Implications of childhood adversity for women's perinatal sleep quality and depressive symptoms over time: A serial mediation model.

This study sought to examine the effects of childhood adversity on the longitudinal associations between perinatal sleep quality and depressive symptoms, and to determine the prospective associations between these constructs over time. A cross-lagged autoregressive model was used to examine the longitudinal association between sleep quality and depressive symptoms at four points during the perinatal period: 18 and 32 weeks of pregnancy, and 6 and 12 weeks postpartum. Longitudinal mediation models were used to examine whether sleep quality or depressive symptoms mediated the effects of childhood adversity on these symptoms. Most participants (86%) reported poor sleep quality during pregnancy. Significant cross-lagged effects of depressive symptoms on subsequent sleep quality were observed during pregnancy and postpartum. Depressive symptoms significantly mediated the effects of childhood trauma on sleep quality during pregnancy, but sleep quality did not significantly mediate the effects of childhood trauma on depressive symptoms. While sleep quality and depressive symptoms tend to co-occur, our analyses indicate that perinatal depressive symptoms work as the primary driver of sleep quality over time. Childhood adversity may have long-reaching effects in women as it was associated with more depressive symptoms in the perinatal period, which in turn appeared to undermine sleep quality.

Deep health: A qualitative, woman-centered perspective of health during pregnancy.

OBJECTIVE: To explore and define a woman-centered perspective on health during pregnancy. DESIGN: Qualitative study using abductive thematic analysis of semi-structured interview data. SETTING & PARTICIPANTS: Twenty pregnant participants, primarily single and low-income, were recruited from an urban women's health clinic in the Midwestern United States and interviewed during mid-to-late pregnancy. FINDINGS: Women experienced health as "deeper than physical health" to include emotional well-being, financial stability, and support. We defined the central theme of Deep Health to be an embodied sense of happiness, energy, stability, and purpose (Being) supported through positive health practices (Doing) and adequate financial and social resources (Having). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: While the Doing aspects of health are often a focal point for health promotion efforts in prenatal care, a restricted focus on lifestyle behaviors may contribute to a lack of shared understanding about health between women and their healthcare providers. Greater attention to the Being and Having aspects of health may work to bolster shared priorities for health between pregnant women and their providers.

An integrative review of factors and interventions affecting the well-being and safety of nurses during a global pandemic.

BACKGROUND: Nurses experienced physical and mental exhaustion during the COVID-19 pandemic. Understanding the impact of the pandemic on nurses and effective strategies to support them is critical for increasing nurse resilience and reducing burnout. AIMS: The aims of this study were (1) to synthesize the literature examining how factors associated with the COVID-19 pandemic affected the well-being and safety of nurses (2) and to review interventions which may promote nurse mental health during crises. METHODS: Using an integrative review approach, a comprehensive search of the literature was conducted in March 2022 using the following databases: PubMed, CINAHL, Scopus, and Cochrane. We included quantitative, qualitative, and mixed-method primary research articles published in English in peer-reviewed journals from March 2020 through February 2021. Included articles focused on nurses caring for COVID-19 patients and addressed psychological factors, supportive hospital leadership strategies, or interventions to support well-being. Studies were excluded if they focused on professions outside of nursing. Included articles were summarized and appraised for quality. Findings were synthesized using content analysis. RESULTS: Of the 130 articles initially identified, 17 were included. Articles were quantitative (n = 11), qualitative (n = 5), and mixed methods (n = 1). Three themes were identified: (1) loss of life, hope, and professional identity; (2) lack of visible and supportive leadership; and (3) insufficient planning and response. These experiences contributed to increased symptoms of anxiety, stress, depression, and moral distress in nurses.

Linking Electronic Health Records With Wearable Technology From the All of Us Research Program.

