This study aimed to evaluate the effects of a supportive care intervention based on Swanson’s Caring Theory on infertility-related stress and coping strategies among women and their partners undergoing assisted reproductive treatment (ART). This single-blind randomized controlled trial was conducted with 100 couples undergoing ART at the IVF Center of Ondokuz Mayıs University Health Practice and Research Center, Türkiye. Couples were randomly assigned to either the intervention group receiving Swanson’s Caring Theory–based supportive care or the control group receiving routine care. Data were collected at baseline prior to treatment initiation (T1), pre–embryo transfer (T2), and one month following embryo transfer (T3). Infertility-related stress and coping strategies were assessed using the COMPI Fertility Problem Stress Scales and the COMPI Coping Strategy Scales. Repeated-measures ANOVA and t tests were used for analyses. Compared with controls, women and men in the intervention group demonstrated significantly greater reductions in infertility-related stress scores from T1 to T2 (all p < .001). Significant group × time interactions were also identified for active coping, meaning-based coping, active-avoidance coping, and passive-avoidance coping among both women and men (all p ≤ .010). Active coping and meaning-based coping increased over time in the intervention group, whereas passive-avoidance coping also increased during the active treatment phase. Exploratory analyses among participants with unsuccessful ART outcomes indicated lower infertility-related stress scores in the intervention group at T3. Women in the intervention group also reported lower active-avoidance coping scores, whereas both women and men reported higher active coping and meaning-based coping scores. Passive-avoidance coping scores decreased from T2 to T3 among intervention participants with unsuccessful ART outcomes. Supportive care grounded in Swanson’s Caring Theory may reduce infertility-related stress and influence coping responses among couples undergoing ART treatment. Although increases were observed in active and meaning-based coping, coping patterns were not uniformly adaptive across all domains and treatment stages. The findings support the potential value of integrating structured supportive care into routine IVF services; however, exploratory findings related to unsuccessful ART outcomes should be interpreted with caution. Trial registration ClinicalTrials.gov NCT07557069 (retrospectively registered).
Child maltreatment experiences may impact both mental and physical health in pregnancy and are associated with increased interpersonal difficulties. However, facets of psychosocial and physical health are interrelated, making it difficult to identify effects of maltreatment experiences. Therefore, this study aims to improve our understanding of how experiences of childhood maltreatment are associated with perinatal bio-psycho-social health employing an exploratory network approach. The analysis focused on whether there are differential effects of maltreatment subtypes, namely physical, sexual and emotional abuse as well as physical and emotional neglect. N = 131 pregnant women (gestational age of 10–20 weeks) answered questionnaires on their own child maltreatment experiences, depressive and anxiety symptoms, maternal-foetal attachment, social support and couple relationship quality. Additionally, medical information was collected from their maternity passports. We estimated a regularized partial correlation network to model the associations between these variables. Maltreatment experiences were associated with lower prenatal social support and higher prenatal depression scores, but not with pregnancy-related anxiety, maternal-foetal attachment and prenatal relationship quality. A link between maltreatment and medical risk emerged only in a reduced network model including only emotional child maltreatment subtypes, but not physical or sexual maltreatment. Among subtypes, emotional abuse and emotional neglect emerged as most central in the network. Emotional abuse and neglect experiences may function as risk factors for biopsychosocial health in early pregnancy. Thus, maltreatment experiences should be examined carefully in medical history. Their effects, especially regarding perceived social support, need to be addressed in prenatal care by gynaecologists and midwives.
Postpartum depression (PPD) is a prevalent psychological condition among birthing women. While several psycho-socio-economic and neurobiological factors influence its development, its relationship with smoking behavior and nicotine addiction remains largely inconclusive. In this combinatorial study, we first evaluate the relationship between smoking and depressive behaviors in postpartum women using data extracted from pertinent primary epidemiological studies. Additionally, to discern the molecular and cellular mechanisms underlying this association, we identified common genetic elements and evaluated their functional attributes using in silico analyses. Meta-analytical assessment of systematically collected data from 38 studies indicated that smoking women are twice as likely to develop PPD, compared to their non-smoking counterparts. While geocultural attributes did not affect this relationship, timing of smoking was a significant moderator, with current and gestational smoking statuses being more strongly linked with PPD outcome, compared to the past smoking habit. Further, depression scores in smoking postpartum women were higher than those in non-smoking controls. Analysis of the common protein-encoding genes underlying the pathophysiology of nicotine addiction and PPD revealed several critical hub proteins (viz., AKT1, JUN, CTNNB1, PTEN, EGFR, ESR1, SRC, STAT3, FN1, IL1B, IL6, TNF, TP53, GAPDH, INS, MYC, and ALB) which were predicted to alter multiple pathophysiological pathways associated with transcriptional expression, intra- and intercellular signaling transduction, metabolism, and immune functions. Our results indicate that smoking is strongly associated with depressive behavior in postpartum women, although this association involve mediation of additional environmental and psychosocial elements. Moreover, network analysis of common genetic elements identified several potentially disrupted neurophysiological pathways in postpartum women with smoking and depressive behaviors which may aid in characterizing the underlying relationship between the two conditions.
