Deirdre Gartland

Physical health after childbirth and maternal depression in the first 12 months post partum: Results of an Australian nulliparous pregnancy cohort study

OBJECTIVE to investigate the relationship between maternal physical health problems and depressive symptoms in the first year after childbirth. DESIGN prospective pregnancy cohort study. SETTING Melbourne, Victoria, Australia. POPULATION 1507 nulliparous women. METHODS women were recruited from six public hospitals between six and 24 weeks gestation. Written questionnaires were completed at recruitment and at three, six and 12 months post partum. OUTCOME MEASURES Edinburgh Postnatal Depression Scale (EPDS); standardised measures of urinary and faecal incontinence, a checklist of symptoms for other physical health problems. RESULTS overall, 16.1% of women reported depressive symptoms during the first 12 months post partum, with point prevalence at three, six and 12 months post partum of 6.9%, 8.8% and 7.8% respectively. The most commonly reported physical health problems in the first three months were tiredness (67%), back pain (47%), breast problems (37%), painful perineum (30%), and urinary incontinence (29%). Compared with women reporting 0-2 health problems in the first three months post partum, women reporting 5 or more health problems had a six-fold increase in likelihood of reporting concurrent depressive symptoms at three months post partum (Adjusted OR=6.69, 95% CI=3.0-15.0) and a three-fold increase in likelihood of reporting subsequent depressive symptoms at 6-12 months post partum (Adjusted OR=3.43, 95% CI 2.1-5.5). CONCLUSIONS poor physical health in the early postnatal period is associated with poorer mental health throughout the first 12 months post partum. Early intervention to promote maternal mental health should incorporate assessment and intervention to address common postnatal physical health problems.

Depressive symptoms and intimate partner violence in the 12 months after childbirth: a prospective pregnancy cohort study

Please cite this paper as: Woolhouse H, Gartland D, Hegarty K, Donath S, Brown S. Depressive symptoms and intimate partner violence in the 12 months after childbirth: a prospective pregnancy cohort study. BJOG 2011;118:000–000. DOI: 10.1111/j.1471‐0528.2011.03219.x.

Development of a multi-dimensional measure of resilience in adolescents: the Adolescent Resilience Questionnaire

BackgroundThe concept of resilience has captured the imagination of researchers and policy makers over the past two decades. However, despite the ever growing body of resilience research, there is a paucity of relevant, comprehensive measurement tools. In this article, the development of a theoretically based, comprehensive multi-dimensional measure of resilience in adolescents is described.MethodsExtensive literature review and focus groups with young people living with chronic illness informed the conceptual development of scales and items. Two sequential rounds of factor and scale analyses were undertaken to revise the conceptually developed scales using data collected from young people living with a chronic illness and a general population sample.ResultsThe revised Adolescent Resilience Questionnaire comprises 93 items and 12 scales measuring resilience factors in the domains of self, family, peer, school and community. All scales have acceptable alpha coefficients. Revised scales closely reflect conceptually developed scales.ConclusionsIt is proposed that, with further psychometric testing, this new measure of resilience will provide researchers and clinicians with a comprehensive and developmentally appropriate instrument to measure a young persons capacity to achieve positive outcomes despite life stressors.

Fecal incontinence during the first 12 months postpartum: complex causal pathways and implications for clinical practice.

OBJECTIVES: To investigate whether postpartum fecal incontinence is less common in women who had a cesarean delivery and more common in women who had an operative vaginal birth compared with women who had a spontaneous vaginal birth for their first newborn, and whether postpartum fecal incontinence is more common in women who report intimate-partner violence. METHODS: This was a multicenter, prospective, nulliparous pregnancy cohort (n=1,507) using standardized measures to assess frequency and severity of fecal incontinence in pregnancy and at 3, 6, 9, and 12 months postpartum. RESULTS: Approximately 17% reported fecal incontinence at some point in the first 12 months postpartum, with 12.8% reporting fecal incontinence beyond the first 3 months postpartum. Fecal incontinence at 4 to12 months postpartum was significantly more common among women who had experienced emotional violence, physical violence, or both in the first 12 months postpartum (18.8% compared with 11.5%, adjusted odds ratio [OR] 1.62, 95% confidence interval [CI] 1.05–2.50). Compared with spontaneous vaginal birth, cesarean delivery (13.1% compared with 11.3%, adjusted OR 0.99, 95% CI 0.65–1.53), and operative vaginal birth (15.0% compared with 11.3%, adjusted OR 1.33, 95% CI 0.86–2.07) did not significantly alter the likelihood of fecal incontinence beyond the first 3 months postpartum. CONCLUSION: Understanding causal pathways for postpartum fecal incontinence requires attention to the interplay of pregnancy and birth events and upstream factors such as intimate-partner violence. This has implications for how clinicians present evidence and discuss risks associated with vaginal birth and cesarean delivery. In this nulliparous cohort, method of birth was not a major determinant of fecal incontinence status beyond 3 months postpartum. LEVEL OF EVIDENCE: II

Physical Health and Recovery in the First 18 Months Postpartum: Does Cesarean Section Reduce Long‐Term Morbidity?

