Preventive interventions for paternal perinatal depression: a scoping review protocol.

INTRODUCTION: The objective of this scoping review is to map the literature describing preventive interventions for paternal perinatal depression. Depression is a common mental disorder experienced by fathers as well as mothers around childbirth. Perinatal depression has negative consequences for men, and suicide is the most serious adverse effect. Impaired father-child relationships can also result from perinatal depression, negatively impacting child health and development. Considering its severe effects, early prevention of perinatal depression is important. However, little is known about preventive interventions for paternal perinatal depression including Asian populations. METHODS AND ANALYSIS: This scoping review will consider studies of preventive interventions for perinatal depression in men with a pregnant wife or partner, and new fathers (less than 1 year post partum). Preventive intervention includes any form of intervention intended to prevent perinatal depression. Primary prevention intended to promote mental health will also be included if depression is included as an outcome. Interventions for those with a formal diagnosis of depression will be excluded. MEDLINE (EBSCOhost), CINAHL (EBSCOhost), APA PsycINFO (EBSCOhost), Cochrane Central Register of Controlled Trials and Ichushi-Web (Japan's medical literature database) will be searched for published studies, and Google Scholar and ProQuest Health and Medical Collection will be searched for grey literature. Beginning in 2012, the search will include the last 10 years of research. Screening and data extraction will be performed by two independent reviewers. Data will be extracted using a standardised data extraction tool and presented in diagrammatic or tabular form, accompanied by a narrative summary. ETHICS AND DISSEMINATION: As this study involves no human participants, approval from a human research ethics committee is not required. Findings of the scoping review will be disseminated through conference presentations and publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: https://osf.io/fk2qe/.

Experiences of transition to motherhood among pregnant women following assisted reproductive technology: a qualitative systematic review.

OBJECTIVE: This systematic review aimed to identify and synthesize available qualitative evidence regarding the experiences of the transition to motherhood among pregnant women following assisted reproductive technology. INTRODUCTION: Pregnant women experience unique challenges to their identity when transitioning to motherhood following assisted reproductive technology. It is important that health care professionals understand the context and complexity of emotional adaptation to pregnancy following assisted reproductive technology. INCLUSION CRITERIA: Any qualitative data from empirical studies that described experiences of the transition to motherhood during pregnancy among women who conceived through assisted reproductive technology were considered for inclusion. METHODS: Several databases were searched for published and unpublished studies in English or Japanese from 1992 to 2019, including MEDLINE, CINAHL, PsycINFO, ProQuest Health and Medical Collection, Google Scholar, and Open Access Theses and Dissertations (in English); and Ichushi-Web, CiNii, and the Institutional Repositories Database (in Japanese). All included studies were assessed by two independent reviewers. Any disagreements were resolved through discussion. We used the recommended JBI approach to critical appraisal, data extraction, and data synthesis. RESULTS: This review included seven studies that considered pregnant women's (n = 110) experiences of transition to motherhood following assisted reproductive technology. The studies were assessed as moderate to high quality (scores 7-10) based on the JBI critical appraisal checklist for qualitative research. All studies used qualitative methodologies or methods including phenomenology, narrative approach, qualitative description, and qualitative content analysis. There were two studies from Japan, one from Brazil, one from Iran, one from Israel, one from the UK, and one from the USA. In total, 51 supported findings were aggregated into 14 categories, and five synthesized findings: i) Pregnant women following assisted reproductive technology require support to decrease anxiety and improve their belief in pregnancy to internalize a maternal identity; ii) Pregnant women following assisted reproductive technology need reassurance of their lifestyles to ensure a safe passage through pregnancy because of ambivalent feelings about becoming a mother; iii) Pregnant women following assisted reproductive technology develop a maternal identity with affection for the fetus if they switch their mindset from infertility to pregnancy; iv) Pregnant women following assisted reproductive technology need to review their self-image of being infertile and prepare for childbirth or motherhood; v) Pregnancy following assisted reproductive technology contributes to the emergence of positive feelings and changing the women's sense of self and other personal relationships. Based on the ConQual approach, the confidence in the synthesized findings was rated as moderate to low. CONCLUSIONS: The synthesized findings highlight the importance of understanding the uncertainty and ambivalent feelings women have about their pregnancy, delayed development of attachment to their fetus and formation of a maternal identity, alteration in their relationships, and the social context of pregnancy via assisted reproductive technology among pregnant women following assisted reproductive technology. Health care professionals need to be aware of the specific care needs of these women relating to the unique pathway in the identity transition to motherhood following assisted reproductive technology. More research on development and implementation of specific intervention programs for expectant mothers following assisted reproductive technology is needed. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019138200.

