The impact of prenatal psychologic and obstetric parameters on postpartum depression in late-term pregnancies: A preliminary study.

OBJECTIVE: To determine the prenatal psychologic (anxiety and depression) and perinatal obstetric (pregnancy and labor complications) predictors of postpartum depression (PPD) in late-term pregnancies. MATERIALS AND METHODS: A total of 149 women with late-term gestation who were hospitalized for antenatal fetal surveillance were included. All participants were asked to complete Hospital Anxiety and Depression Scale immediately after hospitalization and Edinburgh Postnatal Depression Scale in the postpartum period. Demographic, psychologic, and obstetric variables were tested as predictors of PPD by regression analysis. RESULTS: High scores for prenatal anxiety, depression, and PPD were detected in 17.4%, 12.8%, and 23.5% of the participants, respectively. The mode of delivery was not associated with PPD for late-term pregnancies. Women having urgent cesarean, planned cesarean, and vaginal delivery had similar rates of PPD (28.1%, 23.8%, and 21.9%, respectively). In the multivariant analysis, prenatal depression [odds ratio (OR), 9.85; 95% confidence interval (CI), 2.72-35.65], prenatal anxiety (OR, 4.95; 95% CI, 1.59-15.39) and suspicion of fetal distress (OR, 4.44; 95% CI, 1.13-13.64) were found to be independent predictors of PPD. CONCLUSION: For late-term pregnancies, women with prenatal anxiety or depression and had cesarean delivery due to the suspicion of fetal distress were at risk for PPD.

Responding to refusal of recommended cesarean section: Promoting good parenting.

Consideration of what a "good parent" would do in controversial perinatal cases has been largely absent from to ethics literature. This article argues when a cesarean section is required to prevent death or serious disability for a fetus, the pregnant woman has an ethical (although not legal) obligation to undergo that procedure even when she has concerns or conflicting commitments. Further, a clinician may be justified in using persuasive counseling when there is grave harm at stake that the patient has a moral obligation to prevent. This conclusion is tested by exploring its implications in several other analogous controversial contexts.

Economic downturns and male cesarean deliveries: a time-series test of the economic stress hypothesis.

BACKGROUND: In light of the recent Great Recession, increasing attention has focused on the health consequences of economic downturns. The perinatal literature does not converge on whether ambient economic declines threaten the health of cohorts in gestation. We set out to test the economic stress hypothesis that the monthly count of cesarean deliveries (CD), which may gauge the level of fetal distress in a population, rises after the economy declines. We focus on male CD since the literature reports that male more than female fetuses appear sensitive to stressors in utero. METHODS: We tested our ecological hypothesis in California for 228 months from January 1989 to December 2007, the most recent data available to us at the time of our tests. We used as the independent variable the Bureau of Labor Statistics unadjusted total state employment series. Time-series methods controlled for patterns of male CD over time. We also adjusted for the monthly count of female CD, which controls for well-characterized factors (e.g., medical-legal environment, changing risk profile of births) that affect CD but are shared across infant sex. RESULTS: Findings support the economic stress hypothesis in that male CD increases above its expected value one month after employment declines (employment coefficient = -24.09, standard error = 11.88, p = .04). Additional exploratory analyses at the metropolitan level indicate that findings in Los Angeles and Orange Counties appear to drive the State-level relation. CONCLUSIONS: Contracting economies may perturb the health of male more than female fetuses sufficiently enough to warrant more CD. Male relative to female CD may sensitively gauge the cohort health of gestations.

Cognitive function after intrauterine growth restriction and very preterm birth.

OBJECTIVE: To evaluate the effects of intrauterine growth restriction (IUGR) with absent or reversed end-diastolic blood flow in the umbilical artery and very preterm birth on cognitive outcome at 5 to 8 years of age. METHODS: We studied 34 children with IUGR born at a median of 26.9 gestational weeks (GWs) (range: 24-29 GWs) (PT-IUGR), 34 matched preterm appropriate-for-gestational age (PT-AGA) children, and 34 term AGA children (T-AGA) by using the Wechsler Preschool and Primary Scale of Intelligence, Wechsler Intelligence Scale for Children, Strengths and Difficulties Questionnaire, and Brown's attention-deficit disorder (ADD) scales. RESULTS: The PT-IUGR group had mean (SD) scores on the verbal IQ (VIQ) and full-scale IQ (FSIQ) of 83.8 (17.3) and 78.9 (16.6), respectively, compared with the PT-AGA group, which had scores of 96.0 (14.5) and 90.1 (14.2) (P = .003 and P < .007), and the T-AGA group, which had scores of 101.3 (12) and 102.9 (13.2) (P < .001 and P < 001), respectively. The VIQ difference remained significant after adjustment for parental level of education, gestational age at birth, and neonatal morbidity. Performance IQ (PIQ) did not differ between the PT-IUGR and PT-AGA groups; their mean PIQs were lower than that of the T-AGA group (P < .001). Boys in the PT-IUGR group scored lower than girls in VIQ and FSIQ (P = .005 and .007, respectively). Behavior and ADD scores did not differ between the preterm groups. CONCLUSIONS: Children born very preterm after IUGR have an increased risk for cognitive impairment at early school age compared with children delivered very preterm for other reasons. Differences in cognitive outcome were restricted to boys who may have been especially vulnerable to the influence of IUGR and very preterm birth.

