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Implications of antenatal depression and anxiety for obstetric outcome
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Department of Obstetrics and Gynecology, Sunderby Hospital, Luleå, Sweden.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
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2004 (Engelska)Ingår i: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 104, nr 3, s. 467-476Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: To investigate the obstetric outcome and health care consumption during pregnancy, delivery, and the early postpartum period in an unselected population-based sample of pregnant women diagnosed with antenatal depressive and/or anxiety disorders, compared with healthy subjects. METHODS: Participants were 1,495 women attending 2 obstetric clinics in Northern Sweden. The Primary Care Evaluation of Mental Disorders was used to evaluate depressive and anxiety disorders in the second trimester of pregnancy. To assess demographic characteristics, obstetric outcome, and complications, the medical records of the included women were reviewed. RESULTS: Significant associations were found between depression and/or anxiety and increased nausea and vomiting, prolonged sick leave during pregnancy and increased number of visits to the obstetrician, specifically, visits related to fear of childbirth and those related to contractions. Planned cesarean delivery and epidural analgesia during labor were also significantly more common in women with antenatal depression and/or anxiety. CONCLUSION: There is an association between antenatal depressive and/or anxiety disorders and increased health care use (including cesarean deliveries) during pregnancy and delivery.

Ort, förlag, år, upplaga, sidor
Lippincott Williams & Wilkins, 2004. Vol. 104, nr 3, s. 467-476
Nyckelord [en]
Adult, Anxiety, Depression, Female, Humans, Pregnancy, Pregnancy Complications, Pregnancy Outcome
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Identifikatorer
URN: urn:nbn:se:umu:diva-16442DOI: 10.1097/01.AOG.0000135277.04565.e9ISI: 000225415200007PubMedID: 15339755OAI: oai:DiVA.org:umu-16442DiVA, id: diva2:156115
Tillgänglig från: 2007-09-28 Skapad: 2007-09-28 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
Ingår i avhandling
1. Implications of psychiatric disorders during pregnancy and the postpartum period - A population-based study
Öppna denna publikation i ny flik eller fönster >>Implications of psychiatric disorders during pregnancy and the postpartum period - A population-based study
2004 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: Depressive and anxiety disorders are common health problems, affecting women at least twice as often as men. Although some studies have been made on pregnant women or, especially, in the postpartum period, most of these studies have been performed on small samples, mainly specific risk groups such as teenage mothers, women of low socioeconomic status and certain ethnic groups. Also, there is a lack of studies on antenatal and postpartum depression and/or anxiety using diagnostic criteria adhering to the Diagnostic and Statistical Manual of Mental disorders, fourth edition (DSM-IV).

Aims and methods: The aims were to estimate the point prevalence of mood, anxiety and eating disorders, based on DSM-IV criteria, in an unselected population during the second trimester of pregnancy, and to assess the obstetric and neonatal outcome, as well as the health care consumption during pregnancy, delivery and the early postpartum period among women with a psychiatric disorder, compared to healthy subjects. Finally, we aimed to investigate depression and anxiety, and associated maternal characteristics and events through pregnancy and the postpartum period in the same group of women. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used for assessment of psychiatric disorders during the second trimester of pregnancy and three to six months after delivery. From October 2nd, 2000, to October 1st, 2001 all women attending the second trimester routine ultrasound-screening at two different hospitals in northern Sweden (at Umeå University Hospital and at Sunderby Central Hospital) were approached for participation in the study. After delivery, data were extracted from the medical records of the mothers and their offspring to evaluate obstetric and neonatal outcome. Three to six months after delivery, the women who had an antenatal depression and/or anxiety were contacted for an assessment using the PRIME-MD. The same procedure was made in a control group, consisting of 500 women, randomly selected among those who did not have any psychiatric diagnosis according to the PRIME-MD investigation during the second trimester of pregnancy.

Results and conclusions: Of the 1555 women in the study population, 220 (14.1%) had one or more PRIME-MD diagnoses. Living single, low socioeconomic status, smoking, multiparity and a body mass index of 30 or more were significantly associated with a psychiatric diagnosis in the second trimester of pregnancy. Women with antenatal depression and/or anxiety more often suffered from nausea and vomiting during pregnancy were more often on sick leave, and they visited their obstetrician more often than healthy subjects, specifically because of fear of childbirth and premature contractions. Also, they were more commonly delivered by elective caesarean section, had an increased use of epidural analgesia and reported a longer self-experienced duration of labor. Severe complications of pregnancy, delivery, and the early postpartum period were not affected by antenatal depression and/or anxiety. There was no significant difference in neonatal outcome depending on antenatal depressive or anxiety disorder. Fewer cases of depressive and/or anxiety disorders were prevalent postpartum, but there was a significant shift from a majority of sub-threshold diagnoses during pregnancy to full DSM-IV diagnoses during the postpartum period. Previous psychiatric disorder and living singly were significantly associated with both a new-onset and a postpartum continuation/recurrence of depression and/or anxiety. Postpartum continuation/recurrence of a psychiatric disorder was additionally associated with smoking, obesity, and adverse obstetric events.

Ort, förlag, år, upplaga, sidor
Umeå: Klinisk vetenskap, 2004. s. 134
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 926
Nyckelord
Obstetrics and gynaecology, Anxiety, Depression, Neonatal, Obstetric, Population-based, Postpartum, Pregnancy, Obstetrik och kvinnosjukdomar
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Forskningsämne
obstetrik och gynekologi
Identifikatorer
urn:nbn:se:umu:diva-369 (URN)91-7305-750-9 (ISBN)
Disputation
2004-12-10, Sal B, 9 tr, Tandläkarhögskolan, 90187, Umeå, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2004-11-17 Skapad: 2004-11-17 Senast uppdaterad: 2009-10-01Bibliografiskt granskad

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Andersson, LiselottWulff, MarianneBixo, Marie

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