Recent Submissions

  • Review of mobile apps for women with anxiety in pregnancy: Maternity care professionals' guide to locating and assessing anxiety apps

    Rennick-Egglestone, Stefan (2022)
    BACKGROUNDMental health and pregnancy apps are widely available and have the potential to improve health outcomes and enhance women's experience of pregnancy. Women frequently access digital information throughout their pregnancy. However, health care providers and women have little information to guide them toward potentially helpful or effective apps.OBJECTIVEThis review aimed to evaluate a methodology for systematically searching and reviewing commercially available apps that support pregnant women with symptoms of anxiety in order to assist maternity care professionals in identifying resources that they could recommend for these women.METHODSA stepwise systematic approach was used to identify, select, describe, and assess the most popular and highly user-rated apps available in the United Kingdom from January to March 2021. This included developing a script-based search strategy and search process, writing evaluation criteria, and conducting a narrative description and evaluation of the selected apps.RESULTSUseful search terms were identified, which included nonclinical, aspirational, and problem-based phrases. There were 39 apps selected for inclusion in the review. No apps specifically targeted women with anxiety in pregnancy. Of the 39 apps included in the review, 33 (85%) focused solely on mind-body techniques to promote relaxation, stress reduction, and psychological well-being. Only 8 of the 39 (21%) apps included in the review reported that health care professionals had contributed to app development and only 1/39 (3%) provided empirical evidence on the effectiveness and acceptability of the app. The top 12/39 (31%) apps were evaluated by 2 independent reviewers using the developed criteria and scores. There was a small negative correlation between the reviewers' scores and app user rating scores, with higher user rating scores associated with lower reviewer scores.CONCLUSIONSApp developers, publishers, and maternity care professionals should seek advice from women with lived experience of anxiety symptoms in pregnancy to locate, promote, and optimize the visibility of apps for pregnant women. There is a lack of resources that provide coping strategies based on current evidence for the treatment of anxiety in pregnancy. Maternity care providers are limited in their ability to locate and recommend acceptable and trustworthy apps because of the lack of information on the evidence base, development, and testing of apps. Maternity care professionals and women need access to libraries of trusted apps that have been evaluated against relevant and established criteria.
  • A comparison of simultaneous and sequential visuo-spatial memory in children born very preterm

    Groom, Madeleine J. (2021)
    Research suggests that children born very preterm (≤32 weeks' gestation) are at greater risk of impairments in information processing (particularly when information is presented simultaneously rather than sequentially) and visuo-spatial short-term and working memory relative to children born at term. This study compared the performance of children born very preterm with their term-born peers to elucidate the nature of group differences in these areas. 113 children (65 very preterm; 48 term-born) aged 8-to-11 years completed four visuo-spatial recall tasks. Tasks varied by presentation type (simultaneous or sequential) and memory type (short-term or working memory). Both groups recalled more locations in simultaneous than sequential tasks, and in short-term than working memory tasks. In short-term memory tasks, children born at term recalled more locations than children born very preterm for the sequential task, but groups did not differ on the simultaneous task. The opposite pattern was observed in the working memory tasks, with no group differences on the sequential task, but better performance on the simultaneous task for children born at term. Our findings indicate that simultaneous processing may not be impaired in children born very preterm per se, with poorer performance observed only under high cognitive demand. This interaction suggests very preterm birth may affect the level of cognitive resources available during feature integration, the consequences of which become apparent when resources are already stretched. The impact of interactions with cognitive demand in this population should be an important consideration for educational support strategies, and for assessment in research and clinic.
  • Perinatal mental health amongst refugee and asylum-seeking women in the UK

