Experiencing pregnancy in the context of lupus and antiphospholipid syndrome: a grounded theory.

OBJECTIVE: To understand the meanings attributed to pregnancy in the context of Lupus and antiphospholipid syndrome by women and healthcare professionals. METHOD: Qualitative research, using Symbolic Interactionism as a theoretical framework and Grounded Theory, a constructivist perspective. Data were collected between January and August 2022, through online interviews with 27 women with Lupus located on the social network Facebook and in-person or remote interviews with 12 healthcare professionals. RESULTS: The theoretical model constructed has two categories: "Equal conditions, distinct experiences: experiencing the gestational process" shows that obstetric complications and lack of connection with healthcare professionals trigger negative meanings to the experience; and "Therapeutic management interfering in the attribution of meanings to the experience", demonstrates that the way women interact with healthcare professionals and how they manage treatment favors a positive reframing. FINAL CONSIDERATIONS: The meanings attributed to pregnancy are elaborated and modified according to the interpretation of previous and current experiences, healthcare trajectory and interactions with healthcare professionals. Previous guidance, planning, bonding and trust in healthcare professionals enable positive meanings, while obstetric complications, unqualified assistance and lack of bonding with professionals provide negative meanings.

The effect of prenatal education on health anxiety of primigravid women.

BACKGROUND AND AIM: Health anxiety is a mental disorder that characterized by an excessive fear about health and physical symptoms. High anxiety in pregnancy is associated with adverse outcomes. The aim of this study was to investigate the effect of prenatal education on health anxiety of primigravid women. METHODS: The present study was quasi-experimental study. 122 primiparous pregnant women referred to comprehensive health services Shahrekord (A city in the southwest of Iran) clinics in 2019, after receiving consent to participate in the study, randomly divided into two intervention and control groups. The intervention group participated in 8 sessions (1.5-h), once every 2 weeks, from 20 to 37th weeks of gestation. The health anxiety questionnaire was completed on 20th (before the beginning of the courses), 28th and 37th weeks by two groups. Consequences of pregnancy included weight, Apgar score, delivery type, labor time and first breastfeeding time. SPSS version 16 software was used for data analysis. RESULTS: No significant difference was found type of delivery, gestational age, height, weight, head length, Apgar score, duration of hospitalization and first breastfeeding time. The duration of the active and latent phase of labor was significantly lower and the weight of newborn was significantly higher in the intervention group than the control group (P < 0.05). At 37th week, the scores of illness concern, negative consequence and total health anxiety in the intervention group decreased by 3.42, 0.93 and 4.36 respectively and in control group increased by 2.82, 0.03 and 2.86. CONCLUSION: Pregnancy educational courses has positive effects on health anxiety, decrease duration of labor time and increased newborn weight. In order to improve the outcome of pregnancy, educational classes during pregnancy should be considered.

Pre-pregnancy overweight or obesity moderates the association between prenatal maternal depressive symptoms and infant cord blood omega-3 levels.

BACKGROUND: Empirical evidence has demonstrated associations between pre-pregnancy obesity and perinatal maternal depressive symptoms. Omega-3 is an essential fatty acid derived from dietary sources that is critical for fetal brain development. Pre-pregnancy obesity is associated with higher omega-3 intake, but a weaker association between dietary intake and respective maternal and cord blood omega-3 levels. Further, lower intake of omega-3 during pregnancy has been linked to higher depressive symptoms. Yet, prior studies have not examined the interactive effects of pre-pregnancy overweight or obesity (OWOB) and prenatal maternal mental health symptoms on infant cord blood omega-3 levels. METHODS: Participants included 394 maternal-infant dyads from the NIH Environmental influences on Child Health Outcomes (ECHO) - Safe Passage Study in South Dakota. A pre-pregnancy body mass index (BMI) > 25 was used to dichotomize participants as OWOB (54%) vs. non-OWOB (46%). Prenatal maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) and prenatal maternal anxiety symptoms were measured using the State-Trait Anxiety Inventory (STAI). We implemented linear regression models to examine the interaction term between pre-pregnancy BMI category and prenatal maternal mental health symptoms on cord blood omega-3 levels. Secondary analyses were stratified by pre-pregnancy BMI category. RESULTS: We observed a significant interaction between pre-pregnancy BMI category and prenatal maternal depressive symptoms with cord blood omega-3 (F(4,379) = 6.21, p < .0001, adj. R2 = 0.05). Stratified models revealed an association between prenatal maternal depressive symptoms with lower cord blood omega-3 levels only among individuals with pre-pregnancy OWOB (ß = -0.06, 95% CI = -0.11, -0.02; F (2,208) = 4.00, p < .05, adj R2 = 0.03). No associations were observed among non-OWOB participants. CONCLUSIONS: Findings suggest maternal-placental transfer of omega-3 may represent one pathway by which maternal metabolic and mental health impacts infant development.

Awareness of urinary incontinence in pregnant women as a neglected issue: a cross-sectional study.

Background: Pregnancy and labor are independent risk factors for the development of urinary incontinence (UI). Although UI is common during pregnancy, it is a health problem mostly neglected by pregnant women. The high prevalence of UI in pregnancy and its effects on the postpartum period justifies the need to determine the knowledge and attitudes of pregnant women regarding the prevention and management of UI. It is necessary to increase the awareness of pregnant women about UI, educate, consultant, and integrate pelvic floor muscle training into prenatal care services. This study aims to determine the UI awareness of pregnant women and their knowledge and attitudes in this context. Methods: This cross-sectional study was conducted with 255 pregnant women in a university hospital in Turkey between March and September 2020. Data were collected using the Incontinence Knowledge Questionnaire (PIKQ) and Urinary Incontinence Attitude Scale (UIAS). Results: The UI prevalence was 51% during pregnancy. The mean score of PIKQ was 8.07±2.64, and only 6.3% of participants correctly answered all the questions regarding UI. The mean score of UIAS was 42.33±3.48. A positive correlation was found between UI knowledge and attitude score (r=0.35, p=0.00). Conclusions: The results showed that although UI is prevalent during pregnancy, pregnant women's knowledge of UI is poor. Nearly half of pregnant women need information. They tend to display positive attitudes towards UI, but not sufficient to improve their health-seeking behavior. Strategies should be developed to increase pregnant women's awareness of UI and to encourage them health-seeking behaviors for the prevention/management of UI during prenatal visits.

Impact of an intervention for perinatal anxiety on breastfeeding: findings from the Happy Mother-Healthy Baby randomized controlled trial in Pakistan.

BACKGROUND: The study examined the effects of Happy Mother-Healthy Baby (HMHB), a cognitive-behavioural therapy (CBT) intervention on breastfeeding outcomes for Pakistani women with prenatal anxiety. METHODS: Breastfeeding practices were evaluated in a randomized controlled trial between 2019 and 2022 in a public hospital in Pakistan. The intervention group was randomized to receive six HMHB sessions targeted towards prenatal anxiety (with breastfeeding discussed in the final session), while both groups also received enhanced usual care. Breastfeeding was defined in four categories: early breastfeeding, exclusive early breastfeeding, recent breastfeeding, and exclusive recent breastfeeding. Early breastfeeding referred to the first 24 h after birth and recent breastfeeding referred to the last 24 h before an assessment at six-weeks postpartum. Potential confounders included were mother's age, baseline depression and anxiety levels, stress, social support, if the first pregnancy (or not) and history of stillbirth or miscarriage as well as child's gestational age, gender. Both intent-to-treat and per-protocol analyses were examined. Stratified analyses were also used to compare intervention efficacy for those with mild vs severe anxiety. RESULTS: Out of the 1307 eligible women invited to participate, 107 declined to participate and 480 were lost to follow-up, resulting in 720 women who completed the postpartum assessment. Both intervention and control arms were similar on demographic characteristics (e.g. sex, age, income, family structure). In the primary intent-to-treat analysis, there was a marginal impact of the intervention on early breastfeeding (OR 1.38, 95% CI: 0.99-1.92; 75.4% (N = 273) vs. 69.0% (N = 247)) and a non-significant association with other breastfeeding outcomes (OR1.42, 95% CI: 0.89-2.27; (47) 12.9% vs. (34) 9.5%, exclusive early breastfeeding; OR 1.48, 95% CI: 0.94-2.35; 90% (N = 327) vs. 86% (N = 309), recent breastfeeding; OR1.01, 95% CI: 0.76-1.35; 49% (N = 178) vs 49% (N = 175) exclusive recent breastfeeding). Among those who completed the intervention's six core sessions, the intervention increased the odds of early breastfeeding (OR1.69, 95% CI:1.12-2.54; 79% (N = 154) vs. 69% (N = 247)) and recent breastfeeding (OR 2.05, 95% CI:1.10-3.81; 93% (N = 181) vs. 86% (N = 309)). For women with mild anxiety at enrolment, the intervention increased the odds of recent breastfeeding (OR 2.41, 95% CI:1.17-5.00; 92% (N = 137) vs. 83% (N = 123). CONCLUSIONS: The study highlights the potential of CBT-based interventions like HMHB to enhance breastfeeding among women with mild perinatal anxiety, contingent upon full participation in the intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT03880032.

