Anxiety and Depression among Pregnant Women and Mothers of Children Under one Year in Sindupalchowk District.

BACKGROUND: Common mental disorders such as anxiety and depression among mothers of young children and expectants can silently deteriorate the health of the mother with significant impact on the newborn. The primary aims were to determine the proportion of pregnant women and mothers of children under one year with anxiety and depression and their associated factors in Sindhupalchowk. METHODS: We used the Hopkins Symptom Checklist 25 and a structured questionnaire in a cross-sectional study to collect information from 778 women (164 pregnant women, 614 mothers of children under one year) selected through multi-stage sampling. RESULTS: Among pregnant women, the study found that 21.3%(95%CI:15.7-28.3) had anxiety and 23.8% (95%CI:17.8-31.0) had depression. Being from the Dalit ethnic group was independently associated with anxiety and depression. Among mothers of children under one year, 18.7% (95%CI:15.7-22.1) had anxiety and 15.2% (95%CI:12.4-18.4) had depression. Among these women, low education level; primary source of family income being agriculture, animal husbandry or labour; history of unplanned pregnancy; and use of tobacco were independently associated with anxiety and history of unplanned pregnancy and use of tobacco were independently associated with depression. CONCLUSIONS: A substantial proportion of women had anxiety and depression with higher odds of anxiety and depression in certain group of women. Targeted health system interventions are needed for improving the psychological well being of women, including pregnant women, as well as newborn health and wellbeing.

Variables predicting low infant developmental scores: maternal age above 30 years is a main predictor.

AIM: To explore variables predicting low developmental scores in 6-month-old infants in a population-based study. METHODS: In a longitudinal study representative of pregnant women in Oslo, Norway, questionnaires were answered at 17 and 30 weeks of pregnancy and 6 months after term; N = 1053 after exclusions (women with non-Scandinavian ethnicity, twin births, infants <5.0 or >7.0 months corrected age, and birth weight <2.5 kg), and data were collected from the Norwegian Birth Registry. Measures included sociodemographic variables, maternal mental health and pregnancy life style, data concerning the birth/newborn, and the Ages and Stages Questionnaires (ASQ) for 6-month-olds. Logistic regression analyses were used to identify variables predicting an ASQ score ≤ 15 th percentile. RESULTS: In adjusted analyses, only increasing maternal age and infant having older siblings predicted a low score on ASQ Total. These variables also predicted low scores on several ASQ areas (i.e. Communication, Gross motor, Fine motor, Problem-solving and Personal social), together with maternal major lifetime depression and feeling lonely. Protective variables were increasing infant birth weight (Gross motor) and pregnancy smoking (Communication). Other maternal sociodemographic variables, and infant sex, had no predictive power. Already at a maternal age of 31, the mean age of the pregnant women, the possibility of a low infant score increased significantly. CONCLUSIONS: In this population-based study, higher maternal age, having older siblings, and a history of maternal major lifetime depression, mainly predicts low developmental scores in 6-month-old infants.

Early fetal binge alcohol exposure predicts high behavioral symptom scores in 5.5-year-old children.

BACKGROUND: Fetal binge alcohol exposure has been associated with neurobehavioral and cognitive symptoms. This study explored whether binge drinking mainly before recognition of pregnancy predicted high symptom scores on the Strengths and Difficulties Questionnaire (SDQ) in 5.5-year-old children. METHODS: In a population-based, longitudinal study representative of pregnant women in Oslo, Norway, questionnaires were answered at 17 and 30 weeks of pregnancy, 6 months after term, and at child age 5.5 years (n = 1,116, constituting 66% of the original cohort). Logistic regression analyses identified factors predicting high SDQ scores, and multiple regression analyses identified direct effects on the SDQ Total. RESULTS: Binge exposure (≥5 standard units per occasion [SUpo]) during pregnancy week 0 to 6, that is, 0 to 4 weeks after conception, predicted scores in the Abnormal and Borderline range on the SDQ in 5.5-year-olds, after adjusting for other confounding variables. Very early binge exposure less often than once a week predicted high symptom scores on the SDQ Total (p = 0.05) and Hyperactivity/Inattention (significant), while exposure at least once a week demonstrated a 3- to 5-fold significant increase in high symptom scores on Total, Emotional, and Conduct problems. Reporting ≥8 SUpo had stronger predictive power than reporting 5 to 7 SUpo. The results were not explained by participants reporting major lifetime depression. Other predictive factors, although weaker, were maternal symptoms of depression and anxiety during the child's infancy. High education (mother and father), high income (maternal partner), higher child birth weight, and child female sex reduced the likelihood of high SDQ symptom scores. Path analysis demonstrated early binge exposure to have a direct effect on the SDQ Total score. CONCLUSIONS: Binge drinking up to 4 weeks after conception had a strong and direct predictive effect on SDQ symptom scores in 5.5-year-olds. These results strongly support the advice to avoid binge drinking when planning pregnancy.

Examination of the cut-off scores determined by the Ages and Stages Questionnaire in a population-based sample of 6 month-old Norwegian infants.

