gestational Age Birth Weights in Newborns Born to At-Risk Pregnant Individuals: The IMPACT BCN Randomized Clinical Trial.

Importance: Being born small for gestational age (SGA) is a leading cause of perinatal morbidity and mortality with no effective prevention or therapy. Maternal suboptimal nutrition and high stress levels have been associated with poor fetal growth and adverse pregnancy outcomes. Objective: To investigate whether structured interventions based on a Mediterranean diet or mindfulness-based stress reduction (stress reduction) in high-risk pregnancies can reduce the percentage of newborns who were born SGA and other adverse pregnancy outcomes. Design, Setting, and Participants: Parallel-group randomized clinical trial conducted at a university hospital in Barcelona, Spain, including 1221 individuals with singleton pregnancies (19-23 weeks' gestation) at high risk for SGA. Enrollment took place from February 1, 2017, to October 10, 2019, with follow-up until delivery (final follow-up on March 1, 2020). Interventions: Participants in the Mediterranean diet group (n = 407) received 2 hours monthly of individual and group educational sessions and free provision of extra-virgin olive oil and walnuts. Individuals in the stress reduction group (n = 407) underwent an 8-week stress reduction program adapted for pregnancy, consisting of weekly 2.5-hour sessions and 1 full-day session. Individuals in the usual care group (n = 407) received pregnancy care per institutional protocols. Main Outcomes and Measures: The primary end point was the percentage of newborns who were SGA at delivery, defined as birth weight below the 10th percentile. The secondary end point was a composite adverse perinatal outcome (at least 1 of the following: preterm birth, preeclampsia, perinatal mortality, severe SGA, neonatal acidosis, low Apgar score, or presence of any major neonatal morbidity). Results: Among the 1221 randomized individuals (median [IQR] age, 37 [34-40] years), 1184 (97%) completed the trial (392 individuals assigned to the Mediterranean diet group, 391 to the stress reduction group, and 401 to the usual care group). SGA occurred in 88 newborns (21.9%) in the control group, 55 (14.0%) in the Mediterranean diet group (odds ratio [OR], 0.58 [95% CI, 0.40-0.84]; risk difference [RD], -7.9 [95% CI, -13.6 to -2.6]; P = .004), and 61 (15.6%) in the stress reduction group (OR, 0.66 [95% CI, 0.46-0.94]; RD, -6.3 [95% CI, -11.8 to -0.9]; P = .02). The composite adverse perinatal outcome occurred in 105 newborns (26.2%) in the control group, 73 (18.6%) in the Mediterranean diet group (OR, 0.64 [95% CI, 0.46-0.90]; RD, -7.6 [95% CI, -13.4 to -1.8]; P = .01), and 76 (19.5%) in the stress reduction group (OR, 0.68 [95% CI, 0.49-0.95]; RD, -6.8 [95% CI, -12.6 to -0.3]; P = .02). Conclusions and Relevance: In this randomized trial conducted at a single institution in Spain, treating pregnant individuals at high risk for SGA with a structured Mediterranean diet or with mindfulness-based stress reduction, compared with usual care, significantly reduced the percentage of newborns with birth weight below the 10th percentile. Due to important study limitations, these findings should be considered preliminary and require replication, as well as assessment in additional patient populations, before concluding that these treatments should be recommended to patients. Trial Registration: ClinicalTrials.gov Identifier: NCT03166332.

Risk perceptions among high-risk pregnant women in Nepal: a qualitative study.

BACKGROUND: A woman's perception of risk affects her decisions about seeking obstetric care and following prescribed regimens of care. This study explored the perceptions of high-risk pregnancy among women with high-risk factors. METHODS: A qualitative study was conducted in the Morang district, Nepal. A phenomenological approach was used. In-depth interviews were conducted with 14 participants. Postpartum women with one risk factor for high-risk pregnancy who non-adhere to referral hospital birth were selected purposively. Thematic analysis was done to generate themes and categories. FINDINGS: Two main themes emerged in this study: (i) knowledge and understanding of risk and (ii) normalizing and non-acceptance of risk. The participants had inadequate knowledge of risk in pregnancy and childbirth. Their information source was their personal experiences of risk, witnessing their close relatives, and community incidents. The participants perceived pregnancy as a normal event and did not consider themselves as at risk. They tended to deny risk and perceived that everything was fine with their pregnancy. CONCLUSIONS: The findings of this study provide a glimpse into how women perceived risk and the reasons that lead them to deny the risks and gave home birth. In the presence of risk factors in pregnancy, some women were not convinced that they were at risk. An antenatal check-up should be utilized as a platform to educate women, explore their intentions, and encourage safer births.

