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Background: Weight stigma is defined as negative misconception and stereotypes associated with weight, and it is commonly experienced during pregnancy. Weight stigma during pregnancy may be sourced from trusted close relationships including family members, partners, and friends. Social support is a necessary psychosocial factor for optimal health and wellbeing throughout pregnancy, and weight stigma sourced from these integral relationships may negatively affect health outcomes. The purpose of this study was to assess the impact of weight stigma from close others on maternal health outcomes., Methods: A survey was administered via Qualtrics to pregnant women (≥ 13 weeks, residence within the United States or Canada, ≥ 18 years old, singleton pregnancy). During pregnancy, participants completed questionnaires identifying whether they had experienced weight stigma from a close relationship (i.e., family, partners, or friends), how often, and relationship quality scales for each source. At three months postpartum, they were surveyed about their pregnancy outcomes including gestational diabetes, gestational hypertension, preeclampsia, chronic pain, anxiety/depression. They also completed the Edinburgh Postpartum Depression Scale (EPDS), and a linear regression was performed with frequency of weight stigma. Logistic regressions were performed between frequency of weight stigma and health outcomes. If significant, relationship quality was tested as a potential mediator. Significance was accepted as p < 0.05., Results: 463 participants completed both surveys of which 86% had experienced weight stigma from close others. Frequency of weight stigma was significantly associated with chronic pain (β = 0.689, p < 0.001), and anxiety/depression (β = 0.404, p = 0.005). The relationship between frequency of weight stigma in pregnancy and chronic pain was mediated by quality of all relationships. Family relationship quality mediated between frequency of weights stigma and anxiety/depression. Frequency of weight stigma was significantly associated with depression symptom severity measured by the EPDS (β = 0.634, p < 0.001)., Conclusion: These findings underscore the issue of weight stigma and show that experiencing this from trusted close others is associated with poor health outcomes like chronic pain. Advocacy efforts to mitigate weight stigma in pregnancy and strengthen close relationships to improve maternal health and wellbeing is warranted., (© 2024. The Author(s).)

Abstract: This article explores the effect of psychosocial stress on Hispanic immigrant women, including access to and use of prenatal care and birth outcomes. In addition to highlighting the health effects for this growing population, the article outlines strategies for clinicians to improve access to adequate prenatal care and to cultivate a supportive environment to promote use of prenatal services., (Copyright © 2023 American Academy of Physician Associates.)

Competing Interests: GCSS has received research support from Roche Diagnostics, Illumina, and Pfizer (fetal growth, restriction and preeclampsia, preterm birth, and infection). GCSS is a paid consultant to GSK (preterm birth) and is a member of a Data Monitoring Committee for GSK trials of RSV vaccination in pregnancy. Current or recent government or charity grant support: Medical Research Council, National Institute of Health and Care Research, Wellcome Trust, and Wellcome Leap.

Introduction: Women experience high rates of depression, particularly during pregnancy and the postpartum periods. Using population-based data from Bangladesh and Pakistan, we estimated the burden of antenatal depression, its risk factors, and its effect on preterm birth., Methods: The study uses the following data: maternal depression measured between 24 and 28 weeks of gestation using the 9-question Patient Health Questionnaire (PHQ-9); data on pregnancy including an ultrasound before 19 weeks of gestation; data on pregnancy outcomes; and data on woman's age, education, parity, weight, height, history of previous illness, prior miscarriage, stillbirth, husband's education, and household socioeconomic data collected during early pregnancy. Using PHQ-9 cutoff score of ≥12, women were categorized into none to mild depression or moderate to moderately severe depression. Using ultrasound data, preterm birth was defined as babies born <37 weeks of gestation. To identify risk ratios (RR) for antenatal depression, unadjusted and adjusted RR and 95% confidence intervals (CI) were calculated using log- binomial model. Log-binomial models were also used for determining the effect of antenatal depression on preterm birth adjusting for potential confounders. Data were analyzed using Stata version 16 (StataCorp LP)., Results: About 6% of the women reported moderate to moderately severe depressive symptoms during the antenatal period. A parity of ≥2 and the highest household wealth status were associated with an increased risk of depression. The overall incidence of preterm birth was 13.4%. Maternal antenatal depression was significantly associated with the risk of preterm birth (ARR, 95% CI: 1.34, 1.02-1.74)., Conclusion: The increased risk of preterm birth in women with antenatal depression in conjunction with other significant risk factors suggests that depression likely occurs within a constellation of other risk factors. Thus, to effectively address the burden of preterm birth, programs require developing and providing integrated care addressing multiple risk factors., Competing Interests: The authors have declared that no competing interests exist.

Introduction: The reported effects of SARS-CoV-2 on pregnancy outcomes are conflicting; studies frequently overlook the placenta, which is critical for the health of the mother and infant(s). This study aimed to determine the effect of pandemic stress ± SARS CoV-2 infection on placental histopathology., Methods: Women were recruited in Canada (n = 69); France (n = 21) or in the UK (n = 25), between March and October 2020. Historic controls (N = 20) were also included. Placenta and fetal membrane samples were collected rapidly after delivery and were fixed and stained for histopathological analysis. Maternal demographical data and obstetric outcomes were recorded., Results: Over 80% of the placentas from SARS-CoV-2+ pregnancies had histopathological abnormalities: predominantly structural (71-86%) or inflammatory (9-22%), depending on geographical location. Excessive fibrin was seen in all sites, whereas deciduitis (Canada), calcifications (UK), agglutinations and chorangiosis (France) predominated in different locations. The frequency of abnormalities was significantly higher than in SARS-CoV-2 negative women (50%, p < 0.05). Demographic and obstetric data were similar in the SARS-CoV-2+ women across all sites - characterised by predominantly Black/Middle Eastern women, and women with elevated body mass index., Discussion: Overall, the frequency of placental abnormalities is increased in SARS-CoV-2+ women, but the incidence of placental abnormalities is also higher in SARS-CoV-2- women that gave birth during the pandemic, which highlights the importance of appropriate control groups to ascertain the roles of pandemic stress and SARS-CoV-2 infection on the placenta and pregnancy outcomes., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Competing interests: Sunir Das reports grants from the Canadian Institutes of Health Research, the Province of Ontario, Alkermes, Medicenna and Abbvie, as well as royalties from the Oxford University Press, outside the submitted work. He also reports payments from the Congress of Nerological Surgeons, the American Association of Neurological Surgeons, the Society for Neuro-Oncology, the Subcortical Surgery Group and Medexus, outside the submitted work. No other competing interests were declared.

Competing Interests: Competing interests: Fiona Mattatall is co-chair of the Transgender Working Group of the Society of Obstetricians and Gynaecologists of Canada. No other competing interests were declared.

In late December 2019, the COVID-19 pandemic caused a great threat to people's lives worldwide. As a special category of the population, pregnant women are vulnerable during emergencies. This study was designed to explore whether or not the COVID-19 pandemic has influenced maternal and infant outcomes. We collected maternal characteristics, laboratory results, condition in the third trimester, maternal outcome, fetal or neonatal outcomes, and characteristics of amniotic fluid, umbilical cord and placenta from pregnant women and fetals or newborns in the first affiliated hospital of Jinan university from 24 January to 31 March 2020 (peak period), chose the same types of data at the hospital during the same period in 2019 and 1 January-23 January 2020 (prior to the outbreak of COVID-19 in 2020) as a control. Our study focused on uncomplicated singleton pregnancies among women not infected by COVID-19. The results demonstrated that there was not an increase in adverse outcomes of pregnant women and newborns during the COVID-19 pandemic; This might be associated with the updated design of major epidemic prevention and control systems in Guangzhou, and the extension of pregnant women's rest time during the third trimester of pregnancy. Nevertheless, the survey showed an increased incidence rate of 25-hydroxyvitamin D and zinc deficiency in newborns during the epidemic, implying that pregnant women should participate in appropriate physical exercise, increase their exposure to outdoor sunlight and improve nutrition intake to ensure healthy newborns during the quarantine period. Our study has provided some guidance for maternal management during the COVID-19 pandemic., (© 2021. The Author(s).)

