Browsing by Subject "Pregnancy, High-Risk"
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Item A Biopsychosocial Model of Attachment Styles and Adverse Birth Outcomes in High-Risk Pregnancies(2016-04-13) Cassedy, Hannah; Robinson, Richard C.; Frank, Blake; Bernstein, Ira; Evans, Harry M.; Stringer, Claude A.Because stress during pregnancy can contribute to preterm birth, low birth weight, and other adverse birth outcomes, there is a need for research on psychosocial factors that may mitigate this risk. Social support and attachment security have been shown to buffer the effects of stress in certain contexts. This study therefore evaluated the degree to which social support, attachment anxiety, and attachment avoidance affect stress-related birth outcomes in a sample of women with high-risk pregnancies. The study focused on women who had been hospitalized for pregnancy complications, as the population was identified as in need of further biopsychosocial research. The hypotheses were that women with more secure attachment would have greater social support, less stress, and therefore superior birth outcomes. Participants (N = 188) completed the 10-Item Perceived Stress Scale, Social Provisions Scale, and Experiences in Close Relationship Scale-Short Form, during their pregnancies. Birth outcome data (gestational age, birth weight, and Apgar scores) were extracted from their medical records after delivery. Biserial correlation analyses revealed that high stress levels were associated with more insecure attachment styles. Analysis of variance indicated that participants were more likely to have avoidant attachment if they were black, poorly educated, or unmarried. Hierarchical multiple regression analyses revealed that stress, social support, and attachment levels were not predictive of birth outcomes over and above the effects of physiological risk factors. This result diverges from research on low-risk pregnancies, where a clear link is observed between stress and adverse birth outcomes. By contrast, in this sample of high-risk pregnancies, psychosocial factors did not influence the profound effects of biological risk. In high-risk pregnancies, therefore, psychosocial interventions may be better suited to target psychosocial, rather than biological, outcomes. Furthermore, this study highlights a need for further research into demographic disparities in attachment styles, as well as the sociocultural factors that may impact them.Item Maternal and Fetal Representations, Dimensions of Personality, and Prenatal Attachment in Women Hospitalized with High Risk Pregnancy(2006-08-11) Brandon, Anna Rachel; Evans, Harry M.The present study investigated the effects of self-criticism, dependency, object representation, and risk upon maternal antenatal attachment in women hospitalized during pregnancy with high risk of maternal or fetal demise. Ninety-one women completed the Depressive Experiences Questionnaire (Blatt, D'Affliti, and Quinlan, 1976), the Object Relations Inventory (Blatt et al.,1992), the Maternal Antenatal Attachment Scale (Condon, 1973), the Edinburgh Postpartum Depression Scale (Cox, Holden, and Sagovsky, 1987) and the Center for Epidemiological Studies Depression Scale (Unauthored, 1999) within the first three days of hospital admission. No relationship was indicated between maternal representations and antenatal fetal attachment, nor was there a correlation between maternal representation and fetal representation. Self-critical mothers significantly scored lower in the measure of antenatal attachment quality and endorsed a higher number of depressive symptoms. Mothers hospitalized because of maternal risk were not significantly different in their reports of attachment than were mothers hospitalized because of fetal risk, and no significant differences were found across severity of risk factors as evaluated by the Hobel Risk Assessment. Consistent with previous research, depressive symptomatology was associated with a lower quality of maternal antenatal attachment overall. Results suggest that maternal narratives may not be significantly linked with reported antenatal attachment and depressive symptoms have a stronger association with reductions of antenatal attachment than dependent or self-critical tendencies.Item Object Representation, Relationship Satisfaction, Maternal-Fetal Attachment, and Depression in High-Risk Pregnancy(2010-01-12) Keller, Mary Jane; Brandon, Anna RachelLittle is known about the nature of a woman’s early caregiver object relations and the role they play in her relationship satisfaction, maternal-fetal attachment and possible experience of depression in a high risk pregnancy in the context of antepartum hospitalization. This study investigated the effects of a woman’s internal object representations of her early female and male caregivers and the association between her development as evidenced in her rated written narratives and the relationship satisfaction she experience with her current romantic partner, the attachment she felt toward the child she carried, and her experience of depression in a high risk pregnancy. One hundred sixteen women completed the Object Relations Inventory (ORI), Maternal Antenatal Attachment Scale (MAAS), The Edinburg Postnatal Depression Scale (EPDS) and the Depressive Experiences Questionnaire (DEQ) during antepartum hospitalization. Participants also completed the Dyadic Adjustment Scale (DAS). There was a positive correlation between reported satisfaction in a primary romantic relationship and the rating of a woman’s representation of her level Differentiation-Relatedness with her primary male caregiver (ORI-DR-M), usually her father. There was also a significant relationship between depressive symptoms, as measured by the EPDS and the Quality of a woman’s attachment to fetus or unborn child (MAAS-Q). No relationship between a woman’s ORI-DR for her primary male or female caregiver and depressive symptoms was identified. Nor was any association found between dependency (anaclitic depression) and a woman object representation of her mother or self-criticism (introjective depression) and a woman’s object representation of her father. The findings do suggest that the object representation level of woman’s relationship with her father influences the quality of her relationship with her romantic partner during hospitalization for complications of pregnancy. [Keywords: high risk pregnancy; maternal-fetal attachment; Object Relations Inventory; relationship satisfaction; father; object representation; pregnancy; depression]Item Peripartum cardiomyopathy: balancing heart failure and motherhood(2003-11-13) Drazner, Mark H.Item Pregnancy and Lupus Nephritis: A Review(2017-03-31) Bansal, Sukriti; Rajora, Nilum; Nwariaku, Fiemu; Saxena, RameshBACKGROUND: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder often affecting women of reproductive age, whose fertility is typically unaltered by their disease. SLE - and lupus nephritis (LN) in particular - has a significant impact on the course of pregnancy, as well as the outcomes for mother and fetus. Ideally patients have been in remission for a minimum of 6 months prior to conception. LN in pregnancy increases the patient's risk of SLE flare, as well poor outcomes including fetal loss, pre-eclampsia, and maternal death. Good outcomes are achievable for these patients, and have been well documented in the developed world, but less is known about patients in developing nations. METHODS: A literature review was performed of the available literature in regards to lupus nephritis and pregnancy in developing nations. Few studies were available, primarily retrospective case series. A review of these studies was performed, and analyzed for trends in regards to the impact of active disease at conception or lupus nephritis on flare rates, live birth rates, and fetal loss rates. The studies were also examined for any notable geographic trends. RESULTS: Based on the studies reviewed, there is a trend observed between active disease at conception and a lower rate of live birth. A trend was observed between high rates of LN and higher rates of flare, which many studies reported as being statistically significant. A relationship between high rates of LN and higher rates of fetal loss was also observed. With regards to geographic trends, lower overall live birth rates and higher rates of active disease at conception were noted in Indian studies. Interestingly, lower rates of pre-eclampsia were also noted in the Indian studies. Higher rates of flare were observed in the Asian studies. CONCLUSION: Good outcomes are possible for patients with lupus nephritis seeking pregnancy, even in low resource settings. More research is necessary to fully understand the relationships between active disease at conception or lupus nephritis on flare rates, live birth rates, and fetal loss rates.