Hospitalisation in high-risk pregnancy patients: is prenatal attachment affected?

Objective: To compare prenatal attachment in women hospitalised due to high-risk pregnancy with prenatal attachment in non-hospitalised patients. To describe the impact of social support, socio-demographic factors and the nature of the pregnancy on prenatal attachment, anxiety and depression. Study Design: An exploratory, cross-sectional and descriptive study utilising the Maternal Antenatal Attachment Scale, the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory. The sample comprised 80 hospitalised and 88 non-hospitalised patients. Result: No difference in prenatal attachment was found between the two groups. The hospitalised group presented higher levels of depressive symptomatology and anxiety. Social support had a significant effect on the hospitalised group, improving attachment quality. Conclusion: Incorporation of members of the patient's support network may help to improve quality of prenatal attachment during hospitalisation. Detection and treatment of anxiety and/or depression in hospitalised patients is recommended given their impact on the mental health of mother and baby.

The Relationship between Adaptation to Pregnancy and Prenatal Attachment in High-Risk Pregnancies.

BACKGROUND: Although pregnancy is a physiological process, there are various changes which need to be adapted to. Adaptation and prenatal attachment are important for both the mother's and baby's health. These situations are more crucial for women with high-risk pregnancy. The study aimed to determine the relationship between adaptation to pregnancy and prenatal attachment among women with high-risk pregnancy, as well as socio-demographic and obstetric parameters which affected this adaptation. SUBJECTS AND METHODS: This descriptive and analytic study's data were collected from high-risk pregnant women (n=479) who were receiving treatment at two public hospitals in Turkey using Prenatal Self-Evaluation Form (PSEQ) and Prenatal Attachment Inventory (PAI). Descriptive statistics, correlation and comparative analyses were used in data analyses. RESULTS: It was determined that adaptation to pregnancy was medium and prenatal attachment was high in high-risk pregnant (PSEQ mean score:159.43±27.05; PAI mean score: 63.79±10.75). There was a significant negative relationship between the scales (r=-0.556, p<0.01). This relationship showed that as adaptation to pregnancy increased, prenatal attachment also increased. There was significant difference in the PSEQ by age, educational status, employment status, marital status, year of marriage, spouse's educational and employment status, having health insurance, family type, income status, spouse's attitudes towards pregnancy, number of pregnancies, number of births, having living children, whether the pregnancy was planned, pregnancy week and prenatal attachment. CONCLUSION: According to results, there is relationship between adaptation to pregnancy and prenatal attachment in high-risk pregnancies and some sociodemographic and obstetric factors affects adaptation to pregnancy. Determining these factors can serve as a guide for preventing and reducing additional problems that may be encountered in pregnancy and postpartum period in high-risk pregnant women.

Pregnancy vs. paycheck: a qualitative study of patient's experience with employment during pregnancy at high risk for preterm birth.

