A qualitative exploration of active ingredients and mechanisms of action of an online singing programme with mothers experiencing postnatal depression during the COVID-19 pandemic: SHAPER-PNDO study. (preprint)

Background Social distancing restrictions and the suspension of in-person treatment and support contributed to an increase in postnatal depression during the coronavirus disease 2019 (COVID-19) pandemic. Creative health interventions can help to alleviate anxiety and depression, with studies showing that singing is particularly effective for supporting the mental health of new mothers. We adapted an in-person group singing programme (Breathe Melodies for Mums (M4M)) to online delivery during the COVID-19 pandemic to support the mental health of new mothers, and, in a feasibility study, found improvements in postnatal depression (PND) symptoms at 6-month follow up. The current qualitative study aimed to explore how and why M4M-online impacted the mental health of those taking part.Methods We took a theory-based approach using the Ingredients in Arts in Health (INNATE) Framework of ‘active ingredients’ and the Multi-level Leisure Mechanisms Framework of ‘mechanisms of action’ to identify and categorise intervention components and change mechanisms. Iterative consensus building between three researchers were complemented by qualitative semi-structured online interviews with 24 women experiencing PND symptoms who took part in M4M-online. Data were analysed inductively using reflexive thematic analysis.Results Consistency was found between the online and in-person interventions in active ingredients relating to project design, content, programme management and the composition of the group. Key differences were in the social and contextual ingredients. Psychological, social and behavioural mechanisms for improved mental health and wellbeing included: 1) Increased self-confidence as a mother, 2) Increased positive emotional responses, 3) A supported change in identity, 4) Reduced loneliness and isolation, 5) Increased social bonding and connections with family and 6) Enhanced sense of time through new routines.Conclusions Participating in online group singing can support new mothers experiencing PND by triggering psychological, social and behavioural responses that lead to improved mental health. Key programme features are identified which can be used to design future online creative health interventions or tailor in-person activities for remote delivery to support populations who may face practical and social barriers to attending in-person.

Impact of COVID-19 pandemic on mental health during pregnancy and postpartum: A cross-sectional study (preprint)

Objective: - To determine the prevalence of peripartum depression (PPD) and anxiety during the COVID-19 pandemic, any differences between COVID-infected and non-infected mothers and its risk factors. Study design- Cross-sectional study. Setting- Tertiary care maternity hospital Population- Pregnant and postpartum women Methods- Questionnaire based direct interview. EPDS (Edinburgh postnatal depression scale) score, COVID-19 anxiety scale (CAS) was used. Outcome measures- Possible PPD (EPDS13), Probable PPD (EPDS14), Peripartum anxiety (EPDS anxiety sub score4), COVID-19 related anxiety and risk factors of PPD. Results- Out of 842 eligible subjects, 142 were confirmed COVID-19 positive and 670 patients were without the infection. The mean age was 25±3.9 years and 571 (67.8%) subjects were postpartum. Among the subjects, 383 (45.5%) had possible depression, 317 (37.6%) had probable depression. Peripartum anxiety was observed among 763(90.6%) subjects and the median CAS score was 15(8-28). While there was no significant difference in the prevalence of PPD, peripartum anxiety was higher among COVID non-infected subjects (91.6% vs 86.6%, p=0.04). The CAS score was higher among COVID-19 infected compared to the non-infected [17(10-28) vs 15(8-25), p=0.00]. In multivariate analysis, history of psychiatric illness [OR- 4.2(95% CI- 1.82-9.93), p=0.001], domestic violence [OR-2.4(95% CI-1.16-5.10), p=0.019] and past obstetric complications [OR-1.5(95%CI-1.01-2.27), p=0.042] were significant risk factors for PPD. Conclusion- High prevalence of PPD was observed during COVID-19 pandemic without any significant difference between COVID-19 infected and non-infected subjects. COVID-19 infected patients had higher COVID related anxiety. Funding- None taken Keywords- peripartum depression; EPDS; COVID-19 anxiety scale.

