Psychological adversity in pregnancy: what works to improve outcomes?

2014 ◽  
Vol 9 (2) ◽  
pp. 96-108 ◽  
Author(s):  
Vivette Glover ◽  
Jane Barlow
Keyword(s):  
Pregnant Women ◽  
Prenatal Stress ◽  
Risk Groups ◽  
Anxiety And Depression ◽  
Content Type ◽  
Increased Risk ◽  
Social Adversity ◽  
Long Term Impact ◽  
The Impact ◽  
In Pregnancy

Purpose – Foetal programming is one of the key mechanisms by which physical and social adversity is biologically embedded during pregnancy. While early interest in such programming focused on the long-term impact of the mother's nutritional state on the child's later physical health, more recent research has identified an increased risk of psychopathology in children of women who have experienced stress, anxiety and depression during pregnancy. The purpose of this paper is to examine the literature addressing the impact of stress in pregnancy and the implications for practice. Design/methodology/approach – An overview of the literature has been provided. Findings – Both anxiety and depression in pregnancy are common, with a prevalence in the region of 20 per cent. Exposure in pregnancy to anxiety, depression and stress from a range of sources (e.g. bereavement, relationship problems, external disasters and war), is associated with a range of physical (e.g. congenital malformations, reduced birthweight and gestational age), neurodevelopmental, cognitive, and emotional and behavioural (e.g. ADHD, conduct disorder) problems. The magnitude is significant, with the attributable risk of childhood behaviour problems due to prenatal stress being between 10 and 15 per cent, and the variance in cognitive development due to prenatal stress being around 17 per cent. A range of methods of intervening are effective in improving both maternal anxiety and depression, and in the longer term should improve outcomes for the infant and child. Research limitations/implications – This research highlights the importance of intervening to support the psychological wellbeing of pregnant women to improve outcomes for infants and children, and points to the need for further research into innovative ways of working, particularly with high-risk groups of pregnant women. Originality/value – The paper provides an update of earlier overviews.

scholarly journals Planning for a cohort study to investigate the impact and management of influenza in pregnancy in a future pandemic

2015 ◽  
Vol 3 (6) ◽  
pp. 1-48 ◽  
Author(s):  
Marian Knight ◽  
Peter Brocklehurst ◽  
Pat O’Brien ◽  
Maria A Quigley ◽  
Jennifer J Kurinczuk
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Influenza Pandemic ◽  
Influenza Infection ◽  
H1n1 Influenza ◽  
Steering Committee ◽  
Pandemic Strain ◽  
Increased Risk ◽  
The Impact ◽  
In Pregnancy

BackgroundEvidence from the 2009 A/H1N1 influenza pandemic demonstrated that pregnant women are particularly vulnerable to infection and at an increased risk of death. Active data collection through the UK Obstetric Surveillance System (UKOSS) about women admitted to hospital during the 2009 A/H1N1 pandemic was used to inform ongoing clinical guidance regarding the use of antiviral treatment for pregnant women and demonstrated that, in addition to an increased risk of maternal morbidity, influenza infection in pregnancy is associated with poor perinatal outcomes, including an increased risk of stillbirth and preterm birth. This evidence influenced the decision to offer routine influenza immunisation to pregnant women. Even in a non-epidemic period, pregnant women continue to die from influenza.ObjectiveTo establish, and then to put into hibernation, the study mechanisms needed to mount a rapid investigation of the impact of pandemic influenza in pregnancy in the event of a newly emerging pandemic strain.DesignA new UKOSS cohort study was designed, based on the 2009–10 study, and following consultation with the Pandemic Flu Planning Group at the Royal College of Obstetricians and Gynaecologists and the UKOSS Steering Committee, to identify potential previously unanswered questions.SettingUK maternity units.ParticipantsAll pregnant women admitted to hospital with influenza in a future pandemic.Main outcome measuresManagement of pregnant women with influenza infection, intervention rates, treatment and pregnancy outcome for both the mother and fetus.ResultsThe study was designed and approved by the UKOSS Steering Committee and then placed into hibernation for activation in the event of an influenza pandemic.ConclusionsPregnant women, as a result of their changed immunological status, appear to be particularly susceptible to infection, including from influenza. The existence of the UKOSS enabled us to rapidly mount a study of pregnant women who were hospitalised with 2009 A/H1N1 influenza. Minor modifications to incorporate previously unanswered questions and our previous study enabled us to design, and then put into hibernation, a new study ready to investigate the impact and management of influenza in pregnancy, which is poised for activation in the event of a newly emerging pandemic strain. This will enable real-time data to be available on which to base rapid changes in clinical management as the as-yet-unforeseen pandemic unfolds. In the event of an influenza pandemic the study will be available to be immediately activated following expedited regulatory approvals.Trial registrationCurrent Controlled Trials ISRCTN44137563.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Clinical Outcomes of Submicroscopic Infections and Correlates of Protection of VAR2CSA Antibodies in a Longitudinal Study of Pregnant Women in Colombia

2018 ◽  
Vol 86 (4) ◽  
Author(s):  
Kenneth Gavina ◽  
Sedami Gnidehou ◽  
Eliana Arango ◽  
Chloe Hamel-Martineau ◽  
Catherine Mitran ◽  
...  
Keyword(s):  
Birth Weight ◽  
Pregnant Women ◽  
Gestational Age ◽  
Significant Risk ◽  
Adverse Outcomes ◽  
Mixed Infections ◽  
Content Type ◽  
Delivery Outcomes ◽  
The Impact ◽  
In Pregnancy

ABSTRACTMalaria in pregnancy can cause serious adverse outcomes for the mother and the fetus. However, little is known about the effects of submicroscopic infections (SMIs) in pregnancy, particularly in areas wherePlasmodium falciparumandPlasmodium vivaxcocirculate. A cohort of 187 pregnant women living in Puerto Libertador in northwest Colombia was followed longitudinally from recruitment to delivery. Malaria was diagnosed by microscopy, reverse transcription-quantitative PCR (RT-qPCR), and placental histopathology. Gestational age, hemoglobin concentration, VAR2CSA-specific IgG levels, and adhesion-blocking antibodies were measured during pregnancy. Statistical analyses were performed to evaluate the impact of SMIs on birth weight and other delivery outcomes. Twenty-five percent of women (45/180) were positive for SMIs during pregnancy. Forty-seven percent of infections (21/45) were caused byP. falciparum, 33% were caused byP. vivax, and 20% were caused by mixedPlasmodiumspp. Mixed infections ofP. falciparumandP. vivaxwere associated with lower gestational age at delivery (P= 0.0033), while other outcomes were normal. Over 60% of women had antibodies to VAR2CSA, and there was no difference in antibody levels between those with and without SMIs. The anti-adhesion function of these antibodies was associated with protection from SMI-related anemia at delivery (P= 0.0086). SMIs occur frequently during pregnancy, and while mixed infections of bothP. falciparumandP. vivaxwere not associated with a decrease in birth weight, they were associated with significant risk of preterm birth. We propose that the lack of adverse delivery outcomes is due to functional VAR2CSA antibodies that can protect pregnant women from SMI-related anemia.

scholarly journals The Impact of Microorganisms in Pregnancy

2021 ◽  
pp. 22-38
Author(s):  
Nastaran Ghandali ◽  
Hoda Sabati ◽  
Ali Emami ◽  
Masumeh Dadashaliha
Keyword(s):  
Pregnant Women ◽  
Viral Infections ◽  
Adverse Outcomes ◽  
Physiological Changes ◽  
Timely Manner ◽  
Increased Risk ◽  
Recent Outbreak ◽  
Immune Changes ◽  
The Impact ◽  
In Pregnancy

The pregnancy process involves many physiological changes, including weight gain, hormonal, metabolic and immune changes. One of the effective factors in this process is infection caused by microorganisms. Originally, before the advent of antibiotics, pregnancy was known as a risk factor for severe complications of pneumococcal pneumonia. Among viral infections, the 2009 flu pandemic issued a newer warning that some infections may disproportionately affect pregnant women and cause miscarriage and its complications during pregnancy. Generalization of pregnancy as a condition of suppression of the general immune system or increased risk is misleading and prevents the establishment of adequate guidelines for the treatment of pregnant women during epidemics. Viral infection has also become an important factor in pregnancy conditions. The recent outbreak of Ebola and other viral outbreaks and epidemics shows how pregnant women show worse outcomes (such as preterm delivery and fetal adverse outcomes) than the general population and non-pregnant women. The purpose of this article is studying pathogenesis of microorganisms and the risks which pose to the mother and the fetus. In order to investigate these factors, from 120 article prepared from google scholar and Pub med, Elsevier database. Knowing these factors can increase the ability to treat the infections in a timely manner and prevent their effects on the fetus and the patient.

scholarly journals The impact of COVID-19 on patients with stroke: an integrative review

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Suebsarn Ruksakulpiwat
Keyword(s):  
Distress Syndrome ◽  
Stroke Severity ◽  
Efficient Treatment ◽  
Content Type ◽  
Stroke Treatment ◽  
Increased Risk ◽  
Long Term Impact ◽  
Meta Analyses ◽  
The Impact

PurposeThis review aims to evaluate the evidence of the impact of COVID-19 on patients with stroke.Design/methodology/approachThe author carried out a review following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for a review article. PubMed, the Web of Science and CINAHL Plus Full Text were searched from January 2019 to October 2020. Twenty-three studies were included in the final review, incorporating a total of 9,819 stroke patients.FindingsThe most commonly reported effects of COVID-19 on patients with stroke were delayed stroke treatment (n = 14 studies), thrombotic, blood and immune system complications (n = 8), increased risk of stroke severity and disability (n = 6), increased mortality (n = 8), elevated D-dimer levels (n = 4), comorbidity and acute respiratory distress syndrome (ARDS) (n = 6) and prolonged hospitalization (n = 4).Originality/valueCOVID-19 has affected patients with stroke in various ways, either directly or indirectly, prior to admission or in hospital. The findings should help guide further investigation of the long-term impact of COVID-19 on patients with stroke and help to establish proper guidelines for the provision of efficient treatment for affected patients.

scholarly journals Incidence, risk factors and impact of seasonal influenza in pregnancy: A national cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244986
Author(s):  
Nicola Vousden ◽  
Kathryn Bunch ◽  
Marian Knight ◽  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Pregnant Women ◽  
Neonatal Intensive Care ◽  
Seasonal Influenza ◽  
Perinatal Outcomes ◽  
Severe Infection ◽  
Risk Groups ◽  
Increased Risk ◽  
In Pregnancy

Background Pregnant women are particularly vulnerable to severe infection from influenza resulting in poor neonatal outcomes. The majority of evidence relates to pandemic 2009 A/H1N1 influenza. The objective of this study was to describe the characteristics and outcomes of pregnant women hospitalised with seasonal influenza. Methods This national, prospective, observational cohort study used the UK Obstetric Surveillance System (UKOSS) to identify all pregnant women admitted to hospital between 01/11/2016 and 31/10/2018 with laboratory confirmed influenza at any gestation and up to two days after giving birth. These were compared to women admitted to give birth that did not have influenza. Baseline characteristics, immunization status, maternal and perinatal outcomes were compared. Results There were 405 women admitted to hospital with laboratory confirmed influenza in pregnancy: 2.7 per 10,000 maternities. Compared to 694 comparison women, women with influenza were less likely to be professionally employed (aOR 0.59, 95%CI 0.39–0.89) or immunised in the relevant season (aOR 0·59, 0·39–0·89) and more likely to have asthma (aOR 2.42, 1.30–4.49) or have had a previous pregnancy complication (aOR 2·47, 1·33–4·61). They were more likely to be admitted to intensive care (aOR 21.3, 2.78–163.1) and to have a cesarean birth (aOR 1·42, 1·02–1.98). Their babies were more likely to be admitted to neonatal intensive care (aOR 1.86, 1·01–3·42). Conclusions Immunization reduces the risk of hospitalisation with influenza in pregnancy which is associated with increased risk of morbidity for both the mother and baby. There is a continued need to increase awareness of safety and effectiveness of immunization in pregnancy and provision within antenatal care settings, especially for high-risk groups.

