At-risk Mothers Research Articles

Identification of mothers with mental health problems is accidental: perceptions of health care providers on availability, access, and support for maternal mental health care for adolescent mothers in Malawi

BackgroundIntegration of maternal mental health into primary health care is considered a strategy to improve access to mental health support in low- and middle-income countries (LMICs). Health care workers’ (HCWs) and traditional practitioners’ (traditional healers, herbalists, traditional birth attendants, spiritual healers, prophets, and community health volunteers) perceptions of the availability and management of adolescent mothers’ maternal mental health care were explored in rural Malawi. Recognizing and identifying the barriers associated with access to maternal mental health support is essential to improving the mental health of adolescent mothers.MethodsA descriptive qualitative design (DQ) was used to explore HCWs’ and traditional practitioners’ perceptions of maternal mental health services for adolescent mothers. In-depth interviews were conducted with HCWs (n = 6), and three focus group discussions were conducted with 30 community-based traditional practitioners. Participants were purposefully recruited because they provide formal or informal health services to adolescent mothers during the postnatal period at Mitundu Rural Hospital and its catchment area in Lilongwe District, in Malawi. Interviews were analyzed using reflective thematic analysis and inductive thinking.ResultsThematic analysis found four themes to describe access to maternal mental health care for adolescent mothers. Participant perceptions were themed around health system challenges and how cultural background and beliefs influence access to mental health care and support. The themes were: (1) Inadequate staff development; (2) Limited resources (medication and infrastructure); (3) Limited policy and guidelines implementation; and (4) Cultural background and belief influence on help-seeking. HCWs suggested improving pre-service and in-service training to improve mental health assessment of mothers, while traditional practitioners wanted to increase their awareness of mental health issues.ConclusionParticipants emphasized that multifaceted factors influenced access to mental health support. These factors affect the assessment, treatment, and support of adolescent mothers and help-seeking by mothers. Therefore, strengthening the healthcare system and empowering providers with the knowledge and skills to recognize at-risk mothers and provide timely support is essential.

Maternal Antenatal Depression Is Associated With Metabolic Alterations That Predict Birth Outcomes and Child Neurodevelopment and Mental Health

BackgroundEvidence regarding metabolic alterations associated with maternal antenatal depression (AD) is limited, and their role as potential biomarkers that improve the prediction of AD and adverse childbirth, neurodevelopmental, and mental health outcomes remains unexplored. MethodsIn a cohort of 331 mother-child dyads, we studied associations between AD (a history of medical register diagnoses and/or a Center for Epidemiological Studies Depression Scale score during pregnancy ≥ 20) and 95 metabolic measures analyzed 3 times during pregnancy. We tested whether the AD-related metabolic measures increased variance explained in AD over its risk factors and in childbirth, neurodevelopmental, and mental health outcomes over AD. We replicated the findings in a cohort of 416 mother-child dyads. ResultsElastic net regression identified 15 metabolic measures that collectively explained 25% (p < .0001) of the variance in AD, including amino and fatty acids, glucose, inflammation, and lipids. These metabolic measures increased the variance explained in AD over its risk factors (32.3%, p < .0001 vs. 12.6%, p = .004) and in child gestational age (9.0%, p < .0001 vs. 0.7%, p = .34), birth weight (9.0%, p = .03 vs. 0.7%, p = .33), developmental milestones at the age of 2.3 to 5.7 years (21.0%, p = .002 vs. 11.6%, p < .001), and any mental or behavioral disorder by the age of 13.1 to 16.8 years (25.2%, p = .03 vs. 5.0%, p = .11) over AD, child sex, and age. These findings were replicated in the independent cohort. ConclusionsAD was associated with alterations in 15 metabolic measures, which collectively improved the prediction of AD over its risk factors and birth, neurodevelopmental, and mental health outcomes in children over AD. These metabolic measures may become biomarkers that can be used to identify at-risk mothers and children for personalized interventions.

