Attachment insecurity, heart rate variability, and perceived social support in a diverse sample of young adults.

Psychological and physical factors are robustly associated with perceived social support. Drawing from the literature on attachment style in adults and psychophysiology, we examined the possibility that the interaction of attachment insecurity and resting heart rate variability (HRV) was associated with perceived social support in a diverse sample of young adults living in the U.S (N = 145, Mage = 20.45) that was majority Latino (n = 77). Analyses revealed three key findings. First, in the overall sample, attachment avoidance and attachment anxiety were negatively associated with perceived social support, but in the Latino sample, only attachment avoidance was negatively associated with perceived social support. Second, HRV was not associated with perceived social support in the overall sample nor in the Latino sample. Third, attachment insecurity and HRV interacted to predict perceived social support only in the Latino sample such that, for those with lower levels of HRV, attachment anxiety was positively associated with perceived social support. This study underscores the importance of examining both psychological and physiological processes with careful consideration of ethnicity/culture in order to better understand perceived social support.

Is HbA1c associated with birth weight? A multivariable analysis of Pakistani pregnant women.

AIM: Globally, one in seven infants is born with low birth weight and 3%-7% of infants are born with high birth weight, with the greatest burden noted in low- and middle-income countries. This study investigated the association between maternal prenatal glucose regulation and birth weight and the moderating effect of fetal sex among Pakistani women. METHODS: Secondary data from a prospective longitudinal study of healthy pregnant women from Pakistan (N = 189) was used. Participants provided a blood sample (12-19 weeks' gestational age) for the assessment of HbA1c (%). Birth weight (g) was collected following delivery. RESULTS: Higher maternal HbA1c was associated with higher birth weight (b = 181.81, t[189] = 2.15, p = 0.03), which was moderated by fetal sex (b = -326.27, t[189] = -2.47, p = 0.02), after adjusting for gestational age at birth, ethnicity, and pregnancy weight. Among women carrying a male fetus, every 1% increase in HbA1c predicted a 182 g increase in birth weight (b = 181.81, t[189] = 2.15, p = 0.03). CONCLUSIONS: Results extend research from high-income countries and indicate that fetal sex may have implications for glucose regulation in early to mid-pregnancy. Future research should examine sociocultural factors, which could elucidate potential mediating factors in the relation between HbA1c and birth weight in healthy pregnancies.

Maternal Diet Quality and Prenatal Depressive Symptoms: The Moderating Role of Economic Well-Being.

Prenatal depression is prevalent and adversely impacts maternal and infant health. This study addresses a critical literature gap and investigates the association between maternal diet quality and prenatal depressive symptoms, as well as the moderating effect of economic well-being on this link. A cross-sectional design was used, including 43 healthy pregnant women in the second trimester aggregated from two research projects. Prenatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Dietary quality was evaluated using two non-consecutive 24 h dietary recalls, from which the Adapted Dietary Inflammatory Index (ADII) and the Healthy Eating Index (HEI)-2015 were derived. Economic well-being was indicated by the income-to-poverty ratio. A higher HEI-2015 (adherence to dietary guidelines; ß = -0.53, p = 0.01) and negative ADII (anti-inflammatory diet; ß = 0.40, p = 0.06) were associated with fewer prenatal depressive symp-toms. Among pregnant women with worse economic well-being, a pro-inflammatory diet was as-sociated with more prenatal depressive symptoms (b = 1.69, p = 0.004), but among those with better economic well-being, the association was not significant (b = 0.51, p = 0.09). Dietary interventions aimed at reducing dietary inflammation might hold some promise for improving mental health among pregnant women who are economically vulnerable.

Domestic violence assault during the first year of the COVID-19 pandemic: a longitudinal community study.

