Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs.

PubMed

Nakku, Juliet E M; Okello, Elialilia S; Kizza, Dorothy; Honikman, Simone; Ssebunnya, Joshua; Ndyanabangi, Sheila; Hanlon, Charlotte; Kigozi, Fred

2016-07-22

Perinatal mental illness is a common and important public health problem, especially in low and middle-income countries (LMICs). This study aims to explore the barriers and facilitators, as well as perceptions about the feasibility and acceptability of plans to deliver perinatal mental health care in primary care settings in a low income, rural district in Uganda. Six focus group discussions comprising separate groups of pregnant and postpartum women and village health teams as well as eight key informant interviews were conducted in the local language using a topic guide. Transcribed data were translated into English, analyzed, and coded. Key themes were identified using a thematic analysis approach. Participants perceived that there was an important unmet need for perinatal mental health care in the district. There was evidence of significant gaps in knowledge about mental health problems as well as negative attitudes amongst mothers and health care providers towards sufferers. Poverty and inability to afford transport to services, poor partner support and stigma were thought to add to the difficulties of perinatal women accessing care. There was an awareness of the need for interventions to respond to this neglected public health problem and a willingness of both community- and facility-based health care providers to provide care for mothers with mental health problems if equipped to do so by adequate training. This study highlights the acceptability and relevance of perinatal mental health care in a rural, low-income country community. It also underscores some of the key barriers and potential facilitators to delivery of such care in primary care settings. The results of this study have implications for mental health service planning and development for perinatal populations in Uganda and will be useful in informing the development of integrated maternal mental health care in this rural district and in similar settings in other low and middle income countries.

Use of Online Forums for Perinatal Mental Illness, Stigma, and Disclosure: An Exploratory Model.

PubMed

Moore, Donna; Drey, Nicholas; Ayers, Susan

2017-02-20

Perinatal mental illness is a global health concern; however, many women with the illness do not get the treatment they need to recover. Interventions that reduce the stigma around perinatal mental illness have the potential to enable women to disclose their symptoms to health care providers and consequently access treatment. There are many online forums for perinatal mental illness and thousands of women use them. Preliminary research suggests that online forums may promote help-seeking behavior, potentially because they have a role in challenging stigma. This study draws from these findings and theoretical concepts to present a model of forum use, stigma, and disclosure. This study tested a model that measured the mediating role of stigma between online forum use and disclosure of affective symptoms to health care providers. A Web-based survey of 200 women who were pregnant or had a child younger than 5 years and considered themselves to be experiencing psychological distress was conducted. Women were recruited through social media and questions measured forum usage, perinatal mental illness stigma, disclosure to health care providers, depression and anxiety symptoms, barriers to disclosure, and demographic information. There was a significant positive indirect effect of length of forum use on disclosure of symptoms through internal stigma, b=0.40, bias-corrected and accelerated (BCa) 95% CI 0.13-0.85. Long-term forum users reported higher levels of internal stigma, and higher internal stigma was associated with disclosure of symptoms to health care providers when controlling for symptoms of depression and anxiety. Internal stigma mediates the relationship between length of forum use and disclosure to health care providers. Findings suggest that forums have the potential to enable women to recognize and reveal their internal stigma, which may in turn lead to greater disclosure of symptoms to health care providers. Clinicians could refer clients to trustworthy and

Perinatal support to protect maternal mental health.

PubMed

McCaul, Anthony; Stokes, Jayne

Family Action is a charity that helps more than 45,000 vulnerable families and children across England a year by offering emotional, practical and financial support. A pilot of a perinatal support project in Southwark, London was found to reduce mental health problems in vulnerable women and is now being extended. Such schemes complement the work of health visitors and other health professionals. Commissioners need to be aware of the long-term impact of such low-cost interventions in the early years.

Integrated perinatal mental health care: a national model of perinatal primary care in vulnerable populations.

PubMed

Lomonaco-Haycraft, Kimberly C; Hyer, Jennifer; Tibbits, Britney; Grote, Jennifer; Stainback-Tracy, Kelly; Ulrickson, Claire; Lieberman, Alison; van Bekkum, Lies; Hoffman, M Camille

2018-06-18

IntroductionPerinatal mood and anxiety disorders (PMADs) are the most common complication of pregnancy and have been found to have long-term implications for both mother and child. In vulnerable patient populations such as those served at Denver Health, a federally qualified health center the prevalence of PMADs is nearly double the nationally reported rate of 15-20%. Nearly 17% of women will be diagnosed with major depression at some point in their lives and those numbers are twice as high in women who live in poverty. Women also appear to be at higher risk for depression in the child-bearing years. In order to better address these issues, an Integrated Perinatal Mental Health program was created to screen, assess, and treat PMADs in alignment with national recommendations to improve maternal-child health and wellness. This program was built upon a national model of Integrated Behavioral Health already in place at Denver Health. A multidisciplinary team of physicians, behavioral health providers, public health, and administrators was assembled at Denver Health, an integrated hospital and community health care system that serves as the safety net hospital to the city and county of Denver, CO. This team was brought together to create a universal screen-to-treat process for PMAD's in perinatal clinics and to adapt the existing Integrated Behavioral Health (IBH) model into a program better suited to the health system's obstetric population. Universal prenatal and postnatal depression screening was implemented at the obstetric intake visit, a third trimester prenatal care visit, and at the postpartum visit across the clinical system. At the same time, IBH services were implemented across our health system's perinatal care system in a stepwise fashion. This included our women's care clinics as well as the family medicine and pediatric clinics. These efforts occurred in tandem to support all patients and staff enabling a specially trained behavioral health provider

Common perinatal mental disorders in northern Viet Nam: community prevalence and health care use

PubMed Central

Tran, Thach; La, Buoi thi; Kriitmaa, Kelsi; Rosenthal, Doreen; Tran, Tuan

2010-01-01

Abstract Objective To establish the prevalence of common perinatal mental disorders their determinants, and their association with preventive health care use among women in one rural and one urban province in northern Viet Nam. Methods We conducted a cross-sectional survey of cohorts of pregnant women and mothers of infants recruited systematically in 10 randomly-selected communes. The women participated in psychiatrist-administered structured clinical interviews and separate structured interviews to assess sociodemographic factors, reproductive health, the intimate partner relationship, family violence and the use of preventive and psychiatric health care. Associations between these variables and perinatal mental disorders were explored through univariate analyses and multivariable logistic regression. Findings Among women eligible for the study (392), 364 (93%) were recruited. Of these, 29.9% (95% confidence interval, CI: 25.20–34.70) were diagnosed with a common perinatal mental disorder (CPMD). The frequency of such disorders during pregnancy and in the postpartum period was the same. Their prevalence was higher among women in rural provinces (odds ratio, OR: 2.17; 95% CI: 1.19–3.93); exposed to intimate partner violence (OR: 2.11; 95% CI: 1.12–3.96); fearful of other family members (OR: 3.36; 95% CI: 1.05–10.71) or exposed to coincidental life adversity (OR: 4.40; 95% CI: 2.44–7.93). Fewer women with a CPMD used iron supplements than women without a CPMD, but the results were not statistically significant (P = 0.05). None of the women studied had ever received mental health care. Conclusion Perinatal depression and anxiety are prevalent in women in northern Viet Nam. These conditions are predominantly determined by social factors, including rural residence, poverty and exposure to family violence. At present the needs of women with common perinatal mental disorders are unrecognized and not attended to and their participation in essential

Women's use of online resources and acceptance of e-mental health tools during the perinatal period.

PubMed

Fonseca, Ana; Gorayeb, Ricardo; Canavarro, Maria Cristina

2016-10-01

The women's professional help-seeking rate for perinatal depression is low, despite the prevalent and disabling nature of this condition. Therefore, new approaches should be implemented to increase women's access and utilization of treatment resources, namely e-mental health tools. This study aimed to characterize women's current pattern of use of online resources for mental heal issues and women's acceptance of e-mental health tools during the perinatal period, and to investigate its main determinants. This study used an online cross-sectional survey that was completed by 546 women during the perinatal period. 31.3% had prior knowledge of websites targeting mental health illness. Women presenting an actual need for help (i.e., a positive screen for depression) reported greater use of online resources and greater engagement in e-health behaviors related to mental health (d=0.46-0.61), and being more accepting of e-mental health tools, particularly of informative websites. Women's perceptions concerning the e-mental tools were found to predict their intentions to use them. The results seem to globally support Portuguese women's acceptance of e-mental health tools. To improve the level of acceptance, women should be involved as stakeholders in the development of new e-mental health tools and provided with specific information before their utilization. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Knowledge, confidence, skills and practices among midwives in the republic of Ireland in relation to perinatal mental health care: The mind mothers study.

PubMed

Carroll, Margaret; Downes, Carmel; Gill, Ailish; Monahan, Mark; Nagle, Ursula; Madden, Deirdre; Higgins, Agnes

2018-05-18

The study aimed to identify midwives' competency in perinatal mental health care in terms of their knowledge, confidence, skill and educational priorities, and to explore their clinical practices in relation to the assessment and management of perinatal mental health problems. An exploratory descriptive study design was used on a sample of 438 midwives in the Republic of Ireland. Data were collected over a two-month period in 2016 using an anonymous, self-completed survey designed by the research team. The majority of midwives cared for women with perinatal mental health problems in their clinical practice; however, beyond depression and anxiety, their knowledge of perinatal mental health problems was quite limited. Similarly, midwives reported a lack of skill in opening a discussion with women on sensitive issues, such as sexual abuse, intimate partner violence and psychosis, and providing information to women's partners/families. The findings indicated that midwives adopted a selective approach to screening for perinatal mental health problems, with a tendency not to inquire about sensitive topics, or address them only with women deemed at-risk. Timely and appropriate care is required to ensure the best outcomes for women with perinatal mental health problems and their families. A greater understanding of perinatal mental health among midwives is required to enable them to provide support and information to women and their families, and to identify when specialist intervention is required. Education and other structural supports, such as care pathways and documentation, is required to train and support midwives in their key role of caring for, and collaborating with, women with perinatal mental health problems. Copyright © 2018 Elsevier Ltd. All rights reserved.

Women's experiences of participating in a prospective, longitudinal postpartum depression study: insights for perinatal mental health researchers.

PubMed

Andrighetti, Heather J; Semaka, Alicia; Austin, Jehannine C

2017-08-01

Barriers to recruitment for research on mental illness include participant distrust of researchers and social stigma. Though these issues may be acutely important in perinatal mental health research, they remain unexplored in this context. In order to inform strategies to more fully engage women in perinatal mental health research, we explored the motivations and experiences of women with a history of major depressive disorder who participated in a prospective longitudinal research study on postpartum depression (PPD). Sixteen women with a history of depression who had either completed or recently made a decision about participation in a longitudinal research study about PPD were interviewed by telephone. Qualitative, semi-structured interviews explored participants' decision-making about, and experiences of, participation. Interviews were audio-recorded, transcribed, and qualitatively analyzed using elements of grounded theory methodology. Follow-up interviews were conducted with four participants to refine and clarify preliminary results. Foundational elements necessary for women to consider participating in PPD research included personal acceptance of illness and trust in the research team/institution. Other main motivators included perceived personal relevance, anticipated benefits (including access to support/resources, learning opportunities, and improved self-worth), altruism, and accessible study procedures. Our data suggest that participating in perinatal mental health research may help women make meaning of their mental illness experience and is perceived as providing support. The findings-particularly around the importance of participant-researcher rapport and accessibility of study design-may inform strategies that improve participation rates, decrease attrition, and maximize participant benefits in perinatal mental health research.

Mental health consultations in the perinatal period: a cost-analysis of Medicare services provided to women during a period of intense mental health reform in Australia.

PubMed

Chambers, Georgina M; Randall, Sean; Mihalopoulos, Cathrine; Reilly, Nicole; Sullivan, Elizabeth A; Highet, Nicole; Morgan, Vera A; Croft, Maxine L; Chatterton, Mary Lou; Austin, Marie-Paule

2017-12-05

Objective To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients' costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year). Method A retrospective study of MBS utilisation and costs (in 2011-12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken. Results The cost of mental health consultations during the perinatal period was A$17.5million for women giving birth in 2007, rising to A$29million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner. Conclusion Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives. What is known about the topic? The mental healthcare landscape in Australia has changed significantly over the

Factors affecting implementation of perinatal mental health screening in women of refugee background.

PubMed

Nithianandan, Nishani; Gibson-Helm, Melanie; McBride, Jacquie; Binny, Amanda; Gray, Kylie M; East, Christine; Boyle, Jacqueline A

2016-11-18

For women of refugee background, the increased risk of mental illness associated with pregnancy is compounded by pre- and post-settlement stressors. In Australia, antenatal screening for depression and anxiety symptoms using the Edinburgh Postnatal Depression Scale is recommended for all women. Despite this, screening is not routinely implemented and little is known about barriers and enablers to implementation for women of refugee background. Semi-structured interviews were conducted with a range of health professionals (n = 28: midwives, obstetricians, perinatal mental health and refugee health experts, interpreters) and women of refugee background (n = 9). Themes generated from thematic analysis were examined in relation to the Theoretical Domains Framework and Cultural Competence Conceptual Framework, followed by identification of effective behaviour change techniques to address the barriers and enablers identified by participants. These techniques formed the basis of recommendations to inform sustainable implementation of screening and referral. Almost all participants perceived perinatal mental health screening to be necessary and most recognised the importance of post-traumatic stress disorder (PTSD) screening. Barriers and enablers were identified and related to eight domains: knowledge, skills, professional roles, beliefs about capabilities and consequences, environmental context, social influences and behavioural regulation. This research clarifies how mental health screening may be integrated into routine antenatal care for women of refugee background, in order to improve provision of recommended care. These theory-informed recommendations include an inter-disciplinary approach, coordinating care within and across services, addition of PTSD screening, and effective communication with women.

Mental health treatment patterns in perinatally HIV-infected youth and controls.

PubMed

Chernoff, Miriam; Nachman, Sharon; Williams, Paige; Brouwers, Pim; Heston, Jerry; Hodge, Janice; Di Poalo, Vinnie; Deygoo, Nagamah Sandra; Gadow, Kenneth D

2009-08-01

Youths perinatally infected with HIV often receive psychotropic medication and behavioral treatment for emotional and behavioral symptoms. We describe patterns of intervention for HIV-positive youth and youth in a control group in the United States. Three hundred nineteen HIV-positive youth and 256 controls, aged 6 to 17 years, enrolled in the International Maternal Adolescent AIDS Clinical Trials 1055, a prospective, 2-year observational study of psychiatric symptoms. One hundred seventy-four youth in the control group were perinatally exposed to HIV, and 82 youth were uninfected children living in households with HIV-positive members. Youth and their primary caregivers completed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-referenced symptom-rating scales. Children's medication and behavioral psychiatric intervention histories were collected at entry. We evaluated the association of past or current psychiatric treatment with HIV status, baseline symptoms, and impairment by using multiple logistic regression, controlling for potential confounders. HIV-positive youth and youth in the control group had a similar prevalence of psychiatric symptoms (61%) and impairment (14% to 15%). One hundred four (18%) participants received psychotropic medications (stimulants [14%], antidepressants [6%], and neuroleptic agents [4%]), and 127 (22%) received behavioral treatment. More HIV-positive youth than youth in the control group received psychotropic medication (23% vs 12%) and behavioral treatment (27% vs 17%). After adjusting for symptom class and confounders, HIV-positive children had twice the odds of children in the control group of having received stimulants and >4 times the odds of having received antidepressants. Caregiver-reported symptoms or impairment were associated with higher odds of intervention than reports by children alone. HIV-positive children are more likely to receive mental health interventions than control-group children

Perinatal Health of Women with Intellectual and Developmental Disabilities and Comorbid Mental Illness

PubMed Central

Cobigo, Virginie; Lunsky, Yona; Dennis, Cindy-Lee; Vigod, Simone

2016-01-01

Objective: Women with intellectual and developmental disabilities (IDD) have high rates of adverse perinatal outcomes. However, the perinatal health of women with co-occurring IDD and mental illness (dual diagnosis) is largely unknown. Our objectives were to 1) describe a cohort of women with dual diagnosis in terms of their social and health characteristics and 2) compare their risks for adverse maternal and neonatal outcomes to those of women with IDD only. Method: We conducted a population-based study using linked Ontario (Canada) health and social services administrative data to identify singleton obstetric deliveries to women with dual diagnosis (n = 2080) and women with IDD only (n = 1852; 2002–2012). Primary maternal outcomes were gestational diabetes, gestational hypertension, preeclampsia/eclampsia, and venous thromboembolism. Primary neonatal outcomes were preterm birth, small for gestational age, and large for gestational age. We also examined several secondary outcomes. Results: Women with dual diagnosis were more likely than women with IDD only to live in poor neighborhoods and to have prepregnancy health conditions; however, they had more frequent prenatal care. Infants born to women with dual diagnosis had increased risks for preterm birth (adjusted relative risk [aRR] 1.31, 95% confidence interval [CI] 1.08 to 1.59) and neonatal morbidity (aRR 1.35, 95% CI 1.03 to 1.76) compared with infants born to women with IDD only. All other primary and secondary outcomes were nonsignificant. Conclusions: Comorbid mental illness contributes little additional risk for adverse perinatal outcomes among women with IDD. Women with dual diagnosis and women with IDD alone require increased surveillance for maternal and neonatal complications. PMID:27310242

Women's Use of Multi sector Mental Health Services in a Community-Based Perinatal Depression Program

ERIC Educational Resources Information Center

Price, Sarah Kye

2010-01-01

Low-income and ethnic minority women have been described as at risk for experiencing depression during and around the time of pregnancy, a finding complicated by low levels of mental health service use within this population. This study retrospectively examined data from a community-based perinatal depression project targeting low-income women in…

Sexual and Drug Use Behavior in Perinatal HIV-Infected Youth: Mental Health and Family Influences

ERIC Educational Resources Information Center

Mellins, Claude A.; Elkington, Katherine S.; Brackis-Cott, Elizabeth; Bauermeister, Jose A.; Dolezal, Curtis; McKay, Mary; Wiznia, Andrew; Bamji, Mahrukh; Abrams, Elaine J.

2009-01-01

A study found that youth and caregiver mental health problem have greater impact than key environmental factors and family functioning on sex and drug use risk behaviors in perinatally human immunodeficiency virus (HIV)-infected (PHIV+) and PHIV- youths. No differences in the rates of sexual risk behavior and substance use were observed between…

The feasibility of a role for community health workers in integrated mental health care for perinatal depression: a qualitative study from Surabaya, Indonesia.

PubMed

Surjaningrum, Endang R; Minas, Harry; Jorm, Anthony F; Kakuma, Ritsuko

2018-01-01

Indonesian maternal health policies state that community health workers (CHWs) are responsible for detection and referral of pregnant women and postpartum mothers who might suffer from mental health problems (task-sharing). The documents have been published for a while, however reports on the implementation are hardly found which possibly resulted from feasibility issue within the health system. To examine the feasibility of task-sharing in integrated mental health care to identify perinatal depression in Surabaya, Indonesia. Semi-structured interviews were conducted with 62 participants representing four stakeholder groups in primary health care: program managers from the health office and the community, health workers and CHWs, mental health specialists, and service users. Questions on the feasibility were supported by vignettes about perinatal depression. WHO's health systems framework was applied to analyse the data using framework analysis. Findings indicated the policy initiative is feasible to the district health system. A strong basis within the health system for task-sharing in maternal mental health rests on health leadership and governance that open an opportunity for training and supervision, financing, and intersectoral collaboration. The infrastructure and resources in the city provide potential for a continuity of care. Nevertheless, feasibility is challenged by gaps between policy and practices, inadequate support system in technologies and information system, assigning the workforce and strategies to be applied, and the lack of practical guidelines to guide the implementation. The health system and resources in Surabaya provide opportunities for task-sharing to detect and refer cases of perinatal depression in an integrated mental health care system. Participation of informal workforce might facilitate in closing the gap in the provision of information on perinatal mental health.

Efficacy, Feasibility, and Acceptability of Perinatal Yoga on Women's Mental Health and Well-Being: A Systematic Literature Review.

PubMed

Sheffield, Karen M; Woods-Giscombé, Cheryl L

2016-03-01

Perinatal major depressive disorder affects 20% of women, while perinatal anxiety affects 10% of women. Although pharmacological treatment has shown effectiveness, many pregnant women are concerned about potential adverse effects on the fetus, maternal-infant bonding, and child development. Approximately 38% of American adults use complementary and alternative medicine, including yoga and other mind-body strategies. Although complementary and alternative medicine has been less studied in the perinatal population, it potentially offers women and their providers alternatives to traditional medication for treatment of perinatal depression and anxiety. Thus, the purpose of this systematic review was to examine existing empirical literature on yoga and its effects on women's health and well-being during the perinatal period. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systemic literature reviews, literature searches using relevant search terms were performed in four major electronic databases: CINAHL, PubMed, PsycINFO, and EMBASE. Thirteen publications met inclusion criteria. Results indicated that yoga interventions are generally effective in reducing anxiety and depression in pregnant women. The use of yoga in the perinatal period shows promise in improving mental health and well-being for women and infants. This review can inform future yoga intervention studies and clinical practice with the perinatal population. © The Author(s) 2015.

Understanding the mental health of youth living with perinatal HIV infection: lessons learned and current challenges

PubMed Central

Mellins, Claude A; Malee, Kathleen M

2013-01-01

Introduction Across the globe, children born with perinatal HIV infection (PHIV) are reaching adolescence and young adulthood in large numbers. The majority of research has focused on biomedical outcomes yet there is increasing awareness that long-term survivors with PHIV are at high risk for mental health problems, given genetic, biomedical, familial and environmental risk. This article presents a review of the literature on the mental health functioning of perinatally HIV-infected (PHIV+) adolescents, corresponding risk and protective factors, treatment modalities and critical needs for future interventions and research. Methods An extensive review of online databases was conducted. Articles including: (1) PHIV+ youth; (2) age 10 and older; (3) mental health outcomes; and (4) mental health treatment were reviewed. Of 93 articles identified, 38 met inclusion criteria, the vast majority from the United States and Europe. Results These studies suggest that PHIV+ youth experience emotional and behavioural problems, including psychiatric disorders, at higher than expected rates, often exceeding those of the general population and other high-risk groups. Yet, the specific role of HIV per se remains unclear, as uninfected youth with HIV exposure or those living in HIV-affected households displayed similar prevalence rates in some studies, higher rates in others and lower rates in still others. Although studies are limited with mixed findings, this review indicates that child-health status, cognitive function, parental health and mental health, stressful life events and neighbourhood disorder have been associated with worse mental health outcomes, while parent–child involvement and communication, and peer, parent and teacher social support have been associated with better function. Few evidence-based interventions exist; CHAMP+, a mental health programme for PHIV+ youth, shows promise across cultures. Conclusions This review highlights research limitations that

Motor Testing at 1 Year Improves the Prediction of Motor and Mental Outcome at 2 Years after Perinatal Hypoxic-Ischaemic Encephalopathy

ERIC Educational Resources Information Center

van Schie, Petra Em; Becher, Jules G.; Dallmeijer, Annet J.; Barkhof, Frederik; van Weissenbruch, Mirjam M.; Vermeulen, R. Jeroen

2010-01-01

Aim: To investigate the predictive value of motor testing at 1 year for motor and mental outcome at 2 years after perinatal hypoxic-ischaemic encephalopathy (HIE) in term neonates. Method: Motor and mental outcome at 2 years was assessed with the Bayley Scales of Infant Development, 2nd edition (BSID-II) in 32 surviving children (20 males, 12…

Perinatal depression and screening among Aboriginal Australians in the Kimberley.

PubMed

Kotz, Jayne; Munns, Ailsa; Marriott, Rhonda; Marley, Julia V

2016-02-01

Adhoc culturally questionable perinatal mental-health screening among Aboriginal women in the Kimberley. Mental-health issues, substance abuse and suicide attempts are high among young Aboriginal women in Australia. There is no evidence that the Edinburgh Postnatal Depression Scale (EPDS) is effective or culturally safe. Screening practices are complicated by limited understanding of the complex cultural interface between Western and Aboriginal beliefs and notions about health and mental-health. What is the current context of perinatal mental-health screening practices among Aboriginal women in the Kimberley and what might be considered a culturally safe approach? A review of the literature and exploration of current screening practices preceded community participatory action research (CPAR) of perinatal mental-health screening. More than 100 Kimberley women and 72 health practitioners contributed to this joint strategic body of work. Recommendations for practice include one single culturally appropriate Kimberley version of the EPDS.

Perinatal depression: a review of US legislation and law.

PubMed

Rhodes, Ann M; Segre, Lisa S

2013-08-01

Accumulating research documenting the prevalence and negative effects of perinatal depression, together with highly publicized tragic critical incidents of suicide and filicide by mothers with postpartum psychosis, have fueled a continuum of legislation. Specialists in perinatal mental health should recognize how their work influences legislative initiatives and penal codes, and take this into consideration when developing perinatal services and research. Yet, without legal expertise, the status of legislative initiatives can be confusing. To address this shortfall, we assembled an interdisciplinary team of academics specializing in law, as well as perinatal mental health, to summarize these issues. This review presents the relevant federal and state legislation and summarizes the criminal codes that governed the court decisions on cases in which a mother committed filicide because of postpartum psychosis. Moreover, the review aims to help researchers and providers who specialize in perinatal depression understand their role in this legal landscape.

Midwives' perceptions and experiences of caring for women who experience perinatal mental health problems: An integrative review.

PubMed

Noonan, Maria; Doody, Owen; Jomeen, Julie; Galvin, Rose

2017-02-01

perinatal mental health is an important public health issue and consideration must be given to care provision for effective support and care of women in the perinatal period. to synthesise primary research on midwives' perceived role in Perinatal Mental Health (PMH). integrative review. Whittemore and Knafl's (2005) framework was employed. A systematic search of the literature was completed. Studies were included if they met the following criteria: primary qualitative, quantitative and mixed methods research studies published in peer reviewed journals between January 2006 to February 2016, where the population of interest were midwives and the outcomes of interest were their perceived role in the management of women with PMH problems. The methodological quality of studies was assessed using the relevant CASP (Critical Appraisal Skills Programmes, 2014) criteria for quantitative and qualitative research studies. Data extraction, quality assessment and thematic analysis were conducted. a total of 3323 articles were retrieved and 22 papers were included in the review (15 quantitative, 6 qualitative and one mixed method study). The quality of the studies included was good overall. Two overarching themes emerged relating to personal and professional engagement. Within personal engagement four sub themes are presented: knowledge, skills, decision making and attitude. Within professional engagement four themes are presented: continuous professional development, organisation of care, referral, and support. the findings indicate midwives require continuous professional development opportunities that address knowledge, attitudes to PMH, communication and assessment skills. However educational and training support in the absence of appropriate referral pathways and support systems will have little benefit. Copyright © 2016 Elsevier Ltd. All rights reserved.

Australian midwives knowledge, attitude and perceived learning needs around perinatal mental health.

PubMed

Hauck, Yvonne L; Kelly, Georgina; Dragovic, Milan; Butt, Janice; Whittaker, Pamela; Badcock, Johanna C

2015-01-01

a cross sectional survey was undertaken to explore midwives' knowledge of, and attitudes towards, mental health disorders in childbearing women vis-à-vis their perceived mental health learning needs. a 50.1% response rate included 238 midwives employed in the only public tertiary maternity hospital in Western Australia from March to June 2013. The survey comprised a mixture of custom-designed questions and vignettes presenting various disorders. Only 37.6% of midwives felt well-equipped to support women, whilst 50.2% reported insufficient access to information. Demand was highest for education on: personality disorders (77.8%); the impact of childbearing on mental health disorders (74.2%); and skills for handling stress and aggression (57.8%). Knowledge scores were variable: on average eight out of a maximum 13 questions were answered correctly, but few (2.7%) answered more than 11 correctly, and 3.7% scored ≤4 correct. Across disorders, recognition from vignettes was highest for depression (93.9%), and lowest for schizophrenia (65.6%). Surprisingly, there were no associations between general knowledge scores and previous mental health experience, recent professional development, or access to information around mental health. The majority endorsed positive beliefs about midwives' role in mental health assessment, and belief in women's recovery (83.5%), however, cluster analysis of warmth and competence ratings revealed negative stereotyping of mental health disorders. Midwives accept it is their role to assess the mental health status of women but many feel ill-equipped to do so and express a strong desire for further knowledge and skills across a range of perinatal mental health topics. Attitudes to recovery are positive but negative stereotypes exist; therefore awareness of potential bias is important to negate their influence on care. Learning needs may change due to trends in clinical practice. Strategies are needed to recognise negative beliefs and to

Prevalence and risk of mental disorders in the perinatal period among migrant women: a systematic review and meta-analysis.

PubMed

Anderson, Fraser M; Hatch, Stephani L; Comacchio, Carla; Howard, Louise M

2017-06-01

This study was conducted in order to evaluate the prevalence and risk of mental disorders in the perinatal period among migrant women. Six databases (including MEDLINE) were searched from inception to October 19th, 2015, in addition to citation tracking. Studies were eligible if mental disorders were assessed with validated tools during pregnancy and up to 1 year postpartum among women born outside of the study country. Of 3241 abstracts screened, 53 met the inclusion criteria for the review. Only three studies investigated a mental disorder other than depression. Unadjusted odds ratios were pooled using random effects meta-analysis for elevated depression symptoms during pregnancy (n = 12) and the postpartum (n = 24), stratified by study country due to heterogeneity. Studies from Canada found an increased risk for antenatal (OR = 1.86, 95% CIs 1.32-2.62) and postnatal elevated depression symptoms (OR = 1.98, 95% CIs 1.57-2.49) associated with migrant status. Studies from the USA found a decreased risk of antenatal elevated depression symptoms (OR = 0.71, 95% CIs 0.51-0.99), and studies from the USA and Australia found no association between migrant status and postnatal elevated depression symptoms. Low social support, minority ethnicity, low socioeconomic status, lack of proficiency in host country language and refugee or asylum-seeking status all put migrant populations at increased risk of perinatal mental disorders.

‘It's leaflet, leaflet, leaflet then, “see you later”’: black Caribbean women's perceptions of perinatal mental health care

PubMed Central

Edge, Dawn

2011-01-01

Background Despite high levels of psychosocial risks, black women of Caribbean origin rarely consult health professionals regarding symptoms of perinatal depression. Reasons for this are unclear as there has been little perinatal mental health research among this ethnic group. Aim To examine stakeholder perspectives on what might account for low levels of consultation for perinatal depression among a group of women who are, theoretically, vulnerable. Design of study A qualitative study using focus group interviews. Setting Community settings in the northwest of England. Method A purposive sample of black Caribbean women (n = 42) was split into focus groups and interviewed. This sample was drawn from a larger study. Interviews were digitally recorded and transcribed verbatim. Framework analysis was used to generate themes. Results Perceptions of practitioners' lack of compassion in delivering physical care and women's inability to develop confiding relationships with professionals during pregnancy and childbirth were significant barriers to consulting for depressive symptoms in particular, and health needs more generally. Advocating a ‘stepped-care’ approach, black Caribbean women suggested that new care pathways are required to address the full spectrum of perinatal mental health need. Apparently eschewing mono-ethnic, ‘culturally sensitive’ models, women suggested there was much to be gained from receiving care and support in mixed ethnic groups. Conclusion Black Caribbean women's suggestions for more collaborative, community-based models of care are in line with policy, practice, and the views of members of other ethnic groups. Adopting such approaches might provide more sustainable mechanisms for improving access and engagement both among so-called hard-to-reach groups and more generally, thereby potentially improving maternal and child outcomes. PMID:21439184

Detecting the severity of perinatal anxiety with the Perinatal Anxiety Screening Scale (PASS).

PubMed

Somerville, Susanne; Byrne, Shannon L; Dedman, Kellie; Hagan, Rosemary; Coo, Soledad; Oxnam, Elizabeth; Doherty, Dorota; Cunningham, Nadia; Page, Andrew C

2015-11-01

The Perinatal Anxiety Screening Scale (PASS; Somerville et al., 2014) reliably identifies perinatal women at risk of problematic anxiety when a clinical cut-off score of 26 is used. This study aimed to identify a severity continuum of anxiety symptoms with the PASS to enhance screening, treatment and research for perinatal anxiety. Antenatal and postnatal women (n=410) recruited from the antenatal clinics and mental health services at an obstetric hospital completed the Edinburgh Postnatal Depression Scale (EPDS), the Depression, Anxiety and Stress Scale (DASS-21), the Spielberg State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory II (BDI), and the PASS. The women referred to mental health services were assessed to determine anxiety diagnoses via a diagnostic interview conducted by an experienced mental health professional from the Department of Psychological Medicine - King Edward Memorial Hospital. Three normative groups for the PASS, namely minimal anxiety, mild-moderate anxiety, and severe anxiety, were identified based on the severity of anxiety indicated on the standardised scales and anxiety diagnoses. Two cut-off points for the normative groups were calculated using the Jacobson-Truax method (Jacobson and Truax, 1991) resulting in three severity ranges: 'minimal anxiety'; 'mild-moderate anxiety'; and 'severe anxiety'. The most frequent diagnoses in the study sample were adjustment disorder, mixed anxiety and depression, generalised anxiety, and post-traumatic stress disorder. This may limit the generalisability of the severity range results to other anxiety diagnoses including obsessive compulsive disorder and specific phobia. Severity ranges for the PASS add value to having a clinically validated cut-off score in the detection and monitoring of problematic perinatal anxiety. The PASS can now be used to identify risk of an anxiety disorder and the severity ranges can indicate developing risk for early referrals for further assessments

Perinatal mental health service provision in Switzerland and in the UK.

PubMed

Amiel Castro, Rita T; Schroeder, Katrin; Pinard, Claudia; Blöchlinger, Patricia; Künzli, Hansjörg; Riecher-Rössler, Anita; Kammerer, Martin

2015-01-01

The epidemiology of maternal perinatal-psychiatric disorders as well as their effect on the baby is well recognised. Increasingly well researched specialised treatment methods can reduce maternal morbidity, positively affect mother-baby bonding and empower women's confidence as a mother. Here, we aimed to compare guidelines and the structure of perinatal-psychiatric service delivery in the United Kingdom and in Switzerland from the government's perspective. Swiss cantons provided information regarding guidelines and structure of service delivery in 2000. A subsequent survey using the same questionnaire was carried out in 2007. In the UK, similar information was accessed through published reports from 2000-2012. Guidelines for perinatal psychiatry exist in the UK, whereas in Switzerland in 2000 none of the 26 cantons had guidelines, and in 2007 only one canton did. Joint mother-baby admissions on general psychiatric wards were offered by 92% of the Swiss cantons. In the UK, pregnant women and joint mother-baby admissions are only advised onto specialised perinatal-psychiatric units. In Switzerland, in 2007, three specialised units (max. 24 beds) were in place corresponding to 1 unit per 2.5 million people, while in the UK there were 22 mother-baby units (168 beds) in 2012 (1 unit per 2.8 million). In the UK, less than 50% of trusts provided specialised perinatal-psychiatric health care. The main difference between the UK and Switzerland was the absence of guidelines, regular assessment and plans for future development of perinatal psychiatry in Switzerland. There are still geographical differences in the provision of perinatal-psychiatric services in the UK.

The Social Nature of Perceived Illness Representations of Perinatal Depression in Rural Uganda.

PubMed

Sarkar, Nandini D P; Bardaji, Azucena; Peeters Grietens, Koen; Bunders-Aelen, Joske; Baingana, Florence; Criel, Bart

2018-06-07

While the global health community advocates for greater integration of mental health into maternal health agendas, a more robust understanding of perinatal mental health, and its role in providing integrated maternal health care and service delivery, is required. The present study uses the Illness Representation Model, a theoretical cognitive framework for understanding illness conceptualisations, to qualitatively explore multiple stakeholder perspectives on perinatal depression in rural Uganda. A total of 70 in-depth interviews and 9 focus group discussions were conducted with various local health system stakeholders, followed by an emergent thematic analysis using NVivo 11. Local communities perceived perinatal depression as being both the fault of women, and not. It was perceived as having socio-economic and cultural causal factors, in particular, as being partner-related. In these communities, perinatal depression was thought to be a common occurrence, and its negative consequences for women, infants and the community at large were recognised. Coping and help-seeking behaviours prescribed by the participants were also primarily socio-cultural in nature. Placing the dynamics and mechanisms of these local conceptualisations of perinatal depression alongside existing gaps in social and health care systems highlights both the need of, and the opportunities for, growth and prioritisation of integrated perinatal biomedical, mental, and social health programs in resource-constrained settings.

The National Perinatal Depression Initiative: An evaluation of access to general practitioners, psychologists and psychiatrists through the Medicare Benefits Schedule.

PubMed

Chambers, Georgina M; Randall, Sean; Hoang, Van Phuong; Sullivan, Elizabeth A; Highet, Nicole; Croft, Maxine; Mihalopoulos, Cathrine; Morgan, Vera A; Reilly, Nicole; Austin, Marie-Paule

2016-03-01

To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness. Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative. The proportion of women giving birth who accessed at least one mental health item during the perinatal period increased from 88 to 141 per 1000 between 2007 and 2010. The difference-in-difference analysis showed that while there was an overall increase in Medicare Benefits Schedule mental health item access as a result of the National Perinatal Depression Initiative, this did not reach statistical significance. However, the National Perinatal Depression Initiative was found to significantly increase access in subpopulations of women, particularly those aged under 25 and over 34 years living in major cities. In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new

The impact of peer support in the context of perinatal mental illness: a meta-ethnography.

PubMed

Jones, Catriona C G; Jomeen, Julie; Hayter, Mark

2014-05-01

this paper is a report of a systematic review and meta-ethnography to explore the impact of peer support in the context of perinatal mental illness (PMI). systematic review methods identified five qualitative studies about women's experiences of PMI, and the impact peer support has on their journey towards emotional well-being. Findings from the identified studies were synthesised into themes, using meta-ethnography. the meta-ethnography produced four themes; 'Isolation: the role of peer support', 'Seeking validation through peer support', 'The importance of social norms of motherhood', and 'Finding affirmation/a way forward; the impact of peer support'. These themes represent women's experiences of PMI, their encounters with peer support groups within that context, and the impact of such encounters on their mental health status. recognising the risk of isolation and having pathways of referral to peer support networks is important, as are practitioners roles in nurturing peer support networks in perinatal care. More research is required to establish the most successful formats/structures of peer support. Practitioners should also recognise their individual and collective professional duty to challenge stereotypical depictions of motherhood wherever they arise, as this 'gold standard' benchmark of good mothering engenders guilt about not being good enough, often leaving women feeling inadequate. isolation is a key factor in PMI. Practitioners should be instrumental in their acceptance and development of peer support for PMI, ensuring these networks are valued, nurtured and encouraged. This study illustrates the powerful effect of professional and social forces on how new mothers feel about themselves. Copyright © 2013 Elsevier Ltd. All rights reserved.

Interventions for common perinatal mental disorders in women in low- and middle-income countries: a systematic review and meta-analysis.

PubMed

Rahman, Atif; Fisher, Jane; Bower, Peter; Luchters, Stanley; Tran, Thach; Yasamy, M Taghi; Saxena, Shekhar; Waheed, Waquas

2013-08-01

To assess the effectiveness of interventions to improve the mental health of women in the perinatal period and to evaluate any effect on the health, growth and development of their offspring, in low- and middle-income (LAMI) countries. Seven electronic bibliographic databases were systematically searched for papers published up to May 2012 describing controlled trials of interventions designed to improve mental health outcomes in women who were pregnant or had recently given birth. The main outcomes of interest were rates of common perinatal mental disorders (CPMDs), primarily postpartum depression or anxiety; measures of the quality of the mother-infant relationship; and measures of infant or child health, growth and cognitive development. Meta-analysis was conducted to obtain a summary measure of the clinical effectiveness of the interventions. Thirteen trials representing 20 092 participants were identified. In all studies, supervised, non-specialist health and community workers delivered the interventions, which proved more beneficial than routine care for both mothers and children. The pooled effect size for maternal depression was -0.38 (95% confidence interval: -0.56 to -0.21; I (2) = 79.9%). Where assessed, benefits to the child included improved mother-infant interaction, better cognitive development and growth, reduced diarrhoeal episodes and increased immunization rates. In LAMI countries, the burden of CPMDs can be reduced through mental health interventions delivered by supervised non-specialists. Such interventions benefit both women and their children, but further studies are needed to understand how they can be scaled up in the highly diverse settings that exist in LAMI countries.

Perinatal nutrition in maternal mental health and child development: Birth of a pregnancy cohort.

PubMed

Leung, Brenda M Y; Giesbrecht, Gerald F; Letourneau, Nicole; Field, Catherine J; Bell, Rhonda C; Dewey, Deborah

2016-02-01

Mental disorders are one of the leading contributors to the global burden of disease. The Alberta Pregnancy Outcomes and Nutrition (APrON) study was initiated in 2008 to better understand perinatal environmental impacts on maternal mental health and child development. This pregnancy cohort was established to investigate the relationship between the maternal environment (e.g. nutritional status), maternal mental health status, birth outcomes, and child development. The purpose of this paper is to describe the creation of this longitudinal cohort, the data collection tools and procedures, and the background characteristics of the participants. Participants were pregnant women age 16 or older, their infants and the biological fathers. For the women, data were collected during each trimester of pregnancy and at 3, 6, 12, 24, and 36months after the birth of their infant. Maternal measures included diet, stress, current mental and physical health, health history, and lifestyle. In addition, maternal biological samples (DNA, blood, urine, and spot breast milk samples) were banked. Paternal data included current mental and physical health, health history, lifestyle, and banked DNA samples. For infants, DNA and blood were collected as well as information on health, development and feeding behavior. At the end of recruitment in 2012, the APrON cohort included 2140 women, 2172 infants, and 1417 biological fathers. Descriptive statistics of the cohort, and comparison of women who stayed in the study and those who dropped out are discussed. Findings from the longitudinal cohort may have important implications for health policy and clinical practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Family size and perinatal circumstances, as mental health risk factors in a Scottish birth cohort.

PubMed

Riordan, Daniel Vincent; Morris, Carole; Hattie, Joanne; Stark, Cameron

2012-06-01

Higher maternal parity and younger maternal age have each been observed to be associated with subsequent offspring suicidal behaviour. This study aimed to establish if these, and other variables from the perinatal period, together with family size, are also associated with other psychiatric morbidity. Linked datasets of the Scottish Morbidity Record and Scottish death records were used to follow up, into young adulthood, a birth cohort of 897,685. In addition to the index maternity records, mothers' subsequent pregnancy records were identified, allowing family size to be estimated. Three independent outcomes were studied: suicide, self-harm, and psychiatric hospital admission. Data were analysed using Cox regression. Younger maternal age and higher maternal parity were independently associated with increased risk in offspring of suicide, of self-harm and of psychiatric admission. Risk of psychiatric admission was higher amongst those from families of three or more, but, compared with only children, those with two or three siblings had a lower risk of self harm. Perinatal and family composition factors have a broad influence on mental health outcomes. These data suggest that the existence of younger, as well as elder siblings may be important.

Perinatal suicide in Ontario, Canada: a 15-year population-based study.

PubMed

Grigoriadis, Sophie; Wilton, Andrew S; Kurdyak, Paul A; Rhodes, Anne E; VonderPorten, Emily H; Levitt, Anthony; Cheung, Amy; Vigod, Simone N

2017-08-28

Death by suicide during the perinatal period has been understudied in Canada. We examined the epidemiology of and health service use related to suicides during pregnancy and the first postpartum year. In this retrospective, population-based cohort study, we linked health administrative databases with coroner death records (1994-2008) for Ontario, Canada. We compared sociodemographic characteristics, clinical features and health service use in the 30 days and 1 year before death between women who died by suicide perinatally, women who died by suicide outside of the perinatal period and living perinatal women. The perinatal suicide rate was 2.58 per 100 000 live births, with suicide accounting for 51 (5.3%) of 966 perinatal deaths. Most suicides occurred during the final quarter of the first postpartum year, with highest rates in rural and remote regions. Perinatal women were more likely to die from hanging (33.3% [17/51]) or jumping or falling (19.6% [10/51]) than women who died by suicide non-perinatally ( p = 0.04). Only 39.2% (20/51) had mental health contact within the 30 days before death, similar to the rate among those who died by suicide non-perinatally (47.7% [762/1597]; odds ratio [OR] 0.71, 95% confidence interval [CI] 0.40-1.25). Compared with living perinatal women matched by pregnancy or postpartum status at date of suicide, perinatal women who died by suicide had similar likelihood of non-mental health primary care and obstetric care before the index date but had a lower likelihood of pediatric contact (64.5% [20/31] v. 88.4% [137/155] at 30 days; OR 0.24, 95% CI 0.10-0.58). The perinatal suicide rate for Ontario during the period 1994-2008 was comparable to international estimates and represents a substantial component of Canadian perinatal mortality. Given that deaths by suicide occur throughout the perinatal period, all health care providers must be collectively vigilant in assessing risk. © 2017 Canadian Medical Association or its licensors.

Interventions for common perinatal mental disorders in women in low- and middle-income countries: a systematic review and meta-analysis

PubMed Central

Fisher, Jane; Bower, Peter; Luchters, Stanley; Tran, Thach; Yasamy, M Taghi; Saxena, Shekhar; Waheed, Waquas

2013-01-01

Abstract Objective To assess the effectiveness of interventions to improve the mental health of women in the perinatal period and to evaluate any effect on the health, growth and development of their offspring, in low- and middle-income (LAMI) countries. Methods Seven electronic bibliographic databases were systematically searched for papers published up to May 2012 describing controlled trials of interventions designed to improve mental health outcomes in women who were pregnant or had recently given birth. The main outcomes of interest were rates of common perinatal mental disorders (CPMDs), primarily postpartum depression or anxiety; measures of the quality of the mother–infant relationship; and measures of infant or child health, growth and cognitive development. Meta-analysis was conducted to obtain a summary measure of the clinical effectiveness of the interventions. Findings Thirteen trials representing 20 092 participants were identified. In all studies, supervised, non-specialist health and community workers delivered the interventions, which proved more beneficial than routine care for both mothers and children. The pooled effect size for maternal depression was −0.38 (95% confidence interval: −0.56 to −0.21; I2 = 79.9%). Where assessed, benefits to the child included improved mother–infant interaction, better cognitive development and growth, reduced diarrhoeal episodes and increased immunization rates. Conclusion In LAMI countries, the burden of CPMDs can be reduced through mental health interventions delivered by supervised non-specialists. Such interventions benefit both women and their children, but further studies are needed to understand how they can be scaled up in the highly diverse settings that exist in LAMI countries. PMID:23940407

Dual role of astrocytes in perinatal asphyxia injury and neuroprotection.

PubMed

Romero, J; Muñiz, J; Logica Tornatore, T; Holubiec, M; González, J; Barreto, G E; Guelman, L; Lillig, C H; Blanco, E; Capani, F

2014-04-17

Perinatal asphyxia represents an important cause of severe neurological deficits including delayed mental and motor development, epilepsy, major cognitive deficits and blindness. However, at the moment, most of the therapeutic strategies were not well targeted toward the processes that induced the brain injury during perinatal asphyxia. Traditionally, experimental research focused on neurons, whereas astrocytes have been more related with the damage mechanisms of perinatal asphyxia. In this work, we propose to review possible protective as well as deleterious roles of astrocytes in the asphyctic brain with the aim to stimulate further research in this area of perinatal asphyxia still not well studied. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Prediction of perinatal depression from adolescence and before conception (VIHCS): 20-year prospective cohort study.

PubMed

Patton, George C; Romaniuk, Helena; Spry, Elizabeth; Coffey, Carolyn; Olsson, Craig; Doyle, Lex W; Oats, Jeremy; Hearps, Stephen; Carlin, John B; Brown, Stephanie

2015-08-29

Perinatal depression is a neglected global health priority, affecting 10-15% of women in high-income countries and a greater proportion in low-income countries. Outcomes for children include cognitive, behavioural, and emotional difficulties and, in low-income settings, perinatal depression is associated with stunting and physical illness. In the Victorian Intergenerational Health Cohort Study (VIHCS), we aimed to assess the extent to which women with perinatal depressive symptoms had a history of mental health problems before conception. VIHCS is a follow-up study of participants in the Victorian Adolescent Health Cohort Study (VAHCS), which was initiated in August, 1992, in the state of Victoria, Australia. In VAHCS, participants were assessed for health outcomes at nine timepoints (waves) from age 14 years to age 29 years. Depressive symptoms were measured with the Revised Clinical Interview Schedule and the General Health Questionnaire. Enrolment to VIHCS began in September, 2006, during the ninth wave of VAHCS; depressive symptoms at this timepoint were measured with the Composite International Diagnostic Interview. We contacted women every 6 months (from age 29 years to age 35 years) to identify any pregnancies. We assessed perinatal depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) by computer-assisted telephone interview at 32 weeks of gestation, 8 weeks after birth, and 12 months after birth. We defined perinatal depression as an EPDS score of 10 or more. From a stratified random sample of 1000 female participants in VAHCS, we enrolled 384 women with 564 pregnancies. 253 (66%) of these women had a previous history of mental health problems at some point in adolescence or young adulthood. 117 women with a history of mental health problems in both adolescence and young adulthood had 168 pregnancies, and perinatal depressive symptoms were reported for 57 (34%) of these pregnancies, compared with 16 (8%) of 201 pregnancies in 131 women

Maternal perinatal mental health and offspring academic achievement at age 16: the mediating role of childhood executive function.

PubMed

Pearson, Rebecca M; Bornstein, Marc H; Cordero, Miguel; Scerif, Gaia; Mahedy, Liam; Evans, Jonathan; Abioye, Abu; Stein, Alan

2016-04-01

Elucidating risk pathways for under-achieving at school can inform strategies to reduce the number of adolescents leaving school without passing grades in core subjects. Maternal depression can compromise the quality of parental care and is associated with multiple negative child outcomes. However, only a few small studies have investigated the association between perinatal maternal depression and poor academic achievement in adolescence. The pathways to explain the risks are also unclear. Prospective observational data from 5,801 parents and adolescents taking part in a large UK population cohort (Avon-Longitudinal-Study-of-Parents-and-Children) were used to test associations between maternal and paternal depression and anxiety in the perinatal period, executive function (EF) at age 8, and academic achievement at the end of compulsory school at age 16. Adolescents of postnatally depressed mothers were 1.5 times (1.19, 1.94, p = .001) as likely as adolescents of nondepressed mothers to fail to achieve a 'pass' grade in math; antenatal anxiety was also an independent predictor of poor math. Disruption in different components of EF explained small but significant proportions of these associations: attentional control explained 16% (4%, 27%, p < .001) of the association with postnatal depression, and working memory explained 17% (13%, 30%, p = .003) of the association with antenatal anxiety. A similar pattern was seen for language grades, but associations were confounded by maternal education. There was no evidence that paternal factors were independently associated with impaired child EF or adolescent exams. Maternal postnatal depression and antenatal anxiety are risk factors for adolescents underachieving in math. Preventing, identifying, and treating maternal mental health in the perinatal period could, therefore, potentially increase adolescents' academic achievement. Different aspects of EF partially mediated these associations. Further work is needed, but

Depression in perinatally HIV-infected pregnant women compared to non-perinatally HIV-infected and HIV-uninfected pregnant women.

PubMed

Angrand, Ruth C; Sperling, Rhoda; Roccobono, Kinga; Osborne, Lauren M; Jao, Jennifer

2018-05-18

"Depression (as noted in chart by a physician)" was compared between HIV infected pregnant women and controls. Perinatally HIV-infected (PHIV), non-perinatally HIV-infected (NPHIV), and HIV-uninfected (HIV-U) pregnant women were all compared using a logistic regression model. Overall, HIV-infected women had higher rates of depression than HIV-U, with PHIV women demonstrating a clinically and statistically significant increased risk compared to HIV-U women [adjusted OR: 15.9, 95% CI = 1.8-143.8]. Future studies in larger populations are warranted to confirm these findings and further elucidate mental health outcomes of PHIV and NPHIV pregnant women.

Disasters and Perinatal Health: A Systematic Review

PubMed Central

Harville, EW; Xiong, X; Buekens, P

2012-01-01

Background The empirical literature on the effects of disaster on pregnancy and the postpartum period is limited. The objective of this review was to examine the existing evidence on the effect of disasters on perinatal health. Methods A systematic review was conducted by searching electronic databases (MEDLINE, EMBASE, Cinahl, PsycInfo), including literature on disasters and pregnancy outcomes (e.g., preterm birth, low birthweight, congenital anomalies), mental health, and child development. 110 articles were identified, but many published reports were anecdotes or recommendations rather than systematic studies. The final review included 49 peer-reviewed studies that met inclusion criteria. Results Studies addressing the World Trade Center disaster of September 11th and other terrorist attacks, environmental/chemical disasters, and natural disasters such as hurricanes and earthquakes were identified. Disasters of various types may reduce fetal growth in some women, though there does not appear to be an effect on gestational age at birth. Severity of exposure is the major predictor of mental health issues among pregnant and postpartum women. The mother's mental health after a disaster may more strongly influence on child development than any direct effect of disaster-related prenatal stress. Conclusions There is evidence that disaster impacts maternal mental health and some perinatal health outcomes, particular among highly-exposed women. Future research should focus on under-studied outcomes such as spontaneous abortion. Relief workers and clinicians should concentrate on the most exposed women, particularly with respect to mental health. PMID:21375788

Suicide during Perinatal Period: Epidemiology, Risk Factors, and Clinical Correlates

PubMed Central

Orsolini, Laura; Valchera, Alessandro; Vecchiotti, Roberta; Tomasetti, Carmine; Iasevoli, Felice; Fornaro, Michele; De Berardis, Domenico; Perna, Giampaolo; Pompili, Maurizio; Bellantuono, Cesario

2016-01-01

Perinatal period may pose a great challenge for the clinical management and treatment of psychiatric disorders in women. In fact, several mental illnesses can arise during pregnancy and/or following childbirth. Suicide has been considered a relatively rare event during the perinatal period. However, in some mental disorders (i.e., postpartum depression, bipolar disorder, postpartum psychosis, etc.) have been reported a higher risk of suicidal ideation, suicide attempt, or suicide. Therefore, a complete screening of mothers’ mental health should also take into account thoughts of suicide and thoughts about harming infants as well. Clinicians should carefully monitor and early identify related clinical manifestations, potential risk factors, and alarm symptoms related to suicide. The present paper aims at providing a focused review about epidemiological data, risk factors, and an overview about the main clinical correlates associated with the suicidal behavior during the pregnancy and postpartum period. Practical recommendations have been provided as well. PMID:27570512

Suicide during Perinatal Period: Epidemiology, Risk Factors, and Clinical Correlates.

PubMed

Orsolini, Laura; Valchera, Alessandro; Vecchiotti, Roberta; Tomasetti, Carmine; Iasevoli, Felice; Fornaro, Michele; De Berardis, Domenico; Perna, Giampaolo; Pompili, Maurizio; Bellantuono, Cesario

2016-01-01

Perinatal period may pose a great challenge for the clinical management and treatment of psychiatric disorders in women. In fact, several mental illnesses can arise during pregnancy and/or following childbirth. Suicide has been considered a relatively rare event during the perinatal period. However, in some mental disorders (i.e., postpartum depression, bipolar disorder, postpartum psychosis, etc.) have been reported a higher risk of suicidal ideation, suicide attempt, or suicide. Therefore, a complete screening of mothers' mental health should also take into account thoughts of suicide and thoughts about harming infants as well. Clinicians should carefully monitor and early identify related clinical manifestations, potential risk factors, and alarm symptoms related to suicide. The present paper aims at providing a focused review about epidemiological data, risk factors, and an overview about the main clinical correlates associated with the suicidal behavior during the pregnancy and postpartum period. Practical recommendations have been provided as well.

Optimizing the treatment of mood disorders in the perinatal period

PubMed Central

Meltzer-Brody, Samantha; Jones, Ian

2015-01-01

The perinatal period is a time of high risk for women with unipolar and bipolar mood disorders. We discuss treatment considerations for perinatal mood disorders, including unipolar and bipolar depression as well as postpartum psychosis. We further explore the unique issues faced by women and their families across the full trajectory of the perinatal period from preconception planning through pregnancy and following childbirth. Treatment of perinatal mood disorders requires a collaborative care approach between obstetrics practitioners and mental health providers, to ensure that a thoughtful risk : benefit analysis is conducted. It is vital to consider the risks of the underlying illness versus risks of medication exposure during pregnancy or lactation. When considering medication treatment, attention must be paid to prior medication trials that were most efficacious and best tolerated. Lastly, it is important to assess the impact of individual psychosocial stressors and lifestyle factors on treatment response. PMID:26246794

Estimated cost of a health visitor-led protocol for perinatal mental health.

PubMed

Oluboyede, Yemi; Lewis, Anne; Ilott, Irene; Lekka, Chrysanthi

2010-06-01

Anecdotally, protocols, care pathways and clinical guidelines are time consuming to develop and sustain, but there is little research about the actual costs of their development, use and audit.This is a notable gap considering the pervasiveness of such documents that are intended to reduce unacceptable variations in practice by standardising care processes. A case study research design was used to calculate the resource use costs of a protocol for perinatal mental health, part of the core programme for health visitors in a primary care trust in the west of England. The methods were in-depth interviews with the operational lead for the protocol (a health visitor) and documentary analysis. The total estimated cost of staff time over a five-year period (2004 to 2008) was Euro 73,598, comprising Euro 36,162 (49%) for development and Euro 37,436 (51%) for implementation. Although these are best estimates dependent upon retrospective data, they indicate the opportunity cost of staff time for a single protocol in one trust over five years. When new protocols, care pathways or clinical guidelines are proposed, the costs need to be considered and weighed against the benefits of engaging frontline staff in service improvements.

Perinatal Depression – the Fourth Inflammatory Morbidity of Pregnancy? Theory and Literature Review

PubMed Central

Osborne, Lauren M.; Monk, Catherine

2015-01-01

Perinatal depression is one of the leading causes of maternal morbidity and mortality. The biological etiology of this disorder remains in question, despite considerable research into the contributions of hormonal imbalance, the role of monoamines, and dysregulation of the HPA axis. Because inflammation is known to be associated with major depression in men and non-perinatal women as well as with other important morbidities of pregnancy (such as preeclampsia, preterm birth, and gestational diabetes), and because these morbidities may correlate with perinatal depression, inflammation may be a common physiological pathway that can also help explain perinatal depression. In this paper, we review the theoretical background of inflammation in perinatal depression and then review the literature concerning immune and inflammatory factors in the etiology and course of perinatal depression. We close with recommendations for future studies in this still relatively unexplored area. Identification and understanding of a common pathophysiology between other pregnancy morbidities and perinatal depression would link physical and mental well-being, likely leading to better treatment and prevention. PMID:23608136

Depression in the perinatal period: awareness, attitudes and knowledge in the Australian population.

PubMed

Highet, Nicole J; Gemmill, Alan W; Milgrom, Jeannette

2011-03-01

To establish a benchmark of awareness, knowledge and attitudes in Australia in relation to depression and its treatment in the perinatal period, and to identify demographic factors associated with perinatal mental health literacy. A cross-sectional telephone survey (n = 1201) of a randomly selected sample of adults in each State and Territory of Australia, conducted in late 2009. Depression was the most frequently cited general health problem for women after childbirth (43.6% of spontaneous responses), in contrast to previous findings of low awareness of depression generally. A total of 94% of adults believed that postnatal depression requires specialized treatment. Older Australians (55 + years) identified postnatal depression less readily than younger Australians. Although well recognized as a specific mental health issue, as a general health issue antenatal depression had low recognition and was viewed by 52% of respondents as 'normal'. Community beliefs about perinatal rates of depression appeared realistic. Men and women differed in their knowledge and beliefs about the symptoms and causes of postnatal depression. Difficulty in mother-infant bonding was seen as a common sign of postnatal depression, particularly by women. Most commonly, postnatal depression was perceived as having a biological rather than psychosocial etiology (30% of men, 41% of women). Recognition of anxiety in the postnatal period was relatively low, although higher among those with mental health training. Over 80% of Australians believed that all new mothers should be routinely assessed for depression. Awareness of postnatal depression appeared to be at a high level in the community, but both anxiety and antenatal depression were comparatively under-recognized, suggesting there is considerable scope for awareness-raising. Established risk factors for postnatal depression were not coherently recognized. Ongoing tracking of perinatal mental health literacy in Australia is likely to be

Women's intentions of informal and formal help-seeking for mental health problems during the perinatal period: The role of perceived encouragement from the partner.

PubMed

Fonseca, Ana; Canavarro, Maria Cristina

2017-07-01

this study aimed to examine the relationship between women's intentions to seek informal help and to seek professional help and to explore the indirect effects of women's perceived encouragement to seek professional help from their male partner. Moreover, this study aimed to examine if these relationships vary as function of the presence of higher levels of perinatal distress. cross-sectional internet survey. participants were recruited through advertisements published in pamphlets and posted on social media websites (e.g., Facebook) and websites and forums that focused on pregnancy and childbirth. 231 women (pregnant/ had a baby during the last 12 months) completed the survey. participants were questioned about sociodemographic and clinical data and were assessed concerning perinatal distress (Edinburgh Postpartum Depression Scale and Hospital Anxiety and Depression Scale), intentions to seek informal and formal help (General Help-Seeking Questionnaire) and perceived encouragement from the partner to seek professional help. the women reported a significantly higher intention to seek help from their partner than to seek professional help (p < .001). Although women with higher perinatal distress levels presented lower intentions to seek informal help from the male partner (p = .001) and perceived less encouragement from the male partner to seek professional help (p < .001), the presence of perinatal distress did not moderate the relationship between those variables. A significant indirect effect on the relationship between women's intention to seek informal and professional help occurred through the women's perceived encouragement from the male partner to seek professional help. the results of this study highlight the important role of the male partner's encouragement in women's professional help-seeking for mental health problems. awareness campaigns about perinatal distress and about professional treatment benefits may be directed universally to all women in the

Evaluating the quality of perinatal anxiety information available online.

PubMed

Kirby, Paige L; Reynolds, Kristin A; Walker, John R; Furer, Patricia; Pryor, Teaghan A M

2018-06-22

The Internet is an easily accessible source of information for women experiencing anxiety in pregnancy and/or postpartum to use when seeking health information. However, the Internet has several drawbacks, including inaccurate content that may be perceived as being accurate, non-biased, and evidence-based. Prior research indicates that anxiety and postpartum mental health websites have poor quality in terms of describing treatment options. There is a lack of research and knowledge in the area of perinatal anxiety, and an absence of research evaluating perinatal anxiety websites. The purpose of this study was to evaluate the quality of information regarding perinatal anxiety available on the Internet. Websites concerning perinatal anxiety were selected using the Google search engine. Each website was evaluated based on quality of health information, website usability, and readability. The 20 websites included in this study had low to moderate quality scores based on the DISCERN tool. There were no associations found between website order and website quality, or between website readability and website quality. Many websites had high PEMAT scores for the understandability section, which included content, style, and layout of information; however, most did not use visual aids to enhance comprehension. Most websites had low actionability scores, suggesting that information may not be useful in describing what actions may be taken to manage perinatal anxiety. This study highlights the need for high-quality websites concerning perinatal anxiety that are easy to navigate and provide the public with evidence-based information.

Social determinants of mental health: a Finnish nationwide follow-up study on mental disorders.

PubMed

Paananen, Reija; Ristikari, Tiina; Merikukka, Marko; Gissler, Mika

2013-12-01

Most mental disorders start in childhood and adolescence. Risk factors are prenatal and perinatal, genetic as well as environmental and family related. Research evidence is, however, insufficient to explain the life-course development of mental disorders. This study aims to provide evidence on factors affecting mental health in childhood and adolescence. The 1987 Finnish Birth Cohort covers all children born in Finland in 1987 (N=59 476) who were followed up until the age of 21 years. The study covers detailed health, social welfare and sociodemographic data of the cohort members and their parents from Finnish registers. Altogether, 7578 (12.7%) cohort members had had a diagnosed mental disorder. Several prenatal, perinatal and family-related risk factors for mental disorders were found, with sex differences. The main risk factors for mental disorders were having a young mother (OR 1.30 (1.16 to 1.47)), parents' divorce (OR 1.33 (1.26 to 1.41)), death of a parent (OR 1.27 (1.16 to 1.38)), parents' short education (OR 1.23(1.09 to 1.38)), childhood family receiving social assistance (OR 1.61 (1.52 to 1.71)) or having a parent treated at specialised psychiatric care (OR 1.47 (1.39 to 1.55)). Perinatal problem (OR 1.11 (1.01 to 1.22)) and prenatal smoking (OR 1.09 (1.02 to 1.16)) were risk factors for mental disorders, even after controlling for background factors. Elevated risk was seen if the cohort member had only basic education (OR 3.37 (3.14 to 3.62)) or had received social assistance (OR 2.45 (2.30 to 2.60)). Mental disorders had many social risk factors which are interlinked. Although family difficulties increased the risk for mental disorders, they were clearly determined by the cohort member's low education and financial hardship. This study provides evidence for comprehensive preventative and supporting efforts. Families with social adversities and with parental mental health problems should be supported to secure children's development.

Cerebral Dysfunctions Related to Perinatal Organic Damage: Clinical-Neuropathologic Correlations.

ERIC Educational Resources Information Center

Towbin, Abraham

1978-01-01

Recent neuropathology studies identify hypoxia as the main cause of perinatal cerebral damage. Cerebral lesions present at birth, with transition to chronic scar lesions, are correlated to mental retardation, cerebral palsy, epilepsy, and minimal brain dysfunction. Gestation age and severity of hypoxic exposure essentially determine the cerebral…

Approaches to health-care provider education and professional development in perinatal depression: a systematic review.

PubMed

Legere, Laura E; Wallace, Katherine; Bowen, Angela; McQueen, Karen; Montgomery, Phyllis; Evans, Marilyn

2017-07-24

Perinatal depression is the most common mental illness experienced by pregnant and postpartum women, yet it is often under-detected and under-treated. Some researchers suggest this may be partly influenced by a lack of education and professional development on perinatal depression among health-care providers, which can negatively affect care and contribute to stigmatization of women experiencing altered mood. Therefore, the aim of this systematic review is to provide a synthesis of educational and professional development needs and strategies for health-care providers in perinatal depression. A systematic search of the literature was conducted in seven academic health databases using selected keywords. The search was limited to primary studies and reviews published in English between January 2006 and May/June 2015, with a focus on perinatal depression education and professional development for health-care providers. Studies were screened for inclusion by two reviewers and tie-broken by a third. Studies that met inclusion criteria were quality appraised and data extracted. Results from the studies are reported through narrative synthesis. Two thousand one hundred five studies were returned from the search, with 1790 remaining after duplicate removal. Ultimately, 12 studies of moderate and weak quality met inclusion criteria. The studies encompassed quantitative (n = 11) and qualitative (n = 1) designs, none of which were reviews, and addressed educational needs identified by health-care providers (n = 5) and strategies for professional development in perinatal mental health (n = 7). Consistently, providers identified a lack of formal education in perinatal mental health and the need for further professional development. Although the professional development interventions were diverse, the majority focused on promoting identification of perinatal depression and demonstrated modest effectiveness in improving various outcomes. This systematic review reveals a

Relationship in Japan between maternal grandmothers’ perinatal support and their self-esteem

PubMed Central

Iseki, Atsuko; Ohashi, Kazutomo

2014-01-01

This study investigated the influence on their mental well-being of the perinatal support given by Japanese grandmothers. The Rosenberg self-esteem and the Center for Epidemiologic Studies Depression (CES-D) scales were used to assess grandmothers’ mental well-being before and after their daughters’ childbirth. Of 198 grandmothers, 176 (88.9%) supported their daughters and three patterns of perinatal support were observed: grandmothers’ support at the grandparents’ house before childbirth (n = 95) (Satogaeri bunben; Japanese traditional perinatal support), grandmothers’ support at the grandparents’ house after childbirth (n = 53); and grandmothers’ support at the daughters’ house (n = 28). Those who supported their daughters at the grandparents’ house before childbirth – especially the middle-aged (less than 60 years old) – showed significantly lower scores of self-esteem. Scores of CES-D did not significantly change before and after childbirth in either subgroup of grandmothers. It was concluded that grandmothers play an important role in supporting their daughters, and Satogaeri bunben is a typical event in modern Japan. However, Satogaeri bunben is a burden for middle-aged grandmothers, and we need to support them. PMID:23809679

Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies.

PubMed

Ford, Elizabeth; Lee, Suzanne; Shakespeare, Judy; Ayers, Susan

2017-08-01

Up to 20% of women experience anxiety and depression during the perinatal period. In the UK, management of perinatal mental health falls under the remit of GPs. This review aimed at synthesising the available information from qualitative studies on GPs' attitudes, recognition, and management of perinatal anxiety and depression. Meta-synthesis of the available published qualitative evidence on GPs' recognition and management of perinatal anxiety and depression. A systematic search was conducted on Embase, Medline, PsycInfo, Pubmed, Scopus, and Web of Science, and grey literature was searched using Google, Google Scholar, and British Library EThOS. Papers and reports were eligible for inclusion if they reported qualitatively on GPs' diagnosis or treatment of perinatal anxiety or depression. The synthesis was constructed using meta-ethnography. Five themes were established from five eligible papers: labels: diagnosing depression; clinical judgement versus guidelines; care and management; use of medication; and isolation: the role of other professionals. GPs considered perinatal depression to be a psychosocial phenomenon, and were reluctant to label disorders and medicalise distress. GPs relied on their own clinical judgement more than guidelines. They reported helping patients make informed choices about treatment, and inviting them back regularly for GP visits. GPs sometimes felt isolated when dealing with perinatal mental health issues. GPs often do not have timely access to appropriate psychological therapies and use several strategies to mitigate this shortfall. Training must focus on these issues and must be evaluated to consider whether this makes a difference to outcomes for patients. © British Journal of General Practice 2017.

Infertility and Perinatal Loss: When the Bough Breaks

PubMed Central

Byatt, Nancy

2016-01-01

Infertility and perinatal loss are common, and associated with lower quality of life, marital discord, complicated grief, major depressive disorder, anxiety disorders, and posttraumatic stress disorder. Young women, who lack social supports, have experienced recurrent pregnancy loss or a history of trauma and / or preexisting psychiatric illness are at a higher risk of experiencing psychiatric illnesses or symptoms after a perinatal loss or during infertility. It is especially important to detect, assess, and treat depression, anxiety, or other psychiatric symptoms because infertility or perinatal loss may be caused or perpetuated by such symptoms. Screening, psychoeducation, provision of resources and referrals, and an opportunity to discuss their loss and plan for future pregnancies can facilitate addressing mental health concerns that arise. Women at risk of or who are currently experiencing psychiatric symptoms should receive a comprehensive treatment plan that includes the following: (1) proactive clinical monitoring, (2) evidence-based approaches to psychotherapy, and (3) discussion of risks, benefits, and alternatives of medication treatment during preconception and pregnancy. PMID:26847216

Depression Literacy and Awareness of Psychopathological Symptoms During the Perinatal Period.

