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

First-time mothers\u2019 experiences of pregnancy and birth following assisted reproductive technology treatment in Taiwan

Background: Assisted reproductive technology (ART) treatment tends to involve significant physical and emotional commitments that can impact maternal, infant, and family health and well-being. An in-depth understanding of experiences is necessary to provide adequate support for women and their families during pregnancy and transition to parenthood following ART treatment. The aim of this study was to explore first-time mothers\u2019 experiences of pregnancy and transition to parenthood following successful ART treatment in Taiwan. Method: Twelve first-time mothers who conceived and gave live birth using ART treatment were purposively selected from a fertility centre in Taipei, Taiwan. Women\u2019s experiences in pregnancy and in their transition to motherhood were explored using semi-structured in-depth interviews. All interviews were recorded, transcribed, and analysed using the Colaizzi strategy. Results: The mothers\u2019 accounts reflected three main themes: \u2018being different from mothers who became pregnant naturally\u2019, \u2018ensuring health and safety of the foetus\u2019, and \u2018welcoming new lives with excitement\u2019. The difference mothers felt about themselves was evident in four subthemes: becoming pregnant after a long wait, feeling vulnerable during pregnancy, relying on family\u2019s assistance and support, and worrying about the impact of ART on health. The theme on \u2018ensuring health and safety of the foetus\u2019 encompassed three subthemes: activities to protect the unborn baby, monitoring foetal movement constantly to maintain peace of mind, and receiving foetal reduction for the sake of the pregnancy. Narratives around \u2018welcoming new lives with excitement\u2019 reflected four subthemes: overcoming hardship for worthwhile results, realising one\u2019s life and dreams, proving to be fertile enough to give birth, and return to normal life track. Conclusion: Findings indicate the need for educational and psychosocial interventions to support women and their families physically and psychologically during ART treatment. The stigma related to infertility and the psychosocial support from family are aspects to consider while planning intervention programmes

First-time mothers’ experiences of pregnancy and birth following assisted reproductive technology treatment in Taiwan

Background Assisted Reproductive Technology (ART) treatment tends to involve significant physical and emotional commitments that can impact maternal, infant and family health and well-being. An in-depth understanding of experiences is necessary to provide adequate support for women and their families during pregnancy and transition to parenthood following ART treatment. The aim of this study was to explore first-time mothers’ experiences of pregnancy and transition to parenthood following successful ART treatment in Taiwan. Method Twelve first-time mothers who conceived and gave live birth using ART treatment were purposively selected from a fertility centre in Taipei, Taiwan. Women’s experiences in pregnancy and in their transition to motherhood were explored using semi-structured in-depth interviews. All interviews were recorded, transcribed, and analysed using the Colaizzi strategy. Results The mothers’ accounts reflected three main themes: ‘being different from mothers who became pregnant naturally’; ‘ensuring health and safety of the foetus’; and ‘welcoming new lives with excitement’. The difference mothers felt about themselves was evident in four subthemes: becoming pregnant after a long wait, feeling vulnerable during pregnancy, relying on family’s assistance and support, and worrying about the impact of ART on health. The theme on ‘ensuring health and safety of the foetus’ encompassed three subthemes: activities to protect the unborn baby, monitoring foetal movement constantly to maintain peace of mind, and receiving foetal reduction for the sake of the pregnancy. Narratives around ‘welcoming new lives with excitement’ reflected four subthemes: overcoming hardship for worthwhile results, realising one’s life and dreams, proving to be fertile enough to give birth, and return to normal life track. Conclusion Findings indicate the need for educational and psychosocial interventions to support women and their families physically and psychologically during ART treatment. The stigma related to infertility and the psychosocial support from family are aspects to consider while planning intervention programmes

Evaluating effects of a prenatal web-based breastfeeding education program in Taiwan.

[[abstract]]AIMS: The objectives of this study were to evaluate a web-based breastfeeding education programme provided to primigravida in the third trimester of pregnancy with the aim of deepening breastfeeding knowledge and enhancing skills. The study was conducted at a hospital in Taiwan. BACKGROUND: Education is the cornerstone supporting the framework of lactation and breastfeeding. Web-based instruction is an efficient way to provide education. DESIGN: A quasi-experimental design was used. METHODS: The target population was women at 29-36 weeks gestation using the Internet on regular basis. The primigravida were assigned to either the control group (n=60) or the experimental group (n=60) according to time sequence. RESULTS: Women who received web-based breastfeeding education had a higher mean breastfeeding knowledge score and more positive attitude about breastfeeding. In addition, generalized estimating equations (GEE) model was used to examine the breastfeeding rate at different time points. After adjusting for the time trend and infant birth weight, there was a significant effect in exclusive breastfeeding for the experimental group. On the other hand, the web-based breastfeeding education programme also had a significant effect on mixed feeding rate for the experimental group. CONCLUSION: Results suggest that web-based breastfeeding education may contribute to breastfeeding knowledge and attitude and improved breastfeeding rate. RELEVANCE TO CLINICAL PRACTICE: Web-based breastfeeding education programme can achieve success in promoting breastfeeding and provide health professionals with an evidence-based intervention