BACKGROUND: The consequences of the COVID-19 pandemic have been far-reaching, disproportionately impacting vulnerable populations. Of particular concern is the impact on individuals experiencing domestic violence (DV), an urgent public health issue. There have been numerous reports of pandemic-related surges in DV, and it has been speculated that prolonged periods of state-mandated isolation may be the source of these surges. The current study utilized publicly available records to examine fluctuations in DV coinciding with COVID-19 lockdown restrictions in a diverse metropolitan county. METHODS: Data were extracted from local police blotters and mapping engines in Orange County, California (United States), documenting police-reported DV assault. All incidents were coded for time to examine the time course of DV among other types of assault, allowing for a longitudinal view of incidents over a 66-week window. Changepoint analyses were used to determine whether and when DV assaults changed when mapped with coinciding tightening or loosening of restrictions county-wide. Piecewise regression analyses evaluated whether any detected fluctuations were statistically meaningful. RESULTS: In Santa Ana, rates saw a small but significant spike in the week following the first major lockdown in March 2020 (b = .04, SE = .02, t = 2.37, p = .01), remaining stable at this higher level thereafter (b = -.003, SE = .003, t = -1.29, p = .20). In Anaheim, no meaningful change in DV assault rates was observed at any time interval. CONCLUSION: Results suggest that surges in DV vary between communities and that systemic issues may set the stage for the surge of an already endemic problem.

Individual and collective contribution of antenatal psychosocial distress conditions and preterm birth in Pakistani women.

BACKGROUND: We determined whether dimensions of psychosocial distress during pregnancy individually and collectively predicted preterm birth (PTB) in Pakistani women as it may be misleading to extrapolate results from literature predominantly conducted in high-income countries. METHODS: This cohort study included 1603 women recruited from four Aga Khan Hospital for Women and Children in Sindh, Pakistan. The primary binary outcome of PTB (i.e., livebirth before 37 completed weeks' gestation) was regressed on self-reported symptoms of anxiety (Pregnancy-Related Anxiety (PRA) Scale and Spielberger State-Trait Anxiety Inventory Form Y-1), depression (Edinburgh Perinatal Depression Scale (EPDS)), and covariates such as chronic stress (Perceived Stress Scale) assessed with standardized question and scales with established language equivalency (Sindhi and Urdu). RESULTS: All 1603 births occurred between 24 and 43 completed weeks' gestation. PRA was a stronger predictor of PTB than other types of antenatal psychosocial distress conditions. Chronic stress had no effect on the strength of association between PRA and PTB and a slight but non-significant effect on depression. A planned pregnancy significantly lowered risk of PTB among women who experienced PRA. Aggregate antenatal psychosocial distress did not improve model prediction over PRA. CONCLUSIONS: Like studies in high-income countries, PRA became a strong predictor of PTB when considering interactive effects of whether the current pregnancy was planned. Women's resilience and abilities to make sexual and reproductive health decisions are important to integrate in future research. Findings should be generalized with caution as socio-cultural context is a likely effect modifier. We did not consider protective/strength-oriented factors, such as resilience among women.

Does perceived support moderate the link between acculturative stress and problematic eating behaviors? The role of family, significant other, and friend support.

OBJECTIVE: Acculturative stress, often experienced by members of minority groups, is related to problematic eating behaviors. What remains poorly understood is the function of perceived social support in this link. This study evaluated the moderating role of perceived support from family, the significant other, and friends in the association between acculturative stress and problematic eating behaviors, including emotional eating, uncontrolled eating, and cognitive restraint eating. METHOD: An online cross-sectional study was conducted with 497 Asian and Latinx college students using standardized questionnaires. Three hierarchical multivariable models were analyzed, with each eating behavior included as the outcome variable. Demographic variables (Step 1), general perceived stress (Step 2), and predictor variables (i.e., acculturative stress, perceived support; Step 3) were added using Method Enter. Interaction terms were entered using Method Stepwise (Step 4) to test for moderation effects. RESULTS: As perceived family support increased, the magnitude of the link between acculturative stress and higher uncontrolled eating increased (p = .002). When perceived significant other support was higher, the magnitude of the relationship between acculturative stress and higher emotional eating increased (p = .02). Higher perceived friend support was directly related to reduced uncontrolled eating (p = .002). DISCUSSION: This study highlights the heterogeneous effects of various sources of perceived support on the link between acculturative stress and problematic eating behaviors. Findings imply that problematic eating prevention and intervention programs might benefit from considering not only the acculturative stress experienced by racial/ethnic minority young adults but also the sources of support perceived. PUBLIC SIGNIFICANCE: Perceived support from family and the significant other increased the magnitude of the link between higher acculturative stress and increased problematic eating behaviors, whereas support from friends showed a direct relationship with reduced uncontrolled eating. The results highlight the nuanced functions of various sources of perceived social support and contribute to a deeper understanding of potential moderators in the relationship between acculturative stress and problematic eating behaviors among racial/ethnic minorities.

