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

Keywords: advanced maternal age, assisted reproduction, maternal anxiety, postpartum depression

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

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Author Biographies

Anna Rubinshtein, Shupyk National Healthcare University of Ukraine; Leleka Maternity Hospital

Department of Obstetrics and Gynecology No. 1

Oleg Golyanovskiy, Shupik National Healthcare University of Ukraine

Department of Obstetrics and Gynecology No. 1

References

Screening for perinatal depression: Committee Opinion No. 630 (2015). Obstetrics & Gynecology, 125, 1268–1271. doi: http://doi.org/10.1097/01.aog.0000465192.34779.dc

Thorsness, K. R., Watson, C., LaRusso, E. M. (2018). Perinatal anxiety: approach to diagnosis and management in the obstetric setting. American Journal of Obstetrics and Gynecology, 219 (4), 326–345. doi: http://doi.org/10.1016/j.ajog.2018.05.017

Williams, K. E., Koleva, H. (2018). Identification and Treatment of Peripartum Anxiety Disorders. Obstetrics and Gynecology Clinics of North America, 45 (3), 469–481. doi: http://doi.org/10.1016/j.ogc.2018.04.001

Guardino, C. M., Dunkel Schetter, C. (2014). Understanding pregnancy anxiety: concepts, correlates and consequences. Zero to Three, 12–21.

Misri, S., Abizadeh, J., Sanders, S., Swift, E. (2015). Perinatal Generalized Anxiety Disorder: Assessment and Treatment. Journal of Women’s Health, 24 (9), 762–770. doi: http://doi.org/10.1089/jwh.2014.5150

Bayrampour, H., Vinturache, A., Hetherington, E., Lorenzetti, D. L., Tough, S. (2018). Risk factors for antenatal anxiety: A systematic review of the literature. Journal of Reproductive and Infant Psychology, 36 (5), 476–503. doi: http://doi.org/10.1080/02646838.2018.1492097

Koukopoulos, A., Mazza, C., De Chiara, L., Sani, G., Simonetti, A., Kotzalidis, G. D. et. al. (2021). Psychometric Properties of the Perinatal Anxiety Screening Scale Administered to Italian Women in the Perinatal Period. Frontiers in Psychiatry, 12. doi: http://doi.org/10.3389/fpsyt.2021.684579

Ding, X.-X., Wu, Y.-L., Xu, S.-J., Zhu, R.-P., Jia, X.-M., Zhang, S.-F. et. al. (2014). Maternal anxiety during pregnancy and adverse birth outcomes: A systematic review and meta-analysis of prospective cohort studies. Journal of Affective Disorders, 159, 103–110. doi: http://doi.org/10.1016/j.jad.2014.02.027

Yedid Sion, M., Harlev, A., Weintraub, A. Y., Sergienko, R., Sheiner, E. (2015). Is antenatal depression associated with adverse obstetric and perinatal outcomes? The Journal of Maternal-Fetal & Neonatal Medicine, 29 (6), 863–867. doi: http://doi.org/10.3109/14767058.2015.1023708

Abbas Sadeghian, A., Moghadam, K. B., Baradaran, R., Esmaeilzadeh, M. H. (2019). Evaluation of the Relationship between Prenatal Anxiety and Intra-cesarean Hemorrhage. International Journal of Medical Investigation, 8 (3), 40–46.

Tsakiridis, I., Bousi, V., Dagklis, T., Sardeli, C., Nikolopoulou, V., Papazisis, G. (2019). Epidemiology of antenatal depression among women with high-risk pregnancies due to obstetric complications: a scoping review. Archives of Gynecology and Obstetrics, 300 (4), 849–859. doi: http://doi.org/10.1007/s00404-019-05270-1

Sedov, I. D., Anderson, N. J., Dhillon, A. K., Tomfohr‐Madsen, L. M. (2020). Insomnia symptoms during pregnancy: A meta‐analysis. Journal of Sleep Research, 30 (1). doi: http://doi.org/10.1111/jsr.13207

De Chiara, L., Mazza, C., Ricci, E., Koukopoulos, A. E., Kotzalidis, G. D., Bonito, M. et. al. (2021). The Relevance of Insomnia in the Diagnosis of Perinatal Depression: Validation of the Italian Version of the Insomnia Symptom Questionnaire. International Journal of Environmental Research and Public Health, 18 (23), 12507. doi: http://doi.org/10.3390/ijerph182312507

Accortt, E. E., Wong, M. S. (2017). It Is Time for Routine Screening for Perinatal Mood and Anxiety Disorders in Obstetrics and Gynecology Settings. Obstetrical & Gynecological Survey, 72 (9), 553–568. doi: http://doi.org/10.1097/ogx.0000000000000477

Waldenström, U. (2016). Postponing parenthood to advanced age. Upsala Journal of Medical Sciences, 121 (4), 235–243. doi: http://doi.org/10.1080/03009734.2016.1201553

Laopaiboon, M., Lumbiganon, P., Intarut, N., Mori, R., Ganchimeg, T. et. al. (2014). Advanced maternal age and pregnancy outcomes: a multicountry assessment. BJOG: An International Journal of Obstetrics & Gynaecology, 121, 49–56. doi: http://doi.org/10.1111/1471-0528.12659

Gong, X., Hao, J., Tao, F., Zhang, J., Wang, H., Xu, R. (2013). Pregnancy loss and anxiety and depression during subsequent pregnancies: data from the C-ABC study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 166 (1), 30–36. doi: http://doi.org/10.1016/j.ejogrb.2012.09.024

Bedaso, A., Adams, J., Peng, W., Sibbritt, D. (2021). The association between social support and antenatal depressive and anxiety symptoms among Australian women. BMC Pregnancy and Childbirth, 21 (1). doi: http://doi.org/10.1186/s12884-021-04188-4

Deligiannidis, K. M., Freeman, M. P. (2014). Complementary and alternative medicine therapies for perinatal depression. Best Practice & Research Clinical Obstetrics & Gynaecology, 28 (1), 85–95. doi: http://doi.org/10.1016/j.bpobgyn.2013.08.007

Goodman, J. H., Guarino, A., Chenausky, K., Klein, L., Prager, J., Petersen, R. et. al. (2014). CALM Pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety. Archives of Women’s Mental Health, 17 (5), 373–387. doi: http://doi.org/10.1007/s00737-013-0402-7

Milgrom, J., Gemmill, A. W., Ericksen, J., Burrows, G., Buist, A., Reece, J. (2015). Treatment of postnatal depression with cognitive behavioural therapy, sertraline and combination therapy: A randomised controlled trial. Australian & New Zealand Journal of Psychiatry, 49 (3), 236–245. doi: http://doi.org/10.1177/0004867414565474

Pugh, N. E., Hadjistavropoulos, H. D., Dirkse, D. (2016). A Randomised Controlled Trial of Therapist-Assisted, Internet-Delivered Cognitive Behavior Therapy for Women with Maternal Depression. PLOS ONE, 11 (3), e0149186. doi: http://doi.org/10.1371/journal.pone.0149186


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Published
2022-03-31
How to Cite
Rubinshtein, A., & Golyanovskiy, O. (2022). Prevention of perinatal mental disorders in women of advanced maternal age with pregnancy resulted from assisted reproduction. EUREKA: Health Sciences, (2), 10-16. https://doi.org/10.21303/2504-5679.2022.002372
Section
Medicine and Dentistry