Tag Archive for: pregnancy

Addressing Stigma and Inequities in Postpartum Urinary Incontinence Research

Interviewee: Jordyn Cox, Masters Student, University of Alberta | Authors/Editors: Romina Garcia de leon, Janielle Richards (Blog Co-coordinators)

Published: January 24th, 2025

 

Can you tell us a bit about your research? 

Currently, I am focusing on stigma and the lived experiences associated with postpartum urinary incontinence (PUI), and how it impacts health-seeking behaviors, such as seeking healthcare provider support, physical activity, and accessing social support. PUI is the unintentional leaking of urine that can happen after giving birth due to weakened pelvic floor muscles or other changes from pregnancy and childbirth. This condition affects approximately 33% of postpartum women, but it remains highly stigmatized and is rarely discussed, leading to many mothers feeling isolated and ashamed which leads to a lack of accessing care. Despite its prevalence, PUI has a significant impact on mental health and quality of life, yet research addressing its stigma and the barriers it creates—especially for racially diverse populations—remains limited. A key focus of my work is exploring whether racially diverse individuals face unique barriers or experiences compared to their White counterparts. By documenting the lived experiences of diverse populations through interviews, my research seeks to generate actionable, person-informed recommendations for healthcare professionals to mitigate stigma, improve patient-provider relationships, and enhance access to supportive care for all postpartum individuals in Canada.

 

How do you conduct these qualitative measures in your work? 

I have partnered with a local hospital with a group of urogynecologists there to gain feedback throughout the studies process, and through recruitment, I’ve been working with them to target marginalized populations. I also work with a local Edmonton group called the Multicultural Health Brokers which caters their services to immigrant populations and marginalized voices in the community. I’ve been doing a lot of my recruitment through those avenues to try and increase the population to not just be the typical White middle-class-educated groups we see in most research. I have finished recruitment for this study and was able to have my sample come from six different racial backgrounds and a majority identifying as non-White which was a big win for me in terms of the objectives of this study.

 

How did you get interested in your research? 

My interest in women’s health began when I was a child and watched the TV show A Baby Story on TLC which followed mothers throughout their pregnancies and then documented the labour and deliveries of their babies. This show sparked my interest in pregnancy and childbirth. This early interest evolved into a passion as I pursued academic opportunities in pregnancy research during my undergraduate studies, and it has grown from there. As a Black woman, I’ve also witnessed the privilege I hold in accessing certain spaces, and I feel a responsibility to amplify the voices of marginalized individuals who face additional barriers. Women’s health conditions often carry significant stigma, and I feel driven to address these inequities, particularly by examining the experiences of those who are underrepresented in research. Through my work, I hope to shed light on these issues and contribute to creating more equitable healthcare practices.

 

What is the impact you hope to see with your work? 

I hope I can contribute to breaking the stigma surrounding PUI specifically, and making sure it becomes a normalized topic of discussion in healthcare and society. I want to address the stigma-related barriers that prevent people from accessing care, also by highlighting the unique experiences of racially diverse individuals. I wish to inform inclusive healthcare practices across different populations. Ultimately, my goal is to empower women with the knowledge and resources they need, ensuring no one feels shame due to conditions like PUI. In the future, I plan to collaborate with hospitals in my community to build connections between clinical work and research.

I’m starting my PhD soon, where I plan to shift my focus to weight stigma during pregnancy. Specifically, I aim to explore how weight stigma and its internalization affect stress and behavioral outcomes like physical activity during pregnancy. This work will also investigate how these experiences change throughout pregnancy and how factors such as migration status, socioeconomic background, and minority gender identities intersect with weight stigma. Given the significant role of maternal stress and behavior in pregnancy outcomes, this research is a natural extension of my commitment to addressing stigma in women’s health.

 

Where can people learn more about your work?

Learning From Experiences, Adherence, (preconception) Pregnancy (postpartum), Stigma Lab Website (Jordyn’s lab) 

Lab Instagram: @leappps

X account: @jordynncox

Linkedin

The Brain’s Journey during Pregnancy and Menopause: A Spotlight on Estradiol and the Immune System

Authors: Hannah Oppenheimer, PhD student, Arielle Crestol, PhD student, Claudia Barth, Senior Researcher/PI FemHealth Project, Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Oslo, Norway  | Editors:  Romina Garcia de leon Reviewer: Magdalena Martínez-Garcia

Published: June 21st, 2024

There are clear sex and gender differences in several brain-related disorders. For example, relative to men, the lifetime risk for depression is twice as high in women*, and twice as many women develop late-onset Alzheimer’s disease. But what’s  causing these differences?

While the underlying reasons are not yet fully understood, sex hormones and inflammatory processes (i.e., the immune system’s response to irritants such as pathogens), are thought to play important roles. Women’s lifespans are marked by major hormonal and immune-related changes, particularly during pregnancy and menopause. Research suggests that these phases are important for brain health and mental health, both in the short-term and long-term.

What happens during pregnancy that affects brain health and mental health?

During pregnancy, the immune system fluctuates between three immunological stages with unique inflammatory profiles, each corresponding to a trimester. The first is a pro-inflammatory stage, where inflammation is enhanced to allow for the implantation of the embryo and the formation of the placenta. This is followed by an anti-inflammatory stage, namely a reduction in inflammation to support the growth of the fetus. The final stage is again pro-inflammatory and helps initiate birth. A successful pregnancy depends on the adaptation of the maternal immune system to each of these stages. The stages are also linked to hormonal changes such as rises in estradiol — the most abundant form of estrogen in women — which play a vital role in creating an anti-inflammatory immune environment.

Alongside the hormonal and immunological changes, pregnancy and the postpartum period also impact the mother’s neuroplasticity, that is, the brain’s ability to change. Changes in brain volume during pregnancy and postpartum have been associated with fluctuating estradiol levels. These changes can be beneficial! A recent study showed that cortical brain volume changes follow a U-shaped trajectory whereby volume decreases during pregnancy and increases again postpartum. Both the reduction and the increase in volume throughout this trajectory have been linked to a higher mother-to-infant attachment later on, thereby potentially helping women transitioning to motherhood. However, some of these brain changes may also lead to increased vulnerability to mental disorders such as depression, which affect almost one in five women during and after pregnancy.

Do all changes revert postpartum?

While some of the maternal brain changes revert shortly after giving birth, other changes may sustain for years or even decades. Possible long-term impacts of pregnancy on the brain have been shown in studies that found younger-looking brains in middle-aged women with biological children compared to those without (see image). This effect may be linked to the exposure to hormones and inflammatory markers during pregnancy. Furthermore,  regulatory T cells — cells that play a critical role in stopping immune responses when no longer needed and show an increase during pregnancy which persists postpartum  — may reduce risk for Alzheimer’s disease later in life. Another mechanism which may be involved in the relationship between pregnancy and long-term brain health through its effects on the maternal immune system is fetal microchimerism — the lasting presence of fetal cells in the mother’s body long after giving birth.

What happens during menopause?

Hormonal and immune-related changes during the menopause transition are thought to be the basis for menopausal symptoms which are largely neurological in nature, such as hot flashes and night sweats, mood and sleep disturbances, and trouble with memory and cognition. The transition to menopause has also been linked to changes in the brain and a heightened risk of depression. For some women, symptoms and brain changes may stabilize, or even revert after menopause. However, the presence and severity of these symptoms may increase the likelihood of developing Alzheimer’s disease in older age.

With the transition to menopause, estradiol levels decline and again influence the immune system. A balance between pro-inflammatory and anti-inflammatory responses during the reproductive years can shift to an imbalance leaning towards more pro-inflammatory responses during the transition to menopause. This process can get exacerbated in a subset of women, leading to negative health outcomes. Research suggests that the anti-inflammatory processes associated with pregnancy may shape the emerging inflammatory processes during menopause, and thereby influence later brain health.