Physiological and affective responses to green space virtual reality among pregnant women.

BACKGROUND: Benefits of green spaces on stress reduction have been shown in previous studies. Most existing studies to date have focused on the general population. However, there is a lack of understanding of physiological mechanisms underlying the beneficial effects of green space among special populations, such as pregnant women. OBJECTIVES: To examine physiological and affective responses to green space on stress recovery among pregnant women, using simulated green space exposure through virtual reality (VR). METHODS: We recruited 63 pregnant women between 8 and 14 weeks' gestational age for a laboratory experiment. Participants were randomly assigned to view one of three, 5-min, VR videos of an urban scene with different green space levels (i.e., non-green, moderate, and high) after a laboratory stressor, the Trier Social Stress Test. Physiological stress responses were measured via changes in blood pressure, heart rate, skin conductance level, salivary alpha-amylase, and salivary cortisol. Affective response was measured using the Positive and Negative Affect Scale. RESULTS: We found that visual exposure to a green space environment in VR was associated with both physiological and affective stress reduction among pregnant women, including lower systolic blood pressure [-4.6 mmHg, 95% confidence interval (CI): -8.8, -0.4], reduced salivary alpha-amylase concentration (-1.2 ng/ml, 95% CI: -2.2, -0.2), improved overall positive affect (score: 6.6, 95% CI: 0.3, 13.0) and decreased negative affect of anxiety (score: -2.6, 95% CI: -5.19, -0.04) compared to non-green space environment. Exposure to high green space environment in park-like setting had the strongest impacts on stress recovery. CONCLUSION: This study demonstrated that virtual green space exposure could effectively ease stress and improve mental health and well-being during pregnancy. Even a short immersion in VR-based green space environment may bring health benefits, which has significant implications for pregnant women when access to an actual nature may not be possible.

Prenatal allostatic load and preterm birth: A systematic review.

Objective: Allostatic load refers to cumulative neuroendocrine burden and has been postulated to mediate and moderate physiological and psychological stress-related responses. This may have important implications for the risk of preterm birth. This systematic review examines the evidence on the association between prenatal allostatic load and preterm birth. Data sources: A comprehensive search of seven electronic databases was conducted from inception to August 23, 2022 to identify all English-language observational and mixed methods studies examining allostatic load and preterm birth with no year or geographic restrictions. Study eligibility criteria: Studies were included if they measured allostatic load, evaluated as the cumulative effect of any combination of more than one allostatic load biomarker, during pregnancy. Studies must have observed preterm birth, defined as < 37 weeks' gestational age, as a primary or secondary outcome of interest. Study appraisal and synthesis methods: The Quality In Prognosis Studies tool was used to evaluate risk of bias within included studies. A narrative synthesis was conducted to explore potential associations between allostatic load and preterm birth, and sources of heterogeneity. Results: Three prospective cohort studies were identified and revealed mixed evidence for an association between allostatic load and preterm birth. One study reported a statistically significant association while the other two studies reported little to no evidence for an association. Heterogeneity in when and how allostatic load was measured, limitations in study design and cohort socio-demographics may have contributed to the mixed evidence. Conclusions: This review provides insight into key individual-, community-, and study-level characteristics that may influence the association between allostatic load and preterm birth. Knowledge gaps are identified as foci for future research, including heterogeneity in allostatic load biomarkers and allostatic load index algorithms as well as pregnancy-specific considerations for allostatic load measurement. Further investigation of the allostatic load framework in the context of perinatal mental health is needed to advance understandings of maternal, infant, and child health. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020208990, PROSPERO, identifier: CRD42020208990.

Psychometric analysis of the Edinburgh Postnatal Depression Scale and Pregnancy Related Anxiety Questionnaire in Pakistani pregnant women.