BACKGROUND: Pregnant women with a history of preterm birth are at risk for recurrence, often requiring frequent prenatal visits for close monitoring and/or preventive therapies. Employment demands can limit uptake and adherence to recommended monitoring and preterm birth prevention therapies. METHOD: We conducted a qualitative descriptive study using in-depth interviews (IDIs) of pregnant women with a history of preterm birth. IDIs were conducted by trained qualitative interviewers following a semi-structured interview guide focused on uncovering barriers and facilitators to initiation of prenatal care, including relevant employment experiences, and soliciting potential interventions to improve prompt prenatal care initiation. The IDIs were analyzed via applied thematic analysis. RESULTS: We described the interview findings that address women's employment experiences. The current analysis includes 27 women who are majority self-described as non-Hispanic Black (74%) and publically insured (70%). Participants were employed in a range of professions; food services, childcare and retail were the most common occupations. Participants described multiple ways that being pregnant impacted their earning potential, ranging from voluntary work-hour reduction, involuntary duty hour reductions by employers, truncated promotions, and termination of employment. Participants also shared varying experiences with workplace accommodations to their work environment and job duties based on their pregnancy. Some of these accommodations were initiated by a collaborative employee/employer discussion, others were initiated by the employer's perception of safe working conditions in pregnancy, and some accommodations were based on medical recommendations. Participants described supportive and unsupportive employer reactions to requests for accommodations. CONCLUSIONS: Our findings provide novel insights into women's experiences balancing a pregnancy at increased risk for preterm birth with employment obligations. While many women reported positive experiences, the most striking insights came from women who described negative situations that ranged from challenging to potentially unlawful. Many of the findings suggest profound misunderstandings likely exist at the patient, employer and clinical provider level about the laws surrounding employment in pregnancy, safe employment responsibilities during pregnancy, and the range of creative accommodations that often allow for continued workplace productivity even during high risk pregnancy.

Institutional violence in high-risk pregnancy in the light of pregnant women and nurses.

OBJECTIVE: to understand the perception of high-risk nurses and pregnant women about institutional violence in access to basic and specialized care networks in pregnancy. METHOD: a qualitative study developed from March to June 2017 in the city of Fortaleza, state of Ceará, with nurses and pregnant women at high risk. A semi-structured interview was used, analyzed by the thematic analysis technique. Three categories emerged: access of pregnant women to care networks; institutional violence in the perception of nurses; and institutional violence in the perception of pregnant women. RESULTS: participants revealed deficiencies in knowledge about institutional violence. Nurses perceived this violence in the lack of resources and access, few recognized as a violation of rights. The pregnant women reported deficient access to care networks, medicines, tests, and did not perceive this difficulty as violence. FINAL CONSIDERATIONS: institutional violence is present in high-risk pregnancy, nurses and pregnant women do not always perceive this violence as a violation of rights.

A systematic review regarding women's emotional and psychological experiences of high-risk pregnancies.

BACKGROUND: High-risk pregnancy refers to a pregnancy that negatively affects the health of the mother, the baby, or both. High-risk pregnancy evokes a range of emotional and psychological experiences for the expectant mother, and can adversely affect both the mother and the baby's health. Medical research on high-risk pregnancy abounds, while women's emotional/psychological experiences are not sufficiently documented, and hence much less attention and/or programming is directed to support women with high risk pregnancies. METHODS: The aim of this review is to present published evidence of how studies reported on the emotional and psychological experiences of a woman's high-risk pregnancy journey. The systematic review examined qualitative studies over a 10 year period that were published between January 2006 and June 2017. These studies were identified on 10 databases. The study utilised three stages of review (i.e. abstract reading, title reading, and full-text reading) and for a successful conduction of the meta-synthesis, this study applied one of the phases provided by Noblit and Hare. RESULTS: The findings provide empirical evidence that women's emotional and psychological experiences (i.e. shock, fear, frustration, grief, isolation and loneliness, anger, sadness, guilt, and mental health disorder) are evident throughout their high-risk pregnancies experience.

Early detection of mental illness for women suffering high-risk pregnancies: an explorative study on self-perceived burden during pregnancy and early postpartum depressive symptoms among Chinese women hospitalized with threatened preterm labour.