Overall, pregnancy and menopause are transition phases encompassing hormonal and immune-related changes, which can have short-term and long-term effects on women’s brain health and mental health. Scientists are still working to better understand the implications of these relationships, including their role in disorders with large sex differences. Once that is better understood, this knowledge may help pave the way for better treatments, disease prevention, and individualized care.

Potential Effects of Pregnancy on Brain Health Through Hormonal and Immune-Related Changes

Research has found differences in brain health between women with biological children (parous) and women without (nulliparous).

*Although we acknowledge that individuals who are biologically female (i.e., XX) do not always identify as women, we used the gendered term “women” to align with common language usage.

 

Brain Health in Pregnancy, Menopause, and Beyond – Is There a Link with Alzheimer’s disease?

Interviewee: Alesia V. Prakapenka, Assistant Professor, Biomedical Sciences, College of Graduate Studies, Midwestern University  Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators)

Published: January 5, 2024

 

Could you tell us more about the work you do in women’s health?

 

In my lab, we use animal models to understand how hormones impact brain and behavioral health within females and we take on a lifespan approach. We recently were awarded a grant from the Alzheimer’s Association to investigate the relationship between pregnancy, age, and menopause on healthy aging and Alzheimer’s disease progression in female rodent models. We’re very excited to get that work started. Primary outcomes include both short-term and long-term memory measures, as well as evaluation of memory types that engage different brain regions, including hippocampus, frontal cortex, and striatum. We’re also interested in anxiety-like and depressive-like behaviors as these are modulated by hormones and are associated with Alzheimer’s disease. 

 

How did you become involved in this field?

 

I’m fascinated by how learning, memory, and the brain works in general. When I was in high school, I took a psychology class and one of the units was on the brain. That sparked my interest, and I really wanted to learn more about what we know and what we don’t know about the brain. As an undergraduate, I got involved in research in a lab that used animal models to study learning and memory, and one interesting aspect of it was that the lab only worked with male animals. That got me thinking and looking more into the research on how learning and memory works in males versus females. To me, it seemed like there was a gap in understanding female learning, memory, and brain functions compared to males. So, for graduate school, I pursued research that focused specifically on female learning and memory with my co-mentors, Drs. Heather Bimonte-Nelson and Rachael Sirianni. Specifically, I worked on developing strategies to target the delivery of hormones, such as estrogens, to the brain to optimize their cognitive effects in females. My graduate research led to many more questions than answers regarding hormones and female health, which I am excited to continue to research. 

 

What does a typical day in your field look like? 

 

If we’re working with the animals, the timelines are planned out months in advance. With this new project looking at pregnancy and Alzheimer’s disease, for example, we have a schedule set for 2-3 years because we are working with animals throughout their lifespan. Some days, we’re administering treatments, checking in on the health of animals, or testing behavior and memory tasks. And then other days we’re getting to work with the tissue – process it, tag it with antibodies, and then visualize it. And then other days we’re on a computer looking at lots and lots of spreadsheets, analyzing the data and putting it together to understand and share what we find.

 

Are there any interesting findings from your work that you’d like to highlight?

 

My lab is in its second year, so our data collection is currently very fresh and ongoing. For example, as we establish our behavior tasks and protocols in the lab, we are finding that dose-dependent effects of 17beta-estradiol on spontaneous alternation behaviors are modulated by specific task parameters in female rats. And although we do not yet have findings from our lab for our recently funded work, I’d love to highlight valuable findings from other labs’ in the field that informed and sparked this research direction. There are multiple findings, for example, showing that pregnancy is neuroprotective and beneficial for female brain health. There’s also some evidence to suggest that pregnancy can be associated with increased Alzheimer’s disease risk. So, we aim to investigate factors, such as age and menopause type, that may help explain the disparate effects of pregnancy on healthy aging and Alzheimer’s disease pathogenesis.

 

What impact do you hope to see with your work?