BACKGROUND: Few population-based samples have previously published performance on the Ages and Stages Questionnaire (ASQ), a recommended screening tool to detect infant developmental delay. The aim of the study was to investigate performance on the ASQ in a population-based sample of 6-month-old infants. METHODS: In this population-based questionnaire study from Oslo, Norway, the 30 item ASQ 6 month Questionnaire (N = 1053) were included, however without the pictograms, and compared to the Norwegian reference sample (N.ref) (N = 169) and to US cut-off values. Exclusion criteria were maternal non-Scandinavian ethnicity, infant age < 5.0 or > 7.0 months (corrected age), twins, and birth weight < 2.5 kg. Cut-off = 2.5 percentile (equivalent to mean minus 2 standard deviations). Pearson's Chi square and Mann-Whitney U were used to compare items and areas, respectively, with N.ref. RESULTS: The reported ASQ scores were lower on all but one of the 10 significantly different items, and in all areas except Personal social, compared to the N.ref sample. The estimated cut-off values for suspected developmental delay (Communication 25, Gross motor 15, Fine motor 18, Problem solving 25 and Personal social 20) were lower than the recommended American (US) values in all areas, and lower than the Norwegian values in two areas. Scores indicating need for further assessment were reached by 13.8% or 20.5% of the infants (missing items scored according to the US or the Norwegian manual), and by 33.8% or 30.3% of the infants using the recommended US or the Norwegian cut-off values, in this population-based sample. The Fine motor area demonstrated a large variability depending on the different cut-off and scoring possibilities. Both among the items excluding pictograms and the items that do not have pictograms, approximately every third item differed significantly compared to the N.ref sample. CONCLUSION: The psychomotor developmental scores were lower than in the reference samples in this study of ASQ 6 month Questionnaire; to our knowledge the first study to be both representative and comparatively large. Approximately every third child with birth weight above 2.5 kg, received scores suggesting further assessment using recommended ASQ cut-off scores.

Binge alcohol exposure once a week in early pregnancy predicts temperament and sleeping problems in the infant.

BACKGROUND: Prenatal alcohol exposure can cause several cognitive and behavioral difficulties. Few studies have investigated the associations with infant temperament or sleeping patterns. Our aim was to study potential associations between early prenatal binge exposure and infant temperament and sleeping pattern. METHODS: In a population based longitudinal study, representative of pregnant women in Oslo, questionnaires were answered at 17 and 30weeks of pregnancy and 6months after term. Two factors, difficult temperament and sleeping problems, were identified using Principal Component Analysis and dichotomized at the least optimal 14-15%. Logistic regression analyses identified predictive factors. RESULTS: Maternal binge drinking (≥5 drinks per occasion) once a week during pregnancy week 0-6 significantly predicted both difficult temperament (Odds Ratio OR 3.3**; 95% Confidence interval CI 1.4-7.9) and sleeping problems (OR 5.3**; 95% CI 2.1-13.7) in the infant, after adjusting for other confounding factors. Including binge drinking more often than once a week, further increased the OR of sleeping problems (6.0***; 2.7-13.7). Prenatal maternal depressive symptoms also predicted both outcomes. Reduced birth weight predicted difficult temperament. Maternal satisfaction with life reduced the probability of sleeping problems. Maternal smoking, and work stress, during pregnancy had no predictive power. The results were not explained by binge drinking later during pregnancy or higher consumption per occasion. CONCLUSIONS: Binge drinking once a week during pregnancy week 0-6 had stronger predictive power of difficult temperament and sleeping problems during infancy, than other covariates. The findings support advising women to avoid binge drinking when planning pregnancy.

Alcohol use before and during pregnancy: a population-based study.

BACKGROUND: Few population-based studies have estimated alcohol consumption and binge drinking before and during pregnancy. METHODS: The study is a longitudinal questionnaire study. In Norway, virtually 100% attend an ultrasound screening at 17-18 weeks of pregnancy. In Oslo, a representative sample attending this between June 2000 and May 2001 were invited to join the study, accepted by 92%. Non-Norwegian-speaking and/or immigrants from non-Western countries were not invited; 1,749 (93%) completed the first questionnaire. MEASURES: T-ACE (screening for pregnancy risk drinking), frequency of alcohol use, Standard Units (SU) per occasion, SU/week, and binge drinking (>or=5 SU per occasion). Binary logistic regression analyses, Student's t-test and Pearson's chi square were used. RESULTS: Alcohol use was reported by 89% pre-pregnancy and by 23% after pregnancy week 12. Binge drinking was reported by 59% pre-pregnancy and by 25% during weeks 0-6. Change of drinking pattern occurred at pregnancy recognition for 85%, although 78% had planned the pregnancy, fetal welfare being the main reason. Participants reporting alcohol use during pregnancy were older, smokers, with more SU/week pre-pregnancy, had some elevated anxiety score, higher income, and a partner with higher education. However, mental health, high income, or education were not predictive of usually drinking 1 SU per occasion or more, and not of binge drinking. The latter was predicted mainly by smoking during pregnancy and being T-ACE positive. CONCLUSIONS: The study shows a drinking pattern before pregnancy recognition that, according to other studies, in 25% or more may cause suboptimal fetal development.