Introduction: Evidence on perinatal mental health during the coronavirus disease 2019 (COVID-19) pandemic and its potential determinants is limited. Therefore, this multinational study aimed to assess the mental health status of pregnant and breastfeeding women during the pandemic, and to explore potential associations between depressive symptoms, anxiety, and stress and women's sociodemographic, health, and reproductive characteristics., Material and Methods: A cross-sectional, web-based study was performed in Ireland, Norway, Switzerland, the Netherlands, and the UK between 16 June and 14 July 2020. Pregnant and breastfeeding women up to 3 months postpartum who were older than 18 years of age were eligible. The online, anonymous survey was promoted through social media and hospital websites. The Edinburgh Depression Scale (EDS), the Generalized Anxiety Disorder seven-item scale (GAD-7), and the Perceived Stress Scale (PSS) were used to assess mental health status. Regression model analysis was used to identify factors associated with poor mental health status., Results: In total, 9041 women participated (including 3907 pregnant and 5134 breastfeeding women). The prevalence of major depressive symptoms (EDS ≥ 13) was 15% in the pregnancy cohort and and 13% the breastfeeding cohort. Moderate to severe generalized anxiety symptoms (GAD ≥ 10) were found among 11% and 10% of the pregnant and breastfeeding women. The mean (±SD) PSS scores for pregnant and breastfeeding women were 14.1 ± 6.6 and 13.7 ± 6.6, respectively. Risk factors associated with poor mental health included having a chronic mental illness, a chronic somatic illness in the postpartum period, smoking, having an unplanned pregnancy, professional status, and living in the UK or Ireland., Conclusions: This multinational study found high levels of depressive symptoms and generalized anxiety among pregnant and breastfeeding women during the COVID-19 outbreak. The study findings underline the importance of monitoring perinatal mental health during pandemics and other societal crises to safeguard maternal and infant mental health., (© 2021 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Introduction: Despite widespread belief that anxiety causes longer labor, evidence of association is inconsistent. Data gathered as part of a prospective epidemiological longitudinal study were used to investigate associations between antenatal anxiety and pregnancy-specific stress, and labor progression was assessed by duration and use of augmentation., Material and Methods: Pregnant primiparous women completed measures for anxiety and pregnancy-specific stress at 20 weeks' gestation (n = 1145). Birth outcome data were extracted from medical records. Regression analyses and a path analysis assessed associations between antenatal anxiety and pregnancy-specific stress, and indices of labor progression (labor duration and augmentation)., Results: Anxiety/pregnancy-specific stress were not directly associated with duration of stage 1 labor (HIGH/LOW anxiety: mean difference = 13.94 minutes, SD = 20.66, 95% CI -26.60 to 54.49, P < .50)/(HIGH/LOW pregnancy-specific stress: mean difference = 12.05 minutes, SD = 16.09, 95% CI -19.52 to 43.63, P < .45). However, anxiety/pregnancy-specific stress were associated with epidural use (HIGH/LOW anxiety: 39% vs 31%, P < .042; HIGH/LOW pregnancy-specific stress: 38% vs 29%, P < .001), which was itself associated with longer labor (mean difference: 158.79 minutes, SD = 16.76, 95% CI 125.89-191.68, P < .001). Anxiety and pregnancy-specific stress were associated with increased likelihood of augmentation but these associations were nonsignificant after accounting for epidural, which was itself highly associated with augmentation. However, path analysis indicated an indirect effect linking pregnancy-specific stress, but not general anxiety, to labor duration and augmentation: elevated pregnancy-specific stress led to greater use of epidural, which was linked to both increased rates of augmentation, and increased labor duration., Conclusions: Contrary to general belief, general anxiety and specific pregnancy stress were not directly linked to longer duration of stage one labor. However specific pregnancy stress was associated with epidural use, which in turn was significantly associated with risk of augmentation, and longer stage one labor. Identification of pregnancy-specific stress could help to identify women for whom psychological interventions could improve birth experience., (© 2020 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Events that occur during fetal and perinatal life can have consequences on the health and disease of the offspring. The pioneering work on the "Fetal Programming Hypothesis" focused on pregnant women exposed to a great famine that occurred in the Netherlands at the end of World War II. The intrauterine environment of the babies during that famine caused them to low birthweight and determined the appearance of cardiovascular diseases in themselves when they reached adulthood, a risk that was transmitted even to the following generation. In addition to the general stress that a pregnant woman may suffer as a result of the death of a family member, suffering a war or natural disaster such as the SARS-CoV-2 coronavirus, there is another specific type of stress that refers exclusively to the pregnancy process; this is the pregnancy specific-stress. Pregnancy-specific stress is capable of sensitively predicting negative maternal and neonatal outcomes. This type of stress refers to the specific stress of pregnant women related to medical problems, the health of the newborn, the changes that the pregnancy will produce in their social relationships, prematurity, physical changes of pregnancy and fear of labor and birth. The objective of this article was to offer an updated information on pregnancy-specific stress and its consequences for maternal and neonatal health. Thus, we also proposed to offer strategies that midwives and psychologists can use to reduce pregnancy-specific stress levels. In conclusion, midwives and psychologists can work together to reduce pregnancy-specific stress levels.

Objective: In seeking new approaches to improve lupus pregnancy outcomes, we study the association between pregnancy planning, behaviors recommended by American College of Rheumatology's Reproductive Health Guideline 2020, and pregnancy and infant outcomes., Methods: Lupus pregnancies in a prospective registry (1/1/2018 to 4/1/2020) were classified as planned or not-planned using the patient-reported London Measure of Unplanned Pregnancy. These groups were compared for demographics, pre-pregnancy disease activity, pregnancy planning behaviors, and delivery outcomes., Results: Among 43 women with 43 singleton pregnancies the average age was 29.4 years and 42% were Black. Overall, 60% were planned pregnancies and 40% were not-planned (16 ambivalent, 1 unplanned). Women with not-planned pregnancies had lower age, income, and education, and more required Medicaid. Women with not-planned pregnancies were more likely to conceive when lupus activity was higher (p = 0.001), less likely to receive pre-pregnancy counseling with a rheumatologist (p = 0.02), and less likely to continue pregnancy-compatible medications (p = 0.03). Severe PROMISSE adverse pregnancy outcomes (APOs) and severe neonatal outcomes were higher among women with not-planned than planned pregnancies (43% vs 0% p = 0.003; 70% vs 30% p = 0.06)., Conclusion: This study identifies pregnancy intention as a potentially modifiable risk factor for poor outcomes in women with lupus. It highlights a unique population of women with lupus at high risk for pregnancy and infant complications: those ambivalent about pregnancy. These women may not be effectively engaging in health behaviors that prevent pregnancy nor those that will prepare for a safe pregnancy. With effective pregnancy planning and contraception guidance, we may decrease their risk for maternal-fetal morbidity and mortality.

Neurosurgery is male dominated with women representing only 12% of residents and 5% of practicing neurosurgeons. The conflicting demands of training versus pregnancy and motherhood are significant deterrents to women entering the field. We examined pregnancy incidence and timing, perinatal complications, and the perceived career impact of motherhood on female neurosurgeons using an anonymous survey of 643 training, practicing, and retired female neurosurgeons from the United States. Among 260 respondents, 50.8% (132/260) reported pregnancies, with an average age at first pregnancy that was significantly higher than the national average (32.1 vs 26.3 yr). In all, 40.1% (53/132) of respondents reported perinatal complications in at least one of their pregnancies. Only 25% (33/132) of respondents noted designated program maternity allowances. The most significant challenges associated with being a mother and neurosurgeon reported were issues relating to work/life balance, "mommy guilt," and sleep deprivation. A majority of respondents, 70.1% (82/116), reported fear of backlash from co-residents, partners, and staff, as well as hindered career advancement related to childbearing. Female neurosurgeons face challenges surrounding family planning different from those faced by male practitioners. Higher perinatal and fetal complications, backlash from colleagues, and demanding workload are significant issues. Progress requires institutional support and mentorship for women to create a more diverse field of practitioners., (© Congress of Neurological Surgeons 2021.)

Abstract: To compare pregnancy outcomes between patients with gestational diabetes mellitus (GDM) with and without their own blood glucose meter.We conducted a retrospective-cohort study of 835 women with GDM at the Second Hospital of Tianjin Medical University, Tianjin, China from 1 January 2016 to 31 December 2018. Perinatal outcomes of these patients were monitored and collected in the Tianjin Maternal and Child Health System. Each patient was advised by a certified clinical nutritionist regarding dietary analysis and lifestyle recommendations. All pregnant women with GDM were divided into the following 2 groups according to whether they had their own blood glucose meter: women with self-measured blood glucose levels with a routine obstetric examination in the study group (n = 424); and those with non-self-measured blood glucose levels with a double obstetric examination in the control group (n = 411). Maternal and fetal pregnancy outcomes were compared between these 2 groups. According to different self-management modes, the women were also divided into eight subgroups to compare blood sugar control and compliance with recommended insulin therapy.The cesarean section rate was significantly lower in the study group than in the control group (P < .05). The prevalence of large-for-gestational age (P < .05) and macrosomia was significantly lower in the study group than in the control group (both P < .05). The prevalence of appropriate-for-gestational age was significantly higher in the study group than in the control group (P < .05). Birth weight was significantly lower in the study group than in the control group (P < .05). The mean times for blood sugar control and from the doctor recommendation for insulin treatment to the patient compliance in the study group were significantly shorter than those in the control group (both P < .05). The proportion of insulin required in the study group was significantly lower than that in the control group (P < .05). There were no significant differences in the time of controlling blood sugar and compliance among the 4 subgroups of the study group. However, subgroups with a dietary diary in the control group were better.Self-monitoring blood sugar plus a routine obstetric examination can help patients with GDM control blood sugar, even without dietary diaries and treadmills. In addition to increasing the number of obstetric examinations, recording dietary diaries is helpful for controlling blood sugar in patients with GDM who are unwilling to measure blood sugar by themselves., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.)

