The effect of social support around pregnancy on postpartum depression among Canadian teen mothers and adult mothers in the maternity experiences survey

BACKGROUND: Postpartum depression (PPD) is a mood disorder that affects 10–20 percent of women, and can begin any time during first year after delivery lasting for months. Social support may decrease risk of depression during pregnancy for women. However, literature shows that the amount of social support received during and after pregnancy is different for teen mothers and adult mothers. This study examined the effects of social support received during and after pregnancy on PPD among Canadian women and identified if the relationship was different for teen mothers compared to adult mothers. METHODS: The study was based on secondary analysis of the Maternity Experiences Survey. A total of 6,421 women with singleton live births, aged 15 years and older were analyzed. Teen mothers were identified as 15–19 years old and adult mothers were identified as 20 years and older. The main outcome of the study was PPD, which was evaluated using the Edinburg Postnatal Depression Scale. The main independent variable was social support received during pregnancy and after birth. Logistic regression was computed to assess the relationship between social support and PPD after adjusting for confounding variables and age as an interaction term. Adjusted Odds Ratios and 95% Confidence Intervals were reported. RESULTS: PPD was experienced by 14.0% among teen mothers and 7.2% among adult mothers (p < .001). Overall, teen mothers reported receiving more support during pregnancy and after birth than adult mothers (p < .010). The relationship between social support and PPD did not significantly differ for teen compared to adult mothers. Both teen and adult mothers were approximately five times more likely to experience PPD if they received no support or minimal support after the birth of the baby (95% CI, 3.51-7.36). CONCLUSION: Receiving social support especially after birth is important for mothers of all ages to reduce the risk of PPD

Increased cesarean section rate in Central Saudi Arabia: a change in practice or different maternal characteristics

Hanan M Al-Kadri,1 Sultana A Al-Anazi,1 Hani M Tamim21Department of Obstetrics and Gynecology, King Abdulaziz Medical City, 2College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh,&nbsp;Kingdom of Saudi ArabiaBackground: Cesarean section (CS) rate has shown creepy increase. We aimed in this work to identify factors contributing to increasing rate of CS in central Saudi Arabia.Methods: A retrospective cohort study was conducted at King Abdulaziz Medical City. Two groups of women were included (G1 and G2). G1 had delivered by CS during the year 2002 (CS rate 12%), and G2 had delivered by CS during the year 2009 (CS rate 20%). We compared the included women&rsquo;s characteristics, neonates, CS indications, and complications. Data were analyzed using SPSS version 15 program. Odds ratios and confidence intervals were calculated to report precision of categorical data results. A P-value of &le;0.05 was considered significant.Results: A total of 198 women were included in G1 and 200 in G2. Both groups had comparable maternal and fetal characteristics; however, absence of antenatal care has resulted in 70% increase in CS deliveries for G2, P=0.008, OR =0.30, CI 0.12&ndash;0.76. Previous vaginal surgeries have contributed to tenfold increase in CS deliveries for G2, P=0.006, OR =10.37, CI 1.32&ndash;81.78. G2 had eight times increased CS deliveries than G1 due to intrauterine growth restriction, P=0.02, OR =8.21, CI 1.02&ndash;66.25, and 80% increased risk of CS was based on maternal demand, P=0.02, OR =0.20, CI 0.02&ndash;1.71. Decision taken by less-experienced staff was associated with 2.5-fold increase in CS deliveries for G2, P=0.002, OR =2.62, CI 1.39&ndash;4.93. There was a significant increase in CS deliveries under regional analgesia and shorter duration of hospital stay for G2, P=0.0001 and P=0.001, respectively. G2 women had 2.75-fold increase in neonatal intensive care unit admission, P=0.03, OR =2.75, CI 1.06&ndash;7.15.Conclusion: CS delivery rate significantly increased within the studied population. The increased rate of CS may be related to a change in physician&rsquo;s practice rather than a change in maternal characteristics, and it appears to be reducible.Keywords: cesarean section, maternal morbidity, neonatal morbidity, cesarean section rat

Risk of obstructive sleep apnea and excessive daytime sleepiness in hospitalized psychiatric patients

Farid R Talih,1 Jean J Ajaltouni,1 Hani M Tamim,2 Firas H Kobeissy3 1Department of Psychiatry, 2Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; 3Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon Objectives: This study evaluated the risk of developing obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) in hospitalized psychiatric patients at the American University of Beirut Medical Center (AUB-MC). Factors associated with OSA and EDS occurrence in this sample were also examined. Methods: The Berlin questionnaire and the Epworth sleepiness scale; which respectively evaluate OSA and EDS symptoms, were administered to individuals hospitalized at an acute psychiatric treatment unit at the AUB-MC between the dates of January 2014 and October 2016. Additional data collected included general demographics, psychiatric diagnoses, and questionnaires evaluating depression and anxiety symptoms. Statistical analyses utilizing SPSS were performed to determine the prevalence of OSA and EDS, as well as their respective associations with patient profiles. Results: Our results showed that 39.5% of participants were found to have a high risk of sleep apnea and 9.9% of the participants were found to have abnormal daytime sleepiness. The risk of developing OSA was associated with a higher body mass index (BMI) (P=0.02), and depression severity (patient health questionnaire 9 score) (P=0.01). Increasing severity of depressive symptoms was associated with a higher risk of sleep apnea (P=0.01). BMI (odds ratio [OR] =5.97, 95% confidence interval [CI] 1.89&ndash;18.82) and depression severity (OR =4.04, 95% CI 1.80&ndash;9.07) were also found to be predictors of OSA. The psychiatric diagnoses of the participants were not found to have a significant association with the risk of sleep apnea. Conclusion: The risk of OSA is increased among hospitalized psychiatric patients, and this condition can have detrimental effects on psychiatric patients. OSA appears to be under-recognized in this population, psychiatrists should screen for OSA in hospitalized psychiatric patients and refer them for diagnostic testing or treatment when indicated. Keywords: obstructive sleep apnea, excessive daytime sleepiness, depression, anxiety, psychiatric patients, inpatient psychiatr

