•Paternal depression and social relations worsened during the postpartum period.•Parity significantly affected perinatal mental health in men but not in women.•Experienced fathers exhibited a ...significantly higher risk of paternal distress.•Experienced fathers had significantly poorer physical health and social relations.
Mental distress patterns in first-time or experienced mothers and fathers during the transition to parenthood have been inadequately studied. This longitudinal study thus investigated changes in depression, anxiety, and health-related quality of life in both parents from early pregnancy until 1 year postpartum. Parity effects were specifically examined.
In total, 531 pregnant women and their partners were recruited in Taiwan during early prenatal visits from 2011 to 2015, with five follow-ups from midpregnancy to 1 year postpartum. The participants’ self-reported data were collected and analyzed using generalized estimating equation models.
Maternal mental distress levels were highest at 1 month postpartum. During postpartum periods, depression scores increased and social relations domain scores decreased in men. Although mental distress levels were higher in mothers than in fathers, parity evidently affected men. Experienced fathers were independently associated with a 70% higher risk of perinatal depression (odds ratio OR = 1.7, 95% confidence interval CI = 1.2–2.3) and anxiety (OR = 1.7, 95% CI = 1.2–2.6). Experienced fathers also exhibited significantly lower perinatal scores than first-time fathers in the physical health and social relations domains.
Selection of both parents in metropolitan areas with higher socioeconomic status may restrict the generalizability of our findings.
In addition to maternal mental distress during the transition to parenthood, we highlighted experienced fathers’ psychological difficulties throughout perinatal periods. Such trends may indicate unsatisfied needs and could guide timely intervention to prevent adverse consequences.
The level of vitamin D in pregnant women and the effect of vitamin D supplementation are lack in Taiwan.
To investigate the vitamin D serum level and the effect of its supplementation on pregnancy.
...We included 1048 pregnant women who underwent prenatal exam with known serum 25-hydroxyvitamin D3 25(OH)D3 levels and delivery at the Mackay Memorial Hospital, Taipei, Taiwan during 2015–2018. A daily dose 2000 IU of vitamin D was given, starting at 12–16 weeks of pregnancy, to reach the level of 20 ng/mL, and then a maintenance dose of 800 IU/day was given. The other 3654 women without vitamin D supplementation delivered in 2018 served as control group. Pregnancy outcomes were recorded for analysis.
Over 80% of the 1048 pregnant women were vitamin D deficiency. There was an inverse correlation between serum vitamin D levels and maternal body mass index (p = 0.0366). We compared 375 women with serum vitamin D levels increased above 30 ng/mL after supplementation with control group. The rates of preterm birth, low birth weight, and postpartum hemorrhage between these 2 groups were 6.67% vs. 11.19% (p = 0.007), 6.40% vs. 10.0% (p = 0.025), and 1.33% vs. 3.20% (p = 0.04), respectively.
Vitamin D deficiency is very prevalent in pregnant women, especially those with high BMI, in Taiwan. It can be corrected by adequate vitamin D supplementation, which may decrease the risk of pregnancy complications and bring benefits to the fetus.
Iron deficiency anemia (IDA) is a major health burden among women in Asia. Key issues in IDA management in Asia are under-diagnosis and under-treatment. The lack of Asia-specific guidelines, and ...suboptimal utilization of treatment compounds the management of IDA. To address these gaps, a panel of 12 experts in obstetrics, gynecology, and hematology from six regions in Asia convened to review current practices and clinical evidence and provide practical guidance on IDA diagnosis and management in Asian women. The Delphi approach was used to obtain objective opinions and attain consensus on statements pertaining to awareness, diagnosis, and management of IDA. In total, 79 statements attained consensus and are summarized to provide guidance on raising awareness of IDA and approaches for improved diagnosis and treatment of IDA among women in various settings: pregnancy, postpartum, heavy menstrual bleeding, gynecologic cancers, and perioperative care. This clinician-led consensus integrates appropriate recommendations based on clinical evidence and best practices and is intended to guide decision making in the management of iron deficiency/IDA in women. The expert panel raises a call for timely diagnosis and utilization of appropriate treatment, including use of high-dose intravenous iron, stringent blood management, and interdisciplinary collaboration, for optimization of IDA management among women in Asia.