Despite evidence linking prenatal psychosocial stress and social support to perinatal maternal and infant health, no study has explored couple conflict behavior during pregnancy as a predictor of subsequent birth outcomes. The current study examines whether couples' positive and negative conflict behaviors during pregnancy predict their stress during the birth experience and gestational and birth outcomes. Forty-seven first-time expectant couples participated in a conflict discussion during pregnancy that was observationally coded. Several months later, following the birth of their child, couples reported on their subjective childbirth stress. By summing medical chart data on gestational outcomes and birth complications, we computed a cumulative birth risk score. Negative conflict behavior was related to higher cumulative birth risk scores, and conversely, positive conflict behavior was associated with lower birth risk, even after controlling for maternal pregnancy symptoms. Similarly, more negative conflict behavior predicted higher mother-reported birth stress, while positive conflict behavior predicted lower father-reported birth stress. However, birth stress effects became nonsignificant after controlling for maternal pregnancy symptoms. Although the pregnancy literature has focused primarily on maternal characteristics, these findings highlight the significance of couple interactions in predicting parental birth stress and birth outcomes. This study integrates psychological, behavioral, and medical chart data to enhance our understanding of how interpersonal factors influence gestational outcomes and the birth experience. These results have important clinical implications for potential couple interventions during pregnancy that can shape fetal development, the labor and delivery experience, and influence child and family health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Although increasing numbers of gay and lesbian individuals ultimately become parents, the vast majority of research on the transition to parenthood focuses exclusively on heterosexual samples. Even less is known about the physiological implications of this major life transition among those who identify as sexual minorities. The present study begins to redress these gaps in the literature by assessing prospective links between prenatal testosterone, a steroid hormone that is negatively associated with nurturance and caregiving, and postpartum outcomes in a sample of 25 first-time expectant lesbian couples (N = 50 individuals). Consistent with prior work in heterosexual samples, which suggests that lower testosterone promotes both partnering and parenting, we found that, in both partners, lower testosterone during the prenatal period predicted better romantic relationship and parenting outcomes at three-months postpartum (e.g., higher relationship quality, more time spent doing baby care). There was also evidence for dyadic associations; for instance, birth mothers reported more overprotective behavior, and non-birth mothers reported greater commitment, when their female partners had lower testosterone. Together, our findings contribute important new knowledge about the functionality of testosterone in close relationships contexts, including some of the first evidence among sexual minorities., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To assess the prevalence and degrees of maternal prenatal stress among twin-pregnant women and to investigate the impact of prenatal stress on primary pregnancy outcomes. Methods: The Chongqing Longitudinal Twin Study (LoTiS) began in December 2015 in China. Participants of LoTiS who met the inclusion criteria were recruited into this study and completed a stress rating scale (PSRS) in both early and late pregnancy. Maternal prenatal stress was examined in subgroups. Correlations between maternal prenatal stress and primary pregnancy outcomes were analyzed by multivariate logistic regression. Results: A total of 215 eligible twin pregnancies from LoTiS were recruited into this study. The overall mean scores of prenatal stress were 43.41 ± 19.84 and 51.33 ± 20.43 in early and late pregnancy, respectively. The first prenatal stressor was regarding concern about the pregnancy and childbirth safety. Subgroup analyses revealed prenatal stress in late pregnancy that differed based on different pregravid BMIs and education levels. Correlation analysis suggested that the risk of preterm premature rupture of membranes increases 1.8% per unit of stress scale in late pregnancy (OR = 1.018, 95% CI 1.001-1.025). Conclusions: Prenatal stress in twin pregnancies increases with the progression of pregnancy. Higher stress in late pregnancy is associated with a higher risk of premature rupture of membranes; therefore, interventions might be essential for improving pregnancy outcomes.

Women can develop childbirth-related posttraumatic stress disorder (CB-PTSD) in at-term delivery with healthy baby outcome as well as following pre-term delivery and neonatal complications, a potential added stressor. No study compares risk factors of CB-PTSD associated with different infant outcomes. We investigated CB-PTSD risk factors by comparing women with or without neonatal complications. Analysis reveals the importance of antepartum and birth-related risk factors in CB-PTSD above and beyond child outcomes, suggesting childbirth is an independent stressor capable of evoking CB-PTSD., Competing Interests: Declaration of competing interest No financial or personal relationship to disclose. All authors declare no conflict of interest that can influence the study and reported results., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: The impact of antenatal depression on pregnancy outcomes has been well investigated in developed countries, but few studies have been conducted in low-income countries. As depression is significantly affected by socio-economic and cultural factors, it would be difficult to generalize evidence from high-income countries to low-income countries. We conducted a community-based cohort study to estimate the incidence of adverse birth outcomes and the direct and indirect pathways via which depression and other psychosocial risk factors may impact such birth outcomes within Gondar town, Ethiopia., Methods: The study followed 916 pregnant women who were screened for antenatal depression using the Edinburgh Postnatal Depression Scale (EPDS). We also assessed the incidence of preterm births, Low Birth Weight (LBW) and stillbirths. Modified Poisson regression was used to estimate the relative risk of predictors on adverse birth outcomes and a Generalized Structural Equation Model (GSEM) was used to estimate the direct and indirect effect of antenatal depression and other psychological risk factors on adverse birth outcomes., Results: The cumulative incidence of stillbirth, LBW and preterm was 1.90%, 5.25%, and 16.42%, respectively. The risk of preterm birth was 1.61, 1.46, 1.49, and 1.77 times higher among participants who identified as Muslim, reported being fearful of delivery, were government employee's, and who had no antenatal care services, respectively. Partner support moderated the association between depression, preterm birth, and LBW. Depression had no direct effect on birth outcomes but indirectly affected preterm birth via partner support. Religion had both direct and indirect effects on preterm birth, while occupation and fear of delivery had direct effects. The risk of LBW was 9.44 and 2.19 times higher among preterm births and those who had exposure to tobacco, respectively. Stress coping was indirectly associated, and preterm birth and tobacco exposure were directly associated with LBW. The risk of stillbirth was 3.22 times higher in women with antenatal depression and 73% lower in women with higher coping abilities., Conclusions: There was a high incidence of all adverse birth outcomes in Gondar Town. Depression and psychosocial risk factors had important indirect negative effects on risk, while partner support provided a positive indirect effect on the incidence of adverse birth outcomes. Interventions that focus on increasing partner engagement and participation in antenatal support may help reduce adverse birth outcomes by enhancing maternal resilience., Competing Interests: The authors have declared that no competing interests exist.

Objectives: During the perinatal period, 10-20% of women experience anxiety and/or depression. Untreated perinatal depression has the potential for adverse effects on the family and infant resulting in long-term deleterious consequences. This study measured the association between self-reported depression using the Edinburgh Postnatal Depression Scale scores, self-reported anxiety and neonatal birth outcomes., Methods: A retrospective design was used with ObstetriX™ data retrieved from 16 metropolitan and rural hospitals in NSW, Australia during 2009-2014. Data were available for 53,646 singleton births. The Edinburgh Postnatal Depression Scale was used to identify self-reported depression while women self-reported pregnancy related anxiety. Regression modelling measured the effects of self-reported depression and self-reported pregnancy related anxiety on neonatal birth outcomes. Linear regression and logistic regression were used to model the effect on birth weight, gestational age, admission to NICU or the SCN, outcome (stillborn vs livebirth), and Apgar scores. Cox proportional hazards regression was used to estimate the effect on neonatal length of stay., Results: Babies born to women self-reporting anxiety were more likely to have birth complications, be admitted to the nursery, had lower Apgar scores and longer hospital stays. Babies born to women self-identifying as experiencing a level of depression were more likely to have a lower birth weight, shorter gestational age, and, lower Apgar score. These babies were more likely to be admitted to the nursery with an increased length of stay., Conclusions: Perinatal anxiety and depression contribute to poor birth outcomes. Early detection of maternal perinatal anxiety and depression is an important step towards treatment interventions. More research is needed to identify models of care that are effective in identifying and managing perinatal depression and anxiety to improve birth outcomes for women and their babies.

Objective: Patient's trust in physicians is a significant predictor of continuity, adherence, and satisfaction with care. However, it is unclear what influences a woman's trust in her physician. This study sought to determine if women's trust in their clinicians was affected by unexpected outcomes at the time of delivery., Study Design: This is a secondary analysis of a prospective cohort of 300 postpartum women with gestational diabetes mellitus. Participants completed the validated Trust in Physician Scale during their postpartum hospitalization. Participants' scores were compared based on their exposure to an unexpected pregnancy outcome., Results: Of the 300 women consented to participate in this study, 294 completed the Trust in Physician Scale. The mean overall trust score was 80/100 with a range of 42 to 100. Unexpected pregnancy outcomes occurred in 41% (120) of women in this cohort. There was no significant difference in the trust score between women who did and did not have at least one unexpected outcome (0.79 vs. 0.79, p  = 0.93). Additionally, there was no significant association between the trust score and any individual unexpected pregnancy outcome., Conclusion: Unexpected pregnancy outcomes are not associated with changes in women's trust in their obstetric clinicians. These results emphasize the antepartum period as the essential time for patient-physician relationship building which has important implications for postpartum follow-up and long-term psychiatric sequelae from unexpected outcomes., Competing Interests: M.B.K., N.K.A., M.A.C., P.H., and E.F.W. report grants from American Diabetes Association, during the conduct of the study., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Objective: To describe the demographic and clinical characteristics of pregnant and postpartum women in Japan with psychoneurological disorders who attempt suicide., Method: A nationwide retrospective cohort study was conducted using the Diagnosis Procedure Combination database, a national database on acute-care inpatients in Japan. All pregnant and postpartum women who had psychoneurological disorders (ICD-10 codes: O993, F530, F531) and were admitted to participating hospitals from January 2016 to March 2018 were identified. Among eligible patients, the prevalence of suicide attempts, risk factors for suicidal behaviors, maternal outcomes, and other characteristics were investigated., Results: Among the 3,286 eligible patients (3,026 pregnant women and 260 postpartum women), 22 pregnant women and 16 postpartum women had attempted suicide. The prevalence of suicide attempts was significantly higher among postpartum women (6.2%) than among pregnant women (0.7%; P < .001). Postpartum patients were more likely to be aged 30 years or older and to have depression. Wrist cutting was the main method of suicide attempt among pregnant patients, whereas hanging was the main method among postpartum patients. Three postpartum patients died during hospitalization., Conclusions: Postpartum patients were more likely to be in critical condition and to use fatal suicide attempt methods compared with pregnant women., (© Copyright 2020 Physicians Postgraduate Press, Inc.)

Background: The efficacy of yoga on delivery outcomes remaining controversy., Objectives: To evaluate the effects of prenatal yoga on delivery outcomes., Methods: The Cochrane Library, PubMed, Embase, Web of Science, CINAHL and Elsevier databases were searched from inception to January 22, 2020, and randomized, quasi-randomized and non-randomized controlled trials evaluating the effect of yoga on the delivery outcomes in pregnant women were included. The methodological quality was assessed by the Cochrane Collaboration's tool. Meta-analysis was performed using Revman 5.3., Results: This meta-analysis identified that yoga improved vaginal delivery, decreased premature delivery and birth weight of newborns, shorten the labor duration., Conclusion: Prenatal yoga is an effective complementary medicine to improve delivery outcomes and not to increase the risk of fetus, which is worth recommending to pregnant women. But studies involved in this meta-analysis were not all of high quality. The Registration Number in PROSPERO is CRD42019132490., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: Birth outcomes of women with anorexia nervosa are poorly understood. We hypothesized that hospitalization for anorexia nervosa before or during pregnancy is associated with an elevated risk of adverse maternal and infant birth outcomes., Method: We performed a retrospective cohort study of 2,134,945 pregnancies in Quebec, Canada, from 1989 to 2016. The main exposure measure was anorexia nervosa requiring hospital treatment before or during pregnancy. Outcome measures included stillbirth, preterm birth, low birth weight, small-for-gestational age birth, preeclampsia, gestational diabetes, cesarean delivery, and other pregnancy disorders. We computed risk ratios and 95% confidence intervals (CI) for the association between anorexia nervosa and birth outcomes adjusted for maternal characteristics., Results: Compared with no hospitalization, anorexia nervosa hospitalization was associated with 1.99 times the risk of stillbirth (95% CI 1.20-3.30), 1.32 times the risk of preterm birth (95% CI 1.13-1.55), 1.69 times the risk of low birth weight (95% CI 1.44-1.99), and 1.52 times the risk of small-for-gestational age birth (95% CI 1.35-1.72). The associations with low birth weight and small-for-gestational age birth were more prominent in women hospitalized for anorexia nervosa during pregnancy or within 2 years of delivery. Hospitalization for anorexia nervosa was associated with certain maternal outcomes, including precipitate labor, acute liver failure, and admission to an intensive care unit., Discussion: Hospitalization for anorexia nervosa before or during pregnancy is associated with adverse infant and maternal outcomes. Infants are primarily at risk of stillbirth, preterm birth, low birth weight, and small-for-gestational age birth., (© 2020 Wiley Periodicals, Inc.)

Background: In 2017, 46.6 million U.S. adults aged 18 or older self-reported as having mental illness of which 52.0% or 24.2 million are women age 18-49. Perinatal depression and anxiety are linked to adverse outcomes concerning pregnancy, maternal functioning, and healthy child development., Methods and Findings: Using the 2014 Health Center Patient Survey (HCPS), the objectives of the cross-sectional study are to assess the prevalence of self-reported mental health conditions among female patients of reproductive age and to examine the association between depression and physical health. Physical health conditions of interest included self-rated health, obesity, hypertension, smoking, and diabetes, which all have established associations with potential pregnancy complications and fetal health. The study found 40.8% of patients reported depression; 28.8% reported generalized anxiety; and 15.2% met the criteria for serious psychological distress on the Kessler 6 scale. Furthermore, patients with depression had two to three times higher odds of experiencing co-occurring physical health conditions., Conclusions: This study expands the discourse on maternal mental health, throughout the preconception, post-partum, and inter-conception care periods to improve understanding of the inter-correlated physical and mental health issues that could impact pregnancy outcomes and life course trajectory. From 2014 to 2018, the Health Resources and Services Administration (HRSA) has supported investments of nearly $750 million to improve and expand access to mental health and substance use disorder services for prevention, treatment, health education and awareness through comprehensive primary care integration. Moving forward, HRSA will implement strategic training and technical assistance (T/TA) framework that is designed to accelerate the adoption of science driven solutions in primary care in addressing depression for patients with co-occurring chronic conditions and advancing positive maternal outcomes., Competing Interests: The authors have declared that no competing interests exist.

As gestational surrogacy (a process by which intended parents contract with a woman to carry a fetus that the intended parents will raise) increases across the United States, it is imperative that obstetrician/gynecologists understand the unique nuances of caring for patients who are gestational surrogates. Gestational surrogacy offers a route to parenthood for individuals and families who may otherwise have limited options. Understanding surrogacy requires multiple ethical considerations about the potential medical and psychosocial effects on gestational surrogates as well as the families built through surrogacy. There is a dearth of research on the subject, particularly in the United States and other countries that practice compensated surrogacy. Here we seek to review the process of gestational surrogacy in the United States, including the legal landscape, current trends in gestational surrogacy use, and what is known about the medical and social effects of this process on all participants. We also aim to highlight the limitations of available data and to identify topics for future research to provide optimal evidence-based and just care for these patients., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Pregnancy in women with intellectual disability (ID) is increasingly recognised, along with their increased likelihood of experiencing risk factors for adverse pregnancy and infant outcomes., Objectives: We aimed to compare risks of socio-demographic, pregnancy and infant outcomes of women with ID to other women., Methods: All mothers with children born in Western Australia from 1983 to 2012 were linked to the population-based Intellectual Disability Exploring Answers database. Mothers with ID were matched by age and Aboriginality to a population sample of mothers without ID. Pregnancy and birth outcomes were compared for both groups and logistic regression was used to compare outcome risks., Results: Compared to non-Aboriginal mothers without ID, non-Aboriginal mothers with ID were more likely to be of low socio-economic status, be without partner, smoke antenatally and have pre-existing asthma. They had a 1.5 times increased risk of pregnancy complications, specifically pre-eclampsia, urinary tract infection, threatened preterm labour and post-partum haemorrhage. After adjustment for maternal medical conditions and pregnancy complications, infants of Aboriginal mothers with ID had twice the risk of preterm birth and 1.6 times the risk of having percentage of optimal head circumference <95% compared to infants of Aboriginal mothers without ID. Infants of both Aboriginal and non-Aboriginal mothers with ID were more likely to have percentage of optimal birth weight <85% compared to those without ID., Conclusions: For mothers with ID, modifiable risk factors for adverse outcomes need addressing. They may require additional assistance during pregnancy, including more frequent consultations and support to assist with pregnancy management., Competing Interests: Declaration of competing interest No author reports a conflict of interest., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Importance: The prevalence of eating disorders is high among women of reproductive age, yet the association of eating disorders with pregnancy complications and neonatal health has not been investigated in detail, to our knowledge., Objective: To investigate the relative risk of adverse pregnancy and neonatal outcomes for women with eating disorders., Design, Setting, and Participants: This population-based cohort study included all singleton births included in the Swedish Medical Birth Register from January 1, 2003, to December 31, 2014. A total of 7542 women with eating disorders were compared with 1 225 321 women without eating disorders. Statistical analysis was performed from January 1, 2018, to April 30, 2019. Via linkage with the national patient register, women with eating disorders were identified and compared with women free of any eating disorder. Eating disorders were further stratified into active or previous disease based on last time of diagnosis., Main Outcomes and Measures: The risk of adverse pregnancy outcomes (hyperemesis, anemia, preeclampsia, and antepartum hemorrhage), the mode of delivery (cesarean delivery, vaginal delivery, or instrumental vaginal delivery), and the neonatal outcomes (preterm birth, small and large sizes for gestational age, Apgar score <7 at 5 minutes, and microcephaly) were calculated using Poisson regression analysis to estimate risk ratios (RRs). Models were adjusted for age, parity, smoking status, and birth year., Results: There were 2769 women with anorexia nervosa (mean [SD] age, 29.4 [5.3] years), 1378 women with bulimia nervosa (mean [SD] age, 30.2 [4.9] years), and 3395 women with an eating disorder not otherwise specified (EDNOS; mean [SD] age, 28.9 [5.3] years), and they were analyzed and compared with 1 225 321 women without eating disorders (mean [SD] age, 30.3 [5.2] years). All subtypes of maternal eating disorders were associated with an approximately 2-fold increased risk of hyperemesis during pregnancy (anorexia nervosa: RR, 2.1 [95% CI, 1.8-2.5]; bulimia nervosa: RR, 2.1 [95% CI, 1.6-2.7]; EDNOS: RR, 2.6 [95% CI, 2.3-3.0]). The risk of anemia during pregnancy was doubled for women with active anorexia nervosa (RR, 2.1 [95% CI, 1.3-3.2]) or EDNOS (RR, 2.1 [95% CI, 1.5-2.8]). Maternal anorexia nervosa was associated with an increased risk of antepartum hemorrhage (RR, 1.6 [95% CI, 1.2-2.1]), which was more pronounced in active vs previous disease. Women with anorexia nervosa (RR, 0.7 [95% CI, 0.6-0.9]) and women with EDNOS (RR, 0.8 [95% CI, 0.7-1.0]) were at decreased risk of instrumental-assisted vaginal births; otherwise, there were no major differences in mode of delivery. Women with eating disorders, all subtypes, were at increased risk of a preterm birth (anorexia nervosa: RR, 1.6 [95% CI, 1.4-1.8]; bulimia nervosa: RR, 1.3 [95% CI, 1.0-1.6]; and EDNOS: RR, 1.4 [95% CI, 1.2-1.6]) and of delivering neonates with microcephaly (anorexia nervosa: RR, 1.9 [95% CI, 1.5-2.4]; bulimia nervosa: RR, 1.6 [95% CI, 1.1-2.4]; EDNOS: RR, 1.4 [95% CI, 1.2-1.9])., Conclusions and Relevance: The findings of this study suggest that women with active or previous eating disorders, regardless of subtype, are at increased risk of adverse pregnancy and neonatal outcomes and may need increased surveillance in antenatal and delivery care.

