Objective: A high risk pregnancy may introduce additional psychological stress on a pregnant woman. The aim of this study was to review systematically the available evidence of the psychological consequences, in terms of anxiety and depression, of high-risk pregnancy. Methods:A systematic search of the electronic databases was performed. This review considered only quantitative, primary studies in the English language, published during the period 2000-2015 and relevant to the objective. The population of interest was previously high-risk pregnant women. Outcome variables were general anxiety, depressive symptoms and pregnancy-specific anxiety. Seven studies met the inclusion and methodological criteria and were included in the review. Results:The review revealed that high-risk pregnant women had high levels of depression ranging from 18% to 58% and these rates decrease throughout the course of hospitalization and are similar between women hospitalized in a hospital/health centre and women bed-rested in home. The review identifies additionally the main psychosocial variables that were related to antenatal anxiety and depression in high-risk pregnancy.Discussion: Future studies should overcome specific limitations.Health care professionals should enhance the implementation of psychological screening and counselling to populations of high-risk pregnant women hospitalized in a hospital/health centre or bed-rested in home.

Issue The transition to parenthood presents opportunities to promote mother-child health. Though of varying quality, internet information-seeking is prevalent while attendance in antenatal classes is low. Digital innovation can support access to timely and valid information for all, key component of WHO's Respectful Maternity Care. Description of the problem ”Baby Buddy Forward” assessed the cross-national transferability of the innovative Baby Buddy (UK) healthy pregnancy and early parenthood app to the medicalized and decentralized birth environment in Cyprus. Within a Participatory Action Research (PAR) framework, formative qualitative and quantitative methods were employed to engage with the professional and mums-to-be community and deliver a locally relevant resource to enhance user-provider communication and shared decision-making. Results We (a) assessed available resources in a structured quantitative and qualitative rating exercise, (b) identified gaps and priorities in an eDelphi survey (N = 275 mums and 193 professionals, re-rated at annual Midwifery conference), (c) gained in-depth understanding of information-seeking behaviours in a series of focus groups with a diverse set of mums-to-be (N = 100) and (d) explored perceptions about the use of internet for information in pregnancy and the quality of communication with professionals in a questionnaire survey (N = 200). New health communication material was co-created with participants and an intervention for embedding the tool in clinical practice was proposed within the COM-B behavioural change framework. Lessons In a “changing landscape” of antenatal education, Baby Buddy functions as “proof of concept” for cross-national innovation exchange. Beyond a learning experience, the use of PAR provided ground for building transdisciplinary alliances and creating a public health digital resource to enhance the health literacy of new parents and support the educational role of maternal and child health professionals. Key messages Digital resources can reduce social disparities, enrich the user-provider exchange and support the educational role of professionals. PAR provides a framework for co-creation and sense of common purpose.

Background While the transition to parenthood is critical for mother-child health, traditional antenatal education has been questioned. Digital resources provide opportunities for reducing social disparities and enhancing health literacy, particularly important in a medicalized and decentralized birth environment with high caesarean and low breastfeed rates. Methods Within a Participatory Action Research (PAR) framework, formative qualitative and quantitative methods were employed to assess the cross-national transferability of Baby Buddy (UK), and deliver a locally relevant resource to inform, enhance user-provider communications and support shared decision-making. Results Using consensus-building and priority-setting techniques, we engaged with the local health professional community and parents-to-be to assess available resources, identify gaps and priorities in an eDelphi survey (N = 275 mums, 193 professionals) and gain an in-depth understanding on information-seeking behaviours and participation in decision-making in a series of focus groups with antenatal educators (N = 20) and new mums/ mums-to-be (N = 62). New material was co-created with participants and an intervention for embedding the tool in clinical practice was proposed within the COM-B behavioural change framework. Conclusions The project is a “proof of concept” for exchange of innovation and a “complimentary” model of maternal healthcare delivery. Beyond a learning experience for the participants, the use of PAR provided ground for building transdisciplinary alliances. Key messages Other than enhancing health literacy, digital resources can support the educational role of health professionals PAR provides a framework to engage with the community, building a sense of common purpose

Background Information-seeking on the internet is very prevalent, in contrast to low attendance of antenatal classes. In addition to varying quality, few digital resources are developed using participatory research approaches. Methods Antenatal learning needs were explored in a modified Delphi survey among the professional community and parents-to-be/new parents. A list of 174 topics was developed using the Nominal Group Technique among antenatal educators and representatives of local professional associations. In an online survey, the relative importance of each was rated on a 5-point scale by the wider professional community and general public. Topics rated by ≥ 80% as at least “very important” or by ≥ 50% as “essential” by either group were shortlisted and re-rated by delegates of the annual Midwifery conference. Analysis 193 health professionals (77.7% midwives) and 275 mothers-to-be/new mothers (56.4% attendance of antenatal classes) participated in the online survey. Based on pre-set criteria, 95 topics (54.6%) were identified, 55 (31.6%) nominated by both groups. Among 18 themes, those with the highest number of nominated topics were: Breastfeeding, Prematurity, Giving birth, Caring for Baby and Mental health & well-being. There was good agreement between the two groups (r = 0.88) and in the top 20 single topics, thirteen were common. Priorities were largely unchanged in the last round, but a number of new topics emerged, including pre-eclampsia and domestic abuse. On a 1-10 scale, health literary of expectant parent was rated at M = 5.7 (SD 1.5) by professionals. Conclusions In a “changing landscape” of antenatal education, new technologies provide opportunities for broader reach. This formative research study explored the perceived learning needs and local priorities in order to shape the content of Baby Buddy, a public health digital intervention to enhance the health literacy of new parents and support the educational role of health professionals. Key messages Local needs and priorities for a digital parenthood platform were identified using a Delphi method. Participatory formative research can maximize the potential though co-creation and co-ownership.