Mental health outcomes among Chinese prenatal and postpartum women after the implementation of universal two-child policy

Lu, Li; Duan, Zhizhou; Wang, Yuanyuan; Wilson, Amanda; Yong, Yang; Zhu, Longjun; Guo, Yan; Lv, Yonglang; Yang, Xiaonan; Yu, Renjie; Wang, Shuilan; Wu, Zhengyan; Jiang, Ping; Xia, Mengqing; Wang, Guosheng; Wang, Xiuxia; Tao, Ye; Li, Xiaohong; Ma, Liang; Huang, Liming; Dong, Qin; Shen, Hong; Sun, Jue; Li, Shun; Deng, Wei; Chen, Runsen

doi:10.1016/j.jad.2019.12.011

Cited by 17 publications

(16 citation statements)

References 39 publications

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“…Meanwhile, another prospective study also found a lower perceived social support to be associated with PPD symptoms [ 30 ]. Other risk factors identified by the previous studies included smoking, drinking, stress during pregnancy, household income and parity were consistently found in our study [ 7 , 31 – 35 ].…”

Section: Discussionsupporting

confidence: 87%

“…Past history of anxiety and untreated depression during pregnancy is the strongest risk factor of PPD [ 4 ]. In addition to reduced level of reproductive hormones, social determinants including social-economic levels, marital status and other factors such as sleep deprivation, infant’s sex and being primiparous were also well-recognised risk factors associated with PPD [ 5 – 7 ]. Moreover, social support is the key factor involved at the onset of depression and anxiety disorders [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Who is the main caregiver of the mother during the doing-the-month: is there an association with postpartum depression?

Peng

Zhou

et al. 2021

BMC Psychiatry

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Background To examine the relationship between the main caregiver during the “doing-the-month” (a traditional Chinese practice which a mother is confined at home for 1 month after giving birth) and the risk of postpartum depression (PPD) in postnatal women. Methods Participants were postnatal women stayed in hospital and women who attended the hospital for postpartum examination, at 14–60 days after delivery from November 1, 2013 to December 30, 2013. Postpartum depression status was assessed using the Edinburgh Postnatal Depression Scale. Univariate and multivariable logistic regressions were used to identify the associations between the main caregiver during “doing-the-month” and the risk of PPD in postnatal women. Results One thousand three hundred twenty-five postnatal women with a mean (SD) age of 28 (4.58) years were included in the analyses. The median score (IQR) of PPD was 6.0 (2, 10) and the prevalence of PPD was 27%. Of these postnatal women, 44.5% were cared by their mother-in-law in the first month after delivery, 36.3% cared by own mother, 11.1% by “yuesao” or “maternity matron” and 8.1% by other relatives. No association was found between the main caregivers and the risk of PPD after multiple adjustments. Conclusions Although no association between the main caregivers and the risk of PPD during doing-the-month was identified, considering the increasing prevalence of PPD in Chinese women, and the contradictions between traditional culture and latest scientific evidence for some of the doing-the-month practices, public health interventions aim to increase the awareness of PPD among caregivers and family members are warranted.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Who is the main caregiver of the mother during the doing-the-month: is there an association with postpartum depression?

Peng

Zhou

et al. 2021

BMC Psychiatry

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“…The reason of the various rates in these studies might be different self-rating scales, sampling periods. Other reasons might be differences in demographic and socioeconomic facets, since we found differences of age, education level, and family annual income between participants with and without prenatal anxiety, which is consistent with previous studies in China (Kang et al, 2016;Liao et al, 2020;Lu et al, 2020). Due to the cross-sectional design, we could not conclude whether our participants had increased anxiety compared to the period right before COVID-19 pandemic.…”

Section: Discussionsupporting

confidence: 74%

“…A previous study reported that pregnant women experienced fewer anxiety symptoms during the second trimester compared to the other trimesters (Rallis et al, 2014). Nulliparous women might be less anxious than multiparous women (Koelewijn et al, 2017;Liao et al, 2020;Lu et al, 2020). Furthermore, the lack of someone providing emotional support was associated with anxiety symptoms in pregnant women (González-Mesa et al, 2020).…”