Maternal and neonatal risk factors for early-onset group B streptococcal disease: a case control study

Hanan M Al-Kadri,1 Samira S Bamuhair,2 Sameera M Al Johani,3 Namsha A Al-Buriki,1 Hani M Tamim4 1Department of Obstetrics and Gynecology, 2Department of Basic Medical Sciences, 3Microbiology Division, 4Department of Medical Education, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia Objectives: To identify the prominent maternal and neonatal risk factors associated with early-onset group B streptococcus (EOGBS) disease in neonates and to determine their importance by comparing them with a control group. Setting: Neonatal unit at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Patients: Cases were infants <7 days of age with invasive group B streptococcus (GBS) disease diagnosed between January 1, 2000 and December 31, 2009. Controls were healthy infants born in the same hospital during the same period having the same birth weight and gestational age category. Main outcome measures: Maternal risk factors for developing EOGBS disease, feto&ndash;maternal and neonatal clinical data, their morbidities, mortalities, and length of hospital stay. Results: A total of 99 cases and 200 controls were included. The majority of cases presented in the first 72 hours of life (62/99 [63.9%]), of which 87/99 (89.7%) had at least one clinical risk factor for the development of EOGBS disease. Mothers of neonates with EOGBS disease were more likely to have GBS bacteriuria (odds ratio [OR] 10.76, 95% confidence interval [CI] 1.24&ndash;93.42), infection in the peripartum period (OR 8.92, CI 2.87&ndash;27.68), and temperature &ge;38&deg;C (OR 7.10, CI 2.50&ndash;20.17). GBS disease was associated with premature rupture of membranes and fetal tachycardia (P<0.01 for both). Neonates with EOGBS disease were more likely to have respiratory distress disease and convulsions, require tube feeding, and have longer hospital stays compared with the controls (P<0.01 for all). Stepwise multiple logistic regression has identified three risk factors that were associated with the highest tendency for the development of EOGBS disease. These were lack of antenatal attendance (OR =0.30 and CI 0.98&ndash;0.88), rupture of membranes (OR =9.62 and CI 3.1&ndash;29.4), and antibiotic use in labor (OR =0.16 and CI 0.38&ndash;0.67). Conclusion: A number of maternal risk factors were significantly associated with EOGBS disease. Taking these factors into consideration may result in preventing the occurrence of EOGBS disease, improve maternal and neonatal medical care, decrease their hospital stay, and reduce unnecessary hospital resource utilization. Keywords: group B streptococcus, neonatal morbidity, maternal morbidity, antenatal screenin

Tertiary care availability and adolescent pregnancy characteristics in Saudi Arabia

Hanan M Al-Kadri,1 Azza Madkhali,1 Mohammed T Al-Kadi,2 Hanadi Bakhsh,1 Nourah N Alruwaili,2 Hani M Tamim21Department of Obstetrics and Gynecology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 2King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi ArabiaBackground: In this study, we aimed to assess the rate of adolescent delivery in a Saudi tertiary health care center and to investigate the association between maternal age and fetal, neonatal, and maternal complications where a professional tertiary medical care service is provided.Methods: A cross-sectional study was performed between 2005 and 2010 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. All primigravid Saudi women &ge;24 weeks gestation, carrying a singleton pregnancy, aged &lt;35 years, and with no chronic medical problems were eligible. Women were divided into three groups based on their age, ie, group 1 (G1) &lt;16 years, group 2 (G2) &ge;16 up to 19 years, and group 3 (G3) &ge;19 up to 35 years. Data were collected from maternal and neonatal medical records. We calculated the association between the different age groups and maternal characteristics, as well as events and complications during the antenatal period, labor, and delivery.Results: The rates of adolescent delivery were 20.0 and 16.3 per 1,000 births in 2009 and 2010, respectively. Compared with G1 and G2 women, G3 women tended to have a higher body mass index, a longer first and second stage of labor, more blood loss at delivery, and a longer hospital stay. Compared with G1 and G2 women, respectively, G3 women had a 42% and a 67% increased risk of cesarean section, and had a 52% increased risk of instrumental delivery. G3 women were more likely to develop gestational diabetes or anemia, G2 women had a three-fold increased risk of premature delivery (odds ratio 2.81), and G3 neonates had a 50% increased overall risk of neonatal complications (odds ratio 0.51).Conclusion: The adolescent birth rate appears to be low in central Saudi Arabia compared with other parts of the world. Excluding preterm delivery, adolescent delivery cared for in a tertiary health care center is not associated with a significantly increased medical risk to the mother, fetus, or neonate. The psychosocial effect of adolescent pregnancy and delivery needs to be assessed.Keywords: adolescent pregnancy, maternal mortality, maternal morbidity, neonatal mortality, neonatal morbidit