| 1. |
- Schei, Berit, et al.
(author)
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A history of abuse and operative delivery : results from a European multi-country cohort study
- 2014
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In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 9:1
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Journal article (peer-reviewed)abstract
- Objective The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult. Design The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS), or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary and multinomial regression analysis were used to assess the associations. Results Among 3308 primiparous women, sexual abuse as an adult (≥18 years) increased the risk of an elective CS, Adjusted Odds Ratio 2.12 (1.28–3.49), and the likelihood for a non-obstetrically indicated CS, OR 3.74 (1.24–11.24). Women expressing current suffering from the reported adult sexual abuse had the highest risk for an elective CS, AOR 4.07 (1.46–11.3). Neither physical abuse (in adulthood or childhood <18 years), nor sexual abuse in childhood increased the risk of any operative delivery among primiparous women. Among 3416 multiparous women, neither sexual, nor emotional abuse was significantly associated with any kind of operative delivery, while physical abuse had an increased AOR for emergency CS of 1.51 (1.05–2.19). Conclusion Sexual abuse as an adult increases the risk of an elective CS among women with no prior birth experience, in particular for non-obstetrical reasons. Among multiparous women, a history of physical abuse increases the risk of an emergency CS.
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| 2. |
- Lukasse, Mirjam, et al.
(author)
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Childhood abuse and fear of childbirth - a population-based study
- 2010
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In: Birth. - : John Wiley & Sons. - 0730-7659 .- 1523-536X. ; 37:4, s. 267-274
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Journal article (peer-reviewed)abstract
- Abstract: Background: Childhood abuse affects adult health. The objective of this study was to examine the association between a self-reported history of childhood abuse and fear of childbirth. Methods: A population-based, cross-sectional study was conducted of 2,365 pregnant women at five obstetrical departments in Norway. We measured childhood abuse using the Norvold Abuse Questionnaire and fear of childbirth using the Wijma Delivery Expectancy Questionnaire. Severe fear of childbirth was defined as a Wijma Delivery Expectancy Questionnaire score of ≥85. Results: Of all women, 566 (23.9%) had experienced any childhood abuse, 257 (10.9%) had experienced emotional abuse, 260 (11%) physical abuse, and 290 (12.3%) sexual abuse. Women with a history of childhood abuse reported severe fear of childbirth significantly more often than those without a history of childhood abuse, 18 percent versus 10 percent (p = 0.001). The association between a history of childhood abuse and severe fear of childbirth remained significant after adjustment for confounding factors for primiparas (adjusted OR: 2.00; 95% CI: 1.30–3.08) but lost its significance for multiparas (adjusted OR: 1.17; 95% CI: 0.76–1.80). The factor with the strongest association with severe fear of childbirth among multiparas was a negative birth experience (adjusted OR: 5.50; 95% CI: 3.77–8.01). Conclusions: A history of childhood abuse significantly increased the risk of experiencing severe fear of childbirth among primiparas. Fear of childbirth among multiparas was most strongly associated with a negative birth experience.
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| 3. |
- Lukasse, Mirjam, et al.
(author)
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Prevalence of emotional, physical and sexual abuse among pregnant women in six European countries
- 2014
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In: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 93:7, s. 669-677
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Journal article (peer-reviewed)abstract
- Objectives The primary objective was to investigate the prevalence of a history of abuse among women attending routine antenatal care in six northern European countries. Second, we explored current suffering from reported abuse. Design A prospective cohort study. Setting Routine antenatal care in Belgium, Iceland, Denmark, Estonia, Norway, and Sweden between March 2008 and August 2010. Population A total of 7174 pregnant women. Methods A questionnaire including a validated instrument measuring emotional, physical and sexual abuse. Main outcome measure Proportion of women reporting emotional, physical and sexual abuse. Severe current suffering defined as a Visual Analogue Scale score of ≥6. Results An overall lifetime prevalence of any abuse was reported by 34.8% of the pregnant women. The ranges across the six countries of lifetime prevalence were 9.7–30.8% for physical abuse, 16.2–27.7% for emotional abuse, and 8.3–21.1% for sexual abuse. Few women reported current sexual abuse, 0.4% compared with 2.2% current physical abuse and 2.7% current emotional abuse. Current severe suffering was reported by 6.8% of the women who reported physical abuse, 9.8% of those who reported sexual abuse and 13.5% for emotional abuse. Conclusion A high proportion of pregnant women attending routine antenatal care report a history of abuse. About one in ten of them experiences severe current suffering from the reported abuse. In particular, these women might benefit from being identified in the antenatal care setting and being offered specialized care.
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| 4. |
- Wangel, Anne-Marie, et al.