    Hui, Ada; Stickley, Theodore (2020)
    Purpose: Refugee and asylum-seeking women are particularly vulnerable to experiencing mental health difficulties during the perinatal period, with social factors compounding these experiences. Research is limited into the mental health needs of perinatal women who are refugees or seeking asylum. The purpose of this paper is to examine the best available international evidence on this topic and to discuss the findings with relevance to the UK context. Design/methodology/approach: A modified population, intervention, comparison, outcome was used to formulate the research question and search strategy. Databases searched were: cumulative index of nursing and allied health literature, Medline, PsychINFO, Web of Science and Scopus. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis framework, results were screened against an inclusion and exclusion criteria. Each study underwent a quality assessment in which they were appraised using the mixed methods appraisal tool. Findings: Eight papers were retrieved, and a thematic analysis was conducted. Two major themes were identified: mental health needs and social influences. Refugees and asylum seekers are likely to have experienced trauma as reasons for migration. Post-migration stressors, including hostility and dispersal from social networks, lead to cumulative trauma. These each add to the mental health needs of perinatal refugee and asylum-seeking women that cannot be ignored by policymakers, health and social care services or professionals. Originality/value: Refugee and asylum-seeking women are particularly vulnerable to mental health difficulties in the perinatal period. Stressors accumulated pre-, during and post-migration to the host country exacerbate mental distress. In the UK, the treatment of this population may be detrimental to their mental health, prompting the need for greater critical awareness of the socioecological environment that refugee or asylum-seeking women experience. © 2020, Emerald Publishing Limited.
  • Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India

    Rathnaiah, Mohanbabu (2018)
    Background: More than one million babies are born with Low birthweight (LBW) in India every year, often afflicting disadvantaged families. Earlier studies on LBW in India have mostly focused on addressing poverty, nutritional status, and obstetric factors for LBW babies, comprising of preterm babies (<37 weeks) or small for gestational age (SGA) or both. We aim to find the association between antepartum depression and SGA in a public hospital. Methods: Pregnant women with gestational age between 14 to 32 weeks were recruited. The Edinburgh Postnatal Depression Scale (EPDS) was administered to assess depression. Newborn anthropometry was performed soon after delivery. Birth weight less than 10 percentile were classified as SGA, between 10 to 90th percentile was appropriate for gestational age (AGA), and greater than 90th percentile was large for gestational age (LGA). Results: We found that 16.51% (108) of the antenatal mothers had depressive symptoms (EPDS score >11). The women with depressive symptoms delivered a greater proportion of SGA babies (21.3 v/s 15.8) and LGA (9.3 v/s 3.3) compared to women with no symptoms. The odds of women giving birth to a child with SGA were twice as high for women with EPDS scores >11 (adjusted OR = 2.18; 95% CI = 1.23 - 3.87) compared to the women with EPDS scores of ≤11. In terms of Area under curve (AUC), EPDS 11 cut off (AUC: 0.533) narrowly outperformed EPDS 12 cut-off (AUC: 0.4738), which in turn was better than EPDS 13 cut off (AUC: 0.4687) for screening depression in mothers. Conclusions: We have demonstrated the usefulness of the 10-item EPDS screening tool in screening for symptoms of antenatal depression. There is a need to explore implementation of screening, diagnostic services and evidence-based antenatal mental health services by modifying the provisions of ongoing national programs.
  • Sociodemographic and medical risk factors associated with antepartum depression

    Rathnaiah, Mohanbabu (2018)
    Background: The increasing recognition of antenatal depression is an emerging area of concern in developing countries. We conducted a study to estimate the prevalence of antenatal mental distress and its relation with sociodemographic factors, obstetric factors, and physiological wellbeing in pregnant women attending public health facilities in Bengaluru, South India. Methods: Nested within a cohort study, we assessed the mental status in 823 pregnant women in two public referral hospitals. Kessler Psychological Distress Scale (K-10 scale) was used to assess maternal depression. We collected information related to social-demographic characteristics and recent medical complaints. Descriptive statistics and odds ratios were calculated using SPSS version 20. Results: Results show that 8.7% of the women exhibited symptoms of antenatal depression. Sociodemographic characteristics, such as respondent occupation, husband education, husband's occupation, total family income showed significance. First time pregnancy, anemia, and high blood pressure were also associated with mental distress. Conclusion: Our study has demonstrated feasibility of screening for mental health problems in public hospitals. Early detection of mental distress during pregnancy is crucial as it has a direct impact on the fetus. The public health facilities in low- and middle-income countries such as India should consider piloting and scaling up screening services for mental health conditions for pregnant women.
  • First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening

    Guo, Boliang (2017)
    Background: Down's syndrome occurs when a person has three, rather than two copies of chromosome 21; or the specific area of chromosome 21 implicated in causing Down's syndrome. It is the commonest congenital cause of mental disability and also leads to numerous metabolic and structural problems. It can be life-threatening, or lead to considerable ill health, although some individuals have only mild problems and can lead relatively normal lives. Having a baby with Down's syndrome is likely to have a significant impact on family life. Non-invasive screening based on biochemical analysis of maternal serum or urine, or fetal ultrasound measurements, allows estimates of the risk of a pregnancy being affected and provides information to guide decisions about definitive testing. Before agreeing to screening tests, parents need to be fully informed about the risks, benefits and possible consequences of such a test. This includes subsequent choices for further tests they may face, and the implications of both false positive and false negative screening tests (i.e. invasive diagnostic testing, and the possibility that a miscarried fetus may be chromosomally normal). The decisions that may be faced by expectant parents inevitably engender a high level of anxiety at all stages of the screening process, and the outcomes of screening can be associated with considerable physical and psychological morbidity. No screening test can predict the severity of problems a person with Down's syndrome will have. Objectives: To estimate and compare the accuracy of first trimester ultrasound markers alone, and in combination with first trimester serum tests for the detection of Down's syndrome. Search methods: We carried out extensive literature searches including MEDLINE (1980 to 25 August 2011), Embase (1980 to 25 August 2011), BIOSIS via EDINA (1985 to 25 August 2011), CINAHL via OVID (1982 to 25 August 2011), and The Database of Abstracts of Reviews of Effects (the Cochrane Library 2011, Issue 7). We checked reference lists and published review articles for additional potentially relevant studies. Selection criteria: Studies evaluating tests of first trimester ultrasound screening, alone or in combination with first trimester serum tests (up to 14 weeks' gestation) for Down's syndrome, compared with a reference standard, either chromosomal verification or macroscopic postnatal inspection. Data collection and analysis: Data were extracted as test positive/test negative results for Down's and non-Down's pregnancies allowing estimation of detection rates (sensitivity) and false positive rates (1-specificity). We performed quality assessment according to QUADAS criteria. We used hierarchical summary ROC meta-analytical methods to analyse test performance and compare test accuracy. Analysis of studies allowing direct comparison between tests was undertaken. We investigated the impact of maternal age on test performance in subgroup analyses. Main results: We included 126 studies (152 publications) involving 1,604,040 fetuses (including 8454 Down's syndrome cases). Studies were generally good quality, although differential verification was common with invasive testing of only high-risk pregnancies. Sixty test combinations were evaluated formed from combinations of 11 different ultrasound markers (nuchal translucency (NT), nasal bone, ductus venosus Doppler, maxillary bone length, fetal heart rate, aberrant right subclavian artery, frontomaxillary facial angle, presence of mitral gap, tricuspid regurgitation, tricuspid blood flow and iliac angle 90 degrees); 12 serum tests (inhibin A, alpha-fetoprotein (AFP), free beta human chorionic gonadotrophin (shCG), total hCG, pregnancy-associated plasma protein A (PAPP-A), unconjugated oestriol (uE3), disintegrin and metalloprotease 12 (ADAM 12), placental growth factor (PlGF), placental growth hormone (PGH), invasive trophoblast antigen (ITA) (synonymous with hyperglycosylated hCG), growth hormone binding protein (GHBP) and placental protein 13 (PP13)); and maternal age. The most frequently evaluated se um markers in combination with ultrasound markers were PAPP-A and free shCG. Comparisons of the 10 most frequently evaluated test strategies showed that a combined NT, PAPP-A, free shCG and maternal age test strategy significantly outperformed ultrasound markers alone (with or without maternal age) except nasal bone, detecting about nine out of every 10 Down's syndrome pregnancies at a 5% false positive rate (FPR). In both direct and indirect comparisons, the combined NT, PAPP-A, free shCG and maternal age test strategy showed superior diagnostic accuracy to an NT and maternal age test strategy (P &lt; 0.0001). Based on the indirect comparison of all available studies for the two tests, the sensitivity (95% confidence interval) estimated at a 5% FPR for the combined NT, PAPP-A, free shCG and maternal age test strategy (69 studies; 1,173,853 fetuses including 6010 with Down's syndrome) was 87% (86 to 89) and for the NT and maternal age test strategy (50 studies; 530,874 fetuses including 2701 Down's syndrome pregnancies) was 71% (66 to 75). Combinations of NT with other ultrasound markers, PAPP-A and free shCG were evaluated in one or two studies and showed sensitivities of more than 90% and specificities of more than 95%. High-risk populations (defined before screening was done, mainly due to advanced maternal age of 35 years or more, or previous pregnancies affected with Down's syndrome) showed lower detection rates compared to routine screening populations at a 5% FPR. Women who miscarried in the over 35 group were more likely to have been offered an invasive test to verify a negative screening results, whereas those under 35 were usually not offered invasive testing for a negative screening result. Pregnancy loss in women under 35 therefore leads to under-ascertainment of screening results, potentially missing a proportion of affected pregnancies and affecting test sensitivity. Conversely, for the NT, PAPP-A, free shCG and maternal age test strategy, detection rates and false positive rates increased with maternal age in the five studies that provided data separately for the subset of women aged 35 years or more. Authors' conclusions: Test strategies that combine ultrasound markers with serum markers, especially PAPP-A and free shCG, and maternal age were significantly better than those involving only ultrasound markers (with or without maternal age) except nasal bone. They detect about nine out of 10 Down's affected pregnancies for a fixed 5% FPR. Although the absence of nasal bone appeared to have a high diagnostic accuracy, only five out of 10 affected Down's pregnancies were detected at a 1% FPR.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
  • Urine tests for Down's syndrome screening

