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1.
J Affect Disord ; 296: 577-586, 2022 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-34606803

RESUMEN

BACKGROUND: The COVID-19 pandemic gave rise to concerns about its potential impact on the mental health of pregnant and postpartum women as the general postpartum depression rates increased. METHODS: Three postpartum questionnaires (Edinburgh Postnatal Depression Scale - EPDS; Anxiety and Depression Scale - HAD; and a demographic questionnaire about isolation and information acquisition) were used to evaluate the mental health of women with and without COVID-19 and determine the factors associated with depressive symptoms (EPDS ≥ 12). RESULTS: Data from 184 participants with a mean of 56 postpartum days were analyzed. The rate of symptoms compatible with postpartum depression (PPD) was 38.8%, with a 14.3% positive response to item 10 on the EPDS (suicidal ideation - SI). Listening to the news about COVID-19 averaged 4.45 hours a day. Factors related to PPD were concerns about lack of hospital beds (OR = 2.45), absence of a partner (OR = 2.70), and anxiety symptoms (OR = 10). Factors related to SI were anxiety symptoms (OR = 1.56) and friends as a source of information (OR = 5.60). LIMITATIONS: Considering the rapidly changing epidemiological conditions of this pandemic, this study may only be the photograph of an instant. CONCLUSIONS: Higher rates of PPD in the Brazilian population are related not only to anxiety but also to an inadequate family environment, kind of information acquisition and concerns about the lack of hospital beds.


Asunto(s)
COVID-19 , Depresión Posparto , Depresión , Depresión Posparto/diagnóstico , Depresión Posparto/epidemiología , Femenino , Humanos , Pandemias , Periodo Posparto , Embarazo , Escalas de Valoración Psiquiátrica , Factores de Riesgo , SARS-CoV-2
2.
Rev. enferm. UERJ ; 29: e56113, jan.-dez. 2021.
Artículo en Inglés, Portugués | LILACS | ID: biblio-1224567

RESUMEN

Objetivo: descrever a escolha do parto domiciliar planejado acompanhado por enfermeira obstétrica em um centro urbano de grande porte, na perspectiva de mulheres brasileiras. Métodos: estudo qualitativo guiado pela Grounded Theory. Foram entrevistadas dez mulheres com idade entre 20 e 41 anos que tiveram parto domiciliar planejado acompanhadas por enfermeiras obstétricas. As participantes foram recrutadas por meio de rede social, acessando um grupo de mulheres que escreveram sobre seu parto domiciliar. Resultados: Emergiram duas categorias: Não vendo possibilidade de parir naturalmente no ambiente hospitalar e Pensando na segurança do parto domiciliar planejado. O hospital representou vários aspectos desfavoráveis como intervenções desnecessárias e solidão. As mulheres consideravam o lar um lugar seguro para parir, conectado aos cuidados de enfermeiras obstétricas. Conclusão: há mulheres que não desejam parir no hospital, preferindo parir em casa e do ponto de vista dos direitos humanos e dos cuidados desmedicalizados, as enfermeiras obstétricas devem apoiar as mulheres nessa sua decisão.


Objective: to describe the choice of planned homebirth attended by a nurse midwife in a large urban centre, from the perspective of Brazilian women. Methods: in this Grounded Theory study, ten women aged 20 to 41 years, who had a planned homebirth accompanied by a nurse midwife, were interviewed. Participants were recruited through a social network by accessing a group of women who wrote about their homebirth. Results: two categories emerged: seeing no possibility of giving birth naturally in the hospital environment; and thinking about the safety of a planned homebirth. Hospital represented several unfavourable aspects, such as unnecessary interventions and loneliness. Women thought of home as a safe place to give birth, connected with nurse midwife care. Conclusion: there are women who do not wish to give birth in hospital, but prefer to give birth at home and, from the point of view of human rights and de-medicalized care, nurse midwives should support women in their decision.