Maternal depression, psychosocial stress and race/ethnicity: examining barriers to breastfeeding for young mothers

ABSTRACT Background Breastfeeding has a positive impact on child and maternal health outcomes. Black and Latina women and adolescent mothers have lower rates of breastfeeding initiation and continuance in the U.S. Maternal depression and psychosocial stressors may contribute to reduced rates of breastfeeding. The current study aims to better understand behaviours and associated factors related to breastfeeding in a diverse group of adolescent mothers attending a teen-tot clinic for postpartum and infant well care. Methods Participants were 191 mother-infant dyads. Mother’s age ranged from 13 to 25, and 54% of mothers identified as Latina, 22% Black, 11% more than one race and 5% white. Demographic information and breastfeeding behaviour were abstracted from the medical record. Rates of postpartum mood/anxiety symptoms and psychosocial stressors were obtained from screening measures completed at medical visits. Results Analyses revealed that 87% of adolescent mothers in the sample initiated breastfeeding at birth and the racial/ethnic breakdown of those mothers closely mirrored the overall population (58% Hispanic or Latina, 17% Black, 10% more than one race, 5% white). At 2 months postpartum, only 41% of the population was still breastfeeding. Mothers with significant mood/anxiety symptoms at the newborn visit were more likely to be breastfeeding at the 1- and 2-month visits. Mothers with psychosocial stressors at the newborn visit were less likely to be breastfeeding at the 1- and 2-month visits. Conclusion Efforts to promote health equity through breastfeeding for at-risk mothers must occur within the first few weeks postpartum and must consider associated factors including postpartum mood/anxiety symptoms and psychosocial stressors.

Relationship Between Frequency of Remote Visitation and Postpartum Depression in Mothers of Hospitalized Neonates During the COVID-19 Pandemic

ObjectiveTo explore the relationship between symptoms of postpartum depression and the number of remote visitations among mothers of infants in the NICU. DesignRetrospective cohort study. SettingNICU in a medical university in Iwate, Japan. ParticipantsA total of 89 mothers of infants who spent more than 1 month in the NICU from June 2021 to December 2022. MethodsParticipants completed the Edinburgh Postnatal Depression Scale (EPDS) at 4 days and 1 month after birth. We used a one-way analysis of variance with Tukey–Kramer or Games–Howell post hoc tests to examine differences in postpartum depression among three groups based on the frequency of remote visitation: frequent visitation, rare visitation, or no visitation. ResultsOf the 89 mothers, 41 scored 9 points or higher on the EPDS conducted 4 days after birth; among them, 14 did not visit, 13 rarely visited, and 14 frequently visited the NICU remotely through a web camera. The rare visitation group had significantly higher EPDS scores 1 month after birth (M = 9.7, SD = 5.2) than the frequent (M = 5.3, SD = 3.7) and no visitation (M = 5.1, SD = 4.2) groups (p < .05). The rare visitation group demonstrated lower improvement on the EPDS than the frequent and no visitation groups (nonsignificant). ConclusionIt is unclear whether remote visitation reduces symptoms of postpartum depression; however, the frequency of remote visitation could be assessed to identify at-risk mothers in need of social support.

Support and services available to at-risk mothers and their children in maternity residences: a scoping review protocol.

The objective of this scoping review is to identify, categorize, and map the types of support and services available to at-risk mothers and their children in maternity residences. A secondary objective is to identify and map the measures used to evaluate the efficacy of these types of support and services. Pregnant and parenting women and their children experiencing complex challenges related to the social determinants of health, including unstable housing and poverty, are at high risk of long-term negative health and socioeconomic outcomes. Maternity residences may provide support and services that improve this population's outcomes; however, there is little understanding of what services are offered and how efficacious they may be. Therefore, it is necessary to provide a comprehensive overview of support and services in maternity residences, and to identify the measures used to evaluate the efficacy of the support and services. This will provide the foundation to evaluate these services and outcomes and inform the development of future maternity residential programs. Studies including pregnant and parenting women and gender-diverse individuals who are housed in, or accessing the services of, maternity residences in politically stable high-income countries due to challenges rooted in the social determinants of health will be considered for inclusion. We define maternity residences as any agency with a residential component offering support/services to this population. This review will be conducted in accordance with JBI methodology for scoping reviews. The data will be analyzed using a quantitative descriptive analysis approach. The data analysis and discussion will be informed by the Social Determinants of Health, Reproductive Justice, Harm Reduction, and Health in All Policies frameworks.

The cost of doing nothing: Preventable premature births for at-risk women

Background: The effects of poverty in the United States are growing, and the impacts are most severe for the already vulnerable populations. This analysis looks at the cost of doing nothing for at-risk pregnant women in one county in NE Ohio. Most of these women are living at or below the poverty level, lack safe, affordable, and stable housing, and often do not receive recommended levels of prenatal care. This examination uses data from Mahoning County, Ohio, where one program has provided wrap-around support for any at-risk pregnant mother since 2016. Objective: Examine the cost/savings of providing wrap-around support services to at-risk pregnant women. Methods: Data was provided by the Mahoning County Pathway HUB (MCPH) regarding all births since its 2016 inception. Data was extracted from the Ohio Department of Health, the CDC, and other sources regarding the cost of births and specifically premature births. These sources of data were analyzed using causal-comparative methods, in order to understand the frequency of premature births, with, and without the support services provided by the MCPH. Conclusion: The results of these causal-comparative analyses suggest that the cost of doing nothing for at-risk pregnant women is substantial for all stakeholders. Results demonstrate a savings of 2.45 million dollars for the five years included in the analysis. Because most of the services provided by the MCPH are billable to public health insurance, this model of supporting pregnant mothers who are at risk is important. The cost of doing nothing can lead to a lifetime of avoidable suffering and financial hardship for the women and infants who are born premature. The results from the MCPH suggest that this model of support and service delivery is making a difference, based on the lower-than-expected pre-term births over their tenure of operation.

RISK FACTORS OF PERINATAL DEPRESSION IN WOMEN: AN UPDATED SYSTEMATIC REVIEW

Background: Perinatal depression (PND) can result in adverse outcomes for both mother and child, including poorer pregnancy outcomes and long-term emotional, social, and cognitive difficulties in children. Furthermore, it correlates with high morbidity and mortality rates, posing significant burdens on affected individuals, families, and society. The objective of this study is to conduct an extensive systematic review evaluating the risk factors of perinatal depression in women based on literature published within the last five years. Methods: The systematic review followed PRISMA 2020 standards and examined full-text English literature published between 2019 and 2024. This review excluded editorials, review papers from the same journal, and submissions without a DOI. Literature was sourced from online platforms such as PubMed, SagePub, and SpringerLink. Result: A total of 1,161 articles were retrieved from online databases (PubMed, SagePub, and SpringerLink). After three rounds of screening, five articles directly relevant to the systematic review were selected for full-text reading and analysis. Conclusion: Perinatal depression (PND) affects numerous women during and after childbirth, influenced by socioeconomic, psychosocial, and environmental factors like poverty, social support, pregnancy loss, and urban living. Early detection and comprehensive interventions are crucial to support at-risk mothers, promoting better mental health outcomes for both them and their families.

Evaluating cognitive behavioral therapy as a solution for postnatal depression in economically disadvantaged regions.

Postnatal depression (PND) impacts numerous women after childbirth, leading to various impairments in their lives. Mental health interventions, such as cognitive behavioral therapy (CBT), need further evaluation in low- and middle-income countries (LMICs) where resources may be scarce. This study aimed to assess the effectiveness of CBT in treating PND in women from LMICs, comparing it to standard care. A systematic review and meta-analysis were conducted following the PRISMA Statement 2020 guidelines. Databases such as PubMed, CINAHL Plus, Cochrane Library, and PsycINFO were searched until September 2022. A modified Delphi process was employed to identify relevant studies. The primary outcome was mean depression scores, measured by the Edinburgh postnatal depression scale at baseline and post-intervention. Out of 487 studies identified, five trials were included, totaling 1056 participants (520 in the intervention group and 536 in the comparator group). At baseline, a minor, insignificant positive effect size was found (Cohen's d = 0.1, 95% CI = - 0.15, 0.35). Post-CBT, the intervention group showed significant improvements in depression scores (Cohen's d = - 1.9, 95% CI = - 3.8, 0). When accounting for the influence of one study, (Ngai et al., Psychother Psychosom 84:294-303, 2015), which held substantial weight in the initial analysis, the effect size was adjusted to d = 0.5, highlighting a lesser but still significant difference. CBT appears to be effective in improving PND symptoms among women in LMICs and may be considered a first-line treatment for at-risk mothers, including those who are displaced. However, the significant impact of one study on the results emphasizes the need for more rigorous research. The study also highlights the challenges and limitations of providing psychotherapies across LMICs, emphasizing the need for culturally adapted and contextually appropriate interventions to ensure successful implementation and sustainability of mental health care for postnatal women in these settings.

Primary care physicians' perspectives on the identification and management of postnatal mental health problems.

Postnatal mental health problems (PMHPs) are prevalent and negatively affect mothers, children, and society. International and local guidelines recommend that Singapore primary care physicians (PCP) screen, assess, and manage mothers with PMHPs. However, little is known about their experiences and views. We conducted semi-structured interviews with 14 PCPs in Singapore. Interview questions elicited perspectives on the identification and management of mothers with PMHPs. The interview guide was developed from a conceptual framework incorporating the knowledge-attitudes-practices, self-efficacy, and socio-ecological models. Interviews were audio-recorded and transcribed. Thematic analysis was used to identify emergent themes. Singapore PCPs viewed themselves as key providers of first-contact care to mothers with PMHPs. They believed mothers preferred them to alternative providers because of greater accessibility and trust. In detection, they were vigilant in identifying at-risk mothers and favoured clinical intuition over screening tools. PCPs were confident in diagnosing common PMHPs and believed that mothers not meeting diagnostic criteria must be readily recognized and supported. In managing PMHPs, PCPs expressed varying confidence in prescribing antidepressants, which were viewed as second-line to supportive counselling and psychoeducation. Impeding physician factors, constraining practice characteristics and health system limitations were barriers. Looking forward, PCPs aspired to leverage technology and multidisciplinary teams to provide comprehensive, team-based care for the mother-child dyad. Singapore PCPs are key in identifying and managing mothers with PMHPs. To fully harness their potential in providing comprehensive care, PCPs need greater multidisciplinary support and technological solutions that promote remote disclosure and enhanced preparation for their role.

Stagnation of maternal mortality decline in Bangladesh between 2010 and 2016 in spite of an increase in health services utilisation: Examining data from three large cross-sectional surveys.

After a 40% reduction in maternal mortality ratio (MMR) during 2001-2010 in Bangladesh, the MMR level stagnated between 2010 and 2016 despite a steady increase in maternal health services use and improvements in overall socioeconomic status. We revisited the factors that contributed to MMR decline during 2001-2010 and examined the changes in these factors between 2010 and 2016 to explain the MMR stagnation in Bangladesh. We used data from the 2001, 2010, and 2016 Bangladesh Maternal Mortality Surveys, which sampled 566 115 households in total, to estimate the changes in the risk of dying of maternal causes associated with a pregnancy or birth between 2001-2010 and 2010-2016. We carried out Poisson regression analyses with random effects at the sub-district level to explore the relationship between the change in risk of maternal death from 2001 to 2016 and a range of demographic, socioeconomic, and health care factors. Between 2001 and 2016, the proportion of high-risk pregnancies decreased, except for teenage pregnancies. Meanwhile, there were notable improvements in socioeconomic status, access to health services, and the utilisation of maternal health services. A comparison of factors affecting the risk of maternal death between 2001-2010 and 2010-2016 indicated that first pregnancies continued to offer significant protection against maternal deaths. However, subsequent pregnancies among girls under 20 years became a significant risk factor during 2010-2016, increasing the risk of maternal deaths by nearly 3-fold. Among the key maternal health services, only skilled birth attendants (SBA) were identified as a key contributor to MMR reduction during 2001-2010. However, SBA is no longer significantly associated with reducing mortality risk during 2010-2016. Despite continued improvements in the overall socioeconomic status and access to maternal health services in Bangladesh, the stagnation of MMR decline between 2010 and 2016 is associated with multiple teenage pregnancies and the lack of capacity in health facilities to provide quality delivery services, as SBA has been primarily driven by facility delivery. The findings provide a strong rationale for targeting at-risk mothers and strengthening reproductive health services, including family planning, to further reduce maternal mortality in Bangladesh.