Maternal antibiotic exposure and the risk of developing antenatal or postpartum depression: The Maternal Experience Study protocol (preprint)

Background Limited epidemiological evidence suggests a link between antibiotic use and the development of depression. This study seeks to investigate this association in-depth, using a cohort of pregnant individuals. The primary aim is to explore any association between antibiotic use during pregnancy, delivery, and within 12 months postpartum, and the development of antenatal and/or postpartum depression. Methods A national prospective, observational, longitudinal cohort study has been designed to examine the relationship between the use of antibiotics during pregnancy and the development of antenatal depression up to the third trimester (32-42 weeks), as well as the use of antibiotics during pregnancy and within 12 months postpartum and the development of depression during the postpartum period. The development of depression is considered as either a diagnosis by a medical doctor and/or a scoring 13 or higher on the Edinburgh Postnatal Depression Scale. Data will be collected using online surveys, during the third trimester, and at 6 weeks, 6 months, and 12 months postpartum. These surveys include a wide range of variables previously identified as being associated with antenatal and postpartum depression (such as level of social support, history of depression, and intimate partner abuse), as well as antibiotic and probiotic use. The impact of the COVID-19 pandemic on both participants’ pregnancy experience and their mental health will also be explored. Recruitment began in August 2021, using a combination of online paid and unpaid advertisements, as well as distribution of the study flyer in relevant clinics and public spaces. It is anticipated that data collection will be completed in early 2024. Discussion This study will provide a much-needed update on the prevalence of depression during pregnancy and postpartum, and its associated factors. It will also, for the first time, comprehensively explore the potential association between antibiotic use during pregnancy and up to 12 months postpartum and the development of depression. Additionally, it will provide a better understanding of the mental health impacts of the COVID-19 pandemic on pregnant individuals in Australia.

The impact of postpartum social support on postpartum mental health outcomes during the COVID-19 pandemic.

Social support is an influential component of postpartum recovery, adjustment, and bonding, which was disrupted by social distancing recommendations related to the COVID-19 pandemic. This study reports on changes in the availability of social support for postpartum women during the pandemic, investigates how those changes may have contributed to postpartum mental health, and probes how specific types of social support buffered against poor postpartum mental health and maternal-infant bonding impairment. Participants were 833 pregnant patients receiving prenatal care in an urban USA setting and using an electronic patient portal to access self-report surveys at two time points, during pregnancy (April-July 2020) and at ~12 weeks postpartum (August 2020-March 2021). Measures included an assessment of COVID-19 pandemic-related change in social support, sources of social support, ratings of emotional and practical support, and postpartum outcomes including depression, anxiety, and maternal-infant bonding. Overall self-reported social support decreased during the pandemic. Decreased social support was associated with an increased risk of postpartum depression, postpartum anxiety, and impaired parent-infant bonding. Among women reporting low practical support, emotional support appeared to protect against clinically significant depressive symptoms and impaired bonding with the infant. Decreases in social support are associated with a risk for poor postpartum mental health outcomes and impaired maternal-infant bonding. Evaluation and promotion of social support are recommended for healthy adjustment and functioning of postpartum women and families.

Impact of covid-19 pandemic over depressive symptoms among mothers from a population-based birth cohort in southern brazil.

PURPOSE: Our aim was to assess the impact of COVID-19 on depressive symptoms among mothers from a population-based birth cohort in Pelotas, Southern Brazil. METHODS: A subgroup of mothers from the Pelotas 2004 Birth Cohort was assessed pre-pandemic (November,2019 to March,2020) and mid-pandemic (August-December,2021). In both follow-ups, depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Pre-pandemic (T1) and pandemic-related predictors (T2) were analyzed. Prevalence of depression (EPDS score ≥ 13) at T1 and T2 were compared with chi-square test. Changes in EPDS from T1 to T2 were estimated by multivariate latent change score modelling. RESULTS: 1,550 women were assessed. Prevalence of depression increased 38.1% (from 18.9% at T1 to 26.1% at T2) (p < 0.001). At T1, higher schooling, higher family income and being employed or working were related to lower EPDS, whereas being beneficiary of a cash transfer program and a larger number of people living in the household predicted higher EPDS. The deterioration of ones' own perception of quality of overall health (ß = 0.191; SE = 0.028; p < 0.001) and worst family financial situation due to the pandemic (ß = 0.083; SE = 0.024; p = 0.001) predicted the increase in EPDS from T1 to T2. CONCLUSION: Almost two years after the beginning of the pandemic, the prevalence of depressive symptoms among the women was higher than before the pandemic. The deterioration of ones' own perception of quality of overall health and worst family financial situation due to the pandemic are proxies for the effect of COVID-19 pandemic (the true exposure of interest) in the women mental health.