Objetivo: describir la elección del parto domiciliario planificado con enfermera obstétrica en un gran centro urbano, desde la perspectiva de mujeres brasileñas. Métodos: estudio cualitativo guiado por la Grounded Theory. Se entrevistó a diez mujeres entre 20 y 41 años que tuvieron parto domiciliario planificado, siendo acompañadas de enfermeras obstétricas. Las participantes fueron reclutadas a través de red social, accediendo a un grupo de mujeres que escribieron sobre su parto en domicilio. Resultados: surgieron dos categorías: las que no veían posibilidad de dar a luz naturalmente en el hospital y las que pensaron en la seguridad del parto domiciliario planificado. El hospital representó varios aspectos desfavorables como intervenciones innecesarias y soledad. Las mujeres consideraban que el hogar era un ambiente seguro para dar a luz, vinculado al cuidado de enfermeras obstétricas. Conclusión: hay mujeres que no desean dar a luz en el hospital, prefieren hacerlo en casa y, desde el punto de vista de los derechos humanos y de los cuidados sin la intervención de un médico, las enfermeras obstétricas deben apoyarlas en esa decisión.


Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Parto Domiciliario/enfermería , Parto Normal/enfermería , Enfermeras Obstetrices , Mujeres Embarazadas/psicología , Seguridad del Paciente , Parto Domiciliario/psicología , Parto Normal/psicología
3.
Rev. enferm. UERJ ; 29: e56246, jan.-dez. 2021.
Artículo en Inglés, Portugués | LILACS-Express | LILACS | ID: biblio-1283149

RESUMEN

Objetivo: identificar na literatura evidências relacionadas à assistência de enfermagem a gestantes usuárias de crack e cocaína nos serviços de saúde. Método: revisão integrativa realizada em julho de 2020, com publicações dos últimos dez anos nas bases de dados Embase (Medline e PubMed), PsycINFO, Scopus e Cinahl. Resultados: foram encontrados 49 artigos, sendo incluídos dois internacionais e quatro nacionais. Dentre os conceitos que fundamentam a assistência de enfermagem às gestantes usuárias de crack e cocaína destacam-se: acolhimento, vínculo e encaminhamentos a serviços especializados. Três estudos abordam o despreparo e desconhecimento do enfermeiro diante deste cuidado e constata-se a infrequência de atitudes consonantes com a política de saúde mental. Conclusão: o acompanhamento integral e sistematizado pelo enfermeiro durante o período gestacional é indispensável e necessita de aprimoramento na linha da redução de danos. Os achados sugerem estratégias diferenciadas para a assistência de enfermagem e reforçam as lacunas práticas e científicas relacionadas ao tema.


Objective: to identify, in the literature, evidence relating to nursing care for pregnant women crack and cocaine users in health services. Method: this integrative review was conducted in July 2020, with publications from the previous ten years in the Embase (Medline and PubMed), PsycINFO, Scopus, and Cinahl databases. Results: the search strategy found 49 research papers and included two international and four national studies. Among the concepts that underlie nursing care for pregnant women who use crack and cocaine, the following stand out: supportive reception, bonding, and referral to specialized services. Three studies addressed nurses' lack of preparedness and knowledge in providing such care, and attitudes aligned with mental health policy were found to be infrequent. Conclusion: systematic, comprehensive monitoring by nurses is essential during the gestational period and the harm reduction component needs improvement. The findings recommend differentiated nursing care strategies and underline the gaps in the practice and science relating to this issue.


Objetivo: identificar en la literatura evidencias relacionadas con la atención de enfermería a embarazadas que consumen crack y cocaína en los servicios de salud. Método: revisión integradora realizada en julio de 2020, con publicaciones de los últimos diez años en las bases de datos Embase (Medline y PubMed), PsycINFO, Scopus y Cinahl. Resultados: se encontraron 49 artículos, siendo dos internacionales y cuatro nacionales. Entre los conceptos que sustentan la atención de enfermería a las embarazadas usuarias crack y cocaína, destacan: acogida, vinculación y derivación a servicios especializados. Tres estudios abordan la falta de preparación y el desconocimiento de los enfermeros en cuanto a esta atención. Se constata también la falta de actitudes alineadas con la política de salud mental. Conclusión: el seguimiento integral y sistemático por parte de enfermeros durante el período gestacional es fundamental y necesita perfeccionamiento en la reducción de daños. Los hallazgos sugieren estrategias de asistencia de enfermería diferenciadas y refuerzan las brechas prácticas y científicas relacionadas con el tema.

