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"Postpartum"
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Tranexamic Acid to Prevent Obstetrical Hemorrhage after Cesarean Delivery
In a placebo-controlled trial involving patients undergoing cesarean delivery, prophylactic use of tranexamic acid did not lead to a significantly lower risk of a composite outcome of maternal death or blood transfusion.
Journal Article
Long-term effects of mHealth consultation services on postpartum depressive symptoms and the mediating role of loneliness: A follow-up study of a randomized controlled trial
Although the short-term preventive effects of mHealth consultation intervention on postpartum depressive symptoms have been demonstrated, the long-term effects and role of alleviating loneliness on depressive symptoms remain unclear.
This follow-up study extended our previous trial, which ended at three months postpartum, by continuing observation to 12 months. Participants in the original trial were randomized to the mHealth group (
= 365) or the usual care group (
= 369). Women in the mHealth group had access to free, unlimited mHealth consultation services with healthcare professionals from enrollment through four months postpartum. The primary outcome of this study was the risk of elevated postpartum depressive symptoms at 12 months post-delivery (Edinburgh Postnatal Depression Scale score of ≥9). The mediation effect of alleviating loneliness on the primary outcome was also evaluated, using the UCLA loneliness scale at three months postpartum.
A total of 515 women completed the follow-up questionnaires (mHealth group, 253/365; usual care group, 262/369; 70.2% of the original participants). Compared to the usual care group, the mHealth group had a lower risk of elevated postpartum depressive symptoms at 12 months post-delivery (36/253 [14.2%] vs. 55/262 [21.0%], risk ratio: 0.68 [95% confidence interval: 0.46-0.99]). Mediation analysis showed that reducing loneliness at three months post-delivery mediated approximately 20% of the total effect of the intervention on depressive symptoms 12 months post-delivery.
mHealth consultation services provided during the early perinatal period may help alleviate depressive symptoms at 12 months postpartum.
Journal Article
Assessing the effectiveness of mindfulness-based programs on mental health during pregnancy and early motherhood - a randomized control trial
Background
The process of entering motherhood is highly stressful for women, with 15–85% of new mothers experiencing postpartum blues or depression. This study was designed to evaluate the efficacy of a mindfulness-based childbirth and parenting program in improving psychological health during the postpartum period.
Methods
This research was a randomized controlled trial with single blinding. Recruitment began after the participating hospital granted formal approval. A total of 74 women between 13 and 28-weeks gestation were allocated either to the intervention group or to the comparison group. The intervention program included a series of eight, 3-h classes held once weekly and 1 day of 7-h silent meditation. Psychological health was assessed at baseline and 3-months postpartum.
Results
Significant differences in stress and depression were observed in both groups over time. Stress scores and depression scores were significantly better in the intervention group than in the comparison group at 3-months postpartum (F = 7.19,
p
= .009 and F = 7.36,
p
= .008, respectively). No significant difference between the groups was identified for mindfulness scores at 3-months postpartum.
Conclusions
The intervention program effectively reduced postpartum self-perceived stress and depression, suggesting that this program provides acceptable and long-term benefits to women during pregnancy and the postpartum period. The teaching and practice of mindfulness meditation and parenting education during pregnancy may help reduce stress and depression in pregnant women as they transition into parenthood.
Trial registration
The ClinicalTrials.gov identifier for this study is:
NCT03185910
. The study was retrospectively registered on 14 June 2017.
Journal Article
Telephone-based nurse-delivered interpersonal psychotherapy for postpartum depression: nationwide randomised controlled trial
Postpartum depression and anxiety are under-addressed public health problems with numerous treatment access barriers, including insufficiently available mental health specialist providers.
To examine the effectiveness of nurse-delivered telephone interpersonal psychotherapy (IPT) for postpartum depression. Trial registration ISRCTN88987377.
