Prevalence and factors associated with antenatal depressive symptoms across trimesters: a study of 110,584 pregnant women covered by a mobile app-based screening programme in Shenzhen, China.

BACKGROUND: Antenatal depression is a significant public health issue affecting pregnant women both globally and in China. Using data from a mobile app-based screening programme, this study explored the prevalence and factors associated with antenatal depressive symptoms across different trimesters in Shenzhen. METHODS: A retrospective cross-sectional study was conducted on pregnant women who gave birth in any hospital in Shenzhen between July 2021 and May 2022 and underwent depression screening using an official maternal and infant health mobile app at least once during pregnancy. Depressive symptoms were evaluated using the 9-item Patient Health Questionnaire (PHQ-9), with cut-off scores of 5 and 10 for mild and high level of symptoms, respectively. The prevalence for each trimester was determined by calculating the proportion of women scoring 5 or higher. A variety of sociodemographic, obstetric, psychological, and lifestyle factors were assessed for their association with depressive symptoms. Chi-square test and multivariate logistic regression were performed to identify significant predictors. RESULTS: A total of 110,584 pregnant women were included in the study, with an overall prevalence of depressive symptoms of 18.0% and a prevalence of high-level symptoms of 4.2%. Depressive symptoms were most prevalent in the first trimester (10.9%) and decreased in the second (6.2%) and third trimesters (6.3%). Only a small proportion (0.4%) of women showed persistent depressive symptoms across all trimesters. Anxiety symptoms in early pregnancy emerged as the most significant predictor of depressive symptoms. Other factors linked to an increased risk throughout pregnancy include lower marital satisfaction, living with parents-in-law, experience of negative life events, as well as drinking before and during pregnancy. Factors associated with a reduced risk throughout pregnancy include multiparity and daily physical activity. CONCLUSIONS: This large-scale study provides valuable insights into the prevalence and factors associated with antenatal depressive symptoms in Shenzhen. The findings underscore the need for targeted interventions for high-risk groups and the integration of mental health care into routine antenatal services. Continuous, dynamic monitoring of depressive symptoms for pregnant women and ensuring at-risk women receive comprehensive follow-up and appropriate psychological or psychiatric care are crucial for effectively addressing antenatal depression and improving maternal and infant health outcomes.

Risk of depression in pregnancy among pregnant women undergoing high-risk prenatal care.

OBJECTIVE: to identify the risk of depression in pregnancy among pregnant women undergoing follow-up in high-risk prenatal care, to assess the factors associated with higher risk of depression in pregnancy and to compare the risk of depression in each gestational trimester. METHOD: this is a descriptive, correlational, cross-sectional study, conducted with 151 pregnant women in prenatal care in a high-risk pregnancy outpatient clinic at a university hospital in the state of São Paulo, Brazil. Data were collected through an online form. Chi-square and Fisher's exact tests were performed. After the bivariate analysis, the variables were included in the logistic regression model. In the final model, the Odds Ratio was calculated. RESULTS: 118 (78.1%) pregnant women had a higher risk of depression during pregnancy, which was higher in the first trimester, but without statistical significance. The number of pregnancies (OR = 0.32) and marital status (OR = 0.07) remained significantly associated with higher risk of depression during pregnancy as protective factors. CONCLUSION: the results elucidate the importance of screening for depression risk and the significant need to improve access to effective interventions for preventing prenatal depression and promoting mental health.

The prevalence and correlates of peripartum depression in different stages of pregnancy during COVID-19 pandemic in China.

BACKGROUND: Peripartum depression in and after pregnancy are common, reported by 11.9% of women worldwide, and the proportion was even higher during the outbreak of coronavirus disease 2019 (COVID-19). We aimed to investigate the prevalence and risk factors of peripartum depression under the influence of COVID-19 in China. METHODS: Using a cross-sectional design, 2026 pregnant and postpartum women residing in Beijing, Wuhan, and Lanzhou of China were recruited from February 28 to April 9, 2020. The Patient Health Questionnaire-9 was used to assess their depressive symptoms. The women were divided into four subgroups based on pregnancy stage, and a binary logistic regression analysis was conducted on each subgroup. RESULTS: Under the influence of COVID-19, the prevalence rate of peripartum depression among Chinese women was 9.7%. It was 13.6, 10.8, 7.9 and 7.3% in the first, second, third trimester and puerperium, respectively. Regression analysis showed that the influence of current pregnancy status on movement (Mild vs. No, aORs were 3.89, P < 0.001, 2.92, P = 0.003, 1.58, P = 0.150 in the three trimesters, respectively; Severe vs. No, aORs were 13.00, 20.45, 5.38 in the three trimesters, respectively, all P < 0.05), and worries and fears about childbirth (aORs were 2.46, 2.96, 2.50 in the three trimesters, respectively, all P < 0.05) were associated with depression throughout pregnancy. CONCLUSIONS: The prevalence rate of peripartum depression during the COVID-19 outbreak in China was not higher than usual. The influence of current pregnancy status on movement, as well as worries and fears about childbirth were independent risk factors for peripartum depression throughout pregnancy during COVID-19. The stage of pregnancy should be considered when implementing interventions.

Thoughts of self-harm in early and late pregnancy in urban South Africa: Investigating prevalence, predictors and screening options.

BACKGROUND: Thoughts of self-harm (TSH) are an important marker of mental health risk, and risk for attempted and completed suicide. While there is increasing attention being paid to mental health problems in pregnancy in South Africa (SA), TSH have received less attention despite some cross-sectional studies suggesting that prevalence may be high (12 - 39%). There is a dearth of longitudinal research to inform prevention and treatment. OBJECTIVES: To examine the rates of TSH across pregnancy in a longitudinal SA cohort and to investigate factors associated with the onset and persistence of TSH, as well as the relationship between TSH, depression and/or anxiety. METHODS: Women were enrolled in a prospective pregnancy cohort (S1000) in Soweto, SA between 2014 and 2016, and assessed using validated screening measures (Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Index short form) in early and later pregnancy. Data were available for 649 women. TSH were determined using EPDS item 10. Logistic regression and bifactor models were used to determine factors associated with TSH across pregnancy. RESULTS:  Of the 649 women, 18% reported TSH at some stage during their pregnancy. Prevalence of TSH was slightly higher in early pregnancy (12.5%) than later in pregnancy (11.6%). TSH were associated with a history of mental illness (adjusted odds ratio (aOR) 4.17; 95% confidence interval (CI) 1.3 - 13.7; p=0.020), concurrent depression (aOR 4.8; 95%CI 2.7 - 8.6; p<0.001); marital stress (aOR 1.74; 95% CI 1.0 - 3.0; p=0.040); and practical support (aOR 0.43; 95% CI 0.2 - 1.0; p=0.040) using a multivariate logistic regression. Bifactor analysis examining depression and anxiety scales showed that TSH contributed the highest variance to a shared depression and anxiety factor in early pregnancy. Logistic regressions showed that early depression was a strong predictor of later reports of TSH. CONCLUSIONS:  The present study shows that the risk of TSH during pregnancy is relatively common, and starts early during pregnancy. Screening approaches could be simplified to encourage healthcare practitioners working in busy and over-burdened public healthcare settings to engage in identifying at-risk women. Efforts in improving early identification of mental health risk in pregnancy should be matched with strengthening of current treatment and referral options. Since practical support and a good marital relationship reduce the risk of TSH, these may be important avenues of focus for designing interventions.

Increased sugar-sweetened beverage use tendency in pregnancy positively associates with peripartum Edinburgh postpartum depression scores.

The association among sugar sweetened beverages (SSB) consumption, addiction and depression in adults, children and adolescents is widely reported. Dieting patterns during pregnancy is complicated by maternal fetal concerns. Specifically, restrained use of SSB might be potentially a source of perinatal distress. The current study modified diagnostic criteria for Substance Use Disorder (SUD) in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), into SSB-specific questions to assess SSB use tendency. Edinburgh Postpartum Depression Scores (EPDS) is used to assess maternal distress during pregnancy. One hundred and ninety-six consecutive pregnant women receiving antenatal care at Kaohsiung Medical University Hospital were invited to participate in this study. In the first trimester, 46.6% of women had none or 1 DSM-5 symptom, 27.0% had 2-3 symptoms, while 26.4% had ≥ 4 symptoms. The mean numbers of DSM-5 symptoms in each trimester were found to be 2.5 ± 2.25, 2.6 ± 2.45, 2.4 ± 2.43 for the first, second and third trimester, respectively, p = 0.750. While EPDS score showed no difference among DSM-5 symptoms 0-1, 2-3 and ≥ 4 groups in the first trimester (8.1 ± 4.59, 8.4 ± 5.00, 8.8 ± 4.82, p = 0.343), women with ≥ 4 DSM-symptoms was found significantly higher EPDS scores than those with < 4 DSM-symptoms in the second (7.2 ± 4.81, 7.7 ± 4.98, 8.8 ± 4.33, p = 0.030) and third trimester (6.8 ± 5.00, 7.2 ± 4.63, 8.7 ± 5.24, p = 0.019). The relationship remained significant after adjusting for covariates including actual SSB amount consumed (adjusted ß = 0.25 with 95% confident interval (CI) 0.04-0.45 and 0.21 with 95% CI 0.04-0.38 for the second and third trimesters, respectively). Overall, the study is the first to characterize the positive relationship between SSB use tendency and antenatal distress in pregnancy, independent of actual SSB amount consumed. The observational nature of the study design precludes inferences of its underlying socio-psychomotor mechanisms, although restrained SSB use in pregnancy is suspected to contribute. The novel employment of modified SSB-specific DSM-5 scores and EPDS in this setting is feasible and further validation is promising. With better understanding and awareness, pregnant women with increased SSB use tendency should be properly counseled with special attention to their mental state.

Spanish Brief Version of the Pregnancy Related Anxiety Questionnaire: PRAQ-20 / Versión española abreviada del cuestionario de ansiedad relacionada con el embarazo

The aim of this study is to obtain a Spanish brief version of the Pregnancy Related Anxiety Questionnaire and analyse its psychometric properties. A longitudinal study was carried out on a sample of 569 Spanish pregnant women with normal risk status. Participants were assessed in the first, second, and third trimesters of pregnancy by using a socio-demographic and obstetric-gynaecological questionnaire, the PRAQ-55, the Edinburgh Postnatal Depression Scale, and the State-Trait Anxiety Inventory. PRAQ-55 items with factorial loads > .50 were selected resulting in a final scale of 20 items. A cut-off point ≥ 67 (85 th percentile) was used to identify women with high pregnancy-specific anxiety. The findings revealed that PRAQ-20 can be considered a useful screening tool in clinical practice to assess pregnancy-related anxiety in both nulliparous and multiparous pregnant women

El objetivo de este estudio es obtener una versión breve en español del Cuestionario de Ansiedad Relacionada con el Embarazo y analizar sus propiedades psicométricas. Se realizó un estudio longitudinal en una muestra de 569 mujeres embarazadas españolas con un embarazo de riesgo normal. Se evaluó a las participantes en el primer, segundo y tercer trimestre de embarazo utilizando un cuestionario sociodemográfico y obstétrico-ginecológico, el PRAQ-55, la Escala de Depresión Postparto de Edimburgo y el Inventario de Ansiedad de Estado-Rasgo. Se seleccionaron los ítems de la PRAQ-55 con cargas factoriales > .50, lo que dio como resultado una escala final de 20 ítems. Se utilizó como punto de corte 67 (percentil 85) para identificar a aquellas mujeres con elevada ansiedad específica del embarazo. Los resultados mostraron que el PRAQ-20 puede considerarse una herramienta de cribado útil en la práctica clínica para evaluar la ansiedad relacionada con el embarazo tanto en mujeres embarazadas nulíparas como multíparas

Changing patterns of prenatal depression and anxiety status in different trimesters and modified form of Zung scales for pregnant women.

