PersonalTrainer: Childbirth

Wednesday, December 21, 2011

Depressive Symptoms And Intimate Partner Violence In The 12 Months After Childbirth

Main Category: Women's Health / Gynecology
Also Included In: Depression; Pregnancy / Obstetrics
Article Date: 08 Dec 2011 - 2:00 PST

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Forty percent of women who report depressive symptoms following birth also reported intimate partner violence finds a new study published in BJOG: An International Journal of Obstetrics and Gynaecology.

The study also found that most of the women reporting postnatal depressive symptoms first reported this at six months after birth or later.

Intimate partner violence (both physical and emotional abuse) in the perinatal period is associated with a range of physical and psychological health problems including adverse pregnancy and birth outcomes, postnatal depression, and future behavioural problems for children.

This Australian study looked at 1305 nulliparous women. They were recruited from six public hospitals between 6 and 24 weeks of gestation. Written questionnaires were completed at recruitment and at 3, 6 and 12 months postpartum.

Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and intimate partner violence was assessed using the short version of the Composite Abuse Scale.

Information on depressive symptoms was collected at multiple time points, while data on intimate partner violence was only collected at the 12 month follow-up.

The study found that one in six women reported intimate partner violence in the year after having their first baby. Emotional violence was more common than physical violence (14% versus 8%).

Sixteen percent of women reported depressive symptoms in the 12 months postpartum, with most women first reporting depressive symptoms in the second 6 months after birth. Factors associated with postpartum depressive symptoms include: emotional abuse alone, physical abuse, depression in pregnancy and unemployment in early pregnancy.

The significant associations between intimate partner violence and depressive symptoms over the course of the first postpartum year persisted after adjusting for the known confounders of prior depression and relevant socio-demographic characteristics (maternal age, relationship status, and employment status in early pregnancy).

Dr Hannah Woolhouse of the Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute in Victoria, Australia and co-author of the paper said:

"Depression after childbirth has received a lot of attention in recent decades. Known risk factors for developing postnatal depression include a history of depression, poor partner relationships, stressful life events/social health issues, low social support, and low income. Our findings indicate that intimate partner violence is very common among women reporting postnatal depressive symptoms, and may be an important factor for health professionals to consider in managing postnatal distress.

"In both the UK and Australia, universal screening for depressive symptoms in the first few months after childbirth is now recommended as part of routine perinatal care. However we found that most of the women reporting postnatal depressive symptoms first reported this at six months postpartum or later.

"This finding has major implications for clinical practice as many women who develop depression after six months will be missed. Health professionals should regularly enquire about a woman's mental health in the 12 months after birth, rather than at one specific time point."

Professor Philip Steer, Editor of BJOG added:

"This study shows that pregnancy and the postnatal period is a good time to identify and support women who experience both depression and partner violence."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our women's health / gynecology section for the latest news on this subject. Full Citation: Woolhouse H, Gartland D, Hegarty K, Donath S, Brown S. Depressive symptoms and intimate partner violence in the 12 months after childbirth: a prospective pregnancy cohort study. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.03219.x.
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Tuberculosis Diagnosis Rate Higher Among New Mothers After Childbirth

Editor's Choice
Main Category: Tuberculosis
Also Included In: Women's Health / Gynecology
Article Date: 12 Dec 2011 - 9:00 PST

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According to a new UK-wide cohort study published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine, the incidence of TB (tuberculosis) diagnosis is substantially higher in new mothers after childbirth, indicating that this group of women represents a potentially new target group selected for screening.

In a collaborated study, researchers from the Health Protection Agency and the University of East Anglia, evaluated data obtained from the General Practice Research Database on all pregnant women between 1996 and 2008. The Database represents 5.5% of the UK population and contains records from 460 practices across the UK.

Dominik Zenner, degree consultant in public health of the Respiratory Diseases Department at the Health Protection Agency stated:

"Ours is the first primary care based cohort study to quantify the risk of TB during pregnancy and postpartum. Although we found a significantly increased risk of TB in the six months following pregnancy, but not during pregnancy, the risk during pregnancy is almost certainly also increased."

For their study, researchers estimated the incidence rates for TB during pregnancy, six months after birth and outside of pregnancy and adjusted incidence rate ratios (IRRs) in a retrospective cohort study using a model.

They also evaluated a nested self-controlled case series (SCCS) that was adjusted for all non-time-dependent confounders, like country of origin and ethnicity. In the SCSS evaluation, researchers identified pregnant women with TB from the cohort, and compared incidence rates (IRs) in pregnancy and after birth with rates outside pregnancy.

The cohort study included a total of 192,801 women with a total of 264,136 pregnancies. The researchers noted that from 177 TB cases during the study, 22 cases each occurred during pregnancy and within 180 days after giving birth. They established that the approximate TB rate for the combined pregnancy and post-birth period was 15.4 per 100,000 person years. This was substantially higher compared with the rate outside of pregnancy (9.1 per 100,000 person years, p=0.02). After the researchers adjusted for age, region and socio-economic status, they discovered the post-birth TB risk to be substantially higher than the TB risk outside pregnancy (IRR 1.95, CI 1.24-3.07), but noted no significant increase in women during pregnancy (IRR 1.29, CI 0.82-2.03).

The SCCS evaluation confirmed the researchers findings and after adjusting for all non-time bound confounders, the time-span of observation and patients' age they observed no significant increase to the risk outside of pregnancy, whereas the TB risk was substantially increased in women 6 months after giving birth (IRR 1.61, CI 1.01-2.58, p=0.04).

The study was subject to various limitations, such as observational design, and the fact that administrative delays between the diagnosis and recording of TB have occurred. Diagnostic delays may have occurred during pregnancy given that immunological changes during pregnancy gradually increase TB susceptibility and normalize gradually after delivery. All factors combined may account for the failure to demonstrate a substantially increased risk of TB during pregnancy.

Dr. Zenner concluded: "The incidence of TB diagnosis is significantly increased post-partum, probably reflecting an increase in TB incidence during pregnancy. Given our results, targeted screening of pregnant and post-partum women in high-risk groups may be warranted, given that delays in treatment initiation are associated with poorer outcomes for both mothers and their children."

Written by: Grace Rattue

Visit our tuberculosis section for the latest news on this subject. American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine Please use one of the following formats to cite this article in your essay, paper or report: