Predictors of recovery from prenatal depressive symptoms from pregnancy through postpartum.

BACKGROUND: Identifying predictors of the course of depressive symptoms from pregnancy through postpartum is important to inform clinical interventions. METHODS: This longitudinal study investigated predictors of recovery from prenatal elevated depressive symptoms in the postpartum period. Forty-one pregnant women completed demographic, interpersonal, and psychosocial self-report assessment measures at 32 weeks of gestation and again 12 weeks postpartum. RESULTS: Of those with elevated depressive symptoms, defined as a Beck Depression Inventory-II (BDI-II) score ≥10, at the prenatal baseline, 39% (n=16) recovered to nonelevated symptom levels postpartum, whereas 61% (n=25) experienced sustained elevated symptoms. Women who recovered evidenced significantly lower baseline depression severity and more frequent engagement in physical activity and cohabitated with a romantic partner. In multiparous women (n=25), history of past postpartum depression (PPD) differentiated between those with transient and those with persisting symptoms, although history of lifetime depression did not. None of the additional demographic, interpersonal, or psychosocial variables investigated differentiated between groups. Logistic regression analysis showed prenatal depression severity and exercise frequency as predictors of recovery postpartum. CONCLUSIONS: Results suggest most women will not experience spontaneous recovery. Women with prenatal heightened symptom severity and previous experiences with PPD are acutely vulnerable to experience sustained symptoms. In contrast, having a cohabitating partner and engagement in prenatal exercise predicted symptom improvement. Physical exercise may be an important clinical recommendation, as it may improve mood. Given the small sample size, these results are preliminary. Implications and future research recommendations are discussed.

Peripartum length of stay for women with depressive symptoms during pregnancy.

BACKGROUND: Approximately 1 in 10 women suffers from depression during pregnancy. Little is known about whether antepartum depression affects a mother's length of stay at delivery. We aimed to compare peripartum length of stay in women with and without depressive symptoms during pregnancy. METHODS: This study involved secondary data analysis of a larger study exploring antepartum depression. Each subject completed the Center for Epidemiological Studies Depression Scale (CES-D). We used bivariate analyses to compare patient characteristics of women with and without an elevated CES-D, and we used a multivariate Poisson regression to evaluate predictors of length of stay. RESULTS: The study sample included 867 pregnant women. Overall, 18% of study subjects scored >or=16 on the CES-D. In bivariate analyses, a longer stay was associated with an elevated CES-D and minority race, antepartum complications, cesarean delivery, prematurity, multiple gestation, and neonatal length of stay. In the final multivariate model adjusting for sociodemographic, antepartum, and obstetric factors, an elevated CES-D was associated with a significantly longer peripartum stay (0.26 days, CI 0.04-0.48). CONCLUSIONS: Depressive symptoms during pregnancy predict an increase in peripartum length of stay.

Risk factors for depressive symptoms during pregnancy: a systematic review.

The purpose of this study was to evaluate risk factors for antepartum depressive symptoms that can be assessed in routine obstetric care. We evaluated articles in the English-language literature from 1980 through 2008. Studies were selected if they evaluated the association between antepartum depressive symptoms and > or =1 risk factors. For each risk factor, 2 blinded, independent reviewers evaluated the overall trend of evidence. In total, 57 studies met eligibility criteria. Maternal anxiety, life stress, history of depression, lack of social support, unintended pregnancy, Medicaid insurance, domestic violence, lower income, lower education, smoking, single status, and poor relationship quality were associated with a greater likelihood of antepartum depressive symptoms in bivariate analyses. Life stress, lack of social support, and domestic violence continued to demonstrate a significant association in multivariate analyses. Our results demonstrate several correlates that are consistently related to an increased risk of depressive symptoms during pregnancy.

Single versus double-gloving for obstetric and gynecologic procedures.

OBJECTIVE: The purpose of this study was to compare the relative frequency of glove perforations in double-glove versus single-glove sets. STUDY DESIGN: In this prospective cohort study, surgeons single or double-gloved for pelvic surgery procedures at their own discretion. Gloves were collected at the end of each procedure and evaluated for perforations. RESULTS: We tested 1000 sets of gloves: 675 double-glove sets and 325 single-glove sets. The highest rate of perforation (19%) occurred during major gynecologic procedures. Surgical nurses were the most likely member of the surgical team to sustain a glove injury. There was no significant difference in the total perforation rate between double and single glove sets (10% vs 11%). However, there was a significantly greater potential for blood-skin exposure in the single glove sets. Eleven percent of single glove sets contained a perforation, whereas only 2% of double glove sets contained a corresponding defect in the inner and outer gloves (P < .01). CONCLUSION: Surgeons should double-glove for all pelvic surgery procedures.