PubMed

Fonseca, Ana; Silva, Sheila; Canavarro, Maria Cristina

To characterize women's depression literacy during the perinatal period, including their ability to recognize clinically significant symptoms of depression. A quantitative, cross-sectional, survey design. Internet communities and Web sites focused on the topics of pregnancy and motherhood. A total of 194 women during the perinatal period (32.5% pregnant, 67.5% postnatal) completed the survey; 34.0% had clinically significant psychopathological symptoms. Most women were married/cohabiting (82.0%) and employed (71.8%). Women answered self-report questionnaires to assess depression literacy, symptoms of depression, emotional competence, and awareness/recognition of psychopathological symptoms. Women had moderate levels of depression literacy during the perinatal period, with higher literacy levels concerning depression-related characteristics than depression-related treatments. Lower education and lower income were associated with poor depression literacy, whereas prior history of psychiatric problems or treatments was associated with higher levels of depression literacy. An indirect effect through emotional competence in the relationship between depression literacy and awareness/recognition of symptoms was found: women with poor depression literacy tended to have a greater lack of emotional clarity, which negatively affected their symptom awareness and recognition. Our results support the need to improve women's mental health literacy during the perinatal period. Education on mental health topics in the context of a trusting relationship with health professionals may contribute to the promotion of women's depression literacy and emotional competence. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Mindfulness-based Intervention for Perinatal Grief after Stillbirth in Rural India

PubMed Central

Roberts, Lisa R.; Montgomery, Susanne B.

2015-01-01

We explored the concept of using a Mindfulness-based intervention to reduce perinatal grief among Indian women. Data were collected using mixed methods to explore concept acceptability, receptivity, modality, and feasibility of the intervention. The intervention was piloted and evaluated with measures of perinatal grief, psychosocial wellbeing, religious coping, perceived social provision of support, and mindfulness. The intervention was well received and effective in teaching skills to help women deal with high levels of grief and subsequent mental health challenges. To overcome attendance barriers modification is necessary. Partnership with a local nursing school is critical to enhance sustainability of the intervention. PMID:25898268

Governance and mental health: contributions for public policy approach.

PubMed

Díaz-Castro, Lina; Arredondo, Armando; Pelcastre-Villafuerte, Blanca Estela; Hufty, Marc

2017-01-30

To analyze the conceptualization of the term governance on public mental health programs. In this systematic review, we analyzed the scientific literature published in the international scenario during 15 years (from 2000 to 2015). The databases analyzed were: Medline, CINAHL, PsycINFO and PubMed. Governance and mental health were the descriptors. We included relevant articles according to our subject of study and levels of analysis: (i) the concept of governance in mental health; (ii) process and decision spaces; (iii) strategic and pertinent actors who operate in the functioning of the health system, and (iv) social regulations. We excluded letters to the editor, news articles, comments and case reports, incomplete articles and articles whose approach did not include the object of study of this review. We have found five conceptualizations of the term governance on mental health in the area of provision policies and service organization. The agents were both those who offer and those who receive the services: we identified several social norms. The concept of governance in mental health includes standards of quality and attention centered on the patient, and incorporates the consumers of mental healthcare in the decision-making process. Analizar la conceptualización del término gobernanza en las políticas de salud mental. En esta revisión sistemática se analizó literatura científica publicada en el ámbito internacional durante 15 años (de 2000 hasta 2015). Las bases de datos analizadas fueron: Medline, CINAHL, PsycINFO y PubMed. Los descriptores fueron gobernanza y salud mental. Fueron incluidos artículos relevantes de acuerdo a nuestro objeto de estudio y niveles de análisis: (i) concepto de gobernanza en salud mental; (ii) proceso y espacios de decisión; (iii) actores estratégicos y de interés que intervienen en el funcionamiento del sistema de salud, y (iv) normas sociales. Se excluyeron cartas al editor, noticias, comentarios y reporte de caso

Post-traumatic stress disorder in the perinatal period: A concept analysis.

PubMed

Vignato, Julie; Georges, Jane M; Bush, Ruth A; Connelly, Cynthia D

2017-12-01

To report an analysis of the concept of perinatal post-traumatic stress disorder. Prevalence of perinatal post-traumatic stress disorder is rising in the USA, with 9% of the U.S. perinatal population diagnosed with the disorder and an additional 18% being at risk for the condition. Left untreated, adverse maternal-child outcomes result in increased morbidity, mortality and healthcare costs. Concept analysis via Walker and Avant's approach. The databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Academic Search Premier and PsychINFO were searched for articles, written in English, published between 2006-2015, containing the terms perinatal and post-traumatic stress disorder. Perinatal post-traumatic stress disorder owns unique attributes, antecedents and outcomes when compared to post-traumatic stress disorder in other contexts, and may be defined as a disorder arising after a traumatic experience, diagnosed any time from conception to 6 months postpartum, lasting longer than 1 month, leading to specific negative maternal symptoms and poor maternal-infant outcomes. Attributes include a diagnostic time frame (conception to 6 months postpartum), harmful prior or current trauma and specific diagnostic symptomatology defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Antecedents were identified as trauma (perinatal complications and abuse), postpartum depression and previous psychiatric history. Consequences comprised adverse maternal-infant outcomes. Further research on perinatal post-traumatic stress disorder antecedents, attributes and outcomes in ethnically diverse populations may provide clinicians a more comprehensive framework for identifying and treating perinatal post-traumatic stress disorder. Nurses are encouraged to increase their awareness of perinatal post-traumatic stress disorder for early assessment and intervention, and prevention of adverse maternal-infant outcomes. © 2017 John Wiley

Early life programming as a target for prevention of child and adolescent mental disorders

PubMed Central

2014-01-01

This paper concerns future policy development and programs of research for the prevention of mental disorders based on research emerging from fetal and early life programming. The current review offers an overview of findings on pregnancy exposures such as maternal mental health, lifestyle factors, and potential teratogenic and neurotoxic exposures on child outcomes. Outcomes of interest are common child and adolescent mental disorders including hyperactive, behavioral and emotional disorders. This literature suggests that the preconception and perinatal periods offer important opportunities for the prevention of deleterious fetal exposures. As such, the perinatal period is a critical period where future mental health prevention efforts should be focused and prevention models developed. Interventions grounded in evidence-based recommendations for the perinatal period could take the form of public health, universal and more targeted interventions. If successful, such interventions are likely to have lifelong effects on (mental) health. PMID:24559477

Perinatal Support in Substance Abuse: The Requirements of Relationship and Reflection

ERIC Educational Resources Information Center

Bromberg, Stacey R.

2009-01-01

Substance abuse creates enormous risks for the developing relationship between mother and infant. Thus, the perinatal period is a critical aspect of addiction treatment. This article highlights the importance of relationships and the reflective supervision that is crucial in the delivery of integrated infant mental health service for pregnant…

Motor testing at 1 year improves the prediction of motor and mental outcome at 2 years after perinatal hypoxic-ischaemic encephalopathy.

PubMed

van Schie, Petra E M; Becher, Jules G; Dallmeijer, Annet J; Barkhof, Frederik; Van Weissenbruch, Mirjam M; Vermeulen, R Jeroen

2010-01-01

To investigate the predictive value of motor testing at 1 year for motor and mental outcome at 2 years after perinatal hypoxic-ischaemic encephalopathy (HIE) in term neonates. Motor and mental outcome at 2 years was assessed with the Bayley Scales of Infant Development, 2nd edition (BSID-II) in 32 surviving children (20 males, 12 females; mean gestational age 40.2 wk, SD 1.4; mean birthweight 3217g, SD 435) participating in a prospective cohort study of HIE. The predictive value of three motor tests (Alberta Infant Motor Scale [AIMS], BSID-II, and the Neurological Optimality Score [NOS]) at 1 year was analysed, in addition to predictions based on neonatal Sarnat staging and magnetic resonance imaging (MRI). Poor motor test results were defined as an AIMS z-score of <-2, a psychomotor developmental index of the BSID-II of <70, or a NOS of <26. Poor motor and poor mental outcome at 2 years was defined as a psychomotor developmental index or mental developmental index of the BSID-II of <70. Twelve children, all with Sarnat grade II, had a poor motor outcome and 12 children, of whom one had Sarnat grade I, had a poor mental outcome at 2 years. Nine children had cerebral palsy, of whom five had quadriplegia, three had dyskinesia, and one had hemiplegia. Poor motor tests at 1 year increased the probability of a poor motor outcome from 71% (range 92 to 100%), and a poor mental outcome from 59% (range 77 to 100%) in children with Sarnat grade II and abnormal MRI, assessed with the AIMS and BSID-II or NOS respectively. Additional motor testing at 1 year improves the prediction of motor and mental outcome at 2 years in children with Sarnat grade II and abnormal MRI.

Impact of perinatal asphyxia on parental mental health and bonding with the infant: a questionnaire survey of Swiss parents

PubMed Central

Jacobs, Ingo; Gilbert, Leah; Favrod, Céline; Schneider, Juliane; Morisod Harari, Mathilde; Bickle Graz, Myriam

2017-01-01

Objective To compare current mental health symptoms and infant bonding in parents whose infants survived perinatal asphyxia in the last 2 years with control parents and to investigate which sociodemographic, obstetric and neonatal variables correlated with parental mental health and infant bonding in the asphyxia group. Design Cross-sectional questionnaire survey of parents whose children were registered in the Swiss national Asphyxia and Cooling register and of control parents (Post-traumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Mother-to-Infant Bonding Scale). Results The response rate for the asphyxia group was 46.5%. Compared with controls, mothers and fathers in the asphyxia group had a higher frequency of post-traumatic stress disorder (PTSD) symptoms (p<0.001). More mothers (n=28, 56%) had a symptom diagnosis of either full or partial PTSD than controls (n=54, 39%) (p=0.032). Similarly, more fathers (n=31, 51%) had a symptom diagnosis of either partial or full PTSD than controls (n=19, 33%) (p=0.034). Mothers reported poorer bonding with the infant (p=0.043) than controls. Having a trauma in the past was linked to more psychological distress in mothers (r=0.31 (95% CI 0.04 to 0.54)) and fathers (r=0.35 (95% CI 0.05 to 0.59)). For mothers, previous pregnancy was linked to poorer bonding (r=0.41 (95% CI 0.13 to 0.63)). In fathers, therapeutic hypothermia of the infant was related to less frequent PTSD symptoms (r=−0.37 (95% CI −0.61 to −0.06)) and past psychological difficulties (r=0.37 (95% CI 0.07 to 0.60)) to more psychological distress. A lower Apgar score was linked to poorer bonding (r=−0.38 (95% CI −0.64 to −0.05)). Conclusions Parents of infants hospitalised for perinatal asphyxia are more at risk of developing PTSD than control parents. PMID:29637108

Attendance at Mental Health Appointments by Women Who Were Referred During Pregnancy or the Postpartum Period.

PubMed

Albaugh, Avril S; Friedman, Susan Hatters; Yang, Sarah Nagle; Rosenthal, Miriam

2018-01-01

To describe characteristics of women referred to mental health care during pregnancy or the year after giving birth and to identify characteristics associated with attendance at mental health intake visits. Retrospective record review of referral documentation. Women's health practices and perinatal mental health clinics in urban areas. The sample included 647 women during pregnancy or the year after giving birth who were referred for mental health treatment. We reviewed the referral data sent from women's health care providers to perinatal mental health clinics to determine if mental health visits occurred. Fifty percent of the 647 women who accepted perinatal mental health referrals had intake appointments. Women were more likely to participate in an intake appointment if in-home services were offered (p < .01). Those with lower income were also more likely to participate (p < 0.05). Those with histories of perinatal loss and those who self-referred tended to be more likely to participate, although these relationships were statistically nonsignificant. Even among women who accepted referrals to mental health services, only half attended intake appointments. For this group of pregnant women and those in the first year after birth, in-home mental health visits were most likely to result in care engagement, which has important implications for service delivery. Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

A Pilot Study of Heart Rate Variability Biofeedback Therapy in the Treatment of Perinatal Depression on a Specialized Perinatal Psychiatry Inpatient Unit

PubMed Central

Beckham, Jenna; Greene, Tammy B.; Meltzer-Brody, Samantha

2012-01-01

Purpose Heart rate variability biofeedback (HRVB) therapy may be useful in treating the prominent anxiety features of perinatal depression. We investigated the use of this non-pharmacologic therapy among women hospitalized with severe perinatal depression. Methods Three questionnaires, the State Trait Anxiety Inventory (STAI), Warwick Edinburgh Mental Well-Being Scale (WEMWBS), and Linear Analog Self Assessment (LASA), were administered to fifteen women in a specialized inpatient perinatal psychiatry unit. Participants were also contacted by telephone after discharge to assess continued use of HRVB techniques. Results The use of HRVB was associated with an improvement in all three scales. The greatest improvement (−13.867, p<0.001 and −11.533, p<0.001) was among STAI scores. A majority (81.9%, n=9) of women surveyed by telephone also reported continued frequent use at least once per week, and over half (54.6%, n=6) described the use of HRVB techniques as very or extremely beneficial. Conclusions The use of HRVB was associated with statistically significant improvement on all instrument scores, the greatest of which was STAI scores, and most women reported frequent continued use of HRVB techniques after discharge. These results suggest that HRVB may be particularly beneficial in the treatment of the prominent anxiety features of perinatal depression, both in inpatient and outpatient settings. PMID:23179141

Adolescents with perinatally acquired HIV: emerging behavioral and health needs for long-term survivors.

PubMed

Koenig, Linda J; Nesheim, Steven; Abramowitz, Susan

2011-10-01

Because of widespread availability of highly active antiretroviral therapy in the developed world, a large proportion of children with perinatally acquired HIV have survived to adolescence and young adulthood. Although their survival is remarkable, many now experience the long-term effects of HIV infection and its treatment. Further, as these youths have entered adolescence, more is known about the impact of normative developmental transitions on health maintenance behaviors. Although perinatally infected adolescents are healthier than they were a decade or more ago, they are significantly experienced with antiretroviral therapy, with increased virological resistance and other consequences of extended antiretroviral use. Three behavioral health challenges have been documented in the first cohort of long-term survivors: decreased medication adherence, sexual debut and accompanying pregnancy and transmission risk, and mental health problems. These issues are consistent with a developmental press for autonomy, mature sexual relationships and future planning, but must be carefully managed to preserve health. Adolescents with perinatally acquired HIV require coordinated multidisciplinary support services - including adherence support, reproductive health counseling addressing both pregnancy planning and disease transmission, and mental health and educational/vocational planning - so that they can fully benefit from treatment advances. (C) 2011 Lippincott Williams & Wilkins, Inc.

The applicability of the concept of treatment adherence in the context of the Brazilian mental health system.

PubMed

Alvarez, Patricia Elizabeth Sanz de; Rosendo, Ernestina; Alchieri, João Carlos

2016-06-01

To present reflections on the type of research conducted on a treatment adherence among users of Public Mental Health System in Brazil and discuss the applicability of the concept of adherence to treatment in this context. Literature review in SciELO, LILACS, Cochrane Library and PubMed / MEDLINE using the Health Sciences Descriptors (DeCS) treatment, adhesion and "mental health" and the specific vocabulary of the Medical Subject Headings (MeSH) "patient compliance/psychologist" y "mental health". They were included for review the complete texts and theses published between 2007-2012 in Portuguese, English and Spanish. 127 articles were recovered, 32 specifically related to mental health. Eight were excluded for duplicates and after reading the remaining 24 articles were selected for this study 10 conducted in the field of Mental Health in Brazil. No investigations have been identified with focus on adherence to psychosocial treatment offered in public mental health. disregard of the mental health legislation and reinforce the asylum model of assistance. Presentar reflexiones sobre el tipo de investigaciones realizadas en Brasil sobre la adhesión al tratamiento de los usuarios del Sistema Público de Salud Mental y discutir la aplicabilidad del concepto de adhesión al tratamiento en dicho contexto. Revisión bibliográfica en las bases SciELO, LILACS, Biblioteca Cochrane y PubMed/MEDLINE utilizando los descriptores de Ciencias de la Salud (DeCS) adhesión, tratamiento y "salud mental" y el vocabulario específico de Medical Subject Headings (MeSH) "patient compliance/psychologist" y "mental health". Se incluyeron los textos completos y las tesis publicadas entre 2007-2012, en portugués, inglés y español. F1eron recuperados 127 artículos, 32 específicamente de la salud mental. Se excluyeron los 8 duplicados y de los 24 restantes fueron seleccionados para el presente trabajo los 10 realizados en Brasil. No se identificaron enfoques sobre la adhesión al

Untreated perinatal paternal depression: Effects on offspring.

PubMed

Gentile, Salvatore; Fusco, Maria Luigia

2017-06-01

Transition to parenthood represents an important life event which increases vulnerability to psychological disorders. Aim of this article is to analyze all studies which investigated the effects of untreated perinatal paternal depression in offspring. We searched pertinent, peer-reviewed articles published in English (January 1980 to April 2016) on MEDLINE, PsycINFO, and Science.gov. Twenty-three studies met the inclusion criteria. Most of the reviewed studies suffer from methodological limitations, including the small sample, the lack of a structured psychiatric diagnosis, and inclusion bias. Despite such limitations, paternal depression seems to be associated with an increased risk of developmental and behavioural problems and even psychiatric disorders in offspring. In particular, in infants and toddlers such problems vary from increased crying to hyperactivity and conduct problems to psychological and developmental impairment, and poor social outcomes. School-age children of depressed fathers have a doubled risk for suffering from specific psychiatric disorders. Hence, facilitating access to vigorous and evidence based treatments is a public health opportunity for improving the quality of life of depressed parents and their children. Evidences emerging from this review actually suggest that the traditional gender-focused approach to perinatal mood disorders should be completed by a family-centred approach, in order to improve the effectiveness of perinatal mental health programs. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Early Intervention and Perinatal Depression: Is There a Need for Provider Training?

ERIC Educational Resources Information Center

Thomason, Elizabeth; Stacks, Ann M.; McComish, Judith Fry

2010-01-01

An estimated 5-25% of women suffer from perinatal depression (PD). If left untreated, PD can have negative consequences for maternal and child mental health. During pregnancy and the postpartum period, women are in contact with a variety of professionals and paraprofessionals such as public health nurses, early childhood providers and home…

Provider report of the existence of detection and care of perinatal depression: quantitative evidence from public obstetric units in Mexico.

PubMed

Castro, Filipa de; Place, Jean Marie; Allen-Leigh, Betania; Rivera-Rivera, Leonor; Billings, Deborah

2016-08-01

To provide evidence on perinatal mental healthcare in Mexico. Descriptive and bivariate analyses of data from a cross-sectional probabilistic survey of 211 public obstetric units. Over half (64.0%) of units offer mental healthcare; fewer offer perinatal depression (PND) detection (37.1%) and care (40.3%). More units had protocols/guidelines for PND detection and for care, respectively, in Mexico City-Mexico state (76.7%; 78.1%) than in Southern (26.5%; 36.4%), Northern (27.3%; 28.1%) and Central Mexico (50.0%; 52.7%). Protocols and provider training in PND, implementation of brief screening tools and psychosocial interventions delivered by non-clinical personnel are needed.

Perinatal exposure to high-fat diet programs energy balance, metabolism and behavior in adulthood.

PubMed

Sullivan, Elinor L; Smith, M Susan; Grove, Kevin L

2011-01-01

The perinatal environment plays an important role in programming many aspects of physiology and behavior including metabolism, body weight set point, energy balance regulation and predisposition to mental health-related disorders such as anxiety, depression and attention deficit hyperactivity disorder. Maternal health and nutritional status heavily influence the early environment and have a long-term impact on critical central pathways, including the melanocortinergic, serotonergic system and dopaminergic systems. Evidence from a variety of animal models including rodents and nonhuman primates indicates that exposure to maternal high-fat diet (HFD) consumption programs offspring for increased risk of adult obesity. Hyperphagia and increased preference for fatty and sugary foods are implicated as mechanisms for the increased obesity risk. The effects of maternal HFD consumption on energy expenditure are unclear, and future studies need to address the impact of perinatal HFD exposure on this important component of energy balance regulation. Recent evidence from animal models also indicates that maternal HFD consumption increases the risk of offspring developing mental health-related disorders such as anxiety. Potential mechanisms for perinatal HFD programming of neural pathways include circulating factors, such as hormones (leptin, insulin), nutrients (fatty acids, triglycerides and glucose) and inflammatory cytokines. As maternal HFD consumption and obesity are common and rapidly increasing, we speculate that future generations will be at increased risk for both metabolic and mental health disorders. Thus, it is critical that future studies identify therapeutic strategies that are effective at preventing maternal HFD-induced malprogramming. Copyright © 2010 S. Karger AG, Basel.

Reproductive health and lifestyle factors associated with health-related quality of life among perinatally HIV-infected adolescents in Uganda.

PubMed

Mbalinda, Scovia Nalugo; Kiwanuka, Noah; Kaye, Dan K; Eriksson, Lars E

2015-10-21

With increased survival of perinatally HIV - infected adolescents due to antiretroviral therapy (ART), the focus of HIV care has shifted to health-related quality of life (HRQoL) as a measure of disease progression, effects of ART co-morbidity and prognosis. We assessed factors associated with better HRQoL in perinatally HIV -infected adolescents in Uganda by determining the associations between sexual and reproductive health (SRH) or lifestyle experiences on HRQoL. In a cross-sectional study, data on SRH, lifestyle experiences, socio demographic factors, communication with parents on sexuality and satisfaction of SRH services in ART clinics were collected from 614 HIV perinatally infected adolescents aged 10-19 using an interviewer-administered survey questionnaire. HRQoL data were collected using the Medical Outcomes Study HIV Health Survey instrument (MOS-HIV). Factors associated with better HRQoL were analysed using multiple logistic regression. The mean age was 16.2 ± 2.1 years, 362 (58.8 %) were females and 210 (34.2 %) were sexually active. Adolescents on ART were twice likely to present with better physical health (AOR = 2.07, 95 % CI: 1.24-3.46) and four times more likely to present with better mental health (AOR = 3.9, 95 % CI: 2.22-6.92) than those who were not on ART. There were no statistically significant associations between SRH (ever had sex, ever been pregnant, condom use, contraceptive use) or life style factors and physical health or mental health. Those with secondary or tertiary education were more likely to present with a better mental health (AOR = 5.3, 95 % CI: 1.86-15.41) compared those who had attained primary or no education. Participants who desired to have a child in future more likely (AOR 1.7, 95 % CI: 1.05-3.00) to present with a better mental health. Lack of communication with guardians on sexuality (AOR = 0.6, 95 % CI: 0.40-0.89), or dissatisfaction with SRH services (AOR 0.34, 95 % CI: 0.18-0.62) were

New Fathers' Perinatal Depression and Anxiety-Treatment Options: An Integrative Review.

PubMed

O'Brien, Anthony P; McNeil, Karen A; Fletcher, Richard; Conrad, Agatha; Wilson, Amanda J; Jones, Donovan; Chan, Sally W

2017-07-01

More than 10% of fathers experience depression and anxiety during the perinatal period, but paternal perinatal depression (PPND) and anxiety have received less attention than maternal perinatal mental health problems. Few mainstream treatment options are available for men with PPND and anxiety. The aim of this literature review was to summarize the current understanding of PPND and the treatment programs specifically designed for fathers with perinatal depression. Eight electronic databases were searched using a predefined strategy, and reference lists were also hand searched. PPND and anxiety were identified to have a negative impact on family relationships, as well as the health of mothers and children. Evidence suggests a lack of support and tailored treatment options for men having trouble adjusting to the transition to fatherhood. Of the limited options available, cognitive behavioral therapy, group work, and blended delivery programs, including e-support approaches appear to be most effective in helping fathers with perinatal depression and anxiety. The review findings have important implications for the understanding of PPND and anxiety. Future research is needed to address the adoption of father-inclusive and father-specific models of care to encourage fathers' help-seeking behavior. Inclusion of male-specific requirements into support and treatment options can improve the ability of services to engage new fathers. Psychotherapeutic intervention could assist to address the cognitive differences and dissonance for men adjusting to the role of father, including male identity and role expectations.

New Fathers’ Perinatal Depression and Anxiety—Treatment Options: An Integrative Review

PubMed Central

O’Brien, Anthony P.; McNeil, Karen A.; Fletcher, Richard; Conrad, Agatha; Wilson, Amanda J.; Jones, Donovan; Chan, Sally W.

2016-01-01

More than 10% of fathers experience depression and anxiety during the perinatal period, but paternal perinatal depression (PPND) and anxiety have received less attention than maternal perinatal mental health problems. Few mainstream treatment options are available for men with PPND and anxiety. The aim of this literature review was to summarize the current understanding of PPND and the treatment programs specifically designed for fathers with perinatal depression. Eight electronic databases were searched using a predefined strategy, and reference lists were also hand searched. PPND and anxiety were identified to have a negative impact on family relationships, as well as the health of mothers and children. Evidence suggests a lack of support and tailored treatment options for men having trouble adjusting to the transition to fatherhood. Of the limited options available, cognitive behavioral therapy, group work, and blended delivery programs, including e-support approaches appear to be most effective in helping fathers with perinatal depression and anxiety. The review findings have important implications for the understanding of PPND and anxiety. Future research is needed to address the adoption of father-inclusive and father-specific models of care to encourage fathers’ help-seeking behavior. Inclusion of male-specific requirements into support and treatment options can improve the ability of services to engage new fathers. Psychotherapeutic intervention could assist to address the cognitive differences and dissonance for men adjusting to the role of father, including male identity and role expectations. PMID:27694550

Effects of tobacco exposure on perinatal suicidal ideation, depression, and anxiety.

PubMed

Weng, Shu-Chuan; Huang, Jian-Pei; Huang, Ya-Li; Lee, Tony Szu-Hsien; Chen, Yi-Hua

2016-07-22

Previous studies have stressed the importance of tobacco exposure for the mood disorders of depression and anxiety. Although a few studies have focused on perinatal women, none have specifically considered the effects of smoking and secondhand smoke exposure on perinatal suicidal ideation. Thus, this study aimed to investigate the relationships of smoking/secondhand smoke exposure status with suicidal ideation, depression, and anxiety from the first trimester to the first month post partum. This cross-sectional study based on self-reported data was conducted at five hospitals in Taipei, Taiwan from July 2011 to June 2014. The questionnaire inquired about women's pregnancy history, sociodemographic information, and pre-pregnancy smoking and secondhand smoke exposure status, and assessed their suicidal ideation, depression, and anxiety symptoms. Logistic regression models were used for analysis. In the 3867 women in the study, secondhand smoke exposure was positively associated with perinatal depression and suicidal ideation. Compared with women without perinatal secondhand smoke exposure, women exposed to secondhand smoke independently exhibited higher risks for suicidal ideation during the second trimester (odds ratio (OR) = 7.63; 95 % confidence interval (CI) = 3.25-17.93) and third trimester (OR = 4.03; 95 % CI = 1.76-9.23). Women exposed to secondhand smoke had an increased risk of depression, especially those aged 26-35 years (OR = 1.71; 95 % CI = 1.27-2.29). Secondhand smoke exposure also considerably contributes to adverse mental health for women in perinatal periods, especially for the severe outcome of suicidal ideation. Our results strongly support the importance of propagating smoke-free environments to protect the health of perinatal women.

The impact of perinatal stress on the functional maturation of prefronto-cortical synaptic circuits: implications for the pathophysiology of ADHD?

PubMed

Bock, Jörg; Braun, Katharina

2011-01-01

Enriched as well as impoverished or adverse perinatal environment plays an essential role in the development and refinement of neuronal pathways, which are the neural substrate of intellectual capacity and socioemotional competence. Perinatal experience and learning events continuously interact with the adaptive shaping of excitatory, inhibitory, and neuromodulatory synaptic as well as the endocrine stress systems, including the neuronal corticotropin-releasing factor (CRF) pathways. Adverse environments, such as stress and emotional deprivation can not only delay experience-dependent maturation of these pathways, but also induce permanent changes in prefronto-cortical wiring patterns. We assume that such dysfunctional connections are the neuronal basis for the development of psychosocially induced mental disorders during later life. The aim of this review is to focus on the impact of perinatal stress on the neuronal and synaptic reorganization during brain development and possible implications for the etiology and therapy of mental disorders such as ADHD. Copyright © 2011 Elsevier B.V. All rights reserved.

Case-control study of glucocorticoid receptor and corticotrophin-releasing hormone receptor gene variants and risk of perinatal depression.

PubMed

Tan, Ene-Choo; Chua, Tze-Ern; Lee, Theresa M Y; Tan, Hui-San; Ting, Joe L Y; Chen, Helen Y

2015-10-30

Depression during pregnancy or after childbirth is the most frequent perinatal illness affecting women of reproductive age. It could result in unfavourable outcomes for both women and their newborns. The incidence of perinatal depression is higher for those with family history of depression and other mental illness, suggesting the contribution of genetic factors. There is postulation that disruption or fluctuation of reproductive hormones could play a part in women who are sensitive to such changes. This is a case-control study comparing the frequencies of candidate gene variants in patients with perinatal depression with controls. Patients of Chinese descent (N = 725) were recruited from the outpatient clinics of the hospital between 2010 and 2013. Controls were patients who came for postnatal consultations at the obstetrics clinics and scored ≤ 7 on the Edinburgh Postnatal Depression Scale (EPDS) at the postnatal screening programme of the hospital. Cases with confirmed diagnosis of clinical (major) depression related to pregnancy/postpartum were recruited from the hospital's outpatient clinic. Genomic DNA was extracted from saliva samples and genotyped for the polymorphisms of interest. Differences between groups were assessed by chi-square analysis. CRHR1 rs242939 and rs1876828 were not polymorphic in the study population. There was no statistically significant association of perinatal depression for CRHR1 rs242941 and GR rs41423247 (BclI). When all subjects were grouped based on family history of mental illness, there was a statistically significant association of CRHR1 rs242941 with family history regardless of depression status (P = 0.043). There was also a statistically significant difference for GR rs41423247 and regularity of menstrual periods (P < 0.000). Although not statistically significant, women with perinatal depression showed a trend towards higher frequency of self-reported menstrual irregularity. No evidence was found for the

Perinatal grief online.

PubMed

Capitulo, Kathleen Leask

2004-01-01

To describe and interpret the culture of an online perinatal loss group. This qualitative study used ethnography, the study of culture. Methods included participant-observation, review of 447 e-mails, and participants' feedback about the findings. The setting was online in a perinatal loss listserv consisting of mothers and one grandmother who had experienced a perinatal loss through miscarriage, stillbirth, or neonatal death. In this changing group, there were between 82 to 87 participants from North America, Europe, Asia, and Australia. The essence of the culture was Shared Metamorphosis. The Internet connected grieving women who otherwise would likely not have met. Participants shared virtual identities, created a community, and brought meaning to their perpetual losses. Their grief was a process of remembrance and memories, and they used symbols to represent the deceased babies; angels were a commonly discussed symbol. For bereaved mothers "life would never be the same," but joining the community of the perinatal loss listserv meant they would never be alone. The culture of online support can link individuals who are geographically distant but share common issues, in this case a perinatal loss. Professionals can use this study to better understand what women experience after a perinatal loss, and what their role can be in validating and supporting these new "mothers of angels."

NEEDS AND CHALLENGES OF HOME VISITORS CONDUCTING PERINATAL DEPRESSION SCREENING.

PubMed

Doering, Jennifer J; Maletta, Kristyn; Laszewski, Audrey; Wichman, Christina L; Hammel, Jennifer

2017-07-01

This article describes the needs and challenges faced by home visitors, supervisors, and clients when conducting perinatal depression screening. Home visitors (n = 11), supervisors (n = 5), and clients (n = 9) representing rural and urban practice settings in Wisconsin were recruited into three separate focus groups. Themes were identified from the transcribed audio-recorded interviews using content analysis. Results indicate that a trusting relationship was leveraged to facilitate depression screening and referral. Home visitors personalized care to a client's context and to protect confidentiality. Home-visiting practice demanded flexibility and negotiation in decision-making with clients and families. Coordinating access to mental health evaluation in areas of limited access was a common challenge. Participants reported a need for further training on safety management. With adequate training and support, home visitors are well-positioned to promote access to mental health services in vulnerable families to support infant mental health. © 2017 Michigan Association for Infant Mental Health.

Exploring the views and experiences of callers to the PANDA Post and Antenatal Depression Association Australian National Perinatal Depression Helpline: a cross-sectional survey.

PubMed

Biggs, Laura J; Shafiei, Touran; Forster, Della A; Small, Rhonda; McLachlan, Helen L

2015-09-07

Anxiety and depression are common in the perinatal period. Telephone interventions, including telephone peer support and counselling, have been developed to support those experiencing perinatal mental illness. PANDA Post and Antenatal Depression Association provides support to women and men experiencing perinatal mental illness via the Australian National Perinatal Depression Helpline, encompassing both volunteer peer support and professional counselling. This study aimed to explore the experiences of callers to the Helpline. A cross-sectional survey design was used. All new callers from 1(st) May to 30(th) September 2013 were invited to participate. The survey, adapted from a previous survey of PANDA callers, included 23 questions using Likert-type scales, demographic and open-ended questions. Thematic network analysis was undertaken for responses to open-ended questions. 124 responses were received (124/405; 30% response). The majority of callers had called the Helpline regarding themselves (90%), with over one third (33%) of all callers seeking crisis support and help. Ninety-nine per cent of respondents 'agreed' or 'strongly agreed' that staff and/or volunteers understood their concerns, and 97% 'agreed' or 'strongly agreed' that overall PANDA had helped them. Callers described the PANDA service as uniquely tailored to the perinatal period, providing accessible, non-judgemental understanding and support, with a global theme from open-ended comments describing PANDA as 'a safe space to be heard and receive support without judgement'. Recommendations for service changes included increased hours of availability. Callers reported positive experiences of accessing support from the PANDA National Perinatal Depression Helpline. The Helpline was described as an accessible and acceptable telephone support for individuals experiencing perinatal mental illness. Recommendations for changes to the service included an increase in hours of operation to enable greater

Autonomy and social norms in a three factor grief model predicting perinatal grief in India.

PubMed

Roberts, Lisa R; Lee, Jerry W

2014-01-01

Perinatal grief following stillbirth is a significant social and mental health burden. We examined associations among the following latent variables: autonomy, social norms, self-despair, strained coping, and acute grief-among poor, rural women in India who experienced stillbirth. A structural equation model was built and tested using quantitative data from 347 women of reproductive age in Chhattisgarh. Maternal acceptance of traditional social norms worsens self-despair and strained coping, and increases the autonomy granted to women. Greater autonomy increases acute grief. Greater despair and acute grief increase strained coping. Social and cultural factors were found to predict perinatal grief in India.

Trajectories of Perinatal Depressive and Anxiety Symptoms in a Community Cohort.

PubMed

Bayrampour, Hamideh; Tomfohr, Lianne; Tough, Suzanne

2016-11-01

The evidence on trajectories of perinatal depression is mostly based on studies composed of women at high risk for poor mental health. Research on maternal anxiety trajectories is also scarce. Using a large community cohort, the All Our Babies study, in Alberta, Canada, we examined trajectories of perinatal depressive and anxiety symptoms and compared characteristics of women across trajectories. Anxiety and depressive symptoms were measured at the second and third trimesters and at 4 and 12 months postpartum among 1,445 women recruited between May 2008 and December 2010. The state subscale of the Spielberger State-Trait Anxiety Inventory was used to measure anxiety symptoms, and depressive symptoms were measured with the Edinburgh Postnatal Depression Scale. Semiparametric group-based mixed modeling was performed to identify the optimal trajectory shape, number of groups, and proportion of the sample belonging to each trajectory. Model fit was evaluated using the Bayesian information criterion. Multinomial logistic regression analysis was conducted to compare characteristics across the trajectories. Five distinct trajectory groups with constant and variable patterns were identified for both depressive and anxiety symptoms: minimal, mild, antepartum, postpartum, and chronic. Common risk factors of depression and anxiety across groups with elevated symptoms were history of mental health issues (odds ratios [ORs] varied from 1.83 to 7.64), history of abuse/neglect (ORs varied from 1.67 to 8.97), and low social support (ORs varied from 1.64 to 11.37). The magnitude of the influence of the psychosocial risk factors was greater in the chronic group compared to others, suggesting a dose-related relationship. Heterogeneity of anxiety and depressive symptoms highlights the importance of multiple mental health assessments during the perinatal period. The patterns and intensity of postpartum depression differed between community and high-risk samples, underlining the

Adjusting an Available Online Peer Support Platform in a Program to Supplement the Treatment of Perinatal Depression and Anxiety

PubMed Central

Schueller, Stephen M

2016-01-01

Background Perinatal depression and anxiety are common and debilitating conditions. Novel, cost effective services could improve the uptake and the impact of mental health resources among women who suffer from these conditions. E-mental health products are one example of such services. Many publically available e-mental health products exist, but these products lack validation and are not designed to be integrated into existing health care settings. Objective The objective of the study was to present a program to use 7 Cups of Tea (7Cups), an available technological platform that provides online peer (ie, listener) based emotional support, to supplement treatment for women experiencing perinatal depression or anxiety and to summarize patient’s feedback on the resultant program. Methods This study consisted of two stages. First, five clinicians specializing in the treatment of perinatal mood disorders received an overview of 7Cups. They provided feedback on the 7Cups platform and ways it could complement the existing treatment efforts to inform further adjustments. In the second stage, nine women with perinatal depression or anxiety used the platform for a single session and provided feedback. Results In response to clinicians’ feedback, guidelines for referring patients to use 7Cups as a supplement for treatment were created, and a training program for listeners was developed. Patients found the platform usable and useful and their attitudes toward the trained listeners were positive. Overall, patients noted a need for support outside the scheduled therapy time and believed that freely available online emotional support could help meet this need. Most patients were interested in receiving support from first time mothers and those who suffered in the past from perinatal mood disorders. Conclusions The study results highlight the use of 7Cups as a tool to introduce accessible and available support into existing treatment for women who suffer from perinatal mood

Text messaging to support a perinatal collaborative care model for depression: A multi-methods inquiry.

PubMed

Bhat, Amritha; Mao, Johnny; Unützer, Jürgen; Reed, Susan; Unger, Jennifer

Mental health care integrated into obstetric settings improves access to perinatal depression treatments. Digital interactions such as text messaging between patient and provider can further improve access. We describe the use of text messaging within a perinatal Collaborative Care (CC) program, and explore the association of text messaging content with perinatal depression outcomes. We analyzed data from an open treatment trial of perinatal CC in a rural obstetric clinic. Twenty five women with Patient Health Questionnaire-9 score of ≥10 enrolled in CC, and used text messaging to communicate with their Care Manager(CM). We used surveys and focus groups to assessacceptability of text messaging with surveys and focus groups. We calculated the number of text messages exchanged, and analyzed content to understand usage patterns. We explored association between text messaging content and depression outcomes. CMs initiated 85.4% messages, and patients responded to 86.9% messages. CMs used text messaging for appointment reminders, and patients used it to obtain obstetric and parenting information. CMs had concerns about the likelihood of boundary violations. Patients appreciated the asynchronous nature of text messaging. Text messaging is feasible and acceptable within a perinatal CC program. We need further research into the effectiveness of text messaging content, and response protocols. Copyright © 2018 Elsevier Inc. All rights reserved.

Mothers with mental health problems: Contrasting experiences of support within maternity services in the Republic of Ireland.

PubMed

Higgins, Agnes; Tuohy, Teresa; Murphy, Rebecca; Begley, Cecily

2016-05-01

to explore the views and experiences of women with mental health difficulties, in the Republic of Ireland, accessing and receiving care from publicly-funded maternity care services during pregnancy, childbirth and immediate postnatal period in hospital. in total 20 women with a range of mental health problems were recruited. The women had given birth within maternity services with and without specialist perinatal mental health services. a qualitative descriptive design using in-depth face to face interviews was used to explore women׳s experience. Data were analysed using an inductive thematic process. the study offers valuable insights into the maternity care experiences of women with mental health problems, and highlights the deficits and fragmentation of care in maternity units that do not have a specialist mental health service. Even when the women voluntarily disclosed their difficulties, midwives appeared to lack the knowledge and skills to respond sensitively and responsively. there is a need to expand perinatal mental health services in the Republic of Ireland, so that quality service provision is not dependent on geography. In addition, there is a need for education to address the lack of knowledge and understanding of perinatal mental health problems amongst maternity care practitioners. Copyright © 2016 Elsevier Ltd. All rights reserved.

Physical Trauma as an Etiological Agent in Mental Retardation.

ERIC Educational Resources Information Center

Angle, Carol R., Ed.; Bering, Edgar A., Jr., Ed.

The conference on Physical Trauma as a Cause of Mental Retardation dealt with two major areas of etiological concern - postnatal and perinatal trauma. Following two introductory statements on the problem of and issues related to mental retardation (MR) after early trauma to the brain, five papers on the epidemiology of head trauma cover…

Uneven implementation of the National Perinatal Depression Initiative: findings from a survey of Australian women's hospitals.

PubMed

Fisher, Jane; Chatham, Elizabeth; Haseler, Sally; McGaw, Beth; Thompson, Jane

2012-12-01

Australia is a leader in recognising that perinatal mental health problems are prevalent and constitute a significant burden of disease among women. In 2009, the Australian government launched the National Perinatal Depression Initiative (NPDI) to address this. To investigate implementation of Australia's NPDI. Data were collected by a structured online survey assessing: screening for depression and depression risk in women receiving antenatal and postnatal care; staff training about perinatal depression; barriers and enablers to implementing the NPDI recommendations. All Australian members of Women's Healthcare Australasia (WHA) were invited to complete the survey in March 2011. Of 30 Australian WHA members, 14 (46.6%) completed the survey. The sample included a representative distribution of small, medium and large hospitals. All respondents had introduced some NPDI recommendations. Most (80%) reported using the Edinburgh Postnatal Depression Scale (EPDS) to screen for antenatal depression and for risk of developing depression but at varied gestational ages, and with differing cut-off scores for follow-up or referral. Only one assessed depression status postpartum. Responsibility for screening and feedback was predominantly assigned to midwives, most of whom were offered <4 h training. Implementation barriers included insufficient personnel; per-client time requirements; insufficient clarity about screening protocols; difficulties modifying the medical record; few referral options and a lack of training resources. Implementation of the NPDI is uneven among Australian maternity hospitals. Little is known about perinatal mental health screening practices in the private sector and hospitals with <1000 births annually. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

The first antenatal appointment: An exploratory study of the experiences of women with a diagnosis of mental illness.

PubMed

Phillips, Louise; Thomas, Dona

2015-08-01

to explore and gain insight into the expectations and experiences of women with a pre-existing diagnosis of mental illness, of their first booking appointment; to make recommendations for practice development and collaborative partnership working between healthcare professionals. a qualitative design using semi structured interviews and thematic analysis of the data. QSR NVivo 10 software is used to organise the data into themes. the interviews took place either at the women׳s homes, or within the antenatal service with the consent of the woman and relevant practitioners. twelve participants were selected from one antenatal clinic and one perinatal mental health service. the themes identified within the data included the lack of information prior to the initial midwife booking appointment; the perception of too much information at the initial booking appointment and women not being clear about their mental health needs at this time; a general positivity about disclosing mental illness diagnoses; overall positive thoughts about midwives although some midwives appeared less knowledgeable about bipolar disorder, and perceptions about a lack of joined up working between antenatal and perinatal mental health services. it is recommended that GPs receive adequate training in order to equip them with the skills needed to discuss sensitive issues around perinatal mental illness and the impact on pregnancy and childbirth. Women require more information about their booking appointment, and it would be beneficial for their emotional and physical health needs to be assessed at each follow-up antenatal appointment. Midwives need to be facilitated to receive up-to-date knowledge of antenatal and postnatal mental illness and treatments, and the referral process to perinatal mental health services. Copyright © 2015 Elsevier Ltd. All rights reserved.

BEST PRACTICE IN INDIVIDUAL SUPERVISION OF PSYCHOLOGISTS WORKING IN THE FRENCH CAPEDP PREVENTIVE PERINATAL HOME-VISITING PROGRAM: RESULTS OF A DELPHI CONSENSUS PROCESS.

PubMed

Greacen, Tim; Welniarz, Bertrand; Purper-Ouakil, Diane; Wendland, Jaqueline; Dugravier, Romain; Saïas, Thomas; Tereno, Susana; Tubach, Florence; Haddad, Alain; Guedeney, Antoine

2017-03-01

Individual supervision of home-visiting professionals has proved to be a key element for perinatal home-visiting programs. Although studies have been published concerning quality criteria for supervision in North American contexts, little is known about this subject in other national settings. In the context of the CAPEDP program (Compétences parentales et Attachement dans la Petite Enfance: Diminution des risques liés aux troubles de santé mentale et Promotion de la résilience; Parental Skills and Attachment in Early Childhood: Reducing Mental Health Risks and Promoting Resilience), the first randomized controlled perinatal mental health promotion research program to take place in France, this article describes the results of a study using the Delphi consensus method to identify the program supervisors' points of view concerning best practice for the individual supervision of home visitors involved in such programs. The final 18 recommendations could be grouped into four general themes: the organization and setting of supervision sessions; supervisor competencies; relationship between supervisor and supervisee; and supervisor intervention strategies within the supervision process. The quality criteria identified in this perinatal home-visiting program in the French cultural context underline the importance of clinical supervision and not just reflective supervision when working with families with multiple, highly complex needs. © 2017 Michigan Association for Infant Mental Health.

Perinatal asphyxia: CNS development and deficits with delayed onset

PubMed Central

Herrera-Marschitz, Mario; Neira-Pena, Tanya; Rojas-Mancilla, Edgardo; Espina-Marchant, Pablo; Esmar, Daniela; Perez, Ronald; Muñoz, Valentina; Gutierrez-Hernandez, Manuel; Rivera, Benjamin; Simola, Nicola; Bustamante, Diego; Morales, Paola; Gebicke-Haerter, Peter J.

2013-01-01

Perinatal asphyxia constitutes a prototype of obstetric complications occurring when pulmonary oxygenation is delayed or interrupted. The primary insult relates to the duration of the period lacking oxygenation, leading to death if not re-established. Re-oxygenation leads to a secondary insult, related to a cascade of biochemical events required for restoring proper function. Perinatal asphyxia interferes with neonatal development, resulting in long-term deficits associated to mental and neurological diseases with delayed clinical onset, by mechanisms not yet clarified. In the experimental scenario, the effects observed long after perinatal asphyxia have been explained by overexpression of sentinel proteins, such as poly(ADP-ribose) polymerase-1 (PARP-1), competing for NAD+ during re-oxygenation, leading to the idea that sentinel protein inhibition constitutes a suitable therapeutic strategy. Asphyxia induces transcriptional activation of pro-inflammatory factors, in tandem with PARP-1 overactivation, and pharmacologically induced PARP-1 inhibition also down-regulates the expression of proinflammatory cytokines. Nicotinamide has been proposed as a suitable PARP-1 inhibitor. Its effect has been studied in an experimental model of global hypoxia in rats. In that model, the insult is induced by immersing rat fetus into a water bath for various periods of time. Following asphyxia, the pups are delivered, treated, and nursed by surrogate dams, pending further experiments. Nicotinamide rapidly distributes into the brain following systemic administration, reaching steady state concentrations sufficient to inhibit PARP-1 activity for several hours, preventing several of the long-term consequences of perinatal asphyxia, supporting the idea that nicotinamide constitutes a lead for exploring compounds with similar or better pharmacological profiles. PMID:24723845

Intimate partner violence among women with eating disorders during the perinatal period

PubMed Central

Easter, Abigail; Lewis, Rebecca; Howard, Louise M.; Micali, Nadia

2015-01-01

ABSTRACT Objective  Prevalence of intimate partner violence (IPV) during pregnancy is estimated to be 4%–8%. Women with mental health difficulties are at increased risk for IPV during the perinatal period. Prevalence of IPV is high among women with eating disorders (ED); however, prevalence of IPV during the perinatal period among women with ED is unknown. Method  We studied women from a population‐based cohort, the Avon Longitudinal Study of Parents and Children. Prevalence and odds of physical and emotional IPV during and after the perinatal period was investigated among women with lifetime ED, with (n = 174) or without pregnancy shape and weight concern and/or purging behaviors (n = 189), and women with no ED (n = 8723). Results  Women with lifetime ED showed higher prevalence of IPV during and after the perinatal period (physical = 9.6%–14.3% and emotional = 24.1%–28.1%). Lifetime ED was associated with higher odds of physical IPV during the perinatal period (odds ratio: 2.34, 95% confidence interval: 1.11–4.93, p = .03). Lifetime ED with and without pregnancy shape and weight concerns and/or purging was associated with higher odds of IPV after the perinatal period, and higher odds of reporting emotional IPV at all time points. Associations were moderated by partner's response to pregnancy and maternal experience of childhood sexual abuse. Discussion  Mothers with ED and their children may be vulnerable to negative effects due to maternal ED and IPV combined, both of which have been associated with severe and long‐lasting harmful consequences. Partner's response to pregnancy and maternal experience of childhood sexual abuse might contribute to the association between ED and IPV perinatally. © 2015 The Authors. International Journal of Eating Disorders published by Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:727–735) PMID:26032597

A Systematic Review of the Physical, Mental, Social, and Economic Problems of Immigrant Women in the Perinatal Period in Japan.

PubMed

Kita, Sachiko; Minatani, Mariko; Hikita, Naoko; Matsuzaki, Masayo; Shiraishi, Mie; Haruna, Megumi

2015-12-01

The perinatal mortality of immigrants in Japan is higher than that of Japanese women. However, details of the problems of immigrant perinatal women that contribute to worsening of their health are still unknown. This review describes the physical, psychological, social, and economic problems of immigrant women during the perinatal period in Japan. Medline, CINAHL, PsycINFO, and Igaku-Chuo Zasshi were searched and 36 relevant articles were reviewed. The related descriptions were collected and analyzed by using content analysis. The results showed that immigrant perinatal women in Japan experienced the following problems: language barriers, a problematic relationship with a partner, illegal residency, emotional distress, physical distress, adjustment difficulties, lack of utilization of services, social isolation, lack of support, lack of information, low economic status, unsatisfactory health care, and discrimination. These results indicated that multilingual services, strengthening of social and support networks, and political action are necessary to resolve their problems.

Rates and Types of Psychiatric Disorders in Perinatally Human Immunodeficiency Virus-Infected Youth and Seroreverters

ERIC Educational Resources Information Center

Mellins, Claude Ann; Brackis-Cott, Elizabeth; Leu, Cheng-Shiun; Elkington, Katherine S.; Dolezal, Curtis; Wiznia, Andrew; McKay, Mary; Bamji, Mahrukh; Abrams, Elaine J.

2009-01-01

Background: The purpose of this study was to examine 1) the prevalence of psychiatric and substance use disorders in perinatally HIV-infected (HIV+) adolescents and 2) the association between HIV infection and these mental health outcomes by comparing HIV+ youths to HIV exposed but uninfected youths (HIV-) from similar communities. Methods: Data…

Examining the Impact of Trauma-Informed Cognitive Behavioral Therapy on Perinatal Mental Health Outcomes Among Survivors of Intimate Partner Violence (The PATH Study): Protocol for a Feasibility Study

PubMed Central

Parkinson, Sarah; Jackson, Brianna

2018-01-01

Background Intimate partner violence (IPV) is a pervasive public health problem, impacting the health and quality of life of survivors worldwide. The trauma of IPV is associated with a high incidence of mental illness, namely depressive and anxiety disorders, and posttraumatic stress disorder (PTSD). Moreover, literature endorses cognitive behavioral therapy (CBT) interventions as a gold standard for those with symptomatology consistent with anxiety disorders, mood disorders, and PTSD. However, efficacy has not been evaluated among a population of pregnant survivors of IPV. Objective We present the protocol that will be used to explore the efficacy of trauma-informed cognitive behavioral therapy on maternal and child health outcomes for pregnant women with PTSD, depression, or anxiety symptomatology resulting from IPV. A secondary aim will be to test the validity and feasibility of study methodology to support the successful implementation of a full-scale randomized controlled trial. Methods The Promoting Attachment Through Healing (PATH) study will use a mixed-methods approach grounded in an intersectional feminist framework to explore the effectiveness of trauma-informed CBT for pregnant survivors of IPV. Study participants will be recruited through the hospital-based Perinatal Mental Health Clinic (London, Ontario, Canada). A feasibility sample of 20 pregnant women (cohort 1) will be selected to engage in an eight-session antenatal CBT intervention facilitated by the program’s perinatal clinical nurse specialist, with evaluation at baseline, at two months postpartum (intervention and online questionnaire), and at six and twelve months postpartum (online questionnaire only). Concurrently, we will conduct a retrospective audit of 100 medical charts (cohort 2; 50 charts of perinatal women who received CBT and 50 charts of women who did not receive perinatal CBT) from the past five years. The efficacy of the intervention will be based on a reduction of mental

Examining the Impact of Trauma-Informed Cognitive Behavioral Therapy on Perinatal Mental Health Outcomes Among Survivors of Intimate Partner Violence (The PATH Study): Protocol for a Feasibility Study.

PubMed

Jackson, Kimberley T; Parkinson, Sarah; Jackson, Brianna; Mantler, Tara

2018-05-25

Intimate partner violence (IPV) is a pervasive public health problem, impacting the health and quality of life of survivors worldwide. The trauma of IPV is associated with a high incidence of mental illness, namely depressive and anxiety disorders, and posttraumatic stress disorder (PTSD). Moreover, literature endorses cognitive behavioral therapy (CBT) interventions as a gold standard for those with symptomatology consistent with anxiety disorders, mood disorders, and PTSD. However, efficacy has not been evaluated among a population of pregnant survivors of IPV. We present the protocol that will be used to explore the efficacy of trauma-informed cognitive behavioral therapy on maternal and child health outcomes for pregnant women with PTSD, depression, or anxiety symptomatology resulting from IPV. A secondary aim will be to test the validity and feasibility of study methodology to support the successful implementation of a full-scale randomized controlled trial. The Promoting Attachment Through Healing (PATH) study will use a mixed-methods approach grounded in an intersectional feminist framework to explore the effectiveness of trauma-informed CBT for pregnant survivors of IPV. Study participants will be recruited through the hospital-based Perinatal Mental Health Clinic (London, Ontario, Canada). A feasibility sample of 20 pregnant women (cohort 1) will be selected to engage in an eight-session antenatal CBT intervention facilitated by the program's perinatal clinical nurse specialist, with evaluation at baseline, at two months postpartum (intervention and online questionnaire), and at six and twelve months postpartum (online questionnaire only). Concurrently, we will conduct a retrospective audit of 100 medical charts (cohort 2; 50 charts of perinatal women who received CBT and 50 charts of women who did not receive perinatal CBT) from the past five years. The efficacy of the intervention will be based on a reduction of mental illness symptomatology, improved

Understanding and Alleviating Cultural Stressors and Health Disparities in the Perinatal Outcomes of Mexican-American Women

ERIC Educational Resources Information Center

D'Anna-Hernandez, Kimberly; Rivera, Kendra Dyanne

2014-01-01

Women from minority populations, such as Mexican-American women, face unique social and cultural stressors that are different from men and women in the majority population. These differences have important consequences for the physical and mental health of pregnant mothers and contribute to perinatal health inequalities. As the population in the…

Perinatal Brain Injury: Mechanisms, Prevention, and Outcomes.

PubMed

Novak, Christopher M; Ozen, Maide; Burd, Irina

2018-06-01

Perinatal brain injury may lead to long-term morbidity and neurodevelopmental impairment. Improvements in perinatal care have resulted in the survival of more infants with perinatal brain injury. The effects of hypoxia-ischemia, inflammation, and infection during critical periods of development can lead to a common pathway of perinatal brain injury marked by neuronal excitotoxicity, cellular apoptosis, and microglial activation. Various interventions can prevent or improve the outcomes of different types of perinatal brain injury. The objective of this article is to review the mechanisms of perinatal brain injury, approaches to prevention, and outcomes among children with perinatal brain injury. Copyright © 2018 Elsevier Inc. All rights reserved.

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

PubMed Central

Abizadeh, Jasmin; Sanders, Shawn; Swift, Elena

2015-01-01

Abstract Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%–10.5% during pregnancy and 4.4%–10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother–infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum. PMID:26125602

Associations of maternal lifetime trauma and perinatal traumatic stress symptoms with infant cardiorespiratory reactivity to psychological challenge

PubMed Central

Enlow, Michelle Bosquet; Kullowatz, Antje; Staudenmayer, John; Spasojevic, Jelena; Ritz, Thomas; Wright, Rosalind J.

2010-01-01

Objective Trauma influences on perinatal maternal-child interactions may affect the organization of offspring physiological systems involved in health outcomes. This study used a novel advanced system recently adapted for infants to examine associations of maternal lifetime trauma and related psychological symptoms in the perinatal period with infant cardiorespiratory reactivity and behavioral distress in response to a laboratory stressor. Methods Mothers self-reported lifetime exposure to trauma, perinatal traumatic stress, and current symptoms of posttraumatic stress disorder (PTSD) and depression. Heart rate and indices of respiratory volume, timing, and thoraco-abdominal coordination were continuously recorded using a non-invasive respiratory inductance plethysmography device from 23 infants during the Still-Face Paradigm, a videotaped mother-infant dyadic assessment that included baseline, stressor, and recovery phases. Infant behavioral distress during the procedure was also assessed. Results Infants of mothers with low exposure to trauma and perinatal traumatic stress showed expected increases in behavioral distress and cardiorespiratory activation from baseline to stressor and decreases in these parameters from stressor to recovery. Infants of mothers exposed to multiple traumas and with elevated perinatal traumatic stress showed similar patterns of activation from baseline to stressor but failed to show decreases during recovery. These patterns were maintained after controlling for current maternal PTSD and depressive symptoms. Conclusions Maternal lifetime trauma exposure and traumatic stress during the perinatal period were associated with disrupted infant cardiorespiratory regulation and behavioral distress during a stressor protocol. These results support the concept of perinatal programming and its potential role in physical and mental health outcomes. PMID:19553287

[Perinatal tuberculosis].

PubMed

Sáenz-Gómez, Jessica; Karam Bechara, José; Jamaica Balderas, Lourdes

Perinatal tuberculosis is acquired during birth or during the early neonatal period. Although its incidence is unknown, a search was conducted in Medline and 28 cases were found of perinatal tuberculosis reported from 1983 to 2011. Diagnosis of this disease is important due to having nonspecific symptoms that are mistaken for other infectious diseases. The disease has a high mortality rate (60%); therefore, it requires prompt diagnostic suspicion by the medical staff to prevent a fatal outcome. We describe the case of a 3-month-old male whose 29-year-old mother died of septic shock at 15 days of delivery. The infant's condition began within 30 days of age with cough and difficulty breathing with a diagnosis of multiple foci pneumonia. The infant presented respiratory impairment, meriting change of antibiotics twice, without improvement. The autopsy report of the mother revealed peritoneal tuberculosis. PCR was carried out using tracheal aspirate and pleural fluid of the patient, which were positive for Mycobacterium tuberculosis. Perinatal diagnosis of tuberculosis was established. No hepatic granuloma was found. Perinatal infection should be suspected in children with sepsis and/or pneumonia unresponsive to antibiotics. In this care, the history of tuberculosis in the mother should have oriented the diagnosis. Copyright © 2014 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

Participation and retention of youth with perinatal HIV infection in mental health research studies: the IMPAACT P1055 psychiatric comorbidity study.

PubMed

Williams, Paige L; Chernoff, Miriam; Angelidou, Konstantia; Brouwers, Pim; Kacanek, Deborah; Deygoo, Nagamah S; Nachman, Sharon; Gadow, Kenneth D

2013-07-01

Obtaining accurate estimates of mental health problems among youth perinatally infected with HIV (PHIV) helps clinicians develop targeted interventions but requires enrollment and retention of representative youth into research studies. The study design for IMPAACT P1055, a US-based, multisite prospective study of psychiatric symptoms among PHIV youth and uninfected controls aged 6 to 17 years old, is described. Participants were compared with nonparticipants by demographic characteristics and reasons were summarized for study refusal. Adjusted logistic regression models were used to evaluate the association of psychiatric symptoms and other factors with loss to follow-up (LTFU). Among 2281 youth screened between 2005 and 2006 at 29 IMPAACT research sites, 580 (25%) refused to participate, primarily because of time constraints. Among 1162 eligible youth approached, 582 (50%) enrolled (323 PHIV and 259 Control), with higher participation rates for Hispanic youth. Retention at 2 years was significantly higher for PHIV than Controls (84% vs 77%, P = 0.03). In logistic regression models adjusting for sociodemographic characteristics and HIV status, youth with any self-assessed psychiatric condition had higher odds of LTFU compared with those with no disorder (adjusted odds ratio = 1.56, 95% confidence interval: 1.00 to 2.43). Among PHIV youth, those with any psychiatric condition had 3-fold higher odds of LTFU (adjusted odds ratio = 3.11, 95% confidence interval: 1.61 to 6.01). Enrollment and retention of PHIV youth into mental health research studies is challenging for those with psychiatric conditions and may lead to underestimated risks for mental health problems. Creative approaches for engaging HIV-infected youth and their families are required for ensuring representative study populations.

Disadvantaged Neighborhood Influences on Depression and Anxiety in Youth with Perinatally Acquired Human Immunodeficiency Virus: How Life Stressors Matter

ERIC Educational Resources Information Center

Kang, Ezer; Mellins, Claude A.; Dolezal, Curtis; Elkington, Katherine S.; Abrams, Elaine J.

2011-01-01

Children living with perinatal HIV illness (PHIV+) disproportionately reside in disadvantaged neighborhoods and contend with persistent mental health challenges. This study examined the influences of disadvantaged residential neighborhood on anxiety and depression, and potential resources that buffer against internalizing problems when youths were…

Reliability and validity of the Edinburgh Postnatal Depression Scale (EPDS) for detecting perinatal common mental disorders (PCMDs) among women in low-and lower-middle-income countries: a systematic review.

PubMed

Shrestha, Sumitra Devi; Pradhan, Rina; Tran, Thach D; Gualano, Rosa C; Fisher, Jane R W

2016-04-04

The Edinburgh Postnatal Depression Scale (EPDS), originally developed in Britain, is one of the most widely used screening instruments for assessing symptoms of the Perinatal Common Mental Disorders (PCMDs) of depression and anxiety. However, its potential to detect PCMDs in culturally diverse low- and lower-middle income countries (LALMICs) is unclear. This systematic review aimed to appraise formally validated local language versions of the EPDS from these resource-constrained settings. Following the PRISMA protocol, we searched MEDLINE-OVID, CINAHL-Plus and PUBMED to identify studies reporting translation, cultural adaptation and formal validation of the EPDS to detect PCMDs among women in LALMICs. The quality of the studies meeting inclusion criteria was assessed using standard criteria and a new process-based criteria; which was developed specifically for this study. We identified 1281 records among which 16 met inclusion criteria; three further papers were identified by hand-searching reference lists. The publications reported findings from 12 LALMICs in 14 native languages. Most of these local language versions of the EPDS (LLV-EPDS) had lower precision for identifying true cases of PCMDs among women in the general perinatal population compared to the original English version. Only one study met all criteria for culturally sensitive translation, the others had not established the comprehensibility of the local version amongst representative groups of women in pre-testing. Many studies tested the LLV-EPDS only amongst convenience samples recruited at single health facilities. Diagnostic interviews for confirmation of mental disorders could have been influenced by the mental health professionals' lack of blinding to the initial screening results. Additionally, even when diagnostic-interviews were carried out in the local language, questions might not have been understood as most studies followed standard diagnostic protocol which had not been culturally

Countrywide analysis of perinatal outcome.

PubMed

Stembera, Z; Kravka, A; Mandys, F

1988-01-01

The computer laboratory of the Research Institute for the Care of Mother and Child in Prague performs annually a countrywide analysis of perinatal outcome in order to obtain a background for the preparation of the optimal strategy for improving perinatal care in CSR in the future. The total as well as weight specific perinatal mortality rate further sub-divided into early neonatal death rate and late fetal death rate and differentiated according to the birthweight, was correlated with the incidence of different factors influencing the perinatal mortality rate both countrywide and for each of the eight provinces of CSR. This way a correlation was found between some of the mentioned perinatal outcomes and e.g. instrumental equipment of obstetrical departments and neonatal intensive care units, frequency of caesarean sections, or transport of LBW newborns in incubators or "in utero" etc. The results of this analysis have proved that there still remain in some provinces opportunity for further decrease in perinatal mortality due to the incomplete observance of the two intervention strategies "Risk approach" and "New technology" which were introduced in the whole country during the last 10 years.

[Can implementation of intensified perinatal survey be effective in improving the quality of perinatal care?].

PubMed

Troszyński, Michał

2010-01-01

Intensive scientific research and rapid technical progress have influenced the rapid fall in term newborn mortality. At the same time new problems have arisen such as saving the lives of infants with low and very low birth weight. Solving these problems needs reorganization of perinatal care, better equipment, especially in reference units and in outpatient clinics, as well as more intensive staff training. to obtain information whether implementation of intensified perinatal survey of fetus and newborn mortality can improve the quality of perinatal care in Poland. Implementation of the survey based on Central Statistics Office (GUS) data, Ministry of Health MZ-29 section X Document and the author's own studies. In the year 2008 newborn with birth weight less than 2500 g, constituted 6,06% liveborn infants, newborn weighing from 1000 to 2499 g - 5%, those with weight from 500 to 999 g - 0.51% of all live born infants. These figures differ according to voivodeship. The intensive survey concerning birth weight and perinatal mortality indeces in voivodeshipPoland, as well as in individual voivodeships, showed differences between data from the Central Statistics Office and data from the Ministry of Health MZ-29 document. This may be due to different methods of registrating newborn deaths eg. newborns transfered in the first weekoflife from the maternity ward to intensive care neonatal ward or to other specialistic departaments. Another reason for the difference may be discharge of the newborn data according to the place of birth or the mother's place of permanent domicile registration. This causes disturbances in flow of infomation resulting in ineffective analysis of perinatal mortality and of perinatal care evaluation. In the ongoing analysis it was found that in Poland stillbirths occur twice as often as perinatal deaths (4.3 per thousands) stillbirths and 2.15 per thousands perinatal deaths), with significant differences between voivodeships. This makes it

Prevalence of and risk factors for substance use among perinatally human immunodeficiency virus-infected and perinatally exposed but uninfected youth.

PubMed

Alperen, Julie; Brummel, Sean; Tassiopoulos, Katherine; Mellins, Claude A; Kacanek, Deborah; Smith, Renee; Seage, George R; Moscicki, Anna-Barbara

2014-03-01

This study examined risk factors associated with recent substance use (SU) among perinatally human immunodeficiency virus (HIV)-infected (PHIV+) and perinatally exposed, uninfected (PHEU) youth and compared SU lifetime prevalence with the general population of United States (U.S.) adolescents. We conducted cross-sectional and longitudinal analyses of 511 PHIV+ and PHEU youth (mean age at study entry, 13.2 years; 51% female; 69% PHIV+; and 72% African-American) enrolled in a U.S. multisite prospective cohort study between 2007 and 2009. Substance use data were collected by audio computer-assisted self-interview. Youth Risk Behavior Surveillance System and Monitoring the Future data were used to compare SU lifetime prevalence with U.S. samples. Perinatal HIV infection was not a statistically significant risk factor for alcohol or marijuana use. Risk factors for alcohol use among PHIV+ youth included higher severity of emotional and conduct problems and alcohol and marijuana use in the home by the caregiver or others. Risk factors for marijuana use among PHIV+ youth included marijuana use in the home, higher severity of conduct problems, and stressful life events. Similar SU risk factors among PHEU youth included SU in the home and higher severity of conduct and emotional problems. Overall lifetime prevalence of SU by age was similar to that in national surveys. Although SU lifetime prevalence and risk factors for PHIV+ and PHEU adolescents were similar to national norms, the negative consequences are potentially greater for PHIV+ youth. Prevention efforts should begin before SU initiation and address the family and social environment and youth mental health status. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Pre- and Postnatal Influences on Preschool Mental Health: A Large-Scale Cohort Study

ERIC Educational Resources Information Center

Robinson, Monique; Oddy, Wendy H.; Li, Jianghong; Kendall, Garth E.; de Klerk, Nicholas H.; Silburn, Sven R.; Zubrick, Stephen R.; Newnham, John P.; Stanley, Fiona J.; Mattes, Eugen

2008-01-01

Background: Methodological challenges such as confounding have made the study of the early determinants of mental health morbidity problematic. This study aims to address these challenges in investigating antenatal, perinatal and postnatal risk factors for the development of mental health problems in pre-school children in a cohort of Western…

eHealth as the Next-Generation Perinatal Care: An Overview of the Literature.

PubMed

van den Heuvel, Josephus Fm; Groenhof, T Katrien; Veerbeek, Jan Hw; van Solinge, Wouter W; Lely, A Titia; Franx, Arie; Bekker, Mireille N

2018-06-05

Unrestricted by time and place, electronic health (eHealth) provides solutions for patient empowerment and value-based health care. Women in the reproductive age are particularly frequent users of internet, social media, and smartphone apps. Therefore, the pregnant patient seems to be a prime candidate for eHealth-supported health care with telemedicine for fetal and maternal conditions. This study aims to review the current literature on eHealth developments in pregnancy to assess this new generation of perinatal care. We conducted a systematic literature search of studies on eHealth technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care were included. Given the heterogeneity in study methods, used technologies, and outcome measurements, results were analyzed and presented in a narrative overview of the literature. The literature search provided 71 studies of interest. These studies were categorized in 6 domains: information and eHealth use, lifestyle (gestational weight gain, exercise, and smoking cessation), gestational diabetes, mental health, low- and middle-income countries, and telemonitoring and teleconsulting. Most studies in gestational diabetes and mental health show that eHealth applications are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression, and Web-based cognitive behavioral therapy. Apps and exercise programs show a direction toward less gestational weight gain, increase in step count, and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high-risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable

[Impact of perinatal mortality in multiple pregnancies over total perinatal mortality in a hospital in Monterrey, Nuevo León].

PubMed

Hernández-Herrera, Ricardo Jorge; Ramírez-Sánchez, Luis Fernando

2010-07-01

The incidence of multiple pregnancies has increased on the last decade resulting in a rise of premature and underweight newborns infants, with increase of the perinatal morbidity and mortality. To determine the impact of perinatal mortality of multiple pregnancies in the total perinatal mortality. perinatal mortality rate of multiple pregnancies treated in the Unidad Médica de Alta Especialidad No. 23, Monterrey, Nuevo León (Mexico) were analized, from 2002 to 2008. The prevalence of multiple pregnancies, the rate of premature births, the incidence of low-birth weight products and perinatal mortality was estimated. The difference between overall mortality and multiple pregnancy rate was measured by chi2. Of the 144,114 births, there were 1076 (0.8%) fetal deaths and 1,617 (1.10%) neonatal deaths. There were 110 high-order fetal pregnancies (more than three fetuses): 92 triplets, 14 quadruplets, 3 quintuplets and 1 sextuplet, producing a total of 353 newborns. Multiple pregnancies represent 2.8% (59/2093) of the total perinatal mortality (p = 0.3). 79.9% (1674/2093) of the total perinatal mortality were newborns weighing less than 2500 g. In the group of multiple pregnancies, all perinatal deaths occurred in products weighing less than 2500 g. The perinatal mortality of multiple pregnancies does not impact significantly overall perinatal mortality.