 

The impact I hope to see with my work is rooted in student mentorship. Majority of students that I work with are either on a pre-healthcare career path or in their first or second year of medical or dental school. My approach is to mentor students, most of whom will be future healthcare professionals and inevitably working with the female population, to appreciate the complexity of female health and embrace it. I hope to help them understand the research on female health, critically analyze it, and appreciate it so that when they are forming that medical plan for an individual, they can be comfortable addressing female-specific health aspects.

 

Look out for Dr. Prakapenka’s upcoming work funded by the Alzheimer’s Association, through the Sex and Gender in Alzheimer’s Award, titled ‘Alzheimer’s disease pathogenesis in mothers: a role for age and menopause’.

Behind the Science: Pregnancy and Multiple Sclerosis – What’s The Link?

Interviewees: Pia Campagna, Postdoctoral Fellow, Monash University, Melbourne, Australia Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators)

Published: December 15th, 2023

When there are clear sex differences in disease prevalence, researchers must question the underlying factors. Women with Multiple Sclerosis (MS) outnumber men 4 to 1. What is being done to understand this statistic? How can we look into female-specific factors to disentangle these questions? 

For this month’s Behind the Science, we interviewed Pia Campagna who provided some insight into these questions.  

 

Can you tell us about your research? 

Our lab studies Multiple Sclerosis (MS) and other neuro-immunological conditions. Much of my work focuses on incorporating women’s health into MS research by looking at pregnancy and menopause. MS affects 2 million people globally, roughly 75% of which are women. Previous work from our group has shown the clinical effect of pregnancy, where a pregnancy before disease onset delays the onset of MS symptoms by 3.4 years. After onset, the effect of pregnancy is more controversial, but work from our group has shown a protective effect of pregnancy on long-term disability accumulation.In my postdoc, I’m seeking to understand the biological mechanisms underpinning these clinical effects via a national multi-site prospective study.

 

Why did you want to get involved in women’s health? 

I started research in MS due to the demographic of those affected – women. Because of this, it’s an interesting population to study in light of all of the female-specific experiences that interact with this disease. For example, it’s a disease that’s primarily diagnosed in a woman’s reproductive years (20-40 years old) so there are interactions with pregnancy, and due to the chronic nature, women are living with MS during perimenopause and menopause too.

I started my Ph.D., focused on genomics, prognostic modelling and machine learning in MS. It just so happened that other people in our group were doing this fascinating work on pregnancy. I had the opportunity to delve into the epigenetic impacts of pregnancy in women with MS, which sparked my interest in women’s health route MS. I did love the bioinformatic aspects of my Ph.D. work and hope to incorporate that down the line when we have the data available. 

 

Is there anything interesting that you’ve learned from your research findings?

When we compared the whole blood DNA methylation profiles of women with MS who had not given birth, we identified differences in methylation patterns at genes enriched in neurogenesis and axon guidance pathways. After noticing these signals, we hypothesized that the hormonal changes from pregnancy created long-term effects that drive changes to the clinical course of MS.  Now, we are collecting blood from women with and without MS before, during and after pregnancy, so eventually we’ll be able to look at DNA methylation in these different stages, as well as a range of other -omic profiles. 

What impact do you hope to see with this work in the long term?

Not only is the prevalence of MS increasing worldwide but so is the female-to-male ratio. I hope that research focuses more on the female-specific aspects of the disease, which is still very understudied. Although there’s strong evidence that pregnancy is beneficial before onset, and some evidence of a beneficial long-term effect, , it’s surprising to me that we still don’t know how or why. Detangling this will not only be beneficial to women but also more individualized therapeutic targets benefit men as well. Another frontier in MS research that I would like to see more of is the impact of menopause. For example, we still don’t know if the disease gets worse after menopause, how estrogen loss interacts with disease-modifying therapies, or whether they’re as effective. Understanding the clinical aspects of menopause and subsequently, the biological aspects of menopause is an important route to take moving forward.

Where can people learn more about your work?

Behind the Science: Maternal Health in Ethiopia

Interviewee: Abera Kenay Tura, PhD, Assistant Professor of Maternal and Child Health at Haramaya University, Ethiopia; Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: September 29, 2023

Could you tell us more about your research?

