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Chronic stressors, social support, and depression during pregnancy
106
Citations
from
the literature/International
Journal
stressors, social support, and depression during VegaaNY Seguin L.; Potvin L.; St.-Denis M.; Loiselle J. CAN OBSTET GYNECOL 1995 85/4 (583-589) Objectives: To analyze the relationships between stressful life conditions, social support, and depressive symptomatology during pregnancy in women of low socioeconomic status and a comparison group of women of higher socioeconomic status. Methods: Study participants were recruited from four hospital prenatal care clinics. Low socioeconomic status was defined as no more than 1 I years of education and a household income below the poverty level. Higher socioeconomic status was defined as at least 12 years of education and a household income at least one and one-half times the poverty level. Allsubjects were nulliparous, over 18 years of age, and Frenchspeaking. Questionnaires were administered verbally at the participants’ homes during the 30th week of pregnancy, approximately. The Beck Depression Inventory was used to measure depressive symptomatology during the preceding 7 days. Results: Approximately 47% of the low socioeconomic status women and 20% of the higher socioeconomic status women scored 10 or more on the Beck Depression Inventory, indicating a depressive state. Multiple regression analysis demonstrated that chronic stressors (eg, financial and housing problems), negative life events, and inadequate social support were all linked to high depressive symptomatology during pregnancy. Conclusions: During pregnancy, depressive symptoms are common, especially in women of low socioeconomic status, and are strongly related to socioenviromnental factors. chronic
The relationship of maternal attitude toward weight gain to weight gain during pregnancy and low biih weight Copper R.L.; DuBard M.B.; Goldenberg R.L.; Oweis A.I. USA OBSTET GYNECOL 1995 85/4 (590-595) Objective: To evaluate the relationships between maternal attitude toward weight gain, actual weight gain, and infant birth weight. Methods: Maternal attitude toward weight gain during pregnancy was assessed in 1000 women, using an 18-item questionnaire administered at a mean of 20 weeks’ gestation. Composite scores were compared with pregnancy weight gain, maternal body mass index (BMI), and infant birth weight. Results: In the total population, the attitude score was not significantly related to pregnancy weight gain (r = -0.05, P = 0.08) and was negatively associated with birth weight (r = -0.09, P < 0.004). Maternal body size as measured by BMI was strongly associated with both weight gain and birth weight. Obese women (BMI greater than 26.6) tended to have negative attitudes and had the lowest mean weight gain (10.2 kg), but had the heaviest babies (3400 g). Thin women (BMI less than 19.6) had significantly higher attitude scores and a higher mean weight gain (14.1 kg) than did obese women. A significantly larger proportion of thin women achieved recommended gains when compared with larger women, but had the lightest babies (3114 g). Within the group of thin women, after adjustment for smoking, race, and gestational age at delivery,
of Gynecology
& Obstetrics
52 (1996)
105-114
attitude scores were not significantly associated with either weight gain or birth weight. Conclusion: Maternal attitude regarding weight gain is strongly influenced by pre-pregnancy body size; thin women tend to have positive attitudes and obese women tend to have negative attitudes about weight gain. Within BMI groups, a positive attitude does not predict appropriate weight gain or birth weight. These findings may explain in part why nutritional counseling programs tend to be associated with only minimal increases in birth weight.
PREGNANCY
AND
DELIVERY
Measurement of creatine kinase activity and diagnosis of estopic pregnaw Duncan W.C.; Sweeting V.M.; Cawood P.; Illingworth P.J. GBR BR J OBSTET GYNAECOL 1995 IOU3 (233-237) Objective: To investigate whether the measurement of maternal plasma creatine kinase concentration is of clinical value in the diagnosis of tubal ectopic pregnancy. Design: A retrospective observational study covering a three month period. Setting: The gynaceological emergency service of a UK teaching hospital. Subjects: One hundred and twenty women presenting with clinical suspicion of an ectopic pregnancy such that plasma human chorionic gonadotrophin (hC0) concentration was measured. Main outcome measures: Plasma hCG and creatine kinase concentrations were measured. Pregnancies were classified as ectopic pregnancy, complete miscarriage, incomplete miscarriage or ongoing pregnancy. Pregnancies were further classified as uncertain diagnosis if the diagnosis was not clear after initial investigation. Results: Twenty-one of the patients had an ectopic pregnancy. Diagnosis was classified as uncertain in 48”/u of pregnancies studied and in 54”/u of ectopic pregnancies during the study period. The mean plasma creatine kinase was higher in ectopic pregnancies than other pregnancies in the study group (P < 0.01) and remained higher in the subgroup of patients with uncertain diagnosis (P < 0.05) but there were significant overlaps in creatine kinase concentrations in all four clinical groups. When a cut-off point of 45 iu/l is used, the measurement of plasma creatine kinase activity has a sensitivity of 0.57 and a specificity of 0.67 for the diagnosis of ectopic pregnancy. Conclusions: The plasma concentration of creatine kinase is not sufficiently discriminative to be of clinical value in the diagnosis of tubal ectopic pregnancy. Temporizing management of severe pre-eclampia with and without the HELLP syndrome Visser W.; Wallenburg H.C.S. NLD BR J OBSTET GYNAECOL 1995 lO2/2 (111-117) Objective To test the null hypothesis that the course and outcome of pregnancy in patients with severe pre-eclampsia receiving temporizing hemodynamic treatment does not depend on the presence or absence of the syndrome of hemolysis, elevated liver enzymes, and a low platelet count (HELLP). Design A case-controlled study. Setting High risk obstetric unit, University Hospital Rotterdam-Dijkzigt, Rotterdam. Subjects One