BACKGROUND: The mental health of pregnant women, particularly those with elevated risks, has been an issue of global concern. Thus far, few studies have addressed the mental health of pregnant women with threatened preterm labour (TPL). This study investigated the prevalence of self-perceived burden (SPB) among Chinese women hospitalized due to TPL during pregnancy and early postpartum depressive disorders, exploring the effect of SPB and other potential risk factors on the early signs of postpartum depressive disorders. METHODS: A self-reported survey was conducted in the obstetrics department of Anhui Provincial Hospital, China. Women hospitalized with TPL were approached 1 week after delivery. One hundred fifty women were recruited from January 2017 to December 2017. The Self-Perceived Burden Scale (SPBS) and Edinburgh Postnatal Depression Scale (EPDS) were the main measures. Descriptive statistics, Spearman correlations, and a multiple logistic regression were employed for data analysis. RESULTS: SPB and early postpartum depressive disorders were commonly experienced by Chinese women hospitalized with TPL, and SPB was positively and significantly correlated with depressive symptoms. A multiple logistic regression analysis revealed that for the women hospitalized with TPL during pregnancy, the emotional aspect of SPB (OR = 1.42, 95% CI = 1.11-1.83, p = 0.006), age (OR = 1.14, 95% CI = 1.02-1.27, p = 0.023), occupation (OR = 3.48, 95% CI = 1.18-10.20, p = 0.023), the history of scarred uterus (OR = 7.96, 95% CI = 1.49-42.48, p = 0.015), the delivery mode of the present birth (OR = 6.19, 95% CI = 1.72-22.30, p = 0.005), and family support during pregnancy (OR = 0.60, 95% CI = 0.45-0.82, p = 0.001) were significant factors predicting early postpartum depressive symptoms. CONCLUSION: This study indicates that SPB and early postpartum depressive disorders are prevalent mental issues among Chinese women hospitalized with TPL, and that SPB, especially perceived emotional burden, is a strong predictor of early postpartum depressive disorders. Our study suggests the necessity of paying attention to mental health issues, e.g. SPB and postpartum depressive symptoms among hospitalized women with TPL, and providing appropriate interventions at the prenatal stage to prevent adverse consequences.

Home-based telemonitoring versus hospital admission in high risk pregnancies: a qualitative study on women's experiences.

BACKGROUND: Hospital admission during pregnancy complications is considered to be an event of significant impact. Besides conventional in-clinic maternal and fetal monitoring, recent technologies enable home-based telemonitoring with self-measurements in high risk pregnancy. This study is part of a feasibility pilot to explore the usability and acceptability of telemonitoring and aims to gain insight in the experiences and preferences of high risk pregnant women concerning the novel strategy of telemonitoring, opposed to women who were hospitalized in pregnancy. METHODS: Using secured Facebook Groups, we conducted four online focus groups: two focus groups with women who were admitted during pregnancy (n = 11) and two with women who received home telemonitoring in the pilot phase (n = 11). The qualitative data were analyzed thematically. RESULTS: Four major themes emerged from both participant groups: [1] care experience, [2] emotions regarding pregnancy, [3] privacy and [4] impact on daily life. Different views were reported on all four themes, resulting in a direct comparison of experiences during hospitalization and telemonitoring. Most admitted patients reported a growing sense of boredom and anxiety during their clinical admission. Lack of privacy on ward was a great concern, as it affected their contact with hospital staff and family. This issue was not reported amongst telemonitored women. These participants still felt like a patient at times but responded that the comfort of their own home and bed was pleasant. Only a minority of telemonitored participants reported being anxious at times at home, while not having a physician or nurse nearby. Being at home resulted in less travel time for partners or family for hospital visits, which had its positive effects on family life. CONCLUSIONS: Telemonitoring of a high-risk pregnancy provides an innovative manner to monitor fetal and maternal condition from home. Compared to the experiences of hospital admission in high risk pregnancy, it allows women to be in a comforting and private environment during an anxious time in their lives. As future studies should further investigate the safety and cost effectiveness of this novel strategy, women's views on the preference of telemonitoring need to be taken into consideration.

The lived experience of women with a high-risk pregnancy: A phenomenology investigation.

BACKGROUND: Pregnancy is a time of transformation, hope, expectation, and worry for women and their families - none more so than when the pregnancy is at-risk. The objective of this study was to describe the lived experience of women during high-risk pregnancy. METHODS: This qualitative investigation utilized a hermeneutic phenomenology study. The study was conducted in a public health center in a large urban area in southeast Iran. Purposive sampling of 20 women with a high-risk pregnancy. Participants included both nulligravid and multigravid women in the second and third trimesters of pregnancy with varied medical conditions. Data collection used face-to-face interview with transcribed data analyzed using Braun and Clarke's six stage thematic analysis approach. RESULTS: Four themes were extracted and included challenge of family in high-risk pregnancy, challenge of anticipation for motherhood, and challenges for future pregnancies, and challenge of adaptation. CONCLUSIONS: Findings demonstrate that women with a high-risk pregnancy struggle to adapt with burdens related to successful maternal role attainment and family functioning. Fears about pregnancy outcome and future pregnancies are dominant.

