Pregnancy Symptoms Research Articles

Bladder pain syndrome and pregnancy

Bladder pain syndrome (BPS) is a poorly understood condition. In pregnancy, lower urinary tract symptoms and pain are common, but the possibility of BPS is rarely considered and almost never explored. The consequences of BPS on pregnancy and vice versa are poorly understood, and management options appear to be limited. This article reviews the current evidence to allow us to better counsel, investigate, diagnose and manage patients with suspected or known BPS who fall pregnant or who are considering pregnancy.MEDLINE, EMBASE and PubMed were searched for a combination of mesh terms of keywords: ‘cystitis’, ‘interstitial’, ‘bladder’, ‘pain’ and ‘pregnancy’. Relevant articles were identified, reviewed and further relevant articles identified from the references. ConclusionBPS symptoms are very common in pregnancy, with limited data suggesting significant negative effects on the woman and pregnancy. There are safe options for investigation, diagnosis and management in pregnancy. There is a need to raise awareness of the impact of BPS symptoms in pregnancy and the available options for diagnoses and management, improving patient experience and outcomes. Patient summaryPatients with BPS or symptoms akin to BPS need not be abandoned in pregnancy. There is data to support them in making decisions around investigation and management in pregnancy.

P-697 Pre-pregnancy complications - associated factors and wellbeing in early pregnancy: A Swedish cohort study

Abstract Study question Which factors are associated with pre-pregnancy complications and poor well-being in early pregnancy? Summary answer We identified different risk profiles for different pre-pregnancy complications. Besides age and body mass index, exposure to certain prescribed drugs was a modifiable risk factor. What is known already Many couples experience difficulties to become pregnant or carry a pregnancy to term due to unknown causes. Complications including recurrent pregnancy loss (RPL), subfertility (failure to conceive within one year of unprotected intercourse) and the need for artificial reproductive technologies (ART) are increasing worldwide. Previously identified risk factors for involuntary childlessness include higher age, irregular menstruation, endometriosis and polycystic ovary syndrome – however, none of these are modifiable and there are still many cases unexplained. Study design, size, duration Online questionnaires were collected for 5330 unique pregnancies in Sweden from November 2017 – February 2021, collected before 20 weeks of gestation. Participants/materials, setting, methods Participants were defined as having pre-pregnancy complication(s) if they had any of the following: prior RPL (> 3) or late miscarriage, subfertility, or the use of ART. Multivariable logistic regression modelling was used to investigate potential risk factors for pre-pregnancy complications and poor well-being in early pregnancy, reported as odds ratios (OR) with 95% confidence intervals. Main results and the role of chance Pre-pregnancy complications were identified in 1142 participants (21%), with the most common one being subfertility (n = 790, 69%). Risk factors included diagnosed endometriosis (OR 4.43, CI 3.33-5.91), thyroid medication (OR 2.20, CI 1.76-2.74), opioids and other strong pain medication (OR 1.97, CI 1.19-3.19), asthma and allergy medication (OR 1.23, CI 1.03-1.46), body mass index > 25 kg/m2 (OR 1.35, CI 1.07 for BMI 25-29.9 and OR 1.58, CI 1.19-2.07 for BMI ≥ 30) and age over 35 years (OR 1.35, CI 1.07-1.72). Different subgroups of pre-pregnancy complications had unique risk factors. The groups also experienced different symptoms in early pregnancy. Women that had experienced recurrent pregnancy loss were at higher risk of depression during their current pregnancy (OR 1.71, CI 1.21-2.38). All groups were at higher risk for reporting any complications in their current pregnancy (OR 1.33, CI 1.11-1.59), as well as vaginal bleeding (OR 1.72, CI 1.15-2.55). Limitations, reasons for caution We have a high prevalence of participants with RPL, and participants that needed in vitro fertilization (IVF), which indicates a selection bias towards participants with pre-pregnancy complications. Furthermore, we did not collect information on the partner’s medical history, which might play a role in the need for ART. Wider implications of the findings The identified risk factors could be used to identify women at risk for pre-pregnancy complications and help them earlier in the process of trying to conceive, thus assisting them to reduce stress and depression during the pregnancy. Trial registration number Not applicable