OBJECTIVE: To evaluate the feasibility of using electronic health records (EHRs) and wearable data to describe patterns of longitudinal change in day-level heart rate before, during, and after pregnancy and how these patterns differ by age and body mass index. DESIGN: Descriptive secondary analysis feasibility study using data from the National Institutes of Health All of Us Research Program. SETTING: United States. PARTICIPANTS: Women (N = 89) who had a birth or length of gestation code in the EHR and at least 60 days of Fitbit heart rate data during pregnancy. METHODS: We estimated pregnancy-related episodes using EHR codes. Time consisted of five 3-month periods: before pregnancy, first trimester, second trimester, third trimester, and after birth. We analyzed data using descriptive statistics and locally estimated scatterplot smoothing. RESULTS: An average of 330 days (SD = 112) of Fitbit heart rate data (29,392 days) were available from participants. During pregnancy, distinct peaks in heart rate occurred during the first trimester (6% increase) and third trimester (15% increase). CONCLUSION: Future researchers can examine whether longitudinal timing and patterns of heart rate from wearable devices could be leveraged to detect health problems early in pregnancy.

Social Support Buffers the Effects of Prenatal Depressed Mood: A Mixed-Methods Study.

BACKGROUND: Women use various coping strategies to deal with stress and depression. These strategies are shaped by social contexts over the life course and may attenuate and/or exacerbate the physiologic effects of depression. AIMS: The purpose of this study was to determine whether coping strategies (active, disengaged, or social support coping) moderate depression-related diurnal cortisol dysregulation and to explore how social context influences women's use of coping. METHODS: This was a mixed-methods study of pregnant women (N = 65) during mid-pregnancy. Cortisol was measured in saliva collected during the waking hours of the day. Participants completed the Edinburgh Depression Scale and the Brief COPE. A subset of the sample participated in semistructured qualitative interviews (n = 20). RESULTS: Social support coping, but not active or disengaged coping, moderated end-of-day cortisol levels. Among depressed women, higher use of social support was associated with lower and more dynamic (i.e., less flat) diurnal cortisol rhythms. The qualitative findings revealed how complex social dynamics related to financial insecurity, lack of mutuality, and social identity affected women's use of and access to social support. CONCLUSION: These findings support theories of the stress-buffering effects of social support. Future research is needed to examine how social determinants affect access to social support, and how early life social experiences condition women's adaptive formation of social support coping strategies over the life course. Clinically, these findings underscore the value of relationship-centered nursing care for depressed women.

Integrative Review of Early Life Adversity and Cortisol Regulation in Pregnancy.

OBJECTIVE: To synthesize published findings on the relationship between early life adversity and hypothalamic-pituitary-adrenal axis cortisol parameters in pregnant women. DATA SOURCES: We searched PubMed, CINAHL, and PsycINFO databases using variants and combinations of the keywords early life adversity, pregnancy, hypothalamic-pituitary-adrenal axis, and cortisol. STUDY SELECTION: We selected articles that included pregnant participants, included measures of cortisol and early life adversity, were published in English in a peer-reviewed journal, and were of sufficient methodologic quality. Date of publication was unrestricted through May 2020. DATA EXTRACTION: Twenty-five articles met the inclusion criteria and were evaluated for quality and risk of bias. Sources of cortisol included saliva, hair, plasma, and amniotic fluid. DATA SYNTHESIS: We categorized findings according to four physiologically distinct cortisol output parameters: diurnal (daily pattern), phasic (in response to an acute stressor), tonic (baseline level), and pregnancy-related change. Preliminary evidence suggests that early adversity may be associated with elevated cortisol awakening response (diurnal) and blunted response to acute stressors (phasic), irrespective of other psychosocial symptoms or current stress. For women with high levels of current stress or psychological symptoms, early adversity was associated with higher baseline (tonic) cortisol levels. CONCLUSION: Early life adversity in women is linked with alterations in cortisol regulation that are apparent during pregnancy. Researchers should examine how variations in each cortisol parameter differentially predict pregnancy health risk behaviors, maternal mental health, and neonatal health outcomes.

Early life adversity and depressive symptoms predict cortisol in pregnancy.

Evidence suggests that exposure to early life adversity (ELA) programs the hypothalamic-pituitary-adrenal (HPA) axis to influence responses to later adversity and predisposes women to depression. However, few studies have examined whether ELA moderates the HPA cortisol response to adulthood adversity and depressive symptoms in pregnant women. The aims of this study were to determine (a) whether ELA, adulthood adversity, and depressive symptoms differentially predict patterns of cortisol and (b) whether ELA moderates the relationship of adulthood adversity or depressive symptoms to cortisol. This was a descriptive, cross-sectional study of pregnant women (N = 58, mean = 26.5 weeks gestation). Participants completed the Stress and Adversity Inventory and Edinburgh Depression Scale and collected salivary cortisol five times per day for 3 days to assess cortisol awakening response (CAR), diurnal cortisol slope, and cortisol area under the curve (AUC). ELA predicted a larger CAR, while depressive symptoms predicted a blunted CAR and higher cortisol AUC. Adulthood adversity predicted a blunted CAR and steeper diurnal slope, but only in women with high ELA. ELA also moderated the effect of depressive symptoms on diurnal slope. Early adversity and depressive symptoms appear to have significant effects on the HPA axis during pregnancy, with early adversity also moderating effects of depressive symptoms and adulthood adversity on cortisol regulation. Early adversity may be an important factor in identifying unique HPA phenotypes and risk for HPA axis dysregulation in pregnancy.

Interleukin-17A and Chronic Stress in Pregnant Women at 24-28 Weeks Gestation.

BACKGROUND: Allostatic load (AL) is a biopsychosocial model that suggests chronic psychosocial stress leads to physiological dysregulation and poor outcomes. The purpose of this study was to examine AL in pregnant women operationalized using proinflammatory cytokines and psychosocial indicators and perinatal outcomes. OBJECTIVES: The aim of the study was to identify relationships between circulating cytokines/chemokines and the Prenatal Distress Questionnaire, the Maternal Antenatal Attachment Scale, the Emotional Quotient Inventory, the Life Experiences Scale, and demographics in pregnant women. METHODS: A cross-sectional design was used to recruit pregnant women between 24 and 28 weeks of gestation. Blood and stress/emotional indicators were obtained after informed consent. Plasma was abstracted to simultaneously measure 29 cytokines/chemokines using a multiplex array. Cytokine/chemokine levels were compared with continuous variables using Spearman's rho and with categorical variables using Mann-Whitney U. RESULTS: Twenty-five women with medically high-risk (n = 16) and low-risk (n = 9) pregnancies consented. Most women were White (68%) with a mean age of 29 years (SD = 5.9). Although several cytokines and chemokines showed significant correlations with the stress/emotional indicators, only interleukin-17A (IL-17A) was significantly associated with all of the indicators (Prenatal Distress Questionnaire: rs = .528, p = .012; Maternal Antenatal Attachment Scale: rs = -.439, p = .036; Emotional Quotient Inventory total: rs = -.545, p = .007), Life Experiences Scale (rs = .458, p = .032), birth weight (rs = -.499, p = .013), and race (p = .01). DISCUSSION: Increased levels of IL-17A, a known cytokine associated with chronic stress and with poor perinatal outcomes, were associated with high prenatal distress, low maternal attachment, and lower emotional intelligence in pregnant women. Increased levels of IL-17A also were associated with lower birth weight and non-White race. Results support the model of AL in pregnant women and highlight IL-17A as a potential biomarker of AL during pregnancy.

Are Heart Failure and Coronary Artery Bypass Surgery Patients Meeting Physical Activity Guidelines?

PURPOSE: The purpose of this study was to describe subjective and objective physical activity (PA) levels of two groups of cardiovascular patients who were either post-coronary artery bypass graft (CABG) surgery or diagnosed with heart failure (HF). DESIGN: A descriptive comparative design was used for this secondary analysis of data from two prior studies. METHODS: A convenience sample of 62 outpatients was used to examine PA objectively (Actiheart accelerometer) and subjectively (PA interview). FINDINGS: Objectively, 33% of CABG patients and no HF patients met PA recommendations of ≥ 150 min/week. Subjectively, 56% of CABG and 38% of HF patients reported meeting PA recommendations. CONCLUSIONS: Few patients in the current study met PA recommendations. CLINICAL RELEVANCE: Innovative rehabilitation nursing practice strategies are needed (e.g., use of activity trackers, making PA a vital sign) to assist patients in gaining the knowledge and skills to be more active and adhere to PA recommendations.