4.
Rev Assoc Med Bras (1992) ; 67(9): 1268-1273, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34816919

RESUMEN

OBJECTIVE: Psychological effects of the coronavirus disease 2019 (COVID-19) pandemic on pregnant women with diabetes and hypertension are not yet studied. Besides the pregnancy, these women have additional risk factors for severe acute respiratory syndrome due to COVID-19 and are considered a particularly vulnerable, unique population. We aimed to assess their mental health during this pandemic. METHODS: This is a cross-sectional study carried out at a Brazilian tertiary hospital. Women with pregnancies complicated by hypertension and/or diabetes were evaluated. The primary outcome was anxiety, and depressive symptoms evaluated with the State-Trait Anxiety Inventory and Patient Health Questionnaire. Perception of changing habits during quarantine was evaluated as a secondary outcome. RESULTS: Seventy-nine patients were included. The prevalence of State-Trait Anxiety Inventory ≥40 was 79.7% and that of Patient Health Questionnaire ≥10 was 59.2%. Lower social support was correlated with higher scores on both scales. Time spent with electronic devices was perceived as greater by 62% of the women. CONCLUSIONS: Pregnant women with diabetes and hypertension presented high levels of anxiety and depressive symptoms during the COVID-19 pandemic. Considering that these symptoms can affect both the mother's and offspring's health, it is necessary to implement tools to improve their mental health.


Asunto(s)
COVID-19 , Diabetes Mellitus , Hipertensión , Estudios Transversales , Depresión/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Salud Mental , Pandemias , Embarazo , Mujeres Embarazadas , SARS-CoV-2
5.
Int J Public Health ; 66: 602873, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34744568

RESUMEN

Objectives: To describe maternal smoking trends in France between 1972 and 2016, and identify whether maternal characteristics associated with smoking in the 3rd trimester of pregnancy evolved between 2010 and 2016. Methods: Using French National Perinatal Surveys, we estimated proportions of smokers and the number of cigarettes smoked both just before pregnancy and during the 3rd trimester from 1972 to 2016. We used a Poisson model with robust variance to estimate prevalence ratios for smoking during pregnancy. Results: Proportions of mothers quitting smoking were relatively stable (46.0% in 1972 and 45.8% in 2016). The number of cigarettes smoked just before pregnancy and in the 3rd trimester decreased from 1995 onward. However, proportions of smokers remained high before (30.1%) and during the 3rd trimester in 2016 (16.2%). Smoking in the 3rd trimester was associated with a lower education level and lower income in both 2010 and 2016, whereas the association with age, country of birth and parity varied according to the survey year. Conclusion: Early targeted interventions are needed for smokers who plan to have a child and must take smokers' characteristics during pregnancy into account.


Asunto(s)
Mujeres Embarazadas , Fumar Tabaco , Femenino , Francia/epidemiología , Encuestas Epidemiológicas , Humanos , Embarazo , Mujeres Embarazadas/psicología , Fumar Tabaco/epidemiología , Fumar Tabaco/tendencias
6.
BMC Pregnancy Childbirth ; 21(1): 768, 2021 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-34772345

RESUMEN

BACKGROUND: Pregnant and postpartum women face unique challenges and concerns during the COVID-19 pandemic. Thus far, no studies have explored the factors associated with increased levels of worry in this population globally. The current study sought to assess the frequency and sources of worry during the COVID-19 pandemic in an international sample of pregnant and postpartum women. METHODS: We conducted an anonymous, online, cross-sectional survey in 64 countries between May and June 2020. The survey was available in 12 languages and hosted on the Pregistry platform for COVID-19 studies. Participants were sought mainly on social media platforms and online parenting forums. The survey included questions related to demographics, level of worry, support, stress, COVID-19 exposure, frequency of media usage, and mental health indicators. RESULTS: The study included 7561 participants. Eighty-three percent of all participants indicated that they were either 'somewhat' or 'very' worried. Women 13-28 weeks pregnant were significantly more likely to indicate that they were 'very worried' compared to those who were postpartum or at other stages of pregnancy. When compared with women living in Europe, those in Africa, Asia and Pacific, North America and South/Latin America were more likely to have increased levels of worry, as were those who more frequently interacted with social media. Different forms of support and stress also had an impact upon level of worry, while indicators of stress and anxiety were positively associated with worry level. CONCLUSION: Pregnant and postpartum women are vulnerable to the changes in societal norms brought about by the COVID-19 pandemic. Understanding the factors associated with levels of worry within this population will enable society to address potential unmet needs and improve the current and future mental health of parents and children.