A Review of Mobile Applications’ Features for Pregnant Women's Self-care

Mobile applications have been proposed as a helpful tool to provide health-related information to people, and this is more important in pregnancy-related mobile applications. This review study aimed to investigate the features of Persian and English mobile apps for self-care in pregnancy.This descriptive cross-sectional study was done on all Persian and English mobile applications related to pregnancy in 2022. A search was conducted on Iranian digital app market (Bazaar) and "Google Play", using the following keywords: "pregnancy", "pregnant women", "obstetrics", and their Persian translations. For each app, the extracted information included name, user satisfaction rate, and the features and provided information by mobile app.The total number of retrieved applications was 416 apps. After removing the duplicates and applying the inclusion criteria, 63 applications were selected for features extraction. Reviewing the features and information provided by the applications showed that the most frequent categories of information included the following items: childbirth and pregnancy (including timing contractions, fetal movement, symptoms of pregnancy and predicting delivery time), restrictions and limitations (including behavioral limits, sexual restrictions, smoking and alcohol, cosmetics and pregnancy and drug use during pregnancy), and monitoring and control tools (BMI Calculator, managing weight gain during pregnancy, control of blood pressure).Paying attention to pregnant women and meeting their information needs could lead to healthier generation. A wide range of mobile applications related to pregnancy are available with many capabilities. Considering pregnant women’s need for information and using these apps in self-care, it seems essential to develop and design a series of high-quality apps matching pregnant women's needs.

Fecal incontinence and associated pelvic floor dysfunction during and one year after the first pregnancy.

Obstetric anal sphincter injury is an important risk factor for postpartum fecal incontinence but few studies have reported fecal incontinence occurring, even during pregnancy. The first objective of this study was to examine the prevalence of fecal incontinence, obstructed defecation and vaginal bulging early and late in pregnancy and postpartum. The second objective was to assess the association between symptoms in pregnancy, delivery characteristics, and bowel and vaginal bulging symptoms at 1 year postpartum. This prospective cohort study was conducted between October 2014 and October 2017, including 898 nulliparous women enrolled with the maternity healthcare service in Örebro County, Sweden. The women responded to questionnaires regarding pelvic floor dysfunction in early and late pregnancy and at 8 weeks and 1 year postpartum. The data were analyzed using random effect logistic models estimating odds ratios (ORs) and generalized linear models estimating relative risks, with 95% confidence intervals (CIs). At 1 year postpartum, the prevalence of fecal incontinence, obstructed defecation and vaginal bulging was 6% (40/694), 28% (197/699) and 8% (56/695), respectively. Among women with vaginal delivery, the risk of fecal incontinence and vaginal bulging increased significantly both in late pregnancy, with ORs of 3.4 (95% CI 1.5-7.7) and 3.6 (95% CI 1.6-8.1), respectively, and at 1 year postpartum, with ORs of 5.0 (95% CI 2.1-11.5) and 8.3 (95% CI 3.8-18.1), respectively, compared with early pregnancy. Among all women, factors associated with increased prevalence of fecal incontinence 1 year postpartum were fecal incontinence during pregnancy (adjusted relative risk [aRR] 7.4; 95% CI 4.1-13.3), obstructed defecation during pregnancy (aRR 2.0; 95% CI 1.1-3.9) and concurrent obstructed defecation (aRR 2.4; 95% CI 1.3-4.5). This prospective study shows an increased risk of fecal incontinence by late pregnancy, suggesting that the pregnancy itself may be involved in the development of postpartum fecal incontinence. Obstructed defecation during pregnancy and postpartum was found to be associated with increased risk of fecal incontinence postpartum, indicating that postpartum fecal incontinence may be a result of incomplete bowel emptying.