The impact of prenatal mental health on birth outcomes before and during the COVID-19 pandemic in Anhui, China.

Adverse birth outcomes remain challenging public health problems in China. Increasing evidence indicated that prenatal depression and anxiety are associated with adverse birth outcomes, highlighting the importance and severity of prenatal depression and anxiety in China. The COVID-19 pandemic is likely to further exacerbate prenatal mental health problems and increase the risk of adverse birth outcomes. The aim of this study is to assess and compare the impacts of prenatal mental health issues on birth outcomes before and during the COVID-19 pandemic in Ma'anshan, Anhui, China. Participants in this study were women who visited local maternal and child health hospitals in Ma'anshan, Anhui, China. Two independent sets of individual maternal data (npre-pamdemic = 1148; npandemic = 2249) were collected. Prenatal depression and anxiety were measured online using the Edinburgh Postnatal Depression Scale (EPDS) and the General Anxiety Disorder-7 (GAD-7). Adverse birth outcomes were determined using hospital-recorded infant birth weight and gestational age at delivery. In this study, we found that the pandemic cohort had lower mean EPDS and GAD-7 scores than the pre-pandemic cohort. The prevalence of prenatal depression (14.5%) and anxiety (26.7%) among the pandemic cohort were lower than the pre-pandemic cohort (18.6% and 36.3%). No significant difference was found in the prevalence of adverse birth outcomes comparing the two cohorts. Prenatal depression was associated with small gestational age only in the pandemic cohort (OR = 1.09, 95% CI 1.00-1.19, p = 0.042). Overall, this study highlighted an association between prenatal depression and small for gestational age in Anhui, China. Addressing prenatal depression may thus be key in improving birth outcomes. Future studies could focus on potential causal relationships.

Comparative analysis of general and pregnancy-related prenatal anxiety symptoms: progression throughout pregnancy and influence of maternal attachment.

Pregnancy-specific anxiety (PSA) has been differentiated from general anxiety (GA) to better account for the heterogeneity of prenatal anxiety and possible measurement bias. A longitudinal study was conducted to determine the evolution of maternal anxiety symptoms during pregnancy, distinguishing PSA and GA, and the influence of maternal attachment A sample of 155 women (mean age 32.5, SD 3.88) were enrolled in their first trimester of pregnancy (T1) in one center and follow throughout their pregnancy. The Relationship Scales Questionnaire (RSQ), the State-Trait Anxiety Inventory (STAI), and the Pregnancy-Related Anxiety Questionnaire (PRAQ) were completed at T1, and, for the last two, at the second (T2) and third trimesters of pregnancy (T3). Multi-level model found significant decreases in the PRAQ total score and the STAI total score between T1 and T3, but only the PRAQ total score decreased from T1 to T2. Preoccupied maternal attachment was independently associated with higher PRAQ and STAI total scores at T1, T2, and T3. Considering the progressive decline of the levels of PSA and GA during pregnancy, interventions should focus on pregnant mothers with risk factors for a persisting course of anxiety such as preoccupied attachment.

Study protocol: perinatal mood treatment study.

Perinatal depression (PND) affects up to 20% of women and is associated with significant impairment and disability in affected women. In addition, perinatal depression is associated with broader public health and multigenerational consequences. Innovative approaches are needed to reduce the burden of perinatal depression through identification, tracking, and treatment of depressive symptoms during the perinatal period. This study is a randomized clinical trial comparing the relative efficacy of a multi-tiered system of care, Screening and Treatment of Anxiety and Depression (STAND) to perinatal care delivered by a reproductive psychiatrist in reducing symptoms of depression and anxiety. A sample of 167 individuals was randomized between week 28 of pregnancy and 6 months postpartum. A secondary aim compares the original online therapy intervention used in the first half of the study to a newer online therapy program used in the second half of the study for individuals assigned to the STAND treatment. The study measures, intervention groups, and analysis methods are described, as well as expected implications. The findings from this study may improve the methods for tracking symptom changes over time, monitoring treatment response, and providing personalized care for individuals with PND. As such, this study may improve the lives of patients with PND and their families and lower the related health care costs to society.Trial registration NCT: 9/24/2021NCT direct link: https://www.clinicaltrials.gov/study/NCT05056454?term=NCT05056454&rank=1&a=1 .

Maternal Fiber Intake and Perinatal Depression and Anxiety.

(1) Background: Dietary fiber can significantly alter gut microbiota composition. The role of the gut microbiome in the Gut-Brain Axis and modulation of neuropsychiatric disease is increasingly recognized. The role of antenatal diet, particularly fiber intake, in mitigating maternal mental health disorders remains unexplored. The objective of this review is to investigate the association between maternal fiber intake and perinatal depression and anxiety (PDA). (2) Methods: A literature review of PubMed and Google Scholar was conducted using appropriate keyword/MeSH terms for pregnancy, diet, fiber, and mental health. Observational and clinical trials published between 2015 and 2021 were included and data pertaining to dietary patterns (DP), food intake, mental health, and demographic data were extracted. The top three fiber-containing food groups (FG) per study were identified using a sum rank scoring system of fiber per 100 g and fiber per serving size. The consumption of these top three fiber FGs was then ranked for each dietary pattern/group. Mental health outcomes for each study were simplified into three categories of improved, no change, and worsened. The relationship between top three fiber FGs consumed within each DP and mental health outcomes was analyzed using Spearman's correlation. (3) Results: Thirteen of fifty-two studies met the inclusion criteria. Ten (76.9%) studies assessed DPs (seven examined depression only, two examined depression and anxiety, and one examined anxiety only). Seven (53.9%) studies reported at least one significant positive relationship between mental health outcomes and DPs while three reported at least one negative outcome. Three (23.1%) studies compared intake of different food groups between depressed and non-depressed groups. In studies of DPs, the average consumption ranking of the top three fiber FGs bore a significant inverse association with mental health outcomes [r = -0.419 (95%CI: -0.672--0.078)] p = 0.015. In studies comparing the intake of different FGs between depressed and non-depressed groups, the consumption of top-ranking fiber foods was higher in the non-depressed groups, but significantly higher in four of the ten high fiber FGs. (4) Conclusions: This study reframes findings from previously published studies of maternal diet and mental health outcomes to focus on fiber intake specifically, using a fiber ranking system. A significant correlation between lower intake of fiber and poorer mental health outcomes warrants further investigation in future studies.

Perinatal mental health and active-duty military spouses: a scoping review.

INTRODUCTION: Mental health conditions (i.e. depression or anxiety) are the most common complication of pregnancy and childbirth in the United States (U.S.) and are associated with increased maternal and infant morbidity and mortality. Research has demonstrated a relationship between stress and mental health diagnoses in pregnancy; therefore, it is concerning that military families face unique challenges which contribute to additional stressors among spouses of active-duty (AD) military personnel during the perinatal period. The objective of this scoping review was to understand the current state of research on perinatal stress or perinatal mental health among American spouses of AD military personnel. METHODS: The Boolean phrase was created in consultation with 2 health science librarians and the following databases searched in October 2023: PubMed, Embase, Military and Government Collection, CINAHL, and PsychINFO. 2 reviewers identified 481 studies for screening once duplicates were removed. After applying inclusion and exclusion criteria, 21 studies remained for data extraction and analysis. RESULTS: Most of the studies were quantitative, took place in the southern U.S., and the most represented military branch was Air Force. Most of the studies included both AD military members and AD spouses; 28% focused solely on AD spouses. Samples were not racially diverse, and findings identified racial disparities in perinatal mental health conditions. There was a wide variety in outcome measures, including the following general categories: (1) stress, anxiety, and/or depression, (2) maternal-infant attachment, (3) group prenatal care, and (4) deployment focus. Our review identified the following concepts: spouses most at risk for perinatal mental health conditions, the need for perinatal mental health screening, and the need for social support. CONCLUSIONS: Findings from the identified studies indicate a need for additional research in this area. Additionally, findings highlight circumstances unique to this population that result in an increased risk of stress and/or mental health conditions during the perinatal period. Such challenges demand improved mental health screening and additional resources for this population. Meeting the needs of this unique population also requires significant funding and policy change to allow for increased access to mental health resources and to ensure the health of the birthing person and infant.

Experiences of smoking and tobacco use during pregnancy: A qualitative study protocol.

Tobacco use during pregnancy is the main avoidable cause of morbidity and mortality both for pregnant women and their offspring. Between 12 and 22% of pregnant women in industrialized countries smoke during pregnancy, and 13% are unable to stop smoking. Pregnancy is considered an ideal opportunity to intervene and control tobacco use among smokers and their families. However, pregnant women experience barriers to quitting smoking, including social stigma and fear of being judged. Thus, it is necessary to develop interventions for smoking cessation adapted for pregnant women. This paper presents a qualitative study protocol to assess the barriers and facilitators of smoking cessation during pregnancy that female smokers encounter or perceive. It consists of a series of focus groups and individual interviews with female smokers who have been pregnant within the last five years. Participants will be recruited from the Sexual and Reproductive Health Care Services of the Camp de Tarragona. A group of 5-10 women who have been pregnant and tried to quit smoking over the last 5 years will be selected. The data will be collected by means of semistructured interviews. All interviews will be transcribed verbatim, coded and synthesized into categories and main themes. Thematic analysis will be conducted employing an iterative and reflexive approach. The results of this study will offer new perspectives on smoking interventions for pregnant women and enhance our comprehension of the main barriers to and facilitators of smoking cessation during pregnancy. This will contribute to the adaptation of the Tobbstop app, originally designed for the general public, to suit the needs of pregnant women. Consequently, the creation of targeted interventions will positively influence the health outcomes of both pregnant women and newborns. Trial registration: Clinicaltrials.gov ID: NCT05222958. The trial was registered 3 February 2022, at https://clinicaltrials.gov/ct2/show/NCT05222958.

Exploring women's perception and attitude towards antidepressant use: a cross-sectional study.

BACKGROUND: The World Health Organization reports that depression affects more than 280 million people globally. Women are approximately 50% more likely to experience depression compared to men. Depression during pregnancy leads to deterioration of the mother's and the fetus's health. We aim to explore women's perceptions and attitudes toward using antidepressants and to identify the factors that influence decision-making regarding antidepressant use. METHOD: A cross-sectional survey, employing a convenience sampling method, was conducted on a university campus in Riyadh, Saudi Arabia. The survey was developed by the investigators and validated by health practitioners. Answers were reported using a 5-point Likert scale. The responses were summed up to give a total score for each respondent. Respondents who scored above or equal 75% of the total score was considered positive perception or favorable attitude. Binary logistic regression analysis was used to identify factors influencing participants' perception and attitude toward taking antidepressants. RESULTS: A total of 991 subjects were surveyed. The majority of women had negative perceptions and favorable attitudes towards using antidepressants during pregnancy reaching 64%. While women with positive perceptions and favorable attitudes represented about 20% of the study subjects. Participants reported that social stigma, religious beliefs, and fear of addiction significantly influenced their attitudes toward antidepressant use. CONCLUSIONS: This study explores women's perceptions of depression and antidepressant use, revealing that a significant proportion of Saudi women have a negative perception. The research emphasizes the need for tailored awareness programs to promote informed decision-making regarding antidepressant usage among Saudi women.

Physical activity and sleep quality among pregnant women during the first and second trimesters are associated with mental health and adverse pregnancy outcomes.

BACKGROUND: Appropriate physical activity (PA) and good sleep are beneficial to maternal and fetal health. This paper sought to explore the associations of PA and sleep quality among healthy women at the first and second trimesters of pregnancy on mental health and pregnancy outcomes. METHODS: Totally 268 healthy pregnant women were retrospectively analyzed as study subjects, 134 each in the first trimester (FT) and second trimester (ST). Their baseline clinical data were obtained respectively at two stages of pregnancy. The PA/sleep quality of subjects were assessed through the Pregnancy Physical Activity Questionnaire-Chinese version (PPAQ-C)/Pittsburgh Sleep Quality Index (PSQI) scale. The mental health was assessed via the Hospital Anxiety and Depression Scale (HADS). The correlations of PA and sleep quality with mental health were analyzed using Spearman correlation analysis. Pregnancy outcomes of all subjects, associations of moderate intensity (MI) PA and sleep quality with adverse pregnancy outcomes, and independent influencing factors for adverse outcomes were analyzed. RESULTS: Pregnant women in the ST group exhibited higher levels of MI, worse sleep quality, and lower levels of anxiety and depression than those in the FT group. Anxiety and depression were negatively correlated with MI but positively linked with PSQI scores at the first and second trimesters. MI ≥ 7.5 MET-h/week and good sleep quality were associated with a reduced incidence of adverse pregnancy outcomes. CONCLUSION: MI ≥ 7.5 MET-h/week and good sleep quality at the first and second trimesters of pregnancy benefit mental health and markedly reduce the occurrence of adverse pregnancy outcomes.

Navigating weight, risk and lifestyle conversations in maternity care: a qualitative study among pregnant women with obesity.

BACKGROUND: Pregnant women with obesity face heightened focus on weight during pregnancy due to greater risk of medical complications. Closer follow-up in maternety care may contribute to reduce risk and promote health in these women. The aim of this study was to gain a deeper insight in how pregnant women with obesity experience encounters with healthcare providers in maternity care. How is the received maternity care affected by their weight, and how do they describe the way healthcare providers express attitudes towards obesity in pregnancy? METHODS: We conducted in-depth interviews with 14 women in Trøndelag county in Norway with pre-pregnancy BMI of ≥ 30 kg/m2, between 3 and 12 months postpartum. The study sample was strategic regarding age, relationship status, education level, obesity class, and parity. Themes were developed using reflexive thematic analysis. The analysis was informed by contextual information from a prior study, describing the same participants' weight history from childhood to motherhood along with their perceptions of childhood quality. RESULTS: This study comprised of an overarching theme supported by three main themes. The overarching theme, Being pregnant with a high BMI: a vulnerable condition, reflected the challenge of entering maternity care with obesity, especially for women unprepared to be seen as "outside the norm". Women who had grown up with body criticism and childhood bullying were more prepared to have their weight addressed in maternity care. The first theme, Loaded conversations: a balancing act, emphasizes how pregnant women with a history of body criticism or obesity-related otherness proactively protect their integrity against weight bias, stigma and shame. The women also described how some healthcare providers balance or avoid weight and risk conversations for the same reasons. Dehumanization: an unintended drawback of standardized care makes apparent the pitfalls of prioritizing standardization over person-centered care. Finally, the third theme, The ambivalence of discussing weight and lifestyle, represent women's underlying ambivalence towards current weight practices in maternity care. CONCLUSIONS: Our findings indicate that standardized weight and risk monitoring, along with lifestyle guidance in maternity care, can place the pregnant women with obesity in a vulnerable position, contrasting with the emotionally supportive care that women with obesity report needing. Learning from these women's experiences and their urge for an unloaded communication to protect their integrity highlights the importance of focusing on patient-centered practices instead of standardized care to create a safe space for health promotion.

An analytic cross-sectional study of Somali women on the sexual and psychosocial status during pregnancy.

BACKGROUND: Pregnancy is associated with physical, psychological, hormonal, and social alterations that may lead to detrimental effects on sexual function and psychological well-being. This study sought to examine sexual function and psychosocial well-being of pregnant women in Somalia in comparison with their non-pregnant counterparts. METHODS: We enrolled 487 consecutive women in monogamous marriages. Data included maternal age, gravida, parity, gestational week, education status of wives and husbands, and residence area. The participants completed the Female Sexual Function Index (FSFI) and the Brief Symptom Inventory-18 (BSI-18). RESULTS: Of 487 women, 241 were pregnant, and 246 were non-pregnant. The overall incidence of sexual dysfunction was 57.7%, being 64.0% for pregnant and 51.6% for non-pregnant women (p = 0.010). Pregnant women exhibited significantly lower FSFI scores on desire, arousal, lubrication, and orgasm, and significantly higher total BSI, anxiety, depression and somatization scores. The frequencies of sexual dysfunction were 57.9%, 45.9%, and 78.9% during the first, second, and third trimesters, respectively (p = 0.0001). As compared with the first and second trimesters, and non-pregnancy, the third trimester of pregnancy was associated with a significantly lower total FSFI score and significantly decreased levels of desire, arousal, lubrication, and orgasm, as well as a significantly higher total BSI score and a significantly increased level of anxiety. In regression analysis, pregnancy was inversely associated with sexual function parameters of desire, arousal, lubrication, and orgasm, and with BSI parameters of depression, anxiety and somatization. CONCLUSION: Our findings suggest that pregnant women experience considerable sexual and psychosocial deterioration as compared with their non-pregnant counterparts.

Adolescent pregnancy - medical, legal and social issues.

THE PURPOSE OF THE ARTICLE: The article aims to indicate the interdisciplinary and complex nature of the problem of adolescent pregnancy. MATERIALS AND METHODS: An analysis of materials contained in the literature on adolescent pregnancy was used. RESULTS: Adolescent pregnancy is both a serious health and social challenge. Lack of proper sex education, regressive age of sexual initiation, emotional immaturity and limited access to contraception are the main reasons for teenage pregnancy. It can also be the result of sexual abuse, which is a punishable offense. Pregnancy in minors is associated with a higher risk of complications for both the mother and the fetus, such as hypertension, preterm birth, low birth weight, fetal growth restriction, and preeclampsia. Pregnancy is a significant psychological burden and a major trauma for girls. Low socioeconomic status and lack of support from the family or partner exacerbate this problem, increasing the risk of depression and substance abuse. As a multidisciplinary problem, it requires action on multiple fronts to prevent it and to reduce the number of adolescent pregnancies. Increasing access to contraception, medical care, and sexual education is crucial in combating this issue. Adolescent pregnant women are a group of women who require special antenatal care. When planning educational activities for these patients, one should remember about the specific needs of said girls related to key nutrients such as iodine, iron, folic acid, and calcium. A poor diet may result from difficult living conditions and conflicts with family and partners. Moreover, this pregnancy is often unplanned. CONCLUSIONS: A good solution for pregnant adolescents would be the possibility of specialized assistance not only in gynecology and obstetrics, sexology, but also pedagogical, psychological, sociological and dietary.

Determinants of sleep quality among pregnant women in a selected institution in the Southern province, Sri Lanka.

BACKGROUND: Sleep is a vital requirement during pregnancy for the betterment of the fetus and the mother. Sleep quality could vary due to pregnancy-specific psychological and physiological changes. To introduce a tailored programme to enhance the sleep quality of mothers, it is paramount to assess the sleep quality and determinants of sleep. Therefore, this study aimed to assess the determinants of sleep quality among pregnant women in a selected institution in the Southern province of Sri Lanka. METHODS: Hospital-based cross-sectional study was carried out with 245 antenatal women, selected using a systematic random sampling method. A pretested self-administered questionnaire was used to collect data which contains four parts. Below variables were involved and both continuous and categorical data were collected as required. 'Maternal sleep quality, socio-demographic data and gestational age, maternal depression and anxiety.' Data were analyzed using IBM SPSS version 25.0 for Windows by using descriptive statistics, Pearson's Chi-square test, and independent sample T-test (p < 0.05). Logistic regression analysis was used to find the relationship with sleep quality and other variables. P-value of less than 0.05 was considered statistically significant, at 95% CI. RESULTS: The majority of women (60.8%) had good sleep quality and they didn't have either depressive symptoms (63.4%) or anxiety (64.2%). Aged between 34-41 years and third-trimester women had higher rates of poor sleep quality. Varying quality of sleep was identified among three-trimesters with subjective sleep quality, sleep latency, habitual sleep efficiency, and sleep disturbances. In comparison with the first and second trimester, pregnant women in the third trimester had higher score of global PSQI (5.22 ± 2.35), subjective sleep quality (1.23 ± 0.70), sleep latency (1.25 ± 0.86), habitual sleep efficiency (0.14 ± 0.43), and sleep disturbances (1.39 ± 0.58). There was a significant association between gestational age (P = .006), maternal age (P = .009), antenatal depression (P = .034), and anxiety (P = .013) with sleep quality. However, multinomial logistic regression revealed that only gestational age affected on quality of sleep. The first trimester was a protective factor for good quality sleep (Adjusted OR = 3.156) compared to the other two trimesters. CONCLUSION: This study revealed that the majority of women had good sleep quality but quality of sleep was deprived with gestational age. It is expected that the findings of this research will be helpful for health and social care policymakers when formulating guidelines and interventions regarding improving the quality of sleep among pregnant women in Sri Lanka.

The mediating effect of maternal gut microbiota between prenatal psychological distress and neurodevelopment of infants.