Previous studies have stressed the importance of tobacco exposure for the mood disorders of depression and anxiety. Although a few studies have focused on perinatal women, none have specifically ...considered the effects of smoking and secondhand smoke exposure on perinatal suicidal ideation. Thus, this study aimed to investigate the relationships of smoking/secondhand smoke exposure status with suicidal ideation, depression, and anxiety from the first trimester to the first month post partum.
This cross-sectional study based on self-reported data was conducted at five hospitals in Taipei, Taiwan from July 2011 to June 2014. The questionnaire inquired about women's pregnancy history, sociodemographic information, and pre-pregnancy smoking and secondhand smoke exposure status, and assessed their suicidal ideation, depression, and anxiety symptoms. Logistic regression models were used for analysis.
In the 3867 women in the study, secondhand smoke exposure was positively associated with perinatal depression and suicidal ideation. Compared with women without perinatal secondhand smoke exposure, women exposed to secondhand smoke independently exhibited higher risks for suicidal ideation during the second trimester (odds ratio (OR) = 7.63; 95 % confidence interval (CI) = 3.25-17.93) and third trimester (OR = 4.03; 95 % CI = 1.76-9.23). Women exposed to secondhand smoke had an increased risk of depression, especially those aged 26-35 years (OR = 1.71; 95 % CI = 1.27-2.29).
Secondhand smoke exposure also considerably contributes to adverse mental health for women in perinatal periods, especially for the severe outcome of suicidal ideation. Our results strongly support the importance of propagating smoke-free environments to protect the health of perinatal women.
Objective
To explore the effectiveness of a nurse‐led mobile health (mHealth) intervention to prevent excessive gestational weight gain (GWG) in overweight and obese women.
Methods
A randomized ...controlled trial with an experimental study design. Ninety‐two pregnant women with body mass index (BMI) ≥25 kg/m2 at less than 17 weeks gestation were recruited from two prenatal clinics in northern Taiwan from January to June 2020. The experimental group used the MyHealthyWeight (MHW) app and a wearable activity tracker (WAT), and the controls received standard antenatal treatments with no mHealth‐based elements. Two hospital follow‐up visits were scheduled at 24–26 weeks in the second trimester and 34–36 weeks in the third trimester. A generalized estimating equation (GEE) was used to examine the trajectories and the effectiveness of mHealth on GWG.
Results
No difference in GWG was found between the intervention and control groups at baseline (p > 0.05). The GWG trajectory in the entire cohort of women with obesity exhibited a quadratic pattern (ß = 1.8, 95% confidence interval CI = 1.27–2.32), and intervention participants' weekly GWG was gained significantly lower than their controls in the second trimester (p < 0.05). Throughout the pregnancy, the mHealth intervention group had a significantly lower proportion of individuals who exceeded their GWG in both total (21.6% vs. 32.6%) and weekly weight gain (first trimester = 58.7% vs. 65.2%; second trimester = 45% vs. 67.4%; third trimester = 48.6% vs. 55.1%). In particular, among obese women in the third trimester, those in the intervention group gained less gestational weight than their controls. The adjusted body weight difference was 5.44 kg (p = 0.023), signifying the total GWG difference (3.30 vs. 8.74 kg) between the means of the two groups. The GEE model indicated that obese women who were aged 35 years, had prepregnancy exercise habits, perceived self‐efficacy of diet, and more physical activity tended to have low GWG (p < 0.05).
Conclusions
The nurse‐led mHealth‐based intervention shows promising results in significantly preventing excessive GWG among high‐BMI women. More effectiveness was found among the obese subgroup.