(author)
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Emergency cesarean sections can be predicted by markers for stress, worry and sleep disturbances in first-time mothers
- 2011
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In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 90:3, s. 238-244
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Journal article (peer-reviewed)abstract
- Abstract Objective: To identify predictors as free-text markers for mental ill-health from an electronic perinatal record (EMR) system and the association for emergency cesarean section (CS) in nulliparous women. Design: Population-based study using an EMR system. Setting: The catchment area of Malmö University Hospital in Sweden. Population: 6 467 women with complete perinatal electronic records (EMR) were selected of 10 662 nulliparous women presenting with a singleton cephalic baby for vaginal delivery between 2001 and 2006. Methods: Free-text search of markers for mental ill-health and multivariate logistic regression. Main Outcome Measures: Eleven markers for mental ill-health were tested with Cohen’s kappa for agreement and used as exposure variables. Odds ratios (OR) with 95% confidence interval (CI) were calculated for emergency CS, and adjusted for maternal age, diabetes, epidural anesthesia, and gestational weeks <37 and >41 by a multivariate logistic regression model with vaginal delivery as the reference. Results: Three markers identified from the EMR system reached statistically significant associations with an increased risk for emergency CS in nulliparous women: stress adjusted OR 1.66 (95% CI 1.34–2.06), sleep adjusted OR 1.57 (1.14–2.16), and worry adjusted OR 1.41 (1.10–1.79). Conclusions: Free-text words in medical records, indicating stress, sleep disturbances, or worry predicted increased adjusted OR for emergency CS in first-time mothers. Recognizing pregnant women’s reporting of their mental health status could have a predictive bearing on delivery outcomes.
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| 5. |
- Wangel, Anne-Marie, et al.
(author)
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Mental health in pregnant women in Sweden
- 2010
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In: 16th International Congress of the International Society of Psychosomatic Obstetrics and Gynecology (ISPOG). - : 16th International Congress of the International Society of Psychosomatic Obstetrics and Gynecology (ISPOG).
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Conference paper (other academic/artistic)abstract
- Aim: To describe self-reported mental health indicators and to develop a score for mental health status in pregnant women. Method: Cross-sectional data was used from the Swedish population of a European cohort study conducted in 6 countries (Belgium, Iceland, Denmark, Estonia, Norway and Sweden). A total of 1 025 pregnant women in Malmoe, Sweden, filled in a questionnaire including background information and validated instruments to measure signs of depression during previous week by Edinburgh Depression Scale (EDS-5) and present health status. History of psychosocial care, medication, abuse, post traumatic stress symptoms (PTSS) and life events was reported for the past twelve months. EDS score was calculated by cut off >7 and >8. Ethnicity was defined by mother tongue. Results: Most women had Swedish as their mother tongue but 215 women (21.4%) had another language than Swedish. EDS at >7 (14.1%) and >8 (9.1%) was more common in foreign than in Swedish women (p<0.0001). Signs of PTSS as having physical ailments, feelings of numbness, avoidance, intrusion and anxiety in the past 12 months were also more common in this group (p<0.0001). Conclusion Pregnant women with another mother tongue than Swedish may have a less favourable mental health status than Swedish women. The algorithm for mental health score is under development using PTSS and other relevant indicators for the Swedish data. As such it will be analysed for associations with delivery outcomes in the whole BIDENS dataset.
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| 6. |
- Wangel, Anne-Marie, et al.
(author)
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Mental health status in pregnancy among native and non-native Swedish speaking women : a Bidens study
- 2012
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In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 91:12, s. 1395-1401
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Journal article (peer-reviewed)abstract
- Objectives. To describe mental health status in native and non-native Swedish-speaking pregnant women and explore risk factors of depression and of posttraumatic stress symptoms. Design and setting. A cross-sectional questionnaire study was conducted at midwife-based antenatal clinics in Southern, Sweden. Sample. A non-selected group of women in mid-pregnancy participated. Methods. Participants completed a questionnaire including background characteristics, social support, life events, mental health variables and the short Edinburgh Depression Scale. Main outcome measures. Depressive symptoms during last week and posttraumatic stress symptoms during past year. Results. Out of 1003 women, 21.4% reported another language than Swedish as their mother tongue and were defined as non-native. These women were more likely to be younger, have fewer years of education, potential financial problems, and lack of social support. More non-native speakers self-reported depressive, posttraumatic stress, anxiety and, psychosomatic symptoms, and fewer had had consultations with a psychiatrist or psychologist. Of all women 13.8% had depressive symptoms defined by Edinburgh Depression Scale as 7 or above. Non-native status was associated with statistically increased risks of depressive symptoms and having ≥ 1 posttraumatic stress symptom compared to native speaking women. Multivariate modeling including all selected factors resulted in adjusted OR for depressive symptoms of 1.75 (95% CI: 1.11-2.76) and of 1.56 (95% CI: 1.10-2.34) for posttraumatic stress symptoms in non-native Swedish speakers. Conclusion. Non-native Swedish-speaking women had a more unfavorable mental health status than native speakers. In spite of this, non-native speaking women had sought less mental health care.