    Guo, Boliang (2015)
    Background: Down's syndrome occurs when a person has three copies of chromosome 21, or the specific area of chromosome 21 implicated in causing Down's syndrome, rather than two. It is the commonest congenital cause of mental disability and also leads to numerous metabolic and structural problems. It can be life-threatening, or lead to considerable ill health, although some individuals have only mild problems and can lead relatively normal lives. Having a baby with Down's syndrome is likely to have a significant impact on family life. The risk of a Down's syndrome affected pregnancy increases with advancing maternal age. Noninvasive screening based on biochemical analysis of maternal serum or urine, or fetal ultrasound measurements, allows estimates of the risk of a pregnancy being affected and provides information to guide decisions about definitive testing. Before agreeing to screening tests, parents need to be fully informed about the risks, benefits and possible consequences of such a test. This includes subsequent choices for further tests they may face, and the implications of both false positive and false negative screening tests (i.e. invasive diagnostic testing, and the possibility that a miscarried fetus may be chromosomally normal). The decisions that may be faced by expectant parents inevitably engender a high level of anxiety at all stages of the screening process, and the outcomes of screening can be associated with considerable physical and psychological morbidity. No screening test can predict the severity of problems a person with Down's syndrome will have. Objectives: To estimate and compare the accuracy of first and second trimester urine markers for the detection of Down's syndrome. Search methods: We carried out a sensitive and comprehensive literature search of MEDLINE (1980 to 25 August 2011), EMBASE (1980 to 25 August 2011), BIOSIS via EDINA (1985 to 25 August 2011), CINAHL via OVID (1982 to 25 August 2011), The Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2011, Issue 7), MEDION (25 August 2011), The Database of Systematic Reviews and Meta-Analyses in Laboratory Medicine (25 August 2011), The National Research Register (archived 2007), Health Services Research Projects in Progress database (25 August 2011). We studied reference lists and published review articles. Selection criteria: Studies evaluating tests of maternal urine in women up to 24 weeks of gestation for Down's syndrome, compared with a reference standard, either chromosomal verification or macroscopic postnatal inspection. Data collection and analysis: We extracted data as test positive or test negative results for Down's and non-Down's pregnancies allowing estimation of detection rates (sensitivity) and false positive rates (1-specificity). We performed quality assessment according to QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria. We used hierarchical summary ROC (receiver operating characteristic) meta-analytical methods to analyse test performance and compare test accuracy. We performed analysis of studies allowing direct comparison between tests. We investigated the impact of maternal age on test performance in subgroup analyses. Main results: We included 19 studies involving 18,013 pregnancies (including 527 with Down's syndrome). Studies were generally of high quality, although differential verification was common with invasive testing of only high-risk pregnancies. Twenty-four test combinations were evaluated formed from combinations of the following seven different markers with and without maternal age: AFP (alpha-fetoprotein), ITA (invasive trophoblast antigen), s-core fragment, free shCG (beta human chorionic gonadotrophin), total hCG, oestriol, gonadotropin peptide and various marker ratios. The strategies evaluated included three double tests and seven single tests in combination with maternal age, and one triple test, two double tests and 11 single tests without maternal age. Twelve of the 19 studies only evaluated the performance of a single test strategy while the re aining seven evaluated at least two test strategies. Two marker combinations were evaluated in more than four studies; second trimester s-core fragment (six studies), and second trimester s-core fragment with maternal age (five studies). In direct test comparisons, for a 5% false positive rate (FPR), the diagnostic accuracy of the double marker second trimester s-core fragment and oestriol with maternal age test combination was significantly better (ratio of diagnostic odds ratio (RDOR): 2.2 (95% confidence interval (CI) 1.1 to 4.5), P = 0.02) (summary sensitivity of 73% (CI 57 to 85) at a cut-point of 5% FPR) than that of the single marker test strategy of second trimester s-core fragment and maternal age (summary sensitivity of 56% (CI 45 to 66) at a cut-point of 5% FPR), but was not significantly better (RDOR: 1.5 (0.8 to 2.8), P = 0.21) than that of the second trimester s-core fragment to oestriol ratio and maternal age test strategy (summary sensitivity of 71% (CI 51 to 86) at a cut-point of 5% FPR). Authors' conclusions: Tests involving second trimester s-core fragment and oestriol with maternal age are significantly more sensitive than the single marker second trimester s-core fragment and maternal age, however, there were few studies. There is a paucity of evidence available to support the use of urine testing for Down's syndrome screening in clinical practice where alternatives are available.<br/>Copyright &#xa9; 2015 The Cochrane Collaboration.
  • First trimester serum tests for Down's syndrome screening

