Eva Mautner

Quality of life outcomes in pregnancy and postpartum complicated by hypertensive disorders, gestational diabetes, and preterm birth

Health problems can develop during a pregnancy, turning it into a high risk. The aim of this study was to explore the influence of hypertensive disorders, gestational diabetes, and preterm birth as risk factors for health-related quality of life (HRQL) and depressive symptoms during late pregnancy and postpartum. A prospective, longitudinal study was performed with three assessments. Ninety women were recruited in the study including 29 controls. HRQL was measured using the WHO-QOL-BREF questionnaire. Depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS). Statistical analyses were performed using ANOVA and the chi-square test to explore HRQL and depressive symptoms between three pregnancy risk groups and controls. Women of the preterm group had statistically significant higher depression scores and lower HRQL scores on the physical domain during pregnancy than those without complications. Women with hypertensive disorders showed the second most depressive symptoms. Physical and global HRQL improved and depressive symptoms decreased significantly from late pregnancy and early postpartum period to late postpartum. Pregnant specific health problems, especially the risk for preterm delivery is associated with more depressive symptoms and decreased HRQL in pregnancy. Guidance and communication for these women is important. The counseling should be multi professional to reduce childbirth burdens.

The impact of resilience on psychological outcomes in women after preeclampsia: an observational cohort study

BackgroundPreeclampsia is a frequent obstetric complication which affects the mother`s and the fetus’s health and can be life threatening. It also has an impact on psychological outcomes. There may be protective variables such as resilience shielding against psychosocial distress in women experiencing these pregnancy complications. The aim of this study was to examine differences in resilience in terms of quality of life, depression and post-traumatic stress symptoms in women after preeclampsia.MethodsFour international validated questionnaires were used to measure the psychological outcomes (Medical Outcome Study Short-Form SF12, Edinburgh Postnatal Depression Scale EPDS, Resilience Scale RS13, Impact of Event Scale IES-R). Statistical analyses were performed using independent-samples t-test and chi-square test.Results67 women with previous preeclampsia returned the questionnaires. Women with high resilience showed significantly less depression (p = 0.001) and better mental quality of life (p = 0.002) compared to women with low resilience. No group differences were found on the medical and socio-demographic characteristics.ConclusionsResilience has an important impact on the psychological outcomes in women after preeclampsia. A screening for resilience, depression and quality of life may be appropriate to identify these women.

Associations between nausea, vomiting, fatigue and health-related quality of life of women in early pregnancy: The generation r study

The objective of this study was to evaluate the independent associations between nausea, vomiting, fatigue and health-related quality of life of women in early pregnancy in the Generation R study, which is a prospective mother and child cohort. Analyses were based on 5079 women in early pregnancy in the Rotterdam area, the Netherlands. The information on nausea, vomiting and fatigue in the previous three months was measured in the questionnaire at enrollment, as well as potential confounders (i.e., maternal/gestational age, ethnic background, educational level, parity, marital status, body mass index, tobacco and alcohol use, chronic/infectious conditions, uro-genital conditions/symptoms, sleep quality, headache, anxiety, and depression). Health-related quality of life was assessed by the 12-item Short Form Health Survey and physical and mental component summary scores were calculated. Multivariate regression models were performed to evaluate the independent associations of the presence of nausea, vomiting and fatigue with health-related quality of life, adjusting for potential confounders. 33.6% of women experienced daily presence of nausea, 9.6% for vomiting and 44.4% for fatigue. Comparing with women who never reported nausea, vomiting and fatigue, women with daily presence of at least one of these symptoms had significantly lower scores of physical component summary and mental component summary, after adjusting for potential confounders. Our study shows how common nausea, vomiting and fatigue are among women in early pregnancy and how much each of these symptoms negatively impact on health-related quality of life. We call for awareness of this issue from health care professionals, pregnant women and their families.

Are there differences in the health outcomes of mothers in Europe and East-Asia? A cross-cultural health survey.

