Previous Perinatal Losses Research Articles

Previous psychopathology predicted severe COVID-19 concern, anxiety, and PTSD symptoms in pregnant women during "lockdown" in Italy.

Italy was the first COVID-19 pandemic epicenter among European countries and established a period of full “lockdown”, consisting of travel bans, mandatory staying at home, and temporary closure of nonessential businesses. Similar measures are known risk factors for psychological disturbances in the general population; still, little is known about their impact on pregnant women’s mental health during COVID-19 pandemic. The cross-sectional, web-based, national survey “COVID-19 related Anxiety and StreSs in prEgnancy, poSt-partum and breaStfeeding” (COVID-ASSESS) was conducted during the first month of full “lockdown” in Italy. Participants were recruited via social networks with a snowball technique. The questionnaire was specifically developed to examine COVID-19 concerns and included the psychometric tests National Stressful Events Survey (NSESSS) for posttraumatic stress disorder (PTSD) and State-Trait Anxiety Inventory. A multivariable logistic regression model was fitted to explore the association of the concern, anxiety and PTSD symptoms with age, gestational weeks, parity, days of “lockdown”, assisted reproductive technology use, psychopathological history, and previous perinatal losses. Out of 1015 pregnant women reached, 737 (72.6%) fully answered the questionnaire; no woman reported a COVID-19 infection. Median age was 34.4 years [quartiles 31.7, 37.2], median days in “lockdown” were 13.1 [11.0, 17.0], median gestational weeks were 27.8 [19.8, 34.0]. Clinically significant PTSD symptoms were present in 75 women (10.2%, NSESSS cutoff 24) and clinically significant anxiety symptoms were present in 160 women (21.7%, STAI-Y1 cutoff 50). Women were particularly worried about the health of their baby and of their elderly relatives, as well as of the possible impact of pandemic in the future of society. Previous anxiety predicted higher concern and PTSD symptoms; previous depression and anxiety were independently associated with current PTSD symptoms.

Prenatal Attachment and Perinatal Depression: A Systematic Review.

Pregnancy is a period of complex bio-psychological changes, during which the development of an attachment bond to the fetus takes on a central role. Depressive symptoms are common during this period. Both symptoms of depression and low levels of prenatal attachment are related to negative outcomes in caregivers and infants. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, this systematic review analyzes and systematizes 41 studies concerning the association between prenatal attachment and perinatal depression. The majority of the studies reported a significant association between the two. Specifically, prenatal depressive symptoms were found to be negatively associated with prenatal attachment. Furthermore, lower levels of prenatal attachment were related to higher postnatal depressive symptoms, although fewer studies assessed this association. While these results were found across different populations, conflicting findings emerged, suggesting they should be interpreted with caution, particularly in male samples and in non-normative pregnancies (e.g., high-risk pregnancies, medically assisted pregnancies, and pregnancies with previous perinatal losses). These results are clinically important for the perinatal screening process and for implementing preventive and treatment programs. However, future studies are needed to further confirm and generalize these results.

Structure and factors of the risk of premature birth

Objective. To study the structure and risk factors of premature birth. Methods. Prospective open-label non-randomized clinical trial. The study included 11 861 births, including 1806 - premature (15.2%) in the CF “UMS of the National Research Center for Maternity and Childhood.” The odds ratio (OR), the confdence interval (CI) of risk factors for the development of preterm birth have been calculated. Results. When studying the social portrait of prematurely giving birth to women: the level of education (OR - 2.7, SE - 0.29, CI (95%) 1.5-4.8;) employment (OR-2.4, SE-0, 29; CI (95%) 1.3-4.1;) and the woman’s place of residence (OR 1.5, SE 0.29, CI 95% 0.9-2.7) are statistically signifcant risk factors for premature birth. The study of obstetrical anamnesis of pregnant women revealed the following: 14.2% - primitive, 85.8% - repeat pregnancy, 26.3% - with a syndrome of previous perinatal losses (2 or more spontaneous abortions), 32.2% - previous premature births, 2, 4% - with cervical insufciency. Conclusion. The main risk factors for premature birth are cervical insuffciency, repeated pregnancies with a parity of more than 4 (OS-1.19, SE-0.3, CI (95%) 0.7-2.2;), the presence of premature birth and fetal loss in the history (OR-2.66, SE-0.35, CI (95%), 1.3-5.3;), birth of small children (OR-2.38; SE-0.37; CI (95%) 1.2-5.1;). The social portrait of women with preterm birth appears as follows: age 20 to 34 years, predominantly in rural areas, housewives with low and medium education, with habitual loss of pregnancy or previous premature birth, cervical insufciency. Family planning, pre-birth training for a prospective mother and conducting preventive measures in pregnant high-risk groups for premature birth can be a condition for reducing the frequency of preterm labor