Few studies have examined the increased risk for pregnancy complications in women with autism spectrum disorder (ASD) diagnosis. The autism genetic propensity in relation to the complications of pregnancy and birth remains unknown, and is an area critical for informing maternal health and reproductive guidance. Here, we assessed whether maternal genetic liability to ASD is associated with pregnancy complications. The study comprised 28,985 females with at least one pregnancy-related record from the UK Biobank (UKB) cohort. Individual polygenic risk scores (PRS) for ASD were calculated, and pregnancy complications were defined using ICD-10 diagnostic codes. Associations between ASD PRS and pregnancy outcomes were evaluated using logistic regression models adjusted for maternal age at first conception. In the secondary analyses, we used schizophrenia (SCZ) PRS, and analyzed broader, ICD-based clusters of pregnancy outcomes. Maternal ASD PRS showed no nominally significant associations with pregnancy outcomes. Maternal SCZ PRS was nominally associated with a reduced risk of spontaneous delivery (O80) and forceps/vacuum delivery (O81); however, no associations remained significant after FDR correction. Higher genetic liability to ASD was not significantly associated with an increased risk of pregnancy complications in the UKB sample. Findings should be interpreted with caution, given the limitations of PRS, potential selection bias in UKB, and the relatively small sample size of females with pregnancy outcomes in the UKB. Autism PRS enables better understanding of aspects of autism that are otherwise limited by the small sizes of the clinical samples. The genetic liability captured by ASD PRS does not appear to predispose mothers to obstetric complications. The observed increase in obstetric diagnoses among autistic females may instead reflect other genetic influences that are not captured through PRS and/or environmental factors.
Depression is highly prevalent in middle-aged women (MAW), but head-to-head comparisons of first-line interventions in this population are scarce. This systematic review and individual participant data (IPD) meta-analysis examined the comparative efficacy of antidepressant medication (ADM) and interpersonal psychotherapy (IPT) for MAW (aged 40–64) versus other adults (men and non-MAW) on depression, quality of life, and interpersonal problem measures. PubMed, PsycINFO, Embase, and the Cochrane Library were searched January 1, 2025 to identify randomized trials comparing ADM and IPT for adults with depression. IPD were requested and analyzed using mixed-effects models. IPD were obtained from 9 of the 15 (60
Relationship satisfaction is a key factor in women’s mental health and wellbeing outcomes, however, relationship satisfaction may change in times of stress and uncertainty, such as the perinatal period. While positive romantic relationships during the perinatal period may offer benefits, changes in relationship satisfaction and what may contribute to them longitudinally is not currently well understood. One hundred and fifty-seven women in late pregnancy ( 30 weeks gestation) took part in a longitudinal analysis of relationship satisfaction from pregnancy to five years postpartum, across eight timepoints. The study is a secondary analysis of a randomised controlled trial of sleep and diet intervention. Latent growth modelling was used to examine the trajectory of relationship satisfaction change over time and explore predictors of this trajectory. There was a significant decline in relationship satisfaction both during pregnancy and the postpartum. Being of non-White race was associated with overall lower relationship satisfaction (p = 0.004). While being less financially comfortable (p = 0.007), having less than a postgraduate degree (p = 0.049), and older age (p = 0.026) were associated with steeper decrease in relationship satisfaction during the postpartum. This study demonstrates that relationship satisfaction declines from pregnancy to five years postpartum in a sample of Australian mothers. Minority race, financial comfortability, education level and age may influence the magnitude of this trajectory. These findings highlight a need to better support couples during this challenging time, not just through pregnancy and birth, but also through early childhood. Relationship satisfaction declined from late pregnancy to five years postpartum, in a sample of Australian mothers. The decline in relationship satisfaction was more significant for those less financially comfortable, with lower education attainment and older age. Although relationship satisfaction decreased through the perinatal period, it mostly remained within non-distress level.