Associations of polymetabolic risk of high maternal pre-pregnancy body mass index with pregnancy complications, birth outcomes, and early childhood neurodevelopment: findings from two pregnancy cohorts

BackgroundA substantial proportion of maternal pregnancy complications, adverse birth outcomes and neurodevelopmental delay in children may be attributable to high maternal pre-pregnancy Body Mass Index (BMI). However, BMI alone is insufficient for the identification of all at-risk mothers and children as many women with non-obesity(< 30 kg/m2) or normal weight(18.5–24.99 kg/m2) and their children may suffer from adversities. Evidence suggests that BMI-related metabolic changes during pregnancy may predict adverse mother–child outcomes better than maternal anthropometric BMI.MethodsIn a cohort of 425 mother–child dyads, we identified maternal BMI-defined metabolome based on associations of 95 metabolic measures measured three times during pregnancy with maternal pre-pregnancy BMI. We then examined whether maternal BMI-defined metabolome performed better than anthropometric BMI in predicting gestational diabetes, hypertensive disorders, gestational weight gain (GWG), Caesarian section delivery, child gestational age and weight at birth, preterm birth, admission to neonatal intensive care unit (NICU), and childhood neurodevelopment. Based on metabolic measures with the highest contributions to BMI-defined metabolome, including inflammatory and glycolysis-related measures, fatty acids, fluid balance, ketone bodies, lipids and amino acids, we created a set of maternal high BMI-related polymetabolic risk scores (PMRSs), and in an independent replication cohort of 489 mother–child dyads tested their performance in predicting the same set of mother–child outcomes in comparison to anthropometric BMI.ResultsBMI-defined metabolome predicted all of the studied mother–child outcomes and improved their prediction over anthropometric BMI, except for gestational hypertension and GWG. BMI-related PMRSs predicted gestational diabetes, preeclampsia, Caesarian section delivery, admission to NICU, lower gestational age at birth, lower cognitive development score of the child, and improved their prediction over anthropometric BMI. BMI-related PMRSs predicted gestational diabetes, preeclampsia, Caesarean section delivery, NICU admission and child’s lower gestational age at birth even at the levels of maternal non-obesity and normal weight.ConclusionsMaternal BMI-defined metabolome improves the prediction of pregnancy complications, birth outcomes, and neurodevelopment in children over anthropometric BMI. The novel, BMI-related PMRSs generated based on the BMI-defined metabolome have the potential to become biomarkers identifying at-risk mothers and their children for timely targeted interventions even at the level of maternal non-obesity and normal weight.

Haemolytic Disease of Newborn in a baby Delivered by Mother with Complete Anti-D Prophylaxis: An Unusual Case Report

Haemolytic Disease of the Newborn (HDN), also known as erythroblastosis foetalis, is an immune-mediated disorder among neonates with a wide range of clinical presentations. The occurrence of HDN due to ABO-Rh incompatibility between the mother and baby is becoming rare due to increased knowledge of the disease and adherence to Good Clinical Practices (GCP) during pregnancy. This case report highlights a rare case of HDN in which, despite following GCP, standard care, an uneventful antenatal period, and timely administration of Anti-D immunoprophylaxis, the mother delivered a baby with HDN. The baby was successfully managed by a group of skilled and caring clinicians. Therefore, it is crucial to screen all at-risk mothers for HDN to identify it earlier and treat it successfully. This case report is rare in terms of the baby’s survival with HDN born to a mother who had already received timely Anti-D immunoprophylaxis. Additionally, there is a need to emphasise on recent advances in diagnosis, such as foetal Doppler studies, and treatment options.