Asunto(s)
Ansiedad/etiología , COVID-19/psicología , Complicaciones del Embarazo/etiología , Adolescente , Adulto , Ansiedad/epidemiología , Ansiedad/psicología , Estudios Transversales , Femenino , Salud Global/estadística & datos numéricos , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Oportunidad Relativa , Periodo Posparto/psicología , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/psicología , Factores de Riesgo , Estrés Psicológico/epidemiología , Estrés Psicológico/etiología , Estrés Psicológico/psicología , Adulto Joven
7.
Pan Afr Med J ; 39: 271, 2021.
Artículo en Francés | MEDLINE | ID: mdl-34754348

RESUMEN

This study is based on a psychoanalytically inspired psychological investigation of two pregnant women with COVID-19 at different stages of pregnancy in the Department of Obstetrics and Gynaecology A at the Charles Nicolle Hospital. Our study was conducted between 2020 and 2021, until deliveries. Two young Tunisian women aged 28 and 30 years were tested positive for COVID-19 during pregnancy. They suffered from emotional shock. In this study, we discuss the different points of collision between life and death by describing, in detail, the experiences of these two women during their confinement.


Asunto(s)
Ansiedad/psicología , COVID-19/psicología , Mujeres Embarazadas/psicología , Estrés Psicológico/psicología , Adulto , COVID-19/epidemiología , COVID-19/prevención & control , Femenino , Humanos , Salud Mental , Pandemias , Embarazo , SARS-CoV-2
9.
Ceska Gynekol ; 86(5): 304-310, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34736327

RESUMEN

OBJECTIVE: The aim of this study was to compare the relation between the quality of life, level of depression and some other psychological characteristics of women and the method (pharmacological or instrumental) they chose to terminate their pregnancy up to 49 days of amenorrhoea. METHODS: From Jan 1st, 2019 to Aug 31st, 2020 we prospectively analyzed data obtained by evaluating questionnaires from 106 women with a choice of pharmacological (faUUT) and 105 women with a choice of surgical (iUUT) termination of pregnancy. The questionnaires focused on their quality of life and other characteristics. RESULTS: Women undergoing faUUT have a statistically significantly higher quality of life (P = 0.001), they are physically (P = 0.003) and mentally (P = 0.027) healthier, they have a higher socioeconomic status, and they are more satisfied with their environment (P = 0.022). CONCLUSION: Women with a differently chosen method of termination of pregnancy had a statistically significantly different quality of life as a whole. This difference is statistically significant in the sub-areas of the quality of life: feeling of physical health and mental well-being, satisfaction with the environment, and subjective perception of the quality of life. The result doesnt confirm a statistically significant difference between both groups on the level of depression and their cohabitation.


Asunto(s)
Aborto Inducido , Calidad de Vida , Femenino , Humanos , Embarazo , Encuestas y Cuestionarios
10.
BMC Pregnancy Childbirth ; 21(1): 769, 2021 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-34772367

RESUMEN

BACKGROUND: Up to 50% of women in areas of high socio-economic deprivation are at risk of developing depressive symptoms in pregnancy. Feeling well supported, can facilitate good mental health perinatally. A brief, innovative intervention to facilitate access to support and resources was developed and tested. This included one antenatal and one postnatal session, each with three evidence-based components: i) support from a non-professional peer to enable a woman to identify her needs; ii) information about local community services and signposting; and iii) development of a personalised If-Then plan to access that support. The aims were to evaluate the intervention and research methods for feasibility and acceptability for perinatal women, maternity care providers and peers, and provide preliminary effectiveness indications. METHODS: Pregnant women living in an area of high deprivation were recruited from community-based antenatal clinics and randomised to intervention or control condition (a booklet about local resources). Outcome measures included women's use of community services by 34 + weeks gestation and 6 months postnatally; mental health and wellbeing measures, and plan implementation. Interviews and focus groups were conducted with women participants, providers, and peers. Data were analysed using framework analysis. Recruitment and retention of peers and participants, intervention fidelity, and acceptability of outcome measures were recorded. RESULTS: Peer facilitators could be recruited, trained, retained and provide the intervention with fidelity. One hundred twenty six women were recruited and randomised, 85% lived in the 1% most deprived UK areas. Recruitment constituted 39% of those eligible, improving to 54% after midwifery liaison. Sixty five percent were retained at 6 months postnatally. Women welcomed the intervention, and found it helpful to plan access to community services. Providers strongly supported the intervention philosophy and integrated this easily into services. The study was not powered to detect significant group differences but there were positive trends in community service use, particularly postnatally. No differences were evident in mental health and wellbeing. CONCLUSIONS: This intervention was well received and easily integrated into existing services. Women living in highly deprived areas could be recruited, randomised and retained. Measures were acceptable. Peer facilitators were successfully trained and retained. Full effectiveness studies are warranted.