Childbirth-related PTSD is a population-level postpartum mental health concern that remains under-recognized due to limited routine PTSD screening and symptom overlap with postpartum depression and anxiety. The condition is associated with impaired mother–infant bonding and is supported by converging biological evidence consistent with PTSD in other trauma-exposed populations. We propose that DSM-6 add a PTSD timing specifier, “with postpartum onset”, defined as the onset of PTSD symptoms within 4 weeks after delivery following a childbirth event that satisfies DSM Criterion A. A full PTSD diagnosis would still require that symptoms persist for more than 1 month, as required by DSM criteria. This targeted update could improve recognition, coding, screening pathways, and research harmonization for childbirth-related PTSD.
To investigate how unintended pregnancy (UP) is associated with the occurrence of mental health (MH) problems one year later among womxn, while also considering pregnancy outcome (abortion/continuation), co-occurring risks and protective factors. We examine this in the Dutch context, given available abortion care up to 24 weeks gestation and high diversity in people’s pregnancy intentions. We hypothesized that MH problems are more prevalent among those whose pregnancy was more unintended. Data from the Dutch BluePrInt study included both womxn who had an abortion (AB, n = 152) and who continued their UP (CT, n = 212). They filled out an online survey shortly after their abortion (AB) or around 14 weeks gestation (CT), and at follow-up one year later. Key variables included pregnancy intendedness (continuously measured), anxiety/depression symptoms (measured with a screening tool based on the CIDI), social- and partner support, abuse experiences, UP-related variables (difficulty deciding, uncertainty, pressure, and negative emotions) and socioeconomic position. 26.5
Antenatal depression (AD) is a mental health condition estimated to affect close to 30
ADHD is a neurodevelopmental disorder linked to impulsivity and self-regulation difficulties. While the association between ADHD and nicotine dependence is well-established, less is known about the association with smokeless tobacco use, such as snuff. Given the adverse health effects of nicotine during pregnancy, this study examines whether women diagnosed with ADHD are more likely to use snuff prior to and early in pregnancy, and whether they persist in use between these periods. This study also explores the associations between ADHD and snuff use in the presence of common psychiatric disorders: depression, anxiety and substance use disorders (SUDs). Using Swedish population-based registers, we identified women who gave birth between 2000 and 2020. ADHD was defined based on clinical diagnoses and/or ADHD medication prescriptions. Snuff use was self-reported during a prenatal care visit. Logistic regression models estimated odds ratios (ORs) with 95
Postpartum Depression (PPD) is the most common mental health complication of childbirth, and has short-term and long-term consequences for mother, child, and the entire family. PPD is a function of several factors. Prenatal exposure to nicotine (PEN) by Active Tobacco Smoking (ATS), Secondhand Smoking (SHS), or Electronic Nicotine Products (ENPs) is a major potential risk factor. This systematic review and meta-analysis aim to summarize and evaluate all evidence regarding the association between PEN and PPD. We searched the following databases, PubMed, Medline, Cochrane, EMBASE, and CINHAL, for studies published between Jan.1st ,2000 Sep.19th ,2024, with the outcome PPD. Studies quality was assessed using the Newcastle–Ottawa Scale. Pooled Prevalence (PP) was calculated using the Freeman-Tukey Double Arcsine Transformation method. Pooled Odds Ratio (pooled-OR) was estimated using a random-effects model. Sensitivity analysis was conducted using the leave-one-out technique. Of 29 studies in the systematic review, 26 included in the meta-analysis. PP of PPD was 0.15,(95
The peripartum period is a time of increased vulnerability to stress for women, yet no consensus definition of maternal peripartum stress exists. This paper reports work from European COST Action 22114 (TREASURE), which identified key concepts related to maternal peripartum stress in the literature and developed a consensus definition via a qualitative Delphi process involving 161 international researchers and clinicians. The resulting definition supports a shared understanding, enabling more targeted research and evidence-based clinical practice to improve perinatal care.
PurposeThe aim of this study is to better understand perinatal mental health research priorities of neurotypical and neurodivergent people.MethodsA co-designed mixed-methods survey was conducted as part of the Wellbeing Across Neurotypes: Depression and Anxiety (WANDA) study. 709 participants in the United Kingdom (UK) quantitatively rated and ranked research topics within perinatal mental health, with 253 also providing qualitative data.ResultsThe top research priorities were (1) interventions and (2) diagnosis for perinatal mental health problems for birthing people and (3) how these impact parent-infant relationships. Qualitative data revealed additional topics of importance including healthcare experiences, trauma, and neurodiversity.ConslusionsThese results suggest complex, multilevel barriers to accessing diagnosis and support in the UK.
