Anna Hjelmstedt

Personality factors and emotional responses to pregnancy among IVF couples in early pregnancy: a comparative study.

Background. Little is known as to whether negative experiences associated with infertility and IVF treatment persist after successful treatment. The aim of the study was to compare couples who have conceived after IVF and couples who have conceived naturally regarding personality factors and emotional responses to pregnancy.

Patterns of emotional responses to pregnancy, experience of pregnancy and attitudes to parenthood among IVF couples: a longitudinal study

The aim of this longitudinal study was to compare couples who had conceived by in-vitro fertilization (IVF) with couples who had conceived naturally, regarding patterns of emotional response to different stages of pregnancy and to compare their expectations of and attitudes to pregnancy, parenthood and children. Fifty-seven IVF women and 55 of their male partners, and a control group of 43 pregnant women and 39 of their male partners participated. They completed scales measuring emotional responses to pregnancy, attitudes to pregnancy, parenthood and children. The IVF couples were interviewed about their experience of pregnancy. The overall anxiety about losing the pregnancy was higher among the IVF couples from early to late pregnancy. The IVF women experienced the pregnancy in a more positive way and they were less concerned about the childs gender and loss of freedom in their future lives as parents compared to controls. The IVF men were more anxious about the baby being injured during birth. The interviews with the IVF couples confirmed the self-ratings. In conclusion, the results suggest that it is important for healthcare providers to pay attention to an elevated anxiety among IVF couples and to give them extra time to discuss emotions during pregnancy and their future life as parents.

Acupressure to reduce labor pain: a randomized controlled trial

Objective. To evaluate the effect of acupressure administered during the active phase of labor on nulliparous womens ratings of labor pain. Design. Randomized controlled trial. Setting. Public hospital in India. Sample. Seventy‐one women randomized to receive acupressure at acupuncture point spleen 6 (SP6) on both legs during contractions over a 30‐minute period (acupressure group), 71 women to receive light touch at SP6 on both legs during the same period of time (touch group) and 70 women to receive standard care (standard care group). Methods. Experience of in‐labor pain was assessed by visual analog scale at baseline before treatment, immediately after treatment, and at 30, 60 and 120 minutes after treatment. Main outcome measure. Labor pain intensity at different time intervals after treatment compared with before treatment. Results. A reduction of in‐labor pain was found in the acupressure group and was most noticeable immediately after treatment (acupressure group vs. standard care group p < 0.001; acupressure group vs. touch group p < 0.001). Conclusion. Acupressure seems to reduce pain during the active phase of labor in nulliparous women giving birth in a context in which social support and epidural analgesia are not available. However, the treatment effect is small which suggests that acupressure may be most effective during the initial phase of labor.

Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum

Please cite this paper as: Aasheim V, Waldenström U, Hjelmstedt A, Rasmussen S, Pettersson H, Schytt E. Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum. BJOG 2012;119:1108–1116.

Antenatal Depressive Symptoms and Preterm Birth: A Prospective Study of a Swedish National Sample

BACKGROUND Preterm birth is the principal risk factor for neonatal morbidity and mortality. The objective of this study was to investigate the association between antenatal depressive symptoms and preterm birth. METHODS The study included a national sample of 2,904 pregnant women who were recruited at their first booked visit to antenatal clinics in Sweden. Data on depressive symptoms, and sociodemographic and reproductive background were collected by questionnaires. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS). The average length of gestation at the time for completion of the questionnaire was 16 weeks. Data on gestational length were extracted from the Swedish Medical Birth Register. Multiple logistic regression analyses were conducted to estimate the risk of preterm birth associated with antenatal depressive symptoms. RESULTS The presence of antenatal depressive symptoms above a cutoff score of 12 or higher on the EPDS increased the risk for preterm birth (OR: 1.56; 95% CI: 1.03-2.35). Being of age 35 years and over, being a primipara, and having experienced a previous miscarriage were also shown to be significant predictors in a multivariate model. CONCLUSION Pregnant women reporting antenatal depressive symptoms are at elevated risk of preterm birth.

Psychological functioning and predictors of father-infant relationship in IVF fathers and controls

The psychological functioning of fathers with children born after in vitro fertilization (IVF) has received little attention. Among men in general, little is known about predictors of early father-infant relationship (here also defined as attachment). The first aim was to compare IVF fathers and control fathers regarding personality traits, state anxiety, depressive symptoms and early father-infant attachment. The second aim was to assess whether early father-infant relationship is explained by the fathers prenatal relationship with the unborn infant, his personality traits, state anxiety and symptoms of depression. Fifty-three IVF fathers and 36 controls filled in self-rating scales measuring father-infant attachment, personality, anxiety and symptoms of depression at 2 months postpartum. At gestational week 26 their prenatal relationship to the unborn infant was assessed. It was found that IVF fathers rated more somatic and psychic anxiety, indirect aggression and less assertiveness. They were as strongly attached to their infant as the controls. Fathers, who had rated higher attachment to their unborn infant during pregnancy, who were less anxious, more assertive and less irritable, were more attached to their infants than men who had been less attached to their unborn infants and who were more anxious, less assertive and more irritable. In conclusion, although IVF fathers are as strongly attached to their infants as other fathers, they may benefit from emotional support as they have elevated levels of anxiety proneness and indirect aggression. It is important to pay attention during pregnancy to fathers who have a less optimal attachment to their unborn infant and who have high levels of anxiety and irritability, as those three factors are related to a weak emotional father-infant relationship.