I’m leading a research team working on surveillance of severe maternal morbidity and deaths. We recently established a research platform called the Ethiopian Obstetric Surveillance System (EthOSS), where we are registering cases of women having complications like hemorrhage, hypertensive disorders of pregnancy, and severe anemia as well as sepsis. These are the major conditions that lead to deaths of women in Ethiopia and we are not only registering these conditions but also establishing a Confidential Enquiry into Maternal Deaths Committee in collaboration with the University of Oxford that will review cases of women who died from complications in pregnancy and childbirth. These committee members, trained by experts from the University of Oxford and EthOSS investigators will review thoroughly the cases of women to identify why a woman died and then make recommendations for improving care of women. As part of this work, we are also collaborating with countries with similar systems, including Canada. You might be aware that there is a Canadian Obstetric Surveillance System where they are also registering maternal mortality and severe maternal morbidity cases. 

What led you to this field of research and what made you want to study maternal health outcomes?

As someone who is from a low-income country, it’s common to hear about deaths of women or women having severe complications during pregnancy, childbirth, or the postpartum period. Pregnancy and childbirth are normal physiologic processes and it’s a period of joy and celebration for many, but for women who are living in low-resource countries, like ours, it is a period of worry and concern. For example, the risk of death would be high for pregnant women in countries like ours. In order to at least contribute some to this problem, I want to have studies like this. And of course, this was started when I applied for my PhD study on maternal health programs. As a country, it makes sense to study this so that lessons can be learned for improving care of women so that pregnancy and childbirth would be a time of joy and celebration as many others have elsewhere.

Are there any interesting findings from your research that you’d like to share?

We know why women are dying. In many low-resource countries, we say that women are dying from bleeding, hypertensive disorders of pregnancy, or severe infections/sepsis. But what we learned from our confidential inquiry into maternal death is beyond this. It’s true that women who died had bleeding for example or she might have had hypertensive disorders of pregnancy, but the main underlying cause, as has been indicated by the review of the committee, is our health systems’ failure in responding to women who have such complications. If the health system was ready to respond to women’s needs, we could have saved many women. In 9 out of 10 deaths that we have reviewed, there have been delays in helping the women get the appropriate care on time. These delays could happen at what we call “delay one”, which is the delay in recognizing that the woman is in danger, or “delay two” which is the failure of women to reach appropriate facilities on time. And “delay three” is delay in getting the appropriate care after reaching facilities. In many of the cases, even women who reached facilities didn’t get the appropriate care as compared to the national guidelines or the international best practices. We learned that almost all deaths were preventable if the health system was ready to respond to the women’s complications on time.

We have seen, for example, problems with triaging, meaning when transferring women from lower to higher facilities, there are delays in making decisions. Facilities should know what they can do and what they can’t do so that a woman can be transferred to the appropriate facilities where she can get care. But at the same time, we also learned that there are screening issues for women with medical problems who didn’t know that they are pregnant or didn’t know that they have these underlying medical complications, which might make the pregnancy more prone to complications. 

What impact do you hope to see with your work?

We are working with a network of other countries under the auspices of the International Network of Obstetric Survey Systems (INOSS), where I’m the vice chair for Africa, that have already shown that it’s possible to reduce maternal mortality, especially through using this system of obstetric surveillance and confidential enquiry of maternal deaths. From our piloting so far in eastern Ethiopia, we learned that it’s possible to change the system in responding to the tragic loss of women. I want to scale up this to a national program and want to see that our intervention would save more lives in the future like it’s doing in other countries, including yours.

You can find out more about Abra’s work at: 

Pub Med, Linkedin, Researchgate, or contact him by e-mail: daberaf@gmail.com

COVID-19 Vaccine Safety in Pregnancy

Authors: Sue Lu, BSc student in Integrated Science at the University of British Columbia and Research Assistant at the Vaccine Evaluation Centre; Manish Sadarangani, MRCPCH, DPHIL, BM.BCh, MA, Director of the Vaccine Evaluation