Clinical relevance
The mHealth‐based intervention would be successfully implemented by nurses to help high‐BMI women maintain their optimal body weight and promote healthy behavioral changes, particularly in diet and physical activity during pregnancy.
Although mobile devices are used ubiquitously, studies on their detrimental effects on preschoolers are limited. Furthermore, no study has considered shared reading and mobile device usage ...simultaneously. Therefore, this study examined the effects of mobile devices and shared reading on preschoolers' development along with the effects of maternal depression on this association.
Mothers of 202 children aged 2-5 years were recruited in Taiwan. Maternal self-reported questionnaires on mobile device usage, shared reading, and child's emotional and behavioral development were collected. Multiple linear regression models were used for analyses.
Mothers' higher usage time on mobile devices and an education level of college or less were significantly associated with the child's exceeding recommended use of mobile devices. Particularly among depressed mothers, preschoolers' exceeding recommended use of mobile devices was associated with more sleep (β = 9.87, 95% confidence interval CI = 1.34, 18.40) and attention (β = 7.20, 95% CI = 1.50, 12.91) problems, whereas shared reading was associated with less somatic complaints (β = -16.19, 95% CI = -32.22, -0.15) and withdrawn (β = -21.50, 95% CI = -40.52, -2.47), compared with their respective counterparts.
Our study suggested the beneficial effects of shared reading. Moreover, we highlighted the adverse effects of preschoolers' exceeding recommended use of mobile device on sleep and attention problems, especially for children of mothers with depression.
Abstract
Background
Although maternal mental illnesses have been found to influence child health and development, little is known about the impact of maternal positive well-being on child health and ...development. Therefore, this longitudinal study investigated the effects of prenatal subjective well-being on birth outcomes and child development by considering the potential modifier effect of parity.
Methods
Pregnant women in early stages of pregnancy were recruited at five selected hospitals in Taipei, Taiwan, during their prenatal appointments since 2011. Self-reported evaluations were conducted at seven time points up to 2 years postpartum. Linear regression and generalized estimating equation models were used for examination.
Results
Higher prenatal eudaimonic well-being was associated with longer gestational length (adjusted beta aβ = 0.36, 95% confidence interval CI = 0.03, 0.68) and higher birth weight (aβ = 124.71, 95% CI = 35.75, 213.66). Higher positive and negative affect were associated with longer gestational length (aβ = 0.38, 95% CI = 0.06, 0.70) and smaller birth weight (aβ = −93.51, 95% CI = −178.35, −8.67), respectively. For child’s outcomes, we found an association between higher prenatal eudaimonic well-being and decreased risks of suspected developmental delay, particularly for children of multiparous mothers (adjusted odds ratio = 0.18, 95% CI = 0.05, 0.70). Higher levels of prenatal depression and anxiety were significantly associated with increased risks of suspected developmental delay for children of primiparous mothers.
Conclusions
Positive prenatal maternal mental health may benefit birth outcomes and child development, particularly for children of multiparous mothers. Interventions for improving prenatal mental health may be beneficial for child development.
Maternal body mass index (BMI) and gestational weight gain (GWG) are believed to be associated with fetal conditions and maternal complications. The aim of this study was investigating the influence ...of maternal prepregnancy BMI and GWG on pregnancy outcomes and exploring the optimal GWG in Taiwanese singleton women.
Retrospective records of 8146 singleton pregnant women between 2017 and 2019, obtained from a tertiary center in Taiwan were reviewed, and the associations between maternal prepregnancy BMI, GWG, and perinatal outcomes were analyzed. The patients were divided into five groups based on prepregnancy BMIs, defined by Taiwan Health Promotion Administration, as underweight (BMI <18.5 kg/m2), normal-weight (18.5 ≤ BMI <24 kg/m2), overweight (24.0 ≤ BMI <27.0 kg/m2), mild obese (27.0 ≤ BMI <30 kg/m2) and moderate-to-severe obese (BMI ≥30.0 kg/m2), and the lowest risks of different complications were summarized in each group. Also, using the Institute of Medicine and Japanese guidelines as reference, the Taiwanese recommendations for GWG were revised.
