Hamideh Bayrampour

Advanced Maternal Age and the Risk of Cesarean Birth: A Systematic Review

BACKGROUND The increasing pregnancy rate at advanced maternal age is contemporaneous with the increasing rate of cesarean birth. Several studies have found that advanced maternal age is a risk factor for cesarean birth. The objective of this systematic review was to assess the relationship between advanced maternal age and cesarean birth among nulliparous and multiparous women. METHODS To identify relevant studies, we searched the literature for articles published from January 1, 1995 to March 1, 2008, using Medline, EMBASE, PsychINFO, and CINAHL. We also hand-searched the bibliographies of retrieved articles to identify additional related studies. We included all cohort studies and all case-control studies that examined this association in developed countries. The Cochrane Collaborations Review Manager software (5.0) was used to summarize the data. RESULTS Twenty-one studies met the inclusion criteria and were included in the review. All studies demonstrated an increased risk of cesarean birth among women at advanced maternal age compared with younger women, for both nulliparas and multiparas (relative risk varied from 1.39 to 2.76). Because we found extreme heterogeneity (both statistical and clinical) among the included studies, we did not provide a pooled estimate of the risk of cesarean birth. CONCLUSIONS All included studies illustrated an increased risk of cesarean birth among older women. Fifteen studies adjusted this association for potential confounders, which suggests that a valid and independent association is likely to exist between advanced maternal age and cesarean birth. However, the associated factors for this increased risk are not totally understood in the literature.

Advanced maternal age and risk perception: A qualitative study

BackgroundAdvanced maternal age (AMA) is associated with several adverse pregnancy outcomes, hence these pregnancies are considered to be “high risk.” A review of the empirical literature suggests that it is not clear how women of AMA evaluate their pregnancy risk. This study aimed to address this gap by exploring the risk perception of pregnant women of AMA.MethodsA qualitative descriptive study was undertaken to obtain a rich and detailed source of explanatory data regarding perceived pregnancy risk of 15 women of AMA. The sample was recruited from a variety of settings in Winnipeg, Canada. In-depth interviews were conducted with nulliparous women aged 35 years or older, in their third trimester, and with singleton pregnancies. Interviews were recorded and transcribed verbatim, and content analysis was used to identify themes and categories.ResultsFour main themes emerged: definition of pregnancy risk, factors influencing risk perception, risk alleviation strategies, and risk communication with health professionals.ConclusionsSeveral factors may influence womens perception of pregnancy risk including medical risk, psychological elements, characteristics of the risk, stage of pregnancy, and health care provider’s opinion. Understanding these influential factors may help health professionals who care for pregnant women of AMA to gain insight into their perspectives on pregnancy risk and improve the effectiveness of risk communication strategies with this group.

Pregnancy-related anxiety: A concept analysis

OBJECTIVES Evidence suggests that pregnancy-related anxiety is more strongly associated with maternal and child outcomes than general anxiety and depression are and that pregnancy-related anxiety may constitute a distinct concept. However, because of its poor conceptualization, the measurement and assessment of pregnancy-related anxiety have been limited. Efforts to analyze this concept can significantly contribute to its theoretical development. The first objective of this paper was to clarify the concept of pregnancy-related anxiety and identify its characteristics and dimensions. The second aim was to examine the items of current pregnancy-related anxiety measures to determine the dimensions and attributes that each scale addresses, noting any gaps between the current assessment and the construct of the concept. DESIGN A concept analysis was conducted to examine the concept of pregnancy-related anxiety. DATA SOURCES To obtain the relevant evidence, several databases were searched including MEDLINE, PsycINFO, EBSCOs SocINDEX, Psychological and Behavioral Sciences Collection, CINAHL, SCOPUS, and EMBASE. REVIEW METHODS A modified approach based on Walker and Avant (Strategies for theory construction in nursing. 5th ed; 2011) was used. Qualitative or quantitative studies published in English that explored or examined anxiety during pregnancy or its dimensions prospectively or retrospectively were included. RESULTS Thirty eight studies provided data for the concept analysis. Three critical attributes (i.e., affective responses, cognitions, and somatic symptoms), three antecedents (i.e., a real or anticipated threat to pregnancy or its outcomes, low perceived control, and excessive cognitive activity, and four consequences (i.e., negative attitudes, difficulty concentrating, excessive reassurance-seeking behavior, and avoidance behaviors) were identified. Nine dimensions for pregnancy-related anxiety were determined, and a definition of the concept was proposed. The most frequently reported dimensions included anxiety about fetal health, fetal loss, childbirth, and parenting and newborn care. The content of five scales was analyzed to determine the attributes and dimensions measured by each tool. Our findings suggest that the Pregnancy-Related Anxiety Scale tapping five dimensions of pregnancy-related anxiety and the Pregnancy Outcome Questionnaire with six items pertaining to the consequences of pregnancy-related anxiety can respectively be considered the most useful tools for assessing the existence and severity of the concept. CONCLUSIONS The critical attributes of pregnancy-related anxiety are similar to those defined for anxiety disorders. However, the behavioral consequences of pregnancy-related anxiety appear to apply only some women and may serve as important indicators of the severity of the condition. Current tools are useful instruments to determine whether the concept exists and to capture selected domains of pregnancy-related anxiety. A tool that includes all dimensions of the concept and examines the severity of pregnancy-related anxiety is needed.

