Perceived stress may mediate the relationship between antenatal depressive symptoms and preterm birth: A pilot observational cohort study

Background: Screening for changes in pregnancy-related anxiety and depressive symptoms during pregnancy may further our understanding of the relationship between these two variables and preterm birth.Objectives: To determine whether changes in pregnancy-related anxiety and depressive symptoms during pregnancy influence the risk of preterm birth among Pakistani women; explore whether perceived stress moderates or mediates this relationship, and examine the relationship between the various components of pregnancy-related anxiety and preterm birth.Methods: A prospective cohort study design was used to recruit a diverse sample of 300 low-risk pregnant women from four centers of Aga Khan Hospital for Women and Children in Karachi, Pakistan. Changes in pregnancy-related anxiety and depressive symptoms during pregnancy were tested. Multiple logistic regression analysis was used to determine a predictive model for preterm birth. We then determined if the influence of perceived stress could moderate or mediate the effect of depressive symptoms on preterm birth.Results: Changes in pregnancy-related anxiety (OR = 1.1, CI 0.97-1.17, p = 0.167) and depressive symptoms (OR = 0.9, CI 0.85-1.03, p = 0.179) were insignificant as predictors of preterm birth after adjusting for the effects of maternal education and family type. When perceived stress was added into the model, we found that changes in depressive symptoms became marginally significant after adjusting for covariates (OR = 0.9, CI 0.82-1.01, p = 0.082). After adjusting for the mediation effect of change in perceived stress, the effect of change in depressive symptoms on preterm birth were marginally significant after adjusting for covariates. Among six different dimensions of pregnancy-related anxiety, mother\u27s concerns about fetal health showed a trend towards being predictive of preterm birth (OR = 1.3, CI 0.97-1.72, p = 0.078).Conclusions: There may be a relationship between perceived stress and antenatal depressive symptoms and preterm birth. This is the first study of its kind to be conducted in Pakistan. Further research is required to validate these results

Ethnic disparity and exposure to supplements rather than adverse childhood experiences linked to preterm birth in Pakistani women

Background: Adverse childhood experiences (ACEs) are associated with prenatal mental health and negative pregnancy outcomes in high income countries, but whether the same association exists in Pakistan, a low- to middle-income (LMI) country, remains unclear. Methods: Secondary data analyses of a prospective longitudinal cohort study examining biopsychosocial measures of 300 pregnant women at four sites in Karachi, Pakistan. A predictive multiple logistic regression model for preterm birth (PTB; i.e., \u3c37 weeks’ gestation) was developed from variables significantly (P \u3c 0.05) or marginally (P \u3c 0.10) associated with PTB in the bivariate analyses. Results: Of the 300 women, 263 (88%) returned for delivery and were included in the current analyses. The PTB rate was 11.1%. We found no association between ACE and PTB. Mother\u27s education (P = 0.011), mother\u27s ethnicity (P = 0.010), medications during pregnancy (P = 0.006), age at birth of first child or current age if primiparous (P = 0.049) and age at marriage (P = 0.091) emerged as significant in bivariate analyses. Mother\u27s ethnicity and taking medications remained predictive of PTB in the multivariate model. Limitations: Findings are limited by the relatively small sample size which precludes direct testing for possible interactive effects. Conclusions: In sum, pathways to PTB for women in LMI countries may differ from those observed in highincome countries and may need to be modelled differently to include behavioural response to emotional distress and socio-cultural contexts

Adverse Childhood Experiences and Changing Levels of Psychosocial Distress Scores Across Pregnancy in Kenyan Women

Background: Adverse childhood experiences (ACEs) have been associated with deleterious effects on mental health in pregnancy. Methods: The ACE International Questionnaire (ACE-IQ) was used to measure neglect, abuse, and household dysfunction. Longitudinal mixed effect modelling was used to test the effect of ACEs on pregnancy-related anxiety, depressive symptoms, and perceived stress at two time points (12–19 and 22–29 weeks) during pregnancy. Results: A total of 215 women who were predominantly married (81%) and had attained tertiary education (96%) were enrolled. Total ACEs were significantly associated with depressive symptoms (r = 0.23, p \u3c 0.05) and perceived stress (r = 0.18, p \u3c 0.05). As depressive symptoms decreased, t (167) = −8.44, p \u3c 0.001, perceived stress increased, t (167) = 4.60, p \u3c 0.001, and pregnancy-related anxiety remained unchanged as pregnancy progressed. Contact sexual abuse (p \u3c 0.01) and parental death or divorce (p = 0.01) were significantly associated with depression over time (p \u3c 0.01). Total ACEs in this study were associated with depressive symptoms early but not late in pregnancy. Conclusions: Higher total ACEs were positively associated with depressive symptoms and perceived stress during pregnancy, suggesting that mental disorders may have an impact on pregnancy outcomes and ought to be addressed. Further validation of the Edinburgh Postnatal Depression Scale (EPDS) tool in local settings is required

Comorbid Anxiety and Depression among Pregnant Pakistani Women: Higher Rates, Different Vulnerability Characteristics, and the Role of Perceived Stress.

Anxiety and depression commonly co-occur during pregnancy and may increase risk of poor birth outcomes including preterm birth and low birth weight. Our understanding of rates, patterns, and predictors of comorbid anxiety and depression is hindered given the dearth of literature, particularly in low- and middle-income (LMI) countries. The aim of this study is (1) to explore the prevalence and patterns of comorbid antenatal anxiety and depressive symptoms in the mild-to-severe and moderate-to-severe categories among women in a LMI country like Pakistan and (2) to understand the risk factors for comorbid anxiety and depressive symptoms. Using a prospective cohort design, a diverse sample of 300 pregnant women from four centers of Aga Khan Hospital for Women and Children in Pakistan were enrolled in the study. Comorbid anxiety and depression during pregnancy were high and numerous factors predicted increased likelihood of comorbidity, including: (1) High level of perceived stress at any time point, (2) having 3 or more previous children, and (3) having one or more adverse childhood experiences. These risks were increased if the husband was employed in the private sector. Early identification and treatment of mental health comorbidities may contribute to decreased adverse birth outcomes in LMI countries

Comorbid anxiety and depression among pregnant Pakistani women: Higher rates, different vulnerability characteristics, and the role of perceived stress

Anxiety and depression commonly co-occur during pregnancy and may increase risk of poor birth outcomes including preterm birth and low birth weight. Our understanding of rates, patterns, and predictors of comorbid anxiety and depression is hindered given the dearth of literature, particularly in low- and middle-income (LMI) countries. The aim of this study is (1) to explore the prevalence and patterns of comorbid antenatal anxiety and depressive symptoms in the mild-to-severe and moderate-to-severe categories among women in a LMI country like Pakistan and (2) to understand the risk factors for comorbid anxiety and depressive symptoms. Using a prospective cohort design, a diverse sample of 300 pregnant women from four centers of Aga Khan Hospital for Women and Children in Pakistan were enrolled in the study. Comorbid anxiety and depression during pregnancy were high and numerous factors predicted increased likelihood of comorbidity, including: (1) High level of perceived stress at any time point, (2) having 3 or more previous children, and (3) having one or more adverse childhood experiences. These risks were increased if the husband was employed in the private sector. Early identification and treatment of mental health comorbidities may contribute to decreased adverse birth outcomes in LMI countries