No abstract

Objective To examine the role of psychosocial risk factors for low birthweight.Design A prospective study.Setting Obstetric outpatient clinics of the University Hospital Vrije Universiteit, Amsterdam.Participants Three hundred and ninety-six nulliparous women.Methods Questionnaires on background variables, daily stressors, psychological and mental wellbeing, social support and work factors were completed by the women in the first, second and third trimester of pregnancy. Low birthweight for gestational age was defined at different cut off points: 1. I 10th customised birthweight centile (n = 69); 2 . 5 5th customised birthweight centile (n = 54); 3. c 3rd customised birthweight centile (n = 35); and 4. I the 10th Dutch birthweight centile ( n = 40). Multivariate logistic regression was applied and the results were expressed in odds ratios and their 95% confidence intervals. ResultsWhen the cut off level was defined I 5th and < 3rd customised centile, the number of daily stressors in the first trimester was a statistically significant risk factor (OR 1.04, 95% CI 1.01-1.07 and OR 1.04,95% CI 1.01-1.08). No significant psychosocial risk factors could be identified when low birthweight for gestational age was defined I the 10th customised birthweight centile. When low birthweight for gestational age was defined I the 10th Dutch birthweight centile, number of hours housekeeping per week in the first trimester (OR 1.59, 95% CI 1.03-2.46), low subjective severity rating of daily stressors in the first trimester (OR 0.41,95% CI 0.17497) and depressive mood in the first trimester (OR 1.12, 95% CI 1.01-1.24) were statistically significant psychosocial risk factors after controlling for maternal weight and height, number of cigarettes smoked per day and educational level. ConclusionsIn the fist trimester of pregnancy maternal psychosocial factors are associated with an increased risk of low birthweight. The specific psychosocial risk factors found were different when the definition of low birthweight was changed. Therefore, in this field of research, we suggest use of the most valid outcome measure for low birthweight, being the customised birthweight centiles.

In this Dutch study, 1 in 100 women had PTSD following childbirth, with no differences between home- and hospital deliveries after controlling for complications and interventions. Emergency cesarean section, severe labor pain, and poor coping skills were associated with more posttraumatic stress symptoms.

After completion of this article, the reader should be able to summarize that there is still no worldwide consensus on the diagnosis, management, and adverse effects of Gestational Diabetes Mellitus (GDM); explain that all methods of screening vary in sensitivity and depend on very strict preparations for screening; state that there is no agreement on ideal levels of blood glucose to prevent untoward effects; and recall that there are two very large prospective studies that clarify the dark waters and that we should await their results.

The aim of the current study was to investigate the effects of psychosocial variables on well-being and on pregnancy-related complaints throughout pregnancy. Three hundred and ninety-six nulliparous women completed questionnaires on number of daily stressors, social support, gestational factors and mental and physical work load in each trimester of pregnancy. In addition, the following dependent measures were assessed: depression, anxiety, somatic complaints, and the pregnancy-related complaints fatigue, nausea and back pain. The independent variables predicted depression best (r2 = 42-44%), followed by anxiety (R2 = 13-20) and somatic complaints (R2 = 16-21%). Number of daily stressors explained most of the variance. Satisfaction with social support and maternal age were negatively correlated with depression. In contrast, pregnancy-related complaints could be less accurately predicted by psychosocial factors. The amount of explained variance for fatigue ranged between 6 and 10%, for nausea between 2 and 6%, and for back pain between 5 and 7% for the three trimesters. It is concluded that depressive symptoms during pregnancy are associated with negative psychosocial factors, particularly the number of daily stressors and low satisfaction with received social support. To a lesser degree, this is also the case with anxiety and somatic complaints. Pregnancy-related complaints, on the other hand, appear to be relatively independent of psychosocial conditions.