The aim of the current study was to investigate differences in quality of life outcomes and depression of mothers in East-Asia and Central Europe. 170 women in Japan and 226 women in Austria with children between 3 and 5 answered the same cross-culturally validated questionnaires. The Quality of Life Questionnaire from the WHO (WHOQOL-Bref), the Patient Health Questionnaire (PHQ-2), the Sense of Coherence Scale (SOC-13), a Social Support Scale (MSPSS), and questions on gender orientation were used. In all dimensions of QOL (physical, psychological, social, and environmental) Japanese women had lower QOL scores compared to Austrian mothers (P < 001). Seven percent of women in both countries experienced major depression. In both countries sense of coherence, experienced stress level, satisfaction with income, social support, and gender roles had an influence on QOL and depressive symptoms. Mothers in Japan consider life events less comprehensible, manageable, and meaningful and experience less support. Consequently, creating an environment where fathers could be more involved in child rearing and mothers have more opportunities to choose between life styles and working and social environments would improve QOL not only in Japanese mothers but also in other countries all over the world.

Early skin-to-skin contact after cesarean section: A randomized clinical pilot study

Objective Early bonding by skin-to-skin contact (SSC) has been demonstrated to be beneficial for mothers and newborns following vaginal delivery. The aim of this study was to investigate the impact of intraoperative bonding (early SSC) after cesarean section on neonatal adaptation, maternal pain and stress response. Study design This prospective, randomized-controlled pilot study was performed at a single academic tertiary hospital (Department of Obstetrics and Gynecology, Medical University of Graz, Austria) between September 2013 and January 2014. Women were randomly assigned to intraoperative (“early”) SCC (n = 17) versus postoperative (“late”) SCC (n = 18). Main variables investigated were neonatal transition (Apgar score, arterial oxygen saturation, heart rate and temperature), maternal pain perception and both maternal and neonatal stress response by measuring the stress biomarkers salivary free cortisol and salivary alpha amylase. Results There was no evidence for differences in parameters reflecting neonatal transition or stress response between the ‘Early SSC Group’ and the ‘Late SSC Group’. Maternal salivary cortisol and alpha-amylase levels as well as maternal wellbeing and pain did not differ between the groups. However, the rise of maternal salivary alpha-amylase directly after delivery was higher in the ‘Early SSC Group’ compared to the ‘Late SSC Group’ (p = 0.004). Conclusions This study did not reveal significant risks for the newborn in terms of neonatal transition when early SSC is applied in the operating room. Maternal condition and stress marker levels did not differ either, although the rise of maternal salivary alpha-amylase directly after delivery was higher in the ‘Early SSC Group’ compared to the ‘Late SSC Group’, which may indicate a stressor sign due to intensive activation of the sympathetic-adreno-medullary-system. This needs to be further evaluated in a larger prospective randomized trial. Trial registration ClinicalTrials.gov NCT01894880

Trajectories and predictors of women’s health-related quality of life during pregnancy: A large longitudinal cohort study

The objective of this study was to identify distinct trajectories and their predictors of health-related quality of life (HRQOL) of women during pregnancy in a prospective mother and child cohort. Analyses were based on 3936 Dutch pregnant women in Rotterdam area, the Netherlands. Information on potential predictors was collected in early pregnancy by questionnaire. Latent Class Mixture Modelling and Multinomial Logistic Regression were applied to assess the trajectory and predictors of HRQOL during pregnancy. HRQOL was measured by SF-12 in early, mid- and late pregnancy; physical and mental component summary (PCS-12/MCS-12) scores were calculated. Four physical HRQOL trajectories were identified: a healthy trajectory (‘healthy’) in 63.3%, consistently low (‘vulnerable’) in 10.8%; a small increase (‘recovering’) in 12.8% and a large decrease (‘at risk’) in 13.1%. Three mental HRQOL trajectories were identified: a healthy trajectory (‘healthy’) in 86.1%; a large increase (‘recovering’) in 7.5%; and a large decrease (‘at risk’) in 6.4%. Compared with healthy trajectories, the likelihood of following the ‘vulnerable’ physical HRQOL trajectory rather than a healthy trajectory was increased by daily fatigue(OR: 4.82[2.76, 8.40]), pelvic pain (OR:4.76[2.91, 7.78]) and back pain (OR:5.29[3.21, 8.70]); pregnancy-specific anxiety increased the likelihood of following the ‘at risk’ mental HRQOL trajectory (OR:7.95[4.84, 13.05]). Healthy physical and mental HRQOL trajectories during pregnancy were most common. Predictors indicative of poor HRQOL trajectories included pregnancy-related symptoms and anxiety.