Gebelerde Algılanan Eş Desteği ve Gebelik Semptomları

Bu çalışma gebelerin algıladığı eş desteğini ve bu desteğin gebelik semptomlarına olan etkisini belirlemek amacıyla yürütülmüştür. Tanımlayıcı ve ilişkisel tipteki çalışmanın evrenini 1 Temmuz- 31 Aralık 2021 tarihleri arasında İç Anadolu’da bir üniversite hastanesinin kadın doğum polikliniklerine gelen gebeler oluşturmuştur. Çalışma 156 gebe ile tamamlanmıştır. Çalışmanın verileri Kişisel Bilgi Formu, Gebelikte Eş Desteği Algısı Ölçeği (GEDAÖ) ve Gebelik Semptom Envanteri (GSE) kullanılarak elde edilmiştir. Gebelerin yaş ortalamasının 26.9±5,2 ve %63.5’inin 21-30 yaş aralığında olduğu belirlenmiştir. Gebelerin eş desteği algısı ölçeği toplam puan ortalamasının 61.5±14.9 ve gebelik semptom ölçeği puan ortalamasının 45.04±17.6 olduğu tespit edilmiştir. Gebelerin algılanan eş desteği alt boyut ve toplam puan ortalamaları ile gebelik semptomları puan ortalamaları arasındaki ilişkinin istatistiksel olarak anlamlı olmadığı saptanmıştır (p>0.05). Gebelerin algıladığı eş desteği ile deneyimledikleri gebelik semptomları arasında ilişki yoktur. Yaş, gebenin ve eşin öğrenim düzeyi, evlenme şekli, süresi ve gebelik sayısı gebelerin algıladığı eş desteğini etkilemektedir. Doğuma hazırlık eğitimlerinde özellikle eş desteği olmak üzere sosyal desteğin önemi konusuna yer verilmesi önerilebilir.

Anxiety and Depression Symptoms in At-Risk Pregnancy: Influence on Maternal-Fetal Attachment in Tunisia.

To investigate maternal prenatal anxiety and depression in high-risk pregnancies and examine their influence on maternal-fetal attachment. We included 95 hospitalized high-risk pregnant women. The Hospital Anxiety and Depression Scale (HADS) and the Prenatal Attachment Inventory (PAI) were used to assess the primary objective. Internal consistency and construct validity of the PAI were investigated. The average age was 31years and gestational age ranged from 26 to 41weeks. Prevalence of depressive symptoms was 20% and anxiety symptoms 39%. Cronbach alpha coefficient of the PAI Tunisian version was 0.8 and the construct validity in favour of one factor model. PAI scores correlated negatively and significatively with the HADS total score (r = -0.218, p = 0.034) and was attributed to the depression dimension only (r = -0.205, p = 0.046). Emotional wellbeing of pregnant women especially in high-risk pregnancies should be explored in order to prevent consequences on women, their growing fetus, and prenatal attachment.

Characteristics of Chinese women in need of enhanced sexual health attention and at risk of hypoactive sexual desire disorder

BackgroundThe target population for women’s sexual health services in China was unclear. To identify high-risk individuals with psychological barriers to sexual health-seeking behaviors and those at high risk of hypoactive sexual desire disorder (HSDD), we investigated correlates of Chinese women’s unwillingness to communicate sexual health, the shame of sexual health-related disorders, sexual distress, and HSDD.MethodsAn online survey was conducted from April to July 2020.ResultsWe received 3443 valid responses online (effective rate 82.6%). Participants were mainly Chinese urban women of childbearing age (median 26 years old, Q1-Q3 23–30). Women who knew little about sexual health knowledge (aOR 0.42, 95%CI 0.28–0.63) and were ashamed (aOR 0.32–0.57) of sexual health-related disorders were less willing to communicate sexual health. Age (aOR 4.29, 95%CI 2.26–8.17), low income (aOR 1.52–2.11), family burden (aOR 1.34–1.43), and living with friends (aOR 1.39, 95%CI 1.02–1.91) were independent correlates of women’s shame about sexual health-related disorders while living with a spouse (aOR 0.66, 95%CI 0.51–0.86) or children (aOR 0.77, 95%CI 0.62–0.96) were correlated with less shame. Age (aOR 0.98, 95%CI 0.96–0.99) and a postgraduate degree (aOR 0.45, 95%CI 0.28–0.71) were linked with less sexual distress of low sexual desire while having children (aOR 1.38–2.10), intense work pressure (aOR 1.32, 95%CI 1.10–1.60) and heavy family burden (aOR 1.43, 95%CI 1.07–1.92) increased women’s odds of having distress. Women with a postgraduate degree (aOR 0.42, 95%CI 0.19–0.90), more knowledge about sexual health (aOR 0.53–0.67), and decreased sexual desire caused by pregnancy, recent childbirth, or menopausal symptoms (aOR 0.60, 95%CI 0.41–0.85) were less likely to have HSDD, while they were more likely to have HSDD when their decreased sexual desire was due to other sexual issues (aOR 2.56, 95%CI 1.84–3.57) and partners’ sexual problems (aOR 1.72, 95%CI 1.23–2.39).ConclusionSexual health education and related services need to focus on psychological barriers of women with older age, insufficient knowledge of sexual health, intense work pressure, and poor economic conditions. The medical staff need to pay attention to the sexual health of women with intense work or life pressure and a history of gynecological disease. Low sexual desire is not equal to the sexual desire problem, which should be noticed in the future.