BACKGROUND Research examining long-term health outcomes for women after childbirth has been limited. The objective of this study was to investigate the natural history of common morbidities in the 18 months after the birth of a first child, and to explore the hypothesis that women who have a cesarean section for a first birth experience less overall morbidity in the postnatal period. METHODS A prospective nulliparous pregnancy cohort study was conducted of 1,507 women recruited in early pregnancy from six public hospitals in Melbourne, Australia (mean gestation 15 weeks). Follow-up questionnaires at 3, 6, 12, and 18 months postpartum included standardized measures of urinary and fecal incontinence, and a symptom checklist asking about common physical health problems. RESULTS At 6, 12, and 18 months postpartum, no statistically significant differences were found in the proportion of women reporting three or more health problems by method of birth. Compared with women who had a spontaneous vaginal birth, women who had a cesarean section were more likely to report extreme tiredness at 6 months postpartum (adjusted OR: 1.39; 95% CI: 1.07-1.82) and at 12 months postpartum (adjusted OR: 1.40; 95% CI: 1.05-1.85), and were more likely to report back pain at 6 months postpartum (adjusted OR: 1.37; 95% CI: 1.06-1.77) and at 12 months postpartum (adjusted OR: 1.41; 95% CI: 1.06-1.87). Women who had a cesarean section were less likely to report urinary incontinence at 3, 6, and 12 months postpartum, respectively (adjusted OR: 0.26; 95% CI: 0.19-0.36; adjusted OR: 0.36; 95% CI: 0.25-0.52; adjusted OR: 0.48; 95% CI: 0.33-0.68). For all other physical health problems the pattern of morbidity did not differ between cesarean section and spontaneous vaginal birth. CONCLUSIONS Physical health problems commonly persist or recur throughout the first 18 months postpartum, with potential long-term consequences for womens health. Cesarean section does not result in women experiencing less overall morbidity in the postpartum period compared with women who have a spontaneous vaginal birth.

Women's health in early pregnancy: findings from an Australian nulliparous cohort study.

Background:  Much is known about severe maternal morbidity during pregnancy, but there has been little attention paid to the impact of pregnancy itself on women’s general health and well‐being.

The onset, recurrence and associated obstetric risk factors for urinary incontinence in the first 18 months after a first birth: an Australian nulliparous cohort study

Please cite this paper as: Gartland D, Donath S, MacArthur C, Brown S. The onset, recurrence and associated obstetric risk factors for urinary incontinence in the first 18 months after a first birth: an Australian nulliparous cohort study. BJOG 2012;119:1361–1369.

Assessing obstetric risk factors for maternal morbidity: congruity between medical records and mothers' reports of obstetric exposures

OBJECTIVE We sought to assess congruity between data abstracted from medical records with answers to self-administered questionnaires. STUDY DESIGN This was a multicenter prospective nulliparous pregnancy cohort. RESULTS A total of 1507 women enrolled. Analyses were reported for 1296 with medical record data and 3-month postpartum follow-up. There was near-perfect agreement (κ ≥ 0.80) between maternal report and abstracted data for reproductive history, induction/augmentation method, epidural/spinal analgesia, method of birth, perineal repair, infant birthweight, and gestation. Agreement was poor to moderate for maternal position in second stage and duration of pushing. CONCLUSION Maternal report of pregnancy, labor, and birth factors was very reliable and considered more accurate in relation to maternal position in labor and birth, smoking, prior terminations, and miscarriages. Use of routine birthing outcome summaries may introduce measurement error as hospitals differ in their definitions and reporting practices. Using primary data sources (eg, partograms) with clearly defined prespecified criteria will provide the most accurate obstetric exposure and outcome data.

Consultation about urinary and faecal incontinence in the year after childbirth: a cohort study.

To investigate the extent to which primary‐care practitioners routinely inquire about postpartum urinary and faecal incontinence, and assess the proportion of women who disclose symptoms.

Maternal depression and physical health problems in early pregnancy: Findings of an Australian nulliparous pregnancy cohort study

OBJECTIVE to investigate the relationship between physical health problems and depressive symptoms in early pregnancy. DESIGN baseline questionnaire, prospective pregnancy cohort study. SETTING six metropolitan public maternity hospitals in Victoria, Australia. PARTICIPANTS 1507 nulliparous women recruited in early pregnancy. FINDINGS nine per cent of women (131/1500) scored ≥ 13 on the EPDS indicating probable clinical depression in early pregnancy (mean gestation=15 weeks). The five most commonly reported physical health problems were as follows: exhaustion (86.9%), morning sickness (64.3%), back pain (45.6%), constipation (43.5%) and severe headaches or migraines (29.5%). Women scoring ≥ 13 on the EPDS reported a mean of six physical health problems compared with a mean of 3.5 among women scoring <13 on the EPDS. Women reporting five or more physical health problems had a three-fold increase in likelihood of reporting depressive symptoms (Adj OR=3.13, 95% CI 2.14-4.58) after adjusting for socio-demographic factors, including maternal age. CONCLUSIONS the findings from this large multi-centre study show that women experiencing a greater number of physical health problems are at increased risk of reporting depressive symptoms in early pregnancy. IMPLICATIONS FOR PRACTICE early detection and support for women experiencing physical and psychological health problems in pregnancy is an important aspect of antenatal care. The extent of co-morbid physical and psychological health problems underlines the need for comprehensive primary health care as an integral component of antenatal care.