Long-Term Maternal Mental Health after Spontaneous Preterm Birth

Abstract

Objective The aim of this study is to investigate whether a history of spontaneous preterm birth (SPTB) is associated with maternal depressive and anxiety symptoms, or psychosocial distress in the fifth decade of life.

Study Design This is a secondary analysis of the PreCaris-study, a prospective observational study in which we included 350 women with a history of SPTB between 22^0/7 and 36^6/7 weeks of gestation and compared them to 115 women who had a term birth. Primary outcomes were the Depression and Anxiety scores measured using the Hospital Anxiety Depression Scale and Psychosocial distress assessed with the Distress Thermometer for Parents. Secondary outcomes were self-reported impact of the birth in daily life and psychosocial support after delivery.

Results After a median of 13 years after delivery, no significant differences were found in primary outcomes. Significantly more women with a history of SPTB reported that the birth still had impact in daily life; adjusted odds ratio: 2.46 (95% confidence interval: 1.35–4.48). A total of 57 (16.3%) women after SPTB reported to have needed professional psychosocial support after delivery but did not receive it. These women more often had a high Anxiety score (p = 0.030), psychosocial distress (p = 0.001), and influence of birth in daily life (p = 0.000).

Conclusion There are no long-term effects on depressive and anxiety symptoms and psychosocial distress in women who experienced SPTB compared with women who had a full-term pregnancy. A significant part of the women who delivered preterm needed psychosocial support but did not receive it and were at higher risk of anxiety, psychosocial distress, and impact in daily life. We therefore recommend offering all women after SPTB psychosocial support after delivery.

Key Points

• No long-term effects on depressive and anxiety symptoms and psychosocial distress after SPTB.

• A total of 16.3% of the cases needed professional psychosocial support after delivery but did not receive it.

• This subgroup was at higher risk of anxiety symptoms, psychosocial distress, and impact on daily life.

Keywords

spontaneous preterm birth - depression - depressive symptoms - anxiety - psychosocial distress