BACKGROUND: The Edinburgh Postnatal Depression Scale (EPDS) and the Pregnancy-Related Anxiety Scale (PRAQ) are frequently used perinatal mental health scales. OBJECTIVE: To identify the factor structure of the Urdu language versions of EPDS and PRAQ in 280 Pakistani pregnant women. METHOD: The tools were administered at 12-19 weeks' and 22-29 weeks' gestational age (GA). Exploratory factor analyses were undertaken on data collected at 12-19 weeks' GA, to assess both scales. Results obtained at the second time point were used to examine test-retest reliability. The correlation between the scales was computed. RESULTS: A two-factor model yielded the best fit for both scales, which is consistent with findings from previous studies. For the EPDS, acceptable reliability was attained for the overall score (α = 0.77) and for the factor related to depressive symptoms (α = 0.73), but not for the factor related to anhedonia/suicide (α = 0.64). For the PRAQ, acceptable reliability was attained for the overall score (α = 0.83) and for the factor related to pregnancy concerns (α = 0.84), but not for the factor related to childbirth (α = 0.64). Test-retest reliability was acceptable for both overall scales EPDS: r = 0.50; PRAQ: r = 0.45; both p < .001). The Pearson correlation between the EPDS and PRAQ were r = 0.145, p < .05. CONCLUSION: Analysis of the tools confirmed a two-factor structure for both depression and anxiety among Pakistani pregnant women. A weak correlation was found between the EPDS and PRAQ. Further research is required to develop screening instruments for perinatal mental disorders that are applicable to cultural contexts.

Acculturative stress and eating disinhibition among Asian young adults: The role of depressive symptoms and gender.

Acculturative stress is associated with health behaviors that have downstream consequences for health outcomes. Eating disinhibition, a behavior characterized by eating emotionally and uncontrollably in the presence of disinhibiting stimuli, has been consistently associated with acculturative stress, but the underlying mechanism is not well-understood. The current study sought to test the role of depressive symptoms and gender on these associations. Asian undergraduate students (N = 477; 78% female) participated in an online cross-sectional study. Higher acculturative stress was associated with higher eating disinhibition (b = 3.45, 95% CI = [0.75, 6.15]), and depressive symptoms showed a partial indirect effect on this association (indirect effect = 0.57, 95% CIboot = [0.13, 1.34]). Among male young adults (b = 0.98, 95% CIboot = [0.24, 2.39]), the indirect correlation was stronger than among female young adults (b = 0.44, 95% CIboot = [0.05, 1.20]; non-significant trend), implying individual differences underlying the indirect effect of depressive symptoms in the acculturative stress and eating disinhibition correlation. The Intercultural Relations dimension of acculturative stress appeared to drive the observed associations. This study is among the first highlighting the role of acculturative stress, depressive symptoms, and gender in eating disinhibition and provides evidence that can inform health professionals to target at-risk Asian individuals with eating problems.

Total Adverse Childhood Experiences and Preterm Birth: A Systematic Review.

INTRODUCTION: Total adverse childhood experiences (ACEs) are gaining prominence as a risk factor for preterm birth (PTB). The emerging literature examining this relationship reports inconsistent findings. The purpose of this systematic review was to summarize the available evidence exploring whether total ACEs predict PTB. METHODS: A total of 386 studies were returned from searches on PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Nine studies were selected for final analysis and synthesis based on reporting of total ACEs and preterm birth gestational weeks or standard definition of birth before 37 weeks' gestational age. A systematic review rather than meta-analysis was selected to present the findings given the clinical and methodological (e.g., sample studied, measurement tools) heterogeneity of the retrieved studies and pregnancy outcomes measured. RESULTS: The nine studies report on birth outcomes for 6,087 women from a range of sociodemographic and ethnic backgrounds. Despite a wide range of study designs, measurement tools, and timings of ACEs exposure across studies, seven of the nine included studies showed significant relationships between ACEs and PTB. CONCLUSION: Systematic review of the literature suggests that total ACEs are associated with PTB and provides an overview on the known associations. However, to date only nine studies have assessed this link, and more studies are needed, to explore the associations between ACEs and PTB using appropriate and valid instruments and doing so among more diverse populations. Future research should also explore possible biological mechanisms (allostatic load), and moderating and mediating variables.

Perceived stress may mediate the relationship between antenatal depressive symptoms and preterm birth: A pilot observational cohort study.