Effectiveness of parenting education for expectant primiparous women in Asia: a systematic review.

OBJECTIVE: This review evaluated the effectiveness of antenatal parenting education versus usual care for maternal confidence, maternal depressive symptoms, and parenting stress among expectant primiparous women in Asia. INTRODUCTION: Previous reviews on parenting education have mostly examined practices in non-Asian countries and found that no single parenting education program met the needs of all parents. Given that there may be some common characteristics in Asian cultures, such as grandparents' involvement with child care, this review focused on specific interventions in determining the effects of practices on particular outcomes in these populations, so that providers of antenatal education can tailor interventions that are more culturally appropriate for Asian women. INCLUSION CRITERIA: Studies published in English or Japanese that included expectant primiparous women and couples in Asia who received antenatal parenting education were considered. The outcomes were maternal confidence, maternal depressive symptoms, and parenting stress. METHODS: The authors searched for English-language articles up to February 2019 using MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and PsycINFO. They also searched Ichushi-Web for Japanese articles. A gray literature search was conducted using Google Scholar and ProQuest Health and Medical Collection. Two independent reviewers selected studies, and a critical appraisal was undertaken using appropriate JBI tools. Data were presented in narrative form owing to the heterogeneity of the included studies. RESULTS: Four studies involving 652 pregnant women were included: three were randomized controlled trials, and one was a quasi-experimental study. The studies were conducted in China, Hong Kong, and Taiwan, and included the following antenatal parenting education interventions: interpersonal, psychotherapy-oriented childbirth education; childbirth psychoeducation based on the concept of learned resourcefulness; and Internet newborn-care education based on self-efficacy theory. Overall, the methodological quality of the included studies was moderate. Meta-analysis was not possible owing to the heterogeneity, including small sample sizes and differences in intervention content, populations, and follow-up times. A subsequent narrative synthesis was undertaken for each outcome. Of three studies with maternal confidence as an outcome (n = 496), two showed significantly higher maternal confidence at six weeks' (P = 0.000, Cohen's d = 1.41) and three months' postpartum (P = 0.016, Cohen's d = 0.35) in the intervention groups; however, one study showed no significant group differences. Of three studies with maternal depressive symptoms as an outcome (n = 534), two found significantly fewer depressive symptoms at three months' (P = 0.018, Cohen's d = -0.34) and six months' postpartum (P = 0.005, Cohen's d = -0.42) in the intervention groups; however, one study revealed no significant group differences. Parenting stress was examined in one study (n = 156); it showed significantly lower parenting stress (P = 0.017, Cohen's d = 0.38) immediately after the intervention. CONCLUSIONS: There is insufficient evidence to support the effectiveness of a specific type of antenatal parenting education for maternal confidence, maternal depressive symptoms, and parenting stress for expectant primiparous women in Asia. However, the findings suggest that specific theory-oriented antenatal parenting education is potentially effective for those women. Further high-quality studies are needed for antenatal parenting education among expectant primiparous women, especially in Asia.

Experiences of transition to motherhood among pregnant women following assisted reproductive technology: a systematic review protocol of qualitative evidence.