Purpose This randomized controlled trial aimed to investigate the effect of Emotional Freedom Technique (EFT) on premenstrual syndrome, menstrual symptoms, and quality of life among nursing students. Methods The study was conducted with 80 nursing students enrolled at XXX University, who were randomly assigned to an experimental group (n = 40) and a control group (n = 40) using a pretest-posttest design. Data were collected using the Personal Information Form, Premenstrual Syndrome Scale, Menstrual Symptom Scale, Subjective Units of Distress Scale, and the SF-12 Health Survey. The experimental group received EFT interventions, while the control group received no intervention during the study period. Pre- and post-intervention measurements were obtained for both groups. Results Following the intervention, statistically significant differences were found between the experimental and control groups in Premenstrual Syndrome Scale, Menstrual Symptom Scale, and Subjective Units of Distress Scale and their subdimensions (p < 0.05). The experimental group also demonstrated significant improvements from pretest to posttest across these measures (p < 0.05). Regarding quality of life, the Mental Component Summary score of the SF-12 increased significantly in the experimental group (p < 0.05), whereas the Physical Component Summary score showed an increase that did not reach statistical significance (p > 0.05). Conclusions The findings suggest that EFT may be an effective complementary intervention for reducing premenstrual and menstrual symptoms and improving mental aspects of quality of life among nursing students. EFT may be considered a potentially supportive, non-pharmacological approach in the management of menstrual-related symptoms. Trial registration Clinical Trials.gov, NCT06557070.
This study aimed to evaluate the effects of a Mindfulness-Based Stress Reduction (MBSR) program on premenstrual symptom severity, pre-pregnancy fear of childbirth, and psychological well-being in women experiencing Premenstrual Syndrome (PMS). This randomized controlled trial was conducted with 126 women experiencing PMS between June 2023 and November 2025 (MBSR group: n = 63; control group: n = 63). The intervention group participated in an 8-session online MBSR program, delivered twice weekly (40 min per session), while the control group received no intervention. Data were collected using the Premenstrual Syndrome Scale (PMSS), the Childbirth Fear - Prior to Pregnancy Scale (CF-PPS), and the Psychological Well-being Scale (PWBS). Between-group differences were analyzed using analysis of covariance (ANCOVA) adjusting for baseline values, and effect sizes were reported using partial eta-squared (η²). The trial was retrospectively registered (ClinicalTrials.gov, NCT06942169). The MBSR intervention was associated with statistically significant improvements in all outcomes compared to the control group. Adjusted analyses indicated a significant reduction in premenstrual symptom severity (p < 0.001, η²=0.117) and fear of childbirth (p < 0.001, η²=0.125), as well as a significant increase in psychological well-being (p < 0.001, η²=0.285). These findings correspond to moderate effect sizes for PMSS and CF-PPS and a relatively large effect size for PWBS. The findings suggest that MBSR may be an effective non-pharmacological intervention for reducing premenstrual symptoms, decreasing pre-pregnancy fear of childbirth, and improving psychological well-being in women experiencing PMS. However, the results should be interpreted with caution due to the short-term nature of the assessment and the absence of long-term follow-up data.
PURPOSE:The transition to motherhood is characterized by increased stress and changes in coping behaviors, yet limited research has examined how different dimensions of parenting stress relate to maternal functioning and media use over time. Guided by the ABC-X model of family stress, this study examined longitudinal associations between parenting stress, maternal depressive symptoms, parenting self-efficacy (PSE), and media coping behaviors. METHODS:Longitudinal data were collected from 439 mothers across three yearly waves. Parenting stress was measured at Time 1, maternal depression at Times 1 and 2, and parenting efficacy at Times 1 and 3. Health app use was assessed via passive-sensing data, and mothers reported their use of media for emotion regulation at Time 3. Path analyses tested direct associations and moderation by maternal depressive symptoms, controlling for baseline PSE, depressive symptoms, household income, and frequency of cell phone checking at Time 1. RESULTS:Parental distress at Time 1 predicted lower PSE and greater media emotion regulation at Time 3. Maternal depressive symptoms further moderated these associations in distinct ways across outcomes. For media emotion regulation, difficult-child stress was associated with lower use only at higher levels of depressive symptoms. For PSE, depressive symptoms weakened the negative association between parent-child dysfunctional interaction and PSE, with stronger associations at lower levels of depression. No consistent associations emerged for health app use. CONCLUSIONS:Parental distress is a key predictor of maternal functioning, while other stress dimensions show context-dependent associations. Findings highlight the importance of distinguishing stress types and considering maternal emotional context when examining coping and adjustment.