Effect of biological, psychological, and social factors on maternal depressive symptoms in late pregnancy: a cross-sectional study.

Depression commonly occurs during pregnancy and has become a major public health concern. Depression not only affects the individual but also causes adverse consequences for families and children. However, little is known regarding the depression status and its influencing factors in women during late pregnancy in China. This study aimed to assess the prevalence of maternal depressive symptoms in late pregnancy during the coronavirus disease 2019 (COVID-19) pandemic and further explore the effect of biological, psychological, and social factors on depressive symptoms. An institution-based cross-sectional survey was conducted among eligible women in the late pregnancy stage and underwent prenatal examination at Lianyungang Maternal and Child Health Hospital in Jiangsu Province, Eastern China from December 2022 to February 2023. Data regarding depressive symptoms and biological, psychological, and social factors of the pregnant women were collected via a structured questionnaire. Chi-square test, Fisher's exact tests, and binary logistics regression were used to analyze the data. In total, 535 women in the late pregnancy stage were included in this study, 75 (14.0%) of whom exhibited depressive symptoms. A binary logistic regression analysis revealed that pregnant women who were multiparous (OR: 2.420, 95% CI: 1.188-4.932) and had moderate or severe insomnia symptoms (OR: 4.641, 95% CI: 1.787-12.057), anxiety (OR: 8.879, 95% CI: 4.387-17.971), high fear of COVID-19 (OR: 2.555, 95% CI: 1.255-5.199), moderate or severe family dysfunction (OR: 2.256, 95% CI: 1.141-4.461), and poor social support (OR: 2.580, 95% CI: 1.050-6.337) tended to show depressive symptoms. Conversely, pregnant women who received regular prenatal care (OR: 0.481, 95% CI: 0.243-0.951) and had good drinking water quality at home (OR: 0.493, 95% CI: 0.247-0.984) were more likely to avoid developing depressive symptoms. This study found that the prevalence of maternal depressive symptoms during late pregnancy was high and had multiple influencing factors. Thus, screening for depressive symptoms in women in the late pregnancy stage and providing special intervention programs are necessary, especially for those with risk factors.

Childhood family stress modifies the association between perinatal stressful life events and depressive symptoms.

The childhood family environment can influence long-term well-being in part by modifying how individuals' respond to and cope with stress across the life span. Theoretical models propose that childhood stress will either exacerbate (stress sensitization) or attenuate (steeling effect) the effects of adult stress on mental health. This study tests whether childhood family stress modifies the association between stressful life events and depressive symptoms in pregnancy and consecutive postpartum periods. A sample of 127 women reported on depressive symptoms after one birth, during a subsequent pregnancy, and postpartum following that birth. Childhood family stress was assessed with the Risky Families Questionnaire. Stressful life events were measured at all three timepoints to capture the number of life events during both pregnancies and between pregnancies. Associations between stressful life events and depressive symptoms varied as a function of childhood family stress. At the between-persons level, more stressful life events were associated with greater depressive symptoms among women who reported infrequent exposure to childhood family stress in this sample, but not among women who reported more frequent exposure to childhood family stress. Results provide novel evidence that moderate exposure to childhood family stress may attenuate the association between stressful life events and depressive symptoms in the perinatal period, consistent with a steeling effect. That is, some degree of childhood family stress may promote resilience to perinatal stress. Findings underscore the utility of examining the interaction of risk factors across the life span in predicting perinatal mental health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association Between Previous Cesarean Section and Subsequent Ectopic Pregnancy: A Comparative Observational Study