    Guo, Boliang (2015)
    Background: Down's syndrome occurs when a person has three, rather than two copies of chromosome 21; or the specific area of chromosome 21 implicated in causing Down's syndrome. It is the commonest congenital cause of mental disability and also leads to numerous metabolic and structural problems. It can be life-threatening, or lead to considerable ill health, although some individuals have only mild problems and can lead relatively normal lives. Having a baby with Down's syndrome is likely to have a significant impact on family life. Noninvasive screening based on biochemical analysis of maternal serum or urine, or fetal ultrasound measurements, allows estimates of the risk of a pregnancy being affected and provides information to guide decisions about definitive testing. However, no test can predict the severity of problems a person with Down's syndrome will have. Objectives: The aim of this review was to estimate and compare the accuracy of first trimester serum markers for the detection of Down's syndrome in the antenatal period, both as individual markers and as combinations of markers. Accuracy is described by the proportion of fetuses with Down's syndrome detected by screening before birth (sensitivity or detection rate) and the proportion of women with a low risk (normal) screening test result who subsequently had a baby unaffected by Down's syndrome (specificity). Search methods: We conducted a sensitive and comprehensive literature search of MEDLINE (1980 to 25 August 2011), Embase (1980 to 25 August 2011), BIOSIS via EDINA (1985 to 25 August 2011), CINAHL via OVID (1982 to 25 August 2011), The Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 25 August 2011), MEDION (25 August 2011), The Database of Systematic Reviews and Meta-Analyses in Laboratory Medicine (25 August 2011), The National Research Register (Archived 2007), Health Services Research Projects in Progress database (25 August 2011). We did forward citation searching ISI citation indices, Google Scholar and PubMed related articles'. We did not apply a diagnostic test search filter. We also searched reference lists and published review articles. Selection criteria: We included studies in which all women from a given population had one or more index test(s) compared to a reference standard (either chromosomal verification or macroscopic postnatal inspection). Both consecutive series and diagnostic case-control study designs were included. Randomised trials where individuals were randomised to different screening strategies and all verified using a reference standard were also eligible for inclusion. Studies in which test strategies were compared head-to-head either in the same women, or between randomised groups were identified for inclusion in separate comparisons of test strategies. We excluded studies if they included less than five Down's syndrome cases, or more than 20% of participants were not followed up. Data collection and analysis: We extracted data as test positive or test negative results for Down's and non-Down's pregnancies allowing estimation of detection rates (sensitivity) and false positive rates (1-specificity). We performed quality assessment according to QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria. We used hierarchical summary ROC meta-analytical methods or random-effects logistic regression methods to analyse test performance and compare test accuracy as appropriate. Analyses of studies allowing direct and indirect comparisons between tests were undertaken. Main results: We included 56 studies (reported in 68 publications) involving 204,759 pregnancies (including 2113 with Down's syndrome). Studies were generally of good quality, although differential verification was common with invasive testing of only high-risk pregnancies. We evaluated 78 test combinations formed from combinations of 18 different tests, with or without maternal age, ADAM12 (a disintegrin and metalloprotease), AFP (alpha-fetoprotein), inhibin, PAPP-A (pregnancy-associated plasma protein A, ITA free (beta human chorionic gonadotrophin), PlGF (placental growth factor), SP1 (Schwangerschafts protein 1), total hCG, progesterone, uE3 (unconjugated oestriol), GHBP (growth hormone binding protein), PGH (placental growth hormone), hyperglycosylated hCG, ProMBP (proform of eosinophil major basic protein), hPL (human placental lactogen), (free alphahCG, and free shCG to AFP ratio. Direct comparisons between two or more tests were made in 27 studies. Meta-analysis of the nine best performing or frequently evaluated test combinations showed that a test strategy involving maternal age and a double marker combination of PAPP-A and free shCG significantly outperformed the individual markers (with or without maternal age) detecting about seven out of every 10 Down's syndrome pregnancies at a 5% false positive rate (FPR). Limited evidence suggested that marker combinations involving PAPP-A may be more sensitive than those without PAPP-A. Authors' conclusions: Tests involving two markers in combination with maternal age, specifically PAPP-A, free and maternal age are significantly better than those involving single markers with and without age. They detect seven out of 10 Down's affected pregnancies for a fixed 5% FPR. The addition of further markers (triple tests) has not been shown to be statistically superior, the studies included are small with limited power to detect a difference. The screening blood tests themselves have no adverse effects for the woman, over and above the risks of a routine blood test. However some women who have a high risk' screening test result, and are given amniocentesis or chorionic villus sampling (CVS) have a risk of miscarrying a baby unaffected by Down's. Parents will need to weigh up this risk when deciding whether or not to have an amniocentesis or CVS following a high risk' screening test result.<br/>Copyright &#xa9; 2015 The Cochrane Collaboration.
  • Second trimester serum tests for Down's Syndrome screening