BACKGROUND: We described the changing patterns of depression and anxiety status in different trimesters among Chinese pregnant women, and identified the modified form of SDS/SAS for pregnant women and assessed its reliability and validity. METHODS: Changing patterns of depression/ anxiety status in different trimesters were described. The modified form of SDS/SAS was identified for pregnant women. Cohen's Kappa to measure agreement with SDS/SAS, and the ROC analysis was performed to assess its validity. RESULTS: The SDS score in 1st trimester was higher than 2nd and 3rd trimester; there was no significant difference between SDS score in 2nd and 3rd trimester. Modified form of SDS evaluated the depression; the areas under the curve (AUC) in testing group were up to 0.988, 0.989 and 0.992 for 1st, 2nd and 3rd trimester, respectively. Modified form of SAS evaluated the anxiety, the AUC in testing group were up to 0.987, 0.985, 0.987 for 1st, 2nd and 3rd trimester, respectively. CONCLUSION: Pregnant women had higher severity of depression and anxiety status in 1st trimester than that in 2nd and 3rd trimester. The modified form of SDS/SAS may be more brief and suitable to assess the depression and anxiety status in pregnant women.KEY POINTSPregnant women had a higher severity of depression and anxiety status in the 1st trimester than that in the 2nd and 3rd trimester.The present study suggests that prenatal depression and anxiety status are prevalent in Chinese pregnant women.Prevention or treatments focus on high-score items of SDS and SAS would be beneficial for rectifying prenatal depression and anxiety.

Assessing Stress in Pregnancy and Postpartum: Comparing Measures.

INTRODUCTION: Measuring early-life psychosocial stress is complicated by methodological challenges. This paper compares three survey instruments for the assessment of life in pregnancy/postpartum and investigates the effects of the timing of early-life stress for emotional/behavioral difficulties (EBD) of offspring during mid/late childhood and adolescence. METHODS: Observational data were obtained from the European Longitudinal Cohort Study of Pregnancy and Childhood (ELSPAC-CZ), which included 4811 pregnancies in two Czech metropolitan areas. We used data collected between 1991 and 2010 at 20 weeks of pregnancy (T1), after delivery (T2), at 6 months postpartum (T3), and at child's age of 7 years (T4), 11 years (T5), 15 years (T6), and 18 years (T7). Life stress was assessed with (1) the Edinburgh Postnatal Depression Scale (EPDS), (2) a stressful life events (SLE) count based on 42-item inventory, and (3) the SLE measure weighted by perceived stressfulness (PS). Each stress measure was administered at T1, T2, and T3. Child's EBD were assessed with the Strengths and Difficulties Questionnaire at T4, T5, T6, and T7. RESULTS: Each stress measure independently predicted long-term EBD. The best data fit was obtained in a model combining EPDS and SLE. Effect sizes for SLEs decreased between the first half of pregnancy and postpartum, while the effect of EPDS increased. DISCUSSION: SLE-based methods capture an aspect of perinatal stress not adequately assessed by EPDS. Combination of psychological distress measures and SLE-based measures is optimal in predicting EBD of the child. Stress measures based on SLE are suitable for early pregnancy, while self-reports of depressive symptoms may perform better in postpartum.

Trajectories of social support in pregnancy and early postpartum: findings from the All Our Families cohort.

PURPOSE: Low social support during the perinatal period can increase the risk of postpartum depression and anxiety after giving birth but little is known about women's trajectories of social support during this time. This study will identify trajectories of social support among women from second trimester to 4-month postpartum, and the characteristics associated with different trajectories. METHODS: Data from the All Our Families longitudinal birth cohort was used to assess women's perceived social support during their second trimester, third trimester, and at 4-month postpartum (n = 3387). Group-based trajectory modeling was used to determine the number of groups, shape of trajectories, and proportion of women with differing trajectories. Multinomial regression was used to compare probability of group membership. RESULTS: Six distinct trajectory groups were identified, with the majority of participants belonging to groups with stable, high social support (60.6%). Only 2.7% of women had consistently low levels of social support, and 2.3% had rising levels. Membership in groups with lower levels of social support was associated with lower incomes and minority ethnicity. Women whose support improved over time may be more likely to be employed in pregnancy than those whose support remained low. CONCLUSION: Trajectories of social support are relatively stable in pregnancy and early postpartum. Socio-demographic indicators of vulnerability predict initial levels of support, and participating in the workforce may help improve perception of support over time.