BACKGROUND: Prenatal psychological distress and maternal inflammation can increase the risk of neurodevelopmental delay in offspring; recently, the gut microbiota has been shown to may be a potential mechanism behind this association and not fully elucidated in population study. METHODS: Seventy-two maternal-infant pairs who completed the assessments of prenatal psychological distress during the third trimester and neurodevelopment of infants at age 6-8 months of age were included in this study. The gut microbiota and its short-chain fatty acids (SCFAs) of maternal-infant were determined by 16S rRNA sequencing and liquid chromatography-mass spectrometry analysis. Inflammatory cytokines in the blood of pregnant women during the third trimester were detected by luminex liquid suspension microarrays. RESULTS: This study found that infants in the prenatal psychological distress group had poorer fine motor skills (ß = -4.396, 95 % confidence interval (CI) = -8.546, -0.246, p = 0.038), problem-solving skills (ß = -5.198, 95 % CI = -10.358, -0.038, p = 0.048) and total development (ß = -22.303, 95%CI = -41.453, -3.153, p = 0.022) compared to the control group. The study also indicated that the higher level of interleukin-1ß (IL-1ß) (ß = -1.951, 95%CI = -3.321, -0.581, p = 0.005) and interferon-inducible protein-10 (IP-10) (ß = -0.019, 95%CI = -0.034, -0.004, p = 0.015) during the third trimester, the poorer fine motor skills in infants. Also, the higher level of IL-10 (ß = -0.498, 95%CI = -0.862, -0.133, p = 0.007), IL-12p70 (ß = -0.113, 95%CI = -0.178, -0.048, p = 0.001), IL-17 A (ß = -0.817, 95%CI = -1.517, -0.118, p = 0.022), interferon-γ (ß = -0.863, 95%CI = -1.304, -0.422, p < 0.001), IP-10 (ß = -0.020, 95%CI = -0.038, -0.001, p = 0.035), and regulated upon activation normal T cell expressed and secreted (ß = -0.002, 95%CI = -0.003, -0.001, p = 0.005) during the third trimester, the poorer problem-solving skills in infants. After controlling for relevant covariates, this study found that maternal gut microbiota Roseburia mediates the relationship between prenatal psychological distress and total neurodevelopment of infants (a = 0.433, 95%CI = 0.079, 0.787, p = 0.017; b = -19.835, 95%CI = -33.877, -5.792, p = 0.006; c = 22.407, 95%CI = -43.207,-1.608, p = 0.035; indirect effect = -8.584, 95%CI = -21.227, -0.587). CONCLUSIONS: This is the first study to emphasize the role of the maternal-infant gut microbiota in prenatal psychological distress and infant neurodevelopment. Further studies are needed to explore the biological mechanisms underlying the relationship between prenatal psychological distress, maternal-infant gut microbiota, and infant neurodevelopment.

Associations between maternal early pregnancy depression and longitudinal fetal growth.

BACKGROUND: The impacts of maternal depression during mid-to-late pregnancy on fetal growth have been extensively investigated. However, the association between maternal depression during early pregnancy and fetal intrauterine growth are less clear. METHODS: A prospective study comprised 23,465 eligible pregnant women and their offspring was conducted at a hospital-based center in Shanghai. Prenatal depression was assessed used using Patient Health Questionnaire (PHQ-9) before 14 gestational weeks. Differences in fetal growth trajectory of different maternal depressive statuses during three periods (16-23, 24-31, and 32-41 gestational weeks) were compared using a multilevel model with fractional polynomials. RESULTS: Women with depressive symptoms during early pregnancy had higher longitudinal fetal trajectories, with an estimated increase in fetal weight (ß = 0.33; 95 % CI, 0.06-0.61), compared to those without depressive symptoms. Increases in fetal abdominal circumference among women with depressive symptoms were observed before 23 gestational weeks. Offspring born to mothers with early pregnancy depression had a significantly higher birth weight of 14.13 g (95 % CI, 1.33-27.81 g) and an increased risk of severe large size for gestational age (adjusted odds ratio [aOR], 1.64; 95 % CI, 1.32-2.04) and macrosomia (aOR, 1.21; 95 % CI, 1.02-1.43). LIMITATIONS: Self-rated scale was used to assess depressive symptoms rather than clinical diagnosis. And Long-term effects of early pregnancy depression on offspring were not explored. CONCLUSIONS: The study revealed an association between maternal depression during early pregnancy and increased fetal biometrics, higher birth weight, and an elevated risk of severe large size for gestational age and macrosomia.