Qualitative insights into women's personal experiences of perinatal depression and anxiety.

PubMed

Highet, Nicole; Stevenson, Amanda L; Purtell, Carol; Coo, Soledad

2014-09-01

Symptoms of perinatal depression and anxiety are usually described and understood from a nosological perspective. This research sought to gain insight into women's lived experience of postnatal depression and anxiety, the factors that contribute to these symptoms and the context in which they develop. Face to face and telephone interviews were conducted with 28 women from metropolitan and rural areas across Australia, who had experienced postnatal depression and/or anxiety within the last five years. Analysis was conducted from a grounded theory perspective. Particular symptoms of anxiety and depression develop in the context of the numerous changes inherent to the transition to motherhood and contribute to a common experience of frustration and loss. Symptoms were also associated with feelings of dissatisfaction with the pregnancy and motherhood experience. The findings provide useful insights into women's experiences of mental health symptoms during the perinatal period, how these symptoms present and the factors involved in their development and maintenance. The need to consider women's perspectives to develop resources and health promotions strategies, as well as within the context of relationships with health professionals is highlighted. The study emphasizes the need for greater, more accurate information surrounding perinatal depression and the need to increase the profile and awareness of anxiety disorders. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

[Childbirth pain, perinatal dissociation and perinatal distress as predictors of posttraumatic stress symptoms].

PubMed

Boudou, M; Séjourné, N; Chabrol, H

2007-11-01

This prospective, longitudinal study investigated the contributive role of childbirth pain, perinatal distress and perinatal dissociation to the development of PTSD symptoms following childbirth. One hundred and seventeen women participated at the study. The first day after delivery they completed a questionnaire to evaluate pain, the peritraumatic distress inventory (PDI) and the peritraumatic dissociative experience questionnaire (PDEQ). Six weeks after birth, they completed the impact of event scale-revised (IES-R) to measure posttraumatic stress symptoms and the Edinburgh Postnatal Depression Scale (EPDS) to assess maternal depression. A multiple regression analysis revealed that only both components of perinatal distress, life-threat perception and dysphoric emotions were significant predictors of posttraumatic stress symptoms. In another multiple regression analysis predicting dysphoric emotions, affective dimension of pain was the only significant predictor. Perinatal distress was the best predictor of posttraumatic stress symptoms. Dysphoric emotions were associated with affective dimension of pain, suggesting that women distressed by the childbirth pain would have higher risk to develop posttraumatic stress symptoms.

Perinatal Depression and Associated Factors among Mothers in Southern Ethiopia: Evidence from Arba Minch Zuria Health and Demographic Surveillance Site.

PubMed

Gebremichael, Gebrekiros; Yihune, Manaye; Ajema, Dessalegn; Haftu, Desta; Gedamu, Genet

2018-01-01

Background. Perinatal depression is a serious mental health problem that can negatively affect the lives of women and children. The adverse consequences of perinatal depression in high-income countries also occur in low-income countries. Objective. To assess the perinatal depression and associated factors among mothers in Southern Ethiopia. Methods. A community based cross-sectional study was conducted among selected 728 study participants in Arba Minch Zuria HDSS. A pretested questionnaire was used to collect the data. Data were analyzed using STATA version 12 software. Descriptive statistical methods were used to summarize the characteristics of the mothers. Bivariate and multivariable logistic regression was used for analysis. Results. The prevalence of perinatal depression among the study period was 26.7%. In the final multivariable logistic regression, monthly income AOR (95% C.I): 4.2 (1.9, 9.3), parity [AOR (95% C.I): 0.14 (0.03, 0.65)], pregnancy complications AOR (95% C.I): 5 (2.5, 10.4), husband smoking status [AOR (95% C.I): 4.12 (1.6, 10.6)], history of previous depression AOR (95% C.I): 2.7 (1.54, 4.8), and family history of psychiatric disorders were the independent factors associated with perinatal depression. Conclusion. The study showed a high prevalence of perinatal depression among pregnant mothers and mothers who have less than a one-year-old child.

Perinatal Bereavement: A Principle-based Concept Analysis

PubMed Central

FENSTERMACHER, Kimberly; HUPCEY, Judith E.

2013-01-01

Aim This paper is a report of an analysis of the concept of perinatal bereavement. Background The concept of perinatal bereavement emerged in the scientific literature during the 1970s. Perinatal bereavement is a practice based concept, although it is not well defined in the scientific literature and is often intermingled with the concepts of mourning and grief. Design Concept Analysis. Data Sources Using the term ‘perinatal bereavement’ and limits of only English and human, Pub Med and CINAHL were searched to yield 278 available references dating from 1974 – 2011. Articles specific to the experience of perinatal bereavement were reviewed. The final data set was 143 articles. Review Methods The methods of principle-based concept analysis were used. Results reveal conceptual components (antecedents, attributes and outcomes) which are delineated to create a theoretical definition of perinatal bereavement. Results The concept is epistemologically immature, with few explicit definitions to describe the phenomenon. Inconsistency in conceptual meaning threatens the construct validity of measurement tools for perinatal bereavement and contributes to incongruent theoretical definitions. This has implications for both nursing science (how the concept is studied and theoretically integrated) and clinical practice (timing and delivery of support interventions). Conclusions Perinatal bereavement is a multifaceted global phenomenon that follows perinatal loss. Lack of conceptual clarity and lack of a clearly articulated conceptual definition impede the synthesis and translation of research findings into practice. A theoretical definition of perinatal bereavement is offered as a platform for researchers to advance the concept through research and theory development. PMID:23458030

Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review.

PubMed

Ford, Elizabeth; Shakespeare, Judy; Elias, Fatin; Ayers, Susan

2017-02-01

Perinatal anxiety and depression are widespread, with up to 20% of women affected during pregnancy and after birth. In the UK, management of perinatal mental health falls under the remit of general practitioners (GPs). We reviewed the literature on GPs' routine recognition, diagnosis and management of anxiety and depression in the perinatal period. A systematic search of Embase, Medline, PsycInfo, Pubmed, Scopus and Web of Science was conducted. Studies were eligible if they reported quantitative measures of GPs' or Family Physicians' assessment, recognition and management of anxiety or depression in pregnancy or post-partum. Thirteen papers, reporting 10 studies, were identified from the United States, Australia, UK, Netherlands and Canada. All reported on depression; two included anxiety disorders. Reported awareness and ability to diagnose perinatal depression among GPs was high. GPs knew about and used screening tools in the UK but less so in US settings. Antidepressants were the first line of treatment, with various SSRIs considered safest. Counseling by GPs and referrals to specialists were common in the post-natal period, less so in pregnancy. Treatment choices were determined by resources, attitudes, knowledge and training. Data on GPs' awareness and management of perinatal depression were sparse and unlikely to be generalizable. Future directions for research are proposed; such as exploring the management of anxiety disorders which are largely missing from the literature, and understanding more about barriers to disclosure and recognition in primary care. More standardized training could help to improve recognition and management practices. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Bilingual Glossary of Professional Mental Health Terms = Glosario Bilingue de Terminos Profesionales de Salud Mental.

ERIC Educational Resources Information Center

Cherry, Ralph, Comp.

Designed to acquaint social workers and other professionals in the mental health field with the basic terms necessary for professional discussions, paper presentations, and international correspondence, the English/Spanish-Spanish/English glossary lists 130 selected mental health terms. The glossary includes two sections: English to Spanish and…

Perinatal Mortality in the United States, 1950-81.

ERIC Educational Resources Information Center

Powell-Griner, Eve

1986-01-01

This report describes long-term trends in perinatal mortality in the United States in three basic parts: development of perinatal mortality measures, components of fetal and infant mortality, and trends and differentials in perinatal mortality. Perinatal deaths refer to the sum of spontaneous fetal deaths occurring after 20 weeks gestation plus…

Impact of perinatal somatic and common mental disorder symptoms on functioning in Ethiopian women: The P-MaMiE population-based cohort study

PubMed Central

Senturk, Vesile; Hanlon, Charlotte; Medhin, Girmay; Dewey, Michael; Araya, Mesfin; Alem, Atalay; Prince, Martin; Stewart, Robert

2012-01-01

Background Little is known of the relationship between perinatal somatic and common mental disorder (CMD) symptoms and impaired functioning in women from settings where the burden of undernutrition and infectious disease morbidity is high. Methods A population-based sample of 1065 women from Butajira, Ethiopia, was recruited in pregnancy (86.4% of those eligible) and reassessed two months postnatal (954 with singleton, live infants). At both time-points, women were administered a modified version of the Patient Health Questionnaire-15 and the Self-Reporting Questionnaire (locally-validated) to assess somatic and CMD symptoms, respectively. Negative binomial regression was used to investigate associations of CMD and somatic symptoms with functional impairment (World Health Organisation Disability Assessment Scale, version-II), after adjusting for maternal anthropometric measures, physical ill-health and sociodemographic factors. Results In pregnancy, somatic and CMD symptoms were independently associated with worse maternal functional impairment after adjustment for confounders (WHODAS-II score multiplied by 1.09 (95%CI 1.06, 1.13) and 1.11 (95%CI 1.08, 1.14) respectively for each additional symptom). In the postnatal period, the size of association between somatic symptoms and functional impairment was diminished, but the association with CMD symptoms was virtually unchanged (multiplier value 1.04 (95%CI 1.00, 1.09) and 1.11 (95%CI 1.07, 1.16) respectively). Limitations Use of largely self-report measures. Conclusions Somatic and CMD symptoms were independently associated with functional impairment in both pregnancy and the postnatal period, with CMD symptoms showing a stronger and more consistent association. This emphasises the public health relevance of both CMD and somatic symptoms in the perinatal period. PMID:22196052

Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence

PubMed Central

Munk-Olsen, T; Maegbaek, M L; Johannsen, B M; Liu, X; Howard, L M; di Florio, A; Bergink, V; Meltzer-Brody, S

2016-01-01

Perinatal psychiatric episodes comprise various disorders and symptom severity, which are diagnosed and treated in multiple treatment settings. To date, no studies have quantified the incidence and prevalence of perinatal psychiatric episodes treated in primary and secondary care, which we aimed to do in the present study. We designed a descriptive prospective study and included information from Danish population registers to study first-time ever and recurrent psychiatric episodes during the perinatal period, including treatment at psychiatric facilities and general practitioners (GPs). This was done for all women who had records of one or more singleton births from 1998 until 2012. In total, we had information on 822 439 children born to 491 242 unique mothers. Results showed first-time psychiatric episodes treated at inpatient facilities were rare during pregnancy, but increased significantly shortly following childbirth (0.02 vs 0.25 per 1000 births). In comparison, first-time psychiatric episodes treated at outpatient facilities were more common, and showed little variation across pregnancy and postpartum. For every single birth resulting in postpartum episodes treated at inpatient psychiatric facilities, 2.5 births were followed by an episode treated at outpatient psychiatric facility and 12 births by GP-provided pharmacological treatment. We interpret our results the following way: treated severe and moderate psychiatric disorders have different risk patterns in relation to pregnancy and childbirth, which suggests differences in the underlying etiology. We further speculate varying treatment incidence and prevalence in pregnancy vs postpartum may indicate that the current Diagnostic and Statistical Manual of Mental Disorders-5 peripartum specifier not adequately describes at-risk periods across moderate and severe perinatal psychiatric episodes. PMID:27754485

The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands.

PubMed

van Diem, Mariet Th; Timmer, Albertus; Bergman, Klasien A; Bouman, Katelijne; van Egmond, Nico; Stant, Dennis A; Ulkeman, Lida H M; Veen, Wenda B; Erwich, Jan Jaap H M

2012-07-09

Perinatal (mortality) audit can be considered to be a way to improve the careprocess for all pregnant women and their newborns by creating an opportunity to learn from unwanted events in the care process. In unit-based perinatal audit, the caregivers involved in cases that result in mortality are usually part of the audit group. This makes such an audit a delicate matter. The purpose of this study was to implement unit-based perinatal mortality audit in all 15 perinatal cooperation units in the northern region of the Netherlands between September 2007 and March 2010. These units consist of hospital-based and independent community-based perinatal caregivers. The implementation strategy encompassed an information plan, an organization plan, and a training plan. The main outcomes are the number of participating perinatal cooperation units at the end of the project, the identified substandard factors (SSF), the actions to improve care, and the opinions of the participants. The perinatal mortality audit was implemented in all 15 perinatal cooperation units. 677 different caregivers analyzed 112 cases of perinatal mortality and identified 163 substandard factors. In 31% of cases the guidelines were not followed and in 23% care was not according to normal practice. In 28% of cases, the documentation was not in order, while in 13% of cases the communication between caregivers was insufficient. 442 actions to improve care were reported for 'external cooperation' (15%), 'internal cooperation' (17%), 'practice organization' (26%), 'training and education' (10%), and 'medical performance' (27%). Valued aspects of the audit meetings were: the multidisciplinary character (13%), the collective and non-judgmental search for substandard factors (21%), the perception of safety (13%), the motivation to reflect on one's own professional performance (5%), and the inherent postgraduate education (10%). Following our implementation strategy, the perinatal mortality audit has been

Perinatal Complications and Aging Indicators by Midlife

PubMed Central

Caspi, Avshalom; Ambler, Antony; Belsky, Daniel W.; Chapple, Simon; Cohen, Harvey Jay; Israel, Salomon; Poulton, Richie; Ramrakha, Sandhya; Rivera, Christine D.; Sugden, Karen; Williams, Benjamin; Wolke, Dieter; Moffitt, Terrie E.

2014-01-01

BACKGROUND: Perinatal complications predict increased risk for morbidity and early mortality. Evidence of perinatal programming of adult mortality raises the question of what mechanisms embed this long-term effect. We tested a hypothesis related to the theory of developmental origins of health and disease: that perinatal complications assessed at birth predict indicators of accelerated aging by midlife. METHODS: Perinatal complications, including both maternal and neonatal complications, were assessed in the Dunedin Multidisciplinary Health and Development Study cohort (N = 1037), a 38-year, prospective longitudinal study of a representative birth cohort. Two aging indicators were assessed at age 38 years, objectively by leukocyte telomere length (TL) and subjectively by perceived facial age. RESULTS: Perinatal complications predicted both leukocyte TL (β = −0.101; 95% confidence interval, −0.169 to −0.033; P = .004) and perceived age (β = 0.097; 95% confidence interval, 0.029 to 0.165; P = .005) by midlife. We repeated analyses with controls for measures of family history and social risk that could predispose to perinatal complications and accelerated aging, and for measures of poor health taken in between birth and the age-38 follow-up. These covariates attenuated, but did not fully explain the associations observed between perinatal complications and aging indicators. CONCLUSIONS: Our findings provide support for early-life developmental programming by linking newborns’ perinatal complications to accelerated aging at midlife. We observed indications of accelerated aging “inside,” as measured by leukocyte TL, an indicator of cellular aging, and “outside,” as measured by perceived age, an indicator of declining tissue integrity. A better understanding of mechanisms underlying perinatal programming of adult aging is needed. PMID:25349321

Cultural processes in psychotherapy for perinatal loss: Breaking the cultural taboo against perinatal grief.

PubMed

Markin, Rayna D; Zilcha-Mano, Sigal

2018-03-01

This paper argues that there is a cultural taboo against the public recognition and expression of perinatal grief that hinders parents' ability to mourn and their psychological adjustment following a loss. It is proposed that this cultural taboo is recreated within the therapy relationship, as feelings of grief over a perinatal loss are minimized or avoided by the therapist and parent or patient. Importantly, it is suggested that if these cultural dynamics are recognized within the therapy relationship, then psychotherapy has the immense opportunity to break the taboo by validating the parent's loss as real and helping the parent to mourn within an empathic and affect-regulating relationship. Specifically, it is suggested that therapists break the cultural taboo against perinatal grief and help parents to mourn through: acknowledging and not pathologizing perinatal grief reactions, considering intrapsychic and cultural factors that impact a parent's response to loss, exploring cultural reenactments within the therapy relationship, empathizing with the parent's experience of loss and of having to grieve within a society that does not recognize perinatal loss, coregulating the parent's feelings of grief and loss, and helping patients to create personally meaningful mourning rituals. Lastly, the impact of within and between cultural differences and therapist attitudes on the therapy process is discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews.

PubMed

Heslehurst, Nicola; Brown, Heather; Pemu, Augustina; Coleman, Hayley; Rankin, Judith

2018-06-12

Global migration is at an all-time high with implications for perinatal health. Migrant women, especially asylum seekers and refugees, represent a particularly vulnerable group. Understanding the impact on the perinatal health of women and offspring is an important prerequisite to improving care and outcomes. The aim of this systematic review was to summarise the current evidence base on perinatal health outcomes and care among women with asylum seeker or refugee status. Twelve electronic database, reference list and citation searches (1 January 2007-July 2017) were carried out between June and July 2017. Quantitative and qualitative systematic reviews, published in the English language, were included if they reported perinatal health outcomes or care and clearly stated that they included asylum seekers or refugees. Screening for eligibility, data extraction, quality appraisal and evidence synthesis were carried out in duplicate. The results were summarised narratively. Among 3415 records screened, 29 systematic reviews met the inclusion criteria. Only one exclusively focussed on asylum seekers; the remaining reviews grouped asylum seekers and refugees with wider migrant populations. Perinatal outcomes were predominantly worse among migrant women, particularly mental health, maternal mortality, preterm birth and congenital anomalies. Access and use of care was obstructed by structural, organisational, social, personal and cultural barriers. Migrant women's experiences of care included negative communication, discrimination, poor relationships with health professionals, cultural clashes and negative experiences of clinical intervention. Additional data for asylum seekers and refugees demonstrated complex obstetric issues, sexual assault, offspring mortality, unwanted pregnancy, poverty, social isolation and experiences of racism, prejudice and stereotyping within perinatal healthcare. This review identified adverse pregnancy outcomes among asylum seeker and refugee

Let's Meet Your Baby as a Person: From Research to Preventive Perinatal Practice and Back Again, with the Newborn Behavioral Observations

ERIC Educational Resources Information Center

Nicolson, Susan

2015-01-01

This article describes efforts of an Australian tertiary maternity hospital to translate infant mental health research into preventive perinatal and early parenting practice. Clinical practice confirms what is known in the literature: For expectant parents, there can be myriad obstacles to adapting successfully to parenthood and forming a…

A literature review on integrated perinatal care

PubMed Central

Rodríguez, Charo; des Rivières-Pigeon, Catherine

2007-01-01

Context The perinatal period is one during which health care services are in high demand. Like other health care sub-sectors, perinatal health care delivery has undergone significant changes in recent years, such as the integrative wave that has swept through the health care industry since the early 1990s. Purpose The present study aims at reviewing scholarly work on integrated perinatal care to provide support for policy decision-making. Results Researchers interested in integrated perinatal care have, by assessing the effectiveness of individual clinical practices and intervention programs, mainly addressed issues of continuity of care and clinical and professional integration. Conclusions Improvements in perinatal health care delivery appear related not to structurally integrated health care delivery systems, but to organizing modalities that aim to support woman-centred care and cooperative clinical practice. PMID:17786177

Case review of perinatal deaths at hospitals in Kigali, Rwanda: perinatal audit with application of a three-delays analysis.

PubMed

Musafili, Aimable; Persson, Lars-Åke; Baribwira, Cyprien; Påfs, Jessica; Mulindwa, Patrick Adam; Essén, Birgitta

2017-03-11

Perinatal audit and the three-delays model are increasingly being employed to analyse barriers to perinatal health, at both community and facility level. Using these approaches, our aim was to assess factors that could contribute to perinatal mortality and potentially avoidable deaths at Rwandan hospitals. Perinatal audits were carried out at two main urban hospitals, one at district level and the other at tertiary level, in Kigali, Rwanda, from July 2012 to May 2013. Stillbirths and early neonatal deaths occurring after 22 completed weeks of gestation or more, or weighing at least 500 g, were included in the study. Factors contributing to mortality and potentially avoidable deaths, considering the local resources and feasibility, were identified using a three-delays model. Out of 8424 births, there were 269 perinatal deaths (106 macerated stillbirths, 63 fresh stillbirths, 100 early neonatal deaths) corresponding to a stillbirth rate of 20/1000 births and a perinatal mortality rate of 32/1000 births. In total, 250 perinatal deaths were available for audit. Factors contributing to mortality were ascertained for 79% of deaths. Delay in care-seeking was identified in 39% of deaths, delay in arriving at the health facility in 10%, and provision of suboptimal care at the health facility in 37%. Delay in seeking adequate care was commonly characterized by difficulties in recognising or reporting pregnancy-related danger signs. Lack of money was the major cause of delay in reaching a health facility. Delay in referrals, diagnosis and management of emergency obstetric cases were the most prominent contributors affecting the provision of appropriate and timely care by healthcare providers. Half of the perinatal deaths were judged to be potentially avoidable and 70% of these were fresh stillbirths and early neonatal deaths. Factors contributing to delays underlying perinatal mortality were identified in more than three-quarters of deaths. Half of the perinatal deaths were

The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands

PubMed Central

2012-01-01

Background Perinatal (mortality) audit can be considered to be a way to improve the careprocess for all pregnant women and their newborns by creating an opportunity to learn from unwanted events in the care process. In unit-based perinatal audit, the caregivers involved in cases that result in mortality are usually part of the audit group. This makes such an audit a delicate matter. Methods The purpose of this study was to implement unit-based perinatal mortality audit in all 15 perinatal cooperation units in the northern region of the Netherlands between September 2007 and March 2010. These units consist of hospital-based and independent community-based perinatal caregivers. The implementation strategy encompassed an information plan, an organization plan, and a training plan. The main outcomes are the number of participating perinatal cooperation units at the end of the project, the identified substandard factors (SSF), the actions to improve care, and the opinions of the participants. Results The perinatal mortality audit was implemented in all 15 perinatal cooperation units. 677 different caregivers analyzed 112 cases of perinatal mortality and identified 163 substandard factors. In 31% of cases the guidelines were not followed and in 23% care was not according to normal practice. In 28% of cases, the documentation was not in order, while in 13% of cases the communication between caregivers was insufficient. 442 actions to improve care were reported for ‘external cooperation’ (15%), ‘internal cooperation’ (17%), ‘practice organization’ (26%), ‘training and education’ (10%), and ‘medical performance’ (27%). Valued aspects of the audit meetings were: the multidisciplinary character (13%), the collective and non-judgmental search for substandard factors (21%), the perception of safety (13%), the motivation to reflect on one’s own professional performance (5%), and the inherent postgraduate education (10%). Conclusion Following our

Perinatal Safety: From Concept to Nursing Practice

PubMed Central

Kennedy, Holly Powell

2010-01-01

Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians’ individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient’s best interest can be viewed as their “agency for safety.” However, collective agency for safety and commitment to support nurses in their advocacy role is missing in many perinatal care settings. This paper draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse’s role in maintaining safety during labor and birth in acute care settings, and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care. PMID:20147827

Perinatal safety: from concept to nursing practice.

PubMed

Lyndon, Audrey; Kennedy, Holly Powell

2010-01-01

Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians' individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient's best interest can be viewed as their "agency for safety." However, collective agency for safety and commitment to support nurses in their role of advocacy is missing in many perinatal care settings. This article draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse's role in maintaining safety during labor and birth in acute care settings and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care.

Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an international consortium.

PubMed

Putnam, Karen T; Wilcox, Marsha; Robertson-Blackmore, Emma; Sharkey, Katherine; Bergink, Veerle; Munk-Olsen, Trine; Deligiannidis, Kristina M; Payne, Jennifer; Altemus, Margaret; Newport, Jeffrey; Apter, Gisele; Devouche, Emmanuel; Viktorin, Alexander; Magnusson, Patrik; Penninx, Brenda; Buist, Anne; Bilszta, Justin; O'Hara, Michael; Stuart, Scott; Brock, Rebecca; Roza, Sabine; Tiemeier, Henning; Guille, Constance; Epperson, C Neill; Kim, Deborah; Schmidt, Peter; Martinez, Pedro; Di Florio, Arianna; Wisner, Katherine L; Stowe, Zachary; Jones, Ian; Sullivan, Patrick F; Rubinow, David; Wildenhaus, Kevin; Meltzer-Brody, Samantha

2017-06-01

The perinatal period is a time of high risk for onset of depressive disorders and is associated with substantial morbidity and mortality, including maternal suicide. Perinatal depression comprises a heterogeneous group of clinical subtypes, and further refinement is needed to improve treatment outcomes. We sought to empirically identify and describe clinically relevant phenotypic subtypes of perinatal depression, and further characterise subtypes by time of symptom onset within pregnancy and three post-partum periods. Data were assembled from a subset of seven of 19 international sites in the Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium. In this analysis, the cohort was restricted to women aged 19-40 years with information about onset of depressive symptoms in the perinatal period and complete prospective data for the ten-item Edinburgh postnatal depression scale (EPDS). Principal components and common factor analysis were used to identify symptom dimensions in the EPDS. The National Institute of Mental Health research domain criteria functional constructs of negative valence and arousal were applied to the EPDS dimensions that reflect states of depressed mood, anhedonia, and anxiety. We used k-means clustering to identify subtypes of women sharing symptom patterns. Univariate and bivariate statistics were used to describe the subtypes. Data for 663 women were included in these analyses. We found evidence for three underlying dimensions measured by the EPDS: depressed mood, anxiety, and anhedonia. On the basis of these dimensions, we identified five distinct subtypes of perinatal depression: severe anxious depression, moderate anxious depression, anxious anhedonia, pure anhedonia, and resolved depression. These subtypes have clear differences in symptom quality and time of onset. Anxiety and anhedonia emerged as prominent symptom dimensions with post-partum onset and were notably severe. Our findings show that there might be

Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an international consortium

PubMed Central

Putnam, Karen T; Wilcox, Marsha; Robertson-Blackmore, Emma; Sharkey, Katherine; Bergink, Veerle; Munk-Olsen, Trine; Deligiannidis, Kristina M; Payne, Jennifer; Altemus, Margaret; Newport, Jeffrey; Apter, Gisele; Devouche, Emmanuel; Viktorin, Alexander; Magnusson, Patrik; Penninx, Brenda; Buist, Anne; Bilszta, Justin; O’Hara, Michael; Stuart, Scott; Brock, Rebecca; Roza, Sabine; Tiemeier, Henning; Guille, Constance; Epperson, C Neill; Kim, Deborah; Schmidt, Peter; Martinez, Pedro; Di Florio, Arianna; Wisner, Katherine L; Stowe, Zachary; Jones, Ian; Sullivan, Patrick F; Rubinow, David; Wildenhaus, Kevin; Meltzer-Brody, Samantha

2018-01-01

Summary Background The perinatal period is a time of high risk for onset of depressive disorders and is associated with substantial morbidity and mortality, including maternal suicide. Perinatal depression comprises a heterogeneous group of clinical subtypes, and further refinement is needed to improve treatment outcomes. We sought to empirically identify and describe clinically relevant phenotypic subtypes of perinatal depression, and further characterise subtypes by time of symptom onset within pregnancy and three post-partum periods. Methods Data were assembled from a subset of seven of 19 international sites in the Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium. In this analysis, the cohort was restricted to women aged 19–40 years with information about onset of depressive symptoms in the perinatal period and complete prospective data for the ten-item Edinburgh postnatal depression scale (EPDS). Principal components and common factor analysis were used to identify symptom dimensions in the EPDS. The National Institute of Mental Health research domain criteria functional constructs of negative valence and arousal were applied to the EPDS dimensions that reflect states of depressed mood, anhedonia, and anxiety. We used k-means clustering to identify subtypes of women sharing symptom patterns. Univariate and bivariate statistics were used to describe the subtypes. Findings Data for 663 women were included in these analyses. We found evidence for three underlying dimensions measured by the EPDS: depressed mood, anxiety, and anhedonia. On the basis of these dimensions, we identified five distinct subtypes of perinatal depression: severe anxious depression, moderate anxious depression, anxious anhedonia, pure anhedonia, and resolved depression. These subtypes have clear differences in symptom quality and time of onset. Anxiety and anhedonia emerged as prominent symptom dimensions with post-partum onset and were notably severe

[Perinatal Information System. Incorporation latency and impact on perinatal clinical registry].

PubMed

Simini, F; Fernández, A; Sosa, C; Díaz Rossello, J L

2001-10-01

The Perinatal Information System (SIP) is a clinical record, local management and quality assurance software standard in Latin America and the Caribbean. The time to implement SIP in a Maternity Hospital is evaluated as well as the effect of statistics on perinatal health indicators in subsequent years. In the sample of 20 Maternity Hospitals (5 Countries, 40% Private and 60% Public) 85% had a reliable information system by the third year of use of SIP. 15% of hospitals still had problems at that time that were already clear during the second year, a time corrective measures can still be taken. The evaluation of the impact of yearly reports shows that 58% of recommendations were fulfilled, specially those regarding the complete filling-in of clinical records (62%) and to a lesser extent variables that reflect clinical practices and organization of services (52%). The conclusion is that Maternity Hospitals in Latin America and the Caribbean have the capacity to adopt a complex tool of computerized clinical records for quality assurance of perinatal care and monitoring of health indicators.

Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review.

PubMed

Fisher, Jane; Cabral de Mello, Meena; Patel, Vikram; Rahman, Atif; Tran, Thach; Holton, Sara; Holmes, Wendy

2012-02-01

To review the evidence about the prevalence and determinants of non-psychotic common perinatal mental disorders (CPMDs) in World Bank categorized low- and lower-middle-income countries. Major databases were searched systematically for English-language publications on the prevalence of non-psychotic CPMDs and on their risk factors and determinants. All study designs were included. Thirteen papers covering 17 low- and lower-middle-income countries provided findings for pregnant women, and 34, for women who had just given birth. Data on disorders in the antenatal period were available for 9 (8%) countries, and on disorders in the postnatal period, for 17 (15%). Weighted mean prevalence was 15.6% (95% confidence interval, CI: 15.4-15.9) antenatally and 19.8% (19.5-20.0) postnatally. Risk factors were: socioeconomic disadvantage (odds ratio [OR] range: 2.1-13.2); unintended pregnancy (1.6-8.8); being younger (2.1-5.4); being unmarried (3.4-5.8); lacking intimate partner empathy and support (2.0-9.4); having hostile in-laws (2.1-4.4); experiencing intimate partner violence (2.11-6.75); having insufficient emotional and practical support (2.8-6.1); in some settings, giving birth to a female (1.8-2.6), and having a history of mental health problems (5.1-5.6). Protective factors were: having more education (relative risk: 0.5; P = 0.03); having a permanent job (OR: 0.64; 95% CI: 0.4-1.0); being of the ethnic majority (OR: 0.2; 95% CI: 0.1-0.8) and having a kind, trustworthy intimate partner (OR: 0.52; 95% CI: 0.3-0.9). CPMDs are more prevalent in low- and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history.

Mindfulness-based Intervention for Perinatal Grief Education and Reduction among Poor Women in Chhattisgarh, India: a Pilot Study.

PubMed

Roberts, Lisa; Montgomery, Susanne

2016-04-01

Stillbirth is a significant public health problem in low-to-middle-income countries and results in perinatal grief, often with negative psychosocial impact. In low-resource settings, such as Chhattisgarh, India, where needs are high, it is imperative to utilize low-cost, effective interventions. Mindfulness-based stress reduction (MBSR) is an empirically sound intervention that has been utilized for a broad range of physical and mental health problems, and is adaptable to specific populations. The main objective of this pilot study was to explore the feasibility and effectiveness of a shortened, culturally adapted mindfulness-based intervention to address complex grief after stillbirth. We used an observational, pre-post-6-week post study design. The study instrument was made up of descriptive demographic questions and validated scales and was administered as a structured interview due to low literacy rates. We used a community participatory approach to culturally adapt the five-week mindfulness-based intervention and delivered it through two trained local nurses. Quantitative and qualitative data analyses explored study outcomes as well as acceptability and feasibility of the intervention. 29 women with a history of stillbirth enrolled, completed the pretest and began the intervention; 26 completed the five-week intervention and post-test (89.7%), and 23 completed the six-week follow-up assessment (88.5%). Pretest results included elevated psychological symptoms and high levels of perinatal grief, including the active grief, difficulty coping, and despair subscales. General linear modeling repeated measures was used to explore posttest and six-week follow up changes from baseline, controlling for significantly correlated demographic variables. These longitudinal results included significant reduction in psychological symptoms; four of the five facets of mindfulness changed in the desired direction, two significantly; as well as significant reduction in overall

The effect of perinatal anoxia on amino acid metabolism in the developing brain. Part II: The effect of perinatal anoxia on the free amino acid patterns in CSF of infants and children.

PubMed

Kaneko, K

1985-01-01

To clarify the effects of perinatal anoxia on the subsequent amino acid metabolism in the brain of children, free amino acid levels in the cerebrospinal fluid (CSF) were determined in 15 children diagnosed as having cerebral palsy and/or mental retardation with perinatal anoxia, and 58 control children without anoxia, aged from 4 days to 12 yrs. There was no significant difference in total amino acid levels between anoxic children and the controls. In the controls, the Gln level in CSF was high, Arg, Asp and Glu levels in CSF were almost the same during infancy and childhood, and the levels of Orn, Lys, His, Tau, Thr, Ser, Asn, Gly, Ala, Val, Met, Ile, Leu, Tyr and Phe in CSF decreased with age until pre-school age. In the newborns and infants among the anoxic children, the levels of most free amino acids in CSF were relatively high compared with those of the controls and, except Glu and Gln, decreased with age during infancy. The Orn, His, Gly, Tyr and Phe levels in CSF of anoxic children were lower than those of the controls in older infants. These results suggest that perinatal anoxia affected free amino acid patterns in CSF of newborns and infants and that the subsequent disturbance of amino acid metabolism in their brains remained after birth.

Providing Perinatal Mental Health Services in Pediatric Primary Care

ERIC Educational Resources Information Center

Talmi, Ayelet; Stafford, Brian; Buchholz, Melissa

2009-01-01

After birth, newborns and their caregivers are seen routinely and frequently in pediatric primary care settings. The close succession of visits in the first few months of life puts pediatric primary care professionals in a unique position to enhance infant mental health by developing strong relationships with caregivers, supporting babies and…

The Impact of Antenatal Depression on Perinatal Outcomes in Australian Women

PubMed Central

Eastwood, John; Ogbo, Felix A.; Hendry, Alexandra; Noble, Justine; Page, Andrew

2017-01-01

Background In Australia, there is limited evidence on the impact of antenatal depression on perinatal outcomes. This study investigates the association between maternal depressive symptoms during pregnancy and key perinatal outcomes, including birth weight, gestational age at birth, breastfeeding indicators and postnatal depressive symptoms. Method A retrospective cohort of mothers (N = 17,564) of all infants born in public health facilities within South Western Sydney Local Health District and Sydney Local Health District in 2014, in the state of New South Wales (NSW), Australia, was enumerated from routinely collected antenatal data to investigate the risk of adverse perinatal outcomes associated with maternal depressive symptoms during pregnancy. Antenatal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression models that adjusted for confounders were conducted to determine associations between antenatal depressive symptoms and low birth weight, early gestational age at birth (<37 weeks), breast feeding indicators and postnatal depressive symptoms. Results The prevalence of maternal depressive symptoms during pregnancy was 7.0% in the cohort, and was significantly associated with postnatal depressive symptoms [Adjusted Odd Ratios (AOR) = 6.4, 95% CI: 4.8–8.7, P<0.001]. Antenatal depressive symptoms was associated with a higher odds of low birth weight [AOR = 1.7, 95% CI: 1.2–2.3, P = 0.003] and a gestational age at birth of <37 weeks [AOR = 1.3, 95% CI: 1.1–1.7, P = 0.018] compared to women who reported lower EPDS scores in antenatal period. Antenatal depressive symptoms were not strongly associated with non-exclusive breast feeding in the early postnatal period. Conclusion Maternal depressive symptoms in the antenatal period are strongly associated with postnatal depressive symptoms and adverse perinatal outcomes in Australian infants. Early identification of antenatal and postnatal depressive symptoms

Longitudinal study of perinatal maternal stress, depressive symptoms and anxiety.

PubMed

Liou, Shwu-Ru; Wang, Panchalli; Cheng, Ching-Yu

2014-06-01

to understand the trends in, and relationships between, maternal stress, depressive symptoms and anxiety in pregnancy and post partum. a prospective longitudinal survey study was undertaken to explore maternal psychological distress throughout the perinatal period. The participants were recruited after 24 completed weeks of gestation, and were followed-up monthly until one month post partum (four surveys in total). participants were recruited from a single hospital in southern Taiwan, and asked to complete questionnaires in the hospital waiting area. inclusion criteria were: age ≥18 years, able to read and write Chinese, ≥24 weeks of gestation, singleton pregnancy and no pregnancy complications (including a diagnosis of antenatal depression or anxiety disorder). In total, 197 women completed all four surveys (response rate 74.62%). stress was measured with the 10-item Perceived Stress Scale, depressive symptoms were measured with the Center for Epidemiologic Studies' Depression scale, and anxiety was measured with the Zung Self-reported Anxiety Scale. Participants were followed-up at four time points: T1 (25-29 gestational weeks), T2 (30-34 gestational weeks), T3 (>34 gestational weeks) and T4 (4-6 weeks post partum). Appointments for data collection were made in accordance with the participants' antenatal and postnatal check-ups. The three types of maternal distress had different courses of change throughout the perinatal period, as levels of depressive symptoms remained unchanged, anxiety levels increased as gestation advanced but declined after birth, and stress decreased gradually during pregnancy but returned to the T1 level after birth. There was a low to high degree of correlation in maternal stress, depressive symptoms and anxiety in pregnancy and post partum. around one-quarter of the study participants had depressive symptoms during pregnancy and post partum. Stress and anxiety showed opposing courses during the perinatal period. Regardless of the

Rethinking the birthing body: Cartesian dualism and perinatal nursing.

PubMed

Goldberg, Lisa

2002-03-01

This paper highlights the pervasive influence of a Cartesian metaphysics on the medical paradigm and its profound impact on the practice of perinatal nursing in North America. Modern perinatal health care practices are founded on a Cartesian metaphysics that reduce birthing women to the status of object. Such practices deny the holistic aims of perinatal nursing. A philosophical inquiry informs the tenets of this metaphysical discussion regarding the foundations of perinatal nursing practices. Although perinatal health care is founded on a Cartesian metaphysics, an alternative paradigm of embodied practice is suggested as a way of viewing birthing women as embodied subjects. If the foundations of health care, which have been built on a Cartesian metaphysics, are not re-examined, perinatal nurses will be providing care that further reduce women to the status of object.

Workup for Perinatal Stroke Does Not Predict Recurrence.

PubMed

Lehman, Laura L; Beaute, Jeanette; Kapur, Kush; Danehy, Amy R; Bernson-Leung, Miya E; Malkin, Hayley; Rivkin, Michael J; Trenor, Cameron C

2017-08-01

Perinatal stroke, including neonatal and presumed perinatal presentation, represents the age in childhood in which stroke occurs most frequently. The roles of thrombophilia, arteriopathy, and cardiac anomalies in perinatal ischemic stroke are currently unclear. We took a uniform approach to perinatal ischemic stroke evaluation to study these risk factors and their association with recurrent stroke. We reviewed records of perinatal stroke patients evaluated from August 2008 to February 2016 at a single referral center. Demographics, echocardiography, arterial imaging, and thrombophilia testing were collected. Statistical analysis was performed using Fisher exact test. Across 215 cases, the median follow-up was 3.17 years (1.49, 6.46). Females comprised 42.8% of cases. Age of presentation was neonatal (110, 51.2%) or presumed perinatal (105, 48.8%). The median age at diagnosis was 2.9 days (interquartile range, 2.0-9.9) for neonatal stroke and 12.9 months (interquartile range, 8.7-32.8) for presumed perinatal stroke. Strokes were classified as arterial (149, 69.3%), venous (60, 27.9%), both (4, 1.9%), or uncertain (2, 0.9%) by consensus imaging review. Of the 215 cases, there were 6 (2.8%) recurrent ischemic cerebrovascular events. Abnormal thrombophilia testing was not associated with recurrent stroke, except for a single patient with combined antithrombin deficiency and protein C deficiency. After excluding venous events, 155 patients were evaluated for arteriopathy and cardioembolic risk factors; neither was associated with recurrent stroke. Positive family history of thrombosis was not predictive of abnormal thrombophilia testing. Thrombophilia, arteriopathy, or cardioembolic risk factors were not predictive of recurrent events after perinatal stroke. Thrombophilia evaluation in perinatal stroke should only rarely be considered. © 2017 American Heart Association, Inc.

Perinatal outcomes of singleton term breech deliveries in Basra.

PubMed

Alshaheen, H; Abd Al-Karim, A

2010-01-01

This study aimed to assess the perinatal morbidity and mortality in breech deliveries, to study the correlation of parity and birth weight with perinatal mortality by mode of delivery. Of 210 women in labour in Basra maternity and child hospital, 97 underwent vaginal breech deliveries and 113 delivered by caesarean section. Birth trauma was restricted to vaginal deliveries. The perinatal mortality was significantly higher in vaginal deliveries (8.2%) compared with caesarean deliveries (0.9%). A higher perinatal mortality was recorded among infants > 3500-4000 g birth weight in vaginal deliveries. Caesarean section reduced the perinatal mortality in both nulliparous and parous women in term breech infants.

Is there an association between female circumcision and perinatal death?

PubMed Central

Essen, Birgitta; Bodker, Birgit; Sjoberg, N-O; Gudmundsson, Saemundur; Ostergren, P-O; Langhoff-Roos, Jens

2002-01-01

OBJECTIVE: In Sweden, a country with high standards of obstetric care, the high rate of perinatal mortality among children of immigrant women from the Horn of Africa raises the question of whether there is an association between female circumcision and perinatal death. METHOD: To investigate this, we examined a cohort of 63 perinatal deaths of infants born in Sweden over the period 1990-96 to circumcised women. FINDINGS: We found no evidence that female circumcision was related to perinatal death. Obstructed or prolonged labour, caused by scar tissue from circumcision, was not found to have any impact on the number of perinatal deaths. CONCLUSION: The results do not support previous conclusions that genital circumcision is related to perinatal death, regardless of other circumstances, and suggest that other, suboptimal factors contribute to perinatal death among circumcised migrant women. PMID:12219153

Perinatal inflammation and adult psychopathology: From preclinical models to humans.

PubMed

Depino, Amaicha Mara

2018-05-01

Perinatal environment plays a crucial role in brain development and determines its function through life. Epidemiological studies and clinical reports link perinatal exposure to infection and/or immune activation to various psychiatric disorders. In addition, accumulating evidence from animal models shows that perinatal inflammation can affect various behaviors relevant to psychiatric disorders such as schizophrenia, autism, anxiety and depression. Remarkably, the effects on behavior and brain function do not always depend on the type of inflammatory stimulus or the perinatal age targeted, so diverse inflammatory events can have similar consequences on the brain. Moreover, other perinatal environmental factors that affect behavior (e.g. diet and stress) also elicit inflammatory responses. Understanding the interplay between perinatal environment and inflammation on brain development is required to identify the mechanisms through which perinatal inflammation affect brain function in the adult animal. Evidence for the role of the peripheral immune system and glia on perinatal programming of behavior is discussed in this review, along with recent evidence for the role of epigenetic mechanisms affecting gene expression in the brain. Copyright © 2017 Elsevier Ltd. All rights reserved.

Depression and Posttraumatic Stress Symptoms After Perinatal Loss in a Population-Based Sample

PubMed Central

Leon, Irving; Boggs, Martha E.; Sen, Ananda

2016-01-01

Abstract Introduction: Perinatal loss is often a traumatic outcome for families. While there are limited data about depressive outcomes in small populations, information about depression and posttraumatic stress disorder among large racially and economically diverse populations is sparse. Methods: We collaborated with the Michigan Department of Community Health to conduct a longitudinal survey of bereaved mothers with stillbirth or infant death under 28 days of life and live-birth (control) mothers in Michigan. The study assessed 9-month mental health outcomes including self-reported symptoms of depression and posttraumatic stress disorder along with information about demographics, pregnancy and loss experience, social support, and past and present mental health and treatment. Results: Of 1400 women contacted by the State of Michigan, 609 completed surveys and were eligible to participate for a 44% response rate (377 bereaved mothers and 232 control mothers with live births). In multivariable analysis, bereaved women had nearly 4-fold higher odds of having a positive screen for depression and 7-fold higher odds of a positive screen for post-traumatic stress disorder after controlling for demographic and personal risk variables. A minority of screen-positive women were receiving any type of psychiatric treatment. Conclusion: This is the largest epidemiologically based study to date to measure the psychological impact of perinatal loss. Nine months after a loss, bereaved women showed high levels of distress with limited rates of treatment. Symptoms need to be monitored over time for persisting disorder and further research should identify women at highest risk for poor outcomes. PMID:26258870

Depression and Posttraumatic Stress Symptoms After Perinatal Loss in a Population-Based Sample.

PubMed

Gold, Katherine J; Leon, Irving; Boggs, Martha E; Sen, Ananda

2016-03-01

Perinatal loss is often a traumatic outcome for families. While there are limited data about depressive outcomes in small populations, information about depression and posttraumatic stress disorder among large racially and economically diverse populations is sparse. We collaborated with the Michigan Department of Community Health to conduct a longitudinal survey of bereaved mothers with stillbirth or infant death under 28 days of life and live-birth (control) mothers in Michigan. The study assessed 9-month mental health outcomes including self-reported symptoms of depression and posttraumatic stress disorder along with information about demographics, pregnancy and loss experience, social support, and past and present mental health and treatment. Of 1400 women contacted by the State of Michigan, 609 completed surveys and were eligible to participate for a 44% response rate (377 bereaved mothers and 232 control mothers with live births). In multivariable analysis, bereaved women had nearly 4-fold higher odds of having a positive screen for depression and 7-fold higher odds of a positive screen for post-traumatic stress disorder after controlling for demographic and personal risk variables. A minority of screen-positive women were receiving any type of psychiatric treatment. This is the largest epidemiologically based study to date to measure the psychological impact of perinatal loss. Nine months after a loss, bereaved women showed high levels of distress with limited rates of treatment. Symptoms need to be monitored over time for persisting disorder and further research should identify women at highest risk for poor outcomes.

Spatial Analysis of China Province-level Perinatal Mortality

PubMed Central

XIANG, Kun; SONG, Deyong

2016-01-01

Background: Using spatial analysis tools to determine the spatial patterns of China province-level perinatal mortality and using spatial econometric model to examine the impacts of health care resources and different socio-economic factors on perinatal mortality. Methods: The Global Moran’s I index is used to examine whether the spatial autocorrelation exists in selected regions and Moran’s I scatter plot to examine the spatial clustering among regions. Spatial econometric models are used to investigate the spatial relationships between perinatal mortality and contributing factors. Results: The overall Moran’s I index indicates that perinatal mortality displays positive spatial autocorrelation. Moran’s I scatter plot analysis implies that there is a significant clustering of mortality in both high-rate regions and low-rate regions. The spatial econometric models analyses confirm the existence of a direct link between perinatal mortality and health care resources, socio-economic factors. Conclusions: Since a positive spatial autocorrelation has been detected in China province-level perinatal mortality, the upgrading of regional economic development and medical service level will affect the mortality not only in region itself but also its adjacent regions. PMID:27398334

Reticence in disclosure of HIV infection and reasons for bereavement: impact on perinatally infected adolescents' mental health and understanding of HIV treatment and prevention in Johannesburg, South Africa.

PubMed

Woollett, Nataly; Black, Vivian; Cluver, Lucie; Brahmbhatt, Heena

2017-07-01

Survival rates of perinatally infected HIV-positive adolescents (PIA) are increasing in sub-Saharan Africa. There is a gap in understanding how disclosure and bereavement have an impact on PIA beliefs and understanding of their HIV infection and its management. In-depth interviews were conducted with 25 purposively selected adolescents aged 13-19 years from 5 public health clinics in Johannesburg, South Africa. Data were analysed using NVivo 10 using a thematic approach. PIA experience incomplete disclosure both of their HIV status and reasons for their bereavements, which limits their understanding of how they became infected, vertical transmission and prevention options like prevention of mother-to-child transmission (PMTCT). Most participants were orphaned and were experiencing complicated grieving (i.e., engaged in unresolved tasks of grieving) which had a negative impact on their mental health, and ability to accept their HIV status and adhere to treatment. PIA need improved communication regarding vertical transmission and how they became HIV-positive, as well as reasons for death of their loved ones to properly understand their HIV status and engage effectively in management. Honest communication about how relatives died and truthful engagement in the process of disclosure of HIV status is necessary to reduce stigma and complicated grieving, and improve mental health in this population.

Acknowledged Dependence and the Virtues of Perinatal Hospice

PubMed Central

Cobb, Aaron D.

2016-01-01

Prenatal screening can lead to the detection and diagnosis of significantly life-limiting conditions affecting the unborn child. Recognizing the difficulties facing parents who decide to continue the pregnancy, some have proposed perinatal hospice as a new modality of care. Although the medical literature has begun to devote significant attention to these practices, systematic philosophical reflection on perinatal hospice has been relatively limited. Drawing on Alasdair MacIntyre’s account of the virtues of acknowledged dependence, I contend that perinatal hospice manifests and facilitates virtues essential to living well with human dependency and vulnerability. For this reason, perinatal hospice deserves broad support within society. PMID:26661051

Children with Special Needs: Perinatal Education for Adoption Workers.

ERIC Educational Resources Information Center

Vaitenas, Raminta E.

1981-01-01

Advocates adoption workers receive perinatal education so that they may be more competent in placing special needs children. Suggests a perinatal inservice program for social workers which would bridge the gap from the clinical practice setting of perinatal centers to the child welfare arena. (Author/CM)

[Tobacco control policies and perinatal health].

PubMed

Peelen, M J; Sheikh, A; Kok, M; Hajenius, P; Zimmermann, L J; Kramer, B W; Hukkelhoven, C W; Reiss, I K; Mol, B W; Been, J V

2017-01-01

Study the association between the introduction of tobacco control policies in the Netherlands and changes in perinatal outcomes. National quasi-experimental study. We used Netherlands Perinatal Registry data (now called Perined) for the period 2000-2011. We studied whether the introduction of smoke-free legislation in workplaces plus a tobacco tax increase and mass media campaign in January 2004, and extension of the smoke-free law to the hospitality industry accompanied by another tax increase and media campaign in July 2008, was associated with changes in perinatal outcomes. We studied all singleton births (gestational age: 24+0 to 42+6 weeks). Our primary outcome measures were: perinatal mortality, preterm birth and being small-for-gestational-age (SGA). Interrupted time series logistic regression analyses were performed to investigate changes in these outcomes occurred after the introduction of the aforementioned tobacco control policies (ClinicalTrials.gov: NCT02189265). Among 2,069,695 singleton births, 13,027 (0.6%) perinatal deaths, 116,043 (5.6%) preterm live-births and 187,966 (9.1%) SGA live-births were observed. The policies introduced in January 2004 were not associated with significant changes in any of the primary outcome measures. A -4.4% (95% CI: -6.4 to -2.4; p < 0.001) decrease in odds of a SGA birth was observed after the policy extension in July 2008 to include a smoke-free hospitality industry, a further tax increase and another media campaign. This translates to an estimated over 500 cases of SGA being averted per year. A reduction in SGA births, but not preterm birth or perinatal mortality, was observed in the Netherlands after extension of the smoke-free workplace law to include bars and restaurants, in conjunction with a tax increase and media campaign in 2008.

Quality of attachment, perinatal risk, and mother-infant interaction in a high-risk premature sample.

PubMed

Udry-Jørgensen, Laura; Pierrehumbert, Blaise; Borghini, Ayala; Habersaat, Stephanie; Forcada-Guex, Margarita; Ansermet, François; Muller-Nix, Carole

2011-05-01

Thirty-three families, each with a premature infant born less than 33 gestational weeks, were observed in a longitudinal exploratory study. Infants were recruited in a neonatal intensive care unit, and follow-up visits took place at 4 months and 12 months of corrected age. The severity of the perinatal problems was evaluated using the Perinatal Risk Inventory (PERI; A.P. Scheiner & M.E. Sexton, 1991). At 4 months, mother-infant play interaction was observed and coded according to the CARE-index (P.M. Crittenden, 2003); at 12 months, the Strange Situation Procedure (SSP; M.D.S. Ainsworth, M.C. Blehar, E. Waters, & S. Wall, 1978) was administered. Results indicate a strong correlation between the severity of perinatal problems and the quality of attachment at 12 months. Based on the PERI, infants with high medical risks more frequently tended to be insecurely attached. There also was a significant correlation between insecure attachment and dyadic play interaction at 4 months (i.e., maternal controlling behavior and infant compulsive compliance). Moreover, specific dyadic interactive patterns could be identified as protective or as risk factors regarding the quality of attachment. Considering that attachment may have long-term influence on child development, these results underline the need for particular attention to risk factors regarding attachment among premature infants. Copyright © 2011 Michigan Association for Infant Mental Health.

Perinatal mortality attributable to complications of childbirth in Matlab, Bangladesh.

PubMed Central

Kusiako, T.; Ronsmans, C.; Van der Paal, L.

2000-01-01

Very few population-based studies of perinatal mortality in developing countries have examined the role of intrapartum risk factors. In the present study, the proportion of perinatal deaths that are attributable to complications during childbirth in Matlab, Bangladesh, was assessed using community-based data from a home-based programme led by professional midwives between 1987 and 1993. Complications during labour and delivery--such as prolonged or obstructed labour, abnormal fetal position, and hypertensive diseases of pregnancy--increased the risk of perinatal mortality fivefold and accounted for 30% of perinatal deaths. Premature labour, which occurred in 20% of pregnancies, accounted for 27% of perinatal mortality. Better care by qualified staff during delivery and improved care of newborns should substantially reduce perinatal mortality in this study population. PMID:10859856

Perinatal legislative policies and health outcomes.

PubMed

Lorch, Scott A

2017-10-01

Perinatal epidemiology examines the variation and determinants of pregnancy outcomes from a maternal and neonatal perspective. However, improving public and population health also requires the translation of this evidence base into substantive public policies. Assessing the impact of such public policies requires sufficient data to include potential confounding factors in the analysis, such as coexisting medical conditions and socioeconomic status, and appropriate statistical and epidemiological techniques. This review will explore policies addressing three areas of perinatal medicine-elective deliveries prior to 39 weeks' gestation; perinatal regionalization; and mandatory paid maternity leave policies-to illustrate the challenges when assessing the impact of specific policies at the patient and population level. Data support the use of these policies to improve perinatal health, but with weaker and less certain effect sizes when compared to the initial patient-level studies. Improved data collection and epidemiological techniques will allow for improved assessment of these policies and the identification of potential areas of improvement when translating patient-level studies into public policies. Copyright © 2017 Elsevier Inc. All rights reserved.

Perinatal market penetration rate. A tool to evaluate regional perinatal programs.

PubMed

Powers, W F; McGill, L

1987-01-01

Very small babies born in tertiary centers fare better than outborn babies referred for tertiary care after birth. Viewing the 1001-1500 gm regional cohort of fetuses as a potential "market" for center delivery, and measuring a center's penetration into this market, quantitates how well a center draws to itself these small, high-risk fetuses for delivery. An Illinois center's annual penetration rate into its regional market for the years 1973-1983 is presented and significant increases are found. The penetration rates of nine Illinois perinatal centers are calculated and wide discrepancies are found. Defining a high-risk regional cohort as a market stresses a perinatal center's obligation to its region. The penetration rate into a defined market measures how well a center fulfills this obligation.

[Assessment of three-level selective perinatal care based on the analysis of early perinatal death rates and cesarean sections in Poland in 2008].

PubMed

Troszyński, Michał; Niemiec, Tomasz; Wilczyńska, Anna

2009-09-01

The aim of the following work was to assess three-level selective perinatal care in Polish voivodeships in 2008 on the basis of the following parameters: birth rates as well as perinatal death rates, divided into three classes of neonatal weights, in hospitals on each of the three levels. The goal of selective perinatal care is, among other things, to diagnose threats to the mother and/or fetus and direct women with high-risk pregnancies to higher level obstetrics and neonatology clinics and units. The structure of a regional three-level perinatal care, as well as the rules and procedures governing the process of redirecting patients to different levels of perinatal care have been defined in great detail. Perinatal death rates analysis has been carried out on the basis of data received from Voivodeship Public Health Centers in sixteen voivodeships in Poland in 2008. The main document constituted MZ-29 form section X, modified by the authors and subdivided into levels of perinatal care. All data contained in the form have been verified: the numbers concerning birth and death rates as well as perinatal deaths and birth weight subgroups from given voivodeship hospitals. Statistic analysis was limited to the presentation of result tables and graphs within voivodeships. Birth rates and perinatal death rates revealed that in the course of ten years the level of perinatal care, introduced gradually in Poland between the years 1997-1999, resulted in its improvement. Perinatal death rates decreased in the course of ten years from 9.5% in 1999 to 6.45% in 2008, i.e. by 0.3% annually. On the first level, the rate of neonates with very low birth weight, 500-999g, decreased by 5.5% and was 21.1% in 2008 and 36.6% in 1999, whereas on the third level, the birth rate in the same group (500-999g) increased by 12.7% and was 47.7% in 2008 and 35.5% in 1999. There is a growing and alarming tendency to perform cesarean sections. The increase amounted up to 1.2% annually (18.2% in 19999

Adverse effect of high migration stress on mental health during pregnancy: a case report.

PubMed

Lecompte, Vanessa; Richard-Fortier, Zoé; Rousseau, Cécile

2017-02-01

Despite empirical evidence on the numerous consequences associated with high migration stress and mental health problems during pregnancy, a psychosocial stress assessment is rarely done, leaving it largely unaddressed. This case illustration sheds light on the common multiple risk factors related to migration stress that have to be taken into consideration when addressing perinatal mental health, and highlights the importance of obstetric appointments as a unique opportunity to assess psychosocial stress and mobilize interdisciplinary interventions.

Antenatal interpersonal sensitivity is more strongly associated than perinatal depressive symptoms with postnatal mother-infant interaction quality.

PubMed

Raine, Karen; Cockshaw, Wendell; Boyce, Philip; Thorpe, Karen

2016-10-01

Maternal mental health has enduring effects on children's life chances and is a substantial cost driver for child health, education and social services. A key linking mechanism is the quality of mother-infant interaction. A body of work associates maternal depressive symptoms across the antenatal and postnatal (perinatal) period with less-than-optimal mother-infant interaction. Our study aims to build on previous research in the field through exploring the association of a maternal personality trait, interpersonal sensitivity, measured in early pregnancy, with subsequent mother-infant interaction quality. We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine the association between antenatal interpersonal sensitivity and postnatal mother-infant interaction quality in the context of perinatal depressive symptoms. Interpersonal sensitivity was measured during early pregnancy and depressive symptoms in the antenatal year and across the first 21 months of the postnatal period. In a subsample of the ALSPAC, mother-infant interaction was measured at 12 months postnatal through a standard observation. For the subsample that had complete data at all time points (n = 706), hierarchical regression examined the contribution of interpersonal sensitivity to variance in mother-infant interaction quality. Perinatal depressive symptoms predicted little variance in mother-infant interaction. Antenatal interpersonal sensitivity explained a greater proportion of variance in mother-infant interaction quality. The personality trait, interpersonal sensitivity, measured in early pregnancy, is a more robust indicator of subsequent mother-infant-interaction quality than perinatal depressive symptoms, thus affording enhanced opportunity to identify vulnerable mother-infant relationships for targeted early intervention.

Substance use in the perinatal period

PubMed Central

Forray, Ariadna; Foster, Dawn

2015-01-01

Perinatal substance use remains a major public health problem and is associated with a number of deleterious maternal and fetal effects. Polysubstance use in pregnancy is common, and can potentiate adverse maternal and fetal outcomes. Tobacco is the most commonly used substance in pregnancy, followed by alcohol and illicit substances. The treatments for perinatal substance use are limited and consist mostly of behavioral and psychosocial interventions. Of these contingency management has shown the most efficacy. More recently, novel interventions such as progesterone for postpartum cocaine use have shown promise. The purpose of this review is to examine the recent literature on the use of tobacco, alcohol, cannabis, stimulants, and opioids in the perinatal period, their effects on maternal and fetal health and current treatments. PMID:26386836

Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review

PubMed Central

Cabral de Mello, Meena; Patel, Vikram; Rahman, Atif; Tran, Thach; Holton, Sara; Holmes, Wendy

2012-01-01

Abstract Objective To review the evidence about the prevalence and determinants of non-psychotic common perinatal mental disorders (CPMDs) in World Bank categorized low- and lower-middle-income countries. Methods Major databases were searched systematically for English-language publications on the prevalence of non-psychotic CPMDs and on their risk factors and determinants. All study designs were included. Findings Thirteen papers covering 17 low- and lower-middle-income countries provided findings for pregnant women, and 34, for women who had just given birth. Data on disorders in the antenatal period were available for 9 (8%) countries, and on disorders in the postnatal period, for 17 (15%). Weighted mean prevalence was 15.6% (95% confidence interval, CI: 15.4–15.9) antenatally and 19.8% (19.5–20.0) postnatally. Risk factors were: socioeconomic disadvantage (odds ratio [OR] range: 2.1–13.2); unintended pregnancy (1.6–8.8); being younger (2.1–5.4); being unmarried (3.4–5.8); lacking intimate partner empathy and support (2.0–9.4); having hostile in-laws (2.1–4.4); experiencing intimate partner violence (2.11–6.75); having insufficient emotional and practical support (2.8–6.1); in some settings, giving birth to a female (1.8–2.6), and having a history of mental health problems (5.1–5.6). Protective factors were: having more education (relative risk: 0.5; P = 0.03); having a permanent job (OR: 0.64; 95% CI: 0.4–1.0); being of the ethnic majority (OR: 0.2; 95% CI: 0.1–0.8) and having a kind, trustworthy intimate partner (OR: 0.52; 95% CI: 0.3–0.9). Conclusion CPMDs are more prevalent in low- and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history. PMID:22423165

A concept analysis of optimality in perinatal health.

PubMed

Kennedy, Holly Powell

2006-01-01

This analysis was conducted to describe the concept of optimality and its appropriateness for perinatal health care. The concept was identified in 24 scientific disciplines. Across all disciplines, the universal definition of optimality is the robust, efficient, and cost-effective achievement of best possible outcomes within a rule-governed framework. Optimality, specifically defined for perinatal health care, is the maximal perinatal outcome with minimal intervention placed against the context of the woman's social, medical, and obstetric history.

MATERNAL GRIEVING AND THE PERCEPTION OF AND ATTACHMENT TO CHILDREN BORN SUBSEQUENT TO A PERINATAL LOSS.

PubMed

Al-Maharma, Dua' Yousef; Abujaradeh, Hiba; Mahmoud, Khadejah Fahmi; Jarrad, Reem Ahmad

2016-07-01

The purpose of this study was to examine the relationship between maternal grieving for perinatal loss (PL) and the perception of and attachment to children born subsequent to a recent PL among mothers in Jordan. A cross-sectional, descriptive correlational design was used. A convenience sample of 190 mothers of full-term, healthy newborns born subsequent to a recent PL was recruited from seven Maternal and Child Health Care Centers in Jordan. These mothers were assessed using the Perinatal Grief Scale (L.J. Toedter, J.N. Lasker, & J.M. Alhadeff), 1988, the Maternal Postnatal Attachment Scale (J.T. Condon & C.J. Corkindale, 1998), and the Neonatal Perception Inventory II (E. Broussard, 1979). Results showed a significant negative relationship between grief intensity and the attachment level, r = -.37, p = .000, and a significant positive relationship between the attachment level and neonatal perception, r = .28, p = .000. Mothers' grief intensity was significantly affected by their demographic characteristics; however, there was no significant relationship between grief intensity and neonatal perception, r = .23, p = .23. Perinatal grief was negatively related to maternal attachment to the subsequent child. Nurses should address bereaved mothers and their children who might be at risk for developing attachment disturbances to facilitate positive adaptation to the subsequent pregnancy and parenthood. © 2016 Michigan Association for Infant Mental Health.

Minimal Brain Dysfunction: Associations with Perinatal Complications.

ERIC Educational Resources Information Center

Nichols, Paul L.

Examined with over 28,000 7-year-old children whose mothers registered for prenatal care was the relationship between perinatal complications and such characteristics as poor school achievement, hyperactivity, and neurological soft signs associated with the diagnosis of minimal brain dysfunction (MBD). Ten perinatal antecedents were studied:…

Trends in perinatal HIV prevention in New York City, 1994-2003.

PubMed

Peters, Vicki B; Liu, Kai-Lih; Robinson, Lisa-Gaye; Dominguez, Kenneth L; Abrams, Elaine J; Gill, Balwant S; Thomas, Pauline A

2008-10-01

We examined trends in perinatal HIV prevention interventions in New York City implemented during 1994 to 2003 to ascertain the success of the interventions in reducing perinatal transmission. We used data obtained from infant records at 22 hospitals. We used multiple logistic regression to analyze factors associated with prenatal care and perinatal HIV transmission. We analyzed data for 4729 perinatally HIV-exposed singleton births. Of mothers with prenatal care data, 92% had prenatal care. The overall proportion who received prenatal care and were diagnosed with HIV before delivery was 86% in 1994 to 1996 and 90% in 1997 to 2003. Use of prenatal antiretrovirals among mothers who received prenatal care was 63% in 1994 to 1996 and 82% in 1997 to 2003. From 1994 to 2003, cesarean births among the entire sample increased from 15% to 55%. During 1997 to 2003, the perinatal HIV transmission rate among the entire sample was 7%; 45% of mothers of infected infants had missed opportunities for perinatal HIV prevention. During 1997 to 2003, maternal illicit drug use was significantly associated with lack of prenatal care. Lack of prenatal, intrapartum, and neonatal antiretrovirals; maternal illicit drug use; and low birthweight were significantly associated with perinatal HIV transmission. Interventions for perinatal HIV prevention can successfully decrease HIV transmission rates. Ongoing perinatal HIV surveillance allows for monitoring the implementation of guidelines to prevent mother-to-child transmission of HIV and determining factors that may contribute to perinatal HIV transmission.

Identification and Treatment of Adolescents With Perinatal Anxiety and Depression.

PubMed

Hughes, Linda Paine; Austin-Ketch, Tammy; Volpe, Ellen M; Campbell-Heider, Nancy

2017-06-01

Perinatal mood and anxiety disorders (PMAD) are the most common, yet under-diagnosed and undertreated complication of pregnancy, affecting up to 50% of pregnant and parenting teens. PMAD are a global health issue that can have devastating effects on the mental, physical, emotional, developmental health, and social life of the mother, infant, and family. Adolescents present with similar symptoms of PMAD as their adult counterparts, but also experience isolation from their peer group and lack of resources and coping strategies, as well as difficulty sleeping and lack of concentration and ability to focus. Nurses and nurse practitioners are in an ideal position to assess preexisting risk factors for PMAD. The current applied evidence-based article addresses the diagnosis of PMAD, provides a conceptual framework for understanding the intra- and interpersonal dynamics affecting teens with PMAD, and suggests a new screening tool to guide diagnosis. An easy to recall mnemonic for diagnosis and referral (SAIL AHEAD) is proposed. By using the SAIL AHEAD mnemonic, providers will impact adolescents' parenting success and resiliency, thereby enhancing their future success in life. [Journal of Psychosocial Nursing and Mental Health Services, 55(6), 23-29.]. Copyright 2017, SLACK Incorporated.

Delivering perinatal depression care in a rural obstetric setting: a mixed methods study of feasibility, acceptability and effectiveness.

PubMed

Bhat, Amritha; Reed, Susan; Mao, Johnny; Vredevoogd, Mindy; Russo, Joan; Unger, Jennifer; Rowles, Roger; Unützer, Jürgen

2017-09-07

Universal screening for depression during pregnancy and postpartum is recommended, yet mental health treatment and follow-up rates among screen-positive women in rural settings are low. We studied the feasibility, acceptability and effectiveness of perinatal depression treatment integrated into a rural obstetric setting. We conducted an open treatment study of a screening and intervention program modified from the Depression Attention for Women Now (DAWN) Collaborative Care model in a rural obstetric clinic. Depression screen-positive pregnant and postpartum women received problem-solving therapy (PST) with or without antidepressants. A care manager coordinated communication between patient, obstetrician and psychiatric consultant. We measured change in the Patient Health Questionnaire 9 (PHQ-9) score. We used surveys and focus groups to measure patient and provider satisfaction and analyzed focus groups using qualitative analysis. The intervention was well accepted by providers and patients, based on survey and focus group data. Feasibility was also evidenced by recruitment (87.1%) and retention (92.6%) rates and depression outcomes (64% with >50% improvement in PHQ 9) which were comparable to clinical trials in similar urban populations. Conclusions for practice: DAWN Collaborative Care modified for treatment of perinatal depression in a rural obstetric setting is feasible and acceptable. Behavioral health services integrated into rural obstetric settings could improve care for perinatal depression.

Perinatal Practices & Traditions Among Asian Indian Women.

PubMed

Goyal, Deepika

2016-01-01

As the population in the United States grows more diverse, nurses caring for childbearing women must be aware of the many cultural traditions and customs unique to their patients. This knowledge and insight supports women and their families with the appropriate care, information, and resources. A supportive relationship builds trust, offers guidance, and allows for the new family to integrate information from nurses and other healthcare providers with the practice of certain perinatal cultural traditions. The Asian Indian culture is rich in tradition, specifically during the perinatal period. To support the cultural beliefs and practices of Asian Indian women during this time, nurses need to be aware of and consider multiple factors. Many women are navigating the new role of motherhood while making sense of and incorporating important cultural rituals. The purpose of this article is to provide an overview of perinatal cultural practices and traditions specific to the Asian Indian culture that perinatal nurses may observe in the clinical setting. Cultural traditions and practices specific to the pregnancy and postpartum period are described together with symbolism and implications for nursing practice. It is important to note that information regarding perinatal customs is provided in an effort to promote culturally sensitive nursing care and may not pertain to all Asian Indian women living in the United States.

Mental Retardation and Developmental Disabilities (MRDD) Branch. NICHD Report to the NACHHD Council

ERIC Educational Resources Information Center

National Institute of Child Health and Human Development (NICHD), 2005

2005-01-01

This document is the quadrennial report of the Mental Retardation and Developmental Disabilities (MRDD) Branch to the National Advisory Child Health and Human Development (NACHHD) Council. The MRDD Branch is a vital, evolving entity within the Center for Developmental Biology and Perinatal Medicine (CDBPM) at the National Institute of Child …

Improvement of perinatal outcome in diabetic pregnant women.

