Associations of depression and depressive symptoms with preeclampsia: results from a Peruvian case-control study

<p>Abstract</p> <p>Background</p> <p>Preeclampsia involves endothelial dysfunction, platelet dysfunction/activation and sympathetic over-activity similar to cardiovascular disorders (CVD). Depression, an independent risk factor for progression of CVD, was found to be associated with an increased risk of preeclampsia among Finnish women. We examined the relation between depression/depressive symptoms and preeclampsia risk among Peruvian women.</p> <p>Methods</p> <p>The study included 339 preeclamptic cases and 337 normotensive controls. Depression and depressive symptoms during pregnancy were assessed using the Patient Health Questionnaire (PHQ-9). Odds ratios (OR) and 95% confidence intervals (CI) were estimated from logistic regression models.</p> <p>Results</p> <p>The prevalence of moderate depression was 11.5% among cases and 5.3% among controls. The corresponding figures for moderate-severe depression were 3.5% for cases and 2.1% for controls. Compared with non-depressed women, those with moderate depression had a 2.3-fold increased risk of preeclampsia (95% CI: 1.2–4.4), while moderate-severe depression was associated with a 3.2-fold (95% CI: 1.1–9.6) increased risk of preeclampsia. Associations of each of the 9-items of the PHQ-9 depression screening module with preeclampsia risk were also observed.</p> <p>Conclusion</p> <p>Our findings are consistent with the only other published report on this topic. Collectively, available data support recent calls for expanded efforts to study and address depression among pregnant women.</p

Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial

Objectives To investigate the effectiveness of routine ultrasonography in the third trimester in reducing adverse perinatal outcomes in low risk pregnancies compared with usual care and the effect of this policy on maternal outcomes and obstetric interventions. Design Pragmatic, multicentre, stepped wedge cluster randomised trial. Setting 60 midwifery practices in the Netherlands. Participants 13 046 women aged 16 years or older with a low risk singleton pregnancy. Interventions 60 midwifery practices offered usual care (serial fundal height measurements with clinically indicated ultrasonography). After 3, 7, and 10 months, a third of the practices were randomised to the intervention strategy. As well as receiving usual care, women in the intervention strategy were offered two routine biometry scans at 28-30 and 34-36 weeks’ gestation. The same multidisciplinary protocol for detecting and managing fetal growth restriction was used in both strategies. Main outcome measures The primary outcome measure was a composite of severe adverse perinatal outcomes: perinatal death, Apgar score <4, impaired consciousness, asphyxia, seizures, assisted ventilation, septicaemia, meningitis, bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leucomalacia, or necrotising enterocolitis. Secondary outcomes were two composite measures of severe maternal morbidity, and spontaneous labour and birth. Results Between 1 February 2015 and 29 February 2016, 60 midwifery practices enrolled 13 520 women in mid-pregnancy (mean 22.8 (SD 2.4) weeks’ gestation). 13 046 women (intervention n=7067, usual care n=5979) with data based on the national Dutch perinatal registry or hospital records were included in the analyses. Small for gestational age at birth was significantly more often detected in the intervention group than in the usual care group (179 of 556 (32%) v 78 of 407 (19%), P<0.001). The incidence of severe adverse perinatal outcomes was 1.7% (n=118) for the intervention strategy and 1.8% (n=106) for usual care. After adjustment for confounders, the difference between the groups was not significant (odds ratio 0.88, 95% confidence interval 0.70 to 1.20). The intervention strategy showed a higher incidence of induction of labour (1.16, 1.04 to 1.30) and a lower incidence of augmentation of labour (0.78, 0.71 to 0.85). Maternal outcomes and other obstetric interventions did not differ between the strategies. Conclusion In low risk pregnancies, routine ultrasonography in the third trimester along with clinically indicated ultrasonography was associated with higher antenatal detection of small for gestational age fetuses but not with a reduced incidence of severe adverse perinatal outcomes compared with usual care alone. The findings do not support routine ultrasonography in the third trimester for low risk pregnancies. Trial registration Netherlands Trial Register NTR4367

Cardio-metabolic risk in 5-year-old children prenatally exposed to maternal psychosocial stress: the ABCD study