Validation of the Chinese version of the Pregnancy-related Anxiety Questionnaire-Revised (PRAQ-R) and its distinction from general anxiety and depression in pregnant women.

Objective: This study aims to evaluate the reliability and validity of the translated Chinese-Cantonese version of the Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R) in a sample of pregnant women in Hong Kong, China. It also aims to determine whether pregnancy-related anxiety changes significantly across trimesters and if it is differentiated from general anxiety and depression.Method: This study adopts a prospective longitudinal design with a quantitative approach. A consecutive sample of 186 Chinese pregnant women from hospitals in Hong Kong are assessed using the translated Chinese-Cantonese version of the PRAQ-R and other standardized instruments at three time points during the first to third trimester.Results: A confirmatory factor analysis revealed a three-factor structure of the Chinese-Cantonese version of the PRAQ-R, including fear of giving birth, fear of bearing a physically or mentally handicapped child, and concern about one's appearance. The internal consistency was excellent (α = 0.88 to 0.91) for all of the items in the PRAQ-R across the three trimesters. The average variance extract (AVE) and composite reliability (CR) for each factor were greater than the recommended level of CR > 0.70 and AVE > 0.50. Multiple regression analyses showed that a combination of general anxiety and depression explained a small proportion of the variance (10-29%) in the PRAQ-R subscales during the three trimesters.Conclusions: The Chinese-Cantonese version of the PRAQ-R has good validity and reliability, and the results provide evidence of its relevance for Chinese pregnant women with pregnancy-related anxiety in Hong Kong. The finding also shows that pregnancy-related anxiety is a relatively distinctive form of anxiety that is different from general anxiety and depression.

Sedentary behavior relates to mental distress of pregnant women differently across trimesters: An observational study in China.

BACKGROUND: The independent effect of sedentary behavior (SB) on maternal mental health is still unclear. The purpose of this study was to examine the different relationships of SB with maternal distress in pregnant women across the three trimesters, controlling for the confounding factors including physical activity (PA), diet and gestational weight gain. METHODS: Survey data were collected from 1272 participants in different trimesters of pregnancy. The data were divided into three data sets based on trimester, and regression analysis was conducted on each data set. Both the linear and quadratic relationships between SB and mental distress were estimated. RESULTS: There was no significant association between SB and any mental distress symptoms in the first trimester. In the second trimester, SB was positively associated with higher mental overall distress symptoms (ß=0.34, P < 0.001), including depress and anxiety. There is an inverted-U shaped curvilinear relationship between SB and mental distress in the third trimester, as SB-squared is significantly associated with mental overall distress (GSI: ß=-0.65, P = 0.002, depression: ß=-0.53, P = 0.014, anxiety: ß=-0.46, P = 0.031). LIMITATIONS: The data were collected from only one city in China, which may limit the generalizability of the findings for all Chinese women. This was an observational study and causality cannot be established. CONCLUSION: This study found that the relationship between SB and maternal mental distress depends on trimesters. The stage of pregnancy should be considered when designing interventions for pregnant women to change SB to reduce mental distress.

Psychological health of women who have conceived using assisted reproductive technology in Taiwan: findings from a longitudinal study.