Comparison of Demographic and Obstetric Characteristics of Canadian Primiparous Women of Advanced Maternal Age and Younger Age

OBJECTIVE The rate of pregnancy at advanced maternal age (AMA) has increased during recent decades. The purpose of this study is to compare demographic and obstetric characteristics of Canadian primiparous women of AMA with those aged 20 to 29 years. METHODS We conducted a secondary analysis of data collected through the national Maternity Experiences Survey (MES) of the Canadian Perinatal Surveillance System. The sample included 301 primiparous women aged 35 years or over and 1,564 primiparous women aged 20 to 29 years. Estimates of prevalence for each group and their odds ratios were calculated using sample weights of the survey, and variances were calculated using bootstrapping methods adjusting for sampling design and weights. RESULTS Women of AMA were significantly more likely to be better educated, to have higher income, to be employed, and to continue to work until the end of pregnancy than younger women. They also reported having significantly more information on pregnancy, labour, and birth, and they were more likely to attend prenatal classes. They were more likely to have had a miscarriage or infertility treatment, to request or be offered a Caesarean section, and to have a higher rate of Caesarean section. There were no significant differences in rates of preterm birth, low birth weight, and small-for-gestational age infants. CONCLUSION Pregnant women of AMA differ from younger women in demographic characteristics, knowledge level, and some health behaviours and pregnancy outcomes. The growing number of pregnancies at AMA indicates the need for developing appropriate care plans to address the specific needs of this group.

Risk factors of transient and persistent anxiety during pregnancy

PURPOSE chronic poor mental health over the course of pregnancy contributes to greater adverse maternal and child outcomes. Identifying women with chronic depressive or anxiety symptoms can provide opportunities to reduce distress and improve pregnancy outcomes. The objective of this study was to determine risk factors of chronic antenatal depressive and anxiety symptoms using a longitudinal pregnancy cohort in Alberta, Canada. METHODS women with singleton pregnancies were included (N=3021). Anxiety and depressive symptoms were measured in the second and third trimesters using the Spielberger State-Trait Anxiety Inventory and the Edinburgh Postnatal Depression Scale, respectively. On the basis of the timing and persistence of symptoms, the following three mutually exclusive subgroups for each anxiety and depressive symptoms were created: never symptomatic, symptomatic only in the second trimester, and symptomatic at both time points. Separate logistic regression models were used to derive risk factors for each subgroup. FINDINGS women with chronic anxiety or depressive symptoms were distinguished from those with transient symptoms or no symptoms by their optimism scores, in which less optimistic pregnant women had a four-fold increased risk for developing chronic depressive or anxiety symptoms compared with more optimistic women (AOR varied from 4.30 to 4.93). Additionally, high perceived stress, low social support, history of mental health issues were common predictors of chronic anxiety and depressive symptoms in pregnancy. Partner tension was the exclusive predictor of anxiety symptoms (AOR varied from 1.94 to 2.31) and poor physical health (AOR 2.54; 95% CI 1.32-4.89), unplanned pregnancy (AOR 3.05; 95% CI 1.61-5.79), and infertility treatments (AOR 4.98; 95% CI 1.85-13.39) were unique predictors of chronic depressive symptoms. CONCLUSIONS knowledge of the risk factors of chronic poor mental health during pregnancy might inform the development of effective strategies within the limited resources of health-care systems to target populations with greater needs for interventions.

Adherence to Canadian physical activity and sedentary behaviour guidelines among children 2 to 13 years of age.

Active living is relevant for healthy child development and disease prevention. In 2011–2012 new Canadian Physical Activity and Sedentary Behaviour Guidelines were developed for children under four and 5–17 years of age. This cross-sectional study assessed childrens adherence to the national guidelines, using a large sample of Alberta children ages 2–4 and 5–13 years in 2013. The proportions of children achieving the average daily duration of physical activity and screen time recommended were determined, and child and parental predictors of non-achievement were identified. Participants were 631 parent and child dyads. Data were collected by parental reports of physical activity and screen time during weekdays, and analysed using univariate and multivariate techniques (p < 0.05). Logistic regression models were used to examine factors associated with childrens non-achievement of physical activity and screen time recommendations while adjusting for covariates. Sixty-two percent of children aged 2–4 and 26% of children aged 5–13 did not meet physical activity time recommendations, and 64% of children aged 2–4 and 23% of children aged 5–13 exceeded the maximum screen time recommendation. Several associations between parental age and education with non-achievement were observed but associations were not consistent across age groups or behaviours. Among preschoolers, those with middle-age parents were more likely to not achieve physical activity recommendations. Evidence of high non-achievement of the recommendations among children 2–4 years highlights the need for increased programming targeting preschool children. Further research is required to identify modifiable risk factors that may inform future health promotion efforts.