Postpartum women (n = 241) with major depression (on the Structured Clinical Interview for DSM-IV (SCID-I)) from 36 Canadian public health regions in rural and urban settings were randomly assigned to 12 weekly 60 min nurse-delivered telephone-IPT sessions or standard locally available care. The primary outcome was the proportion of women clinically depressed at 12 weeks post-randomisation, with masked intention-to-treat analysis. Secondary outcomes examined included comorbid anxiety, self-reported attachment and partner relationship quality.
At 12 weeks, 10.6% of women in the IPT group (11/104) and 35% in the control group (35/100) remained depressed (OR = 0.22, 95% CI 0.10-0.46), with the IPT group 4.5 times less likely to be clinically depressed (SCID); 21.2% in the IPT group and 51% in the control group had an Edinburgh Postnatal Depression Scale (EPDS) score >12 (OR = 0.26, 95% CI 0.14-0.48), and attachment avoidance decreased more in the IPT group than in the control group (P = 0.02). Significant differences favoured the IPT group for comorbid anxiety and partner relationship quality at all time points, with no differences in health service or antidepressant use. None of the IPT responders relapsed by 36 weeks. Between-group SCID differences were sustained at 24 weeks, but not at 36 weeks.
Nurse-delivered telephone IPT is an effective treatment for diverse urban and rural women with postpartum depression and anxiety that can improve treatment access disparities.
Journal Article
Breaking mum and dad : the insider's guide to parenting anxiety
With more than 1 in 10 new parents experiencing post-natal depression and anxiety, and after suffering the traumatic birth of her son, and herself being diagnosed with post-natal anxiety and birth trauma, Anna Williamson uncovers the real thoughts, feelings and behaviours that many of us experience in those first few weeks and months after becoming a parent.
Book
Evaluating the impact of home supportive counseling and telephone supportive counseling on postpartum depression and anxiety: a randomized controlled trial
Background
Childbirth and postpartum experience often lead to the significant physiological and emotional changes in mothers. Hormonal fluctuations, coupled with the adaptation to maternal roles, play a pivotal role in postpartum depression and anxiety. The present study aimed to evaluate the effect of home and telephone supportive counseling on postpartum depression and anxiety.
Methods
This randomized controlled trial was conducted on 93 primiparous women aged 18–45 years attended the Taleghani and Al-Zahra educational and medical centers in Tabriz, Iran. Subjects were randomly assigned to the home supportive counseling, telephone supportive counseling, and control (receiving routine postpartum care) groups. Home and telephone supportive counseling were conducted for three 30–45 min sessions scheduled on postpartum days 3–5, 7–9, and 20–25. Data were collected using the Edinburgh Postnatal Depression Scale and the Postpartum Specific Anxiety Scale 10–15 days and 42–60 days postpartum, and analyzed using ANCOVA and Kruskal-Wallis tests.
Results
The mean (SD) depression score was 6.23 (3.09) in the telephone supportive counseling group, 4.78 (3.85) in the home supportive counseling group, and 5.79 (3.39) in the control group during 10–15 days postpartum (
P
= 0.016). The mean (SD) anxiety score was 28.11 (9.37) in the telephone supportive counseling group, 27.32 (7.38) in the home supportive counseling group, and 39.88 (7.73) in the control group during 10–15 days postpartum (
P
< 0.001). However, no statistically significant difference in depression and anxiety scores was observed among the three groups during 42–60 days postpartum (
P
> 0.05).
Conclusion
Home supportive counseling effectively alleviates symptoms of postpartum depression within 10–15 days postpartum. Moreover, both home and telephone supportive counseling were found to reduce postpartum anxiety symptoms within 10–15 days postpartum. Considering the cost-effectiveness of phone counseling, it is recommended that healthcare providers use telephone supportive counseling to reduce early postpartum anxiety.
Registration clinical trials
Iranian Registery of Clinical Trials-Beta vertion,
https://irct.behdasht.gov.ir/trial/71775
(IRCT20170506033834N11), registered 2023.8.20.
Journal Article