Anxiety among women experiencing medically complicated pregnancy: A systematic review and meta-analysis.

BACKGROUND: Symptoms of anxiety are common among pregnant and postpartum women, and 15%-20% of pregnancies are affected by medical complications. Despite this, little is known about the relationship of medical complications in pregnancy and women's experience of anxiety. The purpose of this research was to conduct a systematic review and meta-analysis of differences in anxiety symptom severity among women experiencing a medically complicated versus a medically uncomplicated pregnancy. METHODS: This work was guided by the PRISMA reporting process. Electronic databases MEDLINE and PsycINFO were searched to identify studies that met the inclusion criteria. An adaptation of the Newcastle-Ottawa Quality Assessment Scale for case-control studies was used to perform a quality assessment review. A random-effects meta-analysis was used to calculate the estimated average standardized mean differences. RESULTS: Based on the five studies which met our inclusion criteria, findings provide evidence of higher levels of anxiety symptoms among pregnant women experiencing a medically complicated versus a medically uncomplicated pregnancy. Despite considerable heterogeneity, all mean difference estimates are in the direction of greater anxiety in the high-risk groups. CONCLUSIONS: Women experiencing a medically complex pregnancy report higher levels of anxiety symptoms compared to women experiencing a medically uncomplicated pregnancy.

Medically high-risk pregnancy: Women's perceptions of their relationships with health care providers.

The purpose of this article is to examine women's perceptions of the patient-provider relationship in the context of medically high-risk pregnancy (MHRP). Sixteen in-depth interviews were conducted with women hospitalized for MHRP on a maternal-fetal medical unit in the US. Tenets of phenomenology guided the data analysis. We found that beyond normative stress related to managing physical aspects of MHRP, women reported added emotional stressors associated with navigating the fragmented health care environment. This study suggests that improved care coordination and systematic integration of psychosocial professionals within the perinatal interdisciplinary health care team are vital to reduce care-related stressors on this vulnerable patient group.

Knowledge and Attitudes Toward Prenatal Yoga Among Women with High-Risk Pregnancies.

This study sought to evaluate attitudes and knowledge about prenatal yoga and to investigate barriers and facilitators to yoga participation in high-risk pregnant women receiving prenatal care in an academic tertiary care center. We surveyed a convenience sample of women receiving prenatal care through the Maternal-Fetal Medicine practice at Brigham and Women's Hospital. We classified participants as yoga-experienced or yoga-naive depending on self-report. We compared differences between the two groups using the appropriate nonparametric tests and compared bivariate odds ratios for survey results using logistic regression. Of the 100 respondents, 53% had practiced yoga previously. Women with yoga experience were older (age 34.9 ± 5.6 vs. 31.0 ± 6.0 years, p = 0.004), more likely to be college graduates (94% vs. 68%, p = 0.002), and more likely to be White (77% vs. 47%, p = 0.002) than women without previous yoga experience. Previous yoga experience was associated with participant agreement that yoga was safe during their current pregnancy (odds ratio 5.9, 95% confidence interval 1.9-17.7). Of the women surveyed, 56% agreed that they would like to attend a prenatal yoga class. In a multivariate model including age, race, and education, previous yoga experience was the only significant predictor associated with willingness to participate in prenatal yoga classes during current pregnancy (odds ratio 3.1, 95% confidence interval 1.1-8.6). Prior yoga experience was the strongest predictor of willingness to attend a prenatal yoga class in our population. Our results suggest that women with high-risk pregnancies who may benefit from prenatal yoga interventions but lack prior yoga experience may need additional education to facilitate participation.

Pregnant women's history of childhood maltreatment and current opioid use: The mediating role of reflective functioning.

There is an association between the experience of childhood maltreatment and opioid misuse in adults, especially for women. However, we know little about this association in pregnancy, and less about processes that could be the target of interventions to help women better parent their infants. We examined reflective functioning as a putative process. Reflective functioning is the ability to interpret one's own and others' behavior in terms of underlying mental states, e.g., emotions, motivations, and beliefs. We sampled 55 pregnant women who misused opioids and 38 women at high risk due to medical factors, e.g., heart disease. We assessed maltreatment with the Maltreatment and Abuse Chronology of Exposure (MACE; Teicher & Parigger, 2015), and reflective functioning with the Reflective Functioning Questionnaire (RFQ; Fonagy et al., 2016). Maltreatment variables included the sum of severity across all subtypes, number of subtypes experienced, and severity of sexual, physical, and emotional abuse, and of neglect. We created a categorical opioid user group variable: women who used opioids in pregnancy vs. high-risk medical comparisons. We found that women who used opioids in pregnancy had poorer reflective functioning than did high-risk medical comparisons. We also created an opioid use severity scale (ranging from 0 to 3) from urine assays and history of prescribed opioids from medical records. Using Hayes (2012)'s bootstrapping PROCESS macro, we found that reflective functioning mediated the association between all maltreatment variables and opioid use severity. We discuss the results in terms of how best to intervene to improve women's reflective functioning, which may help their ability to parent.

Institutional violence in high-risk pregnancy in the light of pregnant women and nurses / Violencia institucional en embarazos de alto riesgo a la luz de mujeres embarazadas y enfermeras / Violência institucional na gravidez de alto risco à luz das gestantes e enfermeiras

ABSTRACT Objective: to understand the perception of high-risk nurses and pregnant women about institutional violence in access to basic and specialized care networks in pregnancy. Method: a qualitative study developed from March to June 2017 in the city of Fortaleza, state of Ceará, with nurses and pregnant women at high risk. A semi-structured interview was used, analyzed by the thematic analysis technique. Three categories emerged: access of pregnant women to care networks; institutional violence in the perception of nurses; and institutional violence in the perception of pregnant women. Results: participants revealed deficiencies in knowledge about institutional violence. Nurses perceived this violence in the lack of resources and access, few recognized as a violation of rights. The pregnant women reported deficient access to care networks, medicines, tests, and did not perceive this difficulty as violence. Final considerations: institutional violence is present in high-risk pregnancy, nurses and pregnant women do not always perceive this violence as a violation of rights.

RESUMEN Objetivo: comprender la percepción de las enfermeras de alto riesgo y las mujeres embarazadas sobre la violencia institucional en el acceso a redes de atención básica y especializada durante el embarazo. Método: estudio cualitativo, desarrollado de marzo a junio de 2017, Fortaleza, Ceará, con enfermeras y mujeres embarazadas en alto riesgo. Se utilizó una entrevista semiestructurada, analizada por la técnica de análisis temático, surgiendo tres categorías: acceso de mujeres embarazadas a redes de atención; violencia institucional en la percepción de las enfermeras y violencia institucional en la percepción de las mujeres embarazada. Resultados: los participantes revelaron una falta de conocimiento sobre la violencia institucional. Las enfermeras percibieron esta violencia en la falta de recursos y acceso, pocos reconocidos como una violación de los derechos. Las mujeres embarazadas informaron un acceso deficiente a las redes de atención, medicamentos, pruebas y no percibieron esta dificultad como violencia. Consideraciones finales: La violencia institucional está presente en los embarazos de alto riesgo, las enfermeras y las mujeres embarazadas no siempre perciben esta violencia como una violación de los derechos.

RESUMO Objetivo: compreender a percepção das enfermeiras e gestantes de alto risco sobre a violência institucional no acesso as redes de atenção básica e especializada na gestação. Método: estudo qualitativo, desenvolvido de março a junho de 2017, Fortaleza, Ceará, com enfermeiras e gestantes de alto risco. Utilizou-se entrevista semiestruturada, analisada pela técnica de análise temática, emergindo três categorias: acesso das gestantes às redes de atenção; violência institucional na percepção das enfermeiras e violência institucional na percepção das gestantes. Resultados: as participantes revelaram deficiência no conhecimento sobre violência institucional. As enfermeiras perceberam essa violência na insuficiência de recursos, no acesso, poucas reconheceram como violação de direito. As gestantes referiram deficiência no acesso às redes de atenção, medicamentos, exames, e não perceberam essa dificuldade como violência. Considerações finais: a violência institucional está presente na gestação de alto risco, enfermeiras e gestantes nem sempre percebem essa violência como violação de direitos.