OBJECTIVE: This systematic review aims to identify and synthesize available qualitative evidence related to the experiences of transition to motherhood during pregnancy in women who conceived through assisted reproductive technology (ART). INTRODUCTION: Women who conceived through ART experience pregnancy-specific anxiety and paradoxical feelings, and face unique challenges in their identity transition to motherhood. It is important for healthcare professionals working with these women to understand the context and complexity of this special path to parenthood, including the emotional adaptation to pregnancy following ART. A qualitative systematic review can provide the best available evidence to inform development of nursing interventions to meet the needs of pregnant women after ART. INCLUSION CRITERIA: This review will consider any qualitative research data from empirical studies published from 1992-2019 in English or Japanese that described experiences of transition to motherhood during pregnancy in women who conceived with ART. METHODS: This review will follow the JBI approach for qualitative systematic reviews. Databases that will be searched for published and unpublished studies include MEDLINE, CINAHL, PsycINFO, ProQuest Health & Medical Collection, Google Scholar and Open Access Theses and Dissertations (in English), and Ichushi-Web, CiNii and the Institutional Repositories Database (in Japanese). Titles and abstracts will be screened by two independent reviewers in full. The full-text of selected studies will be assessed in detail, and findings and their illustrations will be extracted and aggregated. Any disagreements between the reviewers that arise at each stage will be resolved through discussion, or by a third reviewer.

Effectiveness of parenting education for expectant primiparous women in Asian countries: a quantitative systematic review protocol.

REVIEW QUESTION: What is the effect of antenatal parenting education on parenting stress, maternal depressive symptoms and maternal confidence, compared to usual care, for expectant primiparous women in Asian countries?

Relationship between the mode of conception and depressive symptoms during the first 6 months post-partum in Japan.

PURPOSE: To determine whether conventional treatment and assisted reproductive technology for infertility are associated with depressive symptoms and to identify the predictors of depressive symptoms during the first 6 months' post-partum. METHODS: A prospective cohort design was used, with the participants being recruited from 13 Japanese hospitals. Using self-report questionnaires, a total of 2709 women (response rate: 71.9%) provided longitudinal data at five time points: during their hospital stay and at 1, 2, 4, and 6 months' post-partum. The depressive symptoms were measured by using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS). A logistic regression analysis was used to examine the association between the mode of conception and depressive symptoms and to identify the predictors of the depressive symptoms. RESULTS: There was no significant association between the mode of conception and the depressive symptoms at any time point. Six factors that were associated with the EPDS score were first-time childbirth, emergency cesarean delivery, infant feeding, financial burden, having a male infant, and dissatisfaction with social support. CONCLUSION: There was no significant relationship between the mode of conception and depressive symptoms. Nursing care should be based on individual assessments that focus on parity, the delivery method, infant feeding method, financial burden, the infant's sex, and social support, rather than on the mode of conception.

Shoulder stiffness, back pain, and wrist pain: Are older primiparas more vulnerable?

AIM: To describe changes in prevalence of shoulder stiffness, back pain, and wrist pain during the first 6 months postpartum, and to examine the association of these symptoms with maternal age and parity. METHODS: Participants were recruited from 13 Japanese hospitals between 2012 and 2013. A total of 2709 (response rate 71.9%) women provided longitudinal data, using self-report questionnaires at 5 time points: during their hospital stay, and at 1, 2, 4, and 6 months postpartum. Shoulder stiffness, back pain, and wrist pain were measured, using checklists with yes-no responses. The effects of age and parity were assessed in 4 groups of younger (<35 years) and older (≥35 years) mothers: 983 younger primiparas, 481 older primiparas, 649 younger multiparas, and 596 older multiparas. Chi-square tests and Cochran's Q tests were used to assess effects of group and time. RESULTS: Prevalence of shoulder stiffness, back pain, and wrist pain during the hospital stay significantly increased up to 1 month postpartum for older primiparas, who were also the most vulnerable to back pain and wrist pain at 1 month postpartum. CONCLUSION: Special attention should be given to older primiparas in assessing and providing nursing care for physical symptoms, especially during the first month postpartum.

Course of maternal fatigue and its associated factors during the first 6 months postpartum: a prospective cohort study.