Background: The rise in cesarean delivery rates across the world has raised concerns about its potential impact on the outcome of subsequent pregnancies. Among the concerns is the increased risk of ectopic pregnancy, particularly in the tubal or scar site. This study aimed to assess the connection between previous cesarean delivery and subsequent ectopic pregnancy. Methodology: This is a comparative observational study conducted over a period of 1.5 years at Lalla Ded Hospital in Srinagar. The study recruited 148 cases with clinical symptoms of ectopic pregnancy and confirmed diagnosis, along with 4852 matched controls with intrauterine pregnancies. The inclusion criteria comprised women with a previous history of normal vaginal delivery or cesarean section. Patients with a history of ectopic pregnancy, pelvic inflammatory disease, abortions, tubal pathology or surgery, ARTs, and use of intrauterine contraceptive devices were excluded. The data were analyzed using SPSS version 20.0. Results: Out of the 148 eligible cases, 106 (4.2%) had a previous cesarean section, and 42 (1.7%) had a normal vaginal delivery. The odds ratio for women with a previous cesarean section was 2.59 (95% confidence interval= 1.81 to 3.75), which means that they had a 2.59 times higher risk of having subsequent ectopic pregnancy than those with normal vaginal delivery. Conclusion: The study concludes that a previous cesarean section is linked to an increased risk of subsequent ectopic pregnancy. Women with a history of cesarean section should receive close monitoring during early pregnancy to detect and manage ectopic pregnancy promptly. Further research is necessary to identify the underlying mechanisms and develop strategies to reduce the risk of ectopic pregnancy in these women. Keywords: cesarean delivery, ectopic pregnancy, long-term morbidity, risk factors

Case report of tokophobia

Introduction: Tokophobia is a pathological fear of pregnancy that can lead to avoidance of childbirth. It is classified as primary or secondary. Approximately 20% to 78% of pregnant women report fears associated with pregnancy and childbirth. This report describes a patient with tokophobia: presentation, risk factors, comorbidities, and treatment. Case presentation: A 43-year-old Saudi woman experienced tokophobia upon becoming pregnant for the fifth time. She was assessed in 2 clinical interviews by a consultant psychiatrist specializing in women’s mental health. In addition, she completed several questionnaires that aimed to assess different aspects of her mental health: overall depression, perinatal depression, generalized anxiety, maternal functioning, and fear of childbirth. Several risk factors and comorbidities that may have contributed to the development of tokophobia in this patient were discussed, including traumatic experiences in previous deliveries, the unplanned nature of the pregnancy, perinatal depression, and pronounced symptoms of anxiety. A collaborative decision to perform a C-section was made, in line with obstetric guidelines and good mental health practices. Full symptomatic recovery was achieved immediately after delivery. Conclusion: We hope to increase clinical awareness of the assessment and management of tokophobia, which is a relatively new concept and, as yet, understudied.

Self-diagnosing the end of pregnancy after medication abortion

This qualitative study conducted between November 2020 and March 2021 in the US state of Mississippi examines the experiences of 25 people who obtained medication abortion at the state’s only abortion facility. We conducted in-depth interviews with participants after their abortions until concept saturation was reached, and then analysed the content using inductive and deductive analysis. We assessed how people use embodied knowledge about their individual physical experiences such as pregnancy symptoms, a missed period, bleeding, and visual examinations of pregnancy tissue to identify the beginning and end of pregnancy. We compared this to how people use biomedical knowledge such as pregnancy tests, ultrasounds, and clinical examinations to confirm their self-diagnoses. We found that most people felt confident that they could identify the beginning and end of pregnancy through embodied knowledge, especially when combined with the use of home pregnancy tests that confirmed their symptoms, experiences, and visual evidence. All participants concerned about symptoms sought follow-up care at a medical facility, whereas people who felt confident of the successful end of the pregnancy did so less often. These findings have implications for settings of restricted abortion access that have limited options for follow-up care after medication abortion.