<p>Abstract</p> <p>Background</p> <p>Recent evidence, both animal and human, suggests that modifiable factors during fetal and infant development predispose for cardiovascular disease in adult life and that they may become possible future targets for prevention. One of these factors is maternal psychosocial stress, but so far, few prospective studies have been able to investigate the longer-term effects of stress in detail, i.e. effects in childhood. Therefore, our general aim is to study whether prenatal maternal psychosocial stress is associated with an adverse cardio-metabolic risk profile in the child at age five.</p> <p>Methods/design</p> <p>Data are available from the Amsterdam Born Children and their Development (ABCD) study, a prospective birth cohort in the Netherlands. Between 2003-2004, 8,266 pregnant women filled out a questionnaire including instruments to determine anxiety (STAI), pregnancy related anxiety (PRAQ), depressive symptoms (CES-D), parenting stress (PDH scale) and work stress (Job Content Questionnaire).</p> <p>Outcome measures in the offspring (age 5-7) are currently collected. These include lipid profile, blood glucose, insulin sensitivity, body composition (body mass index, waist circumference and bioelectrical impedance analysis), autonomic nervous system activity (parasympathetic and sympathetic measures) and blood pressure.</p> <p>Potential mediators are maternal serum cortisol, gestational age and birth weight for gestational age (intrauterine growth restriction). Possible gender differences in programming are also studied.</p> <p>Discussion</p> <p>Main strengths of the proposed study are the longitudinal measurements during three important periods (pregnancy, infancy and childhood), the extensive measurement of maternal psychosocial stress with validated questionnaires and the thorough measurement of the children's cardio-metabolic profile. The availability of several confounding factors will give us the opportunity to quantify the independent contribution of maternal stress during pregnancy to the cardio-metabolic risk profile of her offspring. Moreover, the mediating role of maternal cortisol, intrauterine growth, gestational age and potential gender differences can be explored extensively. If prenatal psychosocial stress is indeed found to be associated with the offspring's cardio-metabolic risk, these results support the statement that primary prevention of cardiovascular disease may start even before birth by reducing maternal stress during pregnancy.</p

Medical Expert: The Resident Who Passed the Ultimate Test – The Integration of Roles During the Gynecological Examination

The gynecologist (in training) and health care practitioners (HCPs), in this chapter referred to as examiners, who perform a gynecological examination need to integrate all CanMEDS competences to perform an effective examination. Effective here means an interaction between the HCP and patient, in which the woman feels acknowledged, respected, well treated, and well diagnosed. What the examination as a test for medical expertise illustrates is that each aspect of the CanMEDS model is a conditional fractal; every role is conditional for all the other roles. Communication has to be organized, organization has to be communicated. Everything is connected to everything and that makes it so hard to grasp in the beginning. The medical expert is able to integrate all roles as intrinsic roles. In this chapter, we therefore address the different CanMEDS competences that play a role during a gynecological examination

A Historical Perspective on Patient Education in Clinical Practice and in Medical Education

Over the last 50 years, communication skills training (CST) has been a regular part of medical education in most Western countries. However, until recently, CST programs mainly focused on the skills of history-taking, and patient-education skills were less addressed. With patient education, we refer to the use of educational methods, such as the provision of information, advice, and behavior modification techniques, to influence the patients’ knowledge, opinions, and health and illness behavior in order to ensure that the patient is able to collaborate effectively in deciding on the care that she or he receives and can make the best possible contribution to that care. Furthermore, CST programs in medical and other healthcare education are usually limited to training activities isolated from clinical practice. As a consequence, most healthcare staff has been insufficiently prepared for their patient-education tasks in clinical practice. In order to understand the deficiencies in patient-education skills of healthcare workers, especially of those adhering to the biopsychosocial model of care, this chapter provides a historical overview of patient education in clinical practice and in medical training. The critical-reflections paragraph that concludes this chapter contains some recommendations to remedy these deficiencies

Medical Expert: The Resident Who Passed the Ultimate Test – The Integration of Roles During the Gynecological Examination

The gynecologist (in training) and health care practitioners (HCPs), in this chapter referred to as examiners, who perform a gynecological examination need to integrate all CanMEDS competences to perform an effective examination. Effective here means an interaction between the HCP and patient, in which the woman feels acknowledged, respected, well treated, and well diagnosed. What the examination as a test for medical expertise illustrates is that each aspect of the CanMEDS model is a conditional fractal; every role is conditional for all the other roles. Communication has to be organized, organization has to be communicated. Everything is connected to everything and that makes it so hard to grasp in the beginning. The medical expert is able to integrate all roles as intrinsic roles. In this chapter, we therefore address the different CanMEDS competences that play a role during a gynecological examination