Introduction: Findings concerning the relationship between maternal prenatal and child cortisol concentrations are inconsistent. This study examined whether the influence of an objective traumatic stressor during pregnancy, distance from a natural flood disaster, moderated the association between prenatal maternal diurnal cortisol and 9-year old offspring hair cortisol concentrations., Methods: Data were collected from 56 of the mothers who took part in a study of flood-related pregnancy outcomes in 2009 and their children. Data included distance of the maternal home from evacuation areas, four maternal saliva cortisol assessments (waking, 30 min after waking, afternoon, and before bed) provided within 3-months of the flood crest and child hair samples to assess cortisol secretion over the past month., Results: There was a significant interaction between proximity to flooding during pregnancy and maternal cortisol AUC predicting child hair cortisol, after controlling for maternal age, gestational age at cortisol sampling, sex of the child, current socioeconomic status and current maternal stress. At greater distance from flooding (lower stress conditions) there was a non-statistically significant positive association between maternal cortisol and child cortisol. In contrast, living closer to flooding (higher stress conditions) produced a significant negative association between maternal and child cortisol., Conclusion: Experiencing a traumatic stressor during pregnancy may alter maternal-fetal programming of the hypothalamic-pituitary-adrenal axis. The direct threat of flooding led to offspring cortisol concentrations that resembled cortisol production seen in mothers with symptoms of PTSD and their offspring. This alteration is evident in nine-year-old offspring and may help explain inconsistencies in the previous literature., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Preconception counseling can improve women's health and pregnancy outcomes. Internal health locus of control and belief in the benefits of health-promoting behaviors improve people's engagement in health-promoting behaviors. This study examined whether preconception counseling was related to stress and health locus of control. This randomized controlled trial was conducted from March to November 2016 on 152 healthy 18-35-year-old women intending to become pregnant within the next year in Iran. The intervention group received six sessions of group counseling, and the control group received only usual care. The Perceived Stress Scale, Multidimensional Health Locus of Control Scales and checklist for preconception control were completed before and after the intervention. Repeated measures ANOVA showed a significant post-intervention increase in the mean internal health locus of control ( P  < .001) and preconception control scores ( P  = .034) in the intervention group and the mean perceived stress score ( P  = .001), and chance health locus of control ( P  = .013) decreased significantly. Preconception counseling was associated with increased internal locus of control and reduced perceived stress. Preconception counselors should consider reinforcing women's internal beliefs with an emphasis on the effect of the couple's own behaviors and exposures on pregnancy and fetal outcomes.

Objectives: We examined the socio-demographic and behavioral factors associated with alcohol consumption before and after pregnancy awareness in pregnant women., Methods: This cross-sectional study included 91,828 pregnant women in a nationwide Japanese birth cohort study from 2011 to 2014. Alcohol consumption before and after pregnancy awareness, and sociodemographic behavioral characteristics were assessed through self-reported questionnaires. Determinants of alcohol consumption were investigated using logistic regression., Results: Prevalence of alcohol consumption before and after pregnancy awareness was 50.0% and 2.8%, respectively. Most women consumed low to moderate levels of alcohol. Before pregnancy awareness, high educational level (odds ratios [OR] 1.11, 95% confidence interval [CI] 1.07 to 1.15), high household income (OR 1.16, 95% CI 1.09 to 1.24), and smoking (OR 1.77, 95% CI 1.65 to 1.90) were significantly associated with increased odds of alcohol consumption. After pregnancy awareness, older age (OR 1.73, 95% CI 1.54 to 1.94) and smoking (OR 5.57, 95% CI 4.88 to 6.37) were significantly associated with increased odds of alcohol consumption, and high education level (OR 0.72, 95% CI 0.64 to 0.81) and high household income (OR 0.75, 95% CI 0.63 to 0.89) were significantly associated with decreased odds of alcohol consumption., Conclusion: A half of women consumed alcohol before pregnancy awareness. Guidelines recommend abstinence from alcohol consumption in pregnant women for precaution, although influence of low to moderate levels of prenatal alcohol exposure on the fetus is inconclusive. Social-demographic characteristics differed between women who consumed alcohol before pregnancy awareness and women who continued alcohol after pregnancy awareness.

Psychosocial stress during pregnancy has been associated with adverse pregnancy outcomes including preterm birth (PTB). This has not been studied in Puerto Rico, an area with high PTB rates. Our objective was to develop a conceptual model describing the interrelationships between measures of psychosocial stress and depression, a result of stress, among pregnant women in Puerto Rico and to examine their associations with PTB. We used data from the Puerto Rico Testsite for Exploring Contamination Threats pregnancy cohort (PROTECT, N = 1,047) to examine associations among depression and different continuous measures of psychosocial stress using path analysis. Psychosocial stress during pregnancy was assessed using validated measures of perceived stress, negative life experiences, neighborhood perceptions and social support. Logistic regression was used to examine associations between psychosocial stress measures in tertiles and PTB. Perceived stress, negative life experiences, and neighborhood perceptions influenced depression through multiple pathways. Our model indicated that perceived stress had the strongest direct effect on depression, where one standard deviation (SD) increase in perceived stress was associated with a 57% SD increase in depression. Negative life experiences were directly but also indirectly, through perceived stress, associated with depression. Finally, neighborhood perceptions directly influenced negative life experiences and perceived stress and consequently had an indirect effect on depression. Psychosocial stress was not associated with PTB across any of the measures examined. Our study examined interrelationships between multiple measures of psychosocial stress and depression among a pregnant Puerto Rican population and identified negative neighborhood perceptions as important upstream factors leading to depression. Our findings highlight the complex relationship between psychosocial stress measures and indicate that psychosocial stress and depression, assessed using 5 different scales, were not associated with PTB. Future research should investigate other environmental and behavioral risk factors contributing to higher rates of PTB in this population., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Many studies based on hospital records or vital statistics have found that childbearing women experience benefits of lower rates of intervention with midwifery care versus obstetric care during labor and birth. Surveys of women's views and experiences can provide a richer analysis when comparing intrapartum care of midwives and obstetricians., Methods: This study was a secondary analysis of data from the population-based Listening to Mothers in California survey. The sample, which was representative of 2016 California hospital births, was drawn from birth certificate files and oversampled midwife-attended births. Women responded to the survey in English or Spanish on any device or with a telephone interviewer. The present analysis is based on 1421 of the 2539 participants who identified a midwife or obstetrician as their attendant at a vaginal birth. A bivariate analysis of demographic, attitudinal, and intrapartum variables was conducted. A multivariable model included sociodemographic and attitudinal variables as covariates., Results: Bivariate analyses found significant socioeconomic differences by type of intrapartum care provider, with women in California attended by midwives more likely to be well educated and privately insured than women attended by obstetricians. Women with midwife birth attendants were less likely to report experiencing various intrapartum medical interventions, less likely to experience pressure to have epidural analgesia, and more likely to report that staff encouraged the woman's decision making. Adjusted odds ratios found that women with midwives were less likely to experience medical interventions, including attempted labor induction; labor augmentation; and use of pain medications, epidural analgesia, and intravenous fluids; and less likely to report pressure to have labor induction or epidural analgesia. Women cared for by midwives were more likely to experience any nonpharmacologic pain relief measures and nitrous oxide and to agree that hospital staff encouraged their decision making., Discussion: Using women's own reports of their care experiences and adjusting for possible differences in women's attitudes and case mix, we found that midwifery care of women who had vaginal births was associated with reduced use of medical interventions and increased women's decisional latitude during labor and birth., (© 2019 The Authors. The Journal of Midwifery and Women's Health published by Wiley Periodicals, Inc., on behalf of the American College of Nurse-Midwives.)

Background: African American women are more likely to experience preterm birth compared with White women. Social factors such as neighborhood disorder and experiences of racial discrimination, which disproportionately affect African American women, may partially explain these disparities., Purpose: The purpose of this study was to examine pregnant African American women's perceptions of neighborhood disorder, racial discrimination, and psychological distress and whether these concepts were viewed as influences on birth outcomes., Study Design and Methods: Using a mixed-methods approach, seven pregnant African American women completed questionnaires including scales for neighborhood disorder (Ross Neighborhood Disorder Scale), racial discrimination (Experiences of Discrimination), and psychological distress (Center for Epidemiological Studies Depression Scale; Psychological General Well-Being Index). All constructs were also assessed by semistructured interviews. Within- and across-case analyses were conducted to compare agreement and discordance between the data sources for each construct and to note patterns in the data., Results: The qualitative interviews provided data about women's experiences that were not captured by questionnaires alone. All of the women disclosed concerns about neighborhood conditions, experiences of discrimination, and psychological distress either reported on the questionnaires, during the qualitative interviews, or both. The mixed-methods approach provided a rich source of data that brought into focus the depth of the perceptions around these constructs., Clinical Implications: Maternal-child nurses should assess perceptions of neighborhood environment, racial discrimination, and psychological distress, as these factors may increase the risk for adverse pregnancy and birth outcomes.

Introduction: Exposure to childhood abuse or neglect may lead to negative outcomes during pregnancy in expecting parents, which may contribute to a negative experience of childbearing and have consequences for the developing fetus. This study examined the associations between exposure to childhood abuse or neglect, psychological symptoms, prenatal attachment, and perception of parental competence in expectant parents., Methods: Individuals at low sociodemographic risk were recruited in community perinatal care settings and completed self-report assessment measures of depression, posttraumatic stress disorder, dissociation, personality disorders, perception of parental competence, and prenatal attachment., Results: There were 322 participants (78% women), including 91 adults with a history of childhood abuse or neglect, Participants who were exposed to childhood abuse or neglect reported significantly higher levels of symptoms on all indices of mental health than nonexposed adults, even when controlling for sociodemographic risks. However, both groups reported similar levels of prenatal attachment and parental confidence. The impact of childhood maltreatment was similar in men and women. Structural equation modeling showed that childhood abuse or neglect leads to poor mental health and that poor mental health, but not childhood maltreatment, is associated with low parental confidence and prenatal attachment., Discussion: Psychological symptoms are frequent in expectant parents who experienced maltreatment during their childhood. However, childhood abuse or neglect is not associated with their attitude regarding parenthood and the child in the absence of psychopathology. Supporting mental health may be an important target of parental programs offered during pregnancy to women and men with a history of childhood abuse or neglect., (© 2019 by the American College of Nurse-Midwives.)

Introduction: Midwifery care is associated with positive birth outcomes, access to community birth options, and judicious use of interventions. The aim of this study was to characterize and compare maternity care preferences of university students across a range of maternity care systems and to explore whether preferences align with evidence-based recommendations and options available., Methods: A cross-sectional, web-based survey was completed in 2014 and 2015 by a convenience sample of university students in 8 high-income countries across 4 continents (N = 4569). In addition to describing preferences for midwifery care and community birth options across countries, this study examined sociodemographic characteristics, psychological factors, knowledge about pregnancy and birth, and sources of information that shaped students' attitudes toward birth in relation to preferences for midwifery care and community birth options., Results: Approximately half of the student respondents (48.2%) preferred midwifery-led care for a healthy pregnancy; 9.5% would choose to give birth in a birthing center, and 4.5% preferred a home birth. Preference for midwifery care varied from 10.3% among women in the United States to 78.6% among women in the United Kingdom. Preferences for home birth varied from 0.3% among US women to 18.3% among Canadian women. Women, health science students, those with low childbirth fear, those who learned about pregnancy and birth from friends (compared with other sources, eg, the media), and those who responded from Europe were significantly more likely to prefer midwifery care and community birth. High confidence in knowledge of pregnancy and birth was linked to significantly higher odds of community birth preferences and midwifery care preferences., Discussion: It would be beneficial to integrate childbirth education into high school curricula to promote knowledge of midwifery care, pregnancy, and childbirth and to reduce fear among prospective parents. Community birth options need to be expanded to meet demand among the next generation of maternity service users., (© 2020 by the American College of Nurse-Midwives.)

Background: Adverse childhood experiences (ACE) are associated with an array of health consequences in later life, but few studies have examined the effects of ACEs on women's birth outcomes., Methods: We analyzed data gathered from a sample of 1848 low-income women who received services from home visiting programs in Wisconsin. Archival program records from a public health database were used to create three birth outcomes reflecting each participant's reproductive health history: any pregnancy loss; any preterm birth; any low birthweight. Multivariate logistic regressions were performed to test the linear and non-linear effects of ACEs on birth outcomes, controlling for age, race/ethnicity, and education., Results: Descriptive analyses showed that 84.4% of women had at least one ACE, and that 68.2% reported multiple ACEs. Multivariate logistic regression analyses showed that cumulative ACE scores were associated with an increased likelihood of pregnancy loss (OR = 1.12; 95% CI = 1.08-1.17), preterm birth (OR = 1.07; 95% CI = 1.01-1.12), and low birthweight (OR = 1.08; 95% CI = 1.03-1.15). Additional analyses revealed that the ACE-birthweight association deviated from a linear, dose-response pattern., Conclusions: Findings confirmed that high levels of childhood adversity are associated with poor birth outcomes. Alongside additive risk models, future ACE research should test interactive risk models and causal mechanisms through which childhood adversity compromises reproductive health.

Purpose. To measure utility values that describe women's willingness to tradeoff maternal morbidity for fetal benefit among pregnant and nonpregnant women of reproductive age. Methods. We recruited English-speaking women aged 18 to 45 years in clinical and community-based settings. Eight health states were studied: 4 maternal (healthy, stroke, hysterectomy, death) and 4 neonatal (healthy, severe cerebral palsy [CP], severe mental retardation [MR], death). Utilities were assessed on a subset of 9 pairs of mom/baby delivery outcomes. Participants ranked the 9 pairs of outcomes in order of preference, then standard gamble methods were used to calculate utilities. Numeracy skills were assessed. Results. Utilities were obtained from 477 participants (recruitment rate = 94%). Twenty-one percent were pregnant, 63% were parents, and 54% were African American. Utilities did not differ significantly between pregnant and nonpregnant women or based on numeracy score. The highest (nonhealthy) values were assigned to baby healthy/mom hysterectomy (0.999), baby healthy/mom stroke (0.946), and baby CP/mom healthy (0.940). The lowest values were assigned to baby death/mom hysterectomy (0.203), baby MR/mom death (0.150), and baby death/mom stroke (0.087). Nonwhite participants assigned a significantly higher value to baby MR/mom death ( P = 0.01), baby MR/mom stroke ( P = 0.02), baby MR/mom healthy ( P < 0.01), and baby MR/mom hysterectomy ( P = 0.02) than white participants. Conclusion. When asked to value pairs of maternal/fetal outcomes that required a tradeoff of morbidity and mortality, women tended to assign the highest utility to combinations that resulted in a "healthy baby." They assigned the lowest values to combinations that resulted in a baby's death or MR. Our findings highlight the importance of 1) assessing individual preferences and goals of care for pregnancy outcomes and 2) measuring utilities among reproductive-aged women when modeling obstetric decision making.

To systematically review and meta-analyze research investigating the association between maternal anxiety during pregnancy and outcomes for mother and baby following the immediate delivery period. MEDLINE, Medline In-Process & Other Non-Indexed Citations, PsycINFO, Embase, CINAHL, and the Cochrane library were searched. English-language, prospective studies providing data on outcomes following delivery in women with and without antenatal anxiety (defined by clinical diagnosis or score on validated scale) were included. Three-hundred-fifty-eight articles were retrieved and 13 were included. Titles and abstracts were screened; two reviewers independently reviewed full text articles, conducted quality assessments, extracted, and checked the data. Where available for > 2 studies, random effect meta-analysis was conducted and heterogeneity was quantified. Subanalyses explored moderators, regardless of heterogeneity, including type of anxiety assessment and timing, among others. There were two outcomes that were amenable to meta-analysis. Antenatal anxiety was significantly associated with postpartum depression (PPD) measured within 6 months postpartum (pooled odds ratio [OR] = 2.64, 95% CI 2.02-3.46; 8 studies), regardless of restricting analyses to those studies controlling for prenatal depression (2.45, 1.77-3.39; 6 studies). Associations were also significant when PPD was measured at 1-3 months (2.57, 1.94-3.40; 7 studies) and 6-10 months (4.42, 1.45-13.49; 3 studies). Maternal anxiety was also associated with reduced odds of breastfeeding (0.63, 0.53-0.74; 5 studies). Antenatal anxiety is associated with PPD up to the first 10 months, independent of prenatal depression, and with lower odds of breastfeeding.

Objective: To examine the characteristics of women and babies admitted to the residential parenting services (RPS) of Tresillian and Karitane in the first year following birth., Design: A linked population data cohort study was undertaken for the years 2000-2012., Setting: New South Wales (NSW), Australia., Participants: All women giving birth and babies born in NSW were compared with those admitted to RPS., Results: During the time period there were a total of 1 097 762 births (2000-2012) in NSW and 32 991 admissions to RPS. Women in cohort 1: (those admitted to RPS) were older at the time of birth, more likely to be admitted as a private patient at the time of birth, be born in Australia and be having their first baby compared with women in cohort 2 (those not admitted to an RPS). Women admitted to RPS experienced more birth intervention (induction, instrumental birth, caesarean section), had more multiple births and were more likely to have a male infant. Their babies were also more likely to be resuscitated and have experienced birth trauma to the scalp. Between 2000 and 2012 the average age of women in the RPS increased by nearly 2 years; their infants were older on admission and women were less likely to smoke. Over the time period there was a drop in the numbers of women admitted to RPS having a normal vaginal birth and an increase in women having an instrumental birth., Conclusion: Women who access RPS in the first year after birth are more socially advantaged and have higher birth intervention than those who do not, due in part to higher numbers birthing in the private sector where intervention rates are high. The rise in women admitted to RPS (2000-2012) who have had instrumental births is intriguing as overall rates did not increase., Competing Interests: Competing interests: ICMJE uniform disclosure form has been completed. CF, RM, GO'L and JS all work for the organisations of Tresillian and Karitane and were partners in the project but they did not analyse or interpret the data. An ARC Linkage grant was received for this work LP130100306., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

To evaluate associations between maternal anxiety or depression and adverse pregnancy outcomes, taking possible familial confounding and interaction with asthma into account, we conducted a cohort study of all singleton births in Sweden 2001-2013. We retrieved information about pregnancy, diagnoses of anxiety/depression, asthma, and prescribed medication from the Swedish Medical Birth, National Patient, and Prescribed Drug Registers. We estimated associations with regression models, performed cousin and sibling comparisons, and calculated interactions. In 950 301 identified pregnancies; 5.9% had anxiety/depression and 4.0% had asthma. Anxiety/depression was associated with adverse pregnancy outcomes (e.g. preeclampsia, adjusted Odds Ratio 1.17 (95% Confidence Interval 1.12, 1.22), instrumental delivery (1.14 (1.10, 1.18)), elective (1.62 (1.57, 1.68)) and emergency (1.32 (1.28, 1.35)) caesarean section (CS)). Their children had lower birth weight (-54 g (-59, -49)) and shorter gestational age (-0.29 weeks (-0.31, -0.28)). Associations were not confounded by familial factors and asthma did not modify the effect of anxiety/depression for outcomes other than elective CS, p < 0.001. In women with anxiety/depression diagnosis, untreated women had higher odds of elective CS compared to women on medication (1.30 (1.17, 1.43)). In conclusion, anxiety/depression should be considered when evaluating pregnant women's risk of complications such as preeclampsia and non-vaginal deliveries.

Background : Depression symptomatology in pregnant women is a condition that represents an important risk factor for the health of both women and children. Objectives : The aim of this study was to investigate the influence of women's depression symptomatology on the clinical aspects of their delivery, both directly and indirectly, through mothers' prenatal attachment to their unborn children. Moreover, we analysed whether these aspects affect the well-being of the newborn, assessed through the Apgar score. Methods : A longitudinal design was carried out on a total of 203 pregnant women. At weeks 31-32 of gestation, women filled out the Beck Depression Inventory and the Prenatal Attachment Inventory. The day of childbirth, hospital healthcare staff registered the clinical data of childbirth. Results : A woman's depressive symptomatology negatively affects prenatal attachment to her unborn child and positively affects the clinical aspects of the delivery, both directly and mediated by the quality of prenatal attachment. Moreover, the Apgar score was negatively influenced by the clinical aspects of the delivery and, indirectly, by the depressive symptomatology. Conclusion : Depressive symptomatology during pregnancy has negative outcomes, affecting the delivery experience of women, the first emotional bond with the child, and the well-being of the newborn.

Objectives: State policies regarding alcohol use during pregnancy (alcohol/pregnancy policies) have been in effect for more than 40 years. Previous research finds some policies increase adverse birth outcomes and decrease prenatal care utilization. This research examines whether effects of alcohol/pregnancy policies vary by race; the general hypothesis is that health benefits of policies are concentrated among White women and health harms of policies are concentrated among Black women., Methods: This study uses 1972-2015 Vital Statistics data and policy data from NIAAA's Alcohol Policy Information System and original legal research. The dataset includes more than 150 million singleton births. Outcomes are preterm birth (PTB), low birthweight (LBW), and prenatal care utilization. Logistic regression models include raceXpolicy interaction terms as main predictors, adjust for individual- and state-level controls, include fixed effects for state, year and state-specific time trends, and account for clustering by state., Results: The impact of alcohol/pregnancy policies varied by race for preterm birth, varied in a few cases for low birthweight, and generally did not vary for prenatal care utilization. The hypothesis regarding the direction of differential effects was not supported. Six policies had an adverse impact on PTB and/or LBW for White women. Findings differed for Black women; for Black women, four policies had a beneficial impact for PTB and one had an adverse impact for LBW., Conclusions: The impact of alcohol/pregnancy policies on birth outcomes varies by race. Future research should explore why some policies appear to have opposite effects for White v. Black women., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Around 12% of pregnant women develop gestational diabetes mellitus (GDM), which is associated with increased health risks for both mother and child and pre- and postpartum depression. Little is known about the relationship of GDM with diabetes-specific emotional distress (diabetes distress). The aims of this study are to assess the prevalence of diabetes distress in GDM and its association with adverse pregnancy outcomes., Methods: A prospective cohort study was carried out in an Amsterdam based teaching hospital with an ethnic diverse population. Women diagnosed with GDM completed a set of questionnaires at three time points. Questionnaires consisted of Problem Areas in Diabetes Scale 5 (PAID-5) for diabetes distress (T0-T1), Patient Health Questionnaire 9 (PHQ-9) for depressive symptoms (T0-T2), and questions to assess adverse pregnancy outcomes (T2). Adverse pregnancy outcomes (collected via self-report and if feasible from the medical records) were defined as hypertension, pre-eclampsia, caesarean section, severe perineal tearing, postpartum hemorrhage, postpartum depression, shoulder dystocia, neonatal hospitalization, macrosomia, jaundice, hypoglycemia and other (among which low heart rate, fever, hypoxia). Adverse pregnancy outcomes were dichotomized into none and 1 or more. Additional information was collected from the medical charts. Missing data were imputed via predictive mean matching and a multivariable logistic regression analysis was performed with diabetes distress, depressive symptoms, socioeconomic status, parity and ethnicity as predictors and age, HbA1c, and BMI as covariates., Results: A total of 100 women were included, mean age 32.5 (4.1), mean BMI 26.7 (4.8), 71% were of non-Dutch ethnic background. Elevated diabetes distress (PAID score ≥ 8) was reported by 36% of the women. Multivariable logistic regression analyses revealed that both high diabetes distress (OR 4.70, p = .02) and parity (OR 0.21, p = .02) but not antepartum depressive symptoms were related to adverse pregnancy outcomes., Conclusions: Diabetes distress is likely in women with GDM and our findings suggest an association between both diabetes distress, parity and adverse pregnancy outcomes in women with GDM. This warrants replication and further research into the underlying mechanisms explaining the impact of diabetes distress in GDM and potential interventions to reduce distress.

Stress plays an important role in reproductive health and likely is one of the psychological factors affecting ART success. This study was designed to examine the relationship between the stress level as inferred from the amount of the enzyme alpha-amylase secreted in saliva (SAA) and pregnancy outcome in infertile couples undergoing in vitro fertilization and embryo transplantation (IVF-ET). A prospective cohort study was conducted in the Reproductive Medicine Centre of Zhengzhou University Hospital in Henan, China. Four hundred fifty-seven infertile couples undergoing in vitro fertilization and embryo transplantation (IVF-ET) for the first time participated in the study. Couples collected saliva samples the morning before the start of their first treatment cycle for the measurement of SAA. We found that the level of SAA (and hence, the amount of stress) in female partners, male partners, and couples analyzed together significantly affected IVF-ET outcome. Cutoff levels of SAA that predicted pregnancy failure were 136 μmol/L, 149 μmol/L, and 288 μmol/L in female partners, male partners, and couples, respectively. Female partners, male partners, and couples with high SAA levels had increased risk of pregnancy failure compared to those with low SAA levels. The SAA level directly correlated with the follicle-stimulating hormone level and was inversely proportional to the anti-Müllerian hormone level and endometrial thickness. Some semen parameters of male partners, such as density, survival rate, sperm rapid progressive motility (A%), and progressive motility [(A + B)%], were significantly lower in the high-SAA than in the low-SAA group. Furthermore, couples in the high SAA group had fewer transferable and high-quality embryos. We concluded that a high SAA level, known to be an objective indicator of high stress, increases the risk of pregnancy failure in infertile couples undergoing IVF-ET. Lay summary To explore the relationship between stress, as measured by the levels of the stress biomarker salivary alpha-amylase (SAA), and pregnancy outcome in infertile couples undergoing in vitro fertilization, a prospective cohort study was conducted in the Reproductive Medicine Centre of Zhengzhou University Hospital in Henan, China. Four hundred fifty-seven infertile couples undergoing IVF-ET collected saliva samples the morning before the start of their first treatment cycle for the measurement of SAA. Results of this study demonstrated that a high SAA level, known to be an objective indicator of high stress, increases the risk of pregnancy failure in infertile couples undergoing IVF-ET.

Background: Abnormal BMI is associated with discouraging IVF outcomes in fresh autologous or oocyte donor cycles, whether or not such a relation also holds true for women undergoing frozen-thawed embryo transfer (FET) remains unknown. In addition, it remains unclear the detrimental effect of abnormal BMI on IVF outcomes occurs at the level of ovary or endometrium., Methods: A retrospective study involved 22,043 first FET cycles of all women who had undergone a freeze-all policy during the period from January 2010 to June 2017. To control for the embryo factor, our analysis was restricted to women with high-quality embryo transfer. The main outcome measure was live birth rate per embryo transfer. The secondary endpoints included rates of implantation, clinical pregnancy, multiple pregnancy, and pregnancy loss. Multivariate logistic regression analysis was performed to detect the independent effect of BMI on live birth rate after adjusting for important confounding variables., Results: In the crude analysis, reproductive outcomes were similar between underweight women and normal-weight controls whereas all parameter outcomes were significantly worse in patients with obesity. After adjustment for a number of confounding factors, underweight women had a marginally significant decrease in rates of implantation (adjusted odds ratio (aOR) 0.91; 95% CI 0.85-0.96), clinical pregnancy (aOR 0.91; 95% CI 0.83-0.99), and live birth (aOR 0.91; 95% CI 0.83-0.99) as compared to the women with normal weight. Obesity was significantly associated with decreased implantation (aOR 0.80; 95% CI 0.73-0.87), clinical pregnancy (aOR 0.81; 95% CI 0.71-0.91), and live birth rates (aOR 0.70; 95% CI 0.62-0.80). Moreover, the pregnancy loss rate, both in the first (aOR 1.46; 95% CI 1.15-1.87) and in the second trimester (aOR 2.76; 95% CI 1.67-4.58), was significantly higher in the obesity group than that in the reference group., Conclusions: Among women undergoing first FET with high-quality embryo transfer, low BMI has limited impact on pregnancy and live birth rates. On the contrary, obesity was associated with worse IVF outcomes. Our findings further highlighted that endometrial receptivity played an important role in the poor reproductive outcomes of women with abnormal weight status.

Intimate partner violence (IPV) is a public health problem that affects millions of women worldwide and can occur during both pregnancy and the perinatal period. We aimed to evaluate if the experience of psychological and physical intimate partner violence (IPV) adversely affects pregnancy outcomes. We established a cohort of 779 consecutive mothers receiving antenatal care including ultrasound and giving birth in 15 public hospitals, drawn using cluster sampling of all obstetric services in Andalusia, Spain (February-June 2010). Trained midwives gathered IPV data using the Index of Spouse Abuse validated in the Spanish language (score ranges: 0-100, higher scores reflect more severe IPV; cut-offs: physical IPV = 10, psychological IPV = 25). Socio-demographic data, including lack of kin support, maternal outcomes, and hospitalization were collected. Multivariate logistic regression estimated adjusted odds ratios (AOR), with 95% confidence intervals (CI), of the relationship between psychological and physical IPV and maternal outcomes, controlling for socio-demographic characteristics. Response rate was 92.2%. Psychological IPV, reported by 21.0% (n = 151), was associated significantly with urinary tract infection (127 (23%) vs 56 (37%); AOR = 1.9; 95%CI = 1.2-3.0), vaginal infection (30 (5%) vs 20 (13%); AOR = 2.4; 95%CI = 1.2-4.7) and spontaneous preterm labour (32 (6%) vs 19 (13%); AOR = 2.2; 95%CI = 1.1-4.5). Physical IPV, reported by 3.6% (n = 26), was associated with antenatal hospitalizations (134 (19%) vs 11 (42%); AOR = 2.6; 95%CI = 1.0-7.1). Lack of kin support was associated with spontaneous preterm labour (AOR = 4.7; 95%CI = 1.7-12.8). Mothers with IPV have higher odds of complications. Obstetricians, gynaecologists and midwives should act as active screeners, particularly of the undervalued psychological IPV, to reduce or remedy its effects., Competing Interests: The authors have declared that no competing interest exist.

Maternal symptomatology during pregnancy represents a significant risk factor for women and children. The main focus of this paper is to jointly investigate the role of maternal depression and anxiety during pregnancy on the well-being of the newborn, through their influences on the clinical aspects of labour. A longitudinal study was conducted on 167 pregnant women (M age =32.07, SD = 4.50) recruited in the third trimester of gestation. The data was collected at two different times: the socio-demographical data and prenatal anxiety and depression were assessed at T1 (31-32 week of gestation); the clinical data on childbirth (duration of labour, administration of oxytocin and epidural analgesia) and the Apgar index of the newborn were registered at T2 (the day of childbirth). A structural equation modeling was performed using the MPLUS statistical programme. The results showed that a maternal psychopathological symptomatology during pregnancy constitutes a significant risk factor for the well-being of the newborn. In particular, both prenatal anxiety and depression negatively affect the clinical aspects of the labour experience and, indirectly, the Apgar index. The limitations, strengths, and theoretical and clinical implications are discussed. Impact statement What is already known on this subject? Depression and anxiety during pregnancy can negatively affect the well-being of women, the experience of labour and delivery, and birth outcomes. All of these aspects are documented in literature, however, they are usually analysed independently. What do the results of this study add? This is the first study that analyses all of the above psychological and clinical variables together, testing a theoretical model where prenatal anxiety and depression influence the newborn's Apgar index, through the clinical aspects of labour. The outcomes highlight the role that depressive and anxiety symptoms during pregnancy and the labour experience play on the newborn's wellbeing. What are the implications of these findings for clinical practice and/or further research? Overall, our data confirms the importance of putting a new light on maternal psychological symptoms during pregnancy and birth experience, considering them as complex human processes in which psychological and physical aspects are highly interconnected, influencing maternal and newborn well-being. Our results highlight how important it is that, when approaching the delivery experience, healthcare professionals pay attention not only to the physical condition of pregnant women and newborns, but also to the psychological condition of women, given the impact this can have on delivery and, therefore, on the baby's wellbeing.

Background: Intimate partner violence (IPV) against women is a major public health concern in low income countries. Violence against pregnant women has adverse effects on maternal and newborn outcomes. This study aimed to assess the prevalence and associated factors of intimate partner violence in Southeast Ethiopia pregnant women., Methods: Institutional based cross-sectional study was conducted on pregnant women who were attending antenatal care (ANC) in Bale Zone health institution during study period. Face to face interviews were conducted using a pre-tested structured questionnaire. Data related to socio-demographic characteristic, pregnancy and reproductive history, intimate partner behavior and IPV encountered during recent pregnancy was gathered for this study. Descriptive analysis and logistic regression were used for the data analysis. Odds ratio with 95% CI was computed to determine the presence and strength of associated factors with IPV., Results: A total of 612 pregnant women participated in the study. Of these, 361 (59.0%) pregnant women faced at least one type of IPV during the recent pregnancy. Physical violence (20.3%), sexual violence (36.3%), psychological/emotional violence (33.0), controlling behavior violence (30.4%) and economic violence (27.0) were the type of IPV encountered by participants. An intimate partners who were drank alcohol [AOR = 2.9; 95% CI: (1.5-5.4)], partners who were chewed Khat [AOR = 1.7; 95% CI: (1.1-2.6)], partners who were smoked cigarette [AOR = 2.6; 95% CI: (1.4-4.9)], partners who had aggressive behavior [AOR = 2.8; 95% CI: (1.7-4.6)], having partner age ≥30 year old [AOR = 1.8; 95% CI: (1.2-2.9)], unwanted pregnancy [AOR = 3.3; 95% CI: (1.9-5.5)] and history of adverse pregnancy outcome [AOR = 2.1; 95% CI: (1.2-3.6)] that were the factors that significantly associated with IPV of the pregnant women., Conclusion: The prevalence of IPV during pregnancy was high among the study participants. Intimate partners' use of substance, intimate partners' aggressive behavior, older intimate partners, unwanted pregnancy and history of adverse birth outcome were identified as associated factors for IPV. IPV needs to be considered during ANC service and integrated into the sexual and reproductive health education. Community-based interventions should be advocated as a way of health promotion. Counseling, awareness creation, service provision and program design on IPV is mandatory to minimize the victim., Competing Interests: The authors have declared that no competing interests exist.