Longitudinal Patterns of Multidimensional Violence Exposure and Adolescent Early Sexual Initiation.

Early sexual intercourse is associated with sexually transmitted infections, pregnancy, and depressive symptoms, and delay of intercourse allows adolescents opportunities to practice relationship skills (Coker et al., 1994; Harden, 2012; Kugler et al., 2017; Spriggs & Halpern, 2008). Thus, understanding predictors of early sexual intercourse is crucial. Prior research has suggested that violence exposure is associated with early initiation of sexual intercourse in adolescence (Abajobir et al., 2018; Orihuela et al., 2020). However, most studies have looked only at a single type of violence exposure. In addition, little research has examined longitudinal patterns of violence exposure in order to determine whether there are particular periods when the violence exposure may have the strongest impact on sexual behavior. Guided by life history and cumulative disadvantage theories, we use longitudinal latent class analysis and data from the Future of Families and Child Well-being Study (N = 3,396; 51.1% female, 48.9% male) to examine how longitudinal patterns of multiple types of violence exposures across ages 3 to 15 are associated with early sexual initiation in adolescence. Findings suggest that experiencing persistent physical and emotional abuse across childhood was associated with the greatest prevalence of early sexual initiation. Early exposure to violence was not consistently associated with greater likelihood of sexual initiation; instead, early abuse was more strongly associated with sexual initiation for boys, while late childhood abuse was more strongly associated for girls. These findings suggest that gender-sensitive programs are highly needed to address unique risk factors for boys' and girls' sexual behaviors.

Antepartum depressive symptoms are associated with significant postpartum opioid use

Antepartum depression is common, and outside of childbirth preoperative anxiety and depression have been associated with heightened postoperative pain. In light of the national opioid epidemic, the relationship between antepartum depressive symptoms and postpartum opioid use is particularly relevant. This study evaluated the association between antepartum depressive symptoms and significant postpartum opioid use during birth hospitalization. This retrospective cohort study at an urban academic medical center from 2017 to 2019 included patients who received prenatal care at the medical center and linked pharmacy and billing data with electronic medical records. The exposure was antepartum depressive symptoms, defined as Edinburgh Postnatal Depression Scale ≥10 during the antepartum period. The outcome was significant opioid use, defined as: (1) any opioid use following vaginal birth and (2) the top quartile of total opioid use following cesarean delivery. Postpartum opioid use was quantified using standard conversions for opioids dispensed on postpartum days 1 to 4 to calculate morphine milligram equivalents. Poisson regression was used to calculate risk ratios and 95% confidence intervals, stratified by mode of delivery and adjusted for suspected confounders. Mean postpartum pain score was a secondary outcome. The cohort included 6094 births; 2351 births (38.6%) had an antepartum Edinburgh Postnatal Depression Scale score. Of these, 11.5% had a maximum score ≥10. Significant opioid use was observed in 10.6% of births. We found that individuals with antepartum depressive symptoms were more likely to have significant postpartum opioid use, with an adjusted risk ratio of 1.5 (95% confidence interval, 1.1-2.0). When stratified by mode of delivery, this association was more pronounced for cesarean births, with an adjusted risk ratio of 1.8 (95% confidence interval, 1.1-2.7), and was no longer significant for vaginal births. Mean pain scores after cesarean delivery were significantly higher in parturients with antepartum depressive symptoms. Antepartum depressive symptoms were associated with significant postpartum inpatient opioid use, especially following cesarean delivery. Whether identifying and treating depressive symptoms in pregnancy may impact the pain experience and opioid use postpartum warrants further investigation.

Discovering a pregnancy after 30 weeks: a qualitative study on explanations for unperceived pregnancy

“Unperceived pregnancy” names the phenomenon when a person becomes pregnant unintentionally and is not aware of being pregnant. Scientific explanations are roughly based on two hypotheses: psychological and physiological. We aim to gain a better understanding of unperceived pregnancy by studying the perspectives of people who experienced an unperceived pregnancy and obstetric professionals. Seventeen semi-structured interviews were conducted: eight with women who had experienced an unperceived pregnancy (≥30 weeks’ gestation), six with midwives, and three with gynecologists. Our findings show that women’s explanations for not noticing their pregnancy center around the absence of pregnancy symptoms. The failure to recognize more subtle signs of pregnancy was enforced by inattention, physical distractions, and psychological factors. In contrast, psychological explanations are dominant among obstetric professionals. Our study demonstrates a discrepancy in the explanations provided by women who had experienced an unperceived pregnancy and obstetric professionals. Potentially, this could result in people being unheard and misunderstood. We recommend that future research moves beyond a focus on “denial of pregnancy” to consider both psychological and physiological factors, and how these could potentially interrelate. This broadened approach will enhance our understanding of unperceived pregnancy and can contribute to improved counseling by obstetric professionals.

The Science of Amniotic Fluid Embolism

With many countries around the world facing aging populations and declining birth rates, governments are encouraging women to have children. However, few countries are really concerned about the effects of pregnancy on women, and society is hiding the risks and symptoms of pregnancy and postpartum complications as if to get more women to have children by hiding these facts. What I believe is that only when women truly understand the process and risk factors of pregnancy can they be prepared to give birth with confidence. People are always afraid of the unknown. This article systematically analyzes the disease with the highest mortality rate during pregnancy, amniotic fluid embolism (AFE). Hopefully, this article will make more people aware of this rare but highly fatal disease. This article introduces various aspects of AFE, the most central part of which should be the analysis of the causes of AFE and the current treatment methods. The author hopes that after reading this article, the reader will be able to eliminate as many questions as possible about AFE.

Maternal attachment state of mind and perinatal emotional wellbeing: Findings from a pregnancy cohort study

ObjectivesMaternal attachment state of mind is an important potential predictor of risk and resilience to perinatal emotional wellbeing and early parenting. To explore maternal attachment in relation to perinatal depression and emotional wellbeing. MethodsThis study drew on data collected within an ongoing cohort from 170 women recruited in early pregnancy, including 67 who met criteria for Major Depression. Maternal attachment state of mind was assessed with the Adult Attachment Interview (AAI) in pregnancy. Additional measures included the Structured Clinical Interview for the DSM (SCID), at 12 months the Strange Situation Procedure (SSP), Child Trauma Questionnaire (CTQ), Parenting Stress Index, and antenatal maternal hair cortisol concentrations (HCC). LimitationsSample size to be able to undertake all analyses using the 4 way classifications, cortisol measurement is limited to hair only and there is no prospectively collected measure of childhood trauma in mothers. ConclusionsThis study found that maternal attachment, specifically the Non-Autonomous states of mind, adjusted for clinical depression, was associated with higher cortisol in pregnancy and higher depressive symptoms across pregnancy and the postpartum. Furthermore, separately those with depression and Non-Autonomous states of mind also had higher postpartum parenting stress. There was no significant intergenerational concordance between AAI and SSP attachment classifications. Our findings support future research exploring the role of maternal attachment state of mind in understanding perinatal depression and emotional wellbeing.

Understanding factors influencing home pregnancy test use among women in western Kenya: A qualitative analysis.

There are limited data on home pregnancy test use among women in low-and-middle-income countries. A prior survey found that only 20% of women in western Kenya used a home pregnancy test to confirm their pregnancies before going to antenatal care. This qualitative study aims to understand why women do not use home pregnancy tests in early pregnancy. From April 2021 to July 2021, we interviewed women from four antenatal care clinics in Homa Bay and Siaya counties. We recruited women previously enrolled in the PrEP Implementation for Mothers in Antenatal care (PrIMA) study, a cluster-randomized trial that evaluated the best approaches to implementing PrEP in maternal and child health clinics in Western Kenya (NCT03070600). Interviews were conducted via phone, audio recorded, translated, and transcribed verbatim. We coded and analyzed the transcripts to capture factors influencing women's capability, opportunity, and motivation to use home pregnancy tests. We conducted 48 semistructured interviews with women aged 21-42 years. Twenty-seven women did not use a home pregnancy test in their most recent pregnancy. Seventeen of these women reported not using a home pregnancy test before. Lack of knowledge, mistrust in the accuracy of tests, preferring to rely on signs and symptoms of pregnancy or get a test from the health facility, cost, and accessibility were key barriers to home pregnancy test use. Improving the uptake of home pregnancy testing during early pregnancy will require efforts to enhance community knowledge of test use and associated benefits and reduce cost burdens by making tests more affordable and accessible.

Development of a Mobile Health Application Based on a Mixed Prenatal Care in the Context of COVID-19 Pandemic.

We describe the development and structure of a novel mobile application in a mixed model of prenatal care, in the context of the COVID-19 pandemic. Furthermore, we assess the acceptability of this mobile app in a cohort of patients. First, we introduced a mixed model of prenatal care; second, we developed a comprehensive, computer-based clinical record to support our system. Lastly, we built a novel mobile app as a tool for prenatal care. We used Flutter Software version 2.2 to build the app for Android and iOS smartphones. A cross-sectional study was carried out to assess the acceptability of the app. A mobile app was also built with the main attribute of being connected in real-time with the computer-based clinical records. The app screens detail information about activities programmed and developed in the prenatal care according to gestational age. A downloadable maternity book is available and some screens show warning signs and symptoms of pregnancy. The acceptability assessment was mostly rated positively regarding the characteristics of the mobile app, by 50 patients. This novel mobile app was developed as a tool among pregnant patients to increase the information available about their pregnancies in the provision of a mixed model of prenatal care in the context of the COVID-19 pandemic. It was fully customized to the needs of our users following the local protocols. The introduction of this novel mobile app was highly accepted by the patients.

Role of depressive symptoms on the development of pelvic girdle pain in pregnancy: A prospective inception cohort study.

Pelvic girdle pain in pregnancy is a major public health concern. For too many women, the pain condition causes disability and sick leave, has a negative impact on daily life, and breeds doubt in their view as mother, partner, and worker. The pathophysiology is unknown and causal treatment is lacking. Depression in pregnancy is common, undertreated, and previously associated with pelvic girdle pain with unclear causal direction. A prospective inception cohort study of 356 Swedish women examined them in early and late pregnancy. Women with a positive Posterior Pelvic Pain Provocation test in early pregnancy were not included. The exposure, depressive symptoms in early pregnancy, was self-reported on the Hospital Anxiety and Depression Scale, depression part (0-21). Outcome measure in late pregnancy was a graded score on the Posterior Pelvic Pain Provocation test (0-8). Covariates for statistical adjustment were identified in a directed acyclic graph. Linear robust and logistic regression were used in the statistical analyses. In early pregnancy, the 248 women with negative Posterior Pelvic Pain Provocation test had a mean score of 2.35 (± 2.3 standard deviation) on the Hospital Anxiety and Depression Scale, depression part. In a fully adjusted, multiple robust regression model a positive association was shown between Hospital Anxiety and Depression Scale score, depression part, and the Posterior Pelvic Pain Provocation test score in late pregnancy with an estimated effect of β=0.32 (95% confidence interval [CI] 0.16-0.48, p < 0.001). Dichotomization of exposure (Hospital Anxiety and Depression Scale, depression part <8/≥8) and outcome (Posterior Pelvic Pain Provocation test score 0/>0) rendered adjusted odds ratio 1.71 (95% CI 0.38-7.7) and numbers needed to treat adjusted odds ratio 5.54 (95% CI -3.4-14.5). Depressive symptoms in early pregnancy were associated with the development and intensity of pelvic girdle pain in late pregnancy. Considering the small sample size, screening and treatment for depressive symptoms in early pregnancy may enable a way to reduce and prevent disabling pelvic girdle pain in late pregnancy. Trials are needed to confirm the results.