PubMed

Szilagyi, A; Szabo, I

2001-01-01

Obstetrical and perinatal outcomes in newborns of diabetic pregnant women depend on metabolic control and fetal surveillance during pregnancy. The effects of fetal surveillance on perinatal mortality and morbidity was analyzed in diabetic pregnant women with appropriate glucose control in our regional center for diabetes and pregnancy. 480 deliveries complicated by frank or gestational diabetes occurred in our Department in the period of 1988-1999. Perinatal mortality and morbidity, prevalence of premature deliveries, methods of fetal surveillance, options for respiratory distress syndrome (RDS) profilaxis, cesarean section rate, timing of delivery and its indications and occurrence of malformations have been analyzed. It was found that malformation rate and perinatal mortality may be reduced to even lower level than that of in healthy pregnant women by appropriate glucose control and by using the latest methods of intrauterine fetal surveillance including cardiotocography (non stress test and oxytocin challenge test), doppler fetal artery velocimetry and fetal pulse oximetry. Timing of delivery was needed in 35% of the cases with IDDM and 15% of gestational diabetes due to chronic placental insufficiency. If labour induction was needed before the 38 weeks, amniocentesis was performed to test fetal lung maturity. Direct fetal glucocorticoid administration was used to enhance fetal lung maturation in 14 cases. C-section rate was slightly higher than that of in non diabetic pregnant women. Our perinatal morbidity data (macrosomia, hyperbilirubinemia, hypoglycemia, injuries, infections) are comparable with the data from the literature. Although perinatal mortality with the help of thorough fetal surveillance is even better in diabetic pregnant women than in non diabetic patients, future eye should be focused on factors affecting perinatal morbidity, because it is still higher than in newborns of healthy mothers.

Perinatal pathology: practice suggestions for limited-resource settings.

PubMed

Roberts, Drucilla J

2013-06-01

The practice of perinatal pathology in much of the world suffers, as do all subspecialties of anatomic pathology, from inadequate resources (equipment, consumables, and both professional and technical personnel), from lack of education (not only of the pathologist but also of the clinicians responsible for sending the specimens, and the technicians processing the specimens), and from lack of appropriate government sector support. Perinatal pathology has significant public health-related utility and should be championing its service by providing maternal and fetal/infant mortality and morbidity data to governmental health ministries. It is with this pathologic data that informed decisions can be made on health-related courses of action and allocation of resources. These perinatal pathology data are needed to develop appropriate public health initiatives, specifically toward achieving the Millennium Developmental Goals as the best way to effectively decrease infant and maternal deaths and to determine causes of perinatal mortality and morbidity. The following overview will focus on the utility of perinatal pathology specifically as related to its public health function and will suggest methods to improve its service in resource-poor settings. This article is offered not as a critique of the current practice that most pathologists find themselves working in globally, but to provide suggestions for improving perinatal pathology services, which could be implemented with the limited available resources and manpower most pathology departments currently have. In addition, we offer suggestions for graded improvements ("ramping up") over time.

Impact of perinatal asphyxia on the GABAergic and locomotor system.

PubMed

Van de Berg, W D J; Kwaijtaal, M; de Louw, A J A; Lissone, N P A; Schmitz, C; Faull, R L M; Blokland, A; Blanco, C E; Steinbusch, H W M

2003-01-01

Perinatal asphyxia can cause neuronal loss and depletion of neurotransmitters within the striatum. The striatum plays an important role in motor control, sensorimotor integration and learning. In the present study we investigated whether perinatal asphyxia leads to motor deficits related to striatal damage, and in particular to the loss of GABAergic neurons. Perinatal asphyxia was induced in time-pregnant Wistar rats on the day of delivery by placing the uterus horns, containing the pups, in a 37 degrees C water bath for 20 min. Three motor performance tasks (open field, grip test and walking pattern) were performed at 3 and 6 weeks of age. Antibodies against calbindin and parvalbumin were used to stain GABAergic striatal projection neurons and interneurons, respectively. The motor tests revealed subtle effects of perinatal asphyxia, i.e. small decrease in motor activity. Analysis of the walking pattern revealed an increase in stride width at 6 weeks of age after perinatal asphyxia. Furthermore, a substantial loss of calbindin-immunoreactive (-22%) and parvalbumin-immunoreactive (-43%) cells was found in the striatum following perinatal asphyxia at two months of age. GABA(A) receptor autoradiography revealed no changes in GABA binding activity within the striatum, globus pallidus or substantia nigra. We conclude that perinatal asphyxia resulted in a loss of GABAergic projection neurons and interneurons in the striatum without alteration of GABA(A) receptor affinity. Despite a considerable loss of striatal neurons, only minor deficits in motor performance were found after perinatal asphyxia.

Information Architecture for Perinatal Registration in the Netherlands.

PubMed

Goossen, William T F; Arns-Schiere, Anne Marieke

In the Netherlands, the perinatal registry has undergone significant changes in the past decades. The purpose of this article is to describe the current health care information architecture for the national perinatal registry, including how the national data set is arranged and how electronic messages are used to submit data. We provide implications for women's health care providers based on the creation and implementation of the Dutch perinatal registry system. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Lifetime Exposure to Intimate Partner Violence and Proinflammatory Cytokine Levels Across the Perinatal Period.

PubMed

Robertson Blackmore, Emma; Mittal, Mona; Cai, Xueya; Moynihan, Jan A; Matthieu, Monica M; O'Connor, Thomas G

2016-10-01

Intimate partner violence (IPV) is a public health concern, affecting one-third of US women. Prior research suggests an association between exposure to IPV and poor maternal perinatal health, but the underlying biological correlates are not well understood. This study examined the relationship between exposure to IPV and proinflammatory cytokine levels, a candidate mechanism accounting for poor psychiatric and obstetric outcomes, across the perinatal period. Data were obtained from a prospective, longitudinal cohort study of 171 women receiving obstetrical care from a hospital-based practice serving a predominantly low-income minority population. Participants completed questionnaires on IPV exposure, psychiatric symptoms, and psychosocial and obstetric factors and provided blood samples at 18 and 32 weeks of gestation and 6 weeks and 6 months postpartum. Serum levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) were assayed via enzyme-linked immunosorbent assay. Thirty-five (20.5%) women reported lifetime exposure to IPV and 7 (4.1%) reported being physically hurt in the preceding 12 months (4 while pregnant). Lifetime exposure to IPV was associated with increased likelihood of experiencing perinatal depression and smoking during pregnancy. Women with a history of IPV had significantly higher levels of TNF-α at 18 weeks (z = -2.29, p < 0.05), but significantly smaller changes in levels of IL-6 (β = -0.36, p = 0.04) across time. Lifetime exposure to IPV was associated with a range of adverse mental health outcomes and may affect proinflammatory cytokine levels in pregnancy.

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Support after perinatal death: a study of support and counselling after perinatal bereavement.

PubMed Central

Forrest, G C; Standish, E; Baum, J D

1982-01-01

After an earlier study into the practical aspects of the management of perinatal death, a counselling service was introduced for parents whose baby had died in the perinatal period. The service was monitored, and the parents who received the service were compared with a group that did not. Fifty families were allocated randomly either to the counselling (supported) group or to the contrast group, who received routine hospital care. Assessment was carried out at six and 14 months after the death, using a semi-structured interview and two self-rating scales (the general health questionnaire and the Leeds scales). Two of 16 mothers in the supported group showed psychiatric disorder at six months, compared with 10 of 19 in the contrast group (p less than 0.01, Fisher's exact test). There was no significant difference between the two groups at 14 months, when 80% of all the women studied had recovered psychiatric symptoms. Socially isolated women and those who marital relations lacked intimacy had a higher incidence of psychiatric symptoms at six months. Early pregnancy (within six months) was associated with a higher incidence of psychiatric symptoms in the unsupported group. The duration of bereavement reaction after perinatal death was appreciably shortened by support and counselling. PMID:6814610

Reliability and Validity of Instruments for Assessing Perinatal Depression in African Settings: Systematic Review and Meta-Analysis

PubMed Central

Tsai, Alexander C.; Scott, Jennifer A.; Hung, Kristin J.; Zhu, Jennifer Q.; Matthews, Lynn T.; Psaros, Christina; Tomlinson, Mark

2013-01-01

Background A major barrier to improving perinatal mental health in Africa is the lack of locally validated tools for identifying probable cases of perinatal depression or for measuring changes in depression symptom severity. We systematically reviewed the evidence on the reliability and validity of instruments to assess perinatal depression in African settings. Methods and Findings Of 1,027 records identified through searching 7 electronic databases, we reviewed 126 full-text reports. We included 25 unique studies, which were disseminated in 26 journal articles and 1 doctoral dissertation. These enrolled 12,544 women living in nine different North and sub-Saharan African countries. Only three studies (12%) used instruments developed specifically for use in a given cultural setting. Most studies provided evidence of criterion-related validity (20 [80%]) or reliability (15 [60%]), while fewer studies provided evidence of construct validity, content validity, or internal structure. The Edinburgh postnatal depression scale (EPDS), assessed in 16 studies (64%), was the most frequently used instrument in our sample. Ten studies estimated the internal consistency of the EPDS (median estimated coefficient alpha, 0.84; interquartile range, 0.71-0.87). For the 14 studies that estimated sensitivity and specificity for the EPDS, we constructed 2 x 2 tables for each cut-off score. Using a bivariate random-effects model, we estimated a pooled sensitivity of 0.94 (95% confidence interval [CI], 0.68-0.99) and a pooled specificity of 0.77 (95% CI, 0.59-0.88) at a cut-off score of ≥9, with higher cut-off scores yielding greater specificity at the cost of lower sensitivity. Conclusions The EPDS can reliably and validly measure perinatal depression symptom severity or screen for probable postnatal depression in African countries, but more validation studies on other instruments are needed. In addition, more qualitative research is needed to adequately characterize local

Could Perinatal Asphyxia Induce a Synaptopathy? New Highlights from an Experimental Model

PubMed Central

Herrera, María Inés; Udovin, Lucas Daniel; Kusnier, Carlos; Kölliker-Frers, Rodolfo; de Souza, Wanderley

2017-01-01

Birth asphyxia also termed perinatal asphyxia is an obstetric complication that strongly affects brain structure and function. Central nervous system is highly susceptible to oxidative damage caused by perinatal asphyxia while activation and maturity of the proper pathways are relevant to avoiding abnormal neural development. Perinatal asphyxia is associated with high morbimortality in term and preterm neonates. Although several studies have demonstrated a variety of biochemical and molecular pathways involved in perinatal asphyxia physiopathology, little is known about the synaptic alterations induced by perinatal asphyxia. Nearly 25% of the newborns who survive perinatal asphyxia develop neurological disorders such as cerebral palsy and certain neurodevelopmental and learning disabilities where synaptic connectivity disturbances may be involved. Accordingly, here we review and discuss the association of possible synaptic dysfunction with perinatal asphyxia on the basis of updated evidence from an experimental model. PMID:28326198

Engaging and Retaining Abused Women in Perinatal Home Visitation Programs

PubMed Central

Alhusen, Jeanne L.; Bullock, Linda; Bhandari, Shreya; Ghazarian, Sharon; Udo, Ifeyinwa E.; Campbell, Jacquelyn

2013-01-01

OBJECTIVES: Intimate partner violence (IPV) during pregnancy affects 0.9% to 17% of women and affects maternal health significantly. The impact of IPV extends to the health of children, including an increased risk of complications during pregnancy and the neonatal period, mental health problems, and cognitive delays. Despite substantial sequelae, there is limited research substantiating best practices for engaging and retaining high-risk families in perinatal home visiting (HV) programs, which have been shown to improve infant development and reduce maltreatment. METHODS: The Domestic Violence Enhanced Home Visitation Program (DOVE) is a multistate longitudinal study testing the effectiveness of a structured IPV intervention integrated into health department perinatal HV programs. The DOVE intervention, based on an empowerment model, combined 2 evidence-based interventions: a 10-minute brochure-based IPV intervention and nurse home visitation. RESULTS: Across all sites, 689 referrals were received from participating health departments. A total of 339 abused pregnant women were eligible for randomization; 42 women refused, and 239 women were randomly assigned (124 DOVE; 115 usual care), resulting in a 71% recruitment rate. Retention rates from baseline included 93% at delivery, 80% at 3 months, 76% at 6 months, and 72% at 12 months. CONCLUSIONS: Challenges for HV programs include identifying and retaining abused pregnant women in their programs. DOVE strategies for engaging and retaining abused pregnant women should be integrated into HV programs’ federal government mandates for the appropriate identification and intervention of women and children exposed to IPV. PMID:24187115

Adapting a perinatal empathic training method from South Africa to Germany.

PubMed

Knapp, Caprice; Honikman, Simone; Wirsching, Michael; Husni-Pascha, Gidah; Hänselmann, Eva

2018-01-01

Maternal mental health conditions are prevalent across the world. For women, the perinatal period is associated with increased rates of depression and anxiety. At the same time, there is widespread documentation of disrespectful care for women by maternity health staff. Improving the empathic engagement skills of maternity healthcare workers may enable them to respond to the mental health needs of their clients more effectively. In South Africa, a participatory empathic training method, the "Secret History" has been used as part of a national Department of Health training program with maternity staff and has showed promising results. For this paper, we aimed to describe an adaptation of the Secret History empathic training method from the South African to the German setting and to evaluate the adapted training. The pilot study occurred in an academic medical center in Germany. A focus group ( n  = 8) was used to adapt the training by describing the local context and changing the materials to be relevant to Germany. After adapting the materials, the pilot training was conducted with a mixed group of professionals ( n  = 15), many of whom were trainers themselves. A pre-post survey assessed the participants' empathy levels and attitudes towards the training method. In adapting the materials, the focus group discussion generated several experiences that were considered to be typical interpersonal and structural challenges facing healthcare workers in maternal care in Germany. These experiences were crafted into case scenarios that then formed the basis of the activities used in the Secret History empathic training pilot. Evaluation of the pilot training showed that although the participants had high levels of empathy in the pre-phase (100% estimated their empathic ability as high or very high), 69% became more aware of their own emotional experiences with patients and the need for self-care after the training. A majority, or 85%, indicated that the training

Father-Inclusive Perinatal Parent Education Programs: A Systematic Review.

PubMed

Lee, Joyce Y; Knauer, Heather A; Lee, Shawna J; MacEachern, Mark P; Garfield, Craig F

2018-06-14

Fathers contribute to their children's health starting at the beginning of life. Few parent education programs include fathers. Among those that do, there is little effort to report program effects on father outcomes. In this systematic review, we examined father-inclusive perinatal parent education programs in the United States as they relate to a range of father outcomes. The databases searched were PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and PsycINFO. Studies were included if they included an evaluation of a parent education program and a report of father outcomes measured within 1 year of the child's birth and were conducted within the United States. Of 1353 total articles, 21 met study criteria. The overall state of the father-inclusive perinatal parent education program literature was poor, with few interventions available to fathers. Available programs were associated with increased father involvement, coparenting relationship, partner relationship quality, father's mental health, and father's supportive behaviors. Program effects on father-infant interaction, parenting knowledge, and attitudes and parenting self-efficacy were inconclusive. Three programs emerged as best evidence-based interventions. Risk of bias was high for many studies. Outcome variability, small sample size, and publication bias contributed to the weak evidence base. There is a need for more evidence-based interventions to support fathers. Clinicians play a key role in engaging fathers in early parent education programs and health care settings. PROSPERO registration number: CRD42017050099. Copyright © 2018 by the American Academy of Pediatrics.

The perinatal effects of delayed childbearing.

PubMed

Joseph, K S; Allen, Alexander C; Dodds, Linda; Turner, Linda Ann; Scott, Heather; Liston, Robert

2005-06-01

To determine if the rates of pregnancy complications, preterm birth, small for gestational age, perinatal mortality, and serious neonatal morbidity are higher among mothers aged 35-39 years or 40 years or older, compared with mothers 20-24 years. We performed a population-based study of all women in Nova Scotia, Canada, who delivered a singleton fetus between 1988 and 2002 (N = 157,445). Family income of women who delivered between 1988 and 1995 was obtained through a confidential linkage with tax records (n = 76,300). The primary outcome was perinatal death (excluding congenital anomalies) or serious neonatal morbidity. Analysis was based on logistic models. Older women were more likely to be married, affluent, weigh 70 kg or more, attend prenatal classes, and have a bad obstetric history but less likely to be nulliparous and to smoke. They were more likely to have hypertension, diabetes mellitus, placental abruption, or placenta previa. Preterm birth and small-for-gestational age rates were also higher; compared with women aged 20-24 years, adjusted rate ratios for preterm birth among women aged 35-39 years and 40 years or older were 1.61 (95% confidence interval [CI] 1.42-1.82; P < .001) and 1.80 (95% CI 1.37-2.36; P < .001), respectively. Adjusted rate ratios for perinatal mortality/morbidity were 1.46 (95% CI 1.11-1.92; P = .007) among women 35-39 years and 1.95 (95% CI 1.13-3.35; P = .02) among women 40 years or older. Perinatal mortality rates were low at all ages, especially in recent years. Older maternal age is associated with relatively higher risks of perinatal mortality/morbidity, although the absolute rate of such outcomes is low.

Filling the treatment gap: developing a task sharing counselling intervention for perinatal depression in Khayelitsha, South Africa.

PubMed

Nyatsanza, Memory; Schneider, Marguerite; Davies, Thandi; Lund, Crick

2016-05-26

Perinatal depression is a major public health issue especially in low income settings in South Africa, where there is a shortage of mental health professionals. New psychological interventions delivered by non-specialists are needed to fill the treatment gap. This paper describes the process of developing a manual based task sharing counselling intervention for perinatal depression in Khayelitsha, Cape Town. Qualitative semi-structured interviews were conducted with 26 participants, including service providers and service users at a clinic in Khayelitsha in order to explore the feasibility, acceptability and content of a task sharing counselling intervention. The interviews were recorded, translated and transcribed. Themes were identified using the framework analysis approach and were coded and analysed using NVivo v10. After the semi-structured interviews, a workshop was conducted with mental health experts on evidence-based psychological interventions for depression, together with a document review of counselling manuals for community health workers in South Africa. The findings indicate that a task sharing counselling intervention was acceptable and feasible for depressed women in Khayelitsha, under the following conditions: (1) respondents preferred a female counsellor and felt that clinic based individual sessions should be provided at least once a month by an experienced Xhosa speaking counsellor from the community; and (2) the content of a counselling intervention should include psycho-education on cognitive and behavioural effects of depression, how to cope with interpersonal problems, and financial stressors. Based on these conditions, the review of manuals and expert consultation, key components of the counselling intervention were identified as: psycho-education, problem solving, healthy thinking and behaviour activation. These were included in the final counselling manual. The development of task sharing counselling interventions for perinatal

Functional vision in children with perinatal brain damage.

PubMed

Alimović, Sonja; Jurić, Nikolina; Bošnjak, Vlatka Mejaški

2014-09-01

Many authors have discussed the effects of visual stimulations on visual functions, but there is no research about the effects on using vision in everyday activities (i.e. functional vision). Children with perinatal brain damage can develop cerebral visual impairment with preserved visual functions (e.g. visual acuity, contrast sensitivity) but poor functional vision. Our aim was to discuss the importance of assessing and stimulating functional vision in children with perinatal brain damage. We assessed visual functions (grating visual acuity, contrast sensitivity) and functional vision (the ability of maintaining visual attention and using vision in communication) in 99 children with perinatal brain damage and visual impairment. All children were assessed before and after the visual stimulation program. Our first assessment results showed that children with perinatal brain damage had significantly more problems in functional vision than in basic visual functions. During the visual stimulation program both variables of functional vision and contrast sensitivity improved significantly, while grating acuity improved only in 2.7% of children. We also found that improvement of visual attention significantly correlated to improvement on all other functions describing vision. Therefore, functional vision assessment, especially assessment of visual attention is indispensable in early monitoring of child with perinatal brain damage.

Partner relationship, social support and perinatal distress among pregnant Icelandic women.

PubMed

Jonsdottir, Sigridur Sia; Thome, Marga; Steingrimsdottir, Thora; Lydsdottir, Linda Bara; Sigurdsson, Jon Fridrik; Olafsdottir, Halldora; Swahnberg, Katarina

2017-02-01

It is inferred that perinatal distress has adverse effects on the prospective mother and the health of the foetus/infant. More knowledge is needed to identify which symptoms of perinatal distress should be assessed during pregnancy and to shed light on the impact of women's satisfaction with their partner relationship on perinatal distress. The current study aimed to generate knowledge about the association of the partner relationship and social support when women are dealing with perinatal distress expressed by symptoms of depression, anxiety and stress. A structured interview was conducted with 562 Icelandic women who were screened three times during pregnancy with the Edinburgh Depression Scale and the Depression, Anxiety, Stress Scale. Of these, 360 had symptoms of distress and 202 belonged to a non-distress group. The women answered the Multidimensional Scale of Perceived Social Support and the Dyadic Adjustment Scale. The study had a multicentre prospective design allowing for exploration of association with perinatal distress. Women who were dissatisfied in their partner relationship were four times more likely to experience perinatal distress. Women with perinatal distress scored highest on the DASS Stress Subscale and the second highest scores were found on the Anxiety Subscale. Satisfaction in partner relationship is related to perinatal distress and needs to be assessed when health care professionals take care of distressed pregnant women, her partner and her family. Assessment of stress and anxiety should be included in the evaluation of perinatal distress, along with symptoms of depression. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

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A qualitative study about the gendered experiences of motherhood and perinatal mortality in mountain villages of Nepal: implications for improving perinatal survival.

PubMed

Paudel, Mohan; Javanparast, Sara; Dasvarma, Gouranga; Newman, Lareen

2018-05-15

We aim to examine the gendered contexts of poor perinatal survival in the remote mountain villages of Nepal. The study setting comprised two remote mountain villages from a mid-western mountain district of Nepal that ranks lowest on the Human Development Index (0.304), and is reported as having the lowest child survival rates in the country. The findings are taken from a larger study of perinatal survival in remote mountain villages of Nepal, conducted through a qualitative methodological approach within a framework of social constructionist and critical theoretical perspectives. Data were collected through in-depth interviews with 42 women and their families, plus a range of healthcare providers (nurses/auxiliary nurses, female health volunteers, support staff, Auxiliary Health Worker and a traditional healer) and other stakeholders from February to June, 2015. Data were analysed with a comprehensive coding process utilising the thematic analysis technique. The social construction of gender is one of the key factors influencing poor perinatal survival in the villages in this study. The key emerging themes from the qualitative data are: (1) Gendered social construct and vulnerability for poor perinatal survival: child marriages, son preference and repeated child bearing; (2) Pregnancy and childbirth in intra-familial dynamics of relationships and power; and (3) Perception of birth as a polluted event: birth in Gotha (cowshed) and giving birth alone. Motherhood among women of a low social position is central to women and their babies experiencing vulnerabilities related to perinatal survival in the mountain villages. Gendered constructions along the continuum from pre-pregnancy to postnatal (girl settlement, a daughter-in-law, ritual pollution about mother and child) create challenges to ensuring perinatal survival in these villages. It is imperative that policies and programmes consider such a context to develop effective working strategies for sustained reduction

From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the perinatal depression-research & screening unit study.

PubMed

Banti, Susanna; Mauri, Mauro; Oppo, Annalisa; Borri, Chiara; Rambelli, Cristina; Ramacciotti, Daniele; Montagnani, Maria S; Camilleri, Valeria; Cortopassi, Sonia; Rucci, Paola; Cassano, Giovanni B

2011-01-01

Perinatal depression is a particular challenge to clinicians, and its prevalence estimates are difficult to compare across studies. Furthermore, to our knowledge, there are no studies that systematically assessed the incidence of perinatal depression. The aim of this study is to estimate the prevalence, incidence, recurrence, and new onset of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, minor and major depression (mMD) in an unselected population of women recruited at the third month of pregnancy and followed up until the 12th month postpartum. One thousand sixty-six pregnant women were recruited. Minor and major depression was assessed in a naturalistic, longitudinal study. The Edinburgh Postnatal Depression Scale and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Disorders were administered at different time points during pregnancy and in the postpartum period. The period prevalence of mMD was 12.4% in pregnancy and 9.6% in the postpartum period. The cumulative incidence of mMD in pregnancy and in the postpartum period was 2.2% and 6.8%, respectively. Thirty-two (7.3%) women had their first episode in the perinatal period: 1.6% had a new onset of depression during pregnancy, 5.7% in the postpartum period. Our postpartum prevalence figures, which are lower than those reported in the literature, may reflect treatment during the study, suggesting that casting a multiprofessional network around women in need of support may be potentially useful for reducing the effects of this disorder on the mother and the newborn child. Furthermore, our results indicate that women with a history of depression have a 2-fold risk of developing mMD in the perinatal period. Copyright © 2011 Elsevier Inc. All rights reserved.

Anxiety measures validated in perinatal populations: a systematic review.

PubMed

Meades, Rose; Ayers, Susan

2011-09-01

Research and screening of anxiety in the perinatal period is hampered by a lack of psychometric data on self-report anxiety measures used in perinatal populations. This paper aimed to review self-report measures that have been validated with perinatal women. A systematic search was carried out of four electronic databases. Additional papers were obtained through searching identified articles. Thirty studies were identified that reported validation of an anxiety measure with perinatal women. Most commonly validated self-report measures were the General Health Questionnaire (GHQ), State-Trait Anxiety Inventory (STAI), and Hospital Anxiety and Depression Scales (HADS). Of the 30 studies included, 11 used a clinical interview to provide criterion validity. Remaining studies reported one or more other forms of validity (factorial, discriminant, concurrent and predictive) or reliability. The STAI shows criterion, discriminant and predictive validity and may be most useful for research purposes as a specific measure of anxiety. The Kessler 10 (K-10) may be the best short screening measure due to its ability to differentiate anxiety disorders. The Depression Anxiety Stress Scales 21 (DASS-21) measures multiple types of distress, shows appropriate content, and remains to be validated against clinical interview in perinatal populations. Nineteen studies did not report sensitivity or specificity data. The early stages of research into perinatal anxiety, the multitude of measures in use, and methodological differences restrict comparison of measures across studies. There is a need for further validation of self-report measures of anxiety in the perinatal period to enable accurate screening and detection of anxiety symptoms and disorders. Copyright © 2010 Elsevier B.V. All rights reserved.

Perinatal maternal stress and serotonin signaling: effects on pain sensitivity in offspring.

PubMed

Knaepen, Liesbeth; Pawluski, Jodi L; Patijn, Jacob; van Kleef, Maarten; Tibboel, Dick; Joosten, Elbert A

2014-07-01

It has been estimated that 20% of pregnant women are facing perinatal stress and depression. Perinatal maternal stress has been shown to increase pain sensitivity in offspring. For the treatment of their depressive symptoms, pregnant women are frequently prescribed selective serotonin reuptake inhibitors (SSRIs). Since the descending pain inhibitory circuit matures perinatally, perinatal SSRI exposure has been shown to affect pain sensitivity in offspring. In the present review, we summarize experimental and clinical evidence for the effect of perinatal maternal stress and SSRI exposure on pain sensitivity in offspring. Both experimental and clinical studies show the effect of perinatal maternal stress on regulation of the hypothalamic-pituitary-adrenal (HPA) system and the serotonin pain inhibitory system. Alterations in these two systems likely underlie long-term alterations in the development of pain sensitivity. This review sheds light on the effect of perinatal maternal stress and treatment with SSRIs on offspring pain sensitivity, in relation to the developing HPA system and 5-HT signaling. © 2013 Wiley Periodicals, Inc.

Perinatal Anxiety: Approach to Diagnosis & Management in the Obstetric Setting.

PubMed

Thorsness, Katie R; Watson, Corey; Larusso, Elizabeth M

2018-05-24

Anxiety is common in women during the perinatal period, manifests with various symptomatology and severity, and is associated with significant maternal morbidity and adverse obstetrical and neonatal outcomes. Given the intimate relationship and frequency of contact, the obstetric provider is optimally positioned to create a therapeutic alliance and manage perinatal anxiety. Time constraints, absence of randomized controlled trials, mixed quality of data, and concern for potential adverse reproductive outcomes all limit clinicians' ability to initiate informed risk-benefit discussions. Clear understanding of the role of the obstetric provider in the identification, stabilization, and initiation of medication and/or referral to psychotherapy for women with perinatal anxiety disorders is critical to maternal and neonatal wellbeing. Informed by our clinical practice as perinatal psychiatric providers, we have provided a concise summary of current research on the approach to treatment of perinatal anxiety disorders in the obstetric setting, including psychotherapy and supportive interventions, primary and adjuvant psychiatric medication, and general prescribing pearls. Medications examined include antidepressants, benzodiazepines, sedative-hypnotics, antihistamines, quetiapine, buspirone, propranolol, and melatonin. Further research into management of perinatal anxiety, particularly psychopharmacological management, is warranted. Copyright © 2018 Elsevier Inc. All rights reserved.

Prenatal and Perinatal Morbidity in Children with Tic Disorders: A Mainstream School-based Population Study in Central Spain.

PubMed

Cubo, Esther; Hortigüela, Montesclaros; Jorge-Roldan, Sandra; Ciciliani, Selva Esther; Lopez, Patricia; Velasco, Leticia; Sastre, Emilio; Ausin, Vanesa; Delgado, Vanesa; Saez, Sara; Gabriel-Galán, José Trejo; Macarrón, Jesús

2014-01-01

While current research suggests that genetic factors confer the greatest risk for the development of tic disorders, studies of environmental factors are relatively few, with a lack of consistent risk factors across studies. Our aim is to analyze the association of tic disorders with exposure to prenatal and perinatal morbidity. This was a nested case-control study design. Cases and controls were selected and identified from a mainstream, school-based sample. The diagnosis of tic disorders was assigned by a movement disorder neurologist using 'Diagnostic and statistical manual of mental disorders, 4th edition, text revision' criteria, and neuropsychiatric comorbidities were screened using the Spanish computerized version of the Diagnostic Interview Schedule for Children Predictive Scale. Information regarding the exposure to pre-perinatal risk factors was collected by a retrospective review of the birth certificates. Logistic regression analyses were then performed to test the association of tic disorders with pre-perinatal risk factors. Out of 407 participants, complete pre-perinatal data were available in 153 children (64 with tics and 89 without tics). After adjusting for family history of tics, neonatal respiratory distress syndrome, body mass index, prenatal infection, and coexisting comorbid neuropsychiatric disturbances, tic disorders were associated with prenatal exposure to tobacco (odds ratio [OR] = 3.07, 95% confidence interval [CI] 1.24-7.60, p = 0.007), and cesarean section (OR = 5.78, 95% CI 1.60-20.91, p = 0.01). This nested case-control study of children with tic disorders demonstrates higher adjusted odds for tics in children with exposure to cesarean delivery and maternal smoking. Longitudinal, population-based samples are required to confirm these results.

Epilepsy after perinatal stroke with different vascular subtypes.

PubMed

Laugesaar, Rael; Vaher, Ulvi; Lõo, Silva; Kolk, Anneli; Männamaa, Mairi; Talvik, Inga; Õiglane-Shlik, Eve; Loorits, Dagmar; Talvik, Tiina; Ilves, Pilvi

2018-06-01

With an incidence up to 63 per 100,000 live births, perinatal stroke is an important cause of childhood epilepsy. The aim of the study was to find the prevalence of and predictive factors for epilepsy, and to describe the course of epilepsy in children with perinatal stroke with different vascular subtypes. Patients were retrieved from the Estonian Paediatric Stroke Database with follow-up time at least 24 months. Patients were divided into 5 perinatal stroke syndromes: neonatal arterial ischemic stroke (AIS), neonatal hemorrhagic stroke, neonatal cerebral sinovenous thrombosis, presumed AIS, and presumed periventricular venous infarction. The final study group included 73 children with perinatal stroke (39 boys). With a median follow-up time of 8.6 years, epilepsy was diagnosed in 21/73 (29%) children, most of whom had AIS (17/21, 81%). The 18-year cumulative poststroke epilepsy risk according to the Kaplan-Meier estimator was 40.8% (95% confidence interval [CI] 20.7-55.9%). The median age at epilepsy diagnosis was 50 months (range 1 month to 18.4 years). Children with neonatal AIS had the highest risk of epilepsy, but children with presumed AIS more often had severe epilepsy syndromes. Cortical lesions (odds ratio [OR] 19.7, 95% CI 2.9-133), and involvement of thalamus (OR 9.8, 95% CI 1.8-53.5) and temporal lobe (OR 8.3, 95% CI 1.8-39.6) were independently associated with poststroke epilepsy. The risk for poststroke epilepsy after perinatal stroke depends on the vascular subtype. Patients with perinatal AIS need close follow-up to detect epilepsy and start with antiepileptic treatment on time.

Perinatal Origins of Adult Disease.

PubMed

Simeoni, Umberto; Armengaud, Jean-Baptiste; Siddeek, Benazir; Tolsa, Jean-François

2018-01-01

Epidemiological and experimental studies have shown that the peri-conception period, pregnancy, and infancy are windows of particular sensibility to environmental clues which influence lifelong trajectories across health and disease. Nutrition, stress, and toxins induce epigenetic marks that control long-term gene expression patterns and can be transmitted transgenerationally. Chronic diseases of adulthood such as hypertension, diabetes, and obesity thus have early, developmental origins in the perinatal period. The early epigenome, in interaction with other actors such as the microbiome, add powerful layers of diversity to the biological predisposition generated by the genome. Such "programming" is a normal, adaptive component of development, including in normal pregnancies and births. However, perinatal disease, either maternal (such as pre-eclampsia, ges-tational diabetes, or inflammatory disease) or fetal, and neonatal diseases (such as intrauterine growth restriction and preterm birth) are major conditions of altered programming, translated into an increased risk for chronic disease in these patients when they reach adulthood. Early prevention, optimal perinatal nutrition, and specific follow-up measures are key factors in the early preservation of long-term health. © 2018 S. Karger AG, Basel.

Triplet pregnancies: perinatal outcome evolution.

PubMed

Almeida, Patrícia; Domingues, Ana Patrícia; Belo, Adriana; Fonseca, Etelvina; Moura, Paulo

2014-09-01

To evaluate the obstetric and perinatal outcomes evolution of triplet pregnancies. A prospective observational study was conducted in triplet pregnancies delivered over 16 years in a tertiary obstetric center with differentiated perinatal support. Evaluation of demographic factors, obstetric complications, gestational age at delivery, mode of delivery, birth weight and immediate newborn outcome were done over a 16 years period. A global characterization of the sample was performed considering the listed parameters. Variables were categorized in three groups according to year of occurrence: 1996-2000, 2001-2006, 2007-2011, and all parameters were compared. Of the 33 triplets included, 72.7% resulted from induced pregnancies. All except one patient received prenatal corticosteroids and five received tocolytics. All women delivered prenatally and no significant differences were seen in the mean gestational age at delivery or birth weight towards time. There were three intrauterine fetal deaths. Neonatal immediate outcomes were not significantly different over the years. Despite remarkable progresses in perinatal and neonatal cares, no noticeable impact in triplet gestations' outcomes was seen, sustaining that triplets should be avoided due to their great risk of prematurity and neonatal morbidities, either by limiting the numbers of embryos transferred or by fetal reduction.

Trends in Perinatal HIV Prevention in New York City, 1994–2003

PubMed Central

Liu, Kai-Lih; Robinson, Lisa-Gaye; Dominguez, Kenneth L.; Abrams, Elaine J.; Gill, Balwant S.; Thomas, Pauline A.

2008-01-01

Objectives. We examined trends in perinatal HIV prevention interventions in New York City implemented during 1994 to 2003 to ascertain the success of the interventions in reducing perinatal transmission. Methods. We used data obtained from infant records at 22 hospitals. We used multiple logistic regression to analyze factors associated with prenatal care and perinatal HIV transmission. Results. We analyzed data for 4729 perinatally HIV-exposed singleton births. Of mothers with prenatal care data, 92% had prenatal care. The overall proportion who received prenatal care and were diagnosed with HIV before delivery was 86% in 1994 to 1996 and 90% in 1997 to 2003. Use of prenatal antiretrovirals among mothers who received prenatal care was 63% in 1994 to 1996 and 82% in 1997 to 2003. From 1994 to 2003, cesarean births among the entire sample increased from 15% to 55%. During 1997 to 2003, the perinatal HIV transmission rate among the entire sample was 7%; 45% of mothers of infected infants had missed opportunities for perinatal HIV prevention. During 1997 to 2003, maternal illicit drug use was significantly associated with lack of prenatal care. Lack of prenatal, intrapartum, and neonatal antiretrovirals; maternal illicit drug use; and low birthweight were significantly associated with perinatal HIV transmission. Conclusions. Interventions for perinatal HIV prevention can successfully decrease HIV transmission rates. Ongoing perinatal HIV surveillance allows for monitoring the implementation of guidelines to prevent mother-to-child transmission of HIV and determining factors that may contribute to perinatal HIV transmission. PMID:18309139

[Perinatal mortality in foreign workers (author's transl)].

PubMed

Höfling, H J; Jonas, R; Brusis, E; Lochmüller, H; Selbmann, H K; Holzmann, K; Zander, J

1975-03-01

From 1970 to 1972, there were 216 perinatal deaths among 5595 newborns at the I. Frauenklinik der Universität München. 54 of these deaths were children of foreign workers (so-called "Gastarbeiter"). The data have been processed on punch cards and analysed by a computer. The differences noted underwent significance testing by the CHI-Quadrat test. Only statistical significant results are published. The perinatal mortality in the above period shows no difference between foreign and German ward patients. There is, however, a significant lower perinatal mortality in private patients. We feel that this difference is due to a significant lower rate of prematures in the private patient group. The cocial status as well as higher interest and motivation in health resulting in better prenatal care are discussed as causal reasons for this fact.

Decreasing Malpractice Claims by Reducing Preventable Perinatal Harm.

PubMed

Riley, William; Meredith, Les W; Price, Rebecca; Miller, Kristi K; Begun, James W; McCullough, Mac; Davis, Stanley

2016-12-01

To evaluate the association of improved patient safety practices with medical malpractice claims and costs in the perinatal units of acute care hospitals. Malpractice and harm data from participating hospitals; litigation records and medical malpractice claims data from American Excess Insurance Exchange, RRG, whose data are managed by Premier Insurance Management Services, Inc. (owned by Premier Inc., a health care improvement company). A quasi-experimental prospective design to compare baseline and postintervention data. Statistical significance tests for differences were performed using chi-square, Wilcoxon signed-rank test, and t-test. Claims data were collected and evaluated by experienced senior claims managers through on-site claim audits to evaluate claim frequency, severity, and financial information. Data were provided to the analyzing institution through confidentiality contracts. There is a significant reduction in the number of perinatal malpractice claims paid, losses paid, and indemnity payments (43.9 percent, 77.6 percent, and 84.6 percent, respectively) following interventions to improve perinatal patient safety and reduce perinatal harm. This compares with no significant reductions in the nonperinatal claims in the same hospitals during the same time period. The number of perinatal malpractice claims and dollar amount of claims payments decreased significantly in the participating hospitals, while there was no significant decrease in nonperinatal malpractice claims activity in the same hospitals. © Health Research and Educational Trust.

Mental health in low-to-moderate risk preterm, low birth weight, and small for gestational age children at 4 to 5 years: the role of early maternal parenting.

PubMed

Westrupp, Elizabeth M; Mensah, Fiona K; Giallo, Rebecca; Cooklin, Amanda; Nicholson, Jan M

2012-03-01

The majority of children born preterm, with low birth weight, or small for gestational age are born with low-to-moderate risk (LTM), yet most research focuses on the high-risk group. Little is known about whether children with LTM perinatal risk are at greater risk for mental health problems, or what the role of early maternal parenting is in determining these outcomes. Longitudinal data were from a large nationally representative Australian cohort of 5,000 children, aged 0 to 1, 2 to 3, and 4 to 5 years of age. Participants were 354 children with LTM perinatal risk born at 33 to 36 weeks, with birth weight 1,501 to 2,499 grams, or born between the first and 10th percentiles for gestational age; and 2,461 children in the normal birth weight, term comparison group. Child mental health was measured by mother-report on the Strengths and Difficulties Questionnaire (SDQ). Parenting irritability, warmth, self-efficacy, maternal separation anxiety, and overprotective parenting were measured when children were 0 to 1 and 2 to 3 years of age. Parents in the LTM perinatal risk group were more likely to experience parenting difficulties on one of eight parenting measures (irritable parenting at age 0-1 year) when adjusting for socio-demographic differences (odds ratio = 1.43; 95% confidence interval = 1.05, 1.95, p < .02). This group difference was no longer apparent by age 2 to 3 years. Compared with healthy-term peers, there were small increases in Emotional Symptoms and Total Difficulties on the SDQ for the LTM perinatal risk group at age 4 to 5 years. When accounting for maternal-specific and socio-demographic factors, LTM perinatal risk group continued to predict Emotional Symptoms but not Total Difficulties at age 4 to 5 years. Children with LTM perinatal risk were at a small increased risk for emotional difficulties but did not differ significantly from other children of similar social backgrounds in their risk for generalized mental health problems. These findings

Magnitude of income-related disparities in adverse perinatal outcomes.

PubMed

Shankardass, Ketan; O'Campo, Patricia; Dodds, Linda; Fahey, John; Joseph, Ks; Morinis, Julia; Allen, Victoria M

2014-03-04

To assess and compare multiple measurements of socioeconomic position (SEP) in order to determine the relationship with adverse perinatal outcomes across various contexts. A birth registry, the Nova Scotia Atlee Perinatal Database, was confidentially linked to income tax and related information for the year in which delivery occurred. Multiple logistic regression was used to examine odds ratios between multiple indicators of SEP and multiple adverse perinatal outcomes in 117734 singleton births between 1988 and 2003. Models for after tax family income were also adjusted for neighborhood deprivation to gauge the relative magnitude of effects related to SEP at both levels. Effects of SEP were stratified by single- versus multiple-parent family composition, and by urban versus rural location of residence. The risk of small for gestational age and spontaneous preterm birth was higher across all the indicators of lower SEP, while risk for large for gestational age was lower across indicators of lower SEP. Higher risk of postneonatal death was demonstrated for several measures of lower SEP. Higher material deprivation in the neighborhood of residence was associated with increased risk for perinatal death, small for gestational age birth, and iatrogenic and spontaneous preterm birth. Family composition and urbanicity were shown to modify the association between income and some perinatal outcomes. This study highlights the importance of understanding the definitions of SEP and the mechanisms that lead to the association between income and poor perinatal outcomes, and broadening the types of SEP measures used in some cases.

The distribution of apolipoprotein E alleles in Scottish perinatal deaths

PubMed Central

Becher, J‐C; Keeling, J W; McIntosh, N; Wyatt, B; Bell, J

2006-01-01

Background The apolipoprotein E (ApoE) polymorphism has been well studied in the adult human population, in part because the e4 allele is a known risk factor for Alzheimer's disease. Little is known of the distribution of ApoE alleles in newborns, and their association with perinatal brain damage has not been investigated. Methods ApoE genotyping was undertaken in a Scottish cohort of perinatal deaths (n = 261), some of whom had prenatal brain damage. The distribution of ApoE alleles in perinatal deaths was compared with that in healthy liveborn infants and in adults in Scotland. Results ApoE e2 was over‐represented in 251 perinatal deaths (13% v 8% in healthy newborns, odds ratio (OR) = 1.63, 95% confidence interval (CI) 1.13 to 2.36 and 13% v 8% in adults, OR = 1.67, 95% CI 1.16 to 2.41), both in liveborn and stillborn perinatal deaths. In contrast, the prevalence of ApoE e4 was raised in healthy liveborn infants (19%) compared with stillbirths (13%, OR = 1.59, 95% CI 1.11 to 2.26) and with adults (15%, OR = 1.35, 95% CI 1.04 to 1.76). However, no correlation was found between ApoE genotype and the presence or absence of perinatal brain damage. Conclusions This study shows a shift in ApoE allelic distribution in early life compared with adults. The raised prevalence of ApoE e2 associated with perinatal death suggests that this allele is detrimental to pregnancy outcome, whereas ApoE e4 may be less so. However, ApoE genotype did not appear to influence the vulnerability for perinatal hypoxic/ischaemic brain damage, in agreement with findings in adult brains and in animal models. PMID:16183800

Community Conversations with Parents to Improve Perinatal Care

ERIC Educational Resources Information Center

Martin, Joanne

2007-01-01

The state of Indiana took a unique approach to developing a statewide plan to improve perinatal health outcomes by engaging parents in a series of focus groups, called Community Conversations in Perinatal Care (CCPC), to hear directly from consumers about their health care experiences and needs. Recognizing that disparities exist among different…

Mapping Perinatal Nursing Process Measurement Concepts to Standard Terminologies.

PubMed

Ivory, Catherine H

2016-07-01

The use of standard terminologies is an essential component for using data to inform practice and conduct research; perinatal nursing data standardization is needed. This study explored whether 76 distinct process elements important for perinatal nursing were present in four American Nurses Association-recognized standard terminologies. The 76 process elements were taken from a valid paper-based perinatal nursing process measurement tool. Using terminology-supported browsers, the elements were manually mapped to the selected terminologies by the researcher. A five-member expert panel validated 100% of the mapping findings. The majority of the process elements (n = 63, 83%) were present in SNOMED-CT, 28% (n = 21) in LOINC, 34% (n = 26) in ICNP, and 15% (n = 11) in CCC. SNOMED-CT and LOINC are terminologies currently recommended for use to facilitate interoperability in the capture of assessment and problem data in certified electronic medical records. Study results suggest that SNOMED-CT and LOINC contain perinatal nursing process elements and are useful standard terminologies to support perinatal nursing practice in electronic health records. Terminology mapping is the first step toward incorporating traditional paper-based tools into electronic systems.

Lifetime Exposure to Intimate Partner Violence and Proinflammatory Cytokine Levels Across the Perinatal Period

PubMed Central

Mittal, Mona; Cai, Xueya; Moynihan, Jan A.; Matthieu, Monica M.; O'Connor, Thomas G.

2016-01-01

Abstract Background: Intimate partner violence (IPV) is a public health concern, affecting one-third of US women. Prior research suggests an association between exposure to IPV and poor maternal perinatal health, but the underlying biological correlates are not well understood. This study examined the relationship between exposure to IPV and proinflammatory cytokine levels, a candidate mechanism accounting for poor psychiatric and obstetric outcomes, across the perinatal period. Materials and Methods: Data were obtained from a prospective, longitudinal cohort study of 171 women receiving obstetrical care from a hospital-based practice serving a predominantly low-income minority population. Participants completed questionnaires on IPV exposure, psychiatric symptoms, and psychosocial and obstetric factors and provided blood samples at 18 and 32 weeks of gestation and 6 weeks and 6 months postpartum. Serum levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) were assayed via enzyme-linked immunosorbent assay. Results: Thirty-five (20.5%) women reported lifetime exposure to IPV and 7 (4.1%) reported being physically hurt in the preceding 12 months (4 while pregnant). Lifetime exposure to IPV was associated with increased likelihood of experiencing perinatal depression and smoking during pregnancy. Women with a history of IPV had significantly higher levels of TNF-α at 18 weeks (z = −2.29, p < 0.05), but significantly smaller changes in levels of IL-6 (β = −0.36, p = 0.04) across time. Conclusion: Lifetime exposure to IPV was associated with a range of adverse mental health outcomes and may affect proinflammatory cytokine levels in pregnancy. PMID:26744816

Perinatal thrombosis: implications for mothers and neonates.

PubMed

O'Brien, Sarah H

2015-01-01

Stroke is more likely to occur in the perinatal period than any other time in childhood, and these events can lead to a lifetime of intellectual and motor disabilities, epilepsy, and behavioral challenges. This review describes the epidemiology and natural history of perinatal arterial ischemic stroke (PAIS) and cerebral sinovenous thrombosis (CSVT), risk factors for these complications, recent evidence regarding treatment strategies, and current gaps in knowledge. Existing evidence demonstrates the multifactorial etiology of symptomatic ischemic stroke in neonates, which includes a combination of maternal, delivery, and neonatal factors. The importance of inherited thrombophilia in the pathophysiology and long-term outcomes of perinatal stroke requires additional study. At this time, there is no evidence to support routine extensive thrombophilia screening outside of a research setting. Despite the frequency of perinatal stroke and its association with substantial morbidity, treatment strategies are currently limited, and prevention strategies are nonexistent. Anticoagulation is rarely indicated in PAIS, and more work needs to focus on neuroprotective prevention and alternate treatment strategies. Anticoagulation does appear to be safe in CSVT and may prevent thrombus progression but clinical equipoise remains, and clinical trials are needed to obtain evidence regarding short- and long-term efficacy outcomes. © 2015 by The American Society of Hematology. All rights reserved.

[Studies on flomoxef in the perinatal period].

PubMed

Cho, N; Fukunaga, K; Kunii, K; Kobayashi, I

1991-06-01

Pharmacokinetic, bacteriological and clinical studies on flomoxef (FMOX) in the perinatal period were carried out with the following summary of the results. Antibacterial effects of FMOX on the growth of methicillin-resistant Staphylococcus aureus (MRSA, MIC 400 micrograms/ml), methicillin-sensitive S. aureus (MSSA, MIC 0.78 microgram/ml), Escherichia coli (MIC 3.13 micrograms/ml and MIC 0.20 microgram/ml) in amniotic fluid were determined and it was found that the activity of FMOX was enhanced in the amniotic fluid. FMOX rapidly penetrated into tissues and sera of pregnant women upon intravenous injection and its maternal serum concentrations reached their peak levels shortly after administration. Placental penetration of FMOX to the fetus was good and, after single intravenous injection of 1 g, the concentrations of FMOX in the umbilical cord serum and amniotic fluid exceeded MICs against major causative organisms of perinatal infections. These results indicate that single intravenous injection of FMOX 1 g twice a day is effective for the treatment and prophylaxis of perinatal infections. Injection of FMOX for the treatment of 14 cases of puerperal infections showed excellent clinical effectiveness with 100% clinical effect and 81.8% bacteriological response. No side-effect was observed in any case. All of these results suggested clinical usefulness of FMOX in the perinatal period.

Mother-infant antidepressant concentrations, maternal depression, and perinatal events.

PubMed

Sit, Dorothy; Perel, James M; Wisniewski, Stephen R; Helsel, Joseph C; Luther, James F; Wisner, Katherine L

2011-07-01

The authors explored the relationship of cord-maternal antidepressant concentration ratios and maternal depression with perinatal events and preterm birth. The investigators examined 21 mother-infant pairs that had antidepressant exposure during pregnancy. The antidepressants included serotonin reuptake inhibitors (SRIs) and nortriptyline (a norepinephrine inhibitor and mild SRI). The mothers were evaluated with the Structured Clinical Interview for DSM-IV. Depression ratings were repeated at 20, 30, and 36 weeks' pregnancy. At delivery, investigators assessed cord and maternal antidepressant concentrations, neonatal outcomes on the Peripartum Events Scale (PES), and gestational weeks at birth. The investigators performed this study at the Women's Behavioral HealthCARE Program, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pennsylvania, from April 2003 until September 2006. Mean ± SD cord-to-maternal concentration ratios were 0.52 ± 0.35 (range, 0.00-1.64) for the parent drug and 0.54 ± 0.17 (range, 0.28-0.79) for the metabolite. Nine of 21 mothers (43%) had a major depressive episode. From examining the maximum depression ratings, the mean ± SD Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms Version score was 16.0 ± 7.6. One third (7/21) of infants had at least 1 perinatal event (PES ≥ 1). The frequency of deliveries complicated by any perinatal event was similar in depressed and nondepressed mothers. There was no significant association between perinatal events and cord-to-maternal antidepressant concentration ratios or maternal depression levels. Exposure to short half-life antidepressants compared to fluoxetine resulted in more perinatal events (7/16 = 44% vs 0/5 = 0%; P = .06). Fourteen percent (3/21) of infants were preterm. Preterm birth was not associated with cord-to-maternal metabolite concentration ratios, depression levels, or exposure to fluoxetine

[History of Instituto Nacional de Salud Ocupacional del Peru].

PubMed

Cossio-Brazzan, Juan M

2012-06-01

In Peru, the industry's development has made economic improvements but at the same time, it has had a major impact on the health of the workers; for that reason, it was necessary to generate control mechanisms. So, in 1940 it was created the Departmento de Higiene Industrial, which in 1956 was changed to Instituto de Salud Ocupacional, but it was deactivated in 1994. However, in 2001 it reappeared into the Ministerio de Salud organizational structure with the name of Instituto de Salud Ocupacional "Alberto Hurtado Abadía". Actually, it is the Centro Nacional de Salud Ocupacional y Protección del Ambiente para la Salud (CENSOPAS), organ of the Instituto Nacional de Salud which continues working in synergy with other institutions and sectors, making research to protect the health of exposed persons (workers and community) to contamination and risks associated with economic activities.

[Family, Through Mental Health and Sickness].

PubMed

Solano Murcia, Martha Inés; Vasquez Cardozo, Socorro

2014-01-01

The following article arises from the study "Representaciones sociales en el campo de la salud mental" (Social Representations in the Mental Health Field), in which the objective was to address the social representations in the family context; concerning caring, as well as the burden it implies using a qualitative method. The corpus was built based on the analysis and interpretation gathered from families with mental illness members. There were 17 individual interviews, 13 group interviews and one family group of three generations, held regarding the clinical care of the family member. These interviews were held at three different hospitals in Bogota. The representation of "a family" constitutes the structuring of the meanings of family relationships that cope with mental illness built upon the social and historical life of its members. The three comprehensive categories were: a) Family in good times and bad times; b) mental illness in family interactions, and c) Care and burden. Socially speaking, mental illness can lead to dehumanization, in that it discriminates and stigmatizes, even within the family unit. Caring for a family member with mental illness comes about by hierarchical order, self assignation, and by institutionalization. This latter occurs due to lack of caregivers or because the family does not consider their home the best place to care for such a patient. Copyright © 2013 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Magnitude of income-related disparities in adverse perinatal outcomes

PubMed Central

2014-01-01

Background To assess and compare multiple measurements of socioeconomic position (SEP) in order to determine the relationship with adverse perinatal outcomes across various contexts. Methods A birth registry, the Nova Scotia Atlee Perinatal Database, was confidentially linked to income tax and related information for the year in which delivery occurred. Multiple logistic regression was used to examine odds ratios between multiple indicators of SEP and multiple adverse perinatal outcomes in 117734 singleton births between 1988 and 2003. Models for after tax family income were also adjusted for neighborhood deprivation to gauge the relative magnitude of effects related to SEP at both levels. Effects of SEP were stratified by single- versus multiple-parent family composition, and by urban versus rural location of residence. Results The risk of small for gestational age and spontaneous preterm birth was higher across all the indicators of lower SEP, while risk for large for gestational age was lower across indicators of lower SEP. Higher risk of postneonatal death was demonstrated for several measures of lower SEP. Higher material deprivation in the neighborhood of residence was associated with increased risk for perinatal death, small for gestational age birth, and iatrogenic and spontaneous preterm birth. Family composition and urbanicity were shown to modify the association between income and some perinatal outcomes. Conclusions This study highlights the importance of understanding the definitions of SEP and the mechanisms that lead to the association between income and poor perinatal outcomes, and broadening the types of SEP measures used in some cases. PMID:24589212

Perinatal complications associated with autism--a case control study in a neurodevelopment and early intervention clinic.

PubMed

Nath, Saswati; Roy, Rita; Mukherjee, Suchandra

2012-08-01

Early and intensive intervention can have a profound impact on the quality of life for children at risk for autism. Hence a high degree of suspicion towards babies exposed to known risk factors is warranted. Previous studies have shown that different perinatal factors like antepartum bleeding, postmaturity, birth asphyxia, meconium aspiration syndrome, anaemia in early infancy and exposure to toxins of various origins makes an infant susceptible to development of autism; attention deficit hyperactivity disorder (ADHD) and other neurodevelopmental disorders in later life.This study aims to find out the association of perinatal risk factors in relation to development of autism spectrum disorders. All babies who are at least three years of age, attending the neurodevelopment and early intervention clinic at SSKM Hospital at Kolkata taken as cases. Age matched controls were taken from general paediatric OPD of the same hospital. After history taking, physical and neurological examination, developmental maturity was assessed by the Denver Developmental Screening Test (DDST) and Vineland Social Maturity Scale (VSMS). A semi-structured parent's questionnaire and the modified checklist for autism in toddlers (M-CHAT) was used to screen for autism. Diagnosis was confirmed by DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition, Text Revision) criteria. Significant correlation was found between presence of antepartum haemorrhage, pregnancy induced hypertension, preterm delivery and autism in the baby. Perinatal complications are important risk factor for autism. Knowing the risk factors will help clinicians to be aware of the avoidable complications, and to undertake either preventive steps or intense intervention to reduce the degree of disability.

Introduction of a qualitative perinatal audit at Muhimbili National Hospital, Dar es Salaam, Tanzania

PubMed Central

Kidanto, Hussein L; Mogren, Ingrid; van Roosmalen, Jos; Thomas, Angela N; Massawe, Siriel N; Nystrom, Lennarth; Lindmark, Gunilla

2009-01-01

Background Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality rate (PMR). Methods From 1st August, 2007 to 31st December, 2007 we conducted an audit of perinatal deaths (n = 133) with birth weight 1500 g or more at Muhimbili National Hospital (MNH). The audit was done by three obstetricians, two external and one internal auditors. Each auditor independently evaluated the cases narratives. Suboptimal factors were identified in the antepartum, intrapartum and early neonatal period and classified into three levels of delay (community, infrastructure and health care). The contribution of each suboptimal factor to adverse perinatal outcome was identified and the case graded according to possible avoidability. Degree of agreement between auditors was assessed by the kappa coefficient. Results The PMR was 92 per 1000 total births. Suboptimal factors were identified in 80% of audited cases and half of suboptimal factors were found to be the likely cause of adverse perinatal outcome and were preventable. Poor foetal heart monitoring during labour was indirectly associated with over 40% of perinatal death. There was a poor to fair agreement between external and internal auditors. Conclusion There are significant areas of care that need improvement. Poor monitoring during labour was a major cause of avoidable perinatal mortality. This type of audit was a good starting point for quality assurance at MNH. Regular perinatal audits to identify avoidable causes of perinatal deaths with feed back to the staff may be a useful strategy to reduce perinatal mortality. PMID:19765312

Prenatal and Perinatal Morbidity in Children with Tic Disorders: A Mainstream School-based Population Study in Central Spain

PubMed Central

Cubo, Esther; Hortigüela, Montesclaros; Jorge-Roldan, Sandra; Ciciliani, Selva Esther; Lopez, Patricia; Velasco, Leticia; Sastre, Emilio; Ausin, Vanesa; Delgado, Vanesa; Saez, Sara; Gabriel-Galán, José Trejo; Macarrón, Jesús

2014-01-01

Background While current research suggests that genetic factors confer the greatest risk for the development of tic disorders, studies of environmental factors are relatively few, with a lack of consistent risk factors across studies. Our aim is to analyze the association of tic disorders with exposure to prenatal and perinatal morbidity. Methods This was a nested case–control study design. Cases and controls were selected and identified from a mainstream, school-based sample. The diagnosis of tic disorders was assigned by a movement disorder neurologist using ‘Diagnostic and statistical manual of mental disorders, 4th edition, text revision’ criteria, and neuropsychiatric comorbidities were screened using the Spanish computerized version of the Diagnostic Interview Schedule for Children Predictive Scale. Information regarding the exposure to pre-perinatal risk factors was collected by a retrospective review of the birth certificates. Logistic regression analyses were then performed to test the association of tic disorders with pre-perinatal risk factors. Results Out of 407 participants, complete pre-perinatal data were available in 153 children (64 with tics and 89 without tics). After adjusting for family history of tics, neonatal respiratory distress syndrome, body mass index, prenatal infection, and coexisting comorbid neuropsychiatric disturbances, tic disorders were associated with prenatal exposure to tobacco (odds ratio [OR] = 3.07, 95% confidence interval [CI] 1.24–7.60, p = 0.007), and cesarean section (OR = 5.78, 95% CI 1.60–20.91, p = 0.01). Discussion This nested case–control study of children with tic disorders demonstrates higher adjusted odds for tics in children with exposure to cesarean delivery and maternal smoking. Longitudinal, population-based samples are required to confirm these results. PMID:25562036

Hippocampal volume and memory performance in children with perinatal stroke.

PubMed

Gold, Jeffrey J; Trauner, Doris A

2014-01-01

Pediatric neurologists and neonatologists often are asked to predict cognitive outcome after perinatal brain injury (including likely memory and learning outcomes). However, relatively few data exist on how accurate predictions can be made. Furthermore, although the consequences of brain injury on hippocampal volume and memory performance have been studied extensively in adults, little work has been done in children. We measured the volume of the hippocampus in 27 children with perinatal stroke and 19 controls, and measured their performance on standardized verbal and non-verbal memory tests. We discovered the following: (1) As a group, children with perinatal stroke had smaller left and right hippocampi compared with control children. (2) Individually, children with perinatal stroke demonstrated 1 of 3 findings: no hippocampal loss, unilateral hippocampal loss, or bilateral hippocampal volume loss compared with control children. (3) Hippocampal volume inversely correlated with memory test performance in the perinatal stroke group, with smaller left and right hippocampal volumes related to poorer verbal and non-verbal memory test performance, respectively. (4) Seizures played a significant role in determining memory deficit and extent of hippocampal volume reduction in patients with perinatal stroke. These findings support the view that, in the developing brain, the left and right hippocampi preferentially support verbal and nonverbal memory respectively, a consistent finding in the adult literature but a subject of debate in the pediatric literature. This is the first work to report that children with focal brain injury incurred from perinatal stroke have volume reduction in the hippocampus and impairments in certain aspects of declarative memory. Copyright © 2014 Elsevier Inc. All rights reserved.

Mild Cognitive Impairment in Early Life and Mental Health Problems in Adulthood

PubMed Central

Chen, Chuan-Yu; Lawlor, John P.; Duggan, Anne K.; Hardy, Janet B.; Eaton, William W.

2006-01-01

Objectives. We assessed the extent to which borderline mental retardation and mental retardation at preschool ages are related to emotional and behavioral problems in young adulthood. We also explored early risk factors for having mental health problems as a young adult that might be related to preschool differences in cognitive ability. Methods. We used data from a cohort of births studied in the Johns Hopkins Collaborative Perinatal Study and followed up in the Pathways to Adulthood Study. Preschool cognitive functioning was assessed at 4 years of age. Individual characteristics, psychosocial factors, and mental problems were prospectively evaluated from birth through young adulthood. Results. Children with subaverage cognitive abilities were more likely to develop mental health problems than their counterparts with IQs above 80. Inadequate family interactions were shown to increase 2- to 4-fold the risk of emotional or behavioral problems among children with borderline mental retardation. Conclusions. Subaverage cognitive functioning in early life increases later risk of mental health problems. Future research may help to delineate possible impediments faced at different developmental stages and guide changes in supportive services to better address the needs of children with borderline mental retardation. PMID:17008572

Mild cognitive impairment in early life and mental health problems in adulthood.

PubMed

Chen, Chuan-Yu; Lawlor, John P; Duggan, Anne K; Hardy, Janet B; Eaton, William W

2006-10-01

We assessed the extent to which borderline mental retardation and mental retardation at preschool ages are related to emotional and behavioral problems in young adulthood. We also explored early risk factors for having mental health problems as a young adult that might be related to preschool differences in cognitive ability. We used data from a cohort of births studied in the Johns Hopkins Collaborative Perinatal Study and followed up in the Pathways to Adulthood Study. Preschool cognitive functioning was assessed at 4 years of age. Individual characteristics, psychosocial factors, and mental problems were prospectively evaluated from birth through young adulthood. Children with subaverage cognitive abilities were more likely to develop mental health problems than their counterparts with IQs above 80. Inadequate family interactions were shown to increase 2- to 4-fold the risk of emotional or behavioral problems among children with borderline mental retardation. Subaverage cognitive functioning in early life increases later risk of mental health problems. Future research may help to delineate possible impediments faced at different developmental stages and guide changes in supportive services to better address the needs of children with borderline mental retardation.

Recurrence of perinatal death in Northern Tanzania: a registry based cohort study.

PubMed

Mahande, Michael J; Daltveit, Anne K; Mmbaga, Blandina T; Obure, Joseph; Masenga, Gileard; Manongi, Rachel; Lie, Rolv T

2013-08-29

Perinatal mortality is known to be high in Sub-Saharan Africa. Some women may carry a particularly high risk which would be reflected in a high recurrence risk. We aim to estimate the recurrence risk of perinatal death using data from a hospital in Northern Tanzania. We constructed a cohort study using data from the hospital based KCMC Medical Birth Registry. Women who delivered a singleton for the first time at the hospital between 2000 and 2008 were followed in the registry for subsequent deliveries up to 2010 and 3,909 women were identified with at least one more delivery within the follow-up period. Recurrence risk of perinatal death was estimated in multivariate models analysis while adjusting for confounders and accounting for correlation between births from the same mother. The recurrence risk of perinatal death for women who had lost a previous baby was 9.1%. This amounted to a relative risk of 3.2 (95% CI: 2.2 - 4.7) compared to the much lower risk of 2.8% for women who had had a surviving baby. Recurrence contributed 21.2% (31/146) of perinatal deaths in subsequent pregnancies. Preeclampsia, placental abruption, placenta previa, induced labor, preterm delivery and low birth weight in a previous delivery with a surviving baby were also associated with increased perinatal mortality in the next pregnancy. Some women in Tanzanian who suffer a perinatal loss in one pregnancy are at a particularly high risk of also losing the baby of a subsequent pregnancy. Strategies of perinatal death prevention that target pregnant women who are particularly vulnerable or already have experienced a perinatal loss should be considered in future research.

Perinatal asphyxia: a review from a metabolomics perspective.

PubMed

Fattuoni, Claudia; Palmas, Francesco; Noto, Antonio; Fanos, Vassilios; Barberini, Luigi

2015-04-17

Perinatal asphyxia is defined as an oxygen deprivation that occurs around the time of birth, and may be caused by several perinatal events. This medical condition affects some four million neonates worldwide per year, causing the death of one million subjects. In most cases, infants successfully recover from hypoxia episodes; however, some patients may develop HIE, leading to permanent neurological conditions or impairment of different organs and systems. Given its multifactor dependency, the timing, severity and outcome of this disease, mainly assessed through Sarnat staging, are of difficult evaluation. Moreover, although the latest newborn resuscitation guideline suggests the use of a 21% oxygen concentration or room air, such an approach is still under debate. Therefore, the pathological mechanism is still not clear and a golden standard treatment has yet to be defined. In this context, metabolomics, a new discipline that has described important perinatal issues over the last years, proved to be a useful tool for the monitoring, the assessment, and the identification of potential biomarkers associated with asphyxia events. This review covers metabolomics research on perinatal asphyxia condition, examining in detail the studies reported both on animal and human models.

Common mental disorders and associated factors: a study of women from a rural area.

PubMed

Parreira, Bibiane Dias Miranda; Goulart, Bethania Ferreira; Haas, Vanderlei José; Silva, Sueli Riul da; Monteiro, Juliana Cristina Dos Santos; Gomes-Sponholz, Flávia Azevedo; Parreira, Bibiane Dias Miranda; Goulart, Bethania Ferreira; Haas, Vanderlei José; Silva, Sueli Riul da; Monteiro, Juliana Cristina Dos Santos; Gomes-Sponholz, Flávia Azevedo

2017-05-25

associação de fatores sociais e comportamentais com o transtorno mental comum, entre mulheres rurais. A identificação e a assistência individualizada na atenção primária de saúde são essenciais para a qualidade de vida destas mulheres. Identificar la prevalencia de trastornos mentales comunes y analizar la influencia de las variables socio-demográficas, económicas, de comportamiento y de salud reproductiva en el trastorno mental común en las mujeres en edad fértil, que viven en el municipio rural de Uberaba, Minas Gerais, Brasil. Estudio observacional y transversal. Se usaron instrumentos sociodemográficos, económicos, de comportamiento y salud reproductiva, y el Self-Reporting Questionnaire (SRQ-20) para identificar los trastornos mentales comunes. En el análisis multifactorial de los datos, se utilizó la regresión logística múltiple. El estudio incluyó a 280 mujeres. La prevalencia de los trastornos mentales comunes fue de 35,7%. En el análisis de regresión logística, las variables convivencia con su pareja y la escolarización se asociaron con trastorno mental común, incluso después de ajustar por otras variables. Los resultados muestran la relación entre los factores sociales y de comportamiento con el trastorno mental común entre las mujeres rurales. La identificación y la atención individual en la atención primaria de salud son esenciales para la calidad de vida de las mujeres.

A current landscape of provincial perinatal data collection in Canada.

PubMed

Massey, Kiran A; Magee, Laura A; Dale, Sheryll; Claydon, Jennifer; Morris, Tara J; von Dadelszen, Peter; Liston, Robert M; Ansermino, J Mark

2009-03-01

The Canadian Perinatal Network (CPN) was launched in 2005 as a national perinatal database project designed to identify best practices in maternity care. The inaugural project of CPN is focused on interventions that optimize maternal and perinatal outcomes in women with threatened preterm birth at 22+0 to 28+6 weeks' gestation. To examine existing data collection by perinatal health programs (PHPs) to inform decisions about shared data collection and CPN database construction. We reviewed the database manuals and websites of all Canadian PHPs and compiled a list of data fields and their definitions. We compared these fields and definitions with those of CPN and the Canadian Minimal Dataset, proposed as a common dataset by the Canadian Perinatal Programs Coalition of Canadian PHPs. PHPs collect information on 2/3 of deliveries in Canada. PHPs consistently collect information on maternal demographics (including both maternal and neonatal personal identifiers), past obstetrical history, maternal lifestyle, aspects of labour and delivery, and basic neonatal outcomes. However, most PHPs collect insufficient data to enable identification of obstetric (and neonatal) practices associated with improved maternal and perinatal outcomes. In addition, there is between-PHP variability in defining many data fields. Construction of a separate CPN database was needed although harmonization of data field definitions with those of the proposed Canadian Minimal Dataset was done to plan for future shared data collection. This convergence should be the goal of researchers and clinicians alike as we construct a common language for electronic health records.

Association of premenstrual/menstrual symptoms with perinatal depression and a polymorphic repeat in the polyglutamine tract of the retinoic acid induced 1 gene.

PubMed

Tan, Ene-Choo; Tan, Hui-San; Chua, Tze-Ern; Lee, Theresa; Ng, Jasmine; Ch'ng, Ying-Chia; Choo, Chih-Huei; Chen, Helen Y

2014-06-01

Depression during pregnancy or after childbirth is the most frequent perinatal illness affecting women. We investigated the length distribution of a trinucleotide repeat in RAI1, which has not been studied in perinatal depression or in the Chinese population. Cases (n=139) with confirmed diagnosis of clinical (major) depression related to pregnancy/postpartum were recruited from the outpatient clinic. Controls were patients who came to the obstetrics clinics and scored <7 on the Edinburgh Postnatal Depression Scale (EPDS) (n=540). Saliva samples for DNA analysis, demographic information and self-reported frequency of occurrence of various premenstrual/menstrual symptoms were collected from all participants. Genomic DNA was extracted from saliva and relevant region sequenced to determine the number of CAG/CAA repeats that encodes the polyglutamine tract in the N terminal of the protein. Difference between groups was assessed by chi-square analysis for categorical variables and analysis of variance for quantitative scores. Compared to control subjects, patients with perinatal depression reported more frequent mood changes, cramps, nausea, vomiting, diarrhoea, and headache during premenstrual/menstrual periods (p=0.000). For the RAI1 gene CAG/CAA repeat, there was a statistically significant difference in the genotypic distribution between cases and controls (p=0.031). There was also a statistically significant association between the 14-repeat allele and perinatal depression (p=0.016). Family history, previous mental illness, and physical and psychological symptoms during the premenstrual/menstrual periods were self-reported. EPDS screening was done only once for controls. The RAI1 gene polyglutamine repeat has a different distribution in our population. The 14-repeat allele is associated with perinatal depression and more frequent experience of physical and psychological symptoms during menstrual period. Copyright © 2014 Elsevier B.V. All rights reserved.

Modifying CBT for Perinatal Depression: What Do Women Want?

ERIC Educational Resources Information Center

O'Mahen, Heather; Fedock, Gina; Henshaw, Erin; Himle, Joseph A.; Forman, Jane; Flynn, Heather A.

2012-01-01

The evidence for the efficacy of CBT for depression during the perinatal period is mixed. This was a qualitative study that aimed to understand the perinatal-specific needs of depressed women in an effort to inform treatment modifications that may increase the relevance and acceptability of CBT during this period. Stratified purposeful sampling…

Perinatal death of triplet pregnancies by chorionicity.

PubMed

Kawaguchi, Haruna; Ishii, Keisuke; Yamamoto, Ryo; Hayashi, Shusaku; Mitsuda, Nobuaki

2013-07-01

The purpose of this study was to evaluate the perinatal risk of death by chorionicity at >22 weeks of gestation of triplet pregnancies. In a retrospective cohort study, the perinatal data were collected from triplet pregnancies in Japanese perinatal care centers between 1999 and 2009. We included maternal characteristics and examined the following factors: prenatal interventions, pregnancy outcome, and neonatal outcome. The association between fetal or neonatal death of triplets and chorionicity was evaluated by logistic regression analysis. After the exclusion of 253 cases, the study group comprised 701 cases: 507 trichorionic triamniotic (TT) triplet pregnancies, 144 diamniotic triamniotic (DT) triplet pregnancies, and 50 monochorionic triamniotic (MT) triplet pregnancies. The mortality rate (fetal death at >22 weeks of gestation; neonatal death) in triplets was 2.6% and included 2.1% of TT triplet pregnancies, 3.2% of DT triplet pregnancies, and 5.3% of MT triplet pregnancies. No significant risk of death was identified in DT triplet pregnancies; however, MT triplet pregnancies had a 2.6-fold greater risk (adjusted odds ratio, 2.60; 95% confidence interval, 1.17-5.76; P = .019) compared with TT triplet pregnancies. Prophylactic cervical cerclage did not reduce the perinatal mortality rate at >22 weeks of gestation in triplets. The risk of death for MT triplet pregnancies is significantly higher than that of TT triplet pregnancies; however, the risk of death for DT triplet pregnancies is not. Copyright © 2013 Mosby, Inc. All rights reserved.

Prenatal and perinatal risk factors and the clinical implications on autism spectrum disorder.

PubMed

Chien, Yi-Ling; Chou, Miao-Chun; Chou, Wen-Jiun; Wu, Yu-Yu; Tsai, Wen-Che; Chiu, Yen-Nan; Gau, Susan Shur-Fen

2018-06-01

Prenatal and perinatal factors may increase the risk of autism spectrum disorder. However, little is known about whether unaffected siblings of probands with autism spectrum disorder also share the phenomenon and whether the prenatal/perinatal factors are related to the clinical severity of autistic symptoms. We compared the frequency of prenatal and perinatal factors among 323 probands with autism spectrum disorder (mean age ± standard deviation, 10.7 ± 3.5 years; males, 91.0%), 257 unaffected siblings (11.7 ± 4.5; 42.8%), and 1504 typically developing controls (8.9 ± 1.6 years; 53.1%); and investigated their effects on the severity of autistic symptoms. We found that probands with autism spectrum disorder and their unaffected siblings had more prenatal/perinatal events than typically developing controls with higher numbers of prenatal/perinatal factors in probands than in unaffected siblings. The prenatal/perinatal events were associated with greater stereotyped behaviors, social-emotional problems, socio-communication deficits, and overall severity. We also found that six prenatal/perinatal factors (i.e. preeclampsia, polyhydramnios, oligoamnios, placenta previa, umbilical cord knot, and gestational diabetes) were associated with the severity of autistic symptoms, particularly stereotyped behaviors and socio-communication deficits. Our findings suggest that prenatal and perinatal factors may potentially moderate the clinical expression of autism spectrum disorder. The underlying mechanism warrants further research.

Building a Collaboration One Day at a Time: Integrating Infant Mental Health into a Residential Drug Treatment Program

ERIC Educational Resources Information Center

Heffron, Mary Claire; Purcell, Arlene; Schalit, Jackie

2007-01-01

Families In Recovery Staying Together (FIRST) is a team from Children's Hospital and Research Center at Oakland that has joined in collaboration with two local perinatal residential drug treatment programs to create early childhood mental health services at those sites. The authors highlight the collaboration strategies and challenges the partners…

Developing a Family-Centered, Hospital-Based Perinatal Education Program

PubMed Central

Westmoreland, Marcia Haskins; Zwelling, Elaine

2000-01-01

The development of a family-centered, comprehensive perinatal education program for a large, urban hospital system is described. This program was developed in conjunction with the building of a new women's center and, although the authors were fortunate that several opportunities for educational program development were linked to this project, many of the steps taken and the lessons learned can be helpful to anyone desiring to develop a similar program. This article relates perinatal education to the principles of family-centered maternity care, outlines the criteria for a quality educational program, gives rationale for this type of program development, and offers practical suggestions for starting or enhancing a perinatal education program within a hospital system. PMID:17273228

Participatory design of ehealth solutions for women from vulnerable populations with perinatal depression.

PubMed

Gordon, Mara; Henderson, Rebecca; Holmes, John H; Wolters, Maria K; Bennett, Ian M

2016-01-01

Cultural and health service obstacles affect the quality of pregnancy care that women from vulnerable populations receive. Using a participatory design approach, the Stress in Pregnancy: Improving Results with Interactive Technology group developed specifications for a suite of eHealth applications to improve the quality of perinatal mental health care. We established a longitudinal participatory design group consisting of low-income women with a history of antenatal depression, their prenatal providers, mental health specialists, an app developer, and researchers. The group met 20 times over 24 months. Applications were designed using rapid prototyping. Meetings were documented using field notes. The group achieved high levels of continuity and engagement. Three apps were developed by the group: an app to support high-risk women after discharge from hospital, a screening tool for depression, and a patient decision aid for supporting treatment choice. Longitudinal participatory design groups are a promising, highly feasible approach to developing technology for underserved populations. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Impacts of online and group perinatal education: a mixed methods study protocol for the optimization of perinatal health services.

PubMed

Roch, Geneviève; Borgès Da Silva, Roxane; de Montigny, Francine; Witteman, Holly O; Pierce, Tamarha; Semenic, Sonia; Poissant, Julie; Parent, André-Anne; White, Deena; Chaillet, Nils; Dubois, Carl-Ardy; Ouimet, Mathieu; Lapointe, Geneviève; Turcotte, Stéphane; Prud'homme, Alexandre; Painchaud Guérard, Geneviève; Gagnon, Marie-Pierre

2018-05-29

Prenatal education is a core component of perinatal care and services provided by health institutions. Whereas group prenatal education is the most common educational model, some health institutions have opted to implement online prenatal education to address accessibility issues as well as the evolving needs of future parents. Various studies have shown that prenatal education can be effective in acquisition of knowledge on labour and delivery, reducing psychological distress and maximising father's involvement. However, these results may depend on educational material, organization, format and content. Furthermore, the effectiveness of online prenatal education compared to group prenatal education remains unclear in the literature. This project aims to evaluate the impacts of group prenatal education and online prenatal education on health determinants and users' health status, as well as on networks of perinatal educational services maintained with community-based partners. This multipronged mixed methods study uses a collaborative research approach to integrate and mobilize knowledge throughout the process. It consists of: 1) a prospective cohort study with quantitative data collection and qualitative interviews with future and new parents; and 2) a multiple case study integrating documentary sources and interviews with stakeholders involved in the implementation of perinatal information service networks and collaborations with community partners. Perinatal health indicators and determinants will be compared between prenatal education groups (group prenatal education and online prenatal education) and standard care without these prenatal education services (control group). This study will provide knowledge about the impact of online prenatal education as a new technological service delivery model compared to traditional group prenatal education. Indicators related to the complementarity of these interventions and those available in community settings will

Experiencias sobre el impacto del Programa de Formación en Ética de la Investigación Biomédica y Psicosocial en el ámbito de la salud mental y la investigación conductual.

PubMed

Barrios, Liliana Mondragón

2012-01-01

El propósito de este trabajo es presentar el impacto y la integración que los conocimientos adquiridos en el Programa Internacional de Formación en Ética de la Investigación Biomédica y Psicosocial de la Universidad de Chile han tenido en mi experiencia profesional, en el ámbito de la investigación psicosocial en un Instituto de Salud de México. Para este objetivo, expondré tres áreas en las cuales se ha podido evidenciar tal impacto: trabajo en los comités de ética, desarrollo de programas de académicos en bioética e investigación y publicación sobre ética y bioética. El motivo que me llevó a incursionar en el Programa fue que su enseñanza vincula la investigación psicosocial con la ética y la bioética, lo cual me permitió dirigir este tipo de reflexión hacia problemas como violencia, suicidio, adicciones, depresión y salud mental, y a nuevos campos como los estudios comunitarios, con poblaciones en riesgo o vulnerables, en los cuales las diversas implicaciones son difíciles de indagar.

Experiencias sobre el impacto del Programa de Formación en Ética de la Investigación Biomédica y Psicosocial en el ámbito de la salud mental y la investigación conductual

PubMed Central

Barrios, Liliana Mondragón

2012-01-01

El propósito de este trabajo es presentar el impacto y la integración que los conocimientos adquiridos en el Programa Internacional de Formación en Ética de la Investigación Biomédica y Psicosocial de la Universidad de Chile han tenido en mi experiencia profesional, en el ámbito de la investigación psicosocial en un Instituto de Salud de México. Para este objetivo, expondré tres áreas en las cuales se ha podido evidenciar tal impacto: trabajo en los comités de ética, desarrollo de programas de académicos en bioética e investigación y publicación sobre ética y bioética. El motivo que me llevó a incursionar en el Programa fue que su enseñanza vincula la investigación psicosocial con la ética y la bioética, lo cual me permitió dirigir este tipo de reflexión hacia problemas como violencia, suicidio, adicciones, depresión y salud mental, y a nuevos campos como los estudios comunitarios, con poblaciones en riesgo o vulnerables, en los cuales las diversas implicaciones son difíciles de indagar. PMID:22754085

Metabolic Changes Following Perinatal Asphyxia: Role of Astrocytes and Their Interaction with Neurons.

PubMed

Logica, Tamara; Riviere, Stephanie; Holubiec, Mariana I; Castilla, Rocío; Barreto, George E; Capani, Francisco

2016-01-01

Perinatal Asphyxia (PA) represents an important cause of severe neurological deficits including delayed mental and motor development, epilepsy, major cognitive deficits and blindness. The interaction between neurons, astrocytes and endothelial cells plays a central role coupling energy supply with changes in neuronal activity. Traditionally, experimental research focused on neurons, whereas astrocytes have been more related to the damage mechanisms of PA. Astrocytes carry out a number of functions that are critical to normal nervous system function, including uptake of neurotransmitters, regulation of pH and ion concentrations, and metabolic support for neurons. In this work, we aim to review metabolic neuron-astrocyte interactions with the purpose of encourage further research in this area in the context of PA, which is highly complex and its mechanisms and pathways have not been fully elucidated to this day.

Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses.

PubMed

Gressier, Florence; Guillard, Virginie; Cazas, Odile; Falissard, Bruno; Glangeaud-Freudenthal, Nine M-C; Sutter-Dallay, Anne-Laure

2017-01-01

Suicide is a major public health concern worldwide, and mental disorders have been identified as a main risk factor. Suicide is also one of the leading causes of perinatal maternal mortality, but very few studies have focused on suicide attempts (SA) in the perinatal period. This work aims to assess risk factors associated with SA in pregnancy and in the post-partum period in women with mental health disorders. Women (n = 1439) with psychiatric disorders jointly admitted with their infant to 16 psychiatric Mother-Baby Units over 10 years (2001-2010) were assessed retrospectively for the occurrence of SA in pregnancy or the postpartum period. Multinomial logistic regression was used to explore the independent impact of maternal sociodemographic characteristics, history of childhood maltreatment and abuse, current mental illness and pregnancy data on SA in pregnancy and/or postpartum. One hundred and fifty-four women (11.68%) attempted suicide: 49 in pregnancy (3.71%) and 105 (7.97%) in the post-partum period. SA in pregnancy was related to alcohol use (OR = 2.37[1.02-5.53]; p = 0.04) and smoking during pregnancy (OR = 1.87[1.01-3.49]; p = 0.04) and also to a history of miscarriage (OR = 2.29[1.18-4.41]; p = 0.01). SA in the post-partum period was associated with major depressive episode (OR = 2.72[1.40-5.26]; p = 0.003) or recurrent depression (OR = 4.12[2.25-7.51], p < 0.001) and younger age (OR = 0.96[0.93-0.99], p = 0.03). SAs in the course of pregnancy and the postpartum period have different risk factors. Special attention to risk of suicide is needed during pregnancy for women with severe mental illness and a history of miscarriage, alcohol or cigarette use, young age and depression in the perinatal period. Copyright © 2016 Elsevier Ltd. All rights reserved.

Neuroprotective actions of perinatal choline nutrition

PubMed Central

Blusztajn, Jan Krzysztof; Mellott, Tiffany J.

2017-01-01

Choline is an essential nutrient for humans. Studies in rats and mice have shown that high choline intake during gestation or the perinatal period improves cognitive function in adulthood, prevents memory decline of old age, and protects the brain from damage and cognitive and neurological deterioration associated with epilepsy and hereditary conditions such as Down’s and Rett syndromes. These behavioral changes are accompanied by modified patterns of expression of hundreds of cortical and hippocampal genes including those encoding proteins central for learning and memory processing. The effects of choline correlate with cerebral cortical changes in DNA and histone methylation, thus suggesting an epigenomic mechanism of action of perinatal choline. PMID:23314544

[Perinatal clomiphene citrate treatment changes sexual orientations of male mice].

PubMed

He, Feng-Qin; Zhang, Heng-Rui

2013-10-01

Perinatal period and adolescence are critical for brain development, which is the biological basis of an individual's sexual orientation and sexual behavior. In this study, animals were divided into two groups and their sexual orientations were observed: one group experienced drug treatments during the perinatal period, and the other group was castrated at puberty. The results showed that estradiol treatment had no effect on mature male offspring's sexual orientations, but 9 days and 14 days of clomiphene citrate treatment significantly increased the chance of homosexuality and effeminized behavior. In addition, the sexual orientation of mature normal male offspring, which were castrated when they were 21 days old,was not significant different from the control animals. These findings suggest that the inhibition of perinatal estrogen activities could suppress individual male-typical responses, enhance female-typical responses and induce homosexual orientations. Moreover, the masculinizing effects of estrogen were more obvious during perinatal period than adolescence.

ProvenCare perinatal: a model for delivering evidence/ guideline-based care for perinatal populations.

PubMed

Berry, Scott A; Laam, Leslie A; Wary, Andrea A; Mateer, Harry O; Cassagnol, Hans P; McKinley, Karen E; Nolan, Ruth A

2011-05-01

Geisinger Health System (GHS) has applied its ProvenCare model to demonstrate that a large integrated health care delivery system, enabled by an electronic health record (EHR), could reengineer a complicated clinical process, reduce unwarranted variation, and provide evidence-based care for patients with a specified clinical condition. In 2007 GHS began to apply the model to a more complicated, longer-term condition of "wellness"--perinatal care. ADAPTING PROVENCARE TO PERINATAL CARE: The ProvenCare Perinatal initiative was more complex than the five previous ProvenCare endeavors in terms of breadth, scope, and duration. Each of the 22 sites created a process flow map to depict the current, real-time process at each location. The local practice site providers-physicians and mid-level practitioners-reached consensus on 103 unique best practice measures (BPMs), which would be tracked for every patient. These maps were then used to create a single standardized pathway that included the BPMs but also preserved some unique care offerings that reflected the needs of the local context. A nine-phase methodology, expanded from the previous six-phase model, was implemented on schedule. Pre- to postimplementation improvement occurred for all seven BPMs or BPM bundles that were considered the most clinically relevant, with five statistically significant. In addition, the rate of primary cesarean sections decreased by 32%, and birth trauma remained unchanged as the number of vaginal births increased. Preliminary experience suggests that integrating evidence/guideline-based best practices into work flows in inpatient and outpatient settings can achieve improvements in daily patient care processes and outcomes.

Social Support Following Perinatal Loss

PubMed Central

Kavanaugh, Karen; Trier, Darcie; Korzec, Michelle

2005-01-01

The purpose of this project was to examine parents' descriptions of the ways family and friends supported them after they had experienced a perinatal loss. For this project, a secondary analysis of data from two phenomenological studies on perinatal loss was performed. A combined total of 62 interview transcripts from 22 mothers and 9 fathers were examined. Data analysis included identifying all statements in the interview transcripts that pertained to the ways that family and friends supported parents. The modes of supportive behavior (emotional, advice/feedback, practical, financial, and socializing) in Vaux's theory of social support served as a useful framework for presenting the findings. Parents received emotional support most frequently. Findings from the current study provide data for health care professionals to use to provide guidance to family and friends of bereaved parents. PMID:17426820

Missed Opportunities for Preventing Perinatal Transmission of Human Immunodeficiency Virus, Florida, 2007–2014

PubMed Central

Trepka, Mary Jo; Mukherjee, Soumyadeep; Beck-Sagué, Consuelo; Maddox, Lorene M.; Fennie, Kristopher P.; Sheehan, Diana M.; Prabhakar, Maithri; Thompson, Dan; Lieb, Spencer

2016-01-01

Objectives Despite declining numbers of perinatally exposed infants, an increase in perinatal human immunodeficiency virus (HIV) infections from 2011 to 2013 prompted this study to identify missed perinatal HIV prevention opportunities. Methods Deidentified records of children born from 2007 through 2014, exposed to HIV perinatally, and reported to the Florida Department of Health were obtained. Crude relative risks (RRs) and 95% confidence intervals (CIs) for factors associated with perinatal transmission, nondiagnosis of maternal HIV infection, and nonreceipt of antiretroviral medication were calculated. Results Of the 4337 known singleton births exposed to maternal HIV infection, 70 (1.6%) were perinatally infected. Among perinatal transmission cases, more than one-third of mothers used illegal drugs or acquired a sexually transmitted infection during pregnancy. Perinatal transmission was most strongly associated with maternal HIV diagnosis during labor and delivery (RR 5.66; 95% CI 2.31–13.91) or after birth (RR 26.50; 95% CI 15.44–45.49) compared with antenatally or prenatally. Among the 29 women whose infection was not known before pregnancy and whose child was perinatally infected, 18 were not diagnosed during pregnancy; 12 had evidence of an acute HIV infection, and 6 had no prenatal care. Conclusions Late diagnosis of maternal HIV infection appeared to be primarily the result of acute maternal infections and inadequate prenatal care. In Florida, effective programs to improve utilization of prenatal care and detection and primary prevention of prenatal acute infection are needed. PMID:28158882

Perinatal Programming of Asthma: The Role of Gut Microbiota

PubMed Central

Azad, Meghan B.; Kozyrskyj, Anita L.

2012-01-01

Perinatal programming, a dominant theory for the origins of cardiovascular disease, proposes that environmental stimuli influence developmental pathways during critical periods of prenatal and postnatal development, inducing permanent changes in metabolism. In this paper, we present evidence for the perinatal programming of asthma via the intestinal microbiome. While epigenetic mechanisms continue to provide new explanations for the programming hypothesis of asthma development, it is increasingly apparent that the intestinal microbiota plays an independent and potentially interactive role. Commensal gut bacteria are essential to immune system development, and exposures disrupting the infant gut microbiota have been linked to asthma. This paper summarizes the recent findings that implicate caesarean delivery, breastfeeding, perinatal stress, probiotics, and antibiotics as modifiers of infant gut microbiota in the development of asthma. PMID:22110540

Fathers' views and experiences of their own mental health during pregnancy and the first postnatal year: a qualitative interview study of men participating in the UK Born and Bred in Yorkshire (BaBY) cohort.

PubMed

Darwin, Z; Galdas, P; Hinchliff, S; Littlewood, E; McMillan, D; McGowan, L; Gilbody, S

2017-01-26

The prevalence of fathers' depression and anxiety in the perinatal period (i.e. from conception to 1 year after birth) is approximately 5-10%, and 5-15%, respectively; their children face increased risk of adverse emotional and behavioural outcomes, independent of maternal mental health. Critically, fathers can be protective against the development of maternal perinatal mental health problems and their effects on child outcomes. Preventing and treating paternal mental health problems and promoting paternal psychological wellbeing may therefore benefit the family as a whole. This study examined fathers' views and direct experiences of paternal perinatal mental health. Men in the Born and Bred in Yorkshire (BaBY) epidemiological prospective cohort who met eligibility criteria (baby born <12 months; completed Mental Health and Wellbeing [MHWB] questionnaires) were invited to participate. Those expressing interest (n = 42) were purposively sampled to ensure diversity of MHWB scores. In-depth interviews were conducted at 5-10 months postpartum with 19 men aged 25-44 years. The majority were first-time fathers and UK born; all lived with their partner. Data were analysed using thematic analysis. Four themes were identified: 'legitimacy of paternal stress and entitlement to health professionals' support', 'protecting the partnership', 'navigating fatherhood', and, 'diversity of men's support networks'. Men largely described their 'stress' with reference to exhaustion, poor concentration and irritability. Despite feeling excluded by maternity services, fathers questioned their entitlement to support, noting that services are pressured and 'should' be focused on mothers. Men emphasised the need to support their partner and protect their partnership as central to the successfully navigation of fatherhood; they used existing support networks where available but noted the paucity of tailored support for fathers. Fathers experience psychological distress in the perinatal

Action plan to reduce perinatal mortality.

PubMed

Bhakoo, O N; Kumar, R

1990-01-01

The government of India has set a goal of reducing perinatal mortality from its current rate of 48/1000 to 30-35/1000 by the year 2000. Perinatal deaths result from maternal malnutrition, inadequate prenatal care, complications of delivery, and infections in the postpartum period. Since reductions in perinatal mortality require attention to social, economic, and behavioral factors, as well as improvements in the health care delivery system, a comprehensive strategy is required. Social measures, such as raising the age at marriage to 18 years for females, improving the nutritional status of adolescent girls, reducing the strenuousness of work during pregnancy, improving female literacy, raising women's status in the society and thus in the family, and poverty alleviation programs, would all help eliminate the extent of complications of pregnancy. Measures required to enhance infant survival include improved prenatal care, prenatal tetanus toxoid immunization, use of sterile disposable cord care kits, the provision of mucus extractors and resuscitation materials to birth attendants, the creation of neonatal care units in health facilities, and more efficient referral of high-risk newborns and mothers. Since 90% of births in rural India take place at home priority must be given to training traditional birth attendants in the identification of high risk factors during pregnancy, delivery, and the newborn period.

Psychosocial impact of perinatal loss among Muslim women.

PubMed

Sutan, Rosnah; Miskam, Hazlina Mohd

2012-06-18

Women of reproductive age are vulnerable to psychosocial problems, but these have remained largely unexplored in Muslim women in developing countries. The aim of this study was to explore and describe psychosocial impact and social support following perinatal loss among Muslim women. A qualitative study was conducted in a specialist centre among Muslim mothers who had experienced perinatal loss. Purposive sampling to achieve maximum variation among Muslims in relation to age, parity and previous perinatal death was used. Data was collected by focus group discussion and in-depth unstructured interview until the saturation point met. Sixteen mothers who had recent perinatal loss of wanted pregnancy, had received antenatal follow up from public or private health clinics, and had delivery in our centre participated for the study. All of them had experienced psychological difficulties including feelings of confusion, emptiness and anxiety over facing another pregnancy. Two out of sixteen showed anger and one felt guilt. They reported experiencing a lack of communication and privacy in the hospital during the period of grief. Family members and friends play an important role in providing support. The majority agreed that the decision makers were husbands and families instead of themselves. The respondents felt that repetitive reminder of whatever happened was a test from God improved their sense of self-worth. They appreciated this reminder especially when it came from husband, family or friends closed to them. Muslim mothers who had experienced perinatal loss showed some level of adverse psychosocial impact which affected their feelings. Husbands and family members were the main decision makers for Muslim women. Health care providers should provide psychosocial support during antenatal, delivery and postnatal care. On-going support involving husband should be available where needed.

Psychosocial impact of perinatal loss among Muslim women

PubMed Central

2012-01-01

Background Women of reproductive age are vulnerable to psychosocial problems, but these have remained largely unexplored in Muslim women in developing countries. The aim of this study was to explore and describe psychosocial impact and social support following perinatal loss among Muslim women. Methods A qualitative study was conducted in a specialist centre among Muslim mothers who had experienced perinatal loss. Purposive sampling to achieve maximum variation among Muslims in relation to age, parity and previous perinatal death was used. Data was collected by focus group discussion and in-depth unstructured interview until the saturation point met. Sixteen mothers who had recent perinatal loss of wanted pregnancy, had received antenatal follow up from public or private health clinics, and had delivery in our centre participated for the study. All of them had experienced psychological difficulties including feelings of confusion, emptiness and anxiety over facing another pregnancy. Results Two out of sixteen showed anger and one felt guilt. They reported experiencing a lack of communication and privacy in the hospital during the period of grief. Family members and friends play an important role in providing support. The majority agreed that the decision makers were husbands and families instead of themselves. The respondents felt that repetitive reminder of whatever happened was a test from God improved their sense of self-worth. They appreciated this reminder especially when it came from husband, family or friends closed to them. Conclusion Muslim mothers who had experienced perinatal loss showed some level of adverse psychosocial impact which affected their feelings. Husbands and family members were the main decision makers for Muslim women. Health care providers should provide psychosocial support during antenatal, delivery and postnatal care. On-going support involving husband should be available where needed. PMID:22708998

Perinatal asphyxia in monochorionic versus dichorionic twins: incidence, risk factors and outcome.

PubMed

van Steenis, A; Kromhout, H E; Steggerda, S J; Sueters, M; Rijken, M; Oepkes, D; Lopriore, E

2014-01-01

To estimate the incidence, risk factors, severity and outcome after perinatal asphyxia in monochorionic (MC) versus dichorionic (DC) twins. We included all consecutive near-term MC and DC twins with perinatal asphyxia admitted to our neonatal ward between 2004 and 2013 and compared the perinatal characteristics and neonatal outcome between both groups. The incidence of perinatal asphyxia in MC and DC twin infants was 4.0 (11/272) and 4.0% (8/200; p = 1.00). In contrast to DC twins, asphyxia in MC twins was strongly associated with acute exsanguination and anemia at birth; 64% (7/11) in MC twins and 0% (0/8) in DC twins (p < 0.01). Median hemoglobin level at birth in the MC and DC groups was 11.5 and 18.6 g/dl, respectively (p < 0.01). Perinatal asphyxia in MC twins is often associated with severe anemia at birth due to acute hemorrhage through the placental vascular anastomoses. © 2014 S. Karger AG, Basel.

Mental health consequences of violence against women and girls.

PubMed

Satyanarayana, Veena A; Chandra, Prabha S; Vaddiparti, Krishna

2015-09-01

Recent studies on mental health consequences of violence against women and girls were reviewed in a range of situations. Although several studies continued to show cross-sectional associations between child sexual abuse (CSA) and mental health outcomes, a few prospective studies showed a robust association between CSA and depression. Studies on the impact of dating violence are still at a nascent stage and focus on antecedents of violence rather than its consequences. Women at higher risk, such as adolescents, migrants, the homeless, and women in the perinatal period have been studied and specific vulnerabilities identified. Women reporting bidirectional violence had higher rates of depression and post-traumatic stress disorder (PTSD). Cumulative violence, severity of violence, and recent violence are associated with higher morbidity. Studies among women in conflict zones have emphasized the role of different forms of sexual and physical violence on mental health. Newer emerging areas that need more research include mental health consequences of women in conflict zones and among same sex relationships. There are also few studies on the violence experience of both older women and adolescents. The need to better delineate the psychopathology of complex manifestations of PTSD is underscored.

Improving the quality of perinatal mental health: a health visitor-led protocol.

PubMed

Lewis, Anne; Ilot, Irene; Lekka, Chrysanthi; Oluboyede, Yemi

2011-02-01

The mental health of mothers is of significant concern to community practitioners. This paper reports on a case study exploring the success factors of a well established, health visitor-led protocol to identify and treat women with mild to moderate depression. Data were collected through interviews with a purposive sample of 12 community practitioners, a focus group of four health visitors and observation of a multidisciplinary steering group meeting. The protocol was described as an evidence-based tool and safety net that could be used flexibly to support clinical judgments and tailored to individual needs. Success factors included frontline clinician engagement and ownership, continuity of leadership to drive development and maintain momentum, comprehensive and on-going staff training, and strategic support for the protocol as a quality indicator at a time of organisational change. Quality and clinical leadership are continuing policy priorities. The protocol enabled frontline staff to lead a service innovation, providing a standardised multiprofessional approach to women's mental health needs through effective support, advice and treatment that can be measured and quality assured.

Cortical Reorganization of Language Functioning Following Perinatal Left MCA Stroke

ERIC Educational Resources Information Center

Tillema, Jan-Mendelt; Byars, Anna W.; Jacola, Lisa M.; Schapiro, Mark B.; Schmithorst, Vince J.; Szaflarski, Jerzy P.; Holland, Scott K.

2008-01-01

Objective: Functional MRI was used to determine differences in patterns of cortical activation between children who suffered perinatal left middle cerebral artery (MCA) stroke and healthy children performing a silent verb generation task. Methods: Ten children with prior perinatal left MCA stroke (age 6-16 years) and ten healthy age matched…

Term perinatal mortality audit in the Netherlands 2010-2012: a population-based cohort study.

PubMed

Eskes, Martine; Waelput, Adja J M; Erwich, Jan Jaap H M; Brouwers, Hens A A; Ravelli, Anita C J; Achterberg, Peter W; Merkus, Hans J M W M; Bruinse, Hein W

2014-10-14

To assess the implementation and first results of a term perinatal internal audit by a standardised method. Population-based cohort study. All 90 Dutch hospitals with obstetric/paediatric departments linked to community practices of midwives, general practitioners in their attachment areas, organised in perinatal cooperation groups (PCG). The population consisted of 943 registered term perinatal deaths occurring in 2010-2012 with detailed information, including 707 cases with completed audit results. Participation in the audit, perinatal death classification, identification of substandard factors (SSF), SSF in relation to death, conclusive recommendations for quality improvement in perinatal care and antepartum risk selection at the start of labour. After the introduction of the perinatal audit in 2010, all PCGs participated. They organised 645 audit sessions, with an average of 31 healthcare professionals per session. Of all 1102 term perinatal deaths (2.3/1000) data were registered for 86% (943) and standardised anonymised audit results for 64% (707). In 53% of the cases at least one SSF was identified. Non-compliance to guidelines (35%) and deviation from usual professional care (41%) were the most frequent SSF. There was a (very) probable relation between the SSF and perinatal death for 8% of all cases. This declined over the years: from 10% (n=23) in 2010 to 5% (n=10) in 2012 (p=0.060). Simultaneously term perinatal mortality decreased from 2.3 to 2.0/1000 births (p<0.00001). Possibilities for improvement were identified in the organisation of care (35%), guidelines or usual care (19%) and in documentation (15%). More pregnancies were antepartum selected as high risk, 70% in 2010 and 84% in 2012 (p=0.0001). The perinatal audit is implemented nationwide in all obstetrical units in the Netherlands in a short time period. It is possible that the audit contributed to the decrease in term perinatal mortality. Published by the BMJ Publishing Group Limited. For

The effectiveness of regionalization of perinatal care services--a systematic review.

PubMed

Rashidian, A; Omidvari, A H; Vali, Y; Mortaz, S; Yousefi-Nooraie, R; Jafari, M; Bhutta, Z A

2014-10-01

Several reports recommend the implementation of perinatal regionalization for improvements in maternal and neonatal outcomes, while research evidence on the effectiveness of perinatal regionalization has been limited. The interventional studies have been assessed for robust evidence on the effectiveness of perinatal regionalization on improving maternal and neonatal health outcomes. Bibliographic databases of Medline, EMbase, EconLit, HMIC have been searched using sensitive search terms for interventional studies that reported important patient or process outcomes. At least two authors assessed eligibility for inclusion and the risk of biases and extracted data from the included studies. As meta-analysis was not possible, a narrative analysis as well as a 'vote-counting' analysis has been conducted for important outcomes. After initial screenings 53 full text papers were retrieved. Eight studies were included in the review from the USA, Canada and France. Studies varied in their designs, and in the specifications of the intervention and setting. Only three interrupted time series studies had a low risk of bias, of which only one study reported significant reductions in neonatal and infant mortality. Studies of higher risk of bias were more likely to report improvements in outcomes. Implementing perinatal regionalization programs is correlated with improvements in perinatal outcomes, but it is not possible to establish a causal link. Despite several high profile policy statements, evidence of effect is weak. It is necessary to assess the effectiveness of perinatal regionalization using robust research designs in a more diverse range of countries.

Kinesthetic deficits after perinatal stroke: robotic measurement in hemiparetic children.

PubMed

Kuczynski, Andrea M; Semrau, Jennifer A; Kirton, Adam; Dukelow, Sean P

2017-02-15

While sensory dysfunction is common in children with hemiparetic cerebral palsy (CP) secondary to perinatal stroke, it is an understudied contributor to disability with limited objective measurement tools. Robotic technology offers the potential to objectively measure complex sensorimotor function but has been understudied in perinatal stroke. The present study aimed to quantify kinesthetic deficits in hemiparetic children with perinatal stroke and determine their association with clinical function. Case-control study. Participants were 6-19 years of age. Stroke participants had MRI confirmed unilateral perinatal arterial ischemic stroke or periventricular venous infarction, and symptomatic hemiparetic cerebral palsy. Participants completed a robotic assessment of upper extremity kinesthesia using a robotic exoskeleton (KINARM). Four kinesthetic parameters (response latency, initial direction error, peak speed ratio, and path length ratio) and their variabilities were measured with and without vision. Robotic outcomes were compared across stroke groups and controls and to clinical measures of sensorimotor function. Forty-three stroke participants (23 arterial, 20 venous, median age 12 years, 42% female) were compared to 106 healthy controls. Stroke cases displayed significantly impaired kinesthesia that remained when vision was restored. Kinesthesia was more impaired in arterial versus venous lesions and correlated with clinical measures. Robotic assessment of kinesthesia is feasible in children with perinatal stroke. Kinesthetic impairment is common and associated with stroke type. Failure to correct with vision suggests sensory network dysfunction.

[Perinatal audit in the North of the Netherlands: the first 2 years].

PubMed

van Diem, Mariet Th; Bergman, Klasien A; Bouman, Katelijne; van Egmond, Nico; Stant, Dennis A; Timmer, Albertus; Ulkeman, Lida H M; Veen, Wenda B; Erwich, Jan Jaap H M

2011-01-01

Description of the implementation of local audit meetings and the identified substandard factors, points of special interest, actions for improvement and the opinion of the participating health care providers. Descriptive study. A new organisation and methodology for perinatal mortality audit meetings was introduced in 15 collaborative structures in the northern part of the Netherlands in the period September 2007 to March 2010. During these multidisciplinary audit meetings, cases of perinatal mortality selected by the obstetric collaborative group were discussed in a structured way under the direction of an independent chairman. In total 64 audit meetings were held, in which 677 perinatal health care providers took part at least once, and 112 cases of perinatal death were evaluated. 163 substandard factors were identified. These included : not following the protocol, guideline, standard (31%) or usual care (23%) and insufficient documentation (28%) and communication between health care providers (13%). 442 actions to improve care were reported divided over: 'external collaboration' (15%), 'internal collaboration' (17%), 'practice management' (26%) and 'training and education' (10%). The most valued aspects of the audit meetings were: their multidisciplinary character, the collaborative search for substandard factors, their security, the learning effect and the positive effect on collaboration. Cases of perinatal mortality were discussed in all 15 perinatal collaborative structures in the northern part of the Netherlands. Substandard factors were identified, but further analysis of these factors merits attention. The participants concluded that the multidisciplinary approach and the collaboration during the audit meetings improved the cooperation between perinatal health care providers.

Perinatal and sociodemographic factors at birth predicting conduct problems and violence to age 18 years: comparison of Brazilian and British birth cohorts.

PubMed

Murray, Joseph; Maughan, Barbara; Menezes, Ana M B; Hickman, Matthew; MacLeod, John; Matijasevich, Alicia; Gonçalves, Helen; Anselmi, Luciana; Gallo, Erika A G; Barros, Fernando C

2015-08-01

Many low- and middle-income countries have high levels of violence. Research in high-income countries shows that risk factors in the perinatal period are significant precursors of conduct problems which can develop into violence. It is not known whether the same early influences are important in lower income settings with higher rates of violence. This study compared perinatal and sociodemographic risk factors between Brazil and Britain, and their role in explaining higher rates of conduct problems and violence in Brazil. Prospective population-based birth cohort studies were conducted in Pelotas, Brazil (N = 3,618) and Avon, Britain (N = 4,103). Eleven perinatal and sociodemographic risk factors were measured in questionnaires completed by mothers during the perinatal period. Conduct problems were measured in questionnaires completed by mothers at age 11, and violence in self-report questionnaires completed by adolescents at age 18. Conduct problems were predicted by similar risk factors in Brazil and Britain. Female violence was predicted by several of the same risk factors in both countries. However, male violence in Brazil was associated with only one risk factor, and several risk factor associations were weaker in Brazil than in Britain for both females and males. Almost 20% of the higher risk for conduct problems in Brazil compared to Britain was explained by differential exposure to risk factors. The percentage of the cross-national difference in violence explained by early risk factors was 15% for females and 8% for males. A nontrivial proportion of cross-national differences in antisocial behaviour are related to perinatal and sociodemographic conditions at the start of life. However, risk factor associations are weaker in Brazil than in Britain, and influences in other developmental periods are probably of particular importance for understanding male youth violence in Brazil. © 2014 The Authors. Journal of Child Psychology and Psychiatry published by

Perinatal statistics of a 15-year period in the Central Region of Saudi Arabia.

PubMed

Sobaih, Badr H; Al-Shebly, Mashael M

2013-01-01

Perinatal statistics are one of the most essential outcome indicators used by many developed countries in order to evaluate perinatal services provided to newborns. In this retrospective study, we collected 15 years of perinatal data at King Khalid University Hospital in Riyadh, Saudi Arabia in order to determine stillbirth and other mortality rates in our institute and compare them with international figures. A total of 58,073 babies were evaluated. Data were collected from maternal and neonatal registry books and from perinatal mortality and morbidity meeting reports between 1994 and 2008. Data were entered and analyzed using Microsoft Office Excel 2007. The stillbirth rate was 11.7/1000, early neonatal death rate was 3.4/1000, perinatal mortality rate (PMR) was 14.9/1000, and corrected PMR was 11.9/1000. Our rates were not significantly different from those of North American and European ones. We noticed a dramatic reduction in the corrected PMR in the last 3 years of the study because of greater advancement in perinatal and neonatal care. Our mortality rates were comparable to the North American and European rates which may reflect the quality of perinatal care provided in our institute.

A multilayered approach for the analysis of perinatal mortality using different classification systems.

PubMed

Gordijn, Sanne J; Korteweg, Fleurisca J; Erwich, Jan Jaap H M; Holm, Jozien P; van Diem, Mariet Th; Bergman, Klasien A; Timmer, Albertus

2009-06-01

Many classification systems for perinatal mortality are available, all with their own strengths and weaknesses: none of them has been universally accepted. We present a systematic multilayered approach for the analysis of perinatal mortality based on information related to the moment of death, the conditions associated with death and the underlying cause of death, using a combination of representatives of existing classification systems. We compared the existing classification systems regarding their definition of the perinatal period, level of complexity, inclusion of maternal, foetal and/or placental factors and whether they focus at a clinical or pathological viewpoint. Furthermore, we allocated the classification systems to one of three categories: 'when', 'what' or 'why', dependent on whether the allocation of the individual cases of perinatal mortality is based on the moment of death ('when'), the clinical conditions associated with death ('what'), or the underlying cause of death ('why'). A multilayered approach for the analysis and classification of perinatal mortality is possible by using combinations of existing systems; for example the Wigglesworth or Nordic Baltic ('when'), ReCoDe ('what') and Tulip ('why') classification systems. This approach is useful not only for in depth analysis of perinatal mortality in the developed world but also for analysis of perinatal mortality in the developing countries, where resources to investigate death are often limited.

Challenges of connectedness in personal recovery for rural mothers with mental illness.

PubMed

Hine, Rochelle Helena; Maybery, Darryl; Goodyear, Melinda Jane

2018-04-01

Social connection is a fundamental human need, but challenging for individuals with characteristics that are socially stigmatized. Parenting with mental illness presents obstacles, as well as opportunities, for connection. In the present study, we examined connectedness within a personal recovery paradigm for rural mothers with a mental illness. In-depth interviews with 17 mothers with a mental illness, utilizing constructivist grounded theory, resulted in six categories of meaning, including 'yearning for connection', 'connecting intensely', 'encountering rejection and exclusion', 'choosing isolation', 'being known', and 'finding peers/helping others'. Women expressed a strong desire for connection, but for many, prior experiences of trauma and rejection created barriers to the development of trust, preventing some women from seeking opportunities for connection. Connectedness to self and significant others, and a broader life meaning and purpose can support and expedite personal recovery from mental illness for rural women. However the factors that contribute to the mental illness might also inhibit the development of trust needed to attain social connection. Increasing connectedness in mothers with mental illness is a complex endeavour requiring concerted focus as distinct from other service-delivery goals. The perinatal period could be a key time for intervention. © 2017 Australian College of Mental Health Nurses Inc.

Is Gestational Hypertension Protective against Perinatal Mortality in Twin Pregnancies?

PubMed Central

Luo, Qi-Guang; Zhang, Ji-Yan; Cheng, Wei-Wei; Audibert, Francois; Luo, Zhong-Cheng

2014-01-01

Background Pregnancy-induced or gestational hypertension is a common pregnancy complication. Paradoxically, gestational hypertension has been associated with a protective effect against perinatal mortality in twin pregnancies in analytic models (logistic regression) without accounting for survival time. Whether this effect is real remains uncertain. This study aimed to validate the impact of gestational hypertension on perinatal mortality in twin pregnancies using a survival analysis approach. Methods This was a retrospective cohort study of 278,821 twin pregnancies, using the U.S. 1995–2000 matched multiple birth dataset (the largest dataset available for multiple births). Cox proportional hazard models were applied to estimate the adjusted hazard ratios (aHR) of perinatal death (stillbirth and neonatal death) comparing gestational hypertensive vs. non-hypertensive pregnancies controlling for maternal characteristics and twin cluster-level dependence. Results Comparing births in gestational hypertensive vs. non-hypertensive twin pregnancies, perinatal mortality rates were significantly lower (1.20% vs. 3.38%), so were neonatal mortality (0.72% vs. 2.30%) and stillbirth (0.48% vs. 1.10%) rates. The aHRs (95% confidence intervals) were 0.34 (0.31–0.38) for perinatal death, 0.31 (0.27–0.34) for neonatal death, and 0.45 (0.38–0.53) for stillbirth, respectively. The protective effect of gestational hypertension against perinatal death became weaker over advancing gestational age; the aHRs in very preterm (<32 weeks), mild preterm (32–36 weeks) and term (37+ weeks) births were 0.29, 0.48 and 0.76, respectively. The largest risk reductions in neonatal mortality were observed for infections and immaturity-related conditions. Conclusions Gestational hypertension appears to be beneficial for fetal survival in twin pregnancies, especially in those ending more prematurely or for deaths due to infections and immaturity-related conditions. Prospective studies are

Is gestational hypertension protective against perinatal mortality in twin pregnancies?

PubMed

Luo, Qi-Guang; Zhang, Ji-Yan; Cheng, Wei-Wei; Audibert, Francois; Luo, Zhong-Cheng

2014-01-01

Pregnancy-induced or gestational hypertension is a common pregnancy complication. Paradoxically, gestational hypertension has been associated with a protective effect against perinatal mortality in twin pregnancies in analytic models (logistic regression) without accounting for survival time. Whether this effect is real remains uncertain. This study aimed to validate the impact of gestational hypertension on perinatal mortality in twin pregnancies using a survival analysis approach. This was a retrospective cohort study of 278,821 twin pregnancies, using the U.S. 1995-2000 matched multiple birth dataset (the largest dataset available for multiple births). Cox proportional hazard models were applied to estimate the adjusted hazard ratios (aHR) of perinatal death (stillbirth and neonatal death) comparing gestational hypertensive vs. non-hypertensive pregnancies controlling for maternal characteristics and twin cluster-level dependence. Comparing births in gestational hypertensive vs. non-hypertensive twin pregnancies, perinatal mortality rates were significantly lower (1.20% vs. 3.38%), so were neonatal mortality (0.72% vs. 2.30%) and stillbirth (0.48% vs. 1.10%) rates. The aHRs (95% confidence intervals) were 0.34 (0.31-0.38) for perinatal death, 0.31 (0.27-0.34) for neonatal death, and 0.45 (0.38-0.53) for stillbirth, respectively. The protective effect of gestational hypertension against perinatal death became weaker over advancing gestational age; the aHRs in very preterm (<32 weeks), mild preterm (32-36 weeks) and term (37+ weeks) births were 0.29, 0.48 and 0.76, respectively. The largest risk reductions in neonatal mortality were observed for infections and immaturity-related conditions. Gestational hypertension appears to be beneficial for fetal survival in twin pregnancies, especially in those ending more prematurely or for deaths due to infections and immaturity-related conditions. Prospective studies are required to rule out the possibility of unmeasured

Eating disorders and trauma history in women with perinatal depression.

PubMed

Meltzer-Brody, Samantha; Zerwas, Stephanie; Leserman, Jane; Holle, Ann Von; Regis, Taylor; Bulik, Cynthia

2011-06-01

Although the prevalence of perinatal depression (depression occurring during pregnancy and postpartum) is 10%, little is known about psychiatric comorbidity in these women. We examined the prevalence of comorbid eating disorders (ED) and trauma history in women with perinatal depression. A research questionnaire was administered to 158 consecutive patients seen in a perinatal psychiatry clinic during pregnancy (n=99) or postpartum (n=59). Measures included Structured Clinical Interview for DSM (SCID) IV-based questions for lifetime eating psychopathology and assessments of comorbid psychiatric illness including the State/Trait Anxiety Inventory (STAI), Patient Health Questionnaire (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS), and Trauma Inventory. In this cohort, 37.1% reported a putative lifetime ED history; 10.1% reported anorexia nervosa (AN), 10.1% reported bulimia nervosa (BN), 10.1% reported ED not otherwise specified-purging subtype (EDNOS-P), and 7.0% reported binge eating disorder (BED). Women with BN reported more severe depression (EPDS score, 19.1, standard deviation [SD 4.3], p=0.02; PHQ-severity 14.5, SD 7.4, p=0.02) than the referent group of women with perinatal depression and no ED history (EPDS 13.3, SD=6.1; PHQ 9.0, SD=6.2). Women with AN were more likely to report sexual trauma history than the referent group (62.5% vs. 29.3%, p<0.05), and those with BN were more likely report physical (50.0%, p<0.05) and sexual (66.7%, p<0.05) trauma histories. ED histories were present in over one third of admissions to a perinatal psychiatry clinic. Women with BN reported more severe depression and histories of physical and sexual trauma. Screening for histories of eating psychopathology is important in women with perinatal depression.

Parent and family impact of raising a child with perinatal stroke

PubMed Central

2014-01-01

Background Perinatal stroke is a leading cause of early brain injury, cerebral palsy, and lifelong neurological morbidity. No study to date has examined the impact of raising a child with perinatal stroke on parents and families. However, a large breadth of research suggests that parents, especially mothers, may be at increased risk for psychological concerns. The primary aim of this study was to examine the impact of raising a child with perinatal stroke on mothers’ wellbeing. A secondary aim was to examine how caring for a child with perinatal stroke differentially affects mothers and fathers. Methods In Study I, a matched case-control design was used to compare the wellbeing of mothers of children with perinatal stroke and mothers of children with typical development. In Study II, a matched case-control design was used to compare mother-father dyads. Participants completed validated measures of anxiety and depression, stress, quality of life and family functioning, marital satisfaction, and marital distress. Parents of children with perinatal stroke also completed a recently validated measure of the psychosocial impact of perinatal stroke including guilt and blame outcomes. Disease severity was categorized by parents, validated by the Pediatric Stroke Outcome Measure (PSOM), and compared across the above outcomes in Study I. Results A total of 112 mothers participated in Study I (n = 56 per group; mean child age = 7.42 years), and 56 parents participated in Study II (n = 28 per group; mean child age = 8.25 years). In Study I, parent assessment of disease severity was correlated with PSOM scores (γ = 0.75, p < .001) and associated with parent outcomes. Mothers of children with mild conditions were indistinguishable from controls on the outcome measures. However, mothers of children with moderate/severe conditions had poorer outcomes on measures of depression, marital satisfaction, quality of life, and family functioning. In Study II

Parent and family impact of raising a child with perinatal stroke.

PubMed

Bemister, Taryn B; Brooks, Brian L; Dyck, Richard H; Kirton, Adam

2014-07-14

Perinatal stroke is a leading cause of early brain injury, cerebral palsy, and lifelong neurological morbidity. No study to date has examined the impact of raising a child with perinatal stroke on parents and families. However, a large breadth of research suggests that parents, especially mothers, may be at increased risk for psychological concerns. The primary aim of this study was to examine the impact of raising a child with perinatal stroke on mothers' wellbeing. A secondary aim was to examine how caring for a child with perinatal stroke differentially affects mothers and fathers. In Study I, a matched case-control design was used to compare the wellbeing of mothers of children with perinatal stroke and mothers of children with typical development. In Study II, a matched case-control design was used to compare mother-father dyads. Participants completed validated measures of anxiety and depression, stress, quality of life and family functioning, marital satisfaction, and marital distress. Parents of children with perinatal stroke also completed a recently validated measure of the psychosocial impact of perinatal stroke including guilt and blame outcomes. Disease severity was categorized by parents, validated by the Pediatric Stroke Outcome Measure (PSOM), and compared across the above outcomes in Study I. A total of 112 mothers participated in Study I (n = 56 per group; mean child age = 7.42 years), and 56 parents participated in Study II (n = 28 per group; mean child age = 8.25 years). In Study I, parent assessment of disease severity was correlated with PSOM scores (γ = 0.75, p < .001) and associated with parent outcomes. Mothers of children with mild conditions were indistinguishable from controls on the outcome measures. However, mothers of children with moderate/severe conditions had poorer outcomes on measures of depression, marital satisfaction, quality of life, and family functioning. In Study II, mothers and fathers had similar

Disclosure during prenatal mental health screening.

PubMed

Kingston, Dawn E; Biringer, Anne; Toosi, Amy; Heaman, Maureen I; Lasiuk, Gerri C; McDonald, Sheila W; Kingston, Joshua; Sword, Wendy; Jarema, Karly; Austin, Marie-Paule

2015-11-01

While women and healthcare providers have generally viewed perinatal mental health screening favorably, some qualitative studies suggest that some women intentionally decide not to reveal their symptoms during screening. The purpose of this study was to describe women's reported willingness to disclose mental health concerns during screening and factors associated with this. This cross-sectional study included pregnant women who were >16 years of age and could speak/read English. Women were recruited from five maternity clinics and two community hospitals in Alberta, Canada (May-December, 2013). Eligible women completed the online Barriers and Facilitators of Mental Health Screening Questionnaire on recruitment. The primary outcome for this analysis was women's level of honesty about mental health concerns (completely vs somewhat/not at all honest) during screening. Analyses included descriptive statistics and multivariable logistic regressions to identify factors associated with honesty. Participation rate was 92% (460/500). Seventy-nine percent of women indicated that they could be 'completely honest' during screening. Women who feared their provider would view them as bad mothers were less likely to be honest. We found a significant association between 'less anonymous' modes of screening and honesty. Over eighty percent of women in this study were well-educated, partnered, Caucasian women. As such, generalizability of the study findings may be limited. Most women indicated they could be honest during screening. Stigma-related factors and screening mode influenced women's willingness to disclose. Strategies to reduce stigma during screening are warranted to enhance early detection of prenatal mental illness. Copyright © 2015 Elsevier B.V. All rights reserved.

Maternal Malaria and Perinatal HIV Transmission, Western Kenya1,2

PubMed Central

Ayisi, John G.; van Eijk, Anna M.; ter Kuile, Feiko O.; Shi, Ya Ping; Yang, Chunfu; Kolczak, Margarette S.; Otieno, Juliana A.; Misore, Ambrose O.; Kager, Piet A.; Lal, Renu B.; Steketee, Richard W.; Nahlen, Bernard L.

2004-01-01

To determine whether maternal placental malaria is associated with an increased risk for perinatal mother-to-child HIV transmission (MTCT), we studied HIV-positive women in western Kenya. We enrolled 512 mother-infant pairs; 128 (25.0%) women had malaria, and 102 (19.9%) infants acquired HIV perinatally. Log10 HIV viral load and episiotomy or perineal tear were associated with increased perinatal HIV transmission, whereas low-density malaria (<10,000 parasites/μL) was associated with reduced risk (adjusted relative risk [ARR] 0.4). Among women dually infected with malaria and HIV, high-density malaria (>10,000 parasites/μL) was associated with increased risk for perinatal MTCT (ARR 2.0), compared to low-density malaria. The interaction between placental malaria and MTCT appears to be variable and complex: placental malaria that is controlled at low density may cause an increase in broad-based immune responses that protect against MTCT; uncontrolled, high-density malaria may simultaneously disrupt placental architecture and generate substantial antigen stimulus to HIV replication and increase risk for MTCT. PMID:15200854

Predicting grief intensity after recent perinatal loss.

PubMed

Hutti, Marianne H; Myers, John; Hall, Lynne A; Polivka, Barbara J; White, Susan; Hill, Janice; Kloenne, Elizabeth; Hayden, Jaclyn; Grisanti, Meredith McGrew

2017-10-01

The Perinatal Grief Intensity Scale (PGIS) was developed for clinical use to identify and predict intense grief and need for follow-up after perinatal loss. This study evaluates the validity of the PGIS via its ability to predict future intense grief based on a PGIS score obtained early after a loss. A prospective observational study was conducted with 103 international, English-speaking women recruited at hospital discharge or via the internet who experienced a miscarriage, stillbirth, or neonatal death within the previous 8weeks. Survey data were collected at baseline using the PGIS and the Perinatal Grief Scale (PGS). Follow-up data on the PGS were obtained 3months later. Data analysis included descriptive statistics, Cronbach's alpha, receiver operating characteristic curve analysis, and confirmatory factor analysis. Cronbach's alphas were ≥0.70 for both instruments. PGIS factor analysis yielded three factors as predicted, explaining 57.7% of the variance. The optimal cutoff identified for the PGIS was 3.535. No difference was found when the ability of the PGIS to identify intense grief was compared to the PGS (p=0.754). The PGIS was not inferior to the PGS (AUC=0.78, 95% CI 0.68-0.88, p<0.001) in predicting intense grief at the follow-up. A PGIS score≥3.53 at baseline was associated with increased grief intensity at Time 2 (PGS: OR=1.97, 95% CI 1.59-2.34, p<0.001). The PGIS is comparable to the PGS, has a lower response burden, and can reliably and validly predict women who may experience future intense grief associated with perinatal loss. Copyright © 2017 Elsevier Inc. All rights reserved.

Nursing diagnosis of grieving: content validity in perinatal loss situations.

PubMed

Paloma-Castro, Olga; Romero-Sánchez, José Manuel; Paramio-Cuevas, Juan Carlos; Pastor-Montero, Sonia María; Castro-Yuste, Cristina; Frandsen, Anna J; Albar-Marín, María Jesús; Bas-Sarmiento, Pilar; Moreno-Corral, Luis Javier

2014-06-01

To validate the content of the NANDA-I nursing diagnosis of grieving in situations of perinatal loss. Using the Fehring's model, 208 Spanish experts were asked to assess the adequacy of the defining characteristics and other manifestations identified in the literature for cases of perinatal loss. The content validity index was 0.867. Twelve of the 18 defining characteristics were validated, seven as major and five as minor. From the manifestations proposed, "empty inside" was considered as major. The nursing diagnosis of grieving fits in content to the cases of perinatal loss according to experts. The results have provided evidence to support the use of the diagnosis in care plans for said clinical situation. © 2013 NANDA International.

Gender-specific mental health care needs of women veterans treated for psychiatric disorders in a Veterans Administration Women's Health Clinic.

PubMed

Miller, Laura J; Ghadiali, Nafisa Y

2015-04-01

This pilot study aims to ascertain the prevalence of self-reported premenstrual, perinatal, and perimenopausal influences on mental health, and of gynecologic conditions that could interact with psychiatric conditions, among women veterans receiving psychiatric care within a Veterans Administration (VA) Women's Health Clinic (WHC). Participants included all women veterans (N=68) who received psychiatric evaluations within a VA WHC over a 5-month period. This setting encompasses colocated and coordinated primary care, gynecologic and mental health services. Evaluations included a Women's Mental Health Questionnaire, a psychiatric interview, and medical record review. Deidentified data were extracted from a clinical data repository for this descriptive study. High proportions of study participants reported that their emotional problems intensified premenstrually (42.6%), during pregnancy (33.3%), in the postpartum period (33.3%), or during perimenopause (18.2%). Unintended pregnancy (70.0% of pregnancies) and pregnancy loss (63.5% of women who had been pregnant) were prominent sex-linked stressors. Dyspareunia (22.1% of participants) and pelvic pain (17.6% of participants) were frequent comorbidities. Among women veterans receiving psychiatric care within a VA WHC, there are high rates of self-reported premenstrual, perinatal, and perimenopausal influences on mental health. This population also has substantial comorbidity of psychiatric disorders with dyspareunia and pelvic pain. This underscores the importance of recognizing and addressing women veterans' sex-specific care needs, including interactions among reproductive cycle phases, gynecologic pain, and psychiatric symptoms. The findings support the need for greater awareness of the sex-specific mental health needs of women veterans, and for more definitive studies to further characterize these needs.

Metabolic Changes Following Perinatal Asphyxia: Role of Astrocytes and Their Interaction with Neurons

PubMed Central

Logica, Tamara; Riviere, Stephanie; Holubiec, Mariana I.; Castilla, Rocío; Barreto, George E.; Capani, Francisco

2016-01-01

Perinatal Asphyxia (PA) represents an important cause of severe neurological deficits including delayed mental and motor development, epilepsy, major cognitive deficits and blindness. The interaction between neurons, astrocytes and endothelial cells plays a central role coupling energy supply with changes in neuronal activity. Traditionally, experimental research focused on neurons, whereas astrocytes have been more related to the damage mechanisms of PA. Astrocytes carry out a number of functions that are critical to normal nervous system function, including uptake of neurotransmitters, regulation of pH and ion concentrations, and metabolic support for neurons. In this work, we aim to review metabolic neuron-astrocyte interactions with the purpose of encourage further research in this area in the context of PA, which is highly complex and its mechanisms and pathways have not been fully elucidated to this day. PMID:27445788

Perinatal DDT Exposure Induces Hypertension and Cardiac Hypertrophy in Adult Mice.

PubMed

La Merrill, Michele A; Sethi, Sunjay; Benard, Ludovic; Moshier, Erin; Haraldsson, Borje; Buettner, Christoph

2016-11-01

Dichlorodiphenyltrichloroethane (DDT) was used extensively to control malaria, typhus, body lice, and bubonic plague worldwide, until countries began restricting its use in the 1970s. However, the use of DDT to control vector-borne diseases continues in developing countries. Prenatal DDT exposure is associated with elevated blood pressure in humans. We hypothesized that perinatal DDT exposure causes hypertension in adult mice. DDT was administered to C57BL/6J dams from gestational day 11.5 to postnatal day 5. Blood pressure (BP) and myocardial wall thickness were measured in male and female adult offspring. Adult mice were treated with an angiotensin converting enzyme (ACE) inhibitor, captopril, to evaluate sensitivity to amelioration of DDT-associated hypertension by ACE inhibition. We further assessed the influence of DDT exposure on the expression of mRNAs that regulate BP through renal ion transport. Adult mice perinatally exposed to DDT exhibited chronically increased systolic BP, increased myocardial wall thickness, and elevated expression of mRNAs of several renal ion transporters. Captopril completely reversed hypertension in mice perinatally exposed to DDT. These data demonstrate that perinatal exposure to DDT causes hypertension and cardiac hypertrophy in adult offspring. A key mechanism underpinning this hypertension is an overactivated renin angiotensin system because ACE inhibition reverses the hypertension induced by perinatal DDT exposure. Citation: La Merrill M, Sethi S, Benard L, Moshier E, Haraldsson B, Buettner C. 2016. Perinatal DDT exposure induces hypertension and cardiac hypertrophy in adult mice. Environ Health Perspect 124:1722-1727; http://dx.doi.org/10.1289/EHP164.

Perinatal biomarkers in prematurity: Early identification of neurologic injury

PubMed Central

Andrikopoulou, Maria; Almalki, Ahmad; Farzin, Azadeh; Cordeiro, Christina N.; Johnston, Michael V.; Burd, Irina

2014-01-01

Over the past few decades, biomarkers have become increasingly utilized as non-invasive tools in the early diagnosis and management of various clinical conditions. In perinatal medicine, the improved survival of extremely premature infants who are at high risk for adverse neurologic outcomes has increased the demand for the discovery of biomarkers in detecting and predicting the prognosis of infants with neonatal brain injury. By enabling the clinician to recognize potential brain damage early, biomarkers could allow clinicians to intervene at the early stages of disease, and to monitor the efficacy of those interventions. This review will first examine the potential perinatal biomarkers for neurologic complications of prematurity, specifically, intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and posthemorrhagic hydrocephalus (PHH). It will also evaluate knowledge gained from animal models regarding the pathogenesis of perinatal brain injury in prematurity. PMID:24768951

Social and cultural factors associated with perinatal grief in Chhattisgarh, India.

PubMed

Roberts, Lisa R; Montgomery, Susanne; Lee, Jerry W; Anderson, Barbara A

2012-06-01

Stillbirth is a globally significant public health problem with many medical causes. There are also indirect causal pathways including social and cultural factors which are particularly salient in India's traditional society. The purpose of this study was to explore women's perceptions of stillbirth and to determine how issues of gender and power, social support, coping efforts, and religious beliefs influence perinatal grief outcomes among poor women in rural Chhattisgarh, India. Structured interviews were done face-to-face in 21 randomly selected villages among women of reproductive age (N=355) who had experienced stillbirth (n=178) and compared to those who had not (n=177), in the Christian Hospital, Mungeli catchment area. Perinatal grief was significantly higher among women with a history of stillbirth. Greater perinatal grief was associated with lack of support, maternal agreement with social norms, and younger maternal age. These predictors must be understood in light of an additional finding-distorted sex ratios, which reflect gender discrimination in the context of Indian society. The findings of this study will allow the development of a culturally appropriate health education program which should be designed to increase social support and address social norms, thereby reducing psychological distress to prevent complicated perinatal grief. Perinatal grief is a significant social burden which impacts the health women.

Characteristics of a global classification system for perinatal deaths: a Delphi consensus study.

PubMed

Wojcieszek, Aleena M; Reinebrant, Hanna E; Leisher, Susannah Hopkins; Allanson, Emma; Coory, Michael; Erwich, Jan Jaap; Frøen, J Frederik; Gardosi, Jason; Gordijn, Sanne; Gulmezoglu, Metin; Heazell, Alexander E P; Korteweg, Fleurisca J; McClure, Elizabeth; Pattinson, Robert; Silver, Robert M; Smith, Gordon; Teoh, Zheyi; Tunçalp, Özge; Flenady, Vicki

2016-08-15

Despite the global burden of perinatal deaths, there is currently no single, globally-acceptable classification system for perinatal deaths. Instead, multiple, disparate systems are in use world-wide. This inconsistency hinders accurate estimates of causes of death and impedes effective prevention strategies. The World Health Organisation (WHO) is developing a globally-acceptable classification approach for perinatal deaths. To inform this work, we sought to establish a consensus on the important characteristics of such a system. A group of international experts in the classification of perinatal deaths were identified and invited to join an expert panel to develop a list of important characteristics of a quality global classification system for perinatal death. A Delphi consensus methodology was used to reach agreement. Three rounds of consultation were undertaken using a purpose built on-line survey. Round one sought suggested characteristics for subsequent scoring and selection in rounds two and three. The panel of experts agreed on a total of 17 important characteristics for a globally-acceptable perinatal death classification system. Of these, 10 relate to the structural design of the system and 7 relate to the functional aspects and use of the system. This study serves as formative work towards the development of a globally-acceptable approach for the classification of the causes of perinatal deaths. The list of functional and structural characteristics identified should be taken into consideration when designing and developing such a system.

Episode-Based Payment for Perinatal Care in Medicaid: Implications for Practice and Policy.

PubMed

Jarlenski, Marian; Borrero, Sonya; La Charité, Trey; Zite, Nikki B

2016-06-01

Medicaid is an important source of health insurance coverage for low-income pregnant women and covers nearly half of all deliveries in the United States. In the face of budgetary pressures, several state Medicaid programs have implemented or are considering implementing episode-based payments for perinatal care. Under the episode-based payment model, Medicaid programs make a single payment for all pregnancy-related medical services provided to women with low- and medium-risk pregnancies from 40 weeks before delivery through 60 days postpartum. The health care provider who delivers a live birth is assigned responsibility for all care and must meet certain quality metrics and stay within delineated cost-per-episode parameters. Implementation of cost- and quality-dependent episode-based payments for perinatal care is notable because there is no published evidence about the effects of such initiatives on pregnancy or birth outcomes. In this article, we highlight challenges and potential adverse consequences related to defining the perinatal episode and assigning a responsible health care provider. We also describe concerns that perinatal care quality metrics may not address the most pressing health care issues that are likely to improve health outcomes and reduce costs. In their current incarnations, Medicaid programs' episode-based payments for perinatal care may not improve perinatal care delivery and subsequent health outcomes. Rigorous evaluation of the new episode-based payment initiatives is critically needed to inform policymakers about the intended and unintended consequences of implementing episode-based payments for perinatal care.

Innovations in primary mental healthcare.

PubMed

Reifels, Lennart; Bassilios, Bridget; King, Kylie E; Fletcher, Justine R; Blashki, Grant; Pirkis, Jane E

2013-06-01

We review the evidence on innovations in Tier 2 of the Access to Allied Psychological Services (ATAPS) program, which is designed to facilitate the provision of primary mental healthcare to hard-to-reach and at-risk population groups (including women with perinatal depression, people at risk of self-harm or suicide, people experiencing or at risk of homelessness, people affected by the 2009 Victorian bushfires, people in remote locations, Aboriginal and Torres Strait Islanders and children with mental disorders) and the trialling of new modalities of service delivery (e.g. telephone-based or web-based CBT). The primary focus is on the uptake, outcomes and issues associated with the provision of ATAPS Tier 2. Drawing on data from an ongoing national ATAPS evaluation, including a national minimum dataset, key informant interviews and surveys, the impact of ATAPS innovations is analysed and illustrated through program examples. ATAPS Tier 2 facilitates access to, uptake of and positive clinical outcomes from primary mental healthcare for population groups with particular needs, although it requires periods of time to implement locally. Relatively simple innovations in mental health program design can have important practical ramifications for service provision, extending program reach and improving mental health outcomes for target populations. What is known about the topic? It is recognised that innovative approaches are required to tailor mental health programs for hard-to-reach and at-risk population groups. Divisions of General Practice have implemented innovations in the Access to Allied Psychological Services (ATAPS) program for several years. What does this paper add? Drawing on data from an ongoing national ATAPS evaluation, this paper presents a systematic analysis of the uptake, outcomes and issues associated with provision of the innovative ATAPS program. What are the implications for practitioners? The findings highlight the benefits of introducing

Generation and validation of a universal perinatal database and biospecimen repository: PeriBank.

PubMed

Antony, K M; Hemarajata, P; Chen, J; Morris, J; Cook, C; Masalas, D; Gedminas, M; Brown, A; Versalovic, J; Aagaard, K

2016-11-01

There is a dearth of biospecimen repositories available to perinatal researchers. In order to address this need, here we describe the methodology used to establish such a resource. With the collaboration of MedSci.net, we generated an online perinatal database with 847 fields of clinical information. Simultaneously, we established a biospecimen repository of the same clinical participants. The demographic and clinical outcomes data are described for the first 10 000 participants enrolled. The demographic characteristics are consistent with the demographics of the delivery hospitals. Quality analysis of the biospecimens reveals variation in very few analytes. Furthermore, since the creation of PeriBank, we have demonstrated validity of the database and tissue integrity of the biospecimen repository. Here we establish that the creation of a universal perinatal database and biospecimen collection is not only possible, but allows for the performance of state-of-the-science translational perinatal research and is a potentially valuable resource to academic perinatal researchers.

Term perinatal mortality audit in the Netherlands 2010–2012: a population-based cohort study

PubMed Central

Eskes, Martine; Waelput, Adja J M; Erwich, Jan Jaap H M; Brouwers, Hens A A; Ravelli, Anita C J; Achterberg, Peter W; Merkus, Hans (J) M W M; Bruinse, Hein W

2014-01-01

Objective To assess the implementation and first results of a term perinatal internal audit by a standardised method. Design Population-based cohort study. Setting All 90 Dutch hospitals with obstetric/paediatric departments linked to community practices of midwives, general practitioners in their attachment areas, organised in perinatal cooperation groups (PCG). Population The population consisted of 943 registered term perinatal deaths occurring in 2010–2012 with detailed information, including 707 cases with completed audit results. Main outcome measures Participation in the audit, perinatal death classification, identification of substandard factors (SSF), SSF in relation to death, conclusive recommendations for quality improvement in perinatal care and antepartum risk selection at the start of labour. Results After the introduction of the perinatal audit in 2010, all PCGs participated. They organised 645 audit sessions, with an average of 31 healthcare professionals per session. Of all 1102 term perinatal deaths (2.3/1000) data were registered for 86% (943) and standardised anonymised audit results for 64% (707). In 53% of the cases at least one SSF was identified. Non-compliance to guidelines (35%) and deviation from usual professional care (41%) were the most frequent SSF. There was a (very) probable relation between the SSF and perinatal death for 8% of all cases. This declined over the years: from 10% (n=23) in 2010 to 5% (n=10) in 2012 (p=0.060). Simultaneously term perinatal mortality decreased from 2.3 to 2.0/1000 births (p<0.00001). Possibilities for improvement were identified in the organisation of care (35%), guidelines or usual care (19%) and in documentation (15%). More pregnancies were antepartum selected as high risk, 70% in 2010 and 84% in 2012 (p=0.0001). Conclusions The perinatal audit is implemented nationwide in all obstetrical units in the Netherlands in a short time period. It is possible that the audit contributed to the decrease in

Perinatal DDT Exposure Induces Hypertension and Cardiac Hypertrophy in Adult Mice

PubMed Central

La Merrill, Michele A.; Sethi, Sunjay; Benard, Ludovic; Moshier, Erin; Haraldsson, Borje; Buettner, Christoph

2016-01-01

Background: Dichlorodiphenyltrichloroethane (DDT) was used extensively to control malaria, typhus, body lice, and bubonic plague worldwide, until countries began restricting its use in the 1970s. However, the use of DDT to control vector-borne diseases continues in developing countries. Prenatal DDT exposure is associated with elevated blood pressure in humans. Objective: We hypothesized that perinatal DDT exposure causes hypertension in adult mice. Methods: DDT was administered to C57BL/6J dams from gestational day 11.5 to postnatal day 5. Blood pressure (BP) and myocardial wall thickness were measured in male and female adult offspring. Adult mice were treated with an angiotensin converting enzyme (ACE) inhibitor, captopril, to evaluate sensitivity to amelioration of DDT-associated hypertension by ACE inhibition. We further assessed the influence of DDT exposure on the expression of mRNAs that regulate BP through renal ion transport. Results: Adult mice perinatally exposed to DDT exhibited chronically increased systolic BP, increased myocardial wall thickness, and elevated expression of mRNAs of several renal ion transporters. Captopril completely reversed hypertension in mice perinatally exposed to DDT. Conclusions: These data demonstrate that perinatal exposure to DDT causes hypertension and cardiac hypertrophy in adult offspring. A key mechanism underpinning this hypertension is an overactivated renin angiotensin system because ACE inhibition reverses the hypertension induced by perinatal DDT exposure. Citation: La Merrill M, Sethi S, Benard L, Moshier E, Haraldsson B, Buettner C. 2016. Perinatal DDT exposure induces hypertension and cardiac hypertrophy in adult mice. Environ Health Perspect 124:1722–1727; http://dx.doi.org/10.1289/EHP164 PMID:27325568

Perinatal hypothyroidism modulates antioxidant defence status in the developing rat liver and heart.

PubMed

Zhang, Hongmei; Dong, Yan; Su, Qing

2017-02-01

In the present study, we investigated oxidative stress parameters and antioxidant defence status in perinatal hypothyroid rat liver and heart. We found that the proteincarbonyl content did not differ significantly between the three groups both in the pup liver and in the heart. The OH˙ level was significantly decreased in the hypothyroid heart but not in the liver compared with controls. A slight but not significant decrease in SOD activity was observed in both perinatal hypothyroid liver and heart. A significantly increased activity of CAT was observed in the liver but not in the heart of hypothyroid pups. The GPx activity was considerably increased compared with controls in the perinatal hypothyroid heart and was unaltered in the liver of hypothyroid pups. We also found that vitamin E levels in the liver decreased significantly in hypothyroidism and were unaltered in the heart of perinatal hypothyroid rats. The GSH content was elevated significantly in both hypothyroid liver and heart. The total antioxidant capacity was higher in the liver of the hypothyroid group but not in the hypothyroid heart. Thyroxine replacement could not repair the above changes to normal. In conclusion, perinatal hypothyroidism modulates the oxidative stress status of the perinatal liver and heart.

Demographic survey of the level and determinants of perinatal mortality in Karachi, Pakistan.

PubMed

Fikree, F F; Gray, R H

1996-01-01

A demographic survey was used to estimate the level and determinants of perinatal mortality in eight lower socio-economic squatter settlements of Karachi, Pakistan. The perinatal mortality rate was 54.1 per 1000 births, with a stillbirth to early neonatal mortality ratio of 1:1. About 65% of neonatal deaths occurred in the early neonatal period, and early neonatal mortality contributed 32% of all infant deaths. Risk factor assessment was conducted on 375 perinatal deaths and 6070 current survivors. Poorer socio-economic status variables such as maternal and paternal illiteracy, maternal work outside the home and fewer household assets were significantly associated with perinatal mortality as were biological factors of higher parental age, short birth intervals and poor obstetric history. Multivariable logistic analysis indicated that some socio-economic factors retained their significance after adjusting for the more proximate biological factors. Population attributable risk estimates suggest that public health measures for screening of high-risk women and use of family planning to space births will not improve perinatal mortality substantially without improvement of socio-economic conditions, particularly maternal education. The results of this study indicate that an evaluation of perinatal mortality can be conducted using pregnancy histories derived from demographic surveys.

BUILDING A WORKFORCE COMPETENCY-BASED TRAINING PROGRAM IN INFANT/EARLY CHILDHOOD MENTAL HEALTH.

PubMed

Priddis, Lynn E; Matacz, Rochelle; Weatherston, Deborah

2015-01-01

This article describes findings from a project conducted in Western Australia (Mental Health Commission WA, 2015) that investigated the education and training needs of the Infant/Early Childhood Mental Health (I/ECMH) workforce. We examined international training programs and models of delivery in infant mental health, including a review of the current training available in Australia. Data collected from over 60 interviews were analyzed, and a staged delivery model for I/ECMH training and supervision that aligned with the Michigan Association for Infant Mental Health (2014) Competency Guidelines was recommended. These findings led to the purchase of the Michigan Association for Infant Mental Health (2014) for use in Western Australia. In a very short time, use of the Michigan Competency Framework by the Australian Association for Infant Mental Health West Australian Branch Incorporated has begun to change the training and education opportunities for upskilling the infant and early childhood workforce in Western Australia. It has resulted in a map to guide and develop training in the I/ECMH field for individual practitioners and professionals as well as for workplaces that will ultimately benefit Western Australian infants, young children, and their families during the perinatal period and in the early years. © 2015 Michigan Association for Infant Mental Health.

Healthcare justice and human rights in perinatal medicine.

PubMed

Chervenak, Frank A; McCullough, Laurence B

2016-06-01

This article describes an approach to ethics of perinatal medicine in which "women and children first" plays a central role, based on the concept of healthcare justice. Healthcare justice requires that all patients receive clinical management based on their clinical needs, which are defined by deliberative (evidence-based, rigorous, transparent, and accountable) clinical judgment. All patients in perinatal medicine includes pregnant, fetal, and neonatal patients. Healthcare justice also protects the informed consent process, which is intended to empower the exercise of patient autonomy in the decision-making process about patient care. In the context of healthcare justice, the informed consent process should not be influenced by ethically irrelevant factors. Healthcare justice should be understood as a basis for the human rights to healthcare and to participate in decisions about one's healthcare. Healthcare justice in perinatal medicine creates an essential role for the perinatologist to be an effective advocate for pregnant, fetal, and neonatal patients, i.e., for "women and children first." Copyright © 2016 Elsevier Inc. All rights reserved.

Taurine and taurine-deficiency in the perinatal period.

PubMed

Aerts, Leona; Van Assche, Frans André

2002-01-01

Taurine, a non-protein sulfur amino-acid, is the most abundant free amino-acid in the body and plays an important role in several essential biological processes. Apart from its role in cholesterol degradation, it acts as neurotransmitter, and has a function as osmoregulator and antioxidant in most body tissues. During pregnancy, taurine accumulates in the maternal tissues, to be released in the perinatal period to the fetus via the placenta and to the newborn via the maternal milk. It is accumulated especially in the fetal and neonatal brain. Low maternal taurine levels result in low fetal taurine levels. Taurine-deficiency in the mother leads to growth retardation of the offspring, and to impaired perinatal development of the central nervous system and of the endocrine pancreas. The adult offspring of taurine-deficient mothers display signs of impaired neurological function, impaired glucose tolerance and vascular dysfunction; they may develop gestational diabetes and transmit the effects to the next generation. This transgeneration effect of taurine-deficiency in the perinatal period fits into the concept of fetal origin of adult disease.

Mozambican midwives' views on barriers to quality perinatal care.

PubMed

Pettersson, Karen Odberg; Johansson, Eva; Pelembe, Maria de Fatima M; Dgedge, Clemencia; Christensson, Kyllike

2006-02-01

Our purpose in this study was to explore the midwives' perception of factors obstructing or facilitating their ability to provide quality perinatal care at a central labor ward in Maputo. In-depth interviews were undertaken with 16 midwives and were analyzed according to grounded theory technique. Barriers to provision of quality perinatal care were identified as follows: (i) the unsupportive environment, (ii) nonempowering and limited interaction with women in labor, (iii) a sense of professional inadequacy and inferiority, and (iv) nonappliance of best caring practices. A model based on the midwives' reflections on barriers to quality perinatal care and responses to these were developed. Actions aimed at overcoming the barriers were improvising and identifying areas in need of change. Identified evading actions were holding others accountable and yielding to dysfunction and structural control. In order to improve perinatal care, the midwives need to see themselves as change agents and not as victims of external and internal causal relationships over which they have no influence. It is moreover essential that the midwives chose actions aiming at overcoming barriers to quality perinatal care instead of choosing evading actions, which might jeopardize the health of the unborn and newborn infant. We suggest that local as well as national education programs need to correspond with existing reality, even if they provide knowledge that surpasses the present possibilities in practice. Quality of intrapartum and the immediate newborn care requires a supportive environment, however, which in the context of this study presented such serious obstacles that they need to be addressed on the national level. Structural and administrative changes are difficult to target as these depend on national organization of maternal health care (MHC) services and national health expenditures.

A prototype system for perinatal knowledge engineering using an artificial intelligence tool.

PubMed

Sokol, R J; Chik, L

1988-01-01

Though several perinatal expert systems are extant, the use of artificial intelligence has, as yet, had minimal impact in medical computing. In this evaluation of the potential of AI techniques in the development of a computer based "Perinatal Consultant," a "top down" approach to the development of a perinatal knowledge base was taken, using as a source for such a knowledge base a 30-page manuscript of a chapter concerning high risk pregnancy. The UNIX utility "style" was used to parse sentences and obtain key words and phrases, both as part of a natural language interface and to identify key perinatal concepts. Compared with the "gold standard" of sentences containing key facts as chosen by the experts, a semiautomated method using a nonmedical speller to identify key words and phrases in context functioned with a sensitivity of 79%, i.e., approximately 8 in 10 key sentences were detected as the basis for PROLOG, rules and facts for the knowledge base. These encouraging results suggest that functional perinatal expert systems may well be expedited by using programming utilities in conjunction with AI tools and published literature.

PREGNANCY AND PERINATAL HEALTH, INNER MONGOLIA, CHINA, DECEMBER 1996-DECEMBER 1999

EPA Science Inventory

Pregnancy and Perinatal Health, Inner Mongolia, China, December 1996- December 1999
Subtitle: Pregnancy and Perinatal Health, Inner Mongolia, China
Authors: Z. Liu1, D.T. Lobdell2, L. He1, M. Yang1, R. Kwok2, J. Mumford2
Affiliations:
1 Ba Men Anti-Epidemic Station, ...

Perinatal factors and the risk of bipolar disorder in Finland.

PubMed

Chudal, Roshan; Sourander, Andre; Polo-Kantola, Päivi; Hinkka-Yli-Salomäki, Susanna; Lehti, Venla; Sucksdorff, Dan; Gissler, Mika; Brown, Alan S

2014-02-01

Complications during the perinatal period have been associated with neurodevelopmental disorders like schizophrenia and autism. However, similar studies on bipolar disorder (BPD) have been limited and the findings are inconsistent. The aim of this study was to examine the association between perinatal risk factors and BPD. This nested case-control study, based on the Finnish Prenatal Study of Bipolar Disorders (FIPS-B), identified 724 cases and 1419 matched controls from population based registers. Conditional logistic regression was used to examine the associations between perinatal factors and BPD adjusting for potential confounding due to maternal age, psychiatric history and educational level, place of birth, number of previous births and maternal smoking during pregnancy. Children delivered by planned cesarean section had a 2.5-fold increased risk of BPD (95% CI: 1.32-4.78, P<0.01). No association was seen between other examined perinatal risk factors and BPD. The limitations of this study include: the restriction in the sample to treated cases of BPD in the population, and usage of hospital based clinical diagnosis for case ascertainment. In addition, in spite of the large sample size, there was low power to detect associations for certain exposures including the lowest birth weight category and pre-term birth. Birth by planned cesarean section was associated with risk of BPD, but most other perinatal risk factors examined in this study were not associated with BPD. Larger studies with greater statistical power to detect less common exposures and studies utilizing prospective biomarker-based exposures are necessary in the future. © 2013 Published by Elsevier B.V.

Cognitive-behavioral group treatment for perinatal anxiety: a pilot study.

PubMed

Green, Sheryl M; Haber, Erika; Frey, Benicio N; McCabe, Randi E

2015-08-01

Along with physical and biological changes, a tremendous amount of upheaval and adjustment accompany the pregnancy and postpartum period of a woman's life that together can often result in what is commonly known as postpartum depression. However, anxiety disorders have been found to be more frequent than depression during pregnancy and at least as common, if not more so, during the postpartum period, e.g., Brockington et al., (Archieves Women's Ment Health 9:253-263, 2006; Wenzel et al. (J Anxiety Disord, 19:295-311, 2005). Cognitive-behavioral therapy (CBT) is a well-established psychological treatment of choice for anxiety; however, few studies have specifically examined a cognitive-behavioral intervention targeting perinatal anxiety. This pilot study examined the effectiveness of a cognitive-behavioral group treatment (CBGT) program specifically tailored to address perinatal anxiety in 10 women who were either pregnant or within 12 months postpartum. Participants were recruited from a women's clinic at an academic hospital setting, with anxiety identified as their principal focus of distress. Following a diagnostic interview confirming a primary anxiety disorder and completion of assessment measures, participants completed a 6-week CBGT program. There was a statistically significant reduction in anxiety and depressive symptoms following the CBGT program (all p < 0.05). Participants also reported high acceptability and satisfaction with this treatment for addressing their perinatal anxiety. These findings suggest that CBGT for perinatal anxiety is a promising treatment for both anxiety and depressive symptoms experienced during the perinatal period. Further studies are needed to evaluate the treatment efficacy through larger controlled trials.

Social and Cultural Factors Associated with Perinatal Grief in Chhattisgarh, India

PubMed Central

Roberts, Lisa R.; Montgomery, Susanne; Lee, Jerry W.; Anderson, Barbara A.

2017-01-01

Stillbirth is a globally significant public health problem with many medical causes. There are also indirect causal pathways including social and cultural factors which are particularly salient in India's traditional society. The purpose of this study was to explore women's perceptions of stillbirth and to determine how issues of gender and power, social support, coping efforts, and religious beliefs influence perinatal grief outcomes among poor women in rural Chhattisgarh, India. Structured interviews were done face-to-face in 21 randomly selected villages among women of reproductive age (N = 355) who had experienced stillbirth (n = 178) and compared to those who had not (n = 177), in the Christian Hospital, Mungeli catchment area. Perinatal grief was significantly higher among women with a history of stillbirth. Greater perinatal grief was associated with lack of support, maternal agreement with social norms, and younger maternal age. These predictors must be understood in light of an additional finding—distorted sex ratios, which reflect gender discrimination in the context of Indian society. The findings of this study will allow the development of a culturally appropriate health education program which should be designed to increase social support and address social norms, thereby reducing psychological distress to prevent complicated perinatal grief. Perinatal grief is a significant social burden which impacts the health women. PMID:21956647

Tobacco control policies and perinatal health: a national quasi-experimental study.

PubMed

Peelen, Myrthe J; Sheikh, Aziz; Kok, Marjolein; Hajenius, Petra; Zimmermann, Luc J; Kramer, Boris W; Hukkelhoven, Chantal W; Reiss, Irwin K; Mol, Ben W; Been, Jasper V

2016-04-22

We investigated whether changes in perinatal outcomes occurred following introduction of key tobacco control policies in the Netherlands: smoke-free legislation in workplaces plus a tobacco tax increase and mass media campaign (January-February 2004); and extension of the smoke-free law to the hospitality industry, accompanied by another tax increase and mass media campaign (July 2008). This was a national quasi-experimental study using Netherlands Perinatal Registry data (2000-2011; registration: ClinicalTrials.gov NCT02189265). Primary outcome measures were: perinatal mortality, preterm birth, and being small-for-gestational age (SGA). The association with timing of the tobacco control policies was investigated using interrupted time series logistic regression analyses with adjustment for confounders. Among 2,069,695 singleton births, there were 13,027 (0.6%) perinatal deaths, 116,043 (5.6%) preterm live-births and 187,966 (9.1%) SGA live-births. The 2004 policies were not associated with significant changes in the odds of developing any of the primary outcomes. After the 2008 policy change, a -4.4% (95% CI -2.4; -6.4, p < 0.001) decrease in odds of being SGA was observed. A reduction in SGA births, but not preterm birth or perinatal mortality, was observed in the Netherlands after extension of the smoke-free workplace law to bars and restaurants in conjunction with a tax increase and mass media campaign.

Tobacco control policies and perinatal health: a national quasi-experimental study

PubMed Central

Peelen, Myrthe J.; Sheikh, Aziz; Kok, Marjolein; Hajenius, Petra; Zimmermann, Luc J.; Kramer, Boris W.; Hukkelhoven, Chantal W.; Reiss, Irwin K.; Mol, Ben W.; Been, Jasper V.

2016-01-01

We investigated whether changes in perinatal outcomes occurred following introduction of key tobacco control policies in the Netherlands: smoke-free legislation in workplaces plus a tobacco tax increase and mass media campaign (January-February 2004); and extension of the smoke-free law to the hospitality industry, accompanied by another tax increase and mass media campaign (July 2008). This was a national quasi-experimental study using Netherlands Perinatal Registry data (2000–2011; registration: ClinicalTrials.gov NCT02189265). Primary outcome measures were: perinatal mortality, preterm birth, and being small-for-gestational age (SGA). The association with timing of the tobacco control policies was investigated using interrupted time series logistic regression analyses with adjustment for confounders. Among 2,069,695 singleton births, there were 13,027 (0.6%) perinatal deaths, 116,043 (5.6%) preterm live-births and 187,966 (9.1%) SGA live-births. The 2004 policies were not associated with significant changes in the odds of developing any of the primary outcomes. After the 2008 policy change, a -4.4% (95% CI -2.4; -6.4, p < 0.001) decrease in odds of being SGA was observed. A reduction in SGA births, but not preterm birth or perinatal mortality, was observed in the Netherlands after extension of the smoke-free workplace law to bars and restaurants in conjunction with a tax increase and mass media campaign. PMID:27103591

Perinatal stroke and the risk of developing childhood epilepsy

PubMed Central

Golomb, Meredith R.; Garg, Bhuwan P.; Carvalho, Karen S.; Johnson, Cynthia S.; Williams, Linda S.

2008-01-01

Objectives To describe the prevalence of epilepsy after 6 months-of-age in children with perinatal stroke and examine whether perinatal data predict epilepsy onset and resolution. Study design A retrospective review of 64 children with perinatal stroke. In children with at least 6 months of follow-up data, Kaplan-Meier curves, univariate log-rank tests, and Cox proportional hazards models were used to examine predictors of time to development of seizures, and time to resolution of seizures in children with epilepsy. The association of risk factors with the presence of epilepsy at any time after 6 months-of-age was examined using Fisher’s exact test. Results Forty-one of the 61 children with at least 6 months of follow-up data (67%) had epilepsy between 6 months-of-age and last follow-up, but in 13 of 41 seizures eventually resolved and anticonvulsants were discontinued. Infarct on prenatal ultrasound (p=0.0065) and family history of epilepsy (p=0.0093) were significantly associated with time to development of seizures after 6 months-of-age in the univariate analysis. No assessed variables were associated with time to resolution of epilepsy or with the presence of epilepsy after 6 months-of-age. Conclusions Childhood epilepsy is frequent after perinatal stroke. Evidence of infarction on prenatal ultrasound and a family history of epilepsy predict earlier onset of active seizures. PMID:17889079

Resilience in perinatal HIV+ adolescents in South Africa.

PubMed

Bhana, Arvin; Mellins, Claude A; Small, Latoya; Nestadt, Danielle F; Leu, Cheng-Shiun; Petersen, Inge; Machanyangwa, Sphindile; McKay, Mary

2016-03-01

Increasing numbers of perinatally HIV (PHIV+)-infected youth are surviving into adulthood with better access to treatment. However, few studies examine positive outcomes in the face of adversity (resilience) for PHIV+ youth. Social Action Theory (SAT) provided the theoretical framework for this study of PHIV + youth in South Africa (SA), allowing examination of contextual, social, and self-regulatory factors that influence behavioral health. Data were from youth and caregiver baseline interviews, simply pooled from a pilot (N=66) and larger (n=111) randomized control trial (RCT) of the VUKA Family program. For this analysis, outcomes included emotional and behavioral functioning (total difficulties), and prosocial behaviors. Potential SAT correlates included socio-demographics; caregiver health and mental health; parent-child relationship factors; stigma, and child coping, support; and self-esteem. Regression analyses adjusted for age, gender, and study revealed significant associations at the contextual, social, and self-regulation level. Lower total child difficulties scores were associated with lower caregiver depression (β = 3.906,p < .001), less caregiver-reported communication about difficult issues (β = 1.882, p = .009) and higher youth self-esteem (β = -0.119, p = .020). Greater prosocial behaviors were associated with greater caregiver-reported communication (β = 0.722, p = .020) and child use of wishful thinking for coping (β = 5.532, p = .009). Less youth depression was associated with higher caregiver education (β =-0.399, p = .010), greater caregiver supervision (β = -1.261, p = .012), more social support seeking (β = -0.453, p = .002), higher youth self-esteem (β = -0.067, p < .001), lower internalized stigma (β = 0.608, p = .040), and child use of resignation for coping (β = 1.152, p = .041). Our data support evidence-based family interventions that also promote youth self-regulation skills to enhance the health and mental health of PHIV

Perinatal Care of Infants with Congenital Birth Defects.

PubMed

Sewell, Elizabeth K; Keene, Sarah

2018-06-01

Prenatal diagnosis has changed perinatal medicine dramatically, allowing for additional fetal monitoring, referral and counseling, delivery planning, the option of fetal intervention, and targeted postnatal management. Teams participating in the delivery room care of infants with known anomalies should be knowledgeable about specific needs and expectations but also ready for unexpected complications. A small number of neonates will need rapid access to postnatal interventions, such as surgery, but most can be stabilized with appropriate neonatal care. These targeted perinatal interventions have been shown to improve outcome in selected diagnoses. Copyright © 2018 Elsevier Inc. All rights reserved.

Gestational age-specific perinatal mortality rates for assisted reproductive technology (ART) and other births.

PubMed

Chughtai, Abrar A; Wang, Alex Y; Hilder, Lisa; Li, Zhuoyang; Lui, Kei; Farquhar, Cindy; Sullivan, Elizabeth A

2018-02-01

Is perinatal mortality rate higher among births born following assisted reproductive technology (ART) compared to non-ART births? Overall perinatal mortality rates in ART births was higher compared to non-ART births, but gestational age-specific perinatal mortality rate of ART births was lower for very preterm and moderate to late preterm births. Births born following ART are reported to have higher risk of adverse perinatal outcomes compared to non-ART births. This population-based retrospective cohort study included 407 368 babies (391 952 non-ART and 15 416 ART)-393 491 singletons and 10 877 twins or high order multiples. All births (≥20 weeks of gestation and/or ≥400 g of birthweight) in five states and territories in Australia during the period 2007-2009 were included in the study, using National Perinatal Data Collection (NPDC). Primary outcome measures were rates of stillbirth, neonatal and perinatal deaths. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to estimate the likelihood of perinatal death. Rates of multiple birth and low birthweight were significantly higher in ART group compared to the non-ART group (P < 0.01). Overall perinatal mortality rate was significantly higher for ART births (16.5 per 1000 births, 95% CI 14.5-18.6), compared to non-ART births (11.3 per 1000 births, 95% CI 11.0-11.6) (AOR 1.45, 95% CI 1.26-1.68). However, gestational age-specific perinatal mortality rate of ART births (including both singletons and multiples) was lower for very preterm (<32 weeks' gestation) and moderate to late preterm births (32-36 weeks' gestation) (AOR 0.61, 95% CI 0.53-0.70 and AOR 0.61, 95% CI 0.53-0.70, respectively) compared to non-ART births. Congenital abnormality and spontaneous preterm were the most common causes of neonatal deaths in both ART and non-ART group. Due to different cut-off limit for perinatal period in Australia, the results of this study should be interpreted with cautions for other countries. Australian

Hospital-based perinatal nurses identify the need to improve nursing care of adolescent mothers.

PubMed

Peterson, Wendy E; Davies, Barbara; Rashotte, Judy; Salvador, Anne; Trépanier, Marie-Josée

2012-01-01

To determine whether hospital-based perinatal nurses with expertise in adolescent mother-friendly care identify a need to improve inpatient nursing care of adolescent mothers and how well perinatal units support nurses' capacity to provide adolescent mother-friendly care. A key informant survey of nurses from eight perinatal units at three hospitals (four separate sites) in a Canadian city. Perinatal nurses expert in the care of adolescent mothers were identified by their managers and colleagues. These nurses and all perinatal clinical educators were invited to participate. Twenty-seven of 34 potential key informants completed the survey. Key informants rated their own skill in caring for adolescent mothers higher (median 8.0) than they rated the skill of other nurses (median 6.0) on their units. They attributed their expertise working with adolescent mothers to their clinical and life experiences and their ability to develop rapport with adolescents. A common reason for the assigned lower peer-group ratings was the judgmental manner in which some nurses care for adolescent mothers. Key informants also identified that hospital-based perinatal nurses lack adequate knowledge of community-based resources for adolescent mothers, educational programs related to adolescent mother-friendly care were insufficient, and policies to inform the nursing care of adolescent mothers were not available or known to them. A minority of perinatal nurses have expertise in adolescent mother-friendly care. There is a need for perinatal unit-level interventions to support the development of nurses' skills in caring for adolescent mothers and their knowledge of community-based resources. Peer mentoring and self-reflective practice are promising strategies. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

[An explanatory model of behavior toward mental illness].

PubMed

García-Sílberman, Sarah

2002-01-01

To evaluate a theoretical model designed to explain behaviors toward mental illness, considering some variables related to the construct. A survey was conducted in 1996 on mental disorder beliefs, attitudes, and behavioral intentions. The sample population was stratified by socioeconomic status, age, and gender. Study subjects were 800 individuals from Mexico City's general population. A data collection instrument was constructed and validated, consisting of 120 Likert-type items with five options each. Data were coded and analyzed with the software package SPSS. Internal consistency of the scales was assessed using Cronbach's alpha and construct validity with factorial analysis. Student's t test and ANOVA were used to compare the groups in the different strata. The model allowed to confirm the predictive capacity of the causal chain connecting beliefs, attitudes, and intentions; nevertheless, other study variables did not contribute to explain it, and behavior was scarcely influenced by intentions, depending mainly on experimented necessity. Study findings constitute a basis to understand the attitudes of shame and fear usually related to mental illnesses, to plan efficient actions aimed at modifying them, and to design programs to promote mental health. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Women׳s help-seeking behaviours for depressive symptoms during the perinatal period: Socio-demographic and clinical correlates and perceived barriers to seeking professional help.

PubMed

Fonseca, Ana; Gorayeb, Ricardo; Canavarro, Maria Cristina

2015-12-01

This study aims to characterize the help-seeking behaviours of women who were screened positive for perinatal depression, to investigate its sociodemographic and clinical correlates, and to characterize the perceived barriers that prevent women from seeking professional help. Cross-sectional internet survey. Participants were recruited through advertisements published in pamphlets and posted on social media websites (e.g., Facebook) and websites and forums that focused on pregnancy and childbirth. 656 women (currently pregnant or who had a baby during the last 12 months) completed the survey. Participants were assessed with the Edinburgh Postpartum Depression Scale, and were questioned about sociodemographic and clinical data, help-seeking behaviours and perceived barriers to help-seeking. Different pathways of help-seeking were found, with only 13.6% of women with a perinatal depression seeking help for their emotional problems. Married women, currently pregnant women, and women without history of psychological problems had a higher likelihood of not engaging in any type of help-seeking behaviour. The majority of women who had not sought professional assistance identified several barriers to help-seeking, particularly knowledge barriers. Strategies to increase women׳s help-seeking behaviours should be implemented, namely improving mental health literacy, introducing screening procedures for mental health problems in pre/postnatal health care settings, and offering women innovative opportunities (e.g., web-based tools) that allow them to overcome the practical barriers to help-seeking. Copyright © 2015 Elsevier Ltd. All rights reserved.

Utility of local health registers in measuring perinatal mortality: A case study in rural Indonesia

PubMed Central

2011-01-01

Background Perinatal mortality is an important indicator of obstetric and newborn care services. Although the vast majority of global perinatal mortality is estimated to occur in developing countries, there is a critical paucity of reliable data at the local level to inform health policy, plan health care services, and monitor their impact. This paper explores the utility of information from village health registers to measure perinatal mortality at the sub district level in a rural area of Indonesia. Methods A retrospective pregnancy cohort for 2007 was constructed by triangulating data from antenatal care, birth, and newborn care registers in a sample of villages in three rural sub districts in Central Java, Indonesia. For each pregnancy, birth outcome and first week survival were traced and recorded from the different registers, as available. Additional local death records were consulted to verify perinatal mortality, or identify deaths not recorded in the health registers. Analyses were performed to assess data quality from registers, and measure perinatal mortality rates. Qualitative research was conducted to explore knowledge and practices of village midwives in register maintenance and reporting of perinatal mortality. Results Field activities were conducted in 23 villages, covering a total of 1759 deliveries that occurred in 2007. Perinatal mortality outcomes were 23 stillbirths and 15 early neonatal deaths, resulting in a perinatal mortality rate of 21.6 per 1000 live births in 2007. Stillbirth rates for the study population were about four times the rates reported in the routine Maternal and Child Health program information system. Inadequate awareness and supervision, and alternate workload were cited by local midwives as factors resulting in inconsistent data reporting. Conclusions Local maternal and child health registers are a useful source of information on perinatal mortality in rural Indonesia. Suitable training, supervision, and quality control

Utility of local health registers in measuring perinatal mortality: a case study in rural Indonesia.

PubMed

Burke, Leona; Suswardany, Dwi Linna; Michener, Keryl; Mazurki, Setiawaty; Adair, Timothy; Elmiyati, Catur; Rao, Chalapati

2011-03-17

Perinatal mortality is an important indicator of obstetric and newborn care services. Although the vast majority of global perinatal mortality is estimated to occur in developing countries, there is a critical paucity of reliable data at the local level to inform health policy, plan health care services, and monitor their impact. This paper explores the utility of information from village health registers to measure perinatal mortality at the sub district level in a rural area of Indonesia. A retrospective pregnancy cohort for 2007 was constructed by triangulating data from antenatal care, birth, and newborn care registers in a sample of villages in three rural sub districts in Central Java, Indonesia. For each pregnancy, birth outcome and first week survival were traced and recorded from the different registers, as available. Additional local death records were consulted to verify perinatal mortality, or identify deaths not recorded in the health registers. Analyses were performed to assess data quality from registers, and measure perinatal mortality rates. Qualitative research was conducted to explore knowledge and practices of village midwives in register maintenance and reporting of perinatal mortality. Field activities were conducted in 23 villages, covering a total of 1759 deliveries that occurred in 2007. Perinatal mortality outcomes were 23 stillbirths and 15 early neonatal deaths, resulting in a perinatal mortality rate of 21.6 per 1000 live births in 2007. Stillbirth rates for the study population were about four times the rates reported in the routine Maternal and Child Health program information system. Inadequate awareness and supervision, and alternate workload were cited by local midwives as factors resulting in inconsistent data reporting. Local maternal and child health registers are a useful source of information on perinatal mortality in rural Indonesia. Suitable training, supervision, and quality control, in conjunction with computerisation to

[Marital status and the severity of perinatal depression among pregnant women].

PubMed

Podolska, Magdalena; Sipak-Szmigiel, Olimpia

2010-01-01

Cohabitation existing for ages in all human cultures is becoming more common since the 1960s due to complex changes in postmodern societies. These societies have made the phenomenon of cohabitation the object of adequate theoretical reflection. The aim of this work was to determine whether the marital status of pregnant women affects the severity of perinatal depression. We enrolled 117 gravida hospitalized in 2006 and 2007 at the Department of Maternal-Fetal Medicine, Pomeranian Medical University. The gestational age ranged from week 32 to 40. The clinical condition of each gravida was assessed during routine obstetric history taking. The Edinburgh Postnatal Depression Scale by Cox, Holden, and Sagovski was used as the screening test for perinatal depression. 1. The marital status of the gravida with emphasis on cohabitation is a significant correlate of perinatal depression and its risk. 2. Clinical examination should concentrate not only on the physical and medical condition but also on the psychosocial status of the patient as the predictor of perinatal depression. 3. All pregnant women living in informal partnerships should be offered psychological support.

Seeking help for perinatal psychological distress: a meta-synthesis of women's experiences.

PubMed

Button, Susan; Thornton, Alexandra; Lee, Suzanne; Shakespeare, Judy; Ayers, Susan

2017-10-01

Women may not seek help for perinatal psychological distress, despite regular contact with primary care services. Barriers include ignorance of symptoms, inability to disclose distress, others' attitudes, and cultural expectations. Much of the evidence has been obtained from North American populations and may not, therefore, extrapolate to the UK. To understand the factors affecting women's decision to seek help for perinatal distress. Meta-synthesis of the available published qualitative evidence on UK women's experiences of seeking help for perinatal distress. Systematic searches were conducted in accordance with PRISMA guidelines. Databases searched were PubMed, Scopus, PsycINFO, PsycARTICLES, CINAHL, and Academic Search Complete. Searches of grey literature and references were also conducted. Studies were eligible for inclusion if they reported qualitative data on UK women's experiences of perinatal distress and contact with healthcare professionals. The synthesis was conducted using meta-ethnography. In all, 24 studies were eligible for inclusion. Metasynthesis identified three main themes: identifying a problem, the influence of healthcare professionals, and stigma. These themes build on current understanding of help seeking by identifying the need for women to be able to frame their experience, for healthcare professionals to educate women about their roles, the need for continuity of care, and the way that being seen as a 'bad mother' causes women to self-silence. Perinatal care provision needs to allow for continuity of care and for staff training that facilitates awareness of factors that influence women's help seeking. Further research is required, particularly in relation to effective means of identifying perinatal psychological distress. © British Journal of General Practice 2017.

Integrated Approach to Reduce Perinatal Adverse Events: Standardized Processes, Interdisciplinary Teamwork Training, and Performance Feedback.

PubMed

Riley, William; Begun, James W; Meredith, Les; Miller, Kristi K; Connolly, Kathy; Price, Rebecca; Muri, Janet H; McCullough, Mac; Davis, Stanley

2016-12-01

To improve safety practices and reduce adverse events in perinatal units of acute care hospitals. Primary data collected from perinatal units of 14 hospitals participating in the intervention between 2008 and 2012. Baseline secondary data collected from the same hospitals between 2006 and 2007. A prospective study involving 342,754 deliveries was conducted using a quality improvement collaborative that supported three primary interventions. Primary measures include adoption of three standardized care processes and four measures of outcomes. Chart audits were conducted to measure the implementation of standardized care processes. Outcome measures were collected and validated by the National Perinatal Information Center. The hospital perinatal units increased use of all three care processes, raising consolidated overall use from 38 to 81 percent between 2008 and 2012. The harms measured by the Adverse Outcome Index decreased 14 percent, and a run chart analysis revealed two special causes associated with the interventions. This study demonstrates the ability of hospital perinatal staff to implement efforts to reduce perinatal harm using a quality improvement collaborative. Findings help inform the relationship between the use of standardized care processes, teamwork training, and improved perinatal outcomes, and suggest that a multiplicity of integrated strategies, rather than a single intervention, may be essential to achieve high reliability. © Health Research and Educational Trust.

Perinatal outcome in singleton pregnancies complicated with preeclampsia and eclampsia in Ecuador.

PubMed

Phoa, K Y N; Chedraui, P; Pérez-López, F R; Wendte, J F; Ghiabi, S; Vrijkotte, T; Pinto, P

2016-07-01

Preeclampsia in Ecuador is an understudied subject since available epidemiological data are scarce. The aim of this study was to describe perinatal outcomes among singleton pregnancies complicated with preeclampsia and eclampsia in a sample of low-income Ecuadorian women. Pregnant women complicated with preeclampsia (mild and severe) and eclampsia (defined according to criteria of the ACOG) delivering at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador were surveyed with a structured questionnaire containing maternal (socio-demographic) and neonatal data. Perinatal outcomes were compared according to severity of clinical presentation. A total of 163 women with preeclampsia [mild (23.9%), severe (68.7%) and eclampsia (7.4%)] were surveyed. Perinatal mortality and stillbirth rate was similar among studied groups (mild vs. severe preeclampsia/eclampsia cases). However, severe cases displayed higher rates of adverse perinatal outcomes: lower birth Apgar scores, more preterm births, and more low birth weight and small for gestational age infants. Caesarean-section rate and the number of admissions to intensive or intermediate neonatal care were higher in severe cases. A similar trend was found when analysis excluded preterm gestations. In conclusion, in this specific low-income Ecuadorian population perinatal outcome was adverse in pregnancies complicated with severe preeclampsia/eclampsia.

Prenatal, perinatal and postnatal factors associated with autism spectrum disorder.

PubMed

Hadjkacem, Imen; Ayadi, Héla; Turki, Mariem; Yaich, Sourour; Khemekhem, Khaoula; Walha, Adel; Cherif, Leila; Moalla, Yousr; Ghribi, Farhat

To identify prenatal, perinatal and postnatal risk factors in children with autism spectrum disorder (ASD) by comparing them to their siblings without autistic disorders. The present study is cross sectional and comparative. It was conducted over a period of three months (July-September 2014). It included 101 children: 50 ASD's children diagnosed according to DSM-5 criteria and 51 unaffected siblings. The severity of ASD was assessed by the CARS. Our study revealed a higher prevalence of prenatal, perinatal and postnatal factors in children with ASD in comparison with unaffected siblings. It showed also a significant association between perinatal and postnatal factors and ASD (respectively p=0.03 and p=0.042). In this group, perinatal factors were mainly as type of suffering acute fetal (26% of cases), long duration of delivery and prematurity (18% of cases for each factor), while postnatal factors were represented principally by respiratory infections (24%). As for parental factors, no correlation was found between advanced age of parents at the moment of the conception and ASD. Likewise, no correlation was observed between the severity of ASD and different factors. After logistic regression, the risk factors retained for autism in the final model were: male gender, prenatal urinary tract infection, acute fetal distress, difficult labor and respiratory infection. The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others), as determinant variables for the genesis of ASD. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

DRINKING WATER ARSENIC AND PERINATAL OUTCOMES

EPA Science Inventory

Drinking Water Arsenic and Perinatal Outcomes
DT Lobdell, Z Ning, RK Kwok, JL Mumford, ZY Liu, P Mendola

Many studies have documented an association between drinking water arsenic (DWA) and cancer, vascular diseases, and dermatological outcomes, but few have investigate...

Association of maternal fractures with adverse perinatal outcomes.

PubMed

El Kady, Dina; Gilbert, William M; Xing, Guibo; Smith, Lloyd H

2006-09-01

We sought to assess the effects of fracture injuries on maternal and fetal/neonatal outcomes in a large obstetric population. We performed a retrospective cohort study using a database in which maternal and neonatal hospital discharge summaries were linked with birth and death certificates to identify any relation between maternal fractures and maternal and perinatal morbidity. Fracture injuries and perinatal outcomes were identified with the use of the International Classification of Diseases, 9th revision, Clinical Modification codes. Outcomes were further subdivided on the basis of anatomic site of fracture. A total of 3292 women with > or = 1 fractures were identified. Maternal mortality (odds ratio, 169 [95% CI, 83.2,346.4]) and morbidity (abruption and blood transfusion) rates were increased significantly in women who were delivered during hospitalization for their injury. Women who were discharged undelivered continued to have delayed morbidity, which included a 46% increased risk of low birth weight infants (odds ratio, 1.5 [95% CI, 1.3,1.7]) and a 9-fold increased risk of thrombotic events (odds ratio, 9.2 [95% CI, 1.3,65.7]) Pelvic fractures had the worst outcomes. Fractures during pregnancy are an important marker for poor perinatal outcomes.

The role of inflammation in perinatal brain injury.

PubMed

Hagberg, Henrik; Mallard, Carina; Ferriero, Donna M; Vannucci, Susan J; Levison, Steven W; Vexler, Zinaida S; Gressens, Pierre

2015-04-01

Inflammation is increasingly recognized as being a critical contributor to both normal development and injury outcome in the immature brain. The focus of this Review is to highlight important differences in innate and adaptive immunity in immature versus adult brain, which support the notion that the consequences of inflammation will be entirely different depending on context and stage of CNS development. Perinatal brain injury can result from neonatal encephalopathy and perinatal arterial ischaemic stroke, usually at term, but also in preterm infants. Inflammation occurs before, during and after brain injury at term, and modulates vulnerability to and development of brain injury. Preterm birth, on the other hand, is often a result of exposure to inflammation at a very early developmental phase, which affects the brain not only during fetal life, but also over a protracted period of postnatal life in a neonatal intensive care setting, influencing critical phases of myelination and cortical plasticity. Neuroinflammation during the perinatal period can increase the risk of neurological and neuropsychiatric disease throughout childhood and adulthood, and is, therefore, of concern to the broader group of physicians who care for these individuals.

The role of inflammation in perinatal brain injury

PubMed Central

Hagberg, Henrik; Mallard, Carina; Ferriero, Donna M.; Vannucci, Susan J.; Levison, Steven W.; Vexler, Zinaida S.; Gressens, Pierre

2015-01-01

Inflammation is increasingly recognized as being a critical contributor to both normal development and injury outcome in the immature brain. The focus of this Review is to highlight important differences in innate and adaptive immunity in immature versus adult brain, which support the notion that the consequences of inflammation will be entirely different depending on context and stage of CNS development. Perinatal brain injury can result from neonatal encephalopathy and perinatal arterial ischaemic stroke, usually at term, but also in preterm infants. Inflammation occurs before, during and after brain injury at term, and modulates vulnerability to and development of brain injury. Preterm birth, on the other hand, is often a result of exposure to inflammation at a very early developmental phase, which affects the brain not only during fetal life, but also over a protracted period of postnatal life in a neonatal intensive care setting, influencing critical phases of myelination and cortical plasticity. Neuroinflammation during the perinatal period can increase the risk of neurological and neuropsychiatric disease throughout childhood and adulthood, and is, therefore, of concern to the broader group of physicians who care for these individuals. PMID:25686754

FACTORES SOCIO-ESTRUCTURALES Y EL ESTIGMA HACIA EL VIH/SIDA: EXPERIENCIAS DE PUERTORRIQUEÑOS/AS CON VIH/SIDA AL ACCEDER SERVICIOS DE SALUD

PubMed Central

RIVERA-DIAZ, MARINILDA; VARAS-DIAZ, NELSON; REYES-ESTRADA, MARCOS; SURO, BEATRIZ; CORIANO, DORALIS

2013-01-01

RESUMEN El estigma relacionado al VIH/SIDA continúa afectando la prestación de servicios de salud y el bienestar físico y mental de las personas con VIH/SIDA (PVS). Recientemente la literatura científica ha señalado la importancia de comprender las manifestaciones de estigma más allá de las interacciones individuales. Por tal razón, investigaciones recientes en y fuera de Puerto Rico enfatizan la importancia de entender cómo factores socio-estructurales (FSE) influyen en los procesos de estigmatización social. Con el propósito de examinar los FSE que influyen en las manifestaciones de estigma relacionado al VIH/SIDA, realizamos y analizamos nueve grupos focales compuestos por hombres y mujeres en tratamiento para el VIH/SIDA que habían tenido experiencias estigmatizantes. Los participantes identificaron FSE relacionados a las manifestaciones de estigma, tales como el uso de viviendas especializadas, descentralización de los servicios de salud y el desarrollo de protocolos administrativos excluyentes en los servicios de salud. Los resultados demuestran la importancia de considerar los FSE en el desarrollo e implementación de intervenciones dirigidas a la población. PMID:24639599

Sexual Health Knowledge in a Sample of Perinatally HIV-infected and Perinatally-exposed Uninfected Youth

PubMed Central

Gromadzka, Olga; Santamaria, E. Karina; Benavides, Jessica M.; Dolezal, Curtis; Elkington, Katherine S.; Leu, Cheng-Shiun; McKay, Mary; Abrams, Elaine J.; Wiznia, Andrew; Bamji, Mahrukh; Ann Mellins, Claude

2015-01-01

This study describes sexual health knowledge in perinatally HIV-infected (PHIV+) and perinatally-exposed uninfected (PHIV-) ethnic-minority youth, ages 9–16 years, residing in NYC (n=316). Data on youth sexual health knowledge (e.g., pregnancy, STDs, birth control) and caregiver-adolescent communication about sexual health were examined. Participants in both groups answered only 35% of the sexual health knowledge questions correctly (mean=6.6/19). Higher scores were found among youth who reported more communication about sex with caregivers (vs. those who did not report talking about sex with caregivers; 8.54 vs. 5.84, p<.001) and among PHIV+ youth who were aware of their status (vs. PHIV+ youth who were not; 7.27 vs. 4.70, p<.001). Age was positively correlated with sexual health knowledge (beta=.489, p<.001). Both PHIV+ and PHIV− youth had poor sexual health knowledge, suggesting a need for sexual health education for both groups. Data suggest that interventions focused on caregiver-child risk communication may be important for prevention. PMID:26855617

Macrosomia, Perinatal and Infant Mortality in Cree Communities in Quebec, 1996-2010

PubMed Central

Xiao, Lin; Zhang, Dan-Li; Torrie, Jill; Auger, Nathalie; McHugh, Nancy Gros-Louis; Luo, Zhong-Cheng

2016-01-01

Background Cree births in Quebec are characterized by the highest reported prevalence of macrosomia (~35%) in the world. It is unclear whether Cree births are at greater elevated risk of perinatal and infant mortality than other First Nations relative to non-Aboriginal births in Quebec, and if macrosomia may be related. Methods This was a population-based retrospective birth cohort study using the linked birth-infant death database for singleton births to mothers from Cree (n = 5,340), other First Nations (n = 10,810) and non-Aboriginal (n = 229,960) communities in Quebec, 1996–2010. Community type was ascertained by residential postal code and municipality name. The primary outcomes were perinatal and infant mortality. Results Macrosomia (birth weight for gestational age >90th percentile) was substantially more frequent in Cree (38.0%) and other First Nations (21.9%) vs non-Aboriginal (9.4%) communities. Comparing Cree and other First Nations vs non-Aboriginal communities, perinatal mortality rates were 1.52 (95% confidence intervals 1.17, 1.98) and 1.34 (1.10, 1.64) times higher, and infant mortality rates 2.27 (1.71, 3.02) and 1.49 (1.16, 1.91) times higher, respectively. The risk elevations in perinatal and infant death in Cree communities attenuated after adjusting for maternal characteristics (age, education, marital status, parity), but became greater after further adjustment for birth weight (small, appropriate, or large for gestational age). Conclusions Cree communities had greater risk elevations in perinatal and infant mortality than other First Nations relative to non-Aboriginal communities in Quebec. High prevalence of macrosomia did not explain the elevated risk of perinatal and infant mortality in Cree communities. PMID:27517613

[Effect of perinatal recurrent infection on the brain development in immature mice].

PubMed

Song, Li-Li; Huang, Zhi-Heng; Pei, Yi-Ling; Chen, Chao

2014-12-01

To study the effects of perinatal recurrent infection on the brain development in immature mice. Six pregnant C57BL6 mice were randomly assigned to three groups: intrauterine infection, perinatal recurrent infection and control. The intrauterine infection group was intraperitoneally injected with LPS (0.5 mg/kg) on the 18th day of pregnancy. The perinatal recurrent infection group was injected with LPS (0.5 mg/kg) on the 18th day of pregnancy and their offsprings were intraperitoneally injected with the same dose of LPS daily from postnatal day 3 to 12. The control group was administered with normal saline at the same time points as the recurrent infection group. The short-time neurobehaviors were assessed on postnatal day 13. The mice were then sacrificed to measure brain weights and neuropathological changes using cresyl violet staining. Western blot was used to evaluate the expression of TNF-α, Caspase-3 and myelin basic protein (MBP). The brain weights of the recurrent infection group were significantly lower than the control and intrauterine infection groups (P<0.05) and the recurrent infection group displayed significant neuropathological changes. Perinatal recurrent infection resulted in increased expression levels of TNF-α and Caspase-3, and decreased expression level of MBP compared with the intrauterine infection and control groups (P<0.01). The neurobehavior test showed that the recurrent infection group used longer time in gait reflex, right reflex and geotaxis reflex compared with the control and intrauterine infection groups on postnatal day 13 (P<0.05). Perinatal recurrent infection may exacerbate inflammatory response and cell death in the immature brain, which may be one of the important factors for perinatal brain injury.

The influence of the war on perinatal and maternal mortality in Bosnia and Herzegovina.

PubMed

Fatusić, Z; Kurjak, A; Grgić, G; Tulumović, A

2005-10-01

To investigate the influence of the war on perinatal and maternal mortality during the war conflict in Bosnia and Herzegovina. In a retrospective study we analysed perinatal and maternal mortality in the pre-war period (1988-1991), the war period (1992-1995) and the post-war period (1996-2003). We also analysed the number of deliveries, the perinatal and maternal mortality rates and their causes. During the analysed period we had a range of 3337-6912 deliveries per year, with a decreased number in the war period. During the war period and immediately after the war, the perinatal mortality rate increased to 20.9-26.3% (average 24.28%). After the war the rate decreased to 8.01% in 2003 (p < 0.05). Maternal mortality before the war was 39/100,000 deliveries, during the war it increased to 65/100,000 and after the war it decreased to 12/100,000 deliveries (p < 0.05). The increase in maternal mortality during the war was because of an increased number of uterine ruptures, sepsis and bleeding due to shell injury of pregnant women. During the war we could expect a decreased number of deliveries, and an increased rate of perinatal and maternal mortality and preterm deliveries due to: inadequate nutrition, stress factors (life in refugee's centers, bombing, deaths of relatives, uncertain future...), and break down of the perinatal care system (lack of medical staff, impossibility of collecting valid health records, particularly perinatal information, and the destruction of medical buildings).

Translation and adaptation of the Competencias Esenciales en Salud Pública para los recursos humanos en salud.

PubMed

Almeida, Maria de Lourdes de; Peres, Aida Maris; Ferreira, Maria Manuela Frederico; Mantovani, Maria de Fátima

2017-06-05

to perform the translation and cultural adaptation of the document named Marco Regional de Competencias Esenciales en Salud Pública para los Recursos Humanos en Salud de la Región de las Américas (Regional Framework of Core Competencies in Public Health for Health Human Resources in the Region of Americas) from Spanish to Brazilian Portuguese. a methodological study comprising the following phases: authorization for translation; initial translation; synthesis of translations and consensus; back-translation and formation of an expert committee. in the translation of domain names, there was no difference in 66.7% (N = 4); in the translation of domain description and competencies there were divergences in 100% of them (N = 6, N = 56). A consensus of more than 80% was obtained in the translation and improvement in the expert committee by the change of words and expressions for approximation of meanings to the Brazilian context. the translated and adapted document has the potential of application in research, and use in the practice of collective/public health care in Brazil. realizar a tradução e adaptação cultural do Marco Regional de Competencias Esenciales en Salud Pública para los Recursos Humanos en Salud de la Región de las Américas, do espanhol para a língua portuguesa do Brasil. pesquisa metodológica, que seguiu as fases: autorização para tradução; tradução inicial; síntese das traduções e consenso; retrotradução e composição de um comitê de especialistas. na tradução dos nomes dos domínios, não houve diferença em 66,7 % (N=4); na tradução da descrição dos domínios e das competências ocorreram divergências em 100 % destes (N=6, N=56), obteve-se consenso acima de 80% ainda na tradução, e aprimoramento no comitê de especialistas pela alteração de palavras e expressões para aproximar os significados ao contexto brasileiro. o documento traduzido e adaptado possui potencial de aplicação em pesquisas e utilização na pr

Childhood Maltreatment and Perinatal Mood and Anxiety Disorders: A Systematic Review.

PubMed

Choi, Karmel W; Sikkema, Kathleen J

2016-12-01

Perinatal mood and anxiety disorders (PMADs) compromise maternal and child well-being and may be influenced by traumatic experiences across the life course. A potent and common form of trauma is childhood maltreatment, but its specific impact on PMADs is not well understood. A systematic review was undertaken to synthesize empirical literature on the relationship between maternal histories of childhood maltreatment and PMADs. Of the 876 citations retrieved, 35 reports from a total of 26,239 participants met inclusion criteria, documenting substantial rates of childhood maltreatment and PMADs. Robust trends of association were observed between childhood maltreatment and perinatal depression, as well as post-traumatic stress disorder, but findings for anxiety were less consistent. Examining multivariate results suggested that childhood maltreatment predicts PMADs above and beyond sociodemographic, psychiatric, perinatal, and psychosocial factors, but may also be partially mediated by variables such as later victimization and moderated by protective early relationships. Future research should test mediating and moderating pathways using prospective cohorts, expanding to cross-cultural settings and other disorder outcomes. Treatment and prevention of childhood maltreatment and its sequelae may help mitigate risk for perinatal psychopathology and its impact on maternal and child outcomes. © The Author(s) 2015.

Adverse perinatal conditions and the inner ear.

PubMed

Newton, V

2001-12-01

Epidemiological studies in a number of Western countries have attributed 6-14% of sensorineural hearing impairment from birth or early childhood to problems relating to the birth process [1-4]. In spite of this association it is not always clear in individual instances whether adverse perinatal conditions identified subsequently have been causative of a hearing loss or not. It is possible that the hearing impairment was the consequence of an earlier intrauterine insult or is a coincidental finding. Infants carrying genetic mutations for hearing loss may coincidentally experience perinatal stress. It is therefore important to investigate the cause of a hearing loss discovered in infancy irrespective of the history of the infant having experienced adverse conditions surrounding the time of birth. Copyright 2002 Published by Elsevier Science Ltd.

Perinatal Factors Affecting Expression of Obsessive Compulsive Disorder in Children and Adolescents

PubMed Central

Wieland, Natalie; Carey, Kathleen; Vivas, Fé; Petty, Carter R.; Johnson, Jessica; Reichert, Elizabeth; Pauls, David; Biederman, Joseph

2008-01-01

Abstract Objective To examine whether adverse perinatal experiences of children are associated with obsessive compulsive disorder (OCD) in youth. Methods Subjects were 130 children and adolescents with OCD recruited from a family genetic study of pediatric OCD and 49 matched controls from a contemporaneous family case-control study of attention-deficit/hyperactivity disorder (ADHD). Subjects were comprehensively assessed in multiple domains of function. A systematic history of pregnancy, delivery, and infancy complications was obtained. Results Compared to normal controls, children with OCD had mothers with significantly higher rates of illness during pregnancy requiring medical care (χ2 = 8.61, p = 0.003) and more birth difficulties (induced labor, forceps delivery, nuchal cord, or prolonged labor) (χ2 = 7.51, p = 0.006). Among the OCD-affected children, we found several significant associations between adverse perinatal experiences and earlier age at onset, increased OCD severity, and increased risk for comorbid ADHD, chronic tic disorder, anxiety disorder, and major depressive disorder. Conclusion Although exploratory, our analyses found that children with OCD had higher rates of several adverse perinatal experiences compared with controls. Among OCD-affected children, comorbid psychopathology was predicted by specific perinatal risk factors. Prospective studies of perinatal adverse events that minimize potential recall bias and type I errors are needed. PMID:18759647

The Relationship of Assisted Reproductive Technology on Perinatal Outcomes in Triplet Gestations.

PubMed

Shah, Jaimin S; Roman, Tania; Viteri, Oscar A; Haidar, Ziad A; Ontiveros, Alejandra; Sibai, Baha M

2018-06-08

 To assess whether assisted reproductive technology (ART) is associated with increased risk of adverse perinatal outcomes in triplet gestations compared with spontaneous conception.  Secondary analysis of a multicenter randomized trial for the prevention of preterm birth in multiple gestations. Triplets delivered at ≥ 24 weeks were studied. The primary outcome was the rate of composite neonatal morbidity (CNM) that included one or more of the following: bronchopulmonary dysplasia, respiratory distress syndrome, necrotizing enterocolitis, culture proven sepsis, pneumonia, retinopathy of prematurity, intraventricular hemorrhage, periventricular leukomalacia, or perinatal death.  There were 381 triplets (127 women) of which 89 patients conceived via ART and 38 patients spontaneously. Women with ART were more likely to be older, Caucasian, married, nulliparous, have higher level of education, and develop pre-eclampsia. Spontaneously conceived triplets were more likely to delivery at an earlier gestation (31.2 ± 3.5 vs 32.8 ± 2.7 weeks) ( p  = 0.009) with a lower birth weight ( p  < 0.001). After adjusting for confounders, no differences were noted in culture proven sepsis, perinatal death, CNM, respiratory distress syndrome, or Apgar score < 7 at 5 minutes. All remaining perinatal outcomes were similar.  Triplets conceived by ART had similar perinatal outcomes compared with spontaneously conceived triplets. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

US and territory telemedicine policies: identifying gaps in perinatal care

PubMed Central

Okoroh, Ekwutosi M.; Kroelinger, Charlan D.; Smith, Alexander M.; Goodman, David A.; Barfield, Wanda D.

2016-01-01

BACKGROUND Perinatal regionalization is a system of maternal and neonatal risk-appropriate health care delivery in which resources are ideally allocated for mothers and newborns during pregnancy, labor and delivery, and postpartum, in order to deliver appropriate care. Typically, perinatal risk-appropriate care is provided in-person, but with the advancement of technologies, the opportunity to provide care remotely has emerged. Telemedicine provides distance-based care to patients by consultation, diagnosis, and treatment in rural or remote US jurisdictions (states and territories). OBJECTIVE We sought to summarize the telemedicine policies of states and territories and assess if maternal and neonatal risk-appropriate care is specified. STUDY DESIGN We conducted a 2014 systematic World Wide Web–based review of publicly available rules, statutes, regulations, laws, planning documents, and program descriptions among US jurisdictions (N=59) on telemedicine care. Policies including language on the topics of consultation, diagnosis, or treatment, and those specific to maternal and neonatal risk-appropriate care were categorized for analysis. RESULTS Overall, 36 jurisdictions (32 states; 3 territories; and District of Columbia) (61%) had telemedicine policies with language referencing consultation, diagnosis, or treatment; 29 (49%) referenced consultation, 30 (51%) referenced diagnosis, and 35 (59%) referenced treatment. In all, 26 jurisdictions (22 states; 3 territories; and District of Columbia) (44%), referenced all topics. Only 3 jurisdictions (3 states; 0 territories) (5%), had policy language specifically addressing perinatal care. CONCLUSION The majority of states have published telemedicine policies, but few specify policy language for perinatal risk-appropriate care. By ensuring that language specific to the perinatal population is included in telemedicine policies, access to maternal and neonatal care can be increased in rural, remote, and resource

The Perinatal Risk Index: Early Risks Experienced by Domestic Adoptees in the United States.

PubMed

Marceau, Kristine; De Araujo-Greecher, Marielena; Miller, Emily S; Massey, Suena H; Mayes, Linda C; Ganiban, Jody M; Reiss, David; Shaw, Daniel S; Leve, Leslie D; Neiderhiser, Jenae M

2016-01-01

We aimed to assess comprehensively the prevalence of perinatal risks experienced by a potentially high-risk yet understudied population of children domestically adopted in the United States. Data are from participant report and medical records from mothers (n = 580) who completed a domestic adoption placement with nonrelatives at or near birth (Mean placement age = 7 days). We describe a comprehensive measure of perinatal risks, including divergences from previous assessment tools and the incorporation of multiple reporters, and report the prevalence of various types of perinatal risks. The prevalence of each specific risk factor was generally low, although several risks were more prevalent in this sample than estimates from nationally representative publicly available data. Nearly the entire sample (99%) experienced some type of risk exposure. Birth mothers who placed their children for adoption domestically in the US experience higher levels of perinatal risks than the national average, but not for all specific types of risk. Thus, the developmental trajectories of children adopted domestically may systematically differ from the general population to the extent that these specific perinatal risks impact development.

Association between Hypoxia and Perinatal Arterial Ischemic Stroke: A Meta-Analysis

PubMed Central

Qu, Yi; Wu, Jinlin; Li, Xihong; Mu, Dezhi

2014-01-01

Background Perinatal arterial ischemic stroke (AIS) occurs in an estimated 17 to 93 per 100000 live births, yet the etiology is poorly understood. Although investigators have implicated hypoxia as a potential cause of AIS, the role of hypoxia in AIS remains controversial. The aim of this study was to estimate the association between perinatal hypoxia factors and perinatal arterial ischemic stroke through a meta-analysis of published observational studies. Patients and methods A systematic search of electronically available studies published through July 2013 was conducted. Publication bias and heterogeneity across studies were evaluated and summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with fixed-effects or random-effects models. Results A total of 8 studies describing the association between perinatal hypoxia factors and neonatal arterial ischemic stroke (AIS) met inclusion criteria, and 550 newborns with AIS were enrolled. The associations were found for AIS: preeclampsia (OR 2.14; 95% CI, 1.25 to 3.66), ventouse delivery (OR 2.23; 95% CI, 1.26 to 3.97), fetal heart rate abnormalities (OR 6.30; 95% CI, 3.84 to 10.34), reduced fetal movement (OR 5.35; 95% CI, 2.17 to 13.23), meconium-stained liquor (OR 3.05; 95% CI, 2.02 to 4.60), low Apgar score (OR 5.77; 95% CI, 1.66 to 20.04) and resuscitation at birth (OR 4.59; 95% CI, 3.23 to 6.52). Our data did not show any significant change of the mean risk estimate for oxytocin induction (OR 1.33; 95% CI, 0.84 to 2.11) and low arterial umbilical cord ph (OR 4.63; 95% CI 2.14 to 9.98). Conclusions There is a significant association between perinatal hypoxia factors and AIS. The result indicates that perinatal hypoxia maybe one of causes of AIS. Large scale prospective clinical studies are still warranted. PMID:24587227

Register based monitoring shows decreasing socioeconomic differences in Finnish perinatal health

PubMed Central

Gissler, M; Merilainen, J; Vuori, E; Hemminki, E

2003-01-01

Study objective: Several studies on differences in infant outcome by socioeconomic position have been done, but these have usually been based on ad hoc data linkages. The aim of this paper was to investigate whether socioeconomic differences in perinatal health in Finland could be regularly monitored using routinely collected data from one single register. Design and setting: Since October 1990, the Finnish Medical Birth Register (MBR) has included data on maternal occupation. A special computer program that converted the occupation name into an occupational code and into a socioeconomic position was prepared. Perinatal health was measured with five different indicators. The Finnish MBR data for years 1991 to 1999 (n=565 863 newborns) were used in the study. The study period was divided into three, three year periods to study time trends. Results: An occupational code was derived for 95% of women, but it was not possible to define a socioeconomic position for 22% of women, including, for example, students and housewives (the group "Others"). For the rest, the data showed socioeconomic differences in all perinatal health indicators. Maternal smoking explained up to half of the excess risk for adverse perinatal outcome in the lowest socioeconomic group. The socioeconomic differences narrowed during the 1990s: infant outcome improved in the lowest socioeconomic group, but remained at the same level or even deteriorated in other groups. When comparing the lowest group with the highest group, the odds ratios (OR) adjusted for maternal background characteristics at least halved for prematurity (from 1.32 (95% confidence intervals 1.24 to 1.43) in 1991–1993 to 1.16 (1.08 to 1.25) in 1997–1999), for low birth weight (from 1.49 (1.36 to 1.63) to 1.25 (1.17 to 1.40)), and for perinatal mortality (from 1.79 (1.44 to 2.21) to 1.33 (1.07 to 1.66)). Conclusions: Social inequality in perinatal health outcomes exists in Finland, but seems to have diminished in the 1990s. These

Recurrence of preterm birth and perinatal mortality in northern Tanzania: registry-based cohort study.

PubMed

Mahande, Michael J; Daltveit, Anne K; Obure, Joseph; Mmbaga, Blandina T; Masenga, Gileard; Manongi, Rachel; Lie, Rolv T

2013-08-01

To estimate the recurrence risk of preterm delivery and estimate the perinatal mortality in repeated preterm deliveries. Prospective study in Tanzania of 18 176 women who delivered a singleton between 2000 and 2008 at KCMC hospital. The women were followed up to 2010 for consecutive births. A total of 3359 women were identified with a total of 3867 subsequent deliveries in the follow-up period. Recurrence risk of preterm birth and perinatal mortality was estimated using log-binomial regression and adjusted for potential confounders. For women with a previous preterm birth, the risk of preterm birth in a subsequent pregnancy was 17%. This recurrence risk was estimated to be 2.7-fold (95% CI: 2.1-3.4) of the risk of women with a previous term birth. The perinatal mortality of babies in a second preterm birth of the same woman was 15%. Babies born at term who had an older sibling that was born preterm had a perinatal mortality of 10%. Babies born at term who had an older sibling who was also born at term had a perinatal mortality of 1.7%. Previous delivery of a preterm infant is a strong predictor of future preterm births in Tanzania. Previous or repeated preterm births increase the risk of perinatal death substantially in the subsequent pregnancy. © 2013 Blackwell Publishing Ltd.

Perinatal Problems and Psychiatric Comorbidity Among Children with ADHD

PubMed Central

Owens, Elizabeth B.; Hinshaw, Stephen P.

2013-01-01

Objective Among two large, independent samples of girls with attention-deficit/hyperactivity disorder (ADHD), we examined associations between specific (maternal gestational smoking and drug use, early labor, low birth weight, and infant breathing problems at birth) and cumulative prenatal and perinatal risk factors and psychiatric comorbidity during childhood. Method Data from the (a) Multimodal Treatment Study of Children with ADHD, a randomized clinical trial with 579 children aged 7 to 9.9 years with combined-type ADHD, and the (b) Berkeley Girls ADHD Longitudinal Sample, a naturalistic study of 140 girls with ADHD (93 combined-type and 47 inattentive-type) who were first seen when they were 6 to 12 years old, were analyzed separately. In each sample, perinatal risk factors were assessed retrospectively by maternal report, and current childhood psychiatric comorbidity was assessed using maternal report on the Diagnostic Interview Schedule for Children. Results Consistent findings across these two studies show that infant breathing problems, early labor, and total perinatal problems predicted childhood comorbid depression but not comorbid anxiety or externalizing disorders. These associations remained significant, in both samples, with control of family SES and maternal symptoms of ADHD and depression. Results attenuated slightly with control of the number of child comorbidities plus SES and maternal symptoms. Conclusion Accumulating evidence suggests that perinatal risk factors are important precursors of childhood psychiatric comorbidity and that the association between these risk factors and detrimental psychiatric outcomes cannot be explained by maternal psychiatric symptoms or SES during childhood. PMID:23581554

Building Perinatal Case Manager Capacity Using Quality Improvement.

PubMed

Fitzgerald, Elaine

2015-01-01

Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum.

Effects of prenatal childbirth education for partners of pregnant women on paternal postnatal mental health and couple relationship: A systematic review.

PubMed

Suto, Maiko; Takehara, Kenji; Yamane, Yumina; Ota, Erika

2017-03-01

Partner education during pregnancy may be able to prevent postnatal mental health problems, and support expectant fathers in their transition to parenthood. The aim of this systematic review is to investigate the effects of prenatal childbirth education among partners of pregnant women, particularly regarding paternal postnatal mental health and couple relationship. We searched Medline, CINAHL, EMBASE, PsycINFO, ERIC, and CENTRAL using terms such as "partners of pregnant women," "education," and "prenatal support." Searches were limited to randomized trials. We included 11 trials out of 13 reports that addressed the following topics: childbirth preparation, couple relationship, infants and parenting, postpartum psychosocial issues, and housework sharing. Overall risk of bias was low or unclear. Study outcomes, including parents' mental health (e.g., anxiety, depression, distress), couple relationship, parents' transition adjustment and parenting stress, and parents' satisfaction with their experience of childbirth and prenatal childbirth education programs were reported. The studies included in this review were very diverse regarding intervention intensity and content, outcome types, measurement tools, and outcome timing. This impeded evaluation of the interventions' effectiveness. No sufficient evidence was identified that prenatal childbirth education for partners of pregnant women protects against paternal postnatal depression and couple relationship; however, paternal postnatal mental health is important to maternal and perinatal healthcare. The results of this review suggest that further research and intervention are required to provide partners of pregnant women with evidence-based information and support whole families during the perinatal period. Copyright © 2016 Elsevier B.V. All rights reserved.

Representations of rituals and care in perinatal death in British midwifery textbooks 1937-2004.

PubMed

Cameron, Joan; Taylor, Julie; Greene, Alexandra

2008-09-01

to assess the evolution of attitudes and practices relating to perinatal loss through an analysis of British midwifery textbooks. a literature review of midwifery textbooks, written or edited by midwives, published in the UK after 1902, and a critical analysis of textbooks to determine the ideological and professional standpoints presented to readers. the rhetoric and ritual relating to perinatal loss as portrayed in British midwifery textbooks has changed, with the most dramatic changes taking place in the past 30 years. Evidence to support the changes is largely anecdotal, and little reference is made to research relating to perinatal death. The 'dirty' elements of perinatal death relating to the decay that takes place in the baby's body after death are not addressed. The critique of psychological theory relating to loss is absent, as are alternatives to the model proposed by Kübler Ross. Cultural aspects of loss and bereavement are rarely addressed. the review of midwifery textbooks suggests that an ideological shift has taken place in relation to perinatal loss. The changing demographic trends, and the shift of birth and death from home to hospital, have altered the expectations and experiences of parents and professionals. Midwifery textbooks provide readers with a prescribed and formulaic approach to perinatal loss. the absence of information relating to the appearance of the dead baby, together with the lack of clinical exposure, may mean that midwives are unable to provide parents with appropriate information. The lack of reference to an evidence base that may conflict with the ideology presented in the midwifery textbooks leaves readers with an incomplete understanding of the professional issues relating to perinatal loss.

Marketing and Quality of Life: A Model for Improving Perinatal Health Status

ERIC Educational Resources Information Center

Dever, G. E. Alan; Smith, Leah T.; Stamps, Bunnie V.

2005-01-01

Introduction: A marketing/business model using non-traditional Quality of Life measures was developed to assess perinatal health status on a micro-geographic level. This perinatal health status needs assessment study for Georgia South Central Region was conducted for the years 1994-1999. The model may be applied to any geographic unit in the…

Influence of exposure to perinatal risk factors and parental mental health related hospital admission on adolescent deliberate self-harm risk.

PubMed

Hu, Nan; Li, Jianghong; Glauert, Rebecca A; Taylor, Catherine L

2017-07-01

Adolescent deliberate self-harm (DSH) has been found to be associated with a range of bio-psycho-social factors. Simultaneous investigations of these factors enable more robust estimation of the independent effect of a specific risk factor by adjusting for a more complete set of covariates. However, few studies have had the ability to examine all of these factors together. This study used the linkage of population-level de-identified data collections from government agencies to investigate a range of biological, psychological, and social risk factors and their effects on adolescent risk of DSH (with or without suicidal intent). The investigation was undertaken by progressively adjusting for plausible covariates, including fetal growth status and birth order, early familial social factors, parental hospital admissions due to psychiatric disorders or DSH, and parental all-cause death. Conditional logistic regression was used for data analysis. Children's psychiatric history was analysed to examine the extent to which it may account for the link between the risk factors and adolescent DSH risk. This study identified significant biological and perinatal social risk factors for adolescent DSH risk, including overdue birth, high birth order (≥2), single or teen/young motherhood, high neighbourhood socioeconomic disadvantage, and parental psychiatric and/or DSH-related hospital admissions. Further, parental psychiatric and/or DSH-related admissions, and children's psychiatric admissions in particular, largely attenuated the effects of the perinatal social risk factors but not the biological factors on adolescent DSH risk. These results highlight the importance of taking joint actions involving both health and social services in the prevention of adolescent DSH.

Vitamin-caused faulty perinatal hormonal imprinting and its consequences in adult age.

PubMed

Csaba, G

2017-09-01

Lipid-soluble vitamins (vitamins A, D, E, and K) are actually hormones (exohormones), as they can be directly bound by hormone receptors or are in connection with molecules, which influence hormone receptors. Vitamin D is a transition between endo- and exohormones and the possibility of similar situation in case of other lipid-soluble hormones is discussed. The perinatal exposition with these "vitamins" can cause faulty perinatal hormonal imprinting with similar consequences as the faulty imprinting by the synthetic endohormones, members of the same hormone family or industrial, communal, or medical endocrine disruptors. The faulty imprinting leads to late (lifelong) consequences with altered hormone binding by receptors, altered sexuality, brain function, immunity, bone development, and fractures, etc. In addition, as hormonal imprinting is an epigenetic process, the effect of a single exposure by fat-soluble vitamins is inherited to the progeny generations. As vitamins are handled differently from hormones; however, perinatal treatments take place frequently and sometimes it is forced, the negative late effect of faulty perinatal vitamin-caused hormonal imprinting must be considered.

Self-efficacy and postpartum depression teaching behaviors of hospital-based perinatal nurses.

PubMed

Logsdon, M Cynthia; Foltz, Melissa Pinto; Scheetz, James; Myers, John A

2010-01-01

Based upon the Self-Efficacy Theory, this study examined the relationship between self-efficacy, self-efficacy-related variables, and postpartum depression teaching behaviors of hospital-based perinatal nurses. Findings revealed that teaching new mothers about postpartum depression is related to a perinatal nurse's self-efficacy in postpartum-depression teaching, self-esteem, and the following self-efficacy-related variables: social persuasion (supervisor's expectations for teaching); mastery (postpartum depression continuing education and teaching experience); and vicarious experience (observing other nurses teach new mothers about postpartum depression). Teaching new mothers about postpartum depression can assist mothers in overcoming barriers to depression treatment. Nurse educators and managers play an important role in encouraging postpartum depression education for perinatal nurses.

Identifying the educational needs of nursing staff: the role of the clinical nurse specialist in perinatal nursing.

PubMed

Millhaem, Toni Brown; Timm, Kathleen

2007-01-01

One of the priorities of the perinatal clinical nurse specialist is the identification of educational needs. This article describes the experience of 2 perinatal clinical nurse specialists and presents various methods for identifying the educational needs of perinatal nursing staff in the hospital setting.

The Collaborative Study on Cerebral Palsy, Mental Retardation, and Other Neurological and Sensory Disorders of Infancy and Childhood. Bibliography No. 8. July 1974 through June 1975.

ERIC Educational Resources Information Center

National Inst. of Neurological and Communicative Disorders and Stroke (NIH), Bethesda, MD.

The eighth in a series of annual bibliographies of the Collaborative Perinatal Project lists 30 manuscripts and journal articles from studies on cerebral palsy, mental retardation, and other neurological and sensory disorders of infancy and childhood. Entries are grouped under the categories of core and non-core data publications (based on…

Midwives and the Computerization of Perinatal Data Entry: The Theory of Beneficial Engagement.

PubMed

Craswell, Alison; Moxham, Lorna; Broadbent, Marc

2016-10-01

Theory building in nursing and midwifery both to explain and inform practice is important to advance these professions via provision of a theoretical foundation. This research explored the process of perinatal data entry undertaken by midwives to explore the impact of the movement from paper to computer collection of data. Use of grounded theory methodology enabled theory building, leading to a theoretical understanding of the phenomenon and development of the Theory of Beneficial Engagement grounded in the data. Methods involved in-depth semistructured interviews with 15 users of perinatal data systems. Participants were recruited from 12 different healthcare locations and were utilizing three different electronic systems for data entry. The research question that guided the study focused on examining the influences of using the computer for perinatal data entry. Findings indicated that qualities particular to some midwives denoted engagement with perinatal data entry, suggesting a strong desire to enter complete, timely, and accurate data. The Theory of Beneficial Engagement provides a model of user engagement with systems for perinatal data entry consistent with other theories of engagement. The theory developed describes this phenomenon in a simple, elegant manner that can be applied to other areas where mandatory data entry is undertaken.

Perinatal Asphyxia in a Nonhuman Primate Model

PubMed Central

Misbe, Elizabeth N. Jacobson; Richards, Todd L.; McPherson, Ronald J.; Burbacher, Thomas M.; Juul, Sandra E.

2011-01-01

Perinatal asphyxia is a leading cause of brain injury in neonates, occurring in 2–4 per 1,000 live births, and there are limited treatment options. Because of their similarity to humans, nonhuman primates are ideal for performing preclinical tests of safety and efficacy for neurotherapeutic interventions. We previously developed a primate model of acute perinatal asphyxia using 12–15 min of umbilical cord occlusion. Continuing this research, we have increased cord occlusion time from 15 to 18 min and extended neurodevelopmental follow-up to 9 months. The purpose of this report is to evaluate the increase in morbidity associated with 18 min of asphyxia by comparing indices obtained from colony controls, nonasphyxiated controls and asphyxiated animals. Pigtail macaques were delivered by hysterotomy after 0, 15 or 18 min of cord occlusion, then resuscitated. Over the ensuing 9 months, for each biochemical and physiologic parameters, behavioral and developmental evaluations, and structural and spectroscopic MRI were recorded. At birth, all asphyxiated animals required resuscitation with positive pressure ventilation and exhibited biochemical and clinical characteristics diagnostic of hypoxic-ischemic encephalopathy, including metabolic acidosis and attenuated brain activity. Compared with controls, asphyxiated animals developed long-term physical and cognitive deficits. This preliminary report characterizes the acute and chronic consequences of perinatal asphyxia in a nonhuman primate model, and describes diagnostic imaging tools for quantifying correlates of neonatal brain injury as well as neurodevelopmental tests for evaluating early motor and cognitive outcomes. PMID:21659720

Perinatal asphyxia in a nonhuman primate model.

PubMed

Jacobson Misbe, Elizabeth N; Richards, Todd L; McPherson, Ronald J; Burbacher, Thomas M; Juul, Sandra E

2011-01-01

Perinatal asphyxia is a leading cause of brain injury in neonates, occurring in 2-4 per 1,000 live births, and there are limited treatment options. Because of their similarity to humans, nonhuman primates are ideal for performing preclinical tests of safety and efficacy for neurotherapeutic interventions. We previously developed a primate model of acute perinatal asphyxia using 12-15 min of umbilical cord occlusion. Continuing this research, we have increased cord occlusion time from 15 to 18 min and extended neurodevelopmental follow-up to 9 months. The purpose of this report is to evaluate the increase in morbidity associated with 18 min of asphyxia by comparing indices obtained from colony controls, nonasphyxiated controls and asphyxiated animals. Pigtail macaques were delivered by hysterotomy after 0, 15 or 18 min of cord occlusion, then resuscitated. Over the ensuing 9 months, for each biochemical and physiologic parameters, behavioral and developmental evaluations, and structural and spectroscopic MRI were recorded. At birth, all asphyxiated animals required resuscitation with positive pressure ventilation and exhibited biochemical and clinical characteristics diagnostic of hypoxic-ischemic encephalopathy, including metabolic acidosis and attenuated brain activity. Compared with controls, asphyxiated animals developed long-term physical and cognitive deficits. This preliminary report characterizes the acute and chronic consequences of perinatal asphyxia in a nonhuman primate model, and describes diagnostic imaging tools for quantifying correlates of neonatal brain injury as well as neurodevelopmental tests for evaluating early motor and cognitive outcomes. Copyright © 2011 S. Karger AG, Basel.

Perinatal complications in women with kidney transplant.

PubMed

Vázquez-Rodríguez, Juan G; Ríos-Chavarría, Ana L

2012-01-01

Pregnancy in patients with kidney grafts is considered high-risk. Determine perinatal complications in women with kidney transplants treated by our hospital and compare them with complications reported in national and international literature. We studied perinatal complications in 18 patients with renal transplantation who delivered 19 newborns and were treated between 1 January 2009 and 31 December 2010. Results were compared with previous reports. Maternal age: 28.27 ± 4.70 years old, parity: 2, interval from transplant to conception: 7.52 ± 6.20 years, first prenatal visit 14.35 ± 6.74 weeks, prenatal care: 18.88 ± 9.18 weeks, 6 prenatal visits, gestational age at birth: 33.11 ± 8.72 weeks. Maternal complications: cesarean section: 88.88%, blood transfusion: 38.88%, anaemia: 33.33%, premature rupture of membranes: 22.22%, preterm delivery: 22.22%, urinary tract infection: 16.66%, preeclampsia: 11.11%, uncontrolled hypertension: 11.11%, miscarriage: 11.11%, uterine antony: 5.55%, gestational diabetes: 0%, and mortality: 0%. Foetal complications: premature birth: 52.63%, mortality: 21.05%, intensive care: 21.05%, and low birth weight due to growth restriction: 10.52%. Transplantation complications: filtration impairment without need for dialysis: 5.55%, graft rejection: 0%, and graft loss: 0%. The frequency of perinatal complications was high. Pregnancy had no adverse effect on renal function and patient survival. Stable renal grafts in women of childbearing age is not necessarily a contraindication for pregnancy.

Globalization and perinatal medicine--how do we respond?

PubMed

Kurjak, Asim; Di Renzo, Gian Carlo; Stanojevic, Milan

2010-04-01

Globalization is both inevitable and usually desirable and contains advantageous and disadvantageous issues. It is a source of both hope and of apprehension and is an accelerating process in flow of information, technology, goods and services, and production means. Globalization has a complex influence on perinatal health. The bonds that link perinatologists together transcend geographic, political, religious, and lingual differences, resulting in a globalization that optimizes perinatal care. In this review, we will discuss some of the global problems facing modern perinatologists. Close to 1.5 billion people in the world, live in extreme poverty, a situation which is particularly stark in the developing world, where 80% of them live. Poor people have little or no access to qualified health services and education, and do not participate in the decisions critical to their day-to-day lives. Poverty cannot be defined solely in terms of lack of income. A person, a family, even a nation is not deemed poor only because of low economic resources. Little or no access to health services, lack of access to safe water and adequate nutrition, illiteracy or low educational level, and a distorted perception of rights and needs are also essential components of poverty. Expression of poverty in perinatal health care in developing countries are high maternal death and morbidity rates, huge perinatal and childhood losses, and high birth rates. There are good reasons to define it as a global tragedy in our time. Although the mankind has come quite far because the development of civilization and more advances in the health care were made during the past 100 years than in all previous human history, some inhabitants of our planet are not able to experience it. According to some data, every 3 s a newborn dies, and every minute a pregnant woman dies in the globalized world. All together over 10 million deaths every year, which indicates that health security is not strong enough. It is

Perinatal transmission of human papilomavirus DNA

PubMed Central

Rombaldi, Renato L; Serafini, Eduardo P; Mandelli, Jovana; Zimmermann, Edineia; Losquiavo, Kamille P

2009-01-01

The purpose was to study the perinatal transmission of human papillomavirus DNA (HPV-DNA) in 63 mother-newborn pairs, besides looking at the epidemiological factors involved in the viral DNA transmission. The following sampling methods were used: (1) in the pregnant woman, when was recruited, in cervix and clinical lesions of the vagina, vulva and perineal region; (2) in the newborn, (a) buccal, axillary and inguinal regions; (b) nasopharyngeal aspirate, and (c) cord blood; (3) in the children, buccal was repeated in the 4th week and 6th and 12th month of life. HPV-DNA was identified using two methodologies: multiplex PCR (PGMY09 and MY11 primers) and nested-PCR (genotypes 6/11, 16, 18, 31, 33, 42, 52 and 58). Perinatal transmission was considered when concordance was found in type-specific HPV between mother/newborn or mother/child. HPV-DNA genital was detected in 49 pregnant women submitted to delivery. Eleven newborns (22.4%, n = 11/49) were HPV-DNA positive. In 8 cases (16.3%, n = 8/49) there was type specific HPV concordance between mother/newborn samples. At the end of the first month of life three children (6.1%, n = 3/49) became HPV-DNA positive, while two remained positive from birth. In 3 cases (100%, n = 3/3) there was type specific HPV concordance between mother/newborn samples. In the 6th month, a child (2%, n = 1/49) had become HPV-DNA positive between the 1st and 6th month of life, and there was type specific HPV concordance of mother/newborn samples. All the HPV-DNA positive children (22.4%, n = 11/49) at birth and at the end first month of life (6.1%, n = 3/49) became HPV-DNA negative at the age of 6 months. The HPV-DNA positive child (2%, n = 1/49) from 1st to the 6th month of life became HPV-DNA negative between the 6th and 12th month of life and one child had anogenital warts. In the twelfth month all (100%, n = 49/49) the children studied were HPV-DNA negative. A positive and significant correlation was observed between perinatal transmission

[Review of risks factors in childhood for schizophrenia and severe mental disorders in adulthood].

PubMed

Artigue, Jordi; Tizón, Jorge L

2014-01-01

To provide scientific evidence, using a literature review on psychosocial risk factors in mental health, that a high exposure to psychosocial stress situations in childhood increases the risk of mental disorders in adulthood,. A literature review up to December 2011 in the electronic databases from Medline, Universitat de Barcelona, and the Universitat Autonoma de Barcelona. The keywords used were: childhood, prenatal, vulnerability, risk, abuse, neglect, child mental disorder, schizophrenia, and prevention. Inclusion criteria for the studies reviewed: 1) designed to investigate childhood risk factors; 2) Comparative studies with persons without risk factors; 3) Studies with sufficient statistical significance; 4) Studies with "n" participants equal to o more than 30 persons. There are a group of easily identifiable mental health risk factors in childhood that can help in the prevention of mental disorders in the adulthood. They can be grouped into four categories: A) Pregnancy, birth and perinatal problems; B) Poor interpersonal relations with parents; C) Adverse life events in the first two years of life; D) Cognitive deficits in primary school, and social isolation during school years. There are life events that may increase the possibilities of suffering some kind of Psychopathology. It is necessary to consider those events as Risk Factors for Mental Health. The accumulation of these Risk Factors increases vulnerability to Mental Disorders. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

US and territory telemedicine policies: identifying gaps in perinatal care.

PubMed

Okoroh, Ekwutosi M; Kroelinger, Charlan D; Smith, Alexander M; Goodman, David A; Barfield, Wanda D

2016-12-01

Perinatal regionalization is a system of maternal and neonatal risk-appropriate health care delivery in which resources are ideally allocated for mothers and newborns during pregnancy, labor and delivery, and postpartum, in order to deliver appropriate care. Typically, perinatal risk-appropriate care is provided in-person, but with the advancement of technologies, the opportunity to provide care remotely has emerged. Telemedicine provides distance-based care to patients by consultation, diagnosis, and treatment in rural or remote US jurisdictions (states and territories). We sought to summarize the telemedicine policies of states and territories and assess if maternal and neonatal risk-appropriate care is specified. We conducted a 2014 systematic World Wide Web-based review of publicly available rules, statutes, regulations, laws, planning documents, and program descriptions among US jurisdictions (N = 59) on telemedicine care. Policies including language on the topics of consultation, diagnosis, or treatment, and those specific to maternal and neonatal risk-appropriate care were categorized for analysis. Overall, 36 jurisdictions (32 states; 3 territories; and District of Columbia) (61%) had telemedicine policies with language referencing consultation, diagnosis, or treatment; 29 (49%) referenced consultation, 30 (51%) referenced diagnosis, and 35 (59%) referenced treatment. In all, 26 jurisdictions (22 states; 3 territories; and District of Columbia) (44%), referenced all topics. Only 3 jurisdictions (3 states; 0 territories) (5%), had policy language specifically addressing perinatal care. The majority of states have published telemedicine policies, but few specify policy language for perinatal risk-appropriate care. By ensuring that language specific to the perinatal population is included in telemedicine policies, access to maternal and neonatal care can be increased in rural, remote, and resource-challenged jurisdictions. Published by Elsevier Inc.

Los incendios y su salud

EPA Pesticide Factsheets

El humo de los incendios puede tener un efecto adverso en la salud de las personas, especialmente en aquellas que padecen de enfermedades cardíacas y pulmonares. Vea cómo minimizar su exposición al humo.

Detection and Prevention of Perinatal Infection: Cytomegalovirus and Zika Virus.

PubMed

Wood, Amber M; Hughes, Brenna L

2018-06-01

Congenital cytomegalovirus is the most common viral congenital infection, and affects up to 2% of neonates. Significant sequelae may develop after congenital cytomegalovirus, including hearing loss, cognitive defects, seizures, and death. Zika virus is an emerging virus with perinatal implications; a congenital Zika virus syndrome has been identified, and includes findings such as microcephaly, fetal nervous system abnormalities, and neurologic sequelae after birth. Screening, diagnosis, prevention, and treatment of these perinatal infections are reviewed in this article. Copyright © 2018 Elsevier Inc. All rights reserved.

A theoretical framework for treating perinatal depression using couple-based interventions.

PubMed

Cohen, Matthew J; Schiller, Crystal E

2017-12-01

Between 10% and 20% of women will experience depression in the perinatal period, which begins during pregnancy and extends into the first year after delivery. Perinatal depression (PD) is associated with significant emotional and social impairments that impact women, their children, and their partners. Although the majority of women with PD do not seek treatment, a considerable proportion of those who engage in treatment do not achieve remission. The couples and depression literature suggests that interpersonal processes are central in the development and maintenance of depressive disorders and thus, as researchers seek safe and effective treatments for perinatal populations, there may be therapeutic benefit in examining the role that partners play in women's recovery. The primary goal of this practice review is to highlight the utility of including partners in treatment for maternal PD and propose a model for practitioners to guide their work with couples within this domain. Specifically, this model involves three key components of treatment: psychoeducation, communication training, and behavioral activation. Each component addresses distinct risk factors for women and couples in the perinatal period in hopes of offering guidance to practitioners for how to address PD symptomology through a dyadic lens. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

ENVEJECIMIENTO, SALUD Y ECONOMÍA: La Encuesta Nacional sobre Salud y Envejecimiento en México*

PubMed Central

2017-01-01

RESUMEN México vive una transición demográfica en la cual el porcentaje de la población mayor de 50 años de edad crece aceleradamente como resultado de un aumento considerable en la esperanza de vida. Dicha población tiene necesidades particulares que deben ser tomadas en cuenta en la formulación de políticas, sobre todo en materia de acceso a servicios de salud y seguridad social. En este artículo presentamos una descripción general de la Encuesta Nacional de Salud y Envejecimiento (Enasem), un estudio de panel que comenzó en 2001 y que ofrece una oportunidad única para abordar temas demográficos y económicos complejos por medio de la exploración de las características personales, transferencias socioeconómicas e indicadores de salud para una muestra de 15 186 adultos de edad media y avanzada. También presentamos los resultados más relevantes de diferentes estudios que han utilizado la Enasem hasta la fecha. Nuestra revisión indica que México enfrenta desafíos considerables para satisfacer la demanda de servicios médicos para una población que es amenazada por una creciente presencia de enfermedades crónicas, sobre todo para la población de edad avanzada que no cuenta con cobertura de seguro médico. PMID:29375164

Role of self-compassion in psychological well-being among perinatal women.

PubMed

Felder, Jennifer N; Lemon, Elizabeth; Shea, Kerry; Kripke, Kate; Dimidjian, Sona

2016-08-01

Self-compassion is associated with depression and anxiety in general samples. Although recent research indicates that dysfunctional maternal attitudes predict the development of perinatal depression and anxiety symptoms, no research to date has examined the construct of self-compassion and its relationship with psychological well-being in perinatal women. Pregnant and postpartum women (N = 189) completed self-report measures of depression and anxiety history, current depression and anxiety symptom severity, and self-compassion. Women with higher depression and anxiety symptom severity had significantly lower self-compassion. Additionally, women with self-reported prior history of depression or anxiety had significantly lower self-compassion even while controlling for current depression or anxiety symptom severity, respectively. Our results suggest that self-compassion warrants further attention in the study of the development, maintenance, and treatment of perinatal mood and anxiety disorders.

Co-located perinatal psychiatry clinic: impact of adding a psychologist on clinical quality improvement metrics.

PubMed

Pawar, Deepa; Huang, Chiang-Ching; Wichman, Christina

2018-03-02

To describe the impact of adding a psychologist (the intervention) to a co-located perinatal psychiatry clinic (PPC) in terms of effects on clinical quality improvement (QI) metrics. Six-month pre- and postintervention study design with measurement of QI metrics: number of unique patients treated; number of new and established visits; percent no-shows for new and established visits; and mean wait time to new visit. Number of unique patients treated by the psychiatrist increased by 30%, from 90 preintervention to 118 postintervention (p = .06). Total number of visits completed by the psychiatrist increased by 20% from 174 preintervention to 208 postintervention. Mean wait time for new visits for a physician decreased from 20 days preintervention to 14 days postintervention, with a mean difference of 6.4 days (p = .0015). Percentage of no-shows for new visits increased slightly from 23% preintervention to 26% postintervention (p = .72). The percentage of no-shows for established visits decreased significantly from 22% preintervention to 10% postintervention (p < .005). By adding a psychologist to the co-located PPC, we improved quality of perinatal mental health care by improving efficiency, timeliness and patient-centered care. The psychiatrist saw a greater number of unique patients, decreased wait time to new visits and decreased no-show rates for established visits, likely by better matching patient needs with provider services. A psychologist could be a valuable addition to a PPC, given the shortage of psychiatrists in the United States.

Building Perinatal Case Manager Capacity Using Quality Improvement

PubMed Central

Fitzgerald, Elaine

2015-01-01

ABSTRACT Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum. PMID:26937160

Providing perinatal loss care: satisfying and dissatisfying aspects for midwives.

PubMed

Fenwick, Jennifer; Jennings, Belinda; Downie, Jill; Butt, Janice; Okanaga, Mayumi

2007-12-01

There is limited midwifery research that focuses on midwives experiences and attitudes to providing care for women who experience the death of a baby. There is also limited research investigating care components, and evidence to inform the basis of clinical practice in Australia and internationally. This paper presents the qualitative findings of a small study that aimed to investigate midwives experience, confidence and satisfaction with providing care for women who experienced perinatal loss. Eighty-three Western Australian midwives responded to an open ended question asking them to describe the most and least satisfying aspects of their role when providing care to women who experienced a perinatal loss. Thematic analysis was used to analyse the data. The analysis revealed that Australian midwives gained most satisfaction from providing skilled midwifery care that they considered made a difference to women. This was enabled when midwives were afforded the opportunity to provide continuity of midwifery carer to women throughout the labour, birth and early postnatal period. In terms of the least satisfying aspects of care, midwives identified that they struggled with the emotional commitment needed to provide perinatal loss care, as well as with how to communicate openly and share information with women. Within the context of the study setting, midwifery care for women following perinatal loss reflects the care components espoused in the literature. There are, however, organisational issues within health care that require commitment to continuity of care and further education of practitioners to enhance outcomes for clients.

Using perinatal morbidity scoring tools as a primary study outcome.

PubMed

Hutcheon, Jennifer A; Bodnar, Lisa M; Platt, Robert W

2017-11-01

Perinatal morbidity scores are tools that score or weight different adverse events according to their relative severity. Perinatal morbidity scores are appealing for maternal-infant health researchers because they provide a way to capture a broad range of adverse events to mother and newborn while recognising that some events are considered more serious than others. However, they have proved difficult to implement as a primary outcome in applied research studies because of challenges in testing if the scores are significantly different between two or more study groups. We outline these challenges and describe a solution, based on Poisson regression, that allows differences in perinatal morbidity scores to be formally evaluated. The approach is illustrated using an existing maternal-neonatal scoring tool, the Adverse Outcome Index, to evaluate the safety of labour and delivery before and after the closure of obstetrical services in small rural communities. Applying the proposed Poisson regression to the case study showed a protective risk ratio for adverse outcome following closures as compared with the original analysis, where no difference was found. This approach opens the door for considerably broader use of perinatal morbidity scoring tools as a primary outcome in applied population and clinical maternal-infant health research studies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Localized intestinal perforations as a potential complication of brain hypothermic therapy for perinatal asphyxia.

PubMed

Nishizaki, Naoto; Maiguma, Atsuko; Obinata, Kaoru; Okazaki, Tadaharu; Shimizu, Toshiaki

2016-01-01

Brain hypothermic therapy (BHT) is becoming a frequently used standard of care for perinatal asphyxia. Although cardiovascular side effects, coagulation disorders, renal impairment, electrolyte abnormalities, impaired liver function, opportunistic infections, and skin lesions are well-known adverse effects of BHT in newborns, little information is available on the clinical features of intestinal perforation-related BHT. We herein report a case of therapeutic brain cooling for perinatal asphyxia complicated by localized intestinal perforation. In practice, the neonatologist should be aware that intestinal perforation in an infant with perinatal asphyxia is possible, particularly following BHT.

Marked Liver Tumorigenesis by Helicobacter hepaticus Requires Perinatal Exposure

PubMed Central

Diwan, Bhalchandra A.; Sipowicz, Marek; Logsdon, Daniel; Gorelick, Peter; Anver, Miriam R.; Kasprzak, Kazimierz S.; Anderson, Lucy M.

2008-01-01

Background Although severe hepatitis and liver tumors occur in a high percentage of A/J male mice naturally infected with Helicobacter hepaticus, these effects have not been observed after injection of adult mice with the bacteria. Objectives We tested the hypothesis that perinatal exposure to the bacteria is required for liver tumorigenesis. Methods A/J female mice were infected by intragastric (ig) or intraperitoneal (ip) treatment with 1.5 × 108 H. hepaticus before pregnancy. We examined offspring at progressive time intervals, including some kept until natural death in old age. A/J, BALB/c, and C57BL/6 weanling male mice were similarly treated ig with the bacteria and observed for up to 2 years. Results After ip bacterial infection of A/J females, 41% of their male offspring developed hepatitis and 33% had hepatocellular tumors, including 18% with hepatocellular carcinoma. Treatment by the ig route resulted in a similar incidence of hepatitis in offspring (35%) but fewer total liver tumors (8%) and carcinomas (4%). By contrast, ig instillation of H. hepaticus in weanling A/J, C57BL/6, or BALB/c mice resulted in low incidence of hepatitis (0–20%) and few liver tumors, despite presence of bacteria confirmed in feces. Conclusions Results indicate that a high incidence of liver tumors in mice infected with H. hepaticus requires perinatal exposure. Contributing perinatal factors could include known high sensitivity of neonatal liver to tumor initiation, and/or modulation of immune response to the bacterium or its toxins. Mechanisms of human perinatal sensitivity to such phenomena can be studied with this model. PMID:18941577

Perinatal asphyxia, hypoxia, ischemia and hearing loss. An overview.

PubMed

Borg, E

1997-01-01

Birth hypoxia, asphyxia and ischemia have often been thought to be major causes of early hearing loss or deafness. The purpose of the present review is to focus on the role of these particular factors for perinatal auditory disorders. On the whole, only a small proportion of neonatal hearing loss is caused by perinatal factors. The exact etiology of neonatal hearing loss in children with complicated deliveries is difficult to evaluate due to the large number of causative factors that might be involved. After reviewing the literature covering the past 15-20 years, it is not possible to say that we understand the relative importance of different factors and their interactions. However, in the majority of studies, birth asphyxia is not correlated with hearing loss in babies with complicated deliveries Prolonged artificial ventilation, the presence of severe hypoxic ischemic encephalopathy or persistent pulmonary hypertension are important factors. The brain is more susceptible to anoxia than the ear and both are more likely to be damaged after prolonged pre-, peri- and postnatal hypoxia-ischemia than pure hypoxia during delivery. Perinatal hypoxia is more likely to cause a temporary hearing loss than a permanent one. Preterm babies are more vulnerable than term babies. The total number of risk factors, e.g. medicated by total length of stay in the neonatal intensive care unit and length of artificial ventilation, is the best predictor of risk for hearing loss of perinatal origin. The similarities between hearing loss and cerebral palsy are pointed out; only 8% of the cases of cerebral palsy are considered to be caused by conditions during delivery.

Risk factors for unplanned pregnancy in women with mental illness living in a developing country.

PubMed

du Toit, Elsa; Jordaan, Esme; Niehaus, Dana; Koen, Liezl; Leppanen, Jukka

2018-06-01

Pregnant women in general are at an increased risk of experiencing symptoms of mental illness, and those living in a developing country are even more vulnerable. Research points towards a causal relationship between unplanned pregnancy and perinatal mental illness and suggests that pregnancy planning can aid in reducing the negative impact of mental illness on a woman, her unborn baby, and the rest of the family. In this quantitative, descriptive study, we investigated both socio-demographic factors and variables relating to mental illness itself that may place women at an increased risk of experiencing unplanned pregnancy. Data was gathered at two maternal mental health clinics in Cape Town by means of semi-structured interviews. Univariate analyses of the data revealed five independent key risk factors for unplanned pregnancy: lower levels of education, unmarried status, belonging to the Colored ethnic population, substance use, and having a history of two or more suicide attempts. Some of these factors overlap with findings of similar studies, but others are unique to the specific population (women with mental illness within a developing country). Screening of women based on these risk predictors may pave the way for early interventions and reduce the incidence of unplanned pregnancy and the negative consequences thereof in the South African population.

Influence of farewell rituals and psychological vulnerability on grief following perinatal loss in monochorionic twin pregnancy.

PubMed

Druguet, Mònica; Nuño, Laura; Rodó, Carlota; Arévalo, Silvia; Carreras Moratonas, Elena; Gómez-Benito, Juana

2017-11-02

The aim of this study is to analyze whether the absence of farewell rituals and previous psychological vulnerability are associated with the intensity of grief following perinatal loss in monochorionic twin pregnancy. The sample comprised 28 women who experienced perinatal loss following fetal surgery. Sociodemographic and clinical data and information about farewell rituals were collected through interview. The women also completed a questionnaire about perinatal grief. A history of psychological and/or psychopharmacological treatment was associated with more intense grief following perinatal loss. Women with a history of psychological difficulties are particularly vulnerable to a complicated grief reaction after experiencing perinatal loss. However, the intensity of grief did not differ significantly according to whether or not the women performed some kind of farewell ritual. Further studies are needed to investigate these relationships and to encourage and facilitate the development of specific interventions for this population.

Perinatal Morbidity and Mortality in Offsprings of Diabetic Mothers in Qatif, Saudi Arabia.

ERIC Educational Resources Information Center

Al-Dabbous, Ibrahim A. Al-; And Others

1995-01-01

Studied perinatal and neonatal morbidity and mortality of diabetic mothers and their offspring in Qatif, Saudi Arabia. Suggests diabetes mellitus in pregnancy may be a common problem in Saudi Arabia, as poor maternal diabetic control results in high perinatal morbidity and mortality. Results suggest that health education and improved coverage of…

Perinatal Depression Algorithm: A Home Visitor Step-by-Step Guide for Advanced Management of Perinatal Depressive Symptoms

ERIC Educational Resources Information Center

Laszewski, Audrey; Wichman, Christina L.; Doering, Jennifer J.; Maletta, Kristyn; Hammel, Jennifer

2016-01-01

Early childhood professionals do many things to support young families. This is true now more than ever, as researchers continue to discover the long-term benefits of early, healthy, nurturing relationships. This article provides an overview of the development of an advanced practice perinatal depression algorithm created as a step-by-step guide…

Implications of Comprehensive Mental Health Services Embedded in an Adolescent Obstetric Medical Home.

PubMed

Ashby, Bethany; Ranadive, Nikhil; Alaniz, Veronica; St John-Larkin, Celeste; Scott, Stephen

2016-06-01

Purpose Mental health issues in perinatal adolescents are well documented and studies have shown high rates of depressive disorders among this population. Treatment is challenging because pregnant adolescents are poorly adherent with mental health services. We describe a novel integrated mental health care program for pregnant and parenting adolescent mothers and their children. Methods The Colorado Adolescent Maternity Program (CAMP) is a comprehensive, multidisciplinary teen pregnancy and parenting medical home program serving an ethnically diverse and low socioeconomic status population in the Denver metro area. We describe the Healthy Expectations Adolescent Response Team (HEART), an embedded mental health care program focused on improving identification of mental health symptoms and increasing rates mental health treatment in adolescent mothers. Results From January 1, 2011-January 16 2014, 894 pregnant adolescents were enrolled in CAMP and 885 patients were screened for mental health issues. Prior to HEART's inception, 20 % of patients were identified as having mood symptoms in the postpartum period. Successful referrals to community mental health facilities occurred in only 5 % of identified patients. Following the creation of HEART, 41 % of patients were identified as needing mental health services. Nearly half of the identified patients (47 %) engaged in mental health treatment with the psychologist. Demographic factors including age, parity, ethnicity, and parent and partner involvement did not have a significant impact on treatment engagement. Trauma history was associated with lower treatment engagement. Conclusion Our findings suggest that an embedded mental health program in an adolescent obstetric and pediatric medical home is successful in improving identification and engagement in mental health treatment. Key components of the program include universal screening, intensive social work and case management involvement, and ready access to onsite

Perinatal home care: one entrepreneur's experience.

PubMed

Eaton, D G

1994-10-01

Nurses have responded to the entrepreneurial movement by entering into various nontraditional roles and starting their own businesses. This article describes the author's experience in establishing a perinatal home-care business. The characteristics of women and nurse entrepreneurs are discussed, as are the components of a business plan and how to manage a business.

Advances and hope for perinatal HIV remission and cure in children and adolescents.

PubMed

Rainwater-Lovett, Kaitlin; Uprety, Priyanka; Persaud, Deborah

2016-02-01

The known timing of HIV infection in perinatal transmission, combined with the capacity for early antiretroviral therapy (ART) initiation and immune reconstitution, can provide unique insights into HIV persistence. The scientific basis for a pediatric-specific research agenda aimed at HIV remission and cure is discussed. Accumulating evidence supports a favorable biomarker profile for immunotherapeutic interventions in early treated, perinatally infected individuals. HIV DNA concentrations in infected cells of early treated infants decrease over the first few years of life and, after more than 10 years of ART, the overwhelming majority of noninduced proviral genomes are replication-deficient. With early ART initiation, approximately half of perinatally infected individuals become seronegative. Studies of untreated infants and vaccine trials indicate that infected infants can generate HIV-specific humoral responses. Taken together, this evidence suggests that early treatment results in low levels of replication-competent provirus, an absence of HIV-specific immunity, and the capacity to generate immune responses to potential immunotherapeutic interventions. Perinatally HIV-infected individuals require lifelong ART because of the prompt establishment of viral latency in long-lived resting memory CD4 T cells that rekindle viremia upon treatment cessation. However, intense research efforts are ongoing to perturb HIV latency toward reservoir clearance for virologic remission and cure in which perinatally infected individuals can discontinue ART.

[Surgical treatment of perinatal ovarian cysts].

PubMed

Armas Alvarez, A L; Taboada Santomil, P; Pradillos Serna, J M; Rivera Chavez, L L; Méndez Gallart, R; Estévez Martínez, E; Rodríguez Barca, P; Bautista Casasnovas, A; Varela Cives, R

2010-10-01

Actually, the perinatal ovarian cysts are increasingly being diagnosed by prenatal and neonatal ultrasound. We reported our experience in the surgical management of perinatal ovarian cysts. Patients and methods. We have reviewed the clinical charts of 10 female newborns diagnosed of ovarian cysts who underwent surgical management in our hospital from 1989 to 2009. The ovarian cysts were diagnosed antenatally in 8 cases and period neonatal in 2 cases. The clinical presentation was asymptomatic abdominal mass in 7 cases. Ultrasound confirmed the ovarian mass in 8 patients. CT scan and MRI were necessary for confirm suspected diagnosis in two patients. Ultrasonography showed 7 complex cysts and 3 simple cysts. Surgery of the complicated cysts revealed ovarian torsion in 5 cases and 1 hemorragic cyst. At surgery, 5 patients underwent salpingooophorectomy, 2 patients needed oophorectomy and in 3 cases only cystectomy were necessary. The ovarian torsion is the most common complication and the cause of loss of the ovary. The neonatal ovarian cysts greater than 5 centimetres, symptomatic cysts, complex cysts and cysts persisting for more than 6 months need surgical intervention.

Vitamin B-12 and Perinatal Health.

PubMed

Finkelstein, Julia L; Layden, Alexander J; Stover, Patrick J

2015-09-01

Vitamin B-12 deficiency (<148 pmol/L) is associated with adverse maternal and neonatal outcomes, including developmental anomalies, spontaneous abortions, preeclampsia, and low birth weight (<2500 g). The importance of adequate vitamin B-12 status periconceptionally and during pregnancy cannot be overemphasized, given its fundamental role in neural myelination, brain development, and growth. Infants born to vitamin B-12-deficient women may be at increased risk of neural tube closure defects, and maternal vitamin B-12 insufficiency (<200 pmol/L) can impair infant growth, psychomotor function, and brain development, which may be irreversible. However, the underlying causal mechanisms are unknown. This review was conducted to examine the evidence that links maternal vitamin B-12 status and perinatal outcomes. Despite the high prevalence of vitamin B-12 deficiency and associated risk of pregnancy complications, few prospective studies and, to our knowledge, only 1 randomized trial have examined the effects of vitamin B-12 supplementation during pregnancy. The role of vitamin B-12 in the etiology of adverse perinatal outcomes needs to be elucidated to inform public health interventions. © 2015 American Society for Nutrition.

Comparison of cigarette smoking knowledge, attitudes, and practices among staff in perinatal and other substance abuse treatment settings.

PubMed

Miller-Thomas, Tonya; Leoutsakos, Jeannie-Marie S; Terplan, Mishka; Brigham, Emily P; Chisolm, Margaret S

2014-01-01

Despite the high prevalence and known morbidity and mortality caused by cigarette smoking, 60% to 70% of substance abuse treatment programs lack smoking cessation counseling or fail to offer pharmacotherapy for smoking cessation, including those programs designed to meet the needs of drug-dependent pregnant patients. Previous studies of staff knowledge, attitudes, and practices (S-KAP) at general substance abuse/HIV treatment programs have suggested that staff may contribute to the deficiency in smoking cessation treatment in these settings. It is not known whether similar deficiencies exist at perinatal substance abuse treatment programs. This study compared cigarette S-KAP in perinatal substance abuse (n = 41) and general substance abuse/HIV treatment (Veterans Affairs [VA] medical center, hospital-, and community-based) workforce samples (n = 335). Significant differences were seen between the 2 groups on all measures, but perinatal staff compared favorably to general staff only on measures of barriers to smoking cessation services. Perinatal staff compared unfavorably on all other measures: knowledge, beliefs/attitudes, self-efficacy, and smoking cessation practices. Pair-wise comparisons of knowledge and beliefs/attitudes revealed a significant difference between perinatal and VA staff; of self-efficacy, between perinatal and staff at all other settings; and of smoking cessation practices, between perinatal and VA and community-based staff. These results-showing deficiencies of perinatal staff on most S-KAP measures-are concerning and suggest that identifying gaps in and improving S-KAP in perinatal substance abuse programs is urgently needed, for which the VA may provide an efficacious model.

Linking databases on perinatal health: a review of the literature and current practices in Europe

PubMed Central

Szamotulska, K.; Hindori-Mohangoo, A.D.; Blondel, B.; Macfarlane, A.J.; Dattani, N.; Barona, C.; Berrut, S.; Zile, I.; Wood, R.; Sakkeus, L.; Gissler, M.; Zeitlin, J.

2016-01-01

Background: International comparisons of perinatal health indicators are complicated by the heterogeneity of data sources on pregnancy, maternal and neonatal outcomes. Record linkage can extend the range of data items available and thus can improve the validity and quality of routine data. We sought to assess the extent to which data are linked routinely for perinatal health research and reporting. Methods: We conducted a systematic review of the literature by searching PubMed for perinatal health studies from 2001 to 2011 based on linkage of routine data (data collected continuously at various time intervals). We also surveyed European health monitoring professionals about use of linkage for national perinatal health surveillance. Results: 516 studies fit our inclusion criteria. Denmark, Finland, Norway and Sweden, the US and the UK contributed 76% of the publications; a further 29 countries contributed at least one publication. Most studies linked vital statistics, hospital records, medical birth registries and cohort data. Other sources were specific registers for: cancer (70), congenital anomalies (56), ART (19), census (19), health professionals (37), insurance (22) prescription (31), and level of education (18). Eighteen of 29 countries (62%) reported linking data for routine perinatal health monitoring. Conclusion: Research using linkage is concentrated in a few countries and is not widely practiced in Europe. Broader adoption of data linkage could yield substantial gains for perinatal health research and surveillance. PMID:26891058

Neurometabolite Alterations Associated With Cognitive Performance in Perinatally HIV-Infected Children.

PubMed

Van Dalen, Yvonne W; Blokhuis, Charlotte; Cohen, Sophie; Ter Stege, Jacqueline A; Teunissen, Charlotte E; Kuhle, Jens; Kootstra, Neeltje A; Scherpbier, Henriette J; Kuijpers, Taco W; Reiss, Peter; Majoie, Charles B L M; Caan, Matthan W A; Pajkrt, Dasja

2016-03-01

Despite treatment with combination antiretroviral therapy (cART), cognitive impairment is still observed in perinatally HIV-infected children. We aimed to evaluate potential underlying cerebral injury by comparing neurometabolite levels between perinatally HIV-infected children and healthy controls. This cross-sectional study evaluated neurometabolites, as measured by Magnetic Resonance Spectroscopy (MRS), in perinatally HIV-infected children stable on cART (n = 26) and healthy controls (n = 36).Participants were included from a cohort of perinatally HIV-infected children and healthy controls, matched group-wise for age, gender, ethnicity, and socio-economic status. N-acetylaspartate (NAA), glutamate (Glu), myo-inositol (mI), and choline (Cho) levels were studied as ratios over creatine (Cre). Group differences and associations with HIV-related parameters, cognitive functioning, and neuronal damage markers (neurofilament and total Tau proteins) were determined using age-adjusted linear regression analyses.HIV-infected children had increased Cho:Cre in white matter (HIV-infected = 0.29 ± 0.03; controls = 0.27 ± 0.03; P value = 0.045). Lower nadir CD4+ T-cell Z-scores were associated with reduced neuronal integrity markers NAA:Cre and Glu:Cre. A Centers for Disease Control and Prevention (CDC) stage C diagnosis was associated with higher glial markers Cho:Cre and mI:Cre. Poorer cognitive performance was mainly associated with higher Cho:Cre in HIV-infected children, and with lower NAA:Cre and Glu:Cre in healthy controls. There were no associations between neurometabolites and neuronal damage markers in blood or CSF.Compared to controls, perinatally HIV-infected children had increased Cho:Cre in white matter, suggestive of ongoing glial proliferation. Levels of several neurometabolites were associated with cognitive performance, suggesting that MRS may be a useful method to assess cerebral changes potentially linked to cognitive outcomes.

Prevalence and early determinants of common mental disorders in the 1982 birth cohort, Pelotas, Southern Brazil

PubMed Central

Anselmi, Luciana; Barros, Fernando C; Minten, Gicele C; Gigante, Denise P; Horta, Bernardo L; Victora, Cesar G

2009-01-01

OBJECTIVE To estimate the prevalence of common mental disorders and assess its association with risk factors in a cohort of young adults. METHODS Cross-sectional study nested in a 1982 birth cohort study conducted in Pelotas, Southern Brazil. In 2004-5, 4,297 subjects were interviewed during home visits. Common mental disorders were assessed using the Self-Report Questionnaire. Risk factors included socioeconomic, demographic, perinatal, and environmental variables. The analysis was stratified by gender and crude and adjusted prevalence ratios were estimated by Poisson regression. RESULTS The overall prevalence of common mental disorders was 28.0%; 32.8% and 23.5% in women and men, respectively. Men and women who were poor in 2004-5, regardless of their poor status in 1982, had nearly 1.5-fold increased risk for common mental disorders (p≤0.001) when compared to those who have never been poor. Among women, being poor during childhood (p≤0.001) and black/mixed skin color (p=0.002) increased the risk for mental disorders. Low birth weight and duration of breastfeeding were not associated to the risk of these disorders. CONCLUSIONS Higher prevalence of common mental disorders among low-income groups and race-ethnic minorities suggests that social inequalities present at birth have a major impact on mental health, especially common mental disorders. PMID:19142342

The Relationship Between Maternal Glycemia and Perinatal Outcome

PubMed Central

Landon, Mark B.; Mele, Lisa; Spong, Catherine Y.; Carpenter, Marshall W.; Ramin, Susan M.; Casey, Brian; Wapner, Ronald J.; Varner, Michael W.; Rouse, Dwight J.; Thorp, John M.; Sciscione, Anthony; Catalano, Patrick; Harper, Margaret; Saade, George; Caritis, Steve N; Sorokin, Yoram; Peaceman, Alan M.; Tolosa, Jorge E.; Anderson, Garland D.

2014-01-01

Objective To examine the relationship between varying degrees of maternal hyperglycemia and pregnancy outcomes. Methods This was a secondary analysis of a treatment trial for mild gestational diabetes (GDM) including four cohorts: 1) 473 women with untreated mild GDM; 2) 256 women with a positive 50-gram screen and one abnormal oral glucose tolerance test (OGTT) value; 3) 675 women with a positive screen and no abnormal OGTT values; and 4) 437 women with a normal 50-gram screen. Groups were compared by test of trend for a composite perinatal outcome (neonatal hypoglycemia, hyperbilirubinemia, elevated cord c-peptide level, and perinatal trauma or death), frequency of large-for-gestational-age (LGA) infant, shoulder dystocia, and pregnancy-related hypertension. Three-hour OGTT levels (fasting, 1, 2, and 3 hour) levels were divided into categories and analyzed for their relationship to perinatal and maternal outcomes. Results There were significant trends by glycemic status among the four cohorts for the composite and all other outcomes (p<0.001). Analysis for trend according to OGTT categories showed an increasing relationship between fasting and all post load levels and the various outcomes (p<0.05). Fasting glucose ≥ 90 mg/dl and 1 hour ≥ 165 mg/dl were associated with an increased risk for the composite outcome, odds ratios and 95% CI of 2.0 (1.03-4.15) and 1.46 (1.02-2.11) to 1.52 (1.08-2.15), for the fasting and 1 hour, respectively. A 1 hour glucose ≥ 150 mg/dl was associated with an increased risk for LGA (odds ratios 1.8 (1.02-3.18) to 2.35 (1.35-4.14), however 2 and 3 hour glucose levels did not increase the risk for the composite or LGA until well beyond current GDM diagnostic thresholds. Conclusion A monotonic relationship exists between increasing maternal glycemia and perinatal morbidity. Current OGTT criteria require re-evaluation in determining thresholds for the diagnosis and treatment of GDM. PMID:21309194

Pathophysiology and neuroprotection of global and focal perinatal brain injury: lessons from animal models

PubMed Central

Manganozzi, Lucilla; Moretti, Raffaella; Vexler, Zinaida S.; Gressens, Pierre

2016-01-01

BACKGROUND Arterial ischemic stroke occurs most frequently in term newborns than in the elderly, and brain immaturity affects mechanisms of ischemic injury and recovery. The susceptibility to injury of the brain was assumed to be lower in the perinatal period as compared to childhood. This concept was recently challenged by clinical studies showing marked motor disabilities after stroke in neonates, with the severity of motor and cortical sensory deficits similar in both perinatal and childhood ischemic stroke. The understanding of the triggers and the pathophysiological mechanisms of perinatal stroke has greatly improved in recent years, but many aspects remain still unclear. METHODS In this review, we will focus on the pathophysiology of perinatal stroke and on therapeutic strategies that can protect the immature brain from the consequences of stroke by targeting inflammation and brain microenvironment. RESULTS Studies in neonatal rodent models of cerebral ischemia have shown a potential role for soluble inflammatory molecules as important modulators of injury and recovery. A great effort has been made and is still in act to try neuroprotective molecules based on the new physiopatological acquisition. CONCLUSION In this review we aim to give a comprehensive view of new insights concerning pathophysiological mechanism of focal and global perinatal brain injury and its new therapeutic approaches. PMID:26002050

Development and Evaluation of a Peer Support Program for Parents Facing Perinatal Loss.

PubMed

Diamond, Rachel M; Roose, Rosmarie E

2016-01-01

The purpose of this program evaluation was to understand the perspectives of peer parents and parents receiving support within a peer support program for perinatal bereavement at a midsized hospital within the midwestern United States. To document participants' perceptions of the program, a focus group was conducted with peer parents, and surveys were completed by both peer parents and parents receiving support. In this article we review our model of a peer support program for perinatal bereavement and report on parents' evaluation of the program. Recommendations through which other organizations can develop peer support programs for parents who have experienced a perinatal loss are provided. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

Perinatal outcome of pregnancies complicated by threatened abortion.

PubMed

Verma, S K; Premi, H K; Gupta, T V; Thakur, S; Gupta, K B; Randhawa, I

1994-11-01

One hundred and two cases of viable pregnancies with threatened abortion were studied in the department of obstetrics and gynaecology, Kamla Nehru Hospital, IG Medical College, Shimla between November 1987 and February 1989 and their perinatal outcome was evaluated. The pregnancies continued beyond 28 weeks in 61.7% of the cases. The incidence of prematurity was 19.0%. The incidence of low birth weight (LBW) babies was 23.8%. Apgar score was less than 7 in 22.3%. The incidence of neonatal complications was 25.3%. There was no perinatal mortality. In a control group of 50 cases, the incidence of prematurity and LBW was 8% and 4% respectively. Apgar score less than 7 was noted in 4% and neonatal complications were observed only in 4% of newborns.

The Effect of Childbirth Self-Efficacy on Perinatal Outcomes

PubMed Central

Tilden, Ellen L.; Caughey, Aaron B.; Lee, Christopher S.; Emeis, Cathy

2016-01-01

Objective To synthesize and critique the quantitative literature on measuring childbirth self-efficacy and the effect of childbirth self-efficacy on perinatal outcomes. Data Sources Eligible studies were identified through searching MEDLINE, CINAHL, Scopus, and Google Scholar databases. Study Selection Published research using a tool explicitly intended to measure childbirth self-efficacy and also examining outcomes within the perinatal period were included. All manuscripts were in English and published in peer-reviewed journals. Data Extraction First author, country, year of publication, reference and definition of childbirth self-efficacy, measurement of childbirth self-efficacy, sample recruitment and retention, sample characteristics, study design, interventions (with experimental and quasi-experimental studies), and perinatal outcomes were extracted and summarized. Data Synthesis Of 619 publications, 23 studies published between 1983 and 2015 met inclusion criteria and were critiqued and synthesized in this review. Conclusions There is overall consistency in how childbirth self-efficacy is defined and measured among studies, facilitating comparison and synthesis. Our findings suggest that increased childbirth self-efficacy is associated with a wide variety of improved perinatal outcomes. Moreover, there is evidence that childbirth self-efficacy is a psychosocial factor that can be modified through various efficacy-enhancing interventions. Future researchers will be able to build knowledge in this area through: (a) utilization of experimental and quasi-experimental design; (b) recruitment and retention of more diverse samples; (c) explicit reporting of definitions of terms (e.g. ‘high risk’); (d) investigation of interventions that increase childbirth self-efficacy during pregnancy; and, (e) investigation regarding how childbirth self-efficacy enhancing interventions might lead to decreased active labor pain and suffering. Exploratory research should

The Effect of Childbirth Self-Efficacy on Perinatal Outcomes.

PubMed

Tilden, Ellen L; Caughey, Aaron B; Lee, Christopher S; Emeis, Cathy

2016-01-01

To synthesize and critique the quantitative literature on measuring childbirth self-efficacy and the effect of childbirth self-efficacy on perinatal outcomes. Eligible studies were identified through searches of MEDLINE, CINAHL, Scopus, and Google Scholar databases. Published research articles that used a tool explicitly intended to measure childbirth self-efficacy and that examined outcomes within the perinatal period were included. All articles were in English and were published in peer-reviewed journals. First author, country, year of publication, reference and definition of childbirth self-efficacy, measurement of childbirth self-efficacy, sample recruitment and retention, sample characteristics, study design, interventions (with experimental and quasiexperimental studies), and perinatal outcomes were extracted and summarized. Of 619 publications, 23 studies published between 1983 and 2015 met inclusion criteria and were critiqued and synthesized in this review. There is overall consistency in how childbirth self-efficacy is defined and measured among studies, which facilitates comparison and synthesis. Our findings suggest that increased childbirth self-efficacy is associated with a wide variety of improved perinatal outcomes. Moreover, there is evidence that childbirth self-efficacy is a psychosocial factor that can be modified through various efficacy-enhancing interventions. Future researchers will be able to build knowledge in this area through (a) use of experimental and quasiexperimental design, (b) recruitment and retention of more diverse samples, (c) explicit reporting of definitions of terms (e.g., high risk), (d) investigation of interventions that increase childbirth self-efficacy during pregnancy, and (e) investigation about how childbirth self-efficacy-enhancing interventions might lead to decreased active labor pain and suffering. Exploratory research should continue to examine the potential association between higher prenatal childbirth self

Mothers on the margins: implications for eradicating perinatal HIV.

PubMed

Lindau, Stacy Tessler; Jerome, Jessica; Miller, Kate; Monk, Elizabeth; Garcia, Patricia; Cohen, Mardge

2006-01-01

Tactics aimed at reducing perinatal transmission of HIV are proving ineffective at accomplishing complete eradication: a group of women with HIV remain at very high risk for transmitting the virus to their newborns. This study engaged a uniquely high-risk group of HIV-infected mothers as expert informants on childbearing with HIV to inform strategies to eradicate perinatal HIV transmission. The sample draws from an Illinois Department of Children and Family Services (DCFS) database of 1104 HIV-seropositive women with children in protective services between 1989 and 2001. Of these, 32 women knew their HIV-positive status and gave birth to at least two children after 1997 (zidovudine widely implemented as standard of care). Twelve were accessible and consented to participate. Three others, currently pregnant, also participated. Fifteen interviews were completed. The 15 women had given birth to 78 children (9 HIV-infected), fathered by 62 men. Respondents were severely socioeconomically marginalized. They were aware of their HIV status and the benefits of prophylaxis, most desired healthy babies to parent, and most delivered their babies in hospitals equipped to provide adequate prophylaxis. Yet most received inadequate or no prenatal care and did not disclose their HIV status at delivery. Women indicated that denial and substance use were the primary intrinsic barriers and disrespectful treatment was the primary extrinsic barrier to disclosure and care. Women's recommendations about eradication of perinatal HIV transmission emphasized the problem of substance use, the need for private and thorough communication with medical and DCFS personnel, and the need for positive social relationships to enable HIV positive mothers to engage in care. Attention to potent social and institutional barriers that impair the ability of the most marginalized women to disclose their HIV status and accept care is essential to realize eradication of perinatal transmission.

Robotic Quantification of Position Sense in Children With Perinatal Stroke.

PubMed

Kuczynski, Andrea M; Dukelow, Sean P; Semrau, Jennifer A; Kirton, Adam

2016-09-01

Background Perinatal stroke is the leading cause of hemiparetic cerebral palsy. Motor deficits and their treatment are commonly emphasized in the literature. Sensory dysfunction may be an important contributor to disability, but it is difficult to measure accurately clinically. Objective Use robotics to quantify position sense deficits in hemiparetic children with perinatal stroke and determine their association with common clinical measures. Methods Case-control study. Participants were children aged 6 to 19 years with magnetic resonance imaging-confirmed unilateral perinatal arterial ischemic stroke or periventricular venous infarction and symptomatic hemiparetic cerebral palsy. Participants completed a position matching task using an exoskeleton robotic device (KINARM). Position matching variability, shift, and expansion/contraction area were measured with and without vision. Robotic outcomes were compared across stroke groups and controls and to clinical measures of disability (Assisting Hand Assessment) and sensory function. Results Forty stroke participants (22 arterial, 18 venous, median age 12 years, 43% female) were compared with 60 healthy controls. Position sense variability was impaired in arterial (6.01 ± 1.8 cm) and venous (5.42 ± 1.8 cm) stroke compared to controls (3.54 ± 0.9 cm, P < .001) with vision occluded. Impairment remained when vision was restored. Robotic measures correlated with functional disability. Sensitivity and specificity of clinical sensory tests were modest. Conclusions Robotic assessment of position sense is feasible in children with perinatal stroke. Impairment is common and worse in arterial lesions. Limited correction with vision suggests cortical sensory network dysfunction. Disordered position sense may represent a therapeutic target in hemiparetic cerebral palsy. © The Author(s) 2016.

Una Red de Expertos en Salud Ambiental de Niños (2015)

EPA Pesticide Factsheets

Unidades Pediátricas de Especialidad en Salud Ambiental (PEHSU) tiene expertos en pediatria, alergias e inmunologia, desarrollo neural, toxicologia, y otras, ya que existen varios factores que afectan la salud de los ninos.

[Maternal hemoglobin in Peru: regional differences and its association with adverse perinatal outcomes].

PubMed

Gonzales, Gustavo F; Tapia, Vilma; Gasco, Manuel; Carrillo, Carlos

2011-01-01

To evaluate hemoglobin (Hb) levels in pregnant women from different geographical regions from Peru; to establish anemia and erythrocytocis rates and to establish the role of Hb on adverse perinatal outcomes using the Perinatal Information System (PIS) database of Peruvian Ministry of Health. Data were obtained from 379,816 births of 43 maternity care units between 2000 and 2010. Anemia and erythrocytocis rates were determined in each geographical region as well as rates of adverse perinatal outcomes. To analyze data the STATA program (versión 10.0,Texas, USA) was used. The results were considered significant at p<0.01. Mild anemia rate was higher in the coast (25.8%) and low forest (26.2%). Moderate/severe anemia rate in low forest was 2.6% and at the coast was 1.0%. In the highland, the highest rate of moderate/severe anemia was in the southern highlands (0.6%). The highest rate of erythrocytocis was found in the central highland (23.7%), 11.9% in the southern highland and 9.5% in the north highland. Severe anemia and erythrocytocis were associated with adverse perinatal outcomes. There are differences by Peruvian geographical region in anemia rates. In the central highlands were found the highest rates of erythrocytocis due to hypoxia effect in the high altitudes; however in the southern highlands, erythrocytocis was lower. Severe anemia and erythrocytosis were associated with increased adverse perinatal outcomes.

Development, reliability, and validity of the Alberta Perinatal Stroke Project Parental Outcome Measure.

PubMed

Bemister, Taryn B; Brooks, Brian L; Kirton, Adam

2014-07-01

Perinatal stroke is a leading cause of cerebral palsy and lifelong disability, although parent and family outcomes have not yet been studied in this specific population. The Alberta Perinatal Stroke Project Parental Outcome Measure was developed as a 26-item questionnaire on the impact of perinatal stroke on parents and families. The items were derived from expert opinion and scientific literature on issues salient to parents of children with perinatal stroke, including guilt and blame, which are not well captured in existing measures of family impact. Data were collected from 82 mothers and 28 fathers who completed the Parental Outcome Measure and related questionnaires (mean age, 39.5 years; mean child age, 7.4 years). Analyses examined the Parental Outcome Measure's internal consistency, test-retest reliability, validity, and factor structure. The Parental Outcome Measure demonstrated three unique theoretical constructs: Psychosocial Impact, Guilt, and Blame. The Parental Outcome Measure has excellent internal consistency (Cronbach α = 0.91) and very good test-retest reliability more than 2-5 weeks (r = 0.87). Regarding validity, the Parental Outcome Measure is sensitive to condition severity, accounts for additional variance in parent outcomes, and strongly correlates with measures of anxiety, depression, stress, quality of life, family functioning, and parent adjustment. The Parental Outcome Measure contributes to the literature as the first brief measure of family impact designed for parents of children with perinatal stroke. Copyright © 2014 Elsevier Inc. All rights reserved.

Perinatal Risks in "Late Motherhood" Defined Based On Parity and Preterm Birth Rate - an Analysis of the German Perinatal Survey (20th Communication).

PubMed

Schure, V; Voigt, M; Schild, R L; Hesse, V; Carstensen, M; Schneider, K T M; Straube, S

2012-01-01

Aim: "Late motherhood" is associated with greater perinatal risks but the term lacks precise definition. We present an approach to determine what "late motherhood" associated with "high risk" is, based on parity and preterm birth rate. Materials and Methods: Using data from the German Perinatal Survey of 1998-2000 we analysed preterm birth rates in women with zero, one, or two previous live births. We compared groups of "late" mothers (with high preterm birth rates) with "control" groups of younger women (with relatively low preterm birth rates). Data of 208 342 women were analysed. For women with zero (one; two) previous live births, the "control" group included women aged 22-26 (27-31; 29-33) years. Women in the "late motherhood" group were aged > 33 (> 35; > 38) years. Results: The "late motherhood" groups defined in this way were also at higher risk of adverse perinatal events other than preterm birth. For women with zero (one; two) previous live births, normal cephalic presentation occurred in 89 % (92.7 %; 93.3 %) in the "control" group, but only in 84.5 % (90 %; 90.4 %) in the "late motherhood" group. The mode of delivery was spontaneous or at most requiring manual help in 71.3 % (83.4 %; 85.8 %) in the "control" group, but only in 51.4 % (72.2 %; 76.4 %) in the "late motherhood" group. Five-minute APGAR scores were likewise worse for neonates of "late" mothers and the proportion with a birth weight ≤ 2499 g was greater. Conclusion: "Late motherhood" that is associated with greater perinatal risks can be defined based on parity and preterm birth rate.

Association of maternal KIR gene content polymorphisms with reduction in perinatal transmission of HIV-1

PubMed Central

Omosun, Yusuf O.; Blackstock, Anna J.; Williamson, John; van Eijk, Anne Maria; Ayisi, John; Otieno, Juliana; Lal, Renu B.; ter Kuile, Feiko O.; Slutsker, Laurence

2018-01-01

The role of killer cell immunoglobulin-like receptors (KIRs) in the transmission of HIV-1 has not been extensively studied. Here, we investigated the association of KIR gene content polymorphisms with perinatal HIV-1 transmission. The KIR gene family comprising 16 genes was genotyped in 313 HIV-1 positive Kenyan mothers paired with their infants. Gene content polymorphisms were presented as presence of individual KIR genes, haplotypes, genotypes and KIR gene concordance. The genetic data were analyzed for associations with perinatal transmission of HIV. There was no association of infant KIR genes with perinatal HIV-1 transmission. After adjustment for gravidity, viral load, and CD4 cell count, there was evidence of an association between reduction in perinatal HIV-1 transmission and the maternal individual KIR genes KIR2DL2 (adjusted OR = 0.50; 95% CI: 0.24–1.02, P = 0.06), KIR2DL5 (adjusted OR = 0.47; 95% CI: 0.23–0.95, P = 0.04) and KIR2DS5 (adjusted OR = 0.39; 95% CI: 0.18–0.80, P = 0.01). Furthermore, these maternal KIR genes were only significantly associated with reduction in perinatal HIV transmission in women with CD4 cell count ≥ 350 cells/ μl and viral load <10000 copies/ml. Concordance analysis showed that when both mother and child had KIR2DS2, there was less likelihood of perinatal HIV-1 transmission (adjusted OR = 0.44; 95% CI: 0.20–0.96, P = 0.039). In conclusion, the maternal KIR genes KIR2DL2, KIR2DL5, KIR2DS5, and KIR2DS2 were associated with reduction of HIV-1 transmission from mother to child. Furthermore, maternal immune status is an important factor in the association of KIR with perinatal HIV transmission. PMID:29360870

Combination of Serum Interleukin-1β and 6 Levels in the Diagnosis of Perinatal Asphyxia.

PubMed

Boskabadi, Hassan; Maamouri, Gholamali; Tavakkol Afshari, Jalil; Zakerihamidi, Maryam; Kalateh Molaee, Maryam; Bagheri, Fatemeh; Parizadeh, Mustafa; Ghayour-Mobarhan, Majid; Moradi, Ali; Ferns, Gordon A A

2016-05-01

Perinatal asphyxia is an important cause of death, as well as permanent neurological and developmental complications. Diagnosing in time would lead to better prognosis and applying the most proper treatment. We sought to define the predictive values of serum concentrations of interleukin-1β (IL-1β) and interleukin-6 (IL-6) in newborns with perinatal asphyxia to see if there is a relation between the short-term neurological deficit and serum IL-1β and IL-6 concentrations. This was a prospective (case-control) study conducted between March 2006 and April 2013, at the Neonatal Intensive Care Unit, Mashhad, Iran. Serum IL-1β and IL-6 levels were measured at birth in 38 consecutive uninfected neonates with perinatal asphyxia (blood pH < 7.2, low Apgar score, signs of fetal distress) and 47 randomly selected healthy newborns. The results were compared between the groups, using Chi-Square, t-tests, and Mann-Whitney tests, as well as receiver operator characteristics (ROC) curves and regression models. Serum IL-1β and IL-6 concentrations in the infants who developed perinatal asphyxia were significantly higher compared to values in the normal infants [16.88 vs  3.34 pg/mL for IL-1β, (P = 0.006), and 88.15 vs 6.74 pg/ mL for IL-6, (P < 0.001) respectively]. The sensitivity and  specificity for the diagnosis of perinatal asphyxia using serum IL-6 were 80.5% and 81.6% respectively. The sensitivity and specificity using serum IL-1β were 71% and 89.1%, respectively. Evaluating serum IL-6 and 1β simultaneously, could improve the sensitivity and specificity of early diagnosis of the perinatal  asphyxia. The most appropriate indicator of perinatal asphyxia is combined measurement of interleukin 1β and interleukin 6.

Perinatal mortality in second- vs firstborn twins: a matter of birth size or birth order?

PubMed

Luo, Zhong-Cheng; Ouyang, Fengxiu; Zhang, Jun; Klebanoff, Mark

2014-08-01

Second-born twins on average weigh less than first-born twins and have been reported at an elevated risk of perinatal mortality. Whether the risk differences depend on their relative birth size is unknown. The present study aimed to evaluate the association of birth order with perinatal mortality by birth order-specific weight difference in twin pregnancies. In a retrospective cohort study of 258,800 twin pregnancies without reported congenital anomalies using the US matched multiple birth data 1995-2000 (the available largest multiple birth dataset), conditional logistic regression was applied to estimate the odds ratio (OR) of perinatal death adjusted for fetus-specific characteristics (sex, presentation, and birthweight for gestational age). Comparing second vs first twins, the risks of perinatal death were similar if they had similar birthweights (within 5%) and were increasingly higher if second twins weighed progressively less (adjusted ORs were 1.37, 1.90, and 3.94 if weighed 5.0-14.9%, 15.0-24.9%, and ≥25.0% less, respectively), and progressively lower if they weighed increasingly more (adjusted ORs were 0.67, 0.63, and 0.36 if weighed 5.0-14.9%, 15.0-24.9%, and ≥25.0% more, respectively) (all P < .001). The perinatal mortality rates were not significantly different in cesarean deliveries or preterm (<37 weeks) vaginal deliveries but were significantly higher in second twins in term vaginal deliveries (3.1 vs 1.8 per 1000; adjusted OR, 2.15; P < .001). Perinatal mortality risk differences in second vs first twins depend on their relative birth size. Vaginal delivery at term is associated with a substantially greater risk of perinatal mortality in second twins. Copyright © 2014 Mosby, Inc. All rights reserved.

Perinatal Asphyxia and Brain Development: Mitochondrial Damage Without Anatomical or Cellular Losses.

PubMed

Lima, Jean Pierre Mendes; Rayêe, Danielle; Silva-Rodrigues, Thaia; Pereira, Paula Ribeiro Paes; Mendonca, Ana Paula Miranda; Rodrigues-Ferreira, Clara; Szczupak, Diego; Fonseca, Anna; Oliveira, Marcus F; Lima, Flavia Regina Souza; Lent, Roberto; Galina, Antonio; Uziel, Daniela

2018-03-26

Perinatal asphyxia remains a significant cause of neonatal mortality and is associated with long-term neurodegenerative disorders. In the present study, we evaluated cellular and subcellular damages to brain development in a model of mild perinatal asphyxia. Survival rate in the experimental group was 67%. One hour after the insult, intraperitoneally injected Evans blue could be detected in the fetuses' brains, indicating disruption of the blood-brain barrier. Although brain mass and absolute cell numbers (neurons and non-neurons) were not reduced after perinatal asphyxia immediately and in late brain development, subcellular alterations were detected. Cortical oxygen consumption increased immediately after asphyxia, and remained high up to 7 days, returning to normal levels after 14 days. We observed an increased resistance to mitochondrial membrane permeability transition, and calcium buffering capacity in asphyxiated animals from birth to 14 days after the insult. In contrast to ex vivo data, mitochondrial oxygen consumption in primary cell cultures of neurons and astrocytes was not altered after 1% hypoxia. Taken together, our results demonstrate that although newborns were viable and apparently healthy, brain development is subcellularly altered by perinatal asphyxia. Our findings place the neonate brain mitochondria as a potential target for therapeutic protective interventions.

Reaching perinatal women online: the Healthy You, Healthy Baby website and app.

PubMed

Hearn, Lydia; Miller, Margaret; Lester, Leanne

2014-01-01

Overwhelming evidence reveals the close link between unwarranted weight gain among childbearing women and childhood adiposity. Yet current barriers limit the capacity of perinatal health care providers (PHCPs) to offer healthy lifestyle counselling. In response, today's Internet savvy women are turning to online resources to access health information, with the potential of revolutionising health services by enabling PHCPs to guide women to appropriate online resources. This paper presents the findings of a project designed to develop an online resource to promote healthy lifestyles during the perinatal period. The methodology involved focus groups and interviews with perinatal women and PHCPs to determine what online information was needed, in what form, and how best it should be presented. The outcome was the development of the Healthy You, Healthy Baby website and smartphone app. This clinically-endorsed, interactive online resource provides perinatal women with a personalised tool to track their weight, diet, physical activity, emotional wellbeing, and sleep patterns based on the developmental stage of their child with links to quality-assured information. One year since the launch of the online resource, data indicates it provides a low-cost intervention delivered across most geographic and socioeconomic strata without additional demands on health service staff.

Reaching Perinatal Women Online: The Healthy You, Healthy Baby Website and App

PubMed Central

Hearn, Lydia; Miller, Margaret; Lester, Leanne

2014-01-01

Overwhelming evidence reveals the close link between unwarranted weight gain among childbearing women and childhood adiposity. Yet current barriers limit the capacity of perinatal health care providers (PHCPs) to offer healthy lifestyle counselling. In response, today's Internet savvy women are turning to online resources to access health information, with the potential of revolutionising health services by enabling PHCPs to guide women to appropriate online resources. This paper presents the findings of a project designed to develop an online resource to promote healthy lifestyles during the perinatal period. The methodology involved focus groups and interviews with perinatal women and PHCPs to determine what online information was needed, in what form, and how best it should be presented. The outcome was the development of the Healthy You, Healthy Baby website and smartphone app. This clinically-endorsed, interactive online resource provides perinatal women with a personalised tool to track their weight, diet, physical activity, emotional wellbeing, and sleep patterns based on the developmental stage of their child with links to quality-assured information. One year since the launch of the online resource, data indicates it provides a low-cost intervention delivered across most geographic and socioeconomic strata without additional demands on health service staff. PMID:24872891

Gender dependent association between perinatal morbidity and estrogen receptor-alpha Pvull polymorphism.

PubMed

Derzbach, László; Treszl, András; Balogh, Adám; Vásárhelyi, Barna; Tulassay, Tivadar; Rigó J, János

2005-01-01

Assuming the importance of estrogen in perinatal physiology, we tested the association of an estrogen receptor-alpha (ER-alpha) gene Pvull pP polymorphism with perinatal morbidity in premature infants. The ER-alpha Pp genotype was determined in 69 low-birth weight (LBW) boys and 72 LBW girls, 86 term boys and 81 term girls. The association between risk factors, genotype, gender and perinatal morbidity was tested with binary logistic regression analysis. Boys carrying "p" allele were at lower risk for necrotizing enterocolitis (OR [95% Cl]: 0.24 [0.07-0.83]) and patent ductus arteriosus (OR [95% Cl]: 0.24 [0.05-0.97]). The carrier state of the "p" allele was associated with a 34-h shorter period of oxygen supplementation on average (P=0.0018). Boys with pp genotype were at greater risk for intraventricular hemorrhage (OR [95% Cl]: 4.39 [1.15-16.82]). No association between ER-alpha Pvull polymorphism and morbidity was present in girls. Since homozygocity for any Pvull alleles (i.e. having PP or pp genotype) increases the risk for at least one of the most common perinatal complications, it is likely that the heterozygous carrier state of Pvull genotypes has a protective effect, which is gender-dependent.

Salud mental en desastres naturales: estrategias interventivas con adultos mayores en sectores rurales de Chile.

PubMed

Osorio-Parraguez, Paulina; Espinoza, Adriana

2016-06-01

En el presente artículo se da a conocer una estrategia de intervención llevada a cabo con adultos mayores en la comuna de Paredones, sexta región de Chile, con posterioridad al terremoto y tsunami del 27 de febrero 2010 en Chile, en el contexto de una investigación sobre fortalezas y vulnerabilidades desplegadas por este grupo etario, con posterioridad a un desastre natural. Se presenta una descripción del desarrollo metodológico de la intervención y de los sustentos teóricos y conceptuales en los que se basa. Como resultado de este proceso, se propone una estrategia que trabaje a través de la identificación de las propias experiencias y fortalezas de los sujetos. De tal forma se minimizan los efectos negativos de los determinantes sociales de la salud (como la edad y el lugar de residencia) en contexto de crisis; permitiendo a los adultos mayores fortalecer sus recursos individuales y colectivos, en pro de su bienestar psicosocial. © The Author(s) 2015.

Maternal mental health priorities, help-seeking behaviors, and resources in post-conflict settings: a qualitative study in eastern Uganda.

PubMed

Tol, Wietse A; Ebrecht, BreeOna; Aiyo, Rebecca; Murray, Sarah M; Nguyen, Amanda J; Kohrt, Brandon A; Ndyanabangi, Sheila; Alderman, Stephen; Musisi, Seggane; Nakku, Juliet

2018-02-07

Limited knowledge exists to inform the selection and introduction of locally relevant, feasible, and effective mental health interventions in diverse socio-cultural contexts and health systems. We examined stakeholders' perspectives on mental health-related priorities, help-seeking behaviors, and existing resources to guide the development of a maternal mental health component for integration into non-specialized care in Soroti, eastern Uganda. We employed rapid ethnographic methods (free listing and ranking; semi-structured interviews; key informant interviews and pile sorting) with community health workers (n = 24), primary health workers (n = 26), perinatal women (n = 24), traditional and religious healers (n = 10), and mental health specialists (n = 9). Interviews were conducted by trained Ateso-speaking interviewers. Two independent teams conducted analyses of interview transcripts following an inductive and thematic approach. Smith's Salience Index was used for analysis of free listing data. When asked about common reasons for visiting health clinics, the most salient responses were malaria, general postnatal care, and husbands being absent. Amongst the free listed items that were identified as mental health problems, the three highest ranked concerns were adeka na aomisio (sickness of thoughts); ipum (epilepsy), and emalaria (malaria). The terms epilepsy and malaria were used in ways that reflected both biomedical and cultural concepts of distress. Sickness of thoughts appeared to overlap substantially with major depression as described in international classification, and was perceived to be caused by unsupportive husbands, intimate partner violence, chronic poverty, and physical illnesses. Reported help-seeking for sickness of thoughts included turning to family and community members for support and consultation, followed by traditional or religious healers and health centers if the problem persisted. Our findings add to existing

Perinatal mortality rate in the Netherlands compared to other European countries: a secondary analysis of Euro-PERISTAT data.

PubMed

de Jonge, Ank; Baron, Ruth; Westerneng, Myrte; Twisk, Jos; Hutton, Eileen K

2013-08-01

the poor perinatal mortality ranking of the Netherlands compared to other European countries has led to questioning the safety of primary care births, particularly those at home. Primary care births are only planned at term. We therefore examined to which extent the perinatal mortality rate at term in the Netherlands contributes to its poor ranking. secondary analyses using published data from the Euro-PERISTAT study. women that gave birth in 2004 in the 29 European regions and countries called 'countries' included in the Euro-PERISTAT study (4,328,441 women in total and 1,940,977 women at term). odds ratios and 95% confidence intervals were calculated for the comparison of perinatal mortality rates between European countries and the Netherlands, through logistic regression analyses using summary country data. combined perinatal mortality rates overall and at term. Perinatal deaths below 28 weeks, between 28 and 37 weeks and from 37 weeks onwards per 1000 total births. compared to the Netherlands, perinatal mortality rates at term were significantly higher for Denmark and Latvia and not significantly different compared to seven other countries. Eleven countries had a significantly lower rate, and for eight the term perinatal mortality rate could not be compared. The Netherlands had the highest number of perinatal deaths before 28 weeks per 1000 total births (4.3). the relatively high perinatal mortality rate in the Netherlands is driven more by extremely preterm births than births at term. Although the PERISTAT data cannot be used to show that the Dutch maternity care system is safe, neither should they be used to argue that the system is unsafe. The PERISTAT data alone do not support changes to the Dutch maternity care system that reduce the possibility for women to choose a home birth while benefits of these changes are uncertain. Copyright © 2013 Elsevier Ltd. All rights reserved.

Exposure to Pre- and Perinatal Risk Factors Partially Explains Mean Differences in Self-Regulation between Races.

PubMed

Barnes, J C; Boutwell, Brian B; Miller, J Mitchell; DeShay, Rashaan A; Beaver, Kevin M; White, Norman

2016-01-01

To examine whether differential exposure to pre- and perinatal risk factors explained differences in levels of self-regulation between children of different races (White, Black, Hispanic, Asian, and Other). Multiple regression models based on data from the Early Childhood Longitudinal Study, Birth Cohort (n ≈ 9,850) were used to analyze the impact of pre- and perinatal risk factors on the development of self-regulation at age 2 years. Racial differences in levels of self-regulation were observed. Racial differences were also observed for 9 of the 12 pre-/perinatal risk factors. Multiple regression analyses revealed that a portion of the racial differences in self-regulation was explained by differential exposure to several of the pre-/perinatal risk factors. Specifically, maternal age at childbirth, gestational timing, and the family's socioeconomic status were significantly related to the child's level of self-regulation. These factors accounted for a statistically significant portion of the racial differences observed in self-regulation. The findings indicate racial differences in self-regulation may be, at least partially, explained by racial differences in exposure to pre- and perinatal risk factors.

Clinical and scientific results in perinatal care of pregnancy complicated by insulin dependent diabetes mellitus in Croatia.

PubMed

Djelmis, J

1998-01-01

At the Department of Obstetrics and Gynecology, Perinatal Unit for Diabetes and Fetal Growth, School of Medicine, Zagreb, perinatal care of pregnancies complicated with insulin dependent diabetes melitus (IDDM), has been performed for more than 36 years. The intention of this review is to show our own results in the management of IDDM pregnancies and the latest clinical advances in perinatal care of such pregnancies. Pregnancy complicated with IDDM is at risk because of numerous maternal, fetal and neonatal complications. Recent advances in medicine, especially in diabetology and perinatology, helps clinician avoid or lessen antenatal or perinatal complications in IDDM pregnancies. The main result of improved perinatal care is that today fetal and neonatal mortality in IDDM pregnancy is almost equal to that of healthy pregnant population. Intensive preconceptual care and optimal regulation of IDDM have resulted not only in decreased perinatal mortality but also in a decreased rate of congenital malformation. Tight glycemia control during pregnancy has a beneficial effect on fetal growth. Intensive control of fetal growth, verification of lung maturation at term by amniocenthesis, and control of fetal oxygenation will result in delivery of a mature eutrophic newborn with the lowest rate of neonatal complications possible. Perinatal mortality of less than 2% in IDDM pregnancy can be obtained by planned delivery between 38 and 39 weeks of gestation by either vaginal route or cesarean section, depending on indications. After delivery, intensive care of the newborn is necessary.

Perinatal mortality--a suitable index of health worldwide?

PubMed

Savage, A

1986-11-22

As a result of cultural factors, perinatal mortality may not be the most appropriate measure of health. Comparisons of the health of different countries should not be based on only 1 criterion unless general attitudes are the same. In developed countries, where abortion is widely available, unwanted pregnancies are handled before delivery. In some developing countries in Africa, however, population control may take the form of allowing a newborn to die of starvation, for example. Given this cultural difference, Third World countries rank lowest in perinatal health. It is suggested that mortality and morbidity should be calculated decade by decade before an index is derived. A 20-year old from a developing country, where there is no drug problem and attempted suicide is rare, might receive a higher health rating than his counterpart in developed countries.

Marcé International Society position statement on psychosocial assessment and depression screening in perinatal women.

PubMed

Austin, Marie-Paule

2014-01-01

The position statement aims to articulate the arguments for and against universal psychosocial assessment and depression screening, and provide guidance to assist decision-making by clinicians, policy makers and health services. More specifically it: 1. Outlines the general principles and concepts involved in psychosocial assessment and depression screening; 2. Outlines the current debate regarding benefits and risks in this area of practice including the clinical benefits and the ethical, cultural and resource implications of undertaking universal psychosocial assessment in the primary health care setting; 3. Provides a document that will assist with advocacy for the development of perinatal mental health services in the primary care setting. The statement does not set out to make specific recommendations about psychosocial assessment and depression screening (as these will need to be devised locally depending on existing resources and models of care) nor does it attempt to summarise the vast evidence-base relevant to this debate. Copyright © 2013. Published by Elsevier Ltd.

Impact of prenatal evaluation and protocol-based perinatal management on congenital diaphragmatic hernia outcomes.

PubMed

Lazar, David A; Cass, Darrell L; Rodriguez, Manuel A; Hassan, Saif F; Cassady, Christopher I; Johnson, Yvette R; Johnson, Karen E; Johnson, Anthony; Moise, Kenneth J; Belleza-Bascon, Bella; Olutoye, Oluyinka O

2011-05-01

Although intuitive, the benefit of prenatal evaluation and multidisciplinary perinatal management for fetuses with congenital diaphragmatic hernia (CDH) is unproven. We compared the outcome of prenatally diagnosed patients with CDH whose perinatal management was by a predefined protocol with those who were diagnosed postnatally and managed by the same team. We hypothesized that patients with CDH undergoing prenatal evaluation with perinatal planning would demonstrate improved outcome. Retrospective chart review of all patients with Bochdalek-type CDH at a single institution between 2004 and 2009 was performed. Patients were stratified by history of perinatal management, and data were analyzed by Fisher's Exact test and Student's t test. Of 116 patients, 71 fetuses presented in the prenatal period and delivered at our facility (PRE), whereas 45 infants were either outborn or postnatally diagnosed (POST). There were more high-risk patients in the PRE group compared with the POST group as indicated by higher rates of liver herniation (63% vs 36%, P = .03), need for patch repair (57% vs 27%, P = .004), and extracorporeal membrane oxygenation use (35% vs 18%, P = .05). Despite differences in risk, there was no difference in 6-month survival between groups (73% vs 73%). Patients with CDH diagnosed prenatally are a higher risk group. Prenatal evaluation and multidisciplinary perinatal management allows for improved outcome in these patients. Copyright © 2011 Elsevier Inc. All rights reserved.

The value of customised centiles in assessing perinatal mortality risk associated with parity and maternal size.

PubMed

Gardosi, J; Clausson, B; Francis, A

2009-09-01

We wanted to compare customised and population standards for defining smallness for gestational age (SGA) in the assessment of perinatal mortality risk associated with parity and maternal size. Population-based cohort study. Sweden. Swedish Birth Registry database 1992-1995 with 354 205 complete records. Coefficients were derived and applied to determine SGA by the fully customised method, or by adjustment for fetal sex only, and using the same fetal weight standard. Perinatal deaths and rates of small for gestational age (SGA) babies within subgroups stratified by parity, body mass index (BMI) and maternal size within the BMI range of 20.0-24.9. Perinatal mortality rates (PMR) had a U-shaped distribution in parity groups, increased proportionately with maternal BMI, and had no association with maternal size within the normal BMI range. For each of these subgroups, SGA rates determined by the customised method showed strong association with the PMR. In contrast, SGA based on uncustomised, population-based centiles had poor correlation with perinatal mortality. The increased perinatal mortality risk in pregnancies of obese mothers was associated with an increased risk of SGA using customised centiles, and a decreased risk of SGA using population-based centiles. The use of customised centiles to determine SGA improves the identification of pregnancies which are at increased risk of perinatal death.

Effect of amnioinfusion for meconium stained amniotic fluid on perinatal outcome.

PubMed

Ashfaq, F; Shah, A A

2004-06-01

To see the effect of amnioinfusion on perinatal outcome in cases of meconium staining of liquor. This study was conducted in department of Obstetrics and Gynaecology, unit 1, Jinnah Postgraduate Medical Centre, Karachi, from 1st January 1998 to 31st December 2000. Four hundred patients were included in this study, assigning 200 for amnioinfusion and 200 as control. All patients were matched in both the groups with respect to age, antenatal booking, parity, gestational age, stage of labour, colour of amniotic fluid and fetal birth weight. Both the groups were found to be comparable. The rate of Caesarean section was found to be 37% in amnioinfusion group, which collaborates with other international studies. The fetal outcome was better i.e. 91% alive and healthy, after amnioinfusion due to dilution of meconium stained amniotic fluid with physiological solutions. The perinatal outcome was recorded by Apgar score at 5 minutes. The perinatal morbidity and mortality both were significantly lowered and was found to be 6% as compared to 14% in control, which was also noticed by less number of admissions in nursery i.e. 12% and perinatal deaths. The incidence of meconium aspiration syndrome was found to be 56% in control and was reduced to 22% after amnioinfusion in the other arm of the study. These results are very encouraging and suggestion can be safely made that in future amnioinfusion will be the ideal method of preventing fetal distress due to meconium stained amniotic fluid.

Effects of environmental factors on perinatal outcome: neurological development in cases of intrauterine growth retardation and school performance of children perinatally exposed to ionizing radiation.

PubMed Central

Ikenoue, T; Ikeda, T; Ibara, S; Otake, M; Schull, W J

1993-01-01

We performed two studies to investigate environmental factors in relation to neurological development in infants. The first, a field study, examined the elementary school performance of 929 children who were born from mothers exposed to the atomic bombing of Hiroshima, Japan, August 6, 1945. The most severe mental retardation was observed in the group exposed between 8 and 15 weeks following fertilization, and the second most severely damaged group was exposed between 16 and 25 weeks. The second, a clinical investigation, examined infants in the perinatal center who survived intrauterine growth retardation (IUGR). Those who survived with abnormal neurological development had a mean growth arrest corresponding to a uterine height of 27 weeks of gestation. This was at an earlier stage than those who survived with normal neurological development and had a mean growth arrest corresponding to 29-30 weeks of gestation. A smaller head circumference at birth was closely correlated with abnormal neurological sequelae. These results indicate that the brain development of the fetuses may have been affected by neurotoxic events similar to ionizing radiation. We emphasize the importance of avoiding neurotoxic stress to pregnant women when the fetus is in the critical period of neuronal development, before 27 weeks of gestational age. PMID:8243407

Are all immigrant mothers really at risk of low birth weight and perinatal mortality? The crucial role of socio-economic status.

PubMed

Racape, Judith; Schoenborn, Claudia; Sow, Mouctar; Alexander, Sophie; De Spiegelaere, Myriam

2016-04-08

Increasing studies show that immigrants have different perinatal health outcomes compared to native women. Nevertheless, we lack a systematic examination of the combined effects of immigrant status and socioeconomic factors on perinatal outcomes. Our objectives were to analyse national Belgian data to determine 1) whether socioeconomic status (SES) modifies the association between maternal nationality and perinatal outcomes (low birth weight and perinatal mortality); 2) the effect of adopting the Belgian nationality on the association between maternal foreign nationality and perinatal outcomes. This study is a population-based study using the data from linked birth and death certificates from the Belgian civil registration system. Data are related to all singleton births to mothers living in Belgium between 1998 and 2010. Perinatal mortality and low birth weight (LBW) were estimated by SES (maternal education and parental employment status) and by maternal nationality (at her own birth and at her child's birth). We used logistic regression to estimate the odds ratios for the associations between nationality and perinatal outcomes after adjusting for and stratifying by SES. The present study includes, for the first time, all births in Belgium; that is 1,363,621 singleton births between 1998 and 2010. Compared to Belgians, we observed an increased risk of perinatal mortality in all migrant groups (p < 0.0001), despite lower rates of LBW in some nationalities. Immigrant mothers with the Belgian nationality had similar rates of perinatal mortality to women of Belgian origin and maintained their protection against LBW (p < 0.0001). After adjustment, the excess risk of perinatal mortality among immigrant groups was mostly explained by maternal education; whereas for sub-Saharan African mothers, mortality was mainly affected by parental employment status. After stratification by SES, we have uncovered a significant protective effect of immigration against LBW and

A comprehensive perinatal patient safety program to reduce preventable adverse outcomes and costs of liability claims.

PubMed

Simpson, Kathleen Rice; Kortz, Carol C; Knox, G Eric

2009-11-01

To achieve the goal of safe care for mothers and infants during labor and birth, Catholic Healthcare Partners (CHP; Cincinnati) conducted on-site risk assessments at the 16 hospitals with perinatal units in 2004-2005, with follow-up visits in 2006 through 2008. ON-SITE RISK ASSESSMENTS: In addition to assessing overall organizational risk, the assessments provided each hospital a gap analysis demonstrating up-to-date and outdated practices and strategies and resources necessary to make all practices consistent with current evidence and national guidelines and standards. CRITICAL ASPECTS OF CLINICAL CARE: Review of claims and near-miss data indicate that fetal assessment, labor induction, and second-stage labor care comprise the majority of risk of perinatal harm. Therefore, these clinical areas were the focus of strategies to promote safety. To promote consistency in knowledge and practice, in 2004 a variety of strategies were recommended, including interdisciplinary fetal monitoring education and routine medical record reviews to monitor ongoing adherence to appropriate practice and documentation. Success in implementing essential structural and process components of the perinatal patient safety program have resulted in improvement from 2003 to 2008 in specific outcomes for the 16 perinatal units surveyed, including reduction of perinatal harm, number of claims, and costs of claims. The program continues to evolve with modifications as needed as more evidence becomes available to guide best perinatal practices and new guidelines/standards are published. A patient safety program guided and supported by a health care system can result in safer clinical environments in individual hospitals and in decreased risk of preventable perinatal harm and liability costs.

Psychosocial impact of mothers with perinatal loss and its contributing factors: an insight.

PubMed

Sutan, Rosnah; Amin, Rosnah Mohamad; Ariffin, Khatija Banu; Teng, Tang Zoun; Kamal, Mohd Faiz; Rusli, Rusli Zaim

2010-03-01

To evaluate the psychosocial impact among mothers with perinatal loss and its contributing factors. A cross sectional study was conducted in University Kebangsaan Malaysia Medical Centre (UKMMC) from April 2008 to May 2009 using Edinburgh Postnatal Depression Scale (EPDS) and self administered questionnaire. Sixty-two respondents were included and most of them were working mothers (77.4%). The mean age of the respondents was (31.0+/-5.6) years and a majority of the subjects aged between 20-34 years (77.4%). According to the EPDS score, 53.2% of the respondents had a psychosocial impact with a total score of >9, out of 30. There was a significant relationship between psychosocial impact after perinatal loss and support from friends (P=0.019). However, there were no significant differences between psychosocial impact and history of previous perinatal loss, ethnicity, occupation, educational level, age or total income. Mothers with perinatal loss should be screened for psychosocial impact and offered support when needed. Family and friends should continue to provide emotional support. People who have experienced similar problem before will be able to provide better support than those who have not.

Psychosocial impact of mothers with perinatal loss and its contributing factors: an insight*

PubMed Central

Sutan, Rosnah; Amin, Rosnah Mohamad; Ariffin, Khatija Banu; Teng, Tang Zoun; Kamal, Mohd Faiz; Rusli, Rusli Zaim

2010-01-01

Objective: To evaluate the psychosocial impact among mothers with perinatal loss and its contributing factors. Methods: A cross sectional study was conducted in University Kebangsaan Malaysia Medical Centre (UKMMC) from April 2008 to May 2009 using Edinburgh Postnatal Depression Scale (EPDS) and self administered questionnaire. Results: Sixty-two respondents were included and most of them were working mothers (77.4%). The mean age of the respondents was (31.0±5.6) years and a majority of the subjects aged between 20–34 years (77.4%). According to the EPDS score, 53.2% of the respondents had a psychosocial impact with a total score of >9, out of 30. There was a significant relationship between psychosocial impact after perinatal loss and support from friends (P=0.019). However, there were no significant differences between psychosocial impact and history of previous perinatal loss, ethnicity, occupation, educational level, age or total income. Conclusion: Mothers with perinatal loss should be screened for psychosocial impact and offered support when needed. Family and friends should continue to provide emotional support. People who have experienced similar problem before will be able to provide better support than those who have not. PMID:20205307

Depressive symptomatology and grief in Spanish women who have suffered a perinatal loss.

PubMed

Ridaura, Isabel; Penelo, Eva; Raich, Rosa M

2017-02-01

Perinatal grief differs from other types of mourning. Two goals were set: to describe the progression of the process of grief and the symptoms of depression throughout the year following perinatal loss, and to study its association with socio-economic and obstetric factors. The study involved the participation of 70 women who had suffered a medical termination of pregnancy or a prenatal/postnatal death. Three assessments were made after the loss (after 1 month, 6 months and 1 year) with the Perinatal Grief Scale (PGS) to assess grief and the Beck Depression Inventory (BDI) for depressive symptomatology. Symptoms pertaining to grief and depression were observed in the first month after the loss, and a significant decrease in scores over the two follow-ups. No significant differences were observed in grief and depression depending on the type of loss, no significant associations were found with the age of the mother, her socioeconomic level, or obstetric factors (week of gestation of the loss, having a child or having suffered a previous miscarriage). Perinatal grief is a complex construct, with multiple variables involved, and one which involves significant emotional discomfort.

[Perinatal complications in patients with chronic renal insufficiency on hemodialysis].

PubMed

Vázquez-Rodríguez, Juan Gustavo; del Angel-García, Guadalupe

2010-09-01

Pregnant patients with chronic renal insufficiency treated with hemodialysis experience adverse perinatal results. To compare perinatal complications of patients with chronic renal insufficiency undergoing hemodialysis who become pregnant vs. the complications of women with chronic renal insufficiency not undergoing dialysis but who then require dialysis during gestation. Transversal and retrospective study that included three patients with chronic renal insufficiency on chronic hemodialysis who became pregnant (group A) and three patients with chronic renal insufficiency without hemodialysis at the time of conception but who required dialysis during gestation (group B). Perinatal results were compared. Statistical analysis was performed with measures of central tendency and dispersion and Student t-test. Group A had 25 sessions vs. group B with 29 hemodialysis sessions (p = 0.88). Maternal complications were anemia 100% (six cases), Cesarean delivery 83.3% (group A 2 cases vs. group B 2 cases), preeclampsia 50% (group A 2 cases vs. group B 1 case), uncontrolled hypertension 50% (group A 2 cases vs. group B 1 case), preterm delivery 50% (group A 2 cases vs. group B 1 case), transfusion 33.3% (group A 2 cases), polyhydramnios 33.3% (group A 1 case vs. group B 1 case) and abortion 16.6% (group A 1 case). Fetal complications included fetal loss 16.6% (group A 1 case), neonatal mortality 33.3% (group A 1 cases vs. group B 1 case), prematurity 50% (group A2 cases vs. group B 1 case), fetal distress 50% (group A 1 case vs. group B 2 cases), respiratory failure 33.3% (group A 2 cases) and fetal growth restriction 16.6% (group A 1 case). Frequency of perinatal complications is elevated in both groups.

Transport as a system: reorganization of perinatal assistance in Northern Lombardy.

PubMed

Martinelli, Stefano; Vergani, Patrizia; Zanini, Rinaldo; Bellù, Roberto; Farina, Clotilde; Tagliabue, Paolo

2011-10-01

The organization of perinatal care has been a pivotal mean for improvement in neonatal survivals. Despite the excellent standard of assistance in Lombardy, Obstetrics and Neonatal Units of MBBM Foundation-Monza, Manzoni Hospital-Lecco and Niguarda Hospital-Milan put forward a pilot project proposing reorganization of perinatal care in the northern part of Lombardy. The main goals of the project are implementation of maternal transport system and use of neonatal back transport as a system to increase the availability of intensive care beds. The project's fundamental steps and critical points will be discussed.

The experience and impact of traumatic perinatal event experiences in midwives: A qualitative investigation.

PubMed

Sheen, Kayleigh; Spiby, Helen; Slade, Pauline

2016-01-01

Through their work midwives may experience distressing events that fulfil criteria for trauma. However, there is a paucity of research examining the impact of these events, or what is perceived to be helpful/unhelpful by midwives afterwards. To investigate midwives' experiences of traumatic perinatal events and to provide insights into experiences and responses reported by midwives with and without subsequent posttraumatic stress symptoms. Semi-structured telephone interviews were conducted with a purposive sample of midwives following participation in a previous postal survey. 35 midwives who had all experienced a traumatic perinatal event defined using the Diagnostic and Statistical Manual of Mental Disorders (version IV) Criterion A for posttraumatic stress disorder were interviewed. Two groups of midwives with high or low distress (as reported during the postal survey) were purposefully recruited. High distress was defined as the presence of clinical levels of PTSD symptomatology and high perceived impairment in terms of impacts on daily life. Low distress was defined as any symptoms of PTSD present were below clinical threshold and low perceived life impairment. Interviews were analysed using template analysis, an iterative process of organising and coding qualitative data chosen for this study for its flexibility. An initial template of four a priori codes was used to structure the analysis: event characteristics, perceived responses and impacts, supportive and helpful strategies and reflection of change over time codes were amended, integrated and collapsed as appropriate through the process of analysis. A final template of themes from each group is presented together with differences outlined where applicable. Event characteristics were similar between groups, and involved severe, unexpected episodes contributing to feeling 'out of a comfort zone.' Emotional upset, self-blame and feelings of vulnerability to investigative procedures were reported. High

Manténgase saludable al elegir pescado y mariscos de manera inteligente

EPA Pesticide Factsheets

Los pescados y mariscos son una parte importante de una dieta saludable. Algunos pescados y mariscos pueden contener sustancias químicas que presenten un riesgo para la salud. Información sobre el consumo seguro de pescado y mariscos.

Prenatal and Perinatal Risk Factors for Autism in China

PubMed Central

Zhang, Xin; Lv, Cong-Chao; Tian, Jiang; Miao, Ru-Juan; Xi, Wei; Hertz-Picciotto, Irva

2010-01-01

We conducted a case–control study using 190 Han children with and without autism to investigate prenatal and perinatal risk factors for autism in China. Cases were recruited through public special education schools and controls from regular public schools in the same region (Tianjin), with frequency matching on sex and birth year. Unadjusted analyses identified seven prenatal and seven perinatal risk factors significantly associated with autism. In the adjusted analysis, nine risk factors showed significant association with autism: maternal second-hand smoke exposure, maternal chronic or acute medical conditions unrelated to pregnancy, maternal unhappy emotional state, gestational complications, edema, abnormal gestational age (<35 or >42 weeks), nuchal cord, gravidity >1, and advanced paternal age at delivery (>30 year-old). PMID:20358271

Characterization of U.S. State Laws Requiring Health Care Provider Reporting of Perinatal Substance Use.

PubMed

Jarlenski, Marian; Hogan, Caroline; Bogen, Debra L; Chang, Judy C; Bodnar, Lisa M; Van Nostrand, Elizabeth

State policies pertaining to health care provider reporting of perinatal substance use have implications for provider screening and referral behavior, patients' care seeking and access to prenatal substance use disorder treatment, and pregnancy and birth outcomes. This study sought to characterize specific provisions enacted in state statutes pertaining to mandates that health care providers report perinatal substance use, and to determine the proportion of births occurring in states with such laws. We conducted a systematic content analysis of statutes in all U.S. states that mentioned reporting by health care providers of substance use by pregnant women or infants exposed to substances in utero; inter-rater reliability was high. We calculated the number of states, and proportion of U.S. births occurring in states, with processes for mandatory reporting of perinatal substance use to authorities, and substance use disorder treatment provision for individuals who are reported. Twenty states (corresponding with 31% of births) had laws requiring health care providers to report perinatal substance use to child protective authorities, and four states (18% of births) had laws requiring reporting only when a health care provider believed the substance use was associated with child maltreatment. About one-half of states (13) with any reporting law had a provision promoting substance use disorder treatment in the perinatal period. Findings inform the ongoing debate about how health policies may be used to reduce the population burden of perinatal substance use. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Perinatal Yellow Fever: A Case Report.

PubMed

Diniz, Lilian Martins Oliveira; Romanelli, Roberta Maia Castro; de Carvalho, Andréa Lucchesi; Teixeira, Daniela Caldas; de Carvalho, Luis Fernando Andrade; Cury, Verônica Ferreira; Filho, Marcelo Pereira Lima; Perígolo, Graciele; Heringer, Tiago Pires

2018-04-09

An outbreak of yellow fever in Brazil made it possible to assess different presentations of disease such as perinatal transmission. A pregnant woman was admitted to hospital with yellow fever symptoms. She was submitted to cesarean section and died due to fulminant hepatitis. On the 6th day the newborn developed liver failure and died 13 days later. Yellow fever PCR was positive for both.

Maternal stress and perinatal features in autism and attention deficit/hyperactivity disorder.

PubMed

Say, Gökçe Nur; Karabekiroğlu, Koray; Babadağı, Zehra; Yüce, Murat

2016-04-01

We investigated the shared and non-shared perinatal risk factors for autism spectrum disorders (ASD) and attention deficit/hyperactivity disorder (ADHD) in a clinical sample. Additionally, we compared these groups regarding pre/postpartum maternal stress and the duration of breastfeeding. Children aged 3-18 years old with ASD (n = 100) were compared with age- and gender-matched children with ADHD (n = 100) and with age- and gender-matched healthy controls (n = 80). Prematurity of the neonate and maternal stress/depressive mood in pregnancy were common risk factors shared by ASD and ADHD. Postpartum maternal depressive mood may be more specific to ASD, while shorter duration of breastfeeding may be related to ADHD. ASD and ADHD may have some perinatal features in common. Identification of perinatal factors for ASD and ADHD carries clinical implications in terms of primary prevention. © 2015 Japan Pediatric Society.

El medioambiente y su salud

EPA Pesticide Factsheets

Las acciones que usted toda en su diario vivir tienen un impacto en su medioambiente y su salud. La Agencia de Protección Ambiental de EE.UU. (EPA, por sus siglas en inglés) ofrece información sobre los pasos que puede tomar para protegerse a usted y prote

Maternal education and perinatal outcomes among Spanish women residing in southern Spain (2001-2011).

PubMed

Juárez, Sol; Revuelta-Eugercios, Bárbara A; Ramiro-Fariñas, Diego; Viciana-Fernández, Francisco

2014-10-01

Evidence suggests that educational differences in perinatal outcomes have increased in some countries (Eastern Europe) while remained stable in others (Scandinavian countries). However, less is known about the experience of Southern Europe. This study aims to evaluate the association between maternal education and perinatal outcomes derived from birthweight (low birthweight and macrosomia) and gestational age (pre-term and post-term births) among Spaniards living in the Autonomous Community of Andalusia during the period 2001-2011 (around 19 % of births in Spain); and to evaluate whether the educational differences narrowed or widened during that period, which includes both an economic boom (2001-2008) and the global economic crisis (2009-2011). This study uses the Andalusian Population Longitudinal Database and the Vital Statistics Data provided by the Spanish National Statistics Institute. We study live and singleton births of Spanish mothers who lived in Andalusia at the time of delivery (n = 404,951). ORs with 95 % confidence intervals (crude and adjusted) were estimated using multinomial regression models. A negative educational gradient is observed in all perinatal outcomes studied (i.e., the higher the educational status, the lower the risk of negative perinatal outcomes). However, when disaggregating the sample in two periods, the gradient is only statistically significant for pre-term birth during 2001-2008, while a full gradient is observed in all perinatal indicators in the period 2009-2011 with an increase in the educational inequalities in macrosomia and post-term. Further studies are needed in order to confirm whether there is a causal association between the widening of the educational differences in perinatal outcomes and the onset of the economic crisis in Spain, or the widening can be explained by other factors, such as changes in childbearing patterns and the composition of women accessing motherhood.

Perinatal thiamine deficiency-induced spontaneous abortion and pup-killing responses in rat dams.

PubMed

Bâ, Abdoulaye

2013-03-01

The current study attempts to determine whether thiamine (B1 vitamin) deficiency and chronic alcohol-related thiamine-deficient (TD) status, disturb maternal behavior towards pups. During gestation and lactation, Wistar rat dams were exposed to the following treatments: (i) prenatal TD dams; (ii) perinatal TD dams; (iii) postnatal TD dams; (iv) 12% alcohol/water drinking mothers; (v) ad libitum control dams. Pair-feeding treatments controlled malnutrition related to thiamine deficiency; (vi) prenatal pair-fed (PF) dams; (vii) perinatal PF dams; (viii) postnatal PF dams and included also the control of alcohol consummation: (ix) PF saccharose dams. Dams were observed for gestation outcome and for apparent disorders of the maternal behavior related to the pups at parturition. From the nine experimental groups studied, only pre- and perinatal TD dams exhibited spontaneous abortion (33.36 and 41.66%, respectively) followed by pups-killing responses where, respectively, 4 dams/7 (57.14%) and 5 dams/7 (71.43%) showed disruption of maternal behavior and appearance of cannibalism towards pups which all were killed within 48 hours after parturition. Spontaneous abortion and pup-killing responses were not observed in the dams of any other experimental group, suggesting that perinatal disturbances of hormonal factors underlay these maternal disorders. Previous studies reported that thiamine deficiency-induced degeneration of dopamine neurons may be related to mouse-killing aggression in rats. The present study suggests that perinatal thiamine deficiency-induced alteration of dopaminergic neurons in maternal brain could be a trigger factor of pup-killing responses. Central dopamine and oxytocin have been strongly associated with both the onset and maintenance of maternal behavior and the regulation of maternal aggressiveness as well. Our studies suggest that estrogen control oxytocin levels in brain structures of pregnancy-terminated rats via dopamine transmission. Thiamine

Mental Health in Low-to-Moderate Risk Preterm, Low Birth Weight, and Small for Gestational Age Children at 4 to 5 Years: The Role of Early Maternal Parenting

ERIC Educational Resources Information Center

Westrupp, Elizabeth M.; Mensah, Fiona K.; Giallo, Rebecca; Cooklin, Amanda; Nicholson, Jan M.

2012-01-01

Objectives: The majority of children born preterm, with low birth weight, or small for gestational age are born with low-to-moderate risk (LTM), yet most research focuses on the high-risk group. Little is known about whether children with LTM perinatal risk are at greater risk for mental health problems, or what the role of early maternal…

Maternal mental disorders and pregnancy outcomes: a clinical study in a Japanese population.

PubMed

Hironaka, Masae; Kotani, Tomomi; Sumigama, Seiji; Tsuda, Hiroyuki; Mano, Yukio; Hayakawa, Hiromi; Tanaka, Satoshi; Ozaki, Norio; Tamakoshi, Koji; Kikkawa, Fumitaka

2011-10-01

To assess the maternal and neonatal outcomes of pregnant women with mental disorders in Japan. We conducted this retrospective cohort study to examine the patients who delivered at Nagoya University Hospital (2005-2009). Thereafter, the patients without any complications other than mental disorders and with several sources of psychiatric information were included in the present series, and the maternal and neonatal outcomes between patients with or without maternal mental disorders were compared. The psychiatric outcomes and the adverse effects of psychotropic drugs were also examined. A total of 1649 women delivered during this period, and 63 of them were complicated by maternal mental disorders. After the selection of patients for comparison purposes, women with mental disorders (n = 51) had a slightly but significantly shorter gestational age (39.2 ± 0.2 vs 39.8 ± 0.1 weeks, P = 0.003) and smaller birth weight (2993.0 ± 56.7 vs 3152.4 ± 23.6 g, P = 0.010) compared with the control group (n = 278). Intervention by psychiatrists was required for only 10 patients, and no patients required termination of pregnancy due to exacerbation of mental disorders. In schizophrenia patients who were taking atypical antipsychotics and benzodiazepine, a significant increase in maternal gestational weight gain, and a significant shorter gestational age were detected, respectively, compared with patients who were not receiving any drug treatments. A trend towards a lower birth weight and shorter gestational age was observed in Japanese women with well-controlled mental disorders, but the effect of well-controlled mental disorders on the perinatal outcome was minimal. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

Trastornos mentales y consumo de drogas en la población víctima del conflicto armado en tres ciudades de Colombia.

PubMed

Castaño, Guillermo; Sierra, Gloria; Sánchez, Daniela; Torres, Yolanda; Salas, Carolina; Buitrago, Carolina

2018-05-01

Introducción. La violencia en sus diferentes modalidades incrementa el riesgo de trastornos mentales y de consumo de drogas.Objetivos. Estimar la prevalencia de los trastornos mentales, del uso y abuso de drogas, así como los factores asociados en víctimas de desplazamiento forzado en tres ciudades colombianas.Materiales y métodos. Se hizo un estudio de prevalencia en una muestra de 1.026 personas entre los 13 y los 65 años de edad, a quienes se entrevistó utilizando el instrumento Composite International Diagnostic Interview y el Alcohol Use Disorders Identification Test de la Organización Mundial de la Salud, así como un cuestionario sobre el consumo de drogas modificado a partir de la encuesta del Sistema Interamericano de Datos Uniformes sobre Drogas de la Comisión Interamericana para el Control del Abuso de Drogas de la Organización de Estados Americanos, y otro sobre aspectos relacionados con el desplazamiento forzado. El análisis se hizo mediante el programa estadístico SPSS™, versión 21.Resultados. La prevalencia de vida de los trastornos mentales fue la siguiente: fobia específica, 17,7 %; depresión mayor, 16,4 %; estrés postraumático, 9,9 %; trastorno oposicionista desafiante, 8,9 %; ansiedad por separación, 7,2 %; trastornos de conducta, 5,8 %, y déficit de atención, 5,6 %. La prevalencia de vida del consumo de alcohol fue de 68,7 %; de tabaco, 31,3 %, de marihuana, 11,2 %, de cocaína, 3,5 %, de basuco, 2,0 %, de inhalables, 2,3 %, y de medicamentos ansiolíticos sin receta, 2,5 %, en tanto que 0,7 % de los entrevistados se había inyectado drogas. El presentar cualquiera de los trastornos mentales se asoció con el sexo femenino (odds ratio, OR=1,61; IC95% 1,21-2,14), así como el haber sido sometido a más de un desplazamiento forzado (OR=1,47; IC95 1,05-2,05). El consumo de cualquiera de las drogas se asoció con ser hombre (OR=5,38; IC95% 2,35-12,34).Conclusiones. La alta prevalencia de trastornos mentales y de consumo de

Mothers’ Perception of Quality of Services from Health Centers after Perinatal Loss

PubMed Central

Sereshti, Manije; Nahidi, Fateme; Simbar, Masomeh; Ahmadi, Fazlollah; Bakhtiari, Maryam; Zayeri, Farid

2016-01-01

Introduction Perinatal loss is one of the most stressful life events that parents and caregivers experience. Providing an empathetic, caring environment to support mothers who experience perinatal loss is necessary. The aim of this study was to assess mothers’ perception of the quality of services received from health centers after perinatal loss. Methods This study was conducted in 2014–2015 using qualitative content analysis. Participants in the study were 40 women with a history of miscarriage, stillbirth, or neonatal death who live in Tehran and Shahrekord, Iran. Data were collected from the participants through semi-structured, in-depth interviews, and they were analyzed using qualitative content analysis. Results One theme and six main categories were developed, and they indicated the mothers’ experiences and understandings of the quality of service received after perinatal loss. The major theme was ‘dissatisfaction with the quality of care received.’ The main categories included: 1) effective communication, 2) expecting responsiveness, 3) expecting to respect the patient’s dignity, 4) expecting better care, 5) tension of medical expenses, and 6) insufficient facilities. Conclusion The findings of this study highlighted the weaknesses, inadequacies, strengths, and opportunities in providing health services. They can help reproductive health policy-makers reduce the pain and suffering of the affected families with appropriate measures. PMID:27054012

PREGNANCY AND PERINATAL HEALTH, BAMEN, INNER MONGOLIA, CHINA

EPA Science Inventory

For developing countries, especially in remote rural areas, measures of maternal and perinatal health may be difficult to obtain because it is not systematically collected and/or electronic data is not available. We assisted the public health officials of Bayingnormen (BaMen), In...

Impact of Fetal Versus Perinatal Hypoxia on Sex Differences in Childhood Outcomes: Developmental Timing Matters

PubMed Central

Anastario, Michael; Salafia, Carolyn M.; Fitzmaurice, Garrett; Goldstein, Jill M.

2013-01-01

Purpose To examine how the timing of hypoxic exposure results in specific childhood outcomes and whether there is a differential effect by sex. Methods A sample of 10,879 prospectively followed pregnancies was drawn from the Boston and Providence sites (New England-NE) of the National Collaborative Perinatal Project. Based on placental pathology, we developed and validated a measure of probable chronic fetal hypoxia (CHP) and contrasted the effects of acute perinatal hypoxia on age 7 emotional, behavioral, and cognitive outcomes. Results Perinatal hypoxia had a significant impact on multiple behavioral and cognitive outcomes in boys and girls by age 7, in contrast to probable CHP which had a differential effect on girls and boys such that there was decreased verbal IQ and increased inhibition in females alone. Conclusions Findings underscore the importance of considering the timing of obstetric complications and offspring sex in investigations of the impact of fetal and perinatal hypoxia on offspring’s outcomes throughout the life course. PMID:21327969

Vitamin B-12 and Perinatal Health123

PubMed Central

Finkelstein, Julia L; Layden, Alexander J; Stover, Patrick J

2015-01-01

Vitamin B-12 deficiency (<148 pmol/L) is associated with adverse maternal and neonatal outcomes, including developmental anomalies, spontaneous abortions, preeclampsia, and low birth weight (<2500 g). The importance of adequate vitamin B-12 status periconceptionally and during pregnancy cannot be overemphasized, given its fundamental role in neural myelination, brain development, and growth. Infants born to vitamin B-12-deficient women may be at increased risk of neural tube closure defects, and maternal vitamin B-12 insufficiency (<200 pmol/L) can impair infant growth, psychomotor function, and brain development, which may be irreversible. However, the underlying causal mechanisms are unknown. This review was conducted to examine the evidence that links maternal vitamin B-12 status and perinatal outcomes. Despite the high prevalence of vitamin B-12 deficiency and associated risk of pregnancy complications, few prospective studies and, to our knowledge, only 1 randomized trial have examined the effects of vitamin B-12 supplementation during pregnancy. The role of vitamin B-12 in the etiology of adverse perinatal outcomes needs to be elucidated to inform public health interventions. PMID:26374177

Perinatal outcomes among immigrant mothers over two periods in a region of central Italy

PubMed Central

2011-01-01

Background The number of immigrants has increased in Italy in the last twenty years (7.2% of the Italian population), as have infants of foreign-born parents, but scanty evidence on perinatal outcomes is available. The aim of this study was to investigate whether infants of foreign-born mothers living in Italy have different odds of adverse perinatal outcomes compared to those of native-born mothers, and if such measures changed over two periods. Methods The source of this area-based study was the regional hospital discharge database that records perinatal information on all births in the Lazio region. We analysed 296,739 singleton births born between 1996-1998 and 2006-2008. The exposure variable was the mother's region of birth. We considered five outcomes of perinatal health. We estimated crude and adjusted odds ratios and 95% confidence intervals (CIs) to evaluate the association between mother's region of birth and perinatal outcomes. Results Perinatal outcomes were worse among infants of immigrant compared to Italian mothers, especially for sub-Saharan and west Africans, with the following crude ORs (in 1996-1998 and 2006-2008 respectively): 1.80 (95%CI:1.44-2.28) and 1.95 (95%CI:1.72-2.21) for very preterm births, and 1.32 (95%CI:1.16-1.50) and 1.32 (95%CI:1.25-1.39) for preterm births; 1.18 (95%CI:0.99-1.40) and 1.17 (95%CI:1.03-1.34) for a low Apgar score; 1.22 (95%CI:1.15-1.31) and 1.24 (95%CI:1.17-1.32) for the presence of respiratory diseases; 1.47 (95%CI:1.30-1.66) and 1.45 (95%CI:1.34-1.57) for the need for special or intensive neonatal care/in-hospital deaths; and 1.03 (95%CI:0.93-1.15) and 1.07 (95%CI:1.00-1.15) for congenital malformations. Overall, time did not affect the odds of outcomes differently between immigrant and Italian mothers and most outcomes improved over time among all infants. None of the risk factors considered confounded the associations. Conclusion Our findings suggest that migrant status is a risk factor for adverse perinatal

La salud en personas con discapacidad intelectual en España: estudio europeo POMONA-II

PubMed Central

Martínez-Leal, Rafael; Salvador-Carulla, Luis; Gutiérrez-Colosía, Mencía Ruiz; Nadal, Margarida; Novell-Alsina, Ramón; Martorell, Almudena; González-Gordón, Rodrigo G.; Mérida-Gutiérrez, M. Reyes; Ángel, Silvia; Milagrosa-Tejonero, Luisa; Rodríguez, Alicia; García-Gutiérrez, Juan C.; Pérez-Vicente, Amado; García-Ibáñez, José; Aguilera-Inés, Francisco

2011-01-01

Introducción Estudios internacionales demuestran que existe un patrón diferenciado de salud y una disparidad en la atención sanitaria entre personas con discapacidad intelectual (DI) y población general. Objetivo Obtener datos sobre el estado de salud de las personas con DI y compararlos con datos de población general. Pacientes y métodos Se utilizó el conjunto de indicadores de salud P15 en una muestra de 111 sujetos con DI. Los datos de salud encontrados se compararon según el tipo de residencia de los sujetos y se utilizó la Encuesta Nacional de Salud 2006 para comparar estos datos con los de la población general. Resultados La muestra con DI presentó 25 veces más casos de epilepsia y el doble de obesidad. Un 20% presentó dolor bucal, y existió una alta presencia de problemas sensoriales, de movilidad y psicosis. Sin embargo, encontramos una baja presencia de patologías como la diabetes, la hipertensión, la osteoartritis y la osteoporosis. También presentaron una menor participación en programas de prevención y promoción de la salud, un mayor número de ingresos hospitalarios y un uso menor de los servicios de urgencia. Conclusiones El patrón de salud de las personas con DI difiere del de la población general, y éstas realizan un uso distinto de los servicios sanitarios. Es importante el desarrollo de programas de promoción de salud y de formación profesional específicamente diseñados para la atención de personas con DI, así como la implementación de encuestas de salud que incluyan datos sobre esta población. PMID:21948011

Guidelines on treatment of perinatal depression with antidepressants: An international review

PubMed Central

Kamperman, Astrid M; Boyce, Philip; Bergink, Veerle

2018-01-01

Objective: Several countries have developed Clinical Practice Guidelines regarding treatment of perinatal depressive symptoms and perinatal use of antidepressant. We aimed to compare guidelines to guide clinicians in best clinical practice. Methods: An extensive search in guideline databases, MEDLINE and PsycINFO was performed. When no guidelines were (publicly) available online, we contacted psychiatric-, obstetric-, perinatal- and mood disorder societies of all first world countries and the five largest second world countries. Only Clinical Practice Guidelines adhering to quality criteria of the Appraisal of Guidelines for Research and Evaluation instrument and including a systematic review of evidence were included. Data extraction focussed on recommendations regarding continuation or withdrawal of antidepressants and preferred treatment in newly depressed patients. Results: Our initial search resulted in 1094 articles. After first screening, 40 full-text articles were screened. Of these, 24 were excluded for not being an official Clinical Practice Guidelines. In total, 16 Clinical Practice Guidelines were included originating from 12 countries. Eight guidelines were perinatal specific and eight were general guidelines. Conclusion: During pregnancy, four guidelines advise to continue antidepressants, while there is a lack of evidence supporting this recommendation. Five guidelines do not specifically advise or discourage continuation. For new episodes, guidelines agree on psychotherapy (especially cognitive behavioural therapy) as initial treatment for mild to moderate depression and antidepressants for severe depression, with a preference for sertraline. Paroxetine is not preferred treatment for new episodes but switching antidepressants for ongoing treatment is discouraged (three guidelines). If mothers use antidepressants, observation of the neonate is generally recommended and breastfeeding encouraged. PMID:29506399

Guidelines on treatment of perinatal depression with antidepressants: An international review.

PubMed

Molenaar, Nina M; Kamperman, Astrid M; Boyce, Philip; Bergink, Veerle

2018-04-01

Several countries have developed Clinical Practice Guidelines regarding treatment of perinatal depressive symptoms and perinatal use of antidepressant. We aimed to compare guidelines to guide clinicians in best clinical practice. An extensive search in guideline databases, MEDLINE and PsycINFO was performed. When no guidelines were (publicly) available online, we contacted psychiatric-, obstetric-, perinatal- and mood disorder societies of all first world countries and the five largest second world countries. Only Clinical Practice Guidelines adhering to quality criteria of the Appraisal of Guidelines for Research and Evaluation instrument and including a systematic review of evidence were included. Data extraction focussed on recommendations regarding continuation or withdrawal of antidepressants and preferred treatment in newly depressed patients. Our initial search resulted in 1094 articles. After first screening, 40 full-text articles were screened. Of these, 24 were excluded for not being an official Clinical Practice Guidelines. In total, 16 Clinical Practice Guidelines were included originating from 12 countries. Eight guidelines were perinatal specific and eight were general guidelines. During pregnancy, four guidelines advise to continue antidepressants, while there is a lack of evidence supporting this recommendation. Five guidelines do not specifically advise or discourage continuation. For new episodes, guidelines agree on psychotherapy (especially cognitive behavioural therapy) as initial treatment for mild to moderate depression and antidepressants for severe depression, with a preference for sertraline. Paroxetine is not preferred treatment for new episodes but switching antidepressants for ongoing treatment is discouraged (three guidelines). If mothers use antidepressants, observation of the neonate is generally recommended and breastfeeding encouraged.

Perinatal stress and food allergy: a preliminary study on maternal reports.

PubMed

Polloni, L; Ferruzza, E; Ronconi, L; Lazzarotto, F; Toniolo, A; Bonaguro, R; Muraro, A

2015-01-01

Maternal stress in fetal and early life has been associated with the development of respiratory allergies, but no studies exist about food allergy. Stressful events and the quality of caregiving provided, as they affect the emotional and physiologic regulation of the infant, could alter the hypothalamic-pituitary-adrenal and immune system, facilitating an increased allergic response. This study aimed to investigate the influence of perinatal stress, as perceived by mothers, on developing food allergy in childhood. A survey on pregnancy and the first three months after giving birth was submitted to 59 Italian mothers of at least one child suffering from severe food allergy and one completely healthy child, for a total of 118 children examined. The presence of stressful events and the quality of perinatal period for each child were assessed retrospectively. The food allergic children's data were compared to siblings' data through inferential statistics. The results showed a significantly higher number of stressful events occurred during patients' perinatal period, compared to siblings, in particular bereavements in pregnancy and parenting difficulties in postpartum. Mothers reported harder pregnancies and more stressful, harder, and, in general, worse postpartum when referring to their food-allergic children, in comparison with their siblings (p < .05). Psychological aspects are demonstrated to be involved in the development of allergic diseases. This study constitutes the first step to examine the role of early stress and perinatal psychosocial factors in the pathogenesis of food allergy; further studies are necessary to understand individual psychological impact and its relations with genetic and biological factors.

The Ha Noi Expert Statement: recognition of maternal mental health in resource-constrained settings is essential for achieving the Millennium Development Goals.

PubMed

Fisher, Jane Rw; de Mello, Meena Cabral; Izutsu, Takashi; Tran, Tuan

2011-01-07

Mental health problems in women during pregnancy and after childbirth and their adverse consequences for child health and development have received sustained detailed attention in high-income countries. In contrast, evidence has only been generated more recently in resource-constrained settings.In June 2007 the United Nations Population Fund, the World Health Organization, the Key Centre for Women's Health in Society, a WHO Collaborating Centre for Women's Health and the Research and Training Centre for Community Development in Vietnam convened the first international expert meeting on maternal mental health and child health and development in resource-constrained settings. It aimed to appraise the evidence about the nature, prevalence and risks for common perinatal mental disorders in women; the consequences of these for child health and development and ameliorative strategies in these contexts.The substantial disparity in rates of perinatal mental disorders between women living in high- and low-income settings, suggests social rather than biological determinants. Risks in resource-constrained contexts include: poverty; crowded living situations; limited reproductive autonomy; unintended pregnancy; lack of empathy from the intimate partner; rigid gender stereotypes about responsibility for household work and infant care; family violence; poor physical health and discrimination. Development is adversely affected if infants lack day-to-day interactions with a caregiver who can interpret their cues, and respond effectively. Women with compromised mental health are less able to provide sensitive, responsive infant care. In resource-constrained settings infants whose mothers are depressed are less likely to thrive and to receive optimal care than those whose mothers are well.The meeting outcome is the Hanoi Expert Statement (Additional file 1). It argues that the Millennium Development Goals to improve maternal health, reduce child mortality, promote gender equality

Perinatal features of the RASopathies: Noonan syndrome, cardiofaciocutaneous syndrome and Costello syndrome.

PubMed

Myers, Angela; Bernstein, Jonathan A; Brennan, Marie-Luise; Curry, Cynthia; Esplin, Edward D; Fisher, Jamie; Homeyer, Margaret; Manning, Melanie A; Muller, Eric A; Niemi, Anna-Kaisa; Seaver, Laurie H; Hintz, Susan R; Hudgins, Louanne

2014-11-01

The RASopathies are a family of developmental disorders caused by heritable defects of the RAS/MAPK signaling pathway. While the postnatal presentation of this group of disorders is well known, the prenatal and neonatal findings are less widely recognized. We report on the perinatal presentation of 10 patients with Noonan syndrome (NS), nine with Cardiofaciocutaneous syndrome (CFCS) and three with Costello syndrome (CS), in conjunction with the results of a comprehensive literature review. The majority of perinatal findings in NS, CS, and CFCS are shared: polyhydramnios; prematurity; lymphatic dysplasia; macrosomia; relative macrocephaly; respiratory distress; hypotonia, as well as cardiac and renal anomalies. In contrast, fetal arrhythmia and neonatal hypoglycemia are relatively specific to CS. NS, CS, and CFCS should all be considered as a possible diagnosis in pregnancies with a normal karyotype and ultrasound findings of a RASopathy. Recognition of the common perinatal findings of these disorders should facilitate both their prenatal and neonatal diagnosis. © 2014 Wiley Periodicals, Inc.

Short and long term prognosis in perinatal asphyxia: An update

PubMed Central

Ahearne, Caroline E; Boylan, Geraldine B; Murray, Deirdre M

2016-01-01

Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy (NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy (HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and long-term outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing

Short and long term prognosis in perinatal asphyxia: An update.

PubMed

Ahearne, Caroline E; Boylan, Geraldine B; Murray, Deirdre M

2016-02-08

Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy (NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy (HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and long-term outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing

Perinatal hypoxia increases susceptibility to high-altitude polycythemia and attendant pulmonary vascular dysfunction

PubMed Central

Gonzales, Marcelino; Rodriguez, Armando; Bellido, Diva; Salmon, Carlos Salinas; Ladenburger, Anne; Reardon, Lindsay; Vargas, Enrique; Moore, Lorna G.

2015-01-01

Perinatal exposures exert a profound influence on physiological function, including developmental processes vital for efficient pulmonary gas transfer throughout the lifespan. We extend the concept of developmental programming to chronic mountain sickness (CMS), a debilitating syndrome marked by polycythemia, ventilatory impairment, and pulmonary hypertension that affects ∼10% of male high-altitude residents. We hypothesized that adverse perinatal oxygenation caused abnormalities of ventilatory and/or pulmonary vascular function that increased susceptibility to CMS in adulthood. Subjects were 67 male high-altitude (3,600–4,100 m) residents aged 18–25 yr with excessive erythrocytosis (EE, Hb concentration ≥18.3 g/dl), a preclinical form of CMS, and 66 controls identified from a community-based survey (n = 981). EE subjects not only had higher Hb concentrations and erythrocyte counts, but also lower alveolar ventilation, impaired pulmonary diffusion capacity, higher systolic pulmonary artery pressure, lower pulmonary artery acceleration time, and more frequent right ventricular hypertrophy, than controls. Compared with controls, EE subjects were more often born to mothers experiencing hypertensive complications of pregnancy and hypoxia during the perinatal period, with each increasing the risk of developing EE (odds ratio = 5.25, P = 0.05 and odds ratio = 6.44, P = 0.04, respectively) after other factors known to influence EE status were taken into account. Adverse perinatal oxygenation is associated with increased susceptibility to EE accompanied by modest abnormalities of the pulmonary circulation that are independent of increased blood viscosity. The association between perinatal hypoxia and EE may be due to disrupted alveolarization and microvascular development, leading to impaired gas exchange and/or pulmonary hypertension. PMID:26092986

Perinatal hypoxia increases susceptibility to high-altitude polycythemia and attendant pulmonary vascular dysfunction.

PubMed

Julian, Colleen Glyde; Gonzales, Marcelino; Rodriguez, Armando; Bellido, Diva; Salmon, Carlos Salinas; Ladenburger, Anne; Reardon, Lindsay; Vargas, Enrique; Moore, Lorna G

2015-08-15

Perinatal exposures exert a profound influence on physiological function, including developmental processes vital for efficient pulmonary gas transfer throughout the lifespan. We extend the concept of developmental programming to chronic mountain sickness (CMS), a debilitating syndrome marked by polycythemia, ventilatory impairment, and pulmonary hypertension that affects ∼10% of male high-altitude residents. We hypothesized that adverse perinatal oxygenation caused abnormalities of ventilatory and/or pulmonary vascular function that increased susceptibility to CMS in adulthood. Subjects were 67 male high-altitude (3,600-4,100 m) residents aged 18-25 yr with excessive erythrocytosis (EE, Hb concentration ≥18.3 g/dl), a preclinical form of CMS, and 66 controls identified from a community-based survey (n = 981). EE subjects not only had higher Hb concentrations and erythrocyte counts, but also lower alveolar ventilation, impaired pulmonary diffusion capacity, higher systolic pulmonary artery pressure, lower pulmonary artery acceleration time, and more frequent right ventricular hypertrophy, than controls. Compared with controls, EE subjects were more often born to mothers experiencing hypertensive complications of pregnancy and hypoxia during the perinatal period, with each increasing the risk of developing EE (odds ratio = 5.25, P = 0.05 and odds ratio = 6.44, P = 0.04, respectively) after other factors known to influence EE status were taken into account. Adverse perinatal oxygenation is associated with increased susceptibility to EE accompanied by modest abnormalities of the pulmonary circulation that are independent of increased blood viscosity. The association between perinatal hypoxia and EE may be due to disrupted alveolarization and microvascular development, leading to impaired gas exchange and/or pulmonary hypertension. Copyright © 2015 the American Physiological Society.

Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care.

PubMed

Miller, Margaret; Hearn, Lydia; van der Pligt, Paige; Wilcox, Jane; Campbell, Karen J

2014-01-01

Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.

The Polomeno Family Intervention Framework for Perinatal Education: Preparing Couples for the Transition to Parenthood

PubMed Central

Polomeno, Viola

2000-01-01

Couples face many challenges as they transform themselves from dyad to triad. For some couples, these challenges are life-enriching experiences, while for others, chaos ensues, potentially leading to separation and divorce. The transition to first-time parenthood, even for well-functioning couples, is fraught with potential disorganization. At the same time, it provides opportunities for simultaneous self-growth and conjugal enrichment. What role can perinatal educators play in preparing couples to deal with the changes associated with this transition? To answer this vital question, the author presents her conceptualization of perinatal education as a primary family intervention framework during the perinatal period. PMID:17273190

Raising multiples: mental health of mothers and fathers in early parenthood

PubMed Central

Battle, Cynthia L.; Tezanos, Katherine M.

2015-01-01

The rate of twin and higher-order gestation births has risen dramatically in recent decades in the United States as well as other Western countries. Although the obstetrical and neonatal risks of multiple gestation pregnancies are well-documented, much less is known regarding the mental health impact on parents of multiples during the perinatal and early parenthood period. Given that parents of multiples face greater functional demands, as well as other pressures (financial, medical) this population may be at risk for heightened distress. We conducted a systematic review of quantitative, English language studies that assessed mental health outcomes of parents of multiples during pregnancy, in the first postpartum year, and in the period of early parenthood, including depression, anxiety, stress, and related constructs. Twenty-seven articles published between 1989 and 2014 met selection criteria and were included in the review. Studies utilized a wide range of methods and outcome constructs, often making comparisons difficult. Although some studies found no differences, most investigations that compared mental health outcomes in parents of multiples versus parents of singletons found that parents of multiples experience heightened symptoms of depression, anxiety, and parenting stress. We discuss gaps in the existing body of literature on parental mental health related to multiple gestation birth and conclude by discussing the need for novel intervention strategies to meet the needs of this growing population. Parents of multiples may experience worse mental health outcomes than parents of singletons. More research is needed, and future work should explore potential treatment and support options. PMID:25515039

Perinatal Risks in “Late Motherhood” Defined Based On Parity and Preterm Birth Rate – an Analysis of the German Perinatal Survey (20th Communication)

PubMed Central

Schure, V.; Voigt, M.; Schild, R. L.; Hesse, V.; Carstensen, M.; Schneider, K. T. M.; Straube, S.

2012-01-01

Aim: “Late motherhood” is associated with greater perinatal risks but the term lacks precise definition. We present an approach to determine what “late motherhood” associated with “high risk” is, based on parity and preterm birth rate. Materials and Methods: Using data from the German Perinatal Survey of 1998–2000 we analysed preterm birth rates in women with zero, one, or two previous live births. We compared groups of “late” mothers (with high preterm birth rates) with “control” groups of younger women (with relatively low preterm birth rates). Data of 208 342 women were analysed. For women with zero (one; two) previous live births, the “control” group included women aged 22–26 (27–31; 29–33) years. Women in the “late motherhood” group were aged > 33 (> 35; > 38) years. Results: The “late motherhood” groups defined in this way were also at higher risk of adverse perinatal events other than preterm birth. For women with zero (one; two) previous live births, normal cephalic presentation occurred in 89 % (92.7 %; 93.3 %) in the “control” group, but only in 84.5 % (90 %; 90.4 %) in the “late motherhood” group. The mode of delivery was spontaneous or at most requiring manual help in 71.3 % (83.4 %; 85.8 %) in the “control” group, but only in 51.4 % (72.2 %; 76.4 %) in the “late motherhood” group. Five-minute APGAR scores were likewise worse for neonates of “late” mothers and the proportion with a birth weight ≤ 2499 g was greater. Conclusion: “Late motherhood” that is associated with greater perinatal risks can be defined based on parity and preterm birth rate. PMID:25253904

Trends in concurrent maternal and perinatal deaths at a teaching hospital in Ghana: the facts and prevention strategies.

PubMed

Lassey, Anyetei T; Obed, Sam A

2004-09-01

To determine the trend of concurrent maternal and perinatal mortality at the Korle-Bu Teaching Hospital (KBTH), Ghana, and to propose measures for its prevention. A retrospective study, from January 1995 to December 2002, of all concurrent maternal and perinatal deaths in which the woman was 28 weeks' gestation or more (or, if gestational age was not known, the baby weighed 1000 g or more) and died either undelivered or in the perinatal period (within 1 week of delivery) at the KBTH. Over the 8-year study period, there was a total of 93 622 deliveries at the KBTH with 108 concurrent maternal and perinatal mortalities, giving a ratio of 115.4 concurrent maternal and perinatal deaths per 100 000 deliveries. More than 80% of the mothers who died had little or no formal education. Of the 108 mothers, 22 died undelivered. The leading cause of death was a medical condition in pregnancy along with eclampsia/gestational hypertension. Of the 86 delivered mothers, the leading cause of concurrent death was a medical condition in pregnancy. Approximately two-thirds (72/108) of the perinatal deaths were stillbirths. Over the study period, there was a rising trend of the obstetric disaster of losing both mother and baby. There is a rising trend of concurrent maternal and perinatal mortality at the KBTH. It is suggested that a regular antenatal clinic be established with both an internist and obstetrician to jointly see and manage women with medical problems. There is a need for improved and adequate resources to improve outcomes for both mother and baby. A waiver of user fees for maternity services may be one way to improve access for needy and at-risk mothers. Concurrent maternal and perinatal death is the latest negative reproductive health index of the deteriorating socioeconomic situation in developing countries and needs to be tackled decisively.

Perinatal and paediatric post-mortem magnetic resonance imaging (PMMR): sequences and technique

PubMed Central

Norman, Wendy; Jawad, Noorulhuda; Jones, Rod; Taylor, Andrew M

2016-01-01

As post-mortem MRI (PMMR) becomes more widely used for investigation following perinatal and paediatric deaths, the best possible images should be acquired. In this article, we review the most widely used published PMMR sequences, together with outlining our acquisition protocol and sequence parameters for foetal, perinatal and paediatric PMMR. We give examples of both normal and abnormal appearances, so that the reader can understand the logic behind each acquisition step before interpretation, as a useful day-to-day reference guide to performing PMMR. PMID:26916282

Perinatal development of conjugative enzyme systems.

PubMed Central

Lucier, G W

1976-01-01

The problems and priorities involved in studying the role of conjugagive enzymes in developmental pharmacology are discussed and evaluated. The relative rates of UDP glucuronyltransferase and beta-glucuronidase were studied during perinatal development in hepatic and extrahepatic tissues to determine the net balance of glucuronidation or deglucuronidation at different developmental stages. In general, deglucuronidation predominated over glucuronidation in fetal tissues whereas the converse was evident in adults. 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD), an extremely toxic contaminant of some organochlorine compounds, was shown to be a potent inducer of some hepatic and extrahepatic drug-metabolizing enzymes. TCDD, administered during gestation, induced the postnatal activities of p-nitrophenol glucuronyltransferase and benzpyrene hydroxylase in rats. Foster mother experiments revealed that the postnatal induction was caused primarily by newborn exposure to TCDD in the mother's milk. Tissue distribution experiments with TCDD-14C confirmed these findings. Although TCDD induced non-steroid glucuronidation, no significant effects were evident on the postnatal development of steroid glucuronidation. The synthetic estrogen diethylstilbestrol (DES) is metabolized primarily by glucuronidation. The postnatal development of DES glucuronidation, like the steroid pathway, was not affected by gestational TCDD treatment. The fetal distribution of DES and DES-glucuronide, at different stages of development, correlated well with the perinatal development of steroid glucuronyltransferase activity. PMID:829487

Can facility delivery reduce the risk of intrapartum complications-related perinatal mortality? Findings from a cohort study.

PubMed

Khanam, Rasheda; Baqui, Abdullah H; Syed, Mamun Ibne Moin; Harrison, Meagan; Begum, Nazma; Quaiyum, Abdul; Saha, Samir K; Ahmed, Saifuddin

2018-06-01

Intrapartum complications increase the risk of perinatal deaths. However, population-based data from developing countries assessing the contribution of intrapartum complications to perinatal deaths is scarce. Using data from a cohort of pregnant women followed between 2011 and 2013 in Bangladesh, this study examined the rate and types of intrapartum complications, the association of intrapartum complications with perinatal mortality, and if facility delivery modified the risk of intrapartum-related perinatal deaths. Trained community health workers (CHWs) made two-monthly home visits to identify pregnant women, visited them twice during pregnancy and 10 times in the first two months postpartum. During prenatal visits, CHWs collected data on women's prior obstetric history, socio-demographic status, and complications during pregnancy. They collected data on intrapartum complications, delivery care, and pregnancy outcome during the first postnatal visit within 7 days of delivery. We examined the association of intrapartum complications and facility delivery with perinatal mortality by estimating odds ratios (OR) and 95% confidence intervals (CI) adjusting for covariates using multivariable logistic regression analysis. The overall facility delivery rate was low (3922/24 271; 16.2%). Any intrapartum complications among pregnant women were 20.9% (5,061/24,271) and perinatal mortality was 64.7 per 1000 birth. Compared to women who delivered at home, the risk of perinatal mortality was 2.4 times higher (OR = 2.40; 95% CI = 2.08-2.76) when delivered in a public health facility and 1.3 times higher (OR = 1.32, 95% CI = 1.06-1.64) when delivered in a private health facility. Compared to women who had no intrapartum complications and delivered at home, women with intrapartum complications who delivered at home had a substantially higher risk of perinatal mortality (OR = 3.45; 95% CI = 3.04-3.91). Compared to women with intrapartum complications who

Significado de psicólogas/os de atención primaria de salud sobre la intervención psicosocial de grupo en el tratamiento de la depresión en Chile.