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| 7. |
- Wangel, Anne-Marie
(author)
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Mental ill-health in childbearing women : Markers and risk factors
- 2012
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Doctoral thesis (other academic/artistic)abstract
- The awareness of mental health problems in women of reproductive age has increased worldwide in the recent decades. Much research has focused on symptoms of depression in women and the risk of postpartum depression, as a factor of attachment problems and adverse health effects on the newborn and growing child. Less research has explored risk factors for mental problems during pregnancy and childbirth. Pregnancy can be challenging to a woman’s mental health as posttraumatic stress, fear of childbirth as well as past and present abuse can surface to influence the perinatal period and delivery outcome. Cesarean sections (CS), which also may be linked to mental health problems, have tripled in Sweden over the past 30 years. The aim of this thesis was to investigate mental ill-health identified through markers in pregnancy records; mental disorders associated with different modes of delivery; and analyze risk factors associated with mental health status among childbearing women in Malmö, Sweden. Study 1 investigated the documentation provided in electronic medical records (EMR) of mental health status in 17,443 childbearing women who gave birth at Malmö University Hospital between 2001 and 2006. By performing a free-text search of the perinatal registry system (KIKA), we identified the occurrence of ten selected markers of mental ill-health among pregnant women. Associations with mode of delivery was analyzed in 6467 first-time mothers presenting at term with a singleton cephalic lie baby for vaginal delivery. The result showed that the markers stress, sleep, and worry predicted a significantly increased adjusted risk for emergency CS in first-time mothers, compared with having a spontaneous vaginal delivery. Study 2 linked the national Inpatient Care Register with records from the KIKA-EMR system to investigate types of inpatient care, frequency of psychiatric diagnoses prior to childbirth, and risk of CS.Among the 17,443 women, 39.3% had received inpatient care within 5 years of index birth, 27.3% had had obstetric care, 10.1% somatic care, and 1.9% (333) psychiatric inpatient care. Paper II showed that women with a history of psychiatric inpatient care and those identified from pregnancy records as having markers of mental ill-health were associated with increased adjusted risks of elective and emergency CS. Both Papers I and II suggest that identifying a woman’s mental health status in pregnancy may predict and perhaps prevent CS, especially emergency CS in first-time mothers. The results of Papers III and IV refer to questionnaire data on pregnant women from a Swedish cohort in Malmö as part of the six-country Bidens study (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden). Mother tongue was indicated by 1003 women, showing 78.6% to be native Swedish speakers and 21.4% non-native Swedish speakers. We identified mental health status and analyzed risk factors for symptoms of depression and posttraumatic stress. In all, 13.8% reported moderate depressive symptoms at seven points or above on the short version of the Edinburgh Depression Scale. The score was significantly higher among non-native Swedish-speaking women. Posttraumatic stress was defined as having at least one of three symptoms. Multivariate modeling, including socioeconomic factors, resulted in increased adjusted odds ratios for symptoms of depression and posttraumatic stress in non-native Swedish speakers, compared to native speakers. For Paper IV the same cohort was used to explore experiences of emotional, physical, and sexual abuse, and associations with depressive and posttraumatic stress symptoms. The prevalence of lifetime and recent abuse was similar between the two groups of Swedish-speaking women. A history of abuse was strongly associated with symptoms of depression and posttraumatic stress in pregnancy and was not explained by age, years of education, or being in financial distress. Assessing the language background and history of three types of abuse might predict symptoms of poor mental health in pregnant women. Identifying indicators of a woman’s mental ill-health and assessing her mental health status in pregnancy is an important objective for perinatal health care, as it provides opportunities for early detection and intervention. Preventing mental ill-health in childbearing women would greatly reduce costs to the individual and to society.
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| 8. |
- Wangel, Anne-Marie, et al.
(author)
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Prior psychiatric inpatient care and risk of cesarean sections: a registry study
- 2011
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In: Journal of Psychosomatic Obstetrics and Gynecology. - : Informa Healthcare. - 0167-482X .- 1743-8942. ; 32:4, s. 189-197
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Journal article (peer-reviewed)abstract
- This study of 17,443 childbearing women, investigated the relationship between hospital admissions 5 years prior to index birth, type of mental disorders and risk factors for mode of delivery. Hospital based electronic perinatal medical records between 2001 and 2006, were linked with the Swedish National Inpatient Care Registry 1996-2006. Of all the women, 39.3% had had inpatient care prior to index birth (27.3% had had obstetric, 10.1% somatic, and 1.9% psychiatric inpatient care). Diagnoses of mental disorders at psychiatric admission (n = 333) were categorized into five groups: personality/behavioral/unspecified disorder (30.9%), affective disorders and 'suicide attempt' (28.9%), neurotic/somatoform disorders (18.9%), substance use (17.1%) and schizophrenia (4.2%). Women with history of psychiatric care were more often smokers, below age 24 and single (p < 0.001, respectively), had more markers of mental ill-health in pregnancy records (p = 0.001), compared to women without such previous care, and fewer were nulliparous (p < 0.001). The results show that women with prior psychiatric inpatient care and those with identified mental ill-health in pregnancy records, were associated with increased adjusted risks of cesarean sections. Identifying a woman's mental health status in pregnancy may predict and prevent emergency cesarean section.
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