Aims: To identify the course of maternal fatigue during the first 6 months postpartum and to determine factors associated with it. Design: A prospective cohort study. Methods: Women (N = 2,697) in 13 Japanese hospitals provided longitudinal data using self-report questionnaires at five time points. Maternal fatigue was assessed using the Postnatal Accumulated Fatigue Scale. We focused on the effect of maternal age and parity on the course of maternal fatigue and used a mixed between/within-subjects analysis of variance. Factors associated with maternal fatigue were analysed using stepwise multiple regression. Results: In the 6-month postpartum period, the level of fatigue was highest at 1 month and significantly decreased from 1-4 months postpartum. Primiparas showed a significantly higher level of fatigue than multiparas during hospital stay and their levels of fatigue more closely approximated the 1-month peak. Multiparas showed significantly higher levels of fatigue than younger primiparas at 6-month postpartum. Factors associated with maternal fatigue included satisfaction with sleep, concerns about child-rearing, satisfaction with social support, financial burden and meal times per day.

Association between physical and depressive symptoms during the first 6 months postpartum.

AIM: To examine the relationship between physical symptoms and depressive symptoms among new mothers during the first 6 months postpartum. METHODS: Prospective cohort study design was used in this study. Participants were recruited in 13 Japanese hospitals between 2012 and 2013. A total of 2709 women (response rate of those invited 71.9%) provided longitudinal data using self-report questionnaires at 5 time points: during the hospital stay and at 1, 2, 4, and 6 months postpartum. Depressive symptoms were measured using the Japanese version of the Edinburgh Postnatal Depression Scale. Also, 37 physical symptoms were measured using a yes-or-no checklist. To examine the association between physical symptoms and depressive symptoms, logistic regression analysis was used. RESULTS: There was a significant positive association between physical symptoms and depressive symptoms during the first 6 months postpartum. Fifteen physical symptoms were associated with significantly increased odds of depression at 1, 2, 4, and 6 months post-partum. These symptoms included: loss of appetite, tiredness/languor, and palpitation/shortness of breath. CONCLUSION: Multiple physical symptoms after childbirth were associated with depressive symptomatology. Health professionals should assess for postpartum depression when puerperal women report multiple physical symptoms as independent complaints.

Postpartum maternal function and parenting stress: Comparison by feeding methods.

AIM: This cross-sectional and longitudinal study explored primiparous mothers' functioning and parenting stress on the basis of infant-feeding method over the first 6 months postpartum. METHODS: Participants were Japanese primiparae who delivered live singleton infants (N = 1120). Questionnaires, completed at 1, 2, 4, and 6 months postpartum, included demographics, feeding method, frequency of feedings, time required from infant's feeding to falling asleep, mother's sleep time, Postnatal Accumulated Fatigue Scale, and the original Japanese version of Parenting Stress Short-Form Scale. Chi-square tests and Welch F tests for one-way analysis of variance were conducted. RESULTS: Exclusively breastfeeding mothers fed their infants more frequently, but required less time from infant's feeding to falling asleep than either mixed or formula-feeding mothers. Mixed feeding mothers required more time for infant feeding and reported more severe fatigue and greater parenting stress than breastfeeding mothers at 1 and 2 months postpartum. Exclusively formula-feeding mothers required more time to get their infant back to sleep and reported greater parenting stress than the other groups at 6 months postpartum. Nearly 25% of mothers continued breastfeeding exclusively through the first 6 months postpartum. Mothers often changed feeding methods, with many exclusively breastfeeding by 6 months. CONCLUSION: Feeding methods may affect maternal functioning and parenting stress across the postpartum period.

Fatigue, depression, maternal confidence, and maternal satisfaction during the first month postpartum: A comparison of Japanese mothers by age and parity.