Asunto(s)
Servicios de Salud Comunitaria , Accesibilidad a los Servicios de Salud/organización & administración , Servicios de Salud Materna , Atención Perinatal/métodos , Atención Posnatal/métodos , Adulto , Estudios de Factibilidad , Femenino , Humanos , Grupo Paritario , Proyectos Piloto , Pobreza , Embarazo , Reino Unido
11.
BMC Pregnancy Childbirth ; 21(1): 664, 2021 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-34592953

RESUMEN

BACKGROUND: The outbreak of the COVID-19 pandemic caused great uncertainty about causes, treatment and mortality of the new virus. Constant updates of recommendations and restrictions from national authorities may have caused great concern for pregnant women. Reports suggested an increased number of pregnant women choosing to give birth at home, some even unassisted ('freebirth') due to concerns of transmission in hospital or reduction in birthplace options. During April and May 2020, we aimed to investigate i) the level of concern about coronavirus transmission in Danish pregnant women, ii) the level of concern related to changes in maternity services due to the pandemic, and iii) implications for choice of place of birth. METHODS: We conducted a nationwide cross-sectional online survey study, inviting all registered pregnant women in Denmark (n = 30,009) in April and May 2020. RESULTS: The response rate was 60% (n = 17,995). Concerns of transmission during pregnancy and birth were considerable; 63% worried about getting severely ill whilst pregnant, and 55% worried that virus would be transmitted to their child. Thirtyeight percent worried about contracting the virus at the hospital. The most predominant concern related to changes in maternity services during the pandemic was restrictions on partners' attendance at birth (81%). Especially nulliparous women were concerned about whether cancelled antenatal classes or fewer physical midwifery consultations would affect their ability to give birth or care for their child postpartum.. The proportion of women who considered a home birth was equivalent to pre-pandemic home birth rates in Denmark (3%). During the temporary discontinue of public home birth services, 18% of this group considered a home birth assisted by a private midwife (n = 125), and 6% considered a home birth with no midwifery assistance at all (n = 41). CONCLUSION: Danish pregnant womens' concerns about virus transmission to the unborn child and worries about contracting the virus during hospital appointments were considerable during the early pandemic. Home birth rates may not be affected by the pandemic, but restrictions in home birth services may impose decisions to freebirth for a small proportion of the population.


Asunto(s)
Ansiedad/psicología , Entorno del Parto , COVID-19/psicología , Servicios de Salud Materna , Parto/psicología , Mujeres Embarazadas/psicología , Adulto , COVID-19/transmisión , Estudios Transversales , Dinamarca/epidemiología , Femenino , Humanos , Partería , Embarazo , SARS-CoV-2 , Esposos , Encuestas y Cuestionarios
13.
Artículo en Inglés | MEDLINE | ID: mdl-34639394

RESUMEN

The emergence of COVID-19 has profoundly affected mental health, especially among highly vulnerable populations. This study describes mental health issues among caregivers of young children and pregnant women in three urban informal settlements in Kenya during the first pandemic year, and factors associated with poor mental health. A cross-sectional telephone survey was administered to 845 participants. Survey instruments included the Patient Health Questionnaire-9, General Anxiety Disorder-7 scale, COVID-19 Anxiety Scale, and questions on the perceived COVID-19 effects on caregiver wellbeing and livelihood. Data were analyzed using descriptive statistics, and univariate and multivariate analysis. Caregivers perceived COVID-19 as a threatening condition (94.54%), affecting employment and income activities (>80%). Caregivers experienced discrimination (15.27%) and violence (12.6%) during the pandemic. Levels of depression (34%), general anxiety (20%), and COVID-19 related anxiety (14%) were highly prevalent. There were significant associations between mental health outcomes and economic and socio-demographic factors, violence and discrimination experiences, residency, and perceptions of COVID-19 as a threatening condition. Caregivers high burden of mental health problems highlights the urgent need to provide accessible mental health support. Innovative and multi-sectoral approaches will be required to maximize reach to underserved communities in informal settlements and tackle the root causes of mental health problems in this population.