Internet-based interdisciplinary therapeutic group (Grupo Interdisciplinar Online, GIO) for perinatal anxiety and depression—a randomized pilot study during COVID-19

Early interventions may promote reductions in mothers’ anxiety-depression (AD) symptoms and improvements in their offspring. This longitudinal randomized research was conducted to assess the effects of interdisciplinary online therapeutic groups (GIO) in at-risk mothers and babies during the COVID-19 pandemic in a disadvantaged neighborhood in Barcelona (Spain). A total of 135 babies were born from March 2020 to June 2021 in a primary healthcare center of Barcelona (Spain). Pregnant woman and new mothers were screened for AD symptomatology through EPDS and STAI questionnaires. Seventy-two of them met high-risk criteria for AD and were included in the study. They were randomly assigned into the two groups of the study: 40 participants were assigned to GIO, the therapeutic group (TG), while 32 of them were assigned to the control group (CG) and received treatment as usual. The course of the mothers’ symptomatology was assessed, as well as the baby’s development at 6 months old in a blind pediatric follow-up. No differences were found in AD between both groups before the intervention. However, we obtained a significant decrease in AD symptomatology (EPDS p < .001; STAI state p = .015 and STAI trait p < .001at 6 months of life) after the intervention in the TG compared to the CG. Pediatric follow-up at 6 months demonstrated significant differences between groups in babies’ development assessment (manipulation p = .003; language p < .001; sociability p < .001). The GIO helped to ensure healthy development of the baby and reduction of the mothers’ depressive-anxiety symptomatology.

Increasing postpartum depression screening and resources in pediatric primary care: A quality improvement project to enhance provider confidence

BackgroundUnidentified and untreated postpartum depression (PPD) can have a negative impact on children. This Quality Improvement (QI) project aimed to increase PPD screening through provider education and enhancing pediatric primary care provider (PCP) confidence in using the Edinburg Postnatal Depression Screening (EPDS) tool, discussing PPD with mothers, and providing resources. Design and methodsPCPs and staff were educated on the project. Providers were surveyed prior to and after implementation to assess confidence with screening for and addressing PPD. Mothers of infants 0–6 months were screened using the EPDS at well-care visits. Discussion of PPD and resource support was provided if needed. ResultsA total of 273 mothers met criteria for screening, and of those 65% (n = 178) had a documented score. 12.4% of mothers had a score of 10 or greater, indicating high risk for PPD. Results from PCPs were compared both pre- and post-project. Screening for PPD increased from 3 to 4.5, using the EPDS tool from 2.25 to 4.75, discussing PPD with mothers from 2.75 to 4.25, and providing resources from 2.25 to 4.25. ConclusionsPPD screening increased, and provider confidence with using the EPDS, discussing PPD with mothers, and providing resources in pediatric primary care increased.Practice Implications: Educating PCPs on the importance of PPD screening and providing resources for at-risk mothers can increase identification of PPD in the primary care setting. Enhancing the confidence of providers to discuss PPD with mothers and offer resources to those in need can lead to better outcomes for pediatric patients and their families.

Diagnostic Accuracy of Gestosis Score in Comparison to multi-marker Screening as a Predictor of Preeclampsia at 11-14 Weeks of Pregnancy: A Cohort Study.

Pre-eclampsia is a pregnancy-specific multisystemic disorder associated with adverse feto-maternal outcomes. Low-dose Aspirin therapy started in early pregnancy in high-risk women, has significantly reduced the chances of developing PE. Therefore, screening and identification of at-risk mothers are crucial. The present study was planned to study the predictive ability of gestosis score in predicting early-onset pre-eclampsia by comparing it with the multi-marker model. One hundred sixteen women, more than 19 years of age, with live singleton pregnancy at 11-13 weeks of gestation were recruited from the antenatal outpatient department and formed the study cohort. After a detailed history, screening for pre-eclampsia was performed both by multi-marker screening and by gestosis score. Diagnostic accuracy was compared for the two methods of screening. The incidence of pre-eclampsia in the present study cohort was 26.7%. The sensitivity of gestosis score >/= 3 was 84.38% (67.21-94.72) and specificity was 93.18% (85.75-97.46 %). The positive predictive value was 81.82% (67.2%-90.81%), and the negative predictive value was 94.25 (87.98 - 97.35%). The diagnostic accuracy of the gestosis score was 90.83%. Gestosis scoring is a potential tool that can be used as a cost-effective screening method for pre-eclampsia at 11-14 weeks of gestation in low-resource settings. The sensitivity and negative predictive value of the gestosis score is comparable to multi-marker screening using maternal factors, MAP, Uterine artery PI, PAPP-A, and PlGF.

Psychometric properties of the European Portuguese version of the modified perinatal PTSD questionnaire (PPQ-II)

Childbirth-related posttraumatic stress symptoms (CB-PTSS) are prevalent and have pervasive consequences for the entire family. The development and validation of tools for screening CB-PTSS are deemed necessary to maximize prevention and intervention efforts. This study aims to examine the psychometric properties of the modified perinatal PTSD questionnaire (PPQ-II) in a sample of European Portuguese mothers. Four hundred and fifty-one women, from 1 to 18 months postpartum, participated in an online cross-sectional study that was conducted between February and March 2020. Participants completed the PPQ-II and the Depression Anxiety Stress Scales – 21 (DASS-21). Factor structure was estimated through an Exploratory (EFA; n = 229) and Confirmatory factor analysis (CFA; n = 222). Convergent and known-groups validity and internal consistency of the scale were also computed. The EFA suggested a 2-structure factor (Factor 1 “Arousal”, containing 7 items; and Factor 2 “Avoidance and Intrusion”, containing 4 items), accounting for 48.3% of the total variance of the scale. This factor structure was supported by the CFA, showing an adequate fit to the data. Convergent validity was shown by significant associations between the PPQ-II and DASS-21 subscales. Overall, the scale discriminated between at-risk and low-risk mothers. The McDonald’ omega coefficients attested the high reliability of the PPQ-2 (ranging from 0.78 to 0.89). The PPQ-II is a valid and reliable instrument to routinely screen for CB-PTSS in perinatal health services. It also adds to prior studies demonstrating its cross-cultural validity.

Material hardship in the postpartum year: Links to child maltreatment

BackgroundMillions of mothers with young children in the U.S. struggle to afford basic needs. Material hardships such as inadequate food, housing, and medical care increase risk for child maltreatment as mothers face heightened physical and emotional strain. ObjectiveThe present study applied a person-centered approach to understand unique subtypes of material hardship experienced by at-risk mothers in the postpartum year, and links from hardship subtypes to subsequent child maltreatment. Participants and settingThe sample included at-risk mothers who gave birth in one of 20 large American cities 1998–2000 and retained custody of their children at age 1 and 3 (N = 3966). MethodLatent class analysis (LCA) identified subtypes of material hardship; mean maltreatment scores were estimated across classes. ResultsLCA identified four hardship subtypes with differential risks for maltreatment. Compared to “Stable” mothers, “Cost-Burdened” mothers – who displayed high levels of missed rent and utility payments – were significantly more likely to psychological abuse (χ2 = 5.04, p < 0.05) or neglect (χ2 = 4.46, p < 0.05) their children. “Severely Housing Insecure Mothers” – characterized by elevated rates of doubling up, eviction, and homelessness – were significantly more likely to engage in physical assault (χ2 = 16.25, p < 0.001), psychological aggression (χ2 = 11.15, p < 0.01), and neglect (χ2 = 17.55, p < 0.001). ConclusionsDifficulty maintaining stable and affordable housing is associated with elevated risk of child maltreatment. Efforts to prevent child maltreatment must incorporate access to housing screening and supports, particularly among families with infants.

Pregnancy complications and their association with postpartum depression symptoms: a retrospective study

ABSTRACT Objective Postpartum depression affects around 17% of the women worldwide and has considerable implications for maternal and child health. While some risk factors have been identified, the association between pregnancy and delivery complications and postpartum depression is less well understood. This study aims to determine whether specific pregnancy complications are associated with risk of postpartum depression symptoms (PPDS). Method This study analysed a subset of variables collected as part of a larger study exploring pregnancy circumstances and maternal-foetal health outcomes. Mothers residing in Australia provided information on their biological children aged 3–13 years. Pregnancy complications were analysed using bivariate analyses and binary logistic regression. Results Mothers (N = 1,926) reported on N = 3,210 pregnancies (mean number of pregnancies = 1.27, SD = 0.97). At the time of childbirth, mothers were on average 30.1 years old (SD = 5.14). Experiencing a pregnancy complication increased the risk of PPDS (X2 = 16.45, df = 1, p < 0.001) However, logistic regression analyses indicated an increased risk of PPDS was associated with the specific pregnancy complications of cytomegalovirus (AOR = 7.06, 95% CI[1.51,32.98]), emergency caesarean (AOR = 1.67, 95% CI[1.31,2.12]), foetal distress before birth (AOR = 1.49, 95% CI[1.16,1.91]), induced labour (AOR = 1.55, 95% CI[1.25,1.91]) and placenta previa (AOR = 2.60, 95% CI[1.44,4.71]). Conclusion Specific pregnancy complications were associated with PPDS, suggesting that some complications may pose a greater risk for PPDS than others. This study contributes to the growing understanding of peripartum risk factors for postpartum depression, and suggests that early clinical identification of at-risk mothers and early prophylactic and supportive care may be warranted to reduce that risk.

A feasibility study of Online Mellow Bumps: A Turkish pilot study of an online group-based antenatal parenting intervention

BackgroundAs a result of the COVID-19 pandemic, Mellow Parenting proposed online strategies for some of their interventions. One such intervention was Mellow Bumps – becoming Online Mellow Bumps. The objective of this study was to evaluate the implementation of antenatal parenting intervention Mellow Bumps in an online format and determine if this can be done safely and without detriment to pregnant women in Turkey. MethodThe study used an exploratory study design to investigate routine evaluation data collected pre- and post-intervention. Outcomes were online feasibility, mental health symptoms (depression, anxiety and stress), maternal subjective well-being, perceived quality of relationship with baby, maternal confidence and maternal social connectivity. 128 mums-to-be took part in the intervention between January 2021 and May 2021 from a total of 21 different provinces in Turkey. Results57 pre- and post-intervention responses were eligible for analysis. This gives a response rate of 44.5% for evaluation, though the intervention completion rate was high at 89.5%, suggesting the intervention is engaging and accessible. Improvements were found for maternal stress levels, maternal subjective well-being and perceived relationship with baby. Improvements were also found for maternal confidence and maternal social connectivity. ConclusionsThis is the first study to evaluate the antenatal parenting intervention Mellow Bumps in an online format, namely Online Mellow Bumps. The online format makes the programme accessible for at-risk mothers and families, with the potential to continue reaching wider audiences beyond the pandemic who otherwise might struggle to access support. The findings show that the online group can be effective in improving mental health symptoms and mental well-being, supporting expectant mothers before the baby is born. Future research using a control group, a larger and more inclusive sample, and assessing the longer-term effects on parent and child would be beneficial.

Housing insecurity and employment stability: An investigation of working mothers.

Little evidence informs the relationship between housing insecurity and employment for working mothers. The present study aimed to identify variation in work schedules and supports, as well as the link from housing insecurity to employment experiences in a sample of at-risk mothers. Latent class analysis identified subtypes of employment stability; multinomial logistic regression estimated links from housing insecurity to class membership. Three subtypes of employment stability emerged, "Full-Time and Stable," "Full-Time and Unstable," and "Part-Time Weekend." Housing insecurity increased risk for being in the "Unstable" class relative to the other classes such that these mothers experienced stressful work schedules that offered little support or flexibility for family and child needs. Identifying and intervening on housing insecurity can promote stable employment. Increased workplace supports such as paid leave, flexible schedules, and antidiscrimination training can better enable mothers to juggle the competing demands of motherhood and work.