The rate of cesarean section, hypertensive disorder, preeclampsia, preeclampsia with severe features, and preterm birth were higher in prepregnancy overweight and obese women than in normal-weight women (p < 0.05). In the Taiwanese population, the recommended GWG for underweight pregnant women is 11–15 kg, for normal-weight pregnant women, it is 9.4–13.5 kg, for overweight pregnant women, it is 7.9–11.4 kg, for mild obese pregnant women, it is 7.3–10 kg, and for moderate-to-severe obese pregnant women, it is 4.9–9 kg with lowest perinatal complications.
Unsatisfactory controlled prepregnancy weight (BMI ≥24) and inappropriate body weight gain during pregnancy can increase the risk of adverse pregnancy complications. Taiwanese GWG guidelines should be revised based on the characteristics and clinical data of the local population.
Aim
The percentage of medicine graduates opting for residency in obstetrics and gynecology (OB/GYN) has been decreasing in developed countries, including in Taiwan, Japan, and Korea. This ...multicountry study surveyed the OB/GYN residents affiliated with the Taiwan Association of Obstetrics and Gynecology (TAOG), the Japanese Society of Obstetrics and Gynecology (JSOG), and the Korean Society of Obstetrics and Gynecology (KSOG) to evaluate the factors affecting the choice of pursing OB/GYN.
Methods
A 17‐item questionnaire surveying the factors influencing the choice of pursuing a major medical specialty was translated into Japanese, Korean, and Chinese and administered to postgraduate OB/GYN residents between July 1, 2020, and August 31, 2020. Data on the participants' sex, age, and level of residency were collected. Responses were compared between countries and sexes.
Results
Residents of all three countries chose OB/GYN based on personal interest, and a sense of accomplishment in saving people's life. Other positive factors include improved quality of life; higher salaries; and more opportunity for new techniques, research, and promotion. The negative factors included medical litigations, longer work hours, and unsafe working environments. Korean residents had lower ratings in several items, including “support from family,” “safety of working environment,” and “effectiveness of the alternative dispute resolution system,” which, unlike Japan and Taiwan, is not a no‐fault compensation system for childbirth accidents.
Conclusions
The study findings can guide strategy making, such as decreasing workload and yet maintain training quality, to increase the number of medical students pursuing OB/GYN residency.
Women usually decrease their physical activity (PA) after becoming pregnant. The change in PA may influence their symptom distress (SD). The changes and correlations between SD and PA throughout ...pregnancy remain unclear.
The aims of this study were to describe PA and SD trajectories across all three trimesters and examine their correlations during pregnancy.
A repeated-measure longitudinal study with convenience sampling at a hospital in Northern Taiwan was performed. Participants were recruited at 8-16 weeks of gestation, and two follow-up visits were performed at 24-28 weeks of gestation (second trimester) and after 36 weeks of gestation (third trimester). A total of 225 participants completed the study. The participants completed the Pregnancy Physical Activity Questionnaire (PPAQ) and Pregnancy-related Symptom Disturbance Scale (PSD), and sociodemographic and prenatal variables were recorded.
Throughout pregnancy, SD decreased then increased, showing an overall upward trend, whereas PA showed the opposite pattern, increasing then decreasing, with an overall downward trend. Sedentary activity was positively correlated with both physical and psychological SD during the second and third trimesters. Exceeding the Institute of Medicine's recommendations for gestational weight gain, having childcare support, sport/exercise-type, and light-intensity PA were negatively associated with the physical and psychological SD, while a history of miscarriage and sedentary-intensity PA were positively associated with the physical and psychological SD.
While several factors, including light-intensity PA, were found negatively associated with the physical and psychological SD, sedentary-intensity PA were positively associated with the physical and psychological SD, our findings shed light on future intervention strategies to relieve SD and decrease sedentary behavior among pregnant women.
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