The socio-demographic profile associated with perinatal depression during the COVID-19 era.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has caused an increase in perinatal depression. The aim of this research was to identify which sociodemographic variables are related to the increase in perinatal depression due to the pandemic. In addition to estimating to what extent they predict perinatal depression, differentiating the prenatal and postnatal periods. METHODS: The sample consisted of 3,356 subjects, 1,402 in the prenatal period and 1,954 in the postnatal period. The Edinburgh Postnatal Depression Scale was used to assess depressive symptomatology. A subset of 14 questions was included to collect demographic data. Items from the Spanish version of the Coronavirus Perinatal Experiences Survey were also included. RESULTS: Experiencing the change of environment due to COVID-19 as negative and having a history of mental health predict perinatal depression, otherwise having higher education decreases the risk. In the prenatal stage having symptoms compatible with COVID-19 is a predictor of perinatal depression and having more than 3 years living together with the partner and being a housewife decreases the risk. In the postnatal stage being unemployed is a predictor of prenatal depression and being a first-time mother decreases the risk. CONCLUSIONS: This study highlights the relevance of sociodemographic status. It is essential to be aware of the risk factors of perinatal depression, to make adequate prevention, and to create health policies to alleviate the consequences of the pandemic.

Impact of a postpartum care rehabilitation program to prevent postpartum depression at a secondary municipal hospital in Qingdao China: a cross-sectional study.

BACKGROUND: The emerging postpartum rehabilitation (PPR) program in Chinese hospitals characterized by applying ongoing medical care through traditional cultural practices shows a protective effect in early puerperium in China. This study explores the benefit of PPR program practices to postpartum depression (PPD) and the influencing factors for PPD among Chinese women during the first postnatal six weeks. METHODS: The cross-sectional study included 403 participants and was conducted in a Secondary Municipal Hospital in Qingdao, China, from 01 to 2018 to 31 December 2021. Information on this PPR program was collected during the six-weeks postpartum consultation, including the Edinburgh postnatal depression scale (EPDS) scores, the measurement results for diastasis recti abdominis, and the international physical activity questionnaire (long form) (IPAQ-L) scores. Logistic regression models were used to examine the effect of the PPR program on PPD among the local population. The secondary aim of this study was to investigate possible influencing factors for PPD, such as coronavirus disease 2019 (COVID-19), physical exercises, etc. RESULTS: PPR program has shown a positive effect in preventing PPD (p < 0.001) and diastasis recti prevalence (p < 0.001) during the six-weeks postnatal control in Qingdao, China. Better post-pregnancy weight reduction (p = 0.04) and higher metabolic equivalent of task (MET) value (p < 0.001) were noticed in the non-PPR group. Furthermore, lower PPD risk was associated with factors such as longer relationship duration years (2-5 years) (p = 0.04) and exercising one to three times a week (p = 0.01). A higher PPD risk was related to factors such as urinary incontinence during the postpartum period (p = 0.04) and subjective insomnia (p < 0.001). No significant effect was shown between COVID-19 and the EPDS score in this study (p = 0.50). CONCLUSION: Our results suggested that the PPR program provided protection against PPD and diastasis recti during the first six weeks after delivery. Urinary incontinence and subjective insomnia were the main risk factors for PPD, while longer relationship duration years and exercising one to three times a week gave protective effects to PPD. This study emphasized that a comprehensive ongoing medical care program, such as the PPR program, effectively improves women's mental and physical health in the early postpartum in China.

Postpartum Depressive Symptoms and Experiences During COVID-19.

PURPOSE: To identify postpartum depression risk and describe experiences of women in the first 6 weeks after giving birth during the COVID-19 pandemic. STUDY DESIGN AND METHODS: Using a convergent mixed-methods approach, we recruited a convenience sample of women living in the United States who gave birth March 1, 2020 or later from social media Web sites. Participants completed the Postpartum Depression Screening Scale-Short Form and provided written answers to open-ended questions regarding their experiences at home with their new infant. RESULTS: Our 262 participants were on average 32.6 years of age, the majority were White (82%), married or partnered (91.9%), and college educated (87.4%). Mean postpartum depression score was 17.7 (SD = 5.9) with 75% scoring ≥14, indicating significant postpartum depressive symptoms. Qualitative content analysis revealed five themes: Isolation and seclusion continue; Fear, anxiety, and stress filled the days; Grieving the loss of normal: It's just so sad; Complicated by postpartum depression: A dark time; and There is a silver lining. Quantitative and qualitative findings provided a holistic view of women's depressive symptoms and experiences at home with their infants during the COVID-19 pandemic. CLINICAL IMPLICATIONS: Although policies that reduce risk of COVID-19 exposure and infection for patients and the health care team must continue to be implemented, the adverse effects of depressive symptoms on maternal-infant wellbeing within the context of increased isolation due to the pandemic need to be kept at the forefront. Nurses need to be aware of the consequences of women sheltering in place and social distancing on maternal-infant outcomes, particularly on depression and likelihood of breastfeeding.