[[alternative]]Psychological Health and Parenting Stress Among Women who Conceived Assisted Reproductive Technology: A Triangulation Study

[[abstract]]本研究目的乃在探討接受人工協助生殖科技治療後的懷孕婦女在孕育期之心理健康及親職壓力之時序變化與其相關因子，並探索這群婦女在歷經不孕後經由人工協助生殖科技治療成功生育子嗣的生活經驗。 研究設計方法採三角交叉法，量性研究採縱向設計中的時間序列研究，以台北市某醫院之生殖中心為研究場域，透過網路的問卷調查系統調查三個孕期的母胎依附、孕期壓力、焦慮、憂鬱、社會支持與婚姻關係以及產後二個月的焦慮、憂鬱、社會支持、婚姻關係與親職壓力，總計收取有效樣本158人。質性研究由量性研究中的樣本，抽取接受人工協助生殖科技治療後成功受孕生產，以產後逾二個月之婦女為研究對象，經由一對一的深度訪談來收集資料，收案11人。 量性研究結果三個孕期的焦慮以第一孕期42.30±11.11分為最高，過了第一孕期後婦女的焦慮下降，第二孕期與第三孕期呈現較為穩定的狀態，依序為38.03±10.58分以及38.39±10.36分，而在產後時期焦慮則又上升為41.18±11.68分。三個孕期的憂鬱以第一孕期8.43±4.44分最高，第二孕期為7.21±4.23分、第三孕期則為6.99±4.11分，顯示懷孕婦女的憂鬱在三個孕期呈現逐步下降的趨勢，然而在產後時期憂鬱則又上升為8.39±5.25分。以10分為憂鬱的分割點時，第一孕期有憂鬱症狀者66人(36.9%)、第二孕期為45人(25.7%)、第三孕期為46人(27.4%)、產後時期為55人(34.8%)。 以不同長期追蹤模式來評估心理健康的長期發展，結果發現與焦慮有關的因素為時間變化、懷孕壓力、社會支持、母胎依附、合併中醫治療、胎兒數、母親年齡。與憂鬱有關的因素為時間變化、懷孕壓力、社會支持、孕期不適、合併中醫治療、結婚期間。質性研究結果發現婦女歷經不孕後經由人工協助生殖科技治療成功生育子嗣的生活經驗涵蓋了三個主題：自己與一般自然受孕的母親是不同的、努力確保腹中胎兒的安全與喜迎新生命的到來。 歷經不孕接受人工協助生殖科技治療後懷孕的婦女其第一孕期與產後二個月的焦慮、憂鬱程度較高，不同長期追蹤模式結果顯示壓力與社會支持是影響孕期與產後時期心理健康的重要因子，本研究結果可提供人工生殖機構所屬人員照護婦女時之參考。 本研究建議臨床醫護人員應於婦女的第一孕期與產後二個月時，發展合宜的介入措施以降低婦女的孕期壓力與親職壓力，而社會支持在抵禦周產期的焦慮與憂鬱時可以扮演一個保護性的因子，因此適當的社會支持介入將是合宜也是必須的。[[abstract]]The purpose of this study was to investigate changes over time in related factors for the psychological health and parenting stress during the first, second and third trimesters of pregnancy and postpartum among women who conceived assisted reproductive technology, and to explore the lived experience of pre-expectancy, expectancy and parent phase for two months postpartum. This study adopted a mix-method research design, including a quantitative longitudinal and time-series design repeated measure and a qualitative phenomenon approach. The instruments included: Modified Maternal Fetal Attachment Scale, Pregnancy Stress Rating Scale, State Anxiety Inventory, Edinburgh Postnatal Depression Scale, Maternity Social Support Scale, Intimate Bond Measure and Parenting Stress Index. In quantitative research, a convenience sample consisting of 158 pregnant women at a fertility center in Taiwan completed a web-based questionnaire. In qualitative research, a purposive sample consisted of 11 women two months after delivery, and data were collected through one-on-one interviews. The results showed that women who conceived assisted reproductive technology felt more anxious in the first trimester, and that state anxiety score was 42.30±11.11. After the first trimester, state anxiety score decreased and existed in a stable state. The second and third trimesters were 38.03±10.58 and 38.39±10.36, respectively. At two months postpartum, anxiety score increased to 41.18±11.68. The EPDS scores for the first, second, and third trimesters were 8.43±4.44, 7.21±4.23, and 6.99±4.11, respectively. We found that melancholy decreased smoothly through the pregnancy. However, at two months postpartum, EPDS score increased to 8.39±5.25. Using EPDS ≧10 as the cut off score of depression, the prevalence of depression in the first, second, third trimester and postpartum two months were 36.9%, 25.7%, 27.4%, and 34.8%, respectively. Three GEE time-varying longitudinal models were used to evaluate the longitudinal development of women’s psychological health. The result showed the risk factors for anxiety included the time change, pregnancy psychological stress, social support, maternal-fetal attachment, received Chinese herbals, number of fetus, and age. The related factors for depression included the time change, pregnancy psychological stress, social support, received Chinese herbals, and length of marriage. The qualitative data were analyzed by using Colaizzi’s phenomenological approach, and three themes emerged from the interview data: the conception processes of IVF different from the natural conception, ensuring the fetus safety, and the coming new joyful life. In first trimester and two months postpartum, women who conceived assisted reproductive technology felt more anxious and depressed. Three time-varying longitudinal models found the pregnancy psychological stress and social support would be the most important predictors for psychological health. Our findings may help healthcare professionals to understand the psychological health during pregnancy and postpartum periods among women who conceived assisted reproductive technology and as a theoretical base in providing health care. This study suggested that clinical staff should develop proper intervention in the women’s first trimester and two months after delivery to reduce the women’s psychological stress for pregnancy and parenting stress. In addition, social support can act as a protective factor in resisting anxiety and depression in the perinatal period. Therefore, a proper intervention of social support is both decent and necessary