Citations
from
the literature/International
Journal
stressors, social support, and depression during VegaaNY Seguin L.; Potvin L.; St.-Denis M.; Loiselle J. CAN OBSTET GYNECOL 1995 85/4 (583-589) Objectives: To analyze the relationships between stressful life conditions, social support, and depressive symptomatology during pregnancy in women of low socioeconomic status and a comparison group of women of higher socioeconomic status. Methods: Study participants were recruited from four hospital prenatal care clinics. Low socioeconomic status was defined as no more than 1 I years of education and a household income below the poverty level. Higher socioeconomic status was defined as at least 12 years of education and a household income at least one and one-half times the poverty level. Allsubjects were nulliparous, over 18 years of age, and Frenchspeaking. Questionnaires were administered verbally at the participants’ homes during the 30th week of pregnancy, approximately. The Beck Depression Inventory was used to measure depressive symptomatology during the preceding 7 days. Results: Approximately 47% of the low socioeconomic status women and 20% of the higher socioeconomic status women scored 10 or more on the Beck Depression Inventory, indicating a depressive state. Multiple regression analysis demonstrated that chronic stressors (eg, financial and housing problems), negative life events, and inadequate social support were all linked to high depressive symptomatology during pregnancy. Conclusions: During pregnancy, depressive symptoms are common, especially in women of low socioeconomic status, and are strongly related to socioenviromnental factors. chronic
The relationship of maternal attitude toward weight gain to weight gain during pregnancy and low biih weight Copper R.L.; DuBard M.B.; Goldenberg R.L.; Oweis A.I. USA OBSTET GYNECOL 1995 85/4 (590-595) Objective: To evaluate the relationships between maternal attitude toward weight gain, actual weight gain, and infant birth weight. Methods: Maternal attitude toward weight gain during pregnancy was assessed in 1000 women, using an 18-item questionnaire administered at a mean of 20 weeks’ gestation. Composite scores were compared with pregnancy weight gain, maternal body mass index (BMI), and infant birth weight. Results: In the total population, the attitude score was not significantly related to pregnancy weight gain (r = -0.05, P = 0.08) and was negatively associated with birth weight (r = -0.09, P < 0.004). Maternal body size as measured by BMI was strongly associated with both weight gain and birth weight. Obese women (BMI greater than 26.6) tended to have negative attitudes and had the lowest mean weight gain (10.2 kg), but had the heaviest babies (3400 g). Thin women (BMI less than 19.6) had significantly higher attitude scores and a higher mean weight gain (14.1 kg) than did obese women. A significantly larger proportion of thin women achieved recommended gains when compared with larger women, but had the lightest babies (3114 g). Within the group of thin women, after adjustment for smoking, race, and gestational age at delivery,
of Gynecology
& Obstetrics
52 (1996)
105-114
attitude scores were not significantly associated with either weight gain or birth weight. Conclusion: Maternal attitude regarding weight gain is strongly influenced by pre-pregnancy body size; thin women tend to have positive attitudes and obese women tend to have negative attitudes about weight gain. Within BMI groups, a positive attitude does not predict appropriate weight gain or birth weight. These findings may explain in part why nutritional counseling programs tend to be associated with only minimal increases in birth weight.
PREGNANCY
AND
DELIVERY
Measurement of creatine kinase activity and diagnosis of estopic pregnaw Duncan W.C.; Sweeting V.M.; Cawood P.; Illingworth P.J. GBR BR J OBSTET GYNAECOL 1995 IOU3 (233-237) Objective: To investigate whether the measurement of maternal plasma creatine kinase concentration is of clinical value in the diagnosis of tubal ectopic pregnancy. Design: A retrospective observational study covering a three month period. Setting: The gynaceological emergency service of a UK teaching hospital. Subjects: One hundred and twenty women presenting with clinical suspicion of an ectopic pregnancy such that plasma human chorionic gonadotrophin (hC0) concentration was measured. Main outcome measures: Plasma hCG and creatine kinase concentrations were measured. Pregnancies were classified as ectopic pregnancy, complete miscarriage, incomplete miscarriage or ongoing pregnancy. Pregnancies were further classified as uncertain diagnosis if the diagnosis was not clear after initial investigation. Results: Twenty-one of the patients had an ectopic pregnancy. Diagnosis was classified as uncertain in 48”/u of pregnancies studied and in 54”/u of ectopic pregnancies during the study period. The mean plasma creatine kinase was higher in ectopic pregnancies than other pregnancies in the study group (P < 0.01) and remained higher in the subgroup of patients with uncertain diagnosis (P < 0.05) but there were significant overlaps in creatine kinase concentrations in all four clinical groups. When a cut-off point of 45 iu/l is used, the measurement of plasma creatine kinase activity has a sensitivity of 0.57 and a specificity of 0.67 for the diagnosis of ectopic pregnancy. Conclusions: The plasma concentration of creatine kinase is not sufficiently discriminative to be of clinical value in the diagnosis of tubal ectopic pregnancy. Temporizing management of severe pre-eclampia with and without the HELLP syndrome Visser W.; Wallenburg H.C.S. NLD BR J OBSTET GYNAECOL 1995 lO2/2 (111-117) Objective To test the null hypothesis that the course and outcome of pregnancy in patients with severe pre-eclampsia receiving temporizing hemodynamic treatment does not depend on the presence or absence of the syndrome of hemolysis, elevated liver enzymes, and a low platelet count (HELLP). Design A case-controlled study. Setting High risk obstetric unit, University Hospital Rotterdam-Dijkzigt, Rotterdam. Subjects One