The effectiveness of an internet-based support program on maternal self-efficacy, postpartum depression and social support for primiparous women during the COVID-19 pandemic: Randomized controlled trial.

Background: Many primiparous women usually encounter various parenting and mental health issues after childbirth. The effects of intervention based on internet platform on parenting and mental health outcomes for Chinese first-time mothers remain unknown during the COVID-19 pandemic. Therefore, our research aimed to evaluate the effectiveness of an internet-based support program (ISP) on maternal self-efficacy (MSE), postpartum depression (PPD) and social support for primiparous women amid the pandemic. Methods: A multicenter randomized controlled trial (RCT) was conducted. From May 2020 to March 2021, 242 primiparous women were recruited in the maternity wards of two hospitals in Shenzhen City, China and randomly assigned to the intervention group and the control group. Women in control group (n = 118) received the routine postpartum care, and women in intervention group (n = 118) accessed to the ISP intervention (expert education and peer support) and routine postpartum care. Intervention outcomes were measured at baseline before randomization (T0), post-intervention (T1), and three-month follow up (T2) through questionnaires. The chi-square (χ2), the independent sample t-test and the repeated measures multivariate analysis of covariance were performed, and the two-tailed p-value <0.05 was regarded as statistically significant. Results: In comparison with women in the control group, women in the intervention group had a significantly higher score of MSE at T1 (mean: 73.53, standard deviation [SD]: 6.21) and at T2 (mean: 72.90, SD: 6.73); and a lower score of PPD at T1(mean: 6.03, SD: 2.50) and T2 (mean: 5.70, SD: 2.23); and a higher score of social support at T1 (mean: 45.70, SD: 3.73), but no significant difference at T2 (mean: 42.90, SD: 3.29). Conclusions: The effect of ISP was evaluated to significantly increase the levels of MSE, social support, and to alleviate PPD symptoms for Chinese first-time mothers. As an effective and easily accessible intervention, ISP could become a significant source for health professionals to support primiparous women on parenting and mental health during the COVID-19 pandemic. Trial registration: The trial is registered at the Chinese Clinical Trials Registry (ChiCTR2000033154).

Study characteristical and regional influences on postpartum depression before vs. during the COVID-19 pandemic: A systematic review and meta-analysis.

Background: While the public is under serious pressure from the coronavirus disease 2019 (COVID-19), the final impact and possible contributing factors to postpartum depression symptoms (PPDS) remain unknown. Therefore, a meta-analysis to investigate the association between PPDS and the COVID-19 pandemic was carried out by comparing the data between pre-pandemic and post-pandemic timeframes and exploring the influencing factors. Methods: This systematic review was prospectively registered and recorded in a study protocol (Prospero CRD42022336820, http://www.crd.york.ac.uk/PROSPERO). A comprehensive search of PubMed, Embase, Web of Science, CINALH, Cochrane and Scopus was cmpleted on June 6, 2022. Studies that compared the prevalence of PPD before and during the COVID-19 pandemic period were included. Results: Of 1766 citations identified, 22 studies were included with 15,098 participates before the COVID-19 pandemic and 11,836 participants during the COVID-19 pandemic. Overall, the analysis showed that the epidemic crisis was associated with an increased prevalence of PPDS (OR: 0.81 [0.68, 0.95], P = 0.009, I 2 = 59%). Subgroup analysis was conducted according to the study characteristics and regions. Within the study characteristics classification, results showed an obvious increase in the prevalence of PPDS during the COVID-19 pandemic if PPDS cutoff was defined as Edinburgh postpartum depression score (EPDS) ≥13 points (OR: 0.72 [0.52, 0.98], P = 0.03, I 2 = 67%) and an increased prevalence in follow-ups that happened after 2 weeks (≥ 2 weeks postpartum) (OR: 0.81 [0.68, 0.97], P = 0.02, I 2 = 43%). Selected studies that were high-quality (OR: 0.79 [0.64, 0.97], P = 0.02, I 2 = 56%) demonstrated an increased prevalence of PPDS during the COVID-19 pandemic period. Sorting by regional factors, studies conducted in Asia (OR: 0.81 [0.70, 0.93], P = 0.003, I 2 = 0%) showed an increase of PPDS prevalence rates during the COVID-19 period, while studies conducted in Europe (OR: 0.82 [0.59, 1.13], P = 0.23, I 2 = 71%) and North America (OR: 0.66 [0.42, 1.02], P = 0.06, I 2 = 65%) showed no significant difference. All studies conducted in the developed (OR: 0.79 [0.64, 0.98], P = 0.03, I 2 = 65%) and developing countries (OR: 0.81 [0.69, 0.94], P = 0.007, I 2 = 0%) showed an increase of PPDS during the COVID-19 period. Conclusions: The COVID-19 pandemic is associated with an increased prevalence of PPDS, especially after long-term follow-up and among the group with a high possibility of depression. The negative influence from the pandemic, causing more PPDS was significant in studies from Asia.