Asunto(s)
COVID-19 , Pandemias , Ansiedad/epidemiología , Cuidadores , Niño , Preescolar , Estudios Transversales , Depresión , Femenino , Humanos , Kenia/epidemiología , Salud Mental , Embarazo , SARS-CoV-2 , Teléfono
14.
Sci Rep ; 11(1): 20261, 2021 10 12.
Artículo en Inglés | MEDLINE | ID: mdl-34642429

RESUMEN

While pregnant women are already at-risk for developing symptoms of anxiety and depression, this is heightened during the COVID-19 pandemic. We compared anxiety and depression symptoms, as indicators of psychological distress, before and during COVID-19, and investigated the role of partner, social network and healthcare support on COVID-19-related worries and consequently on psychological distress. A national survey, conducted during the first lockdown in The Netherlands, assessed COVID-19 experiences and psychological distress (N = 1421), whereas a comparison sample (N = 1439) was screened for psychological distress in 2017-2018. During COVID-19, the percentage of mothers scoring above the questionnaires' clinical cut-offs doubled for depression (6% and 12%) and anxiety (24% and 52%). Women reported increased partner support during COVID-19, compared to pre-pandemic, but decreased social and healthcare support. Higher support resulted in lower COVID-19-related worries, which in turn contributed to less psychological distress. Results suggest that a global pandemic exerts a heavy toll on pregnant women's mental health. Psychological distress was substantially higher during the pandemic than the pre-pandemic years. We identified a protective role of partner, social, and healthcare support, with important implications for the current and future crisis management. Whether increased psychological distress is transient or persistent, and whether and how it affects the future generation remains to be determined.


Asunto(s)
COVID-19 , Pandemias , Mujeres Embarazadas/psicología , Distrés Psicológico , Cuarentena/psicología , Estrés Psicológico , Adulto , COVID-19/epidemiología , COVID-19/psicología , Depresión , Femenino , Humanos , Salud Mental , Países Bajos , Embarazo , Encuestas y Cuestionarios , Salud de la Mujer
15.
Health Aff (Millwood) ; 40(10): 1551-1559, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34606354

RESUMEN

Each year approximately 700 people die in the United States from pregnancy-related complications. We describe the characteristics of pregnancy-related deaths due to mental health conditions, including substance use disorders, and identify opportunities for prevention based on recommendations from fourteen state Maternal Mortality Review Committees (MMRCs) from the period 2008-17. Among 421 pregnancy-related deaths with an MMRC-determined underlying cause of death, 11 percent were due to mental health conditions. Pregnancy-related mental health deaths were more likely than deaths from other causes to be determined by an MMRC to be preventable (100 percent versus 64 percent), to occur among non-Hispanic White people (86 percent versus 45 percent), and to occur 43-365 days postpartum (63 percent versus 18 percent). Sixty-three percent of pregnancy-related mental health deaths were by suicide. Nearly three-quarters of people with a pregnancy-related mental health cause of death had a history of depression, and more than two-thirds had past or current substance use. MMRC recommendations can be used to prioritize interventions and can inform strategies to enable screening, care coordination, and continuation of care throughout pregnancy and the year postpartum.


Asunto(s)
Complicaciones del Embarazo , Suicidio , Comités Consultivos , Causas de Muerte , Femenino , Humanos , Mortalidad Materna , Salud Mental , Embarazo , Complicaciones del Embarazo/prevención & control , Suicidio/prevención & control , Estados Unidos
16.
Health Aff (Millwood) ; 40(10): 1605-1611, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34606358

RESUMEN

Poor perinatal mental health is a common pregnancy-related morbidity with potentially serious impacts that extend beyond the individual to their family. A possible contributing factor to poor perinatal mental health is discontinuity in health insurance coverage, which is particularly important among low-income people. We examined impacts of Medicaid expansion on prepregnancy depression screening and self-reported depression and postpartum depressive symptoms and well-being among low-income people giving birth. Medicaid expansion was associated with a 16 percent decline in self-reported prepregnancy depression but was not associated with postpartum depressive symptoms or well-being. Associations between Medicaid expansion and prepregnancy mental health measures increased with time since expansion. Expanding health insurance coverage to low-income people before pregnancy may improve perinatal mental health.