BACKGROUND: Despite the increasing use of Assisted Reproductive Technology (ART) and the significant physical and emotional commitments that these treatments and procedures involve, only limited evidence exists regarding the psychological health of women who undergo ART. This study investigated the changes over time in the psychological health of women who have conceived using ART during the first, second, and third trimesters of pregnancy and during the postpartum period in Taiwan. METHODS: A quantitative longitudinal study was conducted at a fertility centre in Taiwan. 158 pregnant women who had conceived using ART completed a web-based questionnaire that included the following instruments: State Anxiety Inventory, Edinburgh Postnatal Depression Scale, Modified Maternal Foetal Attachment Scale, Pregnancy Stress Rating Scale, Maternity Social Support Scale, Intimate Bond Measure, and Parenting Stress Index. The data were collected the first (9-12 weeks), second (19-22 weeks), third (28-31 weeks) trimesters of pregnancy and at 7-10 weeks postpartum. RESULTS: Levels of anxiety and depression, which are both key indicators of psychological health, were highest during the first trimester, with scores of 42.30 ± 11.11 and 8.43 ± 4.44, respectively. After the first trimester, anxiety scores decreased and remained stable through the remainder of pregnancy, with scores of 38.03 ± 10.58 in the second and 38.39 ± 10.36 in the third trimester, but increased at two-months postpartum, attaining a score of 41.18 ± 11.68. Further, depression scores showed a similar pattern, declining to a mean of 7.21 ± 4.23 in the second and 6.99 ± 4.11 in the third trimester and then increasing to 8.39 ± 5.25 at two-months postpartum. Pregnancy stress and social support were found to be the most important predictors of change in psychological health during pregnancy and the postpartum period. CONCLUSION: Psychological health was found to be poorest during the first trimester and at two-months postpartum. Moreover, pregnancy stress and social support were identified as key predictors of change in psychological health. The findings indicate a need for increased sensitivity among healthcare professionals to the psychological vulnerability of women who have conceived using ART as well as a need to introduce tailored interventions to provide appropriate psychological support to these women.

Significance of Affection Changes during Pregnancy: Intimacy, Passion, and Commitment.

The complex process of gestation involves significant biological, psychological, and social changes for both women and men looking toward the same direction. The aim of this study was to analyze changes occurring in affective health between the members of a couple during pregnancy. For this, a cross sectional descriptive study using Sternberg's questionnaire based on his Triangular Theory of Love (intimacy, passion, and commitment) was implemented. A total of 180 couples participated in the study. Data were collected four times during pregnancy: at the beginning, during the first trimester, the second trimester, and during the third trimester. The level of intimacy was higher at the beginning of pregnancy (123.93 ± 9.67), the same as the level of passion (119 ± 9.83). The commitment score in women was, in general, higher than in men. The commitment score in men increased at the beginning of the third trimester (124.31 ± 7.72). Statistically significant differences between the sexes were found for the level of commitment at the beginning of the pregnancy (p = 0.001) and at the third trimester (p = 0.008), these scores being higher for women than for men. No significant differences between men and women were found for the remaining components of the triangle. During pregnancy, no significant changes were found regarding overall affection throughout the entire period.

Gestational weight gain, physical activity, sleep problems, substance use, and food intake as proximal risk factors of stress and depressive symptoms during pregnancy.

BACKGROUND: Because maternal depressive symptoms and stress during pregnancy are strongly associated with poor health of the mother and the developing child, understanding the predictors of women's mental health problems is important to prevent complications in the perinatal period. Therefore, this study sought to examine the association between six risk factors - gestational weight gain (GWG), low physical activity, sleep problems, alcohol use, cigarette smoking and snack food intake - and mental health problems during pregnancy. We hypothesized that risk factors would predict mental health problems while adjusting for socio-demographic characteristics and pregnancy intention, both cross-sectionally and longitudinally. METHODS: Hierarchical linear regression analyses were conducted in a population-based sample of N = 463 pregnant women during their 2nd trimester (gestational age: 23 to 28 weeks) of whom n = 349 were reassessed during their 3rd trimester (gestational age: 33 to 38 weeks). Women had a mean age of 29.8 ± 4.2 years and a mean pregravid body mass index of 23.5 ± 4.3 kg/m2. Data were collected by the 'Leipzig Research Center for Civilization Diseases' via the Patient Health Questionnaire, Pittsburgh Sleep Quality Index, Food Frequency Questionnaire, self-report items on physical activity and substance use, and objectively measured anthropometrics. RESULTS: Cross-sectionally, while a higher snack food intake and sleep problems predicted depressive symptoms and stress during the 2nd trimester, gestational weight gain predicted stress only. Longitudinally, sleep problems positively predicted depressive symptoms during the 3rd trimester. All results remained significant after controlling for age, pregravid body mass index, and pregnancy intention. GWG and significant longitudinal effects became insignificant when controlling for gestational age or baseline depressive symptoms and stress, respectively. CONCLUSIONS: The results showed that sleep problems were associated with maternal mental health problems during pregnancy. Longitudinal studies using standardized measures, particularly diagnostic interviews and physiological or biochemical markers, are warranted to confirm patterns of risk factors, their association with depressive symptoms and stress during the course of pregnancy, and their effects on mother's and child's health.