Tokophobia refers to a clinically significant fear of childbirth that affects women across the reproductive lifespan. Given its prevalence and association with adverse mental health, obstetric, and reproductive decision-making outcomes, valid and reliable measures are essential to identify women at risk of tokophobia. Tokophobia Severity Scale (TSS) psychometric properties were analyzed in nulliparous non-pregnant, pregnant, and women in the postpartum using data from cross-sectional and longitudinal studies conducted in four countries: Australia, Lithuania, Poland, and Portugal. Sample (n = 1,585) comprised nulliparous non-pregnant (Poland, n = 559), pregnant (Lithuania, n = 197, Portugal, n = 353), and women at two months postpartum (Australia, n = 292; Lithuania, n = 184). Participants completed the TSS, and self-reported questionnaires on sociodemographic, obstetric, fetal/neonatal, mental health-related characteristics, depressive and anxiety symptoms, birth trauma perception, and another measure of fear of childbirth (FOC). Results supported a three-factor model: fear, coping, and intrusive thoughts. Invariance was found across childbearing-age periods and countries. Cronbach’s alpha and McDonald’s omega coefficients for the TSS total score were 0.89-0.90. Known-group validity was established with differences in sociodemographic, obstetric, fetal/neonatal, and mental health-related characteristics. Concurrent validity was found with depressive and anxiety symptoms, and birth trauma perception. Convergent validity was found with another FOC measure. TSS scores in pregnancy predicted elective cesarean section, birth trauma perception, and postpartum depressive and anxiety symptoms. TSS discriminates women with or without clinically significant tokophobia symptoms in childbearing-age periods and countries. TSS is a psychometrically strong measure that can be used to screen clinically significant tokophobia symptoms.
Faced with the crime of infanticide, all nations seek justice for both mothers and their infants. The psychopathology of childbirth and infanticide are among the most complex in human experience. This review takes the example of English law, and traces its evolution during four epochs, as knowledge increased and public attitudes changed. The combination of the 1922 Infanticide Act, recognizing the special circumstances of parturition, and the 1957 Homicide Act, with its concept of diminished responsibility, offer a solution worthy of consideration by other nations.
PurposeThe relationship between perinatal depression and breastfeeding is complicated and reciprocal. While breastfeeding may protect against postpartum depression, perinatal depression can also reduce the likelihood of breastfeeding. Using longitudinal data from Pakistan, we examine the effect of (1) breastfeeding on postpartum depression, stratified by prenatal depression and (2) perinatal depression on breastfeeding.MethodsData were drawn from the Bachpan study in Pakistan at five timepoints: pregnancy, delivery, 3-, 6-, and 12-months postpartum. Breastfeeding (any and exclusive [EBF]) was assessed using 24-hour recall; depression was measured with the Structured Clinical Interview for DSM-5 (SCID). Marginal structural models accounted for the time-varying relationship between depression and breastfeeding to estimate risk ratios (RR) and 95% confidence intervals (CI).ResultsAmong 1,014 postpartum individuals, weighted prevalence of any breastfeeding was 73.6% at delivery, 93.1% at 3-months, 86.1% at 6-months, and 73.0% at 12-months. EBF at 6-months was low (8.7%). Depression prevalence was 25.1% during the third trimester, 13.1% at 3-months, 10.8% at 6-months, and 15.7% at 12-months. Any breastfeeding was associated with a lower risk of postpartum depression (RR: 0.77; 95% CI: 0.51-1.03), though the CI included the null. In turn, perinatal depression reduced the likelihood of any breastfeeding (RR: 0.92; 95% CI: 0.84-0.99). EBF was similarly associated with a lower risk of postpartum depression (RR: 0.94; 95% CI: 0.68-1.20), though the CI also included the null. When stratified by prenatal depression, point estimates suggest that EBF may have a stronger association with lower depression risk among those without prenatal depression compared to those with prenatal depression (RR: 0.77 vs. RR: 1.03), though both CIs included the null.ConclusionsResults support a complex bidirectional relationship between breastfeeding and perinatal depression, where depression reduces breastfeeding likelihood and any breastfeeding shows possible protective associations with depression, though the benefits of EBF may differ by prenatal depression status.