    Guo, Boliang (2012)
    Down's syndrome occurs when a person has three copies of chromosome 21 - or the specific area of chromosome 21 implicated in causing Down's syndrome - rather than two. It is the commonest congenital cause of mental retardation. Noninvasive screening based on biochemical analysis of maternal serum or urine, or fetal ultrasound measurements, allows estimates of the risk of a pregnancy being affected and provides information to guide decisions about definitive testing. A To estimate and compare the accuracy of second trimester serum markers for the detection of Down's syndrome. We carried out a sensitive and comprehensive literature search of MEDLINE (1980 to May 2007), EMBASE (1980 to 18 May 2007), BIOSIS via EDINA (1985 to 18 May 2007), CINAHL via OVID (1982 to 18 May 2007), The Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2007, Issue 1), MEDION (May 2007), The Database of Systematic Reviews and Meta-Analyses in Laboratory Medicine (May 2007), The National Research Register (May 2007), Health Services Research Projects in Progress database (May 2007). We studied reference lists and published review articles. A Studies evaluating tests of maternal serum in women at 14-24 weeks of gestation for Down's syndrome, compared with a reference standard, either chromosomal verification or macroscopic postnatal inspection. Data were extracted as test positive/test negative results for Down's and non-Down's pregnancies allowing estimation of detection rates (sensitivity) and false positive rates (1-specificity).A We performed quality assessment according to QUADAS criteria. We used hierarchical summary ROC meta-analytical methods to analyse test performance and compare test accuracy. Analysis of studies allowing direct comparison between tests was undertaken. We investigated the impact of maternal age on test performance in subgroup analyses. Fifty-nine studies involving 341,261 pregnancies (including 1,994 with Down's syndrome) were included. Studies were generally high quality, although differential verification was common with invasive testing of only high-risk pregnancies. Seventeen studies made direct comparisons between tests. Fifty-four test combinations were evaluated formed from combinations of 12 different tests and maternal age; alpha-fetoprotein (AFP), unconjugated oestriol (uE3), total human chorionic gonadotrophin (hCG), free beta human chorionic gonadotrophin (I²hCG), free alpha human chorionic gonadotrophin (I±hCG), Inhibin A, SP2, CA125, troponin, pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PGF) and proform of eosinophil major basic proteinA (ProMBP).Meta-analysis of 12 best performing or frequently evaluated test combinations showed double and triple tests (involving AFP, uE3, total hCG, free I²hCG) significantly outperform individual markers, detecting six to seven out of every 10 Down's syndrome pregnancies at a 5% false positive rate. Tests additionally involving inhibin performed best (eight out of every 10 Down's syndrome pregnancies) but were not shown to be significantly better than standard triple tests in direct comparisons. Significantly lower sensitivity occurred in women over the age of 35 years. Women who miscarried in the over 35 group were more likely to have been offered an invasive test to verify a negative screening results, whereas those under 35 were usually not offered invasive testing for a negative screening result. Pregnancy loss in women under 35 therefore leads to under ascertainment of screening results, potentially missing a proportion of affected pregnancies and affecting the accuracy of the sensitivity. Tests involving two or more markers in combination with maternal age are significantly more sensitive than those involving one marker. The value of combining four or more tests or including inhibin have not been proven to show statistically significant improvement. Further study is required to investigate reduced test performance in women aged over 35 and the impact of differential pregnancy loss on study findings.[CINAHL N te: The Cochrane Collaboration systematic reviews contain interactive software that allows various calculations in the MetaView.]
  • Renal colic and childbirth pain: Female experience versus male perception