Publication History

Received: 10 May 2022

Accepted: 18 September 2023

Accepted Manuscript online:
27 September 2023

Article published online:
01 November 2023

• References

• 1 Blencowe H, Cousens S, Oestergaard MZ. et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012; 379 (9832) 2162-2172
• 2 Lee AC, Blencowe H, Lawn JE. Small babies, big numbers: global estimates of preterm birth. Lancet Glob Health 2019; 7 (01) e2-e3
• 3 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606) 75-84
• 4 Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJS. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA 2002; 288 (06) 728-737
• 5 Platt MJ. Outcomes in preterm infants. Public Health 2014; 128 (05) 399-403
• 6 Meyer EC, Garcia Coll CT, Seifer R, Ramos A, Kilis E, Oh W. Psychological distress in mothers of preterm infants. J Dev Behav Pediatr 1995; 16 (06) 412-417
• 7 Miles MS, Burchinal P, Holditch-Davis D, Brunssen S, Wilson SM. Perceptions of stress, worry, and support in Black and White mothers of hospitalized, medically fragile infants. J Pediatr Nurs 2002; 17 (02) 82-88
• 8 Garel M, Dardennes M, Blondel B. Mothers' psychological distress 1 year after very preterm childbirth. Results of the EPIPAGE qualitative study. Child Care Health Dev 2007; 33 (02) 137-143
• 9 Bener A. Psychological distress among postpartum mothers of preterm infants and associated factors: a neglected public health problem. Br J Psychiatry 2013; 35 (03) 231-236
• 10 Holditch-Davis D, Santos H, Levy J. et al. Patterns of psychological distress in mothers of preterm infants. Infant Behav Dev 2015; 41: 154-163
• 11 Gray PH, Edwards DM, Gibbons K. Parenting stress trajectories in mothers of very preterm infants to 2 years. Arch Dis Child Fetal Neonatal Ed 2018; 103 (01) F43-F48
• 12 Ouwendijk-Andréa M, Bröring-Starre T, Molderink AC, Laarman CARC, Oostrom KJ, van Dijk-Lokkart EM. Parental emotional distress after discharge from the neonatal intensive care unit: a pilot study. Early Hum Dev 2020; 140: 104892
• 13 Bozzette M, Holditch-Davis D. A preliminary study of depressive symptoms in mothers of 3-year-old prematurely born children. Child Health Care 2015; 44 (01) 54-68
• 14 Treyvaud K, Lee KJ, Doyle LW, Anderson PJ. Very preterm birth influences parental mental health and family outcomes seven years after birth. J Pediatr 2014; 164 (03) 515-521
• 15 Kusters CDJ, van der Pal SM, van Steenbrugge GJ, den Ouden LS, Kollée LAA. The impact of a premature birth on the family; consequences are experienced even after 19 years [in Dutch]. Ned Tijdschr Geneeskd 2013; 157 (25) A5449
• 16 Snaith RP. The Hospital Anxiety And Depression Scale. Health Qual Life Outcomes 2003; 1: 29
• 17 Haverman L, van Oers HA, Limperg PF. et al. Development and validation of the distress thermometer for parents of a chronically ill child. J Pediatr 2013; 163 (04) 1140-6.e2
• 18 Spinhoven P, Ormel J, Sloekers PP, Kempen GI, Speckens AE, Van Hemert AM. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med 1997; 27 (02) 363-370
• 19 Yaari M, Treyvaud K, Lee KJ, Doyle LW, Anderson PJ. Preterm birth and maternal mental health: longitudinal trajectories and predictors. J Pediatr Psychol 2019; 44 (06) 736-747
• 20 Bonanno GA. Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events?. Am Psychol 2004; 59 (01) 20-28
• 21 Singer LT, Fulton S, Kirchner HL. et al. Longitudinal predictors of maternal stress and coping after very low-birth-weight birth. Arch Pediatr Adolesc Med 2010; 164 (06) 518-524
• 22 Talge NM, Holzman C, Wang J, Lucia V, Gardiner J, Breslau N. Late-preterm birth and its association with cognitive and socioemotional outcomes at 6 years of age. Pediatrics 2010; 126 (06) 1124-1131
• 23 Shah PE, Robbins N, Coelho RB, Poehlmann J. The paradox of prematurity: the behavioral vulnerability of late preterm infants and the cognitive susceptibility of very preterm infants at 36 months post-term. Infant Behav Dev 2013; 36 (01) 50-62
• 24 Wolke D, Baumann N, Busch B, Bartmann P. Very preterm birth and parents' quality of life 27 years later. Pediatrics 2017; 140 (03) e20171263
• 25 Saigal S, Burrows E, Stoskopf BL, Rosenbaum PL, Streiner D. Impact of extreme prematurity on families of adolescent children. J Pediatr 2000; 137 (05) 701-706
• 26 Saigal S, Pinelli J, Streiner DL, Boyle M, Stoskopf B. Impact of extreme prematurity on family functioning and maternal health 20 years later. Pediatrics 2010; 126 (01) e81-e88
• 27 Singer LT, Fulton S, Kirchner HL. et al. Parenting very low birth weight children at school age: maternal stress and coping. J Pediatr 2007; 151 (05) 463-469
• 28 Taylor HG, Klein N, Minich NM, Hack M. Long-term family outcomes for children with very low birth weights. Arch Pediatr Adolesc Med 2001; 155 (02) 155-161
• 29 Drotar D, Hack M, Taylor G, Schluchter M, Andreias L, Klein N. The impact of extremely low birth weight on the families of school-aged children. Pediatrics 2006; 117 (06) 2006-2013
• 30 Monroe SM, Slavich GM, Gotlib IH. Life stress and family history for depression: the moderating role of past depressive episodes. J Psychiatr Res 2014; 49: 90-95
• 31 Singer GHS. Meta-analysis of comparative studies of depression in mothers of children with and without developmental disabilities. Am J Ment Retard 2006; 111 (03) 155-169