The aim of the study was to assess fatigue, depressive symptoms, and maternal confidence or satisfaction among older primiparae during the first month postpartum. The number of older Japanese primiparae has rapidly increased. Older primiparae are believed to be at high risk for puerperal morbidity. A multicentre prospective cohort study design was used. Data were examined from 2854 Japanese women who participated in a 6-month prospective cohort study conducted between May 2012 and September 2013. The women were classified into 4 groups based on maternal age and parity. All participants completed the Postnatal Accumulated Fatigue Scale, Japanese Edinburgh Postnatal Depression Scale, Postpartum Maternal Confidence Scale, and Postpartum Maternal Satisfaction Scale. Primiparae in all age groups were more severely fatigued and had a higher risk of postpartum depression than multiparous mothers during the first month postpartum. Older primiparae had significantly lower scores on maternal confidence and maternal satisfaction than the other 3 groups at 1 month postpartum. These findings suggest that postpartum nursing should focus on promoting adequate sleep, providing emotional support, and fostering the process of maternal role adaptation among older Japanese primiparae, particularly during the first postpartum month.

Prevalence of postpartum depressive symptoms during the first 6 months postpartum: Association with maternal age and parity.

BACKGROUND: Depressive symptoms are common in postpartum women. The present study aimed to describe changes in the prevalence of depressive symptoms during the first 6 months postpartum, and their association with maternal age and parity. METHODS: A prospective cohort study was conducted with 3769 women at 13 hospitals in Japan. Depressive symptoms were measured during hospital stay and at 1, 2, 4, and 6 months postpartum, using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS). The effects of maternal age and parity were assessed by comparing four groups: younger primiparas (aged <35 years); older primiparas (≥35 years); younger multiparas (<35 years); and older multiparas (≥35 years). Data were analyzed using a mixed between/within-subjects analysis of variance, Cochran's Q tests, and chi-square tests. RESULTS: Mean EPDS scores significantly decreased from 1 to 2 months postpartum in all groups. The proportion of women with EPDS scores ≥9 significantly decreased during the same period for primiparas but not for multiparas. Primiparas also had significantly higher EPDS scores than multiparas during hospital stay and at 1 month postpartum. LIMITATIONS: As we used convenience sampling, our study sample was not fully representative of Japanese mothers. This study was also limited by our focus on the postpartum period. CONCLUSIONS: The first month postpartum represented peak prevalence for depressive symptoms. Primiparity was a risk factor for depressive symptoms only during the first month postpartum. Healthcare professionals should be sensitive to postpartum duration and parity when monitoring depressive symptoms.

Factors affecting maternal confidence among older and younger Japanese primiparae at one month post-partum.

AIM: To compare the factors that affect maternal confidence at 1 month post-partum between older (≥35 years old) and younger (20-34 years old) primiparous Japanese mothers. METHODS: A multicenter prospective study of mothers who gave birth to live singleton infants in Japan was conducted. Following ethics approval, the participants completed questionnaires 1 day before discharge and 1 month after childbirth. The questionnaires included the Postpartum Maternal Confidence Scale, demographics and background information, prenatal and obstetric data, situational variables and perceptions of daily life, and social support. The obstetric data were extracted from the hospital medical records. Data from the older primiparae (n = 479) and the younger primiparae (n = 1033) were analyzed by using multiple stepwise regressions, controlling for the delivery mode. RESULTS: Maternal confidence at 1 month post-partum was positively associated with emotional support for the older primiparae and appraisal support and exclusive breastfeeding for younger primiparae. In both groups, feeling overwhelmed by daily life, a lack of communication with their partner about the parenting role, and a lack of prior experience in caring for babies were negatively related to maternal confidence. Family budget instability was negatively related to maternal confidence in the younger group. CONCLUSION: Providing care that is based on an understanding of the unique support needs of first-time mothers in different age groups could promote more effective parenting.

Cross-sectional and longitudinal validation of a 13-item fatigue scale among Japanese postpartum mothers.