E-cigarette minimum legal sale age laws and traditional cigarette use among rural pregnant teenagers.

Teenagers under 18 could legally purchase e-cigarettes until states passed minimum legal sale age laws. These laws may have curtailed teenagers' use of e-cigarettes for smoking cessation. We investigate the effect of e-cigarette minimum legal sale age laws on prenatal cigarette smoking and birth outcomes for underage rural teenagers using data on all births from 2010 to 2016 from 32 states. We find that the laws increased prenatal smoking by 0.6 percentage points (pp) overall. These effects were concentrated in prepregnancy smokers, with no effect on prepregnancy non-smokers. These results suggest that the laws reduced cigarette smoking cessation during pregnancy rather than causing new cigarette smoking initiation. Our results may indicate an unmet need for assistance with smoking cessation among pregnant teenagers.

Different trajectories of depressive symptoms during pregnancy.

BACKGROUND: Up to 10-15% of women experience high levels of depressive symptoms during pregnancy. Since these levels of symptoms can vary greatly over time, the current study investigated the existence of possible longitudinal trajectories of depressive symptoms during pregnancy, and aimed to identify factors associated with these trajectories. METHODS: Depressive symptoms were assessed prospectively at each trimester in 1832 women, using the Edinburgh (Postnatal) Depression Scale (E(P)DS). Growth mixture modeling was used to identify trajectories of depressive symptoms during pregnancy. RESULTS: Three trajectories of depressive symptoms (E(P)DS scores) were identified: low stable (class 1, reference group, 83%), decreasing (class 2, 7%), and increasing (class 3, 10%). Classes 2 and 3 had significantly higher mean E(P)DS scores (7-13 throughout pregnancy) compared to the reference group (stable; E(P)DS <4). Factors associated with trajectories 2 and 3 included previous depressive episodes, life events during pregnancy, and unplanned pregnancy. Notably, the only factor distinguishing classes 2 and 3 was the perception of partner involvement experienced by women during their pregnancies. Class 2 (with decreasing E(P)DS scores) reported high partner involvement, while class 3 (with increasing E(P)DS scores) reported poor partner involvement throughout pregnancy. LIMITATIONS: Depressive symptoms were assessed by self-report rather than a diagnostic interview. The participants were more often both highly educated and of Caucasian ethnicity compared to the general Dutch population. CONCLUSIONS: Poor partner involvement was associated with increasing depressive symptoms during pregnancy. Health professionals should focus on partner involvement during pregnancy in order to identify women who are potentially vulnerable for perinatal depression.

Pregnancy, Penile-anal Sex, and Other Sexual Behaviors in the United States, 2011-2015.

We used the US national survey data to examine sexual behavior by pregnancy status and found that, overall, pregnant women did not differ from nonpregnant women in penile-anal sex and associated condom use. Compared with nonpregnant women, pregnant women had lower or similar reports of other sexual behaviors.

Transformation of quality of life in prenatal women with nausea and vomiting.