Factors associated with perceived stress of clinical practice among associate degree nursing students in Taiwan

Abstract Background Clinical placements play an important role in helping nursing students to achieve clinical competence, but these placements can be highly challenging and stressful. It has been shown that stress can be either a trigger or aggravating factor for ill-health in general, but studies have seldom differentiated the impact of general health status on perceived stress. This study examined factors associated with perceived stress of clinical practice among nursing students with a particular focus on the effect of general health status on stress. Methods This was a cross-sectional quantitative study conducted among 724 associate nursing degree students in Southern Taiwan. Results Health status scores varied from 28 to 139, with an average of 68.40 (SD = 25.75). Health status was reported to be ‘good’ (scores 28–55) in 35.5% of participants, moderate (scores 56–83) in 24.6%, and poor (Scores ≧ 84) in 39.9% of participants. Perceived stress scores ranged from 0 to 95 points with an average score of 36.65 (SD ± 15.95). The classification and regression tree (CART) analysis showed health status as the most important factor linked to perceived stress with a Normalized Importance value of 100%. Those who reported general health status (measured through General Health Questionnaire (GHQ)-28) score of ≤34.5 perceived mild stress and those with a score of > 34.5–< 84.5 perceived moderate stress. A score of 84.5 was found to be the point of transition to perceptions of severe stress. When health status score was greater than 84.5, perceived stress was at a severe or extremely severe level. Conclusions Our findings indicated health status as a potential measure to identify students who were most vulnerable to perceived stress. Given the cross-sectional design of this study and the bidirectional relationship between health and stress, more studies are needed to fully establish the predictive link between general health status and vulnerability to stress

Perioperative Blood Transfusion Is Dose-Dependently Associated with Cancer Recurrence and Mortality after Head and Neck Cancer Surgery

Background: The association between perioperative blood transfusion and cancer prognosis in patients with head and neck cancer (HNC) receiving surgery remains controversial. Methods: We designed a retrospective observational study of patients with HNC undergoing tumor resection surgery from 2014 to 2017 and followed them up until June 2020. An inverse probability of treatment weighting (IPTW) was applied to balance baseline patient characteristics in the exposed and unexposed groups. COX regression was used for the evaluation of tumor recurrence and overall survival. Results: A total of 683 patients were included; 192 of them (28.1%) received perioperative packed RBC transfusion. Perioperative blood transfusion was significantly associated with HNC recurrence (IPTW adjusted HR: 1.37, 95% CI: 1.1&ndash;1.7, p = 0.006) and all-cause mortality (IPTW adjusted HR: 1.37, 95% CI: 1.07&ndash;1.74, p = 0.011). Otherwise, there was an increased association with cancer recurrence in a dose-dependent manner. Conclusion: Perioperative transfusion was associated with cancer recurrence and mortality after HNC tumor surgery

Perioperative Blood Transfusion Is Dose-Dependently Associated with Cancer Recurrence and Mortality after Head and Neck Cancer Surgery

Background: The association between perioperative blood transfusion and cancer prognosis in patients with head and neck cancer (HNC) receiving surgery remains controversial. Methods: We designed a retrospective observational study of patients with HNC undergoing tumor resection surgery from 2014 to 2017 and followed them up until June 2020. An inverse probability of treatment weighting (IPTW) was applied to balance baseline patient characteristics in the exposed and unexposed groups. COX regression was used for the evaluation of tumor recurrence and overall survival. Results: A total of 683 patients were included; 192 of them (28.1%) received perioperative packed RBC transfusion. Perioperative blood transfusion was significantly associated with HNC recurrence (IPTW adjusted HR: 1.37, 95% CI: 1.1–1.7, p = 0.006) and all-cause mortality (IPTW adjusted HR: 1.37, 95% CI: 1.07–1.74, p = 0.011). Otherwise, there was an increased association with cancer recurrence in a dose-dependent manner. Conclusion: Perioperative transfusion was associated with cancer recurrence and mortality after HNC tumor surgery