Alcohol consumption, smoking and breastfeeding in the first six months after delivery.

AIM: To study alcohol use and smoking after delivery, and to relate this to breastfeeding. METHODS: A longitudinal questionnaire study, representative of pregnant women in Oslo. Ninety-two per cent agreed to join the study. Non-Norwegian speaking and/or immigrants from non-western countries were not invited. Questionnaires were answered at 17 (T1) and 30 (T2) wk of pregnancy, and 6 mo after term (T3). They were completed by 93% (1749 women) at T1, 82% at T2, and 92% at T3. RESULTS: Six months after delivery, 80% reported alcohol use. The mean alcohol consumption per week was less than half compared to the last 6 mo before pregnancy. The women with the highest pre-pregnancy use reduced the most. Binge drinking (> or = 5 drinks) was also reported by half as many women (29%). However, 6% reported 12 or more drinks per occasion at least once. No demographic or mental health variables predicted binge drinking after pregnancy. Smoking 6 mo after pregnancy was reported by 18%, a reduction of 50% from before pregnancy. Women breastfeeding for at least 6 mo had higher education, less frequently reported binge drinking after delivery and less frequently suffered postnatal depression. CONCLUSION: In this population-based sample were 86% breastfed for at least 6 mo, the level of binge drinking is concerning.

Alcohol consumption before and during pregnancy comparing concurrent and retrospective reports.

BACKGROUND: Reported alcohol consumption during pregnancy has proven to be higher when reported retrospectively during or after the pregnancy, compared with concurrent reports. In a longitudinal, population-based questionnaire study, we investigated whether these findings could be replicated. METHODS: A longitudinal, population-based questionnaire study. Among a representative half of pregnant women in Oslo, 92% accepted to join the study. Non-Norwegian speaking and/or immigrants from nonwestern countries were not invited. Questionnaires were answered at 17 (T1) and 30 weeks of pregnancy (T2) and 6 months after term (T3). The response rate was at T1 93% (N = 1,749), at T2 82%, and at T3 94% [representing 86% (T1), 70% (T2), and 64% of those invited to join the study]. RESULTS: Significantly more alcohol consumption after pregnancy recognition was reported retrospectively at both T2 and T3 [T2 0.15 and T3 0.18 standard units per week (SU/wk)] than concurrently at T1 or T2 (T1 0.10 and T2 0.14 SU/wk). When comparing the 2 retrospective reports at T2 and T3, there was a significant increase over time. Predictive factors for higher retrospective reports were higher age, more SU per week before pregnancy, reported alcohol use after pregnancy recognition (at T1), and depression after the pregnancy. A predictive factor for lower retrospective reporting was anxiety during, but not after, the pregnancy. Contrary to previous suggestions, anxiety concerning abnormality in the 6-month-old child was not a predictive factor. CONCLUSION: Concurrently reported alcohol consumption during pregnancy is probably under-reported. Thus, concurrent reports appear to underestimate fetal exposure.

Consistency of reported alcohol use by pregnant women: anonymous versus confidential questionnaires with item nonresponse differences.

BACKGROUND: Self-report is the best method to attain information about moderate alcohol consumption. However, reported alcohol consumption before and during pregnancy is sensitive to response bias. METHODS: We compared identical questionnaires completed either confidentially or anonymously by pregnant women. A representative half of the pregnant women in Oslo attending ultrasound screening between June 2000 and May 2001 were invited to join a confidential questionnaire study. Another group of pregnant women, selected in the identical manner, were asked to answer the same questionnaire anonymously during the summer of 2001. The questionnaire was completed by 1749 confidentially and 191 anonymously (response rate 93.4% vs 84.4%). For the current study, only women with Scandinavian ethnicity were included: 1707 and 178, respectively. Measures were T-ACE (screening measure for pregnancy risk drinking), reported frequency of alcohol use, Standard Units (SU) per occasion (po), SU per week, and binge drinking (>or=5 SU po), before and during pregnancy. RESULTS: There were no significant differences in reported alcohol consumption between the confidential and the anonymous group for the sample as a whole. Any alcohol consumption was reported by 22.6% and 23.3% during pregnancy week 7-12 and 13+ (confidential group) versus 22.5% and 25.8% (anonymous group). Differences between the groups tended to be larger for SU per week (p=0.07 both before pregnancy and after week 12 of pregnancy) than for the indirect alcohol (T-ACE) and the binge drinking questions. In the confidential group, the women with lower education had close to twice as high item nonresponse on the direct alcohol questions during pregnancy compared with those with higher education. This difference was smaller in the anonymous group. The rate of smoking was not reported differently in the anonymous group. CONCLUSIONS: Among pregnant women, there was no significant difference in self-reported alcohol consumption obtained by confidential or anonymous questionnaires.