scholarly journals Feto-maternal outcome in COVID-19 positive patients with hypertensive disorders in pregnancy

2021 ◽  
Vol 10 (5) ◽  
pp. 1846
Author(s):  
Niranjan N. Chavan ◽  
Hera S. Mirza ◽  
Priyanka Sonawane ◽  
Umme Ammara Iqbal
Keyword(s):  
Pregnant Women ◽  
Neonatal Intensive Care ◽  
Severe Infection ◽  
Risk Groups ◽  
Current Data ◽  
Nasopharyngeal Swab ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
Hypertensive Disorders In Pregnancy ◽  
In Pregnancy

Background: Since the first confirmed case in December 2019, the data pertaining to the COVID-19 pandemic has been rapidly evolving. In current study, the relation of COVID-19 and its effect on pregnant women with hypertensive disorders in pregnancy, including symptoms and foetomaternal outcome were studied.Methods: Women with hypertensive disorders in pregnancy consecutively admitted for delivery and tested via nasopharyngeal swab for SARS-CoV-2 using reverse transcriptase polymerase chain reaction (RT-PCR) from 1 April 2020 to 30 September 2020 were included in the study.Results: In our study, 56 women having hypertensive disorders in pregnancy with COVID-19 infections delivering 60 babies (4 twins), 46.43% were in the age group of <25 years, 51.78 % were <37 weeks gestation. Delivery was by caesarean section in 76.78%. Out of these, 33.92% patients required ICU admission. 40% babies delivered had birth weight of <2.5 kg out of which 13.33% had IUGR and 26.66% were preterm. There was 13.33% stillbirth and 6.66% neonatal deaths. 4 maternal death has been reported.Conclusions: With the current data available it does not appear that pregnant women are at increased risk of severe infection than the general population, but clinicians should be aware of high-risk groups. Women will need to be monitored in their booking maternity units and should be transferred to centres with appropriate neonatal intensive care facilities for delivery. In pregnant women with COVID-19 infection, if maternal illness is not severe, the considerations should be based more on obstetric indications for delivery.

scholarly journals Incidence, risk factors and impact of seasonal influenza in pregnancy: A national cohort study

2020 ◽  
Author(s):  
Nicola Vousden ◽  
Kathryn Bunch ◽  
Marian Knight ◽  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Pregnant Women ◽  
Neonatal Intensive Care ◽  
Seasonal Influenza ◽  
Perinatal Outcomes ◽  
Severe Infection ◽  
Risk Groups ◽  
Increased Risk ◽  
In Pregnancy

Background Pregnant women are particularly vulnerable to severe infection from influenza resulting in poor neonatal outcomes. The majority of evidence relates to pandemic 2009 A/H1N1 influenza. The objective of this study was to describe the characteristics and outcomes of pregnant women hospitalised with seasonal influenza. Methods This national, prospective, observational cohort study used the UK Obstetric Surveillance System (UKOSS) to identify all pregnant women admitted to hospital between 01/11/2016 and 31/10/2018 with laboratory confirmed influenza together with a comparison group of pregnant women. Baseline characteristics, immunisation status, maternal and perinatal outcomes were compared. Results There were 405 women admitted to hospital with laboratory confirmed influenza in pregnancy: 2.7 per 10,000 maternities. Compared to 694 comparison women, women with influenza were less likely to be professionally employed (aOR 0.59, 95%CI 0.39-0.89) or immunised in the relevant season (aOR 0.59, 0.39-0.89) and more likely to have asthma (aOR 2.42, 1.30-4.49) or have had a previous pregnancy complication (aOR 2.47, 1.33-4.61). They were more likely to be admitted to intensive care (aOR 21.3, 2.78-163.1) and to have a caesarean birth (aOR 1.42, 1.02-1.98). Their babies were more likely to be admitted to neonatal intensive care (aOR 1.86, 1.01-3.42). Conclusions Immunisation reduces the risk of hospitalisation with influenza in pregnancy which is associated with increased risk of morbidity for both the mother and baby. There is a continued need to increase awareness of safety and effectiveness of immunisation in pregnancy and provision within antenatal care settings, especially for high risk groups.

scholarly journals Impact of the COVID-19 pandemic on mental health in pregnancy women: results from two cohort studies in China

2020 ◽  
Author(s):  
Hong Mei ◽  
Na Li ◽  
Junwei Li ◽  
Dan Zhang ◽  
Zhongqiang Cao ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Pregnant Women ◽  
Anxiety And Depression ◽  
Significant Difference ◽  
Stress Levels ◽  
Set Up ◽  
Anxiety Depression ◽  
The Impact ◽  
In Pregnancy

Abstract Background The COVID-19 pandemic led to a global atmosphere of anxiety and depression. However, the impact of this disaster on mental health in pregnancy women was not clear. Methods Based on two cohort study, the Novel Coronavirus Disease Influenced Pregnant Cohort Study (NCP) set up during the COVID-19 epidemic and the Healthy Baby Cohort Study (HBC) set up in 2012, we compared the anxiety, depression and stress levels of pregnant women who did not or did go through the COVID-19 pandemic and analyzed the risk factors for mental health in pregnancy women. Results There were 784 and 2448 participants in the CNP and HBC studies involved in the analysis, respectively. We found that there were 23.09% and 4.72% pregnant women suffering for mild and moderate-to-several anxieties for those in the NCP study, and 21.53% and 3.06% in the HBC study. The mild and moderate-to-several depression rate was 25.89% and 11.35% for those in the NCP study, and 19.81% and 0.51% for those in the HBC study, respectively. No significant difference was found for anxiety, depression and stress levels was found at each gestational trimester (p > 0.05). The pandemic of COVID-19 was significantly associated with maternal depression and stress (p < 0.05), with the co-efficient and 95%CI as 0.37 (0.18, 0.55) and − 0.12 (-0.09, -0.32), respectively. Pregnant women with pre-pregnancy obesity, higher educational level or good sleep quality might have lower risks for anxiety, depression and stress compared with the referenced groups. conclusions The pandemic had a huge impact on depression, especially moderate-to-sever level, in pregnant women at whatever gestational week; and that pre-pregnancy obesity, highly educated and sleep well ones had less anxiety and depression risks. The society, especially the family members, should pay more attention to pregnant ones and give more social support to them.

scholarly journals Prevalence of anxiety and depression symptoms in pregnant women with type 2 diabetes and the impact on glycaemic control

2020 ◽  
Author(s):  
Björg Ásbjörnsdóttir ◽  
Marianne Vestgaard ◽  
Nicoline C. Do ◽  
Lene Ringholm ◽  
Lise L.T. Andersen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Pregnant Women ◽  
Anxiety And Depression ◽  
Depression Symptoms ◽  
The Impact

scholarly journals Prenatal electrocardiogram testing and postpartum depression: A population-based cohort study

2021 ◽  
pp. 1753495X2110125
Author(s):  
Jonathan S Zipursky ◽  
Deva Thiruchelvam ◽  
Donald A Redelmeier
Keyword(s):  
Cohort Study ◽  
Postpartum Depression ◽  
Pregnant Women ◽  
Odds Ratio ◽  
Population Based ◽  
Relative Increase ◽  
Organic Disease ◽  
Increased Risk ◽  
Clinical Clue ◽  
In Pregnancy

Background Cardiovascular symptoms in pregnancy may be a clue to psychological distress. We examined whether electrocardiogram testing in pregnant women is associated with an increased risk of subsequent postpartum depression. Methods We conducted a population-based cohort study of pregnant women who delivered in Ontario, Canada comparing women who received a prenatal ECG to women who did not. Results In total, 3,238,218 women gave birth during the 25-year study period of whom 157,352 (5%) received an electrocardiogram during prenatal care. Receiving an electrocardiogram test was associated with a one-third relative increase in the odds of postpartum depression (odds ratio 1.34; 95% confidence interval 1.29–1.39, p < 0.001). Conclusion The association between prenatal electrocardiogram testing and postpartum depression suggests a possible link of organic disease with mental illness, and emphasizes that cardiovascular symptoms may be a clinical clue to the presence of an underlying mood disorder.

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