Fear of childbirth and risk for birth complications in nulliparous women in the Danish National Birth Cohort.

OBJECTIVES: To examine the associations between fear of childbirth and emergency caesarean section and between fear of childbirth and dystocia or protracted labour and fetal distress. DESIGN: Prospective cohort study. SETTING: Danish National Birth Cohort. POPULATION: A total of 25 297 healthy nulliparous women in spontaneous labour with a single fetus in cephalic presentation at term following an uncomplicated pregnancy. METHODS: Data were collected during 1997-2003 from computer-assisted telephone interviews twice in pregnancy linked with national health registers. MAIN OUTCOME MEASURES: Risk for emergency caesarean section of women who feared childbirth; risk for dystocia/protracted labour or fetal distress of women who feared childbirth. RESULTS: Fear of childbirth in early (16 weeks, 6 +/- 29 days) and late (31 weeks, 4 +/- 21 days) pregnancy was associated with emergency caesarean section: OR, 1.23 (1.05-1.47) and 1.32 (1.13-1.55), respectively. When fear of childbirth was expressed at both interviews, the OR was 1.43 (1.13-1.80). Women who feared childbirth had an increased risk for dystocia or protracted labour (OR, 1.33; 1.15-1.54), but not for fetal distress (OR, 0.94; 0.72-1.23). CONCLUSIONS: Fear of childbirth during pregnancy was associated with dystocia and emergency caesarean section but not with fetal distress.

Psychobiology of the amniotic environment.

Water, basic element of amniotic fluid (A.F.), is closely related to Life, Fertility and Motherhood in several cultures and religions. Through material evidences of an essential growth medium and useful diagnostic source, a new concept grow up: the fluid as a first real environment in which fetus lives and acts. Many studies confirm that in A.F. fetus starts his character-building, his memory and his intelligence. The fluid seems to be the first means of learning and acknowledgement. Sounds, smells and tastes are perceived as well as emotions and fears. Urinoterapy and staminal cells sampling shows how A.F. can be considered as an additional terapeutic resource.

[Influence of fetal distress on neonatal behavior neurological assessment and its prognosis].

OBJECTIVE: To study the short and long term prognosis of fetal distress. METHODS: 60 newborns with fetal distress (study group) and 60 normal newborns (control group) were assessed by neonatal behavior neurological assessment (20 items) in neonatal period and by reformed wechsler intelligence scale children-revised at 2 years of age. RESULTS: The total scoring of study group was significantly different from that of control group (P < 0.01). In the study group, there were 41 cases without neonatal asphyxia whose scoring was significantly different from that in the normal group (P < 0.05), whereas the scoring of other 19 cases with neonatal asphyxia was significantly lower than that of the control group (P < 0.001). We also found that the scoring of 38 acute fetal distress cases was significantly different from that of 22 chronic cases (P < 0.01). In two years follow-up study, the scoring of children's intelligence test in acute distress cases was not different from that of controls, but the scoring of intelligence test in chronic distress cases was markedly different from that of controls (P < 0.01). CONCLUSION: Fetal distress could affect neonatal behavior and their intellectual development.

The origin of left hand preference: pathological and non-pathological influences.

Models of the origin of left hand preference were tested with prospective data. Infants with and without a history of perinatal complications, matched for age, sex and parental handedness, were filmed at 6 weeks of age. Children with a history of perinatal complications lacked the rightward headturning bias of those children without a history of perinatal trauma. Children with a history of perinatal complications were also deviant with reference to the duration of a postural reflex and its degree of lateralization. Perinatal complications may delay the establishment of volitional hand use as well as increase the probability of left-handedness. The data were interpreted as supporting SATZ's (Cortex 8, 121-135, 1972) rather than BAKAN et al.'s (Neuropsychologia 11, 363-366, 1973) model of "pathological" left-handedness.