    Clayton, Lucy (2017)
    Renal colic is often described by patients as the worst pain ever experienced.1 Pain during childbirth is also similarly described.2 To date, no study has comparatively evaluated the pain of renal colic to that of childbirth in female patients who have experienced both. Furthermore, no such study has evaluated the perception that men with renal colic have with respect to the pain experienced during childbirth. Here we present our cross-sectional observational study to address these questions. The primary objectives of our study were to answer these questions and highlight the severity of renal colic which is not always faced and treated aggressively.
  • Antenatal support for people with learning disabilities

    Harrison, Ruth (2015)
    Following the introduction of learning disability nurses in acute and primary care in 2009, several health areas were taken into consideration as a priority for change. Maternity services were considered in order to bring this area into line with the other parts of the UK. This article will examine the provision of services for people with learning disabilities, and identify areas for improvement including educational needs for midwives. Outcomes of an audit and evaluations of local services against national policy and provision will be highlighted, barriers faced by both prospective parents with a learning disability and by professionals will be discussed and recommendations for future practice will be presented. Misleading diagnosis, discrepancies in numbers and training developments will also be addressed. Despite Government policy identifying that 'reasonable adjustment' must be made when supporting parents with a learning disability, 23 midwives, team managers and health care assistants in midwifery services in Nottinghamshire have highlighted that there is little awareness in the field locally.
  • Long-term psychosocial sequelae of stillbirth: Phase II of a nested case-control cohort study

    Evans, Chris (2009)
    Stillbirth is associated with increased psychological morbidity in the subsequent pregnancy and puerperium. This study aimed to assess longer-term psychological and social outcomes of stillbirth and to identify factors associated with adverse outcome. We conducted seven-year follow-up of a cohort of women who were initially assessed during and after a pregnancy subsequent to stillbirth, together with pair-matched controls. All women were living with a partner at baseline and none had live children. Measured outcomes at follow-up included depression, posttraumatic stress disorder (PTSD) and partnership breakdown. Comparison variables included social and psychological factors and, for the stillbirth group, factors relating to the lost pregnancy. There were no differences between groups in case level psychological morbidity, but significantly higher levels of PTSD symptoms persisted in stillbirth group mothers who had case level PTSD 7 years earlier. Stillbirth group mothers were more likely to have experienced subsequent partnership breakdown. In the stillbirth group such breakdown was associated with having held the stillborn infant and having had case-level PTSD. Interpretations and clinical implications of these findings are discussed.
  • Psychosocial care of mothers after stillbirth [1] (multiple letters)

    Turton, Penelope; Hopper, Earl; Evans, Chris (2002)
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  • Smoking in pregnancy: The role of the transtheoretical model and the mother's attachment to the fetus

    Laxton-Kane, Martha (2006)
    This study investigated whether pregnant smokers demonstrated cognitive and behavioural patterns hypothesised to underpin the different stages of change (SOC) and whether fetal attachment varied according to this process. A cross-sectional design with women categorised by SOC was used and the sample was recruited from hospital maternity services in the U.K. at their booking clinics with a mean gestation of 14 weeks. Experiential and behavioural processes together with self-efficacy and attachment to the fetus were measured in 637 women. As predicted by the transthoretical model experiential processes were used mostly by women in contemplation and preparation; behavioural processes mostly by women in preparation and action. However, self-efficacy remained constant between precontemplation, contemplation and preparation, but women in action showed significantly higher levels. Women in preparation were significantly more attached to the fetus than women in precontemplation and never smokers. The relevance of the transtheoretical model with pregnant smokers is supported. Foetal attachment may be differentially associated with different SOC in smoking cessation and yield potential for the development of new interventions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(journal abstract)
  • How do memory processes relate to the development of posttraumatic stress symptoms following childbirth?