Association of disrespectful care after childbirth and COVID-19 exposure with postpartum depression symptoms- a longitudinal cohort study in Nepal.

BACKGROUND: The COVID-19 pandemic has led to unprecedented mental stress to women after childbirth. In this study, we assessed the association of disrespectful care after childbirth and COVID-19 exposure before/during labour with postpartum depression symptoms assessed at 7 and 45 days in Nepal. METHODS: A longitudinal cohort study was conducted in 9 hospitals of Nepal among 898 women. The independent data collection system was established in each hospital to collection information on disrespectful care after birth via observation, exposure to COVID-19 infection before/during labour and other socio-demographic via interview. The information on depressive symptoms at 7 and 45 days was collected using the validated Edinburg Postnatal Depression Scale (EPDS) tool. Multi-level regression was performed to assess the association of disrespectful care after birth and COVID-19 exposure with postpartum depression. RESULT: In the study, 16.5% were exposed to COVID-19 before/during labour and 41.8% of them received disrespectful care after childbirth. At 7 and 45 days postpartum, 21.3% and 22.4% of women reported depressive symptoms respectively. In the multi-level analysis, at the 7th postpartum day, women who had disrespectful care and no COVID-19 exposure still had 1.78 higher odds of having depressive symptom (aOR, 1.78; 95% CI; 1.16, 2.72). In the multi-level analysis, at 45th postpartum day, women who had disrespectful care and no COVID-19 exposure had 1.37 higher odds of having depressive symptoms (aOR, 1.37; 95% CI; 0.82, 2.30), but not statistically significant. CONCLUSION: Disrespectful care after childbirth was strongly associated with postpartum depression symptoms irrespective of COVID-19 exposure during pregnancy. Caregivers, even during the global pandemic, should continue to focus their attention for immediate breast feeding and skin-to-skin contact, as this might reduce the risk for depressive symptoms postpartum.

Depression, anxiety, and stress in pregnancy and postpartum: A longitudinal study during the COVID-19 pandemic.

INTRODUCTION: Symptoms of depression, anxiety, and stress in pregnant women are generally highest in the first trimester and then decrease throughout pregnancy, reaching their lowest point in the postpartum period. Pregnant women are a high-risk population for mortality and mental health symptoms due to COVID-19. However, the extent to which the chronic stress of the COVID-19 pandemic alters the trajectory of depression, anxiety and stress symptoms in pregnant/postpartum women is unknown. METHODS: Women (N=127) who were pregnant or who had given birth less than one month prior were recruited via online advertising during the COVID-19 pandemic. Participants were assessed up to three times during the pregnancy and at 1-month postpartum for depression (Edinburgh Postnatal Depression Scale), anxiety, and stress (Depression, Anxiety, and Stress Scale-21). Random intercepts models examined symptom change over time as well as predictors of elevated postpartum psychopathology. RESULTS: On average, women completed their surveys at 8.5 weeks (first trimester), 21 weeks (second trimester), 32 weeks (third trimester) and 7-weeks postpartum. Women reported mild-moderate levels of depression, anxiety, and stress throughout pregnancy. There was a significant change in symptoms of depression and anxiety over time which was best represented by a quadratic rather than linear trajectory: symptoms increased until week 23-25 and then decreased. Stress levels remained consistently elevated over time. Higher symptom levels at 1-month postpartum were predicted by younger age, lower social support, and worry about going to a healthcare facility. Change in routine due to COVID-19 was not predictive of symptom trajectory from pregnancy to postpartum. CONCLUSIONS: During COVID-19, symptoms of depression and anxiety increased from early to mid-pregnancy but then declined slightly while stress levels remained elevated. Observed reductions in symptoms were small. Given the substantial persistent impact of perinatal distress and poor mental health on maternal and fetal health, providers should be aware of heightened levels of these symptoms in pregnant women during large-scale external health stressors such as COVID-19, and should implement screening procedures to identify and appropriately intervene with at-risk women.

Factors associated with postpartum depression symptoms among postpartum women in five countries during the COVID-19 pandemic: an online cross-sectional study.

