The COVID-19 outbreak increases maternal stress during pregnancy, but not the incidence of postpartum depression

The COVID-19 pandemic affects society and may especially have an impact on mental health of vulnerable groups, such as perinatal women. This prospective cohort study compared perinatal symptoms of depression and stress during and before the pandemic. Pregnancy-specific stress increased significantly in women during the pandemic. We found no increase in depressive symptoms during pregnancy nor an increase in incidence of postnatal depression during the pandemic. Clinicians should be aware of increased stress in pregnant women and offer adequate care

The association between facets of mindfulness and COVID-19 related distress: A cross-sectional study

Objectives: Trait mindfulness could function as a protective factor against distress. The current study investigated the relationship of the five distinct facets of mindfulness and COVID-19 related distress. Methods: An online self-report study was conducted in a Dutch sample (N = 811; Mage = 49 ± 17; 54.5 % female) in February 2021. Dispositional mindfulness was assessed with the Five Facet Mindfulness Questionnaire, and the COVID Stress Scale was used to assess COVID-19 related distress. Results: Multivariate regression analyses showed that describing and non-judging were inversely related to COVID-19 related distress. Specifically, describing was related to fewer socioeconomic worries, while describing and non-judging were negatively associated with traumatic stress symptoms. Non-judging was negatively associated with COVID-19-related compulsive checking. Conclusions: The results indicate that individuals high in mindfulness traits describing and non-judging, experience less distress during the pandemic. Teaching mindfulness skills and practice could be helpful in global situations like pandemics

Psychological Distress During Pregnancy and the Development of Pregnancy-Induced Hypertension: A Prospective Study

OBJECTIVE: Pregnancy-induced hypertension (PIH) is associated with serious complications in both the mother and the unborn child. We examined the possible association between trajectories of maternal psychological distress symptoms and PIH separately in primiparous and multiparous women. METHODS: Pregnancy-specific negative affect (P-NA) and depressive symptoms were assessed prospectively at each trimester using the Tilburg Pregnancy Distress Scale pregnancy negative affect subscale (P-NA) and the Edinburgh Depression Scale (EDS). Data on PIH were collected from medical records. Growth mixture modeling analysis was used to identify trajectories of P-NA and EDS. The independent role of P-NA and EDS symptom trajectories on developing PIH was examined using multivariate logistic regression models. RESULTS: One hundred (7.6%) women developed PIH and were compared with 1219 women without hypertension or other complications during pregnancy. Three P-NA trajectories were identified: low stable (reference group; 90%), decreasing (5.2%), and increasing (4.8%). The latter two classes showed persistently and significantly higher P-NA symptoms during pregnancy compared with the reference group. In multiparous women, high P-NA scores (belonging to classes 2 and 3) were related to PIH (odds ratio [OR] = 6.91, 95% confidence interval [CI] = 2.26-21.2), independent of body mass index (OR = 1.17, 95% CI = 1.06-1.27) and previous PIH (OR = 14.82, 95% CI = 6.01-32.7). No associations between P-NA and PIH were found in primiparous women. EDS trajectories were not related to PIH in both primiparous and multiparous women. CONCLUSIONS: In multiparous women, persistently high levels of P-NA symptoms but not depressive symptoms were independently associated with development of PIH

The protective value of trait mindfulness for mothers' anxiety during the perinatal period

Objectives: Anxiety is highly prevalent in the perinatal period and can have negative consequences for the mother and the child. Extensive research has been done on risk factors for anxiety during the perinatal period, but less is known about protective factors. The current study aims to determine the relative contribution of trait mindfulness as a protective factor for anxiety. Methods: A longitudinal study design was used, with four measurement points: 12, 22, and 32 weeks of pregnancy (T0, T1, and T2, respectively), and 6 weeks postpartum (T3). General anxiety was measured at T1, T2, and T3, pregnancy-specific distress was measured at T1 and T2, mindfulness facets (acting with awareness, non-reacting, and non-judging) and partner involvement were measured at T1, and other known risk factors for anxiety were measured at T0. Multilevel regression models were used for statistical analyses. Results: Mindfulness facets measured at T1 were negatively associated with anxiety at T1, T2, and T3, and pregnancy-specific distress at T1 and T2. Of the mindfulness facets, non-judging was shown to have the largest protective effect against anxiety and pregnancy-specific distress. Also compared to partner-involvement and known risk factors, non-judging showed the largest effect on anxiety and pregnancy-specific distress. Conclusions: For pregnant women who are at risk for developing or experiencing high levels of anxiety, it may be beneficial to participate in a mindfulness training with special attention for the attitudinal aspects of mindfulness

The association of unplanned pregnancy with perinatal depression: a longitudinal cohort study

Perinatal depression is common, affecting approximately 7–13% of women. Studies have shown an association between unplanned pregnancy and perinatal depressive symptoms, but many used a cross-sectional design and limited postnatal follow-up. The current study investigated the association of unplanned pregnancy with perinatal depressive symptoms using a longitudinal cohort study that followed women from the first trimester until 12 months postpartum. Pregnant women (N = 1928) provided demographic and clinical data and information about pregnancy intention at the first trimester. Depressive symptoms were assessed during each trimester of pregnancy and five times postpartum using the Edinburgh Postnatal Depression Scale (EPDS) until 12 months postpartum. Mixed model analyses were used to investigate the association between an unplanned pregnancy and the level of depressive symptoms. Women with an unplanned pregnancy (N = 111, 5.8%) reported persistently higher levels of depressive symptoms during the entire perinatal period compared to women with a planned pregnancy, after adjustment for confounders (p < 0.001). However, the course of depressive symptom scores over time in women with an unplanned pregnancy was similar to that of women with a planned pregnancy. Lower age (p = 0.006), unemployment (p = 0.004), and history of depression (p < 0.001) were significantly associated with higher levels of perinatal depressive symptoms. An unplanned pregnancy may have a long-lasting negative impact on a woman’s perinatal mental health. Therefore, women with an unplanned pregnancy may benefit from systematic follow-up during the perinatal period with contingent mental health support