    Briddon, Emma (2011)
    Some women develop posttraumatic stress symptoms (PTSS) following childbirth but little is known about memory processes following childbirth. Models of traumatic memory debate the role of memory disorganization. This study investigates whether there is an association between memory disorganization and PTSS in new mothers. One hundred and twenty-two women were recruited within 72 h of giving birth, completing measures of cognitive and emotional experience, and analgesia, and a narrative account of the birth. 68 of these women responded to a six-week follow-up and completed measures of memory disorganization and PTSS. There was a relationship between memory disorganization and PTSS at follow-up, but not at recruitment. The organization of the immediate narrative may not distinguish between those who later do or do not develop symptoms. Emotional evaluation may be the key factor in facilitating or inhibiting the memory construction process, linking memory to subsequent disorganization and hence to symptoms. (C) 2011 Elsevier Ltd. All rights reserved.
  • Psychiatric causes of maternal deaths: Lessons from the confidential enquiries into maternal deaths

    Oates, Margaret R. (2014)
    The UK Confidential Enquiries into Maternal Deaths, published triennially, are over 50 years old. Its forebears are even older; enquiries into maternal deaths began early in the 19th century in Scotiand. In the 20th century the numbers of women dying from childbirth has steadily declined, influenced by many factors, including improved public health and maternity care, smaller family size, blood transfusions, and antibiotics, to name but a few. The introduction of the Abortion Act in 1967 was followed by a marked reduction of deaths in pregnancy from the consequences of illegal abortion. The rate and causes of maternal death have always been influenced by changes in reproductive epidemiology and technology, and continue to be so. This chapter discusses maternal death and the influences of maternal psychiatric disorder. Psychiatric disorder increases the risk of maternal death. Late pregnancy and the early puerperium increases the risk of suicide. The risks are reducible. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(chapter)
  • The relationships between induced abortion, attitudes towards sexuality and sexual problems

    Bradshaw, Zoe; Slade, Pauline (2005)
    This study aimed to investigate whether abortion is associated with (i) changes in attitudes and feelings towards sexual matters (erotophobia-erotophilia), (ii) sexual problems, and (iii) whether erotophobia-erotophilia and sexual problems are associated. Ninety-eight women having a first-trimester abortion were investigated together with a comparison sample of 51 non-pregnant women. Standardised questionnaires assessing sexual problems and attitudes and feelings towards sexual matters were completed by the study sample (prior to and 2 months after abortion) and the non-pregnant comparison sample. The findings indicated that attitudes and feelings towards sexual matters were similar in the study and comparison sample, and were more positive 2 months after the abortion than prior to it. More sexual problems were experienced following the discovery of the pregnancy than prior to the pregnancy or in the 2 months after abortion. Levels of sexual problems reported by the study sample prior to pregnancy and by the comparison sample were similar. Erotophobia-erotophilia and sexual problems were moderately correlated in the study sample. In conclusion, becoming pregnant did not appear to affect erotophobia-erotophilia, but having the abortion was followed by more positive attitudes and feelings towards sexual matters. Becoming pregnant had short-term negative effects on sexual relationships but these were not sustained following abortion. © British Association for Sexual and Relationship Therapy.
  • Parental guidance

    Ring, Judith (2008)
    Perinatal mental illness is a growing cause for concern among carers involved with child-bearing women.
  • Invited commentaries on . . . Abortion and mental health disorders

    Oates, Margaret R. (2008)
    The finding that induced abortion is a risk factor for subsequent psychiatric disorder in some women raises important clinical and training issues for psychiatrists. It also highlights the necessity for developing evidence-based interventions for these women. P.C. / Evidence suggesting a modest increase in mental health problems after abortion does not support the prominence of psychiatric issues in the abortion debate, which is primarily moral and ethical not psychiatric or scientific. M.O. et al.

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