BACKGROUND: This study aimed to examine factors associated with postpartum depression (PPD) symptoms during the COVID-19 pandemic among postpartum women in five countries, a subject that has not been investigated thus far. METHODS: A multi-country, cross-sectional, online survey was conducted with a convenience sample of 3,523 postpartum women in Brazil, South Korea, Taiwan, Thailand, and the United Kingdom, from July to November 2021. Sociodemographic and obstetric data, food insecurity, COVID-19 positive status, COVID-19 vaccination, infant feeding, breastfeeding belief score, and social support were investigated. PPD and social support were measured using the Edinburgh Postnatal Depression Scale and Maternal Social Support Scale, respectively. Descriptive statistics, chi-squared tests, and t-tests were used to identify associations with PPD symptoms. A binary logistic regression model was used to identify explanatory factors associated with PPD and adjusted odds ratios (OR) and 95% confidence intervals (CIs) were calculated. RESULTS: Women in Taiwan (AOR = 0.5; 95%CI 0.34, 0.73) and Thailand (AOR = 0.68; 95%CI 0.46, 0.99) had a lower risk of PPD symptoms than those in Brazil. In addition, women with planned pregnancies had a lower risk of PPD (AOR = 0.74; 95%CI 0.60, 0.91). Younger women (AOR = 1.62; 95%CI 1.05, 2.51), health problems during pregnancy, delivery, or postpartum (AOR = 1.71; 95%CI 1.42, 2.06), and no change or worse food insecurity during COVID-19 (AOR = 1.66; 95%CI 1.21, 1.27 for no change and AOR = 1.68; 95%CI 1.27, 1.23, respectively) presented a higher likelihood of having PPD. Feeding babies with expressed human milk (AOR = 1.25; 95%CI 1.03, 1.50) and/or complementary food (AOR = 1.51; 95%CI 1.17, 1.94) were associated with PPD symptoms. Women who received low (AOR = 7.74; 95%CI 5.43, 11.03) or medium support (AOR = 3.25; 95%CI 2.71, 3.88) had higher likelihoods of PPD. CONCLUSION: PPD symptoms during the pandemic were high in young women, particularly Brazilian women, with health problems in the puerperal pregnancy cycle who fed their babies expressed breast milk and/or complementary food. Low social support also impacted PPD symptoms. This study highlights the need for the professional screening for PPD and provision of virtual or personal support.

A cross-country study on the impact of governmental responses to the COVID-19 pandemic on perinatal mental health.

This study aimed to analyse the role of governmental responses to the coronavirus disease 2019 (COVID-19) outbreak, measured by the Containment and Health Index (CHI), on symptoms of anxiety and depression during pregnancy and postpartum, while considering the countries' Inequality-adjusted Human Development Index (IHDI) and individual factors such as age, gravidity, and exposure to COVID-19. A cross-sectional study using baseline data from the Riseup-PPD-COVID-19 observational prospective international study (ClinicalTrials.gov: NCT04595123) was carried out between June and October 2020 in 12 countries (Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom). Participants were 7645 pregnant women or mothers in the postpartum period-with an infant aged up to 6 months-who completed the Edinburgh Postnatal Depression Scale (EPDS) or the Generalised Anxiety Disorder Assessment (GAD-7) during pregnancy or the postpartum period. The overall prevalence of clinically significant depression symptoms (EPDS ≥ 13) was 30%, ranging from 20,5% in Cyprus to 44,3% in Brazil. The prevalence of clinically significant anxiety symptoms (GAD-7 ≥ 10) was 23,6% (ranging from 14,2% in Israel and Turkey to 39,5% in Brazil). Higher symptoms of anxiety or depression were observed in multigravida exposed to COVID-19 or living in countries with a higher number of deaths due to COVID-19. Furthermore, multigravida from countries with lower IHDI or CHI had higher symptoms of anxiety and depression. Perinatal mental health is context-dependent, with women from more disadvantaged countries at higher risk for poor mental health. Implementing more restrictive measures seems to be a protective factor for mental health, at least in the initial phase of the COVID-19.

Web-based treatment for depression in pregnancy: a feasibility study of Mum2BMoodBooster.