Оптимізація тактики ведення вагітних з перинатальними втратами в анамнезі

The objective: to improve the effectiveness of gestational complications prevention in women with a previous perinatal losses (PL) by diagnostic methods optimization. Patients and methods. 85 pregnant women with previous perinatal losses were examined. Group II (control group) included 89 pregnant women without PL. The relationship between neurovegetative violations and pregnancy complications in women with adverse obstetric history were found using the heart rate variability method and determination of mother–placenta–fetus system status. Results. The overbalance of the sympathetic effects, mostly in the third trimester, was observed in pregnant women with previous perinatal losses, unlike the control group (p<0,05). This may be explained due to depletion of compensatory reserves of autonomic nervous system. In the second trimester increased sympathetic tone was established after stress tests in women of the main group, probably, because of the compensatory-adaptive reactions of all parts of the autonomic nervous system realization. Conclusion. Vegetative homeostasis violations with increased sympathetic tone cause placental dysfunction with metabolic changes, fetal growth retardation and other gestational complications. The dominance of sympathetic tone in pregnant women with previous perinatal losses and hormonal function of mother–placenta–fetus system indicate an imbalance of neurohumoral regulation and can be the diagnostic and prognostic sign of pregnancy complications. Key words: neurovegetative regulation, perinatal losses, placental dysfunction, cardiointervalography.

Previous prenatal loss as a predictor of perinatal depression and anxiety

Prenatal loss, the death of a fetus/child through miscarriage or stillbirth, is associated with significant depression and anxiety, particularly in a subsequent pregnancy. This study examined the degree to which symptoms of depression and anxiety associated with a previous loss persisted following a subsequent successful pregnancy. Data were derived from the Avon Longitudinal Study of Parents and Children cohort, a longitudinal cohort study in the west of England that has followed mothers from pregnancy into the postnatal period. A total of 13,133 mothers reported on the number and conditions of previous perinatal losses and provided self-report measures of depression and anxiety at 18 and 32 weeks' gestation and at 8 weeks and 8, 21 and 33 months postnatally. Controls for pregnancy outcome and obstetric and psychosocial factors were included. Generalised estimating equations indicated that the number of previous miscarriages/stillbirths significantly predicted symptoms of depression (β = 0.18, s.e. = 0.07, P<0.01) and anxiety (β = 0.14, s.e. = 0.05, P<0.01) in a subsequent pregnancy, independent of key psychosocial and obstetric factors. This association remained constant across the pre- and postnatal period, indicating that the impact of a previous prenatal loss did not diminish significantly following the birth of a healthy child. Depression and anxiety associated with a previous prenatal loss shows a persisting pattern that continues after the birth of a subsequent (healthy) child. Interventions targeting women with previous prenatal loss may improve the health outcomes of women and their children.

Depressive Symptoms in a Sample of Women Following Perinatal Loss

The aim of the study is to identify variables associated with depressive symptoms among women shortly after perinatal loss. Respondents who agreed to participate in the study were interviewed, and sociodemographic data were obtained from them. The Hospital Anxiety and Depression Scale and the Edinburgh Postnatal Depression Scale (EDPS) were thereafter administered on each respondent. Respondents with perinatal loss had high rate of depressive symptoms (52% on EDPS), the rate was significantly higher, when compared with the control group (chi2 = 10.16, P=0.001). Factors significantly associated with depressive symptoms included previous perinatal losses, poor support from husband and occurrence of antenatal complications. Depressive reaction following perinatal loss is very common. Programs need to be designed to help these women cope with their loss and to reduce subsequent psychological morbidity.

Interconceptional Counseling After Perinatal and Infant Loss

Historically, preconceptional health promotion has been recommended for all prospective parents to improve perinatal outcomes. Preconceptional health promotion and interconceptional counseling may be even more beneficial for parents who have had previous perinatal losses. Perinatal loss can be devastating, with long-term effects on subsequent pregnancies and children. A theoretical framework for interconceptional counseling after perinatal loss needs to be developed. Interconceptional counseling can give couples important information to improve outcomes, acknowledge fears and anxieties, evaluate genetic risks, facilitate grieving, and explore attachment and parenting issues.

Neonatal intensive care and premature birth - maternal perceptions and coping

Premature birth and neonatal intensive care are distressing events for mothers requiring active coping. 42 consecutive mothers of infants treated on a NICU were interviewed prospectively during the first week postpartally, after 4–6 weeks and after 5–6 months with a semistructured interview. The mothers had a high rate of previous psychosocial stressors, medical complications and past perinatal losses. The groups with infants under (VLBW) and over 1,500 g were compared. In the first postpartal week, the VLBW mothers showed a significantly higher degree of distress, fears concerning death and handicaps of the child and negative or ambivalent feelings at first contact than mothers with newborns over 1,500 g. In the next weeks, most mothers were able to cope well with social and professional support and the differences between the two groups were no longer significant. Still, fears concerning their child continued at high rates and disturbing memories occurred often, so that at least subgroups do require more intense help during the early stages of adaptation postpartally. One of the subgroups at risk are the VLBW mothers.