Section: Introductionmentioning

confidence: 94%

Association of Stress-Related Factors With Anxiety Among Chinese Pregnant Participants in an Online Crisis Intervention During COVID-19 Epidemic

et al. 2021

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Background: Previous systematic review indicated the prevalence of prenatal anxiety as 14–54%. Pregnant women are a high-risk population for COVID-19. However, the prevalence of anxiety symptoms and related factors is unknown in Chinese pregnant women during COVID-19 outbreak.Objective: To investigate the prevalence of anxiety symptoms and the related factors in Chinese pregnant women who were attending crisis intervention during the COVID-19 pandemic.Methods: The data of this cross-sectional study were collected in about 2 months (February 28 to April 26, 2020). Data analysis was performed from April to May 2020. Participants completed a set of questionnaires via the Wechat Mini-program before starting the online self-help crisis intervention for COVID-19 epidemic. A total of 2,120 Chinese pregnant women who were attending a self-help crisis intervention participated in this study. A survey was developed to address possible stress-related factors in pregnant women during the COVID-19 outbreak, including demographic, socioeconomic, and pregnancy-related factors, as well as COVID-19 related factors. Generalized Anxiety Disorder-7 (GAD-7) scale and the 10-item perceived stress scale were, respectively, employed to measure anxiety and stress-related factors.Results: A total of 21.7% (459) of pregnant women reported at least mild anxiety (≥5 on the GAD-7 scale), and only 82 women reported moderate to severe anxiety (≥10 on the GAD-7 scale). Factors associated with at least mild anxiety included living in Hubei province (OR = 1.68, 95% CI = 1.32–2.13), nobody providing everyday life support (OR = 1.81, 95% CI = 1.18–2.77), pelvic pain or vaginal bleeding (OR = 1.67, 95% CI = 1.32–2.09), and higher perceived stress (OR = 6.87, 95% CI = 5.42–9.02). Having relatives or neighbors with a diagnosis of COVID-19 was not associated with anxiety (p > 0.05).Conclusions and Relevance: Our findings indicate that evaluation and intervention for maternal and infant health are necessary in pregnant women with anxiety during COVID-19 epidemic, especially those with higher perceived stress, less everyday life support, or vaginal bleeding. Interactions among these related medical, social and psychological factors need to be investigated in future studies.

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“…The results suggest that the two-child policy might bring other risk factors that were not included in our study. A recent study suggested that under the newly relaxed universal two-child policy, women may experience higher risk of mental health difficulties during their second pregnancy, 55 and poorer mental health may lead to a higher chance of ETB. Further research is necessary to explore the association between ETB and maternal and newborn outcomes, to reveal more details of the underlying mechanisms of ETB, and inform new interventions for pregnant women.…”

Section: Discussionmentioning

confidence: 99%

Early-term birth and its association with universal two-child policy: a national cross-sectional study in China

et al. 2021

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ObjectiveTo describe the epidemiology of early-term birth (ETB) at the national level in China, and explore the association and mediating factors between ETB and policy between universal two-child policy and ETB, so as to explain the potential reason for such a relationship and provide evidence for future ETB interventions in the era of the new birth control policy.DesignCross-sectional study.ParticipantsThe cross-sectional study used data from China Labour and Delivery Survey between 2015 and 2016. A total of 75 132 survey data collected from 89 hospitals in 25 provinces were included in the analysis. We further explored the association between the universal two-child policy and ETB.ResultsThe weighted incidence of ETB was 30.1 per 100 all births (95% CI 30.06% to 30.14%) or 29.88 per 100 live births (95% CI 29.97% to 30.05%) between 2015 and 2016 in China. There was an association between the universal two-child policy and ETB (relative risk, RR 1.19, 95% CI 1.15 to 1.23), which was not mediated by maternal age (RR 1.17, 95% CI 1.13 to 1.22), previous uterine scars (RR 1.18, 95% CI 1.14 to 1.22), parity (RR 1.19, 95% CI 1.15 to 1.24) and other measured conditions (each p<0.05). Stratified analysis showed that the association between universal two-child policy and ETB were the strongest in multiparous young women or women without previous uterine scars (each p<0.05), and disappeared in all women of advanced maternal age (each p>0.05).ConclusionThe incidence of ETB was high in China when compared with most of reported countries, and there might be a link between two-child policy and ETB. Obstetric practice such as selective induced labour and caesarean section should be revised with ETB risks in mind, when ETB is more likely to happen under the universal two-child policy. Preventing ETB should not be neglected in multiparous young women or those without previous uterine scars under the new policy.

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Mental health outcomes among Chinese prenatal and postpartum women after the implementation of universal two-child policy

Cited by 17 publications

References 39 publications

Who is the main caregiver of the mother during the doing-the-month: is there an association with postpartum depression?

Who is the main caregiver of the mother during the doing-the-month: is there an association with postpartum depression?

Association of Stress-Related Factors With Anxiety Among Chinese Pregnant Participants in an Online Crisis Intervention During COVID-19 Epidemic

Early-term birth and its association with universal two-child policy: a national cross-sectional study in China

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