BACKGROUND: Depression in pregnancy is prevalent, under-treated, and has serious impacts on the wellbeing of women and on child development. Internet programs can reach women who may not access traditional treatments due to distance, stigma or concern about taking medication. We adapted our online postnatal depression program, MumMoodBooster, for antenatal use. We aimed to trial feasibility, acceptability, and potential efficacy of the new Mum2BMoodBooster intervention with depressed pregnant women. METHODS: Twenty-seven pregnant women with Edinburgh Postnatal Depression Scale score > 11 used the program in a feasibility trial. Twenty-one had current diagnoses of major or minor depression on the Structured Clinical Interview for the DSM-IV. Assessment of symptoms occurred at screening/baseline, post-test (8 weeks post-enrollment), and at follow-up (3 months postpartum) using the Patient Health Questionnaire (PHQ-9) and the Depression Anxiety Stress Scales (DASS-21). RESULTS: In this feasibility trial, depression scores on both the PHQ-9 and the DASS-21, showed significant reductions representing large effects, with average symptom scores reduced by > 50%, and maintained in the 'minimal or no depression' range at 3 month follow-up. Anxiety scores also decreased significantly. Program usage was high with 74% of women visiting all six sessions. Program acceptability ratings were moderate to high. CONCLUSIONS: Findings paralleled the magnitude of symptom reductions seen in randomised trials of the postnatal MumMoodBooster program, suggesting that Mum2BMoodBooster is an effective treatment for depressed pregnant women. Effective internet therapies are likely to become increasingly important as the COVID-19 pandemic continues to make face-to-face access to health care problematic during 'lockdowns'.

Developmental Impairment in Children Exposed to Sars-Cov-2 in Utero: A Brazilian Cohort Study. (preprint)

Background The effects of in-utero exposure to maternal SARS-CoV-2 infection on the offspring's neurodevelopment are still unknown.Methods We performed a prospective cohort of babies exposed to SARS-Cov-2 during pregnancy, and a control group of unexposed babies in a low-income area in Northeastern Brazil. All data were prospectively collected from medical records. Children’s neurodevelopment was assessed using the guide for Monitoring Child Development in the IMCI context and the Ages & Stages Questionnaire (ASQ-3), at ages 4, 6, and 12 months. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS).Results We followed 127 children for one year, 69 children in the COVID-19 exposed Group (EG), and 68 in the control group (CG). All mothers were unvaccinated at the time included in the cohort. Maternal demographics were similar in the two groups, but prematurity was more prevalent in mothers infected with COVID-19 (21.7% vs. 8.8%, p = .036) and EPDS scores were also significantly higher among the EG (M = 11.00, SD = 6.00 vs. M = 8.68, SD = 4.72, p = 0.04). Both groups had similar rates of cesarean delivery, Apgar scores, average birth weight, head circumference and length at birth. 20.3% of EG children and 5.9% of the CG received a diagnosis of neurodevelopmental delay within 12 months of life (p = 0.013, RR = 3.44; 95% CI, 1.19–9.95). 10% of EG children presented abnormalities at the cranial ultrasound.Conclusions COVID-19 exposure was associated with neurodevelopmental impairment. This study highlights the importance of specific guidelines in the follow-up of children exposed to in-utero SARS-CoV-2 in order to mitigate or prevent long-term effects on children’s health.

Parental Postnatal Depression in the Time of the COVID-19 Pandemic: A Systematic Review of Its Effects on the Parent-Child Relationship and the Child's Developmental Outcomes.

The international literature has shown that maternal and paternal postnatal depression (PND) is one of the most common mental illnesses in the perinatal period, with significant consequences for parent-infant relationships and infant development. The COVID-19 pandemic has increased the rates of prevalence of PND, exacerbating the mental health risk for new families. This systematic review aims to examine the effect of maternal and paternal PND on parent-infant relationships and children's development in the first 36 months after childbirth during the COVID-19 outbreak. Eligible studies were identified using the following databases: Medline, CINAHL, SCOPUS, PsycINFO, PsycARTICLES, ScienceDirect, and Web of Science. Of the 1252 studies considered, 10 studies met the inclusion criteria. Results showed that maternal PND significantly affected the quality of the early mother-infant relationship and the infant's motor, self-regulation, and socio-emotional development. In addition, the detrimental impact of maternal PND on the quality of early mother-infant relationships seems to become stronger as COVID-19 concerns increase. No studies included fathers. These findings strengthened the importance of planning targeted prevention and treatment strategies to prevent PND and its short- and long-term consequences, especially in the case of stressful and traumatic events. They also suggested the urgent need for further exploration of fathers.

Mental Health Conditions in the Postpartum Period: A Scoping Study (preprint)

Background Many women experience mental health disorders during the postpartum period, which can develop into chronic or recurrent conditions and might have negative consequences on the quality of parent-infant interactions, long-term mental health of the mother, the family, as well as child development. We aimed to Summarize the current literature on mental health disorders during the postpartum period; from 2 to 52 weeks after childbirth.Methods In this scoping study electronic databases were systematically searched for primary studies published in English between January 2016 and December 2022, and we performed an additional quality appraisal. Descriptive statistics for quantitative data and inductive content analysis for qualitative data were used.Results The final body of literature consisted of 34 articles. Three key categories were identified and used to summarize the literature: mental health screening instruments, postpartum mental health conditions, and associated factors with postpartum mental health. Seventeen different screenings instruments were identified, whereof the Edinburgh Postnatal Depression Scale (EPDS) was the most used. The periods during which the participant’s mental health screening evaluation was conducted varied from four to 52 weeks postpartum, and both single and multiple mental health screenings were common. Six mental health conditions were covered, whereof postpartum depression and postpartum anxiety were the most common. Family and partner support were identified as critical factors associated with development of postpartum menatal health conditions, as well as a history of previous mental health- or medical disorders prior to peripartum. Furhermore, the COVID-19 pandemic had impact on social support, resulting in increased levels of anxiety and depression symptoms, as well as postpartum anxiety.Conclusion Offering a spectrum of support services and care should be made available to all relevant subgroups of mothers throughout pregnancy and up to one year after birth, especially for mothers with pre-existing mental health conditions. Future studies are needed on postpartum psychosis, the effect of long-term postpartum mental health conditions on the child’s well-being, and the fathers’ mental health requires further attention.

The Power and Promise of Postpartum Self Care: Evaluation of a Web-Based Tool for Underserved Women.

OBJECTIVES: Joyuus is a culturally diverse, comprehensive online tool designed to address the self-care needs of underserved postpartum women. The tool provides actionable self-care information, knowledge, and skills to improve postpartum health and identifies red flags for when self-care shifts to seeking care. METHODS: We employed a mixed-methods multiphase design to evaluate the Joyuus prototype, including a pre-post evaluation (N = 87) to assess behavioral health outcomes before and after using the tool for a one-month period. 91% completed the post-test (N = 79). The analysis focused on estimation of treatment effect (via 95% confidence intervals) and fitness of instruments in this population. RESULTS: Participants were between 6 months pregnant and one year postpartum, a mean age of 30 years, 100% female, 99% Black, with nearly equal distribution of married (55%) and not married (44%), and above (47%) and below (46%) annual income of $60 K. Key measures saw significant improvement from pre- (mean = 26.44, SD = 5.39) to post (mean = 28.29, SD = 5.26) on the Connor-Davidson Resilience Scale (p < 0.001) Trends toward improvement (not statistically significant) were noted for Depression (EPDS) (p = 0.624) and Anxiety (STAI) (p = 0.286), and no meaningful change on MOS Social Support or COVID-19 Mental Health Impacts Measures. CONCLUSIONS FOR PRACTICE: This pilot study demonstrates that a self-care mobile tool has the potential to address significant health outcomes related to maternal morbidity and mortality. By providing a continuously available companion addressing physical, mental, and real-life questions, it creates value during postpartum for mothers who can often feel overwhelmed or isolated.

Scoping review into models of interconception care delivered at well-child visits for the Australian context.

BACKGROUND: The interconception period provides an opportunity to address women's health risks and optimise birth spacing before the next pregnancy. This scoping review aimed to identify models of interconception care (ICC) delivered at well-child visits (WCVs) around the world, review the impacts of ICC delivered, and what the feasibility and applicability of these models were. METHODS: The global review included clinical studies that that were identified using medical subject headings (MeSH) and keyword combinations. Studies were included if they met the criteria: were clinical studies; examined a model of ICC; were conducted by a registered health professional; and examined women who had given birth within the last 24-months. The following databases were searched: Medline (OVID); CINAHL (EBSCO); PubMed; and Embase (OVID). Relevant studies were screened in Covidence and the data was then extracted using a narrative analysis. RESULTS: Fifteen studies met the inclusion criteria. The benefits of ICC delivered at WCVs included screening for maternal health behaviours and conditions and increase women's uptake of interventions. The studies identified that implementing ICC at WCVs was acceptable to women. Identified challenges included lack of time for health providers, lack of education among women and health providers, and limited funding for WCVs. CONCLUSION: ICC interventions found in this review included family planning counselling and provision of long-acting contraception; health promotion of folic acid; and postpartum depression screening. The research concluded that ICC delivered at WCVs contributes to improving health behaviours for future pregnancies. Increased capacity for this care at WCVs could be achieved with targeted resources and time allocation.