Asunto(s)
Medicaid , Salud Mental , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Cobertura del Seguro , Patient Protection and Affordable Care Act , Embarazo , Estados Unidos
17.
BMC Pregnancy Childbirth ; 21(1): 670, 2021 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-34602060

RESUMEN

BACKGROUND: Coronavirus currently cause a lot of pressure on the health system. Accordingly, many changes occurred in the way of providing health care, including pregnancy and childbirth care. To our knowledge, no studies on experiences of maternity care Providers during the COVID-19 Pandemic have been published in Iran. We aimed to discover their experiences on pregnancy and childbirth care during the current COVID-19 pandemic. METHODS: This study was a qualitative research performed with a descriptive phenomenological approach. The used sampling method was purposive sampling by taking the maximum variation possible into account, which continued until data saturation. Accordingly, in-depth and semi-structured interviews were conducted by including 12 participants, as 4 gynecologists, 6 midwives working in the hospitals and private offices, and 2 midwives working in the health centers. Data were analyzed using Colaizzi's seven stage method with MAXQDA10 software. RESULTS: Data analysis led to the extraction of 3 themes, 9 categories, and 25 subcategories. The themes were as follows: "Fear of Disease", "Burnout", and "Lessons Learned from the COVID-19 Pandemic", respectively. CONCLUSIONS: Maternal health care providers experience emotional and psychological stress and work challenges during the current COVID-19 pandemic. Therefore, comprehensive support should be provided for the protection of their physical and mental health statuses. By working as a team, utilizing the capacity of telemedicine to care and follow up mothers, and providing maternity care at home, some emerged challenges to maternal care services can be overcome.


Asunto(s)
COVID-19/psicología , Personal de Salud/psicología , Servicios de Salud Materna/estadística & datos numéricos , Atención Perinatal/estadística & datos numéricos , Adulto , Agotamiento Psicológico/psicología , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/virología , Emociones/fisiología , Femenino , Ginecología/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Humanos , Recién Nacido , Entrevistas como Asunto , Irán/epidemiología , Servicios de Salud Materna/tendencias , Persona de Mediana Edad , Partería/estadística & datos numéricos , Atención Perinatal/organización & administración , Trastornos Fóbicos/psicología , Embarazo , Investigación Cualitativa , SARS-CoV-2/genética , Estrés Psicológico/psicología , Telemedicina/métodos
18.
J Prev Med Hyg ; 62(2): E399-E406, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34604580

RESUMEN

Infant mortality is among the most important indicators of health and development in global communities. One of the causes of neonatal mortality is low birth weight. This study aims at evaluating the risk factors for LBW in infants. This study was carried out using a nested case-control study in rural areas of Kurdistan province in Western Iran in 2015. The selection of case and control groups was based on the nesting using the risk set sampling approach. In total, 182 and 364 subjects were selected for the case group and the control group respectively. Data analysis was performed using the Stata-12 software with the point and spatial estimation of OR using the conditional logistic regression method. The multivariate logistic regression analysis performed shows that the maternal gestational age, the mother's health history during pregnancy, any medication abuses by the mother, any mental stress during pregnancy, are LBW risk factors (P < 0.05). Prevention of LBW is possible by identifying effective factors and performing appropriate interventions in infants with low birth weight.


Asunto(s)
Recién Nacido de Bajo Peso , Complicaciones del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Estrés Psicológico/psicología , Adulto , Índice de Masa Corporal , Estudios de Casos y Controles , Femenino , Humanos , Lactante , Recién Nacido , Irán/epidemiología , Trastornos Mentales/epidemiología , Madres , Estado Nutricional , Embarazo , Nacimiento Prematuro/etiología , Atención Prenatal , Factores de Riesgo , Población Rural , Factores Socioeconómicos , Estrés Psicológico/epidemiología , Trastornos Relacionados con Sustancias/epidemiología
19.
Medicina (Kaunas) ; 57(10)2021 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-34684150

