Abstract
BackgroundPrenatal stress and other prenatal risk factors (e.g. intimate partner violence) have a negative impact on mother’s health, fetal development as well as enduring adverse effects on the neuro-cognitive, behavioral and physical health of the child. Mothers of low socio-economic status and especially those living in crime-ridden areas are even more exposed to a host of risk factors. Societies of extreme violence, poverty and inequalities, often present difficulties to provide adequate mental health care to the most needed populations. The KINDEX, a brief standardized instrument that assesses 11 different risk factors was used by midwives to identify pregnant women at-risk, in a suburban area with one of the highest levels of domestic violence in Lima. The instrument was designed to be used by medical staff to identify high-risk child-bearing women and, based on the results, to refer them to the adequate psychological or social support providers. The aim of this study is to assess the feasibility of psychosocial screening using the KINDEX in a Latin American Country for the first time, and to explore the relationship of the KINDEX with thee major risk areas, maternal psychopathology, perceived stress and traumatic experiences.MethodsThe study was conducted in cooperation with the gynecological department of a general hospital in a suburban area of Lima. Nine midwives conducted interviews using the KINDEX of ninety-five pregnant women attending the gynecological unit of the hospital. From these, forty pregnant women were re-interviewed by a clinical psychologist using established instruments in order to assess the feasibility of the prenatal assessment in public health settings and the relationship of the KINDEX with maternal perceived stress, psychopathology symptoms and trauma load during pregnancy.ResultsWe found high rates of risk factors in the examined pregnant women comparable with those found in the general population. Significant correlations were found between the KINDEX sum score and the three risks areas, stress, psychopathology and trauma load as assessed in the Clinical Expert interviews. The different risks assessed by the KINDEX are related to higher levels of stress, psychopathology and trauma load, depending on the risk.ConclusionsThe relationship between past adverse experience and current stressors with perceived maternal stress, psychopathology symptoms and traumatic experiences confirm the importance of prenatal assessment for psychosocial risks. The use of KINDEX by midwives providing obstetrical care to pregnant women in urban Peru is feasible and can be used to identify high-risk women and refer them to the adequate mental health or social services for necessary attention and support. Early interventions are essential to mitigating the adverse effects of maternal stress, trauma and psychopathology on the fetus and child.
Highlights
Prenatal stress and other prenatal risk factors have a negative impact on mother’s health, fetal development as well as enduring adverse effects on the neuro-cognitive, behavioral and physical health of the child
Similar assessment tools have used in other countries such as the ALPHA Form [58, 59] and the Antenatal Risk Questionnaire (ANRQ) [60], we provide a comprehensive comparison between the KINDEX and these instruments in a previous publication about the KINDEX Spanish Version [61]
We carried out correlations to examine the relations between the KINDEX, and the three risk areas assessed by the Clinical Expert (CE) interview, the global perceived stress, psychopathology and global trauma load
Summary
Prenatal stress and other prenatal risk factors (e.g. intimate partner violence) have a negative impact on mother’s health, fetal development as well as enduring adverse effects on the neuro-cognitive, behavioral and physical health of the child. The aim of this study is to assess the feasibility of psychosocial screening using the KINDEX in a Latin American Country for the first time, and to explore the relationship of the KINDEX with thee major risk areas, maternal psychopathology, perceived stress and traumatic experiences. Evidence-based studies of the past decades demonstrate the link between psychosocial factors in the prenatal period and adverse perinatal, neonatal and child outcomes and mother-child relationship [1,2,3]. Mother’s adverse experiences during childhood have been linked to later mother-child relationship and offspring adjustment issues [6, 7]. History of childhood maltreatment and abuse of the mother has been related to posttraumatic stress symptoms and depression during pregnancy and the postpartum period [10]. Children exposed to parental trauma, are more prone to early traumatic experiences, such as emotional abuse and neglect; experiences that are related to the development of posttraumatic stress disorder (PTSD) in adulthood [11]
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