Different trajectories of depressive symptoms during pregnancy

ackground:Up to 10–15% of women experience high levels of depressive symptoms during pregnancy. Sincethese levels of symptoms can vary greatly over time, the current study investigated the existence of possiblelongitudinal trajectories of depressive symptoms during pregnancy, and aimed to identify factors associated withthese trajectories.Methods:Depressive symptoms were assessed prospectively at each trimester in 1832 women, using theEdinburgh (Postnatal) Depression Scale (E(P)DS). Growth mixture modeling was used to identify trajectories ofdepressive symptoms during pregnancy.Results:Three trajectories of depressive symptoms (E(P)DS scores) were identified: low stable (class 1, referencegroup, 83%), decreasing (class 2, 7%), and increasing (class 3, 10%). Classes 2 and 3 had significantly highermean E(P)DS scores (7–13 throughout pregnancy) compared to the reference group (stable; E(P)DS <4). Factorsassociated with trajectories 2 and 3 included previous depressive episodes, life events during pregnancy, andunplanned pregnancy. Notably, the only factor distinguishing classes 2 and 3 was the perception of partnerinvolvement experienced by women during their pregnancies. Class 2 (with decreasing E(P)DS scores) reportedhigh partner involvement, while class 3 (with increasing E(P)DS scores) reported poor partner involvementthroughout pregnancy.Limitations:Depressive symptoms were assessed by self-report rather than a diagnostic interview. The partici-pants were more often both highly educated and of Caucasian ethnicity compared to the general Dutch popu-lation.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 arepotentially vulnerable for perinatal depression

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

Parents of young infants report poor mental health and more insensitive parenting during the first Covid-19 lockdown

Background: The Covid-19 pandemic has put an unprecedented pressure on families with children. How parents were affected by the first Covid-19 lockdown during the early postpartum period, an already challenging period for many, is unknown. Aim: To investigate the associations between Covid-19 related stress, mental health, and insensitive parenting practices in mothers and fathers with young infants during the first Dutch Covid-19 lockdown. Methods: The Dutch Covid-19 and Perinatal Experiences (COPE-NL) study included 681 parents of infants between 0 and 6 months (572 mothers and 109 fathers). Parents filled out online questionnaires about Covid-19 related stress, mental health (i.e. anxiety and depressive symptoms), and insensitive parenting. Hierarchical regression models were used to analyze the data. Results: Parents of a young infant reported high rates of Covid-19 related stress, with higher reported stress in mothers compared to fathers. Additionally, the percentages of mothers and fathers experiencing clinically meaningful mental health symptoms during the pandemic were relatively high (mothers: 39.7% anxiety, 14.5% depression; fathers: 37.6% anxiety, 6.4% depression). More Covid-19 related stress was associated with more mental health symptoms in parents and increased insensitive parenting practices in mothers. Conclusions: The results emphasize the strain of the pandemic on young fathers’ and mothers’ mental health and its potential negative consequences for parenting. As poor parental mental health and insensitive parenting practices carry risk for worse child outcomes across the lifespan, the mental health burden of the Covid-19 pandemic might not only have affected the parents, but also the next generation

Antenatal anxiety and depressive symptoms and physiological birth

A comment on the recently published letter by Grogan and Srinivasan: The effect of antenatal depressive and anxious symptoms on the rate of physiological births

Implementing “Online Communities” for pregnant women in times of COVID-19 for the promotion of maternal well-being and mother-to-infant bonding:a pretest–posttest study

Background: The Coronavirus Disease 2019 (COVID-19) pandemic elevated the risk for mental health problems in pregnant women, thereby increasing the risk for long-term negative consequences for mother and child well-being. There was an immediate need for easily accessible interventions for pregnant women experiencing elevated levels of pandemic related stress. Methods: A three-session intervention “Online Communities” (OC) was developed at the beginning of the Dutch lockdown, and implemented by a team of midwives and psychologists specialized in Infant Mental Health. Pretest (N = 34) and posttest (N = 17) measurements of depressive symptoms, worries about COVID-19 and worries in general, and mother-to-infant bonding were administered, as well as a posttest evaluation. Results: At pretest, the OC group was compared to two reference groups of pregnant women from an ongoing pregnancy cohort study: a COVID-19 (N = 209) and pre-COVID-19 reference group (N = 297). OC participants had significantly more depressive symptoms than both reference groups, and less positive feelings of bonding than the COVID-19 but not the pre-COVID-19 reference group. Compared to pretest, significant decreases in depressive symptoms (with significantly less participants scoring above cut-off) and worries about COVID-19 (large effect sizes) and worries in general (moderate to large effect size) were found at posttest for the OC participants. No significant improvement was found in bonding. Participants rated the intervention positively. Conclusions: The current study provides initial evidence supporting the idea that OC is a promising and readily accessible intervention for pregnant women experiencing stress due to the COVID-19 pandemic, and possibly also applicable to other stressors. Trial registration: This intervention was registered in the Netherlands Trial Registration (registration number Trial NL8842, registration date 18/08/2020)