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BackgroundAt prevalence rates of up to 40%, rates of depression and anxiety among women with medically complex pregnancies are 3 times greater than those in community-based samples of pregnant women. However, mental health care is not a component of routine hospital-based antenatal care for medically high-risk pregnant women. ObjectiveThe purpose of this study is to evaluate the effectiveness and feasibility of the hospital-based implementation of a Web-based integrated mental health intervention comprising psychosocial assessment, referral, and cognitive behavioral therapy (CBT) for antenatal inpatients. MethodsThis study is a quasi-experimental design. Pregnant women are eligible to participate if they are (1) 72 hours, (3) able to speak and read English or be willing to use a translation service to assist with completion of the questionnaires and intervention, (4) able to complete follow-up email questionnaires, (5) >16 years of age, and (6) not actively suicidal. Women admitted to the unit for induction (eg,

Objectives Although several studies have examined risk factors associated with abuse during pregnancy or postpartum periods, many used clinic-based or small regional samples, and few were national or population-based, limiting their generalizability and clinical utility. The purpose of this study was to describe the correlates of abuse around the time of pregnancy among a nationally representative sample of women in Canada. Methods Using data from 6421 postpartum women (weighted n = 76,500) who completed the Canadian Maternity Experiences Survey from 10/2006 to 01/2007, we explored the association between demographic, psychosocial, behavioral, medical/obstetric factors and 'any' and 'severe' abuse. 'Any abuse' was defined as an affirmative answer to one or more of 10 items asked about physical or sexual abuse or threats of abuse. 'Severe abuse' was defined as experiencing a combination of threats and physical or sexual abuse. Odds ratios and their 95 % confidence intervals were generated from multivariable logistic regression models. Results 10.5 % of women (weighted n = 8400) reported 'any' abuse and 4.3 % (weighted n = 3400) reported 'severe' abuse in the previous 2 years. Correlates of severe abuse included: age, Author(s): Dawn Kingston[sup.1] , Maureen Heaman[sup.2] , Marcelo Urquia[sup.3] , Patricia O'Campo[sup.3] , Patricia Janssen[sup.4] , Kellie Thiessen[sup.2] , Janet Smylie[sup.3] [sup.5] Author Affiliations: (1) University of Alberta, 11405-87th Ave., [...]

One in six children entering school experiences developmental delay. Maternal mental health represents one of the earliest, modifiable influences in a child's life. The objective of the review was to evaluate the association between maternal mental health and school-age child development, and we hypothesized there would be a negative association. Five databases were searched (Embase, CINAHL, Eric, Psyclnfo, Medline). Key journals and reference lists were hand-searched. Two reviewers assessed studies based on inclusion criteria: (1) the exposure was any form of maternal mental health occurring during pregnancy or postpartum periods; (2) the outcome was child development (>48 months to 8 years); (3) the study recruited participants from developed countries; and (4) publication was in English between January, 1990 and December, 2012. Disagreements were resolved by consensus. Study quality was assessed by two reviewers using the Scottish Intercollegiate Guideline Network and disagreements were resolved by consensus. Data extraction was conducted by one reviewer using standardized forms. Maternal mental health problems in pregnancy and/or the postpartum period increased the likelihood that school-age children experienced suboptimal global, behavioral, cognitive, and socio-emotional development. The findings highlight the need for maternal mental health assessment during the prenatal, postnatal, and early childhood periods. Keywords Prenatal * Postnatal * Mental health * Depression * Anxiety * Stress * School-age * Development * Child, Introduction One in six children entering school experiences developmental delay [1] and trends over the past decade reveal increasing prevalence rates [2, 3]. Children with developmental problems demonstrate lower school [...]

Abstract Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of quality prenatal care, clinical and interpersonal care processes emerged as being most essential to quality care. These processes are important as they have a role in mitigating adverse outcomes, promoting involvement of women in their own care, and keeping women engaged in care. The findings suggest key considerations for the planning, delivery, and evaluation of prenatal care. Most notably, care should be woman-centred and embrace shared decision making as an essential element.