Direct and indirect determinants of prenatal depression among Arab-Bedouin women in Israel: The role of stressful life events and social support.

OBJECTIVE: Prenatal depression (PND) negatively affects the health and well-being of both mother and child. The aim of this study was to identify the direct and indirect determinants of prenatal depression symptoms (PNDS) among Arab-Bedouin women in southern Israel. DESIGN: Data collection was conducted in two women's health centers from October 2017 to February 2018. SETTING: Participants were recruited during visits to women's health centers in southern Israel. PARTICIPANTS: We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. All women were 18+ years of age and 26-38 weeks of gestational age. MEASUREMENTS: PNDS were measured by an Arabic version of the Edinburgh Postnatal Depression Scale. We computed path analyses to identify direct and indirect determinants of PND and estimated the contribution of stressful life events and social support. RESULTS: Positive direct associations emerged between stressful life events, history of depression and gestational age, and PNDS; direct inverse associations were found between social support, PND awareness, and education, and PNDS. History of depression was the single strongest direct predictor of PNDS yet when considering combined direct and indirect effects, the contribution of stressful life events is greater. Stressful life events (via history of depression and PND awareness) and education (via PND awareness) had both direct and indirect effects on PNDS. Age of the mother indirectly affects PNDS via education and PND awareness. Polygamy emerged as neither a direct nor indirect predictor of PNDS. CONCLUSIONS: PNDS in the underserved and understudied Bedouin women has serval direct and indirect predictors. Interventions aiming at reducing stress and increasing social support, via PND awareness might be successful in reducing PND and possibly future postpartum depression.

Long-term risk for maternal cardiovascular morbidities in twin pregnancies complicated with gestational diabetes mellitus - a retrospective cohort study†.

BACKGROUND: Gestational diabetes mellitus (GDM) results in an increased risk for maternal and neonatal complications in singletons. In twin pregnancies, however, scarce data exist regarding its implications. OBJECTIVE: To investigate whether a diagnosis of GDM in twin gestation poses a risk for subsequent maternal long-term cardiovascular morbidity. STUDY DESIGN: A population-based cohort study was conducted, comparing the incidence of cardiovascular morbidity within a group of women with and without a diagnosis of GDM who delivered twins in a tertiary medical center, between the years 1991 and 2014. Mothers with pregestational diabetes mellitus, triplet or higher-order multiples, patients lacking prenatal care, patients with known cardiovascular morbidities prior to or during the current pregnancy and fetal malformations or/and chromosomal abnormalities were excluded. Kaplan-Meier's survival curve was used to estimate the cumulative incidence of cardiovascular-related hospitalizations, and a Cox proportional hazards model was used to estimate the adjusted HRs for cardiovascular morbidity. RESULTS: Of 4256 twin deliveries that met the inclusion criteria, 336 (7.9%) occurred in patients that were diagnosed with GDM. During a follow-up period of more than 10 years, with a median of 3431 (0-9172) days in total, patients with GDM had higher rates of simple cardiovascular events as compared to women without diagnosis of GDM (incidence = 7, 2.1%. OR = 2.7, 95% confidence interval (CI) 1.17-6.12, p = .03). Total cardiovascular hospitalizations were comparable between the groups. There was no difference between the two groups in the rate of complex cardiovascular events, noninvasive or invasive cardiac diagnostic procedures. In a Cox proportional hazards model, which is adjusted for maternal age, ethnicity, hypertensive disorders, and fertility treatments, GDM in twin pregnancies was not found to be associated with long-term cardiovascular morbidity (adjusted HR 1.41, 95% CI 0.77-2.58, p = .26). CONCLUSIONS: While GDM during twin pregnancy might be associated with long-term maternal simple cardiovascular events, the complex, as well as the total morbidities, are comparable to patients without GDM.