PROBLEM: Nausea and vomiting not only cause physical discomfort in pregnant women but also impact their quality of life. BACKGROUND: Few longitudinal studies have been conducted to investigate QOL of women over the course of pregnancy. AIM: To examine the transformation of health-related QOL and related factors among pregnant women with NV during three trimesters. METHODS: A longitudinal research design with convenience sampling was used. A structural questionnaire was used to repeatedly measure the data of 101 pregnant women with NV during the first, second, and third trimesters. A generalized estimating equation (GEE) was used to analyze the collecting data. FINDINGS: The results showed significant differences in symptom distress, prenatal stress, and health-related QOL among the three trimesters in pregnant women with NV (p<0.001). The scores of symptom distress, prenatal stress, and health-related QOL in the first trimester were significantly higher than those in the second and third trimesters (p<0.001). The GEE indicated that the trimester of pregnancy, severity of NV, symptom distress, and prenatal stress were key factors for the transformation of health-related QOL of women with NV during pregnancy. DISCUSSION: The findings of this study are seminal in terms of understanding the relationships between symptom distress, prenatal stress and health-related QOL in pregnant women with NV over the course of a pregnancy. CONCLUSION: This study can serve as a reference for designing interventions (i.e., professional support) for women in different pregnancy stages to improve their health-related QOL during pregnancy.

The courses of maternal and paternal depressive and anxiety symptoms during the prenatal period in the FinnBrain Birth Cohort study.

Maternal prenatal symptoms of depression and anxiety have been suggested to impose differential effects on later offspring development, depending on their characteristics, such as timing, intensity and persistence. Paternal symptoms have been less investigated. While knowledge on these trajectory characteristics is essential for improved comprehension of prenatal stress, prospective studies including both expecting parents have been scarce. We aim at identifying and comparing the trajectories of prenatal depressive and anxiety symptoms in both parents in a pregnancy cohort design. The sample included 3202 mothers and 2076 fathers who were recruited to the FinnBrain Birth Cohort study (www.finnbrain.fi). Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and general anxiety by the anxiety scale of the Symptom Checklist -90 (SCL-90) repeatedly at 14, 24, and 34 gestational weeks. Five differential depressive and four anxiety symptom trajectories were identified across pregnancy both in mothers and in fathers. The trajectories of consistently low depressive or anxiety symptoms were associated with higher educational level in both parents, and with nulliparity and non-smoking during pregnancy in mothers. Parents with consistently high or increasing levels of symptoms had more often prenatal SSRI medication. The congruences between elevated depressive and anxiety symptoms at any point in pregnancy, as well as parental trajectories within families were low. However, in this population-based sample, the self-reported symptom levels of both parents were generally very low. Variance in timing and persistence of parent-reported prenatal depressive and anxiety symptoms is potentially important, while symptom trajectories are very similar in mothers and fathers. These differential symptom trajectories and the significance of their correlates should be acknowledged when studying prenatal stress exposures and the related outcomes in children.

[Association between pregnancy-related anxiety of pregnant women and autism-like behavior in their offspring at 18 months of age].

Objective: To investigate the relationship of pregnancy-related anxiety of pregnant women in second/third trimesters and autism-like behaviors in their offspring at 18 months of age. Methods: Based on a prospective cohort study design, we evaluated the situation of pregnancy-related anxiety of women during second and third trimesters through a Pregnancy-Related Anxiety Questionnaire. Subjects under study were classified into three groups, 1) those with pregnancy- related anxiety during both trimesters, 2) those with pregnancy-related anxiety at one trimester and 3) those without pregnancy-related anxiety in either trimester. When their children were 18 months, autism-like behaviors (ALB) were evaluated, using the part A of Checklist for Autism in Toddlers-23, and then classified into three groups as non-ALB group, minor ALB group and major ALB group. Multi-nominal logistic Regression was used to analyze the relationship of pregnancy-related anxiety with autism-like behaviors. Results: Compared with non-ALB group, children whose mother with pregnancy-related anxiety during both trimesters presented significant higher risk on ALB than children whose mother without pregnancy-related anxiety in these two periods (relative risk, RR=2.43, 95% CI: 1.21-4.86, P=0.012), major factors as pregnant women's IQ and gestational diabetes mellitus, premature delivery and education levels of fosterers on these pregnant women were under control. Our results from the stratified analysis showed: when in the subgroup that mother was the main fosterer of the child, there was an significant increase of risk in children whose mothers with pregnancy-related anxiety during both trimesters (RR=4.22, 95%CI: 1.73-10.32, P=0.002). Conclusion: The association between pregnancy-related anxiety and autism-like behavior was not strong but influenced by the fosterer of the child.