RESUMEN

Background and Objectives: As maternal deaths associated with the SARS-CoV-2 infection remain at several times greater than the general population, significant factors that might contribute to the higher mortality and morbidity rate are the psychological impact of the disease and pregnancy itself. Therefore, the current study's main objective was to assess how pregnant women react and cope with the stress of COVID-19 disease and how it influences their overall health and quality of life in healthcare facilities. Materials and Methods: In this cross-sectional study, we included 304 pregnant women who successfully completed standardized forms to assess our topics of interest, comprising of the Hospital Anxiety and Depression Scale, the Short Form Health Survey-12, the Coping Orientation to Problems Experienced Inventory scale, the CORE-Outcome Measure Questionnaire, and the Quality from the Patient's Perspective questionnaire. Results: Unemployed, pregnant women living in poverty in the rural areas had higher SARS-CoV-2 infection rates during pregnancy. They faced higher anxiety levels and depression rates, with associated increased physical burden and exhaustion. However, these findings are not influenced by hospital care since it remained unchanged among COVID-19 and non-COVID-19 maternity units, excepting significantly lower technical competence scores of COVID-19 facilities. Conclusions: As the pandemic's consequences emerge and additional outbreaks occur, care must prioritize the additional physical burden experienced by pregnant women who have contracted COVID-19, as well as psychological, emotional, and mental health support.


Asunto(s)
COVID-19 , Mujeres Embarazadas , Adaptación Psicológica , Ansiedad/epidemiología , Estudios Transversales , Depresión/epidemiología , Femenino , Humanos , Embarazo , Calidad de Vida , SARS-CoV-2 , Estrés Psicológico/epidemiología
20.
Obstet Gynecol ; 138(5): 770-776, 2021 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-34619717

RESUMEN

OBJECTIVE: To examine the association between adverse childhood experiences and adverse pregnancy outcomes. METHODS: This cohort study included individuals who enrolled in a perinatal collaborative mental health care program (COMPASS [the Collaborative Care Model for Perinatal Depression Support Services]) between 2017 and 2021. Participants completed psychosocial self-assessments, including an adverse childhood experiences screen. The primary exposure was adverse childhood experiences measured by the ACE (adverse childhood experience) score, which was evaluated as a dichotomized variable, with a high ACE score defined as greater than three. Secondary analyses used the ACE score as a continuous variable. Adverse pregnancy outcomes including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age (SGA) births were abstracted from the electronic health record. Bivariable and multivariable analyses were performed, including mediation analyses. RESULTS: Of the 1,274 women with a completed adverse childhood experiences screen, 904 (71%) reported one or more adverse childhood experiences, and 290 (23%) reported a high ACE score (more than three adverse childhood experiences). Adverse childhood experience scores were not associated with gestational diabetes or SGA births. After controlling for potential confounders, individuals with high ACE score had 1.55-fold (95% CI 1.06-2.26) increased odds of having hypertensive disorders of pregnancy and 2.03-fold (95% CI 1.38-2.99) increased odds of preterm birth. Each point increase in ACE score was not associated with a statistically increased odds of hypertensive disorders of pregnancy (adjusted odds ratio [aOR] 1.07, 95% CI 0.99-1.15); however, each additional point on the adverse childhood experiences screen was associated with increased odds of preterm birth (aOR 1.13, 95% CI 1.05-1.22). Mediation analyses demonstrated tobacco use, chronic medical problems, and obesity each partially mediated the observed association between high ACE scores and hypertensive disorders of pregnancy. Having chronic medical comorbidities partially mediated the observed association between high ACE scores and preterm birth. CONCLUSION: One in four individuals referred to a perinatal mental health program who were pregnant or postpartum had a high ACE score. Having a high ACE score was associated with an increased risk of hypertensive disorders of pregnancy and preterm birth. These results underscore how remote events may reverberate through the life course.


Asunto(s)
Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Hipertensión Inducida en el Embarazo/epidemiología , Complicaciones del Embarazo , Nacimiento Prematuro/epidemiología , Rehabilitación Psiquiátrica , Adulto , Adultos Sobrevivientes de Eventos Adversos Infantiles/estadística & datos numéricos , Experiencias Adversas de la Infancia/psicología , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/psicología , Estudios de Cohortes , Femenino , Humanos , Servicios de Salud Mental/estadística & datos numéricos , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/psicología , Resultado del Embarazo/epidemiología , Rehabilitación Psiquiátrica/métodos , Rehabilitación Psiquiátrica/estadística & datos numéricos , Medición de Riesgo , SARS-CoV-2 , Autoevaluación (Psicología) , Estados Unidos/epidemiología
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