Effect of depressive and anxiety symptoms during pregnancy on risk of obstetric interventions.

The effect of prenatal mental health on the risk of obstetric interventions is unclear. The present study examined the associations between depressive and anxiety symptoms in the second and third trimesters and mode of delivery, epidural use and labor induction in a large community‐based pregnancy cohort, in Alberta, Canada.

A Qualitative Analysis of "Naturalistic" Conversations in a Peer-Led Online Support Community for Lung Cancer.

Background: Online support communities are popular in use by patients with cancer and their families for emotional, informational, and social support. Nonetheless, most research has focused on diagnoses other than lung cancer, indicating a need for studies to include more diverse participants and cancer conditions. Objective: Our aim was to describe the content of messages in a United States–based online support community for lung cancer. Methods: A descriptive exploratory qualitative approach was used to analyze a sample of 688 pages with threaded messages across 2 time periods in 2008 and 2009. We analyzed 68 main posts and 586 replies in 344 pages for period 1 (262 users), and 55 main posts and 697 replies in 344 pages for period 2 (307 users). Results: Most users were female and equally divided as patients or support persons. Content analysis generated 9 themes: disease information, diagnostic test information, treatment information, symptoms, marked deterioration, advocacy, experiencing healthcare providers and the system, positive survivorship, and making sense of emotions. Conclusion: Findings highlighted how the online support community is a valued, accessible avenue for information exchange and nonjudgmental emotional support for individuals dealing with lung cancer. Implications for Practice: Findings of daily living needs as articulated in this online community serve as a valuable guide for nurses to: better understand support needs, participate in developing and evaluating effective Internet and educational supports, and be better informed as advocates for more resources for Internet support mechanisms for people dealing with stigmatized conditions such as lung cancer.

Trajectories of Perinatal Depressive and Anxiety Symptoms in a Community Cohort

OBJECTIVE The evidence on trajectories of perinatal depression is mostly based on studies composed of women at high risk for poor mental health. Research on maternal anxiety trajectories is also scarce. Using a large community cohort, the All Our Babies study, in Alberta, Canada, we examined trajectories of perinatal depressive and anxiety symptoms and compared characteristics of women across trajectories. METHODS Anxiety and depressive symptoms were measured at the second and third trimesters and at 4 and 12 months postpartum among 1,445 women recruited between May 2008 and December 2010. The state subscale of the Spielberger State-Trait Anxiety Inventory was used to measure anxiety symptoms, and depressive symptoms were measured with the Edinburgh Postnatal Depression Scale. Semiparametric group-based mixed modeling was performed to identify the optimal trajectory shape, number of groups, and proportion of the sample belonging to each trajectory. Model fit was evaluated using the Bayesian information criterion. Multinomial logistic regression analysis was conducted to compare characteristics across the trajectories. RESULTS Five distinct trajectory groups with constant and variable patterns were identified for both depressive and anxiety symptoms: minimal, mild, antepartum, postpartum, and chronic. Common risk factors of depression and anxiety across groups with elevated symptoms were history of mental health issues (odds ratios [ORs] varied from 1.83 to 7.64), history of abuse/neglect (ORs varied from 1.67 to 8.97), and low social support (ORs varied from 1.64 to 11.37). The magnitude of the influence of the psychosocial risk factors was greater in the chronic group compared to others, suggesting a dose-related relationship. CONCLUSIONS Heterogeneity of anxiety and depressive symptoms highlights the importance of multiple mental health assessments during the perinatal period. The patterns and intensity of postpartum depression differed between community and high-risk samples, underlining the significance of defining suitable cutoffs. Research to examine the impact of these trajectories on child outcomes is needed.

The Impact of Introducing Centering Pregnancy in a Community Health Setting: A Qualitative Study of Experiences and Perspectives of Health Center Clinical and Support Staff

Objectives Introducing new programming into an existing setting may be challenging. Understanding how staff and clinicians who are not directly involved in program delivery view the program can help support program implementation. This study aimed to understand how peripheral staff and clinicians perceived a newly implemented Centering Pregnancy group prenatal care program in a community-based health center and its impact on clinic operations. Methods Semi-structured interviews were conducted with a purposive sample of 12 staff members at a community-based health center. The interview guide covered topics such as perceptions of Centering Pregnancy and how the program impacted their work. An interpretive description approach was used to analyze the interview data. A coding framework was developed iteratively and all interview data were analyzed independently by multiple researchers. Results Staff had overall positive perceptions of Centering Pregnancy, but the level of understanding about the program varied widely. Most respondents viewed the Centering Pregnancy program as separate from other programs offered by the clinic, which created both opportunities and challenges. Opportunities included increased cross-referrals between established services and Centering Pregnancy. Challenges included a lack of communication about responsibilities of staff in relation to Centering Pregnancy patients. Impact on staff and overall clinic operations was perceived to be minimal to moderate, and most tensions related to roles and expectations were resolved. Conclusions for Practice Clear communication regarding fit within clinic structures and processes and expectations of staff in relation to the program was critical to the integration of Centering Pregnancy program into an established health center.