This study examined the psychometric properties of a 13-item fatigue scale for postpartum mothers. Japanese mothers (n = 2026) from a cohort study completed questionnaires (e.g. fatigue scale, Japanese version of the Edinburgh Postnatal Depression Scale, demographics) during their hospital stay after childbirth (baseline) and at 1, 2, 4 and 6 months postpartum. Initial factor analysis of baseline data revealed that the fatigue scale had three factors or subscales (physical, emotional and cognitive). Within-group analysis across each measurement time revealed the same three-factor structure with acceptable fit. Between-group analysis also showed longitudinal factorial invariance across time. The fatigue subscales had acceptable divergent and convergent validities with the depression scale. The subscale scores differed significantly based on participant background. The Japanese Fatigue Scale is a concise and informative tool for assessing aspects of fatigue in clinical settings and in the community.

Factors affecting maternal confidence and satisfaction in older Japanese primiparae during postpartum hospital stay.

The purpose of this study was to identify factors affecting maternal confidence and satisfaction in older Japanese primiparae during their postpartum hospital stay. Participants were Japanese primiparae (age ≥ 35) who delivered live singleton infants (n = 479). Questionnaires completed 1 day before discharge from hospital included the Postpartum Maternal Confidence Scale and the Postpartum Maternal Satisfaction Scale. Data were analysed using stepwise multiple regression for maternal confidence and stepwise logistic regression for maternal satisfaction, after controlling for delivery mode. Maternal confidence was negatively affected by feeling overwhelmed by postpartum routines, needing a longer time for feeding, and a pregnancy with complications. Satisfaction with the birth experience and a longer rooming-in period were related to greater maternal satisfaction. Lack of prior experiences with caring for babies and lack of communication with their partner about parenting role were also associated with lower confidence and satisfaction. These findings provide an important framework for nurses to teach and counsel older first-time mothers.

Predictors of depressive symptoms in older Japanese primiparas at 1 month post-partum: A risk-stratified analysis.

AIM: Older maternal age has become more common in Japan. Studies suggest that older maternal age and primiparity are associated with post-partum depression. The present study aimed to identify predictors of post-partum depression in older Japanese primiparas at 1 month post-partum. METHODS: Participants were 479 primiparas aged 35 years and over, drawn from a prospective cohort study. Data were collected using self-report questionnaires. Depression was measured with the Japanese version of the Edinburgh Postnatal Depression Scale. Stepwise logistic regression analysis was conducted on binary outcome variables of depression at 1 month post-partum, along with a stratified analysis based on the risk status of depression. RESULTS: Five predictors were identified: (i) the depression score during hospital stay; (ii) financial burden; (iii) dissatisfaction with appraisal support; (iv) physical burden in daily life; and (v) concerns about infant caretaking. Stratified analysis identified dissatisfaction with instrumental support in the low-risk group, and the Child-care Value Scale score as unique predictors in the high-risk group. CONCLUSION: These results highlight the importance of early assessment of depressive symptoms and the provision of continuous care.

Age-specific determinants of post-partum fatigue in primiparous women.

AIM: Post-partum fatigue is a serious concern for mothers worldwide. The aim of this study was to identify age-specific determinants of self-perceived fatigue after childbirth among Japanese primiparous women. METHODS: A multicenter prospective cohort study was conducted in Japan. The degree of fatigue was assessed using the Postnatal Accumulated Fatigue Scale during the hospital stay after childbirth. Associated factors were stratified into two age groups (<35 or ≥35 years old); data were analyzed using stepwise multiple regression. RESULTS: In the younger group, significant determinants of post-partum fatigue included: anticipated difficulties in child-rearing after discharge; perception of inadequate sleep conditions; dissatisfaction with childbirth; shorter sleep and meal times; longer duration between feeding and infant bedtime; unemployment; and having hyperemesis gravidarum. In the older group, significant determinants of post-partum fatigue included: anticipated difficulties in child-rearing after discharge; perception of inadequate sleep conditions; shorter meal times; formula feeding; and dissatisfaction with childbirth. CONCLUSION: Primiparous mothers who anticipated new life with their infants to be difficult and who had an irregular lifestyle tended to report higher levels of fatigue during the post-partum hospital stay. Nurses and midwives should assess maternal sleep and eating conditions, providing support to ensure adequate maternal rest. Special efforts should be made to reduce anxiety about new life with infants among younger primiparous women who had experienced hyperemesis gravidarum.

Objective sleep of older primiparous Japanese women during the first 4 months postpartum: an actigraphic study.

This longitudinal study was designed to examine objective sleep parameters of older primiparous Japanese women during the first 4 months postpartum using actigraphy. The participants were 18 older primiparae (Mean (SD) = 37.06 (2.62) years, range 35-44 years) who gave birth to healthy neonates at one of three urban Japanese hospitals. Objective sleep quality was measured using actigraphy for 48 h at 1, 2 and 4 months postpartum. The Friedman test was used to test for differences in sleep parameters across time. Sleep duration (SMIN) increased significantly from 2 months (Mean (M) = 301.94 min) to 4 months (M = 372.78 min). Sleep efficiency (SE) increased significantly from 1 month (73.52%) to 2 (86.66%) and 4 months (89.05%). Waking after sleep onset (WASO) decreased significantly from 1 month (M = 114.64 min) to 2 (M = 40.18 min) and 4 months (M = 38.36 min) and long waking episodes (LWEP) significantly decreased from 1 month (4.67) to 2 (2.69) and 4 months (3.12). Persistent postpartum sleep problems can be a sign of postpartum depression as well as health problems among infants.

Comparing older and younger Japanese primiparae: fatigue, depression and biomarkers of stress.

This cohort study of primiparae was conducted to answer the following questions: Do older (≧ 35 years) and younger (20-29 years) Japanese primiparous mothers differ when comparing biomarkers of stress and measures of fatigue and depression? Are there changes in fatigue, depression and stress biomarkers when comparing older and younger mothers during the postpartum period? The Postnatal Accumulated Fatigue Scale and the Edinburgh Postnatal Depression Scale were administered in a time-series method four times: shortly after birth and monthly afterwards. Assays to measure biomarkers of stress, urinary 17-ketosteroids, urinary 17-hydroxycorticosteroids and salivary chromogranin-A, were collected shortly after delivery and at 1 month postpartum in both groups and a third time in older mothers at the 4th month. Statistical testing showed very little difference in fatigue, depression or stress biomarkers between older and younger mothers shortly after birth or 1 month later. Accumulated fatigue and depression scores of older mothers were highest 1 month after delivery. Additional cohort studies are required to characterize physical/psychological well-being of older Japanese primiparae.

Predicting early post-partum depressive symptoms among older primiparous Japanese mothers.

AIM: The number of older primiparas is increasing in Japan. These women have been shown to be more vulnerable to post-partum depression. This study aimed to identify factors for predicting post-partum depressive symptoms during hospitalization after childbirth in Japanese primiparas aged 35 years and over. METHODS: The present authors used the data of 479 primiparas aged 35 years and over from a prospective cohort study. Data were collected using self-report questionnaires on the day before hospital discharge. The questionnaire consisted of: demographics and background information; depressive symptoms; fatigue; maternal confidence and maternal satisfaction; child-care values; physical symptoms; perceptions of daily life during hospitalization; concerns about child care and daily life; and infant feeding. Additionally, vital records data were obtained from the hospitals. A stepwise logistic regression analysis was performed on the binary outcome variable of depressive symptoms, measured by the Japanese version of the Edinburgh Postnatal Depression Scale. Women who scored 9 or more were considered to be at high risk for post-partum depression. The authors obtained informed consent from all participants and institutional ethics approvals before initiating the study. RESULTS: The following six variables reliably predicted the risk of post-partum depression: emergency cesarean section, lower satisfaction with birth experience, higher physical burden in daily life, long-term complications with the newborn, more concerns about newborn caretaking after discharge, and more concerns about one's own life after discharge. CONCLUSION: Recognition of women with these factors will help nurses to identify those at risk for developing post-partum depression and to provide appropriate care during hospitalization after childbirth.