Prevention of perinatal mental disorders in women of advanced maternal age with pregnancy resulted from assisted reproduction

Abstract

Women of advanced maternal age (AMA) with pregnancies resulting from assisted reproductive technology (ART) have a high risk of the onset and progression of anxious and depressive disorders, associated with adverse obstetric and perinatal outcomes.
 The aim. To improve the mental well-being of pregnant AMA women after ART using the developed algorithm of preventive psychological support.
 Materials and methods. The prospective study comprised 150 patients divided into three equal groups of 50 nulliparous women aged 35–45 years with a singleton pregnancy in the cephalic presentation: the main group consolidated of pregnant women after ART who have got routine psychological support; patients with a pregnancy after ART included to the comparison group and patients with a spontaneous pregnancy from the control group were not consulted routinely.
 To estimate the psychological condition of the patients the level of maternal anxiety using the Spielberg State-Trait Anxiety Inventory (STAI); sleep quality using Pittsburgh Sleep Quality Index (PSQI); the presence of depressive manifestations using Edinburgh Postnatal Depression Scale (EPDS) were assessed.
 Results. We did not observe a significant difference in trait (TA) and state anxiety (SA) levels between the main and comparison groups at terms of 22–24 weeks of gestation; however, these values were significantly lower in the control group. The numbers of patients with high TA and SA levels in the main and comparison groups were also significantly higher than in the control group (p<0.05). We observed no significant increase in TA and SA levels in the main group at gestational terms of 35–37 weeks, in contrast to the comparison and control group. The number of patients with high TA and SA levels in the main group remained significantly lower than in the comparison group. A gradual decrease in TA and SA levels in all groups was observed in the postpartum period, but the differences between the groups remained consistent.
 We did not observe a significant difference in sleep quality score between the study groups at terms of 22–24 weeks of gestation. Patients of all study groups reported sleep disturbance with the pregnancy progression, but average PSQI values at terms of 35–37 weeks of gestation and 6-8 weeks after delivery were significantly lower in the main group compared to the comparison group.
 The incidence and severity of postnatal depressive symptoms, along with the number of patients at high risk of developing depression in the postpartum, were significantly lower in the main group than in the comparison group.
 Conclusions. AMA patients after ART formed a high-risk group for developing anxious and depressive disorders during the pregnancy and postpartum. High anxiety levels compromised sleep patterns have leaded to poorer quality of life of women. Preventive psychological support for patients during the pregnancy and postpartum enabled early detection and correction of depressive symptoms; validly reduced anxiety levels, improved sleep quality and consequently improved the quality of life of women and prevented adverse obstetric, perinatal, and psychiatric outcomes

Management of pregnancy, delivery, and postpartum in patients of advanced maternal age with pregnancies obtained by assisted reproductive technologies

“…Ризик розвитку масивної акушерської кровотечі для цих пацієнток більше ніж у 5 разів вищий, ніж у пацієнток цього самого віку зі спонтанною вагітністю, до того ж для цих жінок характерна висока частота гестаційної анемії [11,12]. Окрім цього, для даної когорти жінок притаманні високі рівні тривожності та виражені порушення сну під час вагітності та у післяпологовий період [12][13][14][15][16].…”