BACKGROUND: Screening for changes in pregnancy-related anxiety and depressive symptoms during pregnancy may further our understanding of the relationship between these two variables and preterm birth. OBJECTIVES: To determine whether changes in pregnancy-related anxiety and depressive symptoms during pregnancy influence the risk of preterm birth among Pakistani women; explore whether perceived stress moderates or mediates this relationship, and examine the relationship between the various components of pregnancy-related anxiety and preterm birth. METHODS: A prospective cohort study design was used to recruit a diverse sample of 300 low-risk pregnant women from four centers of Aga Khan Hospital for Women and Children in Karachi, Pakistan. Changes in pregnancy-related anxiety and depressive symptoms during pregnancy were tested. Multiple logistic regression analysis was used to determine a predictive model for preterm birth. We then determined if the influence of perceived stress could moderate or mediate the effect of depressive symptoms on preterm birth. RESULTS: Changes in pregnancy-related anxiety (OR = 1.1, CI 0.97-1.17, p = 0.167) and depressive symptoms (OR = 0.9, CI 0.85-1.03, p = 0.179) were insignificant as predictors of preterm birth after adjusting for the effects of maternal education and family type. When perceived stress was added into the model, we found that changes in depressive symptoms became marginally significant after adjusting for covariates (OR = 0.9, CI 0.82-1.01, p = 0.082). After adjusting for the mediation effect of change in perceived stress, the effect of change in depressive symptoms on preterm birth were marginally significant after adjusting for covariates. Among six different dimensions of pregnancy-related anxiety, mother's concerns about fetal health showed a trend towards being predictive of preterm birth (OR = 1.3, CI 0.97-1.72, p = 0.078). CONCLUSIONS: There may be a relationship between perceived stress and antenatal depressive symptoms and preterm birth. This is the first study of its kind to be conducted in Pakistan. Further research is required to validate these results.

Empowerment, Stress, and Depressive Symptoms Among Female Survivors of Intimate Partner Violence Attending Personal Empowerment Programs.

Intimate partner violence (IPV) affects one in three women and can have long-lasting psychological effects, with abuse survivors typically exhibiting elevated stress and depressive symptoms. However, women with greater personal empowerment resources (i.e., self-care, agency, self-efficacy) and who practice relaxation techniques generally exhibit lower stress and depressive symptoms. The present study investigated the effectiveness of Personal Empowerment Programs (PEP) and practicing relaxation techniques in promoting empowerment and lowering stress and depressive symptoms. Ninety women were recruited from PEP classes conducted at domestic violence agencies in Orange County, California. Salivary cortisol and affect were assessed before and after one PEP class. Perceived stress, depressive symptoms, empowerment, and relaxation techniques were also assessed. Practicing relaxation techniques correlated with more empowerment. For women without sexual abuse experiences only, having completed more classes (>5 classes) in the program was associated with greater empowerment, less stress, and fewer depressive symptoms. Implications extend to future studies and interventions for IPV survivors.

Corroborative evidence for an association between initial hypothalamic-pituitary-adrenocortical axis reactivity and subsequent habituation in humans.

BACKGROUND: The extant literature predicts that initial hypothalamic-pituitary-adrenocortical (HPA) axis response magnitude and subsequent habituation are associated with health, such that both heightened stress reactivity and non-habituation to repeated stressors are associated with disease. Yet, despite evidence for an association between initial HPA axis reactivity and subsequent habituation, the extant literature often considers health implications of these stress response patterns independently or make interpretations based on an initial response alone. This may be because past tests of the association between reactivity and habituation were subject to statistical bias (e.g., regression to the mean), and no prior work has examined the association between initial cortisol reactivity and subsequent habituation using analytic strategies capable of estimating the unbiased relationship between initial value (i.e., reactivity) and subsequent change (i.e., habituation). Accordingly, the present investigation drew from two previously published studies to test the association between initial HPA axis reactivity and subsequent habituation using analytic strategies capable of estimating the relationship between initial reactivity and subsequent habituation with minimal bias. METHODS: We examined salivary cortisol and plasma ACTH responses to three repeated social-evaluative stressors (Study 1) and salivary cortisol responses to two repeated social-evaluative stressors (Study 2). RESULTS: As predicted, results indicated a negative relationship (Pearson's r ranging from -0.27 to -0.91) where initial HPA axis reactivity was associated with subsequent habituation across both studies, even when using estimation procedures capable of producing an unbiased estimate of this relationship. CONCLUSIONS: Results support the claim that initial HPA axis reactivity to acute stress is associated with subsequent habituation, such that initially high reactors are likely to habituate, whereas initially blunted reactors are likely to sensitize. In view of these results, hypothesized long-term health implications of acute cortisol reactivity and habituation patterns should be considered in tandem.

Comorbid Anxiety and Depression among Pregnant Pakistani Women: Higher Rates, Different Vulnerability Characteristics, and the Role of Perceived Stress.

Anxiety and depression commonly co-occur during pregnancy and may increase risk of poor birth outcomes including preterm birth and low birth weight. Our understanding of rates, patterns, and predictors of comorbid anxiety and depression is hindered given the dearth of literature, particularly in low- and middle-income (LMI) countries. The aim of this study is (1) to explore the prevalence and patterns of comorbid antenatal anxiety and depressive symptoms in the mild-to-severe and moderate-to-severe categories among women in a LMI country like Pakistan and (2) to understand the risk factors for comorbid anxiety and depressive symptoms. Using a prospective cohort design, a diverse sample of 300 pregnant women from four centers of Aga Khan Hospital for Women and Children in Pakistan were enrolled in the study. Comorbid anxiety and depression during pregnancy were high and numerous factors predicted increased likelihood of comorbidity, including: (1) High level of perceived stress at any time point, (2) having 3 or more previous children, and (3) having one or more adverse childhood experiences. These risks were increased if the husband was employed in the private sector. Early identification and treatment of mental health comorbidities may contribute to decreased adverse birth outcomes in LMI countries.

Associations between green space and preterm birth: Windows of susceptibility and interaction with air pollution.

BACKGROUND: Recent studies have reported inconsistent associations between maternal residential green space and preterm birth (PTB, born < 37 completed gestational weeks). In addition, windows of susceptibility during pregnancy have not been explored and potential interactions of green space with air pollution exposures during pregnancy are still unclear. OBJECTIVES: To evaluate the relationships between green space and PTB, identify windows of susceptibility, and explore potential interactions between green space and air pollution. METHODS: Birth certificate records for all births in California (2001-2008) were obtained. The Normalized Difference Vegetation Index (NDVI) was used to characterized green space exposure. Gestational age was treated as a time-to-event outcome; Cox proportional hazard models were applied to estimate the association between green space exposure and PTB, moderately PTB (MPTB, gestational age < 35 weeks), and very PTB (VPTB, gestational age < 30 weeks), after controlling for maternal age, race/ethnicity, education, and median household income. Month-specific green space exposure was used to identify potential windows of susceptibility. Potential interactions between green space and air pollution [fine particulate matter < 2.5 µm (PM2.5), nitrogen dioxide (NO2), and ozone (O3)] were examined on both additive and multiplicative scales. RESULTS: In total, 3,753,799 eligible births were identified, including 341,123 (9.09%) PTBs, 124,631 (3.32%) MPTBs, and 22,313 (0.59%) VPTBs. A reduced risk of PTB was associated with increases in residential NDVI exposure in 250 m, 500 m, 1000 m, and 2000 m buffers. In the 2000 m buffer, the association was strongest for VPTB [adjusted hazard ratio (HR) per interquartile range increase in NDVI: 0.959, 95% confidence interval (CI): 0.942-0.976)], followed by MPTB (HR = 0.970, 95% CI: 0.962-0.978) and overall PTB (HR = 0.972, 95% CI: 0.966-0.978). For PTB, green space during the 3rd - 5th gestational months had stronger associations than those in the other time periods, especially during the 4th gestational month (NDVI 2000 m: HR = 0.970, 95% CI: 0.965-0.975). We identified consistent positive additive and multiplicative interactions between decreasing green space and higher air pollution. CONCLUSION: This large study found that maternal exposure to residential green space was associated with decreased risk of PTB, MPTB, and VPTB, especially in the second trimester. There is a synergistic effect between low green space and high air pollution levels on PTB, indicating that increasing exposure to green space may be more beneficial for women with higher air pollution exposures during pregnancy.

Adverse Childhood Experiences and Changing Levels of Psychosocial Distress Scores Across Pregnancy in Kenyan Women.

BACKGROUND: Adverse childhood experiences (ACEs) have been associated with deleterious effects on mental health in pregnancy. METHODS: The ACE International Questionnaire (ACE-IQ) was used to measure neglect, abuse, and household dysfunction. Longitudinal mixed effect modelling was used to test the effect of ACEs on pregnancy-related anxiety, depressive symptoms, and perceived stress at two time points (12-19 and 22-29 weeks) during pregnancy. RESULTS: A total of 215 women who were predominantly married (81%) and had attained tertiary education (96%) were enrolled. Total ACEs were significantly associated with depressive symptoms (r = 0.23, p < 0.05) and perceived stress (r = 0.18, p < 0.05). As depressive symptoms decreased, t (167) = -8.44, p < 0.001, perceived stress increased, t (167) = 4.60, p < 0.001, and pregnancy-related anxiety remained unchanged as pregnancy progressed. Contact sexual abuse (p < 0.01) and parental death or divorce (p = 0.01) were significantly associated with depression over time (p < 0.01). Total ACEs in this study were associated with depressive symptoms early but not late in pregnancy. CONCLUSIONS: Higher total ACEs were positively associated with depressive symptoms and perceived stress during pregnancy, suggesting that mental disorders may have an impact on pregnancy outcomes and ought to be addressed. Further validation of the Edinburgh Postnatal Depression Scale (EPDS) tool in local settings is required.

Measurement of a Latino cultural value: The Simpatía scale.

OBJECTIVE: Simpatía, a term that captures the tendency to prefer and create social interactions characterized by warmth and emotional positivity while also avoiding conflict and/or overt negativity, is a cultural factor relevant to Latinos. The goal of this article was to develop a scale that measures this cultural value. METHOD: A self-report scale measure of simpatía was developed and administered to a combined sample of Latinos (N = 296) drawn from 3 larger studies. The scale's factor structure was explored, and its internal consistency and validity were tested. RESULTS: Exploratory factor analysis supported an 18-item scale and indicated 2 factors: simpatía-related positivity/warmth and simpatía-related negativity/conflict avoidance. Cronbach's alphas for the overall scale and subscales showed internal consistency. Validity analyses revealed that across subscales, simpatía was positively associated with positive emotion expressivity and dispositional positive emotion. The simpatía-related positivity/warmth subscale was also positively associated with an orientation toward Latino culture. CONCLUSIONS: The Simpatía Scale, which captures dual aspects of simpatía that emphasize the positive and avoid the negative, provides a new tool for advancing the study of Latino culture. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Ethnic disparity and exposure to supplements rather than adverse childhood experiences linked to preterm birth in Pakistani women.

BACKGROUND: Adverse childhood experiences (ACEs) are associated with prenatal mental health and negative pregnancy outcomes in high income countries, but whether the same association exists in Pakistan, a low- to middle-income (LMI) country, remains unclear. METHODS: Secondary data analyses of a prospective longitudinal cohort study examining biopsychosocial measures of 300 pregnant women at four sites in Karachi, Pakistan. A predictive multiple logistic regression model for preterm birth (PTB; i.e., <37 weeks' gestation) was developed from variables significantly (P < 0.05) or marginally (P < 0.10) associated with PTB in the bivariate analyses. RESULTS: Of the 300 women, 263 (88%) returned for delivery and were included in the current analyses. The PTB rate was 11.1%. We found no association between ACE and PTB. Mother's education (P = 0.011), mother's ethnicity (P = 0.010), medications during pregnancy (P = 0.006), age at birth of first child or current age if primiparous (P = 0.049) and age at marriage (P = 0.091) emerged as significant in bivariate analyses. Mother's ethnicity and taking medications remained predictive of PTB in the multivariate model. LIMITATIONS: Findings are limited by the relatively small sample size which precludes direct testing for possible interactive effects. CONCLUSIONS: In sum, pathways to PTB for women in LMI countries may differ from those observed in high-income countries and may need to be modelled differently to include behavioural response to emotional distress and socio-cultural contexts.

COVID-19 and Women's Health: A Low- and Middle-Income Country Perspective.

Corona Virus Disease (COVID-19), a contagious disease, is a global pandemic affecting the lives and health of individuals across borders, genders and races. Much of what is known about the effects of natural disasters and disease outbreaks on women's health in particular, is based on studies conducted in high-income countries. The evolving evidence suggests that COVID-19 has a profound negative impact on the perinatal mental health of women. It is also clear that global pandemics such as COVID-19 disproportionately affect the less affluent, including individuals living in low- and middle-income countries. The purpose of this review is to summarize and critically discuss extant knowledge on COVID-19 as it relates to the perinatal health of women in low and middle-income countries, using Pakistan as a case example. We specifically highlight the effects on perinatal mental health, preterm birth, and timing of the COVID-19 exposure. Our review suggests that it is essential to consider the effects of COVID-19 within this cultural context and that findings from high-income countries do not necessarily translate to the situation in low and middle-income countries.