Characteristics of first-time fathers of advanced age: a Norwegian population-based study

BackgroundThe modern phenomenon of delayed parenthood applies not only to women but also to men, but less is known about what characterises men who are expecting their first child at an advanced age. This study investigates the sociodemographic characteristics, health behaviour, health problems, social relationships and timing of pregnancy in older first-time fathers.MethodsA cross-sectional study was conducted of 14 832 men who were expecting their first child, based on data from the Norwegian Mother and Child Cohort Study (MoBa) carried out by the Norwegian Institute of Public Health. Data were collected in 2005–2008 by means of a questionnaire in gestational week 17–18 of their partner’s pregnancy, and from the Norwegian Medical Birth Register. The distribution of background variables was investigated across the age span of 25 years and above. Men of advanced age (35–39 years) and very advanced age (40 years or more) were compared with men aged 25–34 years by means of bivariate and multivariate logistic regression analyses.ResultsThe following factors were found to be associated with having the first child at an advanced or very advanced age: being unmarried or non-cohabitant, negative health behaviour (overweight, obesity, smoking, frequent alcohol intake), physical and mental health problems (lower back pain, cardiovascular diseases, high blood pressure, sleeping problems, previous depressive symptoms), few social contacts and dissatisfaction with partner relationship. There were mixed associations for socioeconomic status: several proxy measures of high socioeconomic status (e.g. income >65 000 €, self-employment) were associated with having the first child at an advanced or very advanced age, as were several other proxy measures of low socioeconomic status (e.g. unemployment, low level of education, immigrant background).The odds of the child being conceived after in vitro fertilisation were threefold in men aged 34–39 and fourfold from 40 years and above.ConclusionsMen who expect their first baby at an advanced or very advanced age constitute a socioeconomically heterogeneous group with more health problems and more risky health behaviour than younger men. Since older men often have their first child with a woman of advanced age, in whom similar characteristics have been reported, their combined risk of adverse perinatal outcomes needs further attention by clinicians and researchers.

The need for epidural analgesia is related to birthweight – a population-based register study

Objective. To investigate the relation between use of epidural analgesia (EDA) and maternal and fetal characteristics. Design. Population‐based register study. Setting. Nationwide study in Sweden. Population. All 106,775 primiparous women who in 2002–2005 delivered a singleton infant vaginally at term. Methods. Register study with data from the Medical Birth Registry and the Swedish Register of Education. Main outcome measure. Use of EDA during vaginal delivery. Results. A total of 47,810 women (45%) received EDA during labor. EDA was used more often in women who were either young or short, had a high body mass index or a short education, or gave birth to an infant with high birthweight. After adjustment, the positive correlation with birthweight persisted. The use of EDA was twice as high in women with infant birthweight >4,500 g, 60% higher in those with infants weighing between 4,000 and 4,500 g and 25% lower when infants weighed <3,000 g, when compared to those with newborns weighing between 3,000 and 3,500 g. Conclusion. The womans need for EDA is strongly related to birthweight. Prolonged duration of labor and instrumental delivery usually ascribed to EDA may be due to large infants.

Prenatal attachment in Swedish IVF fathers and controls

Our first aim was to investigate the pattern of prenatal attachment among partners of women who have become pregnant via in vitro fertilization (IVF men) and partners of women who have become pregnant without assisted reproductive technology (ART) (controls). A second aim was to analyse whether there is a correlation between degree of prenatal attachment in gestational week 26 and week 36. The third aim was to relate degree of prenatal attachment rated in gestational week 26 and gestational week 36, respectively, to psychosocial factors, way of conception and personality traits among the two groups of fathers. Fifty‐three IVF men from IVF clinics and 37 control men from antenatal clinics in Stockholm were recruited to the study. They completed self‐rating scales measuring prenatal attachment, personality, marital relationship, anxiety and depression. The results showed that IVF fathers are attached to their unborn children to the same extent as other fathers. Prenatal attachment increases during pregnancy although individual scores on prenatal attachment seem to be relatively stable. Contributors to prenatal attachment are ambivalence as well as the personality traits detachment and psychastenia.

Negative Emotions and Cytokines in Maternal and Cord Serum at Preterm Birth

Problem  This study investigates whether affectivity differs between mothers delivering preterm and term and whether maternal and umbilical cord serum cytokines differ between these groups. Further, whether there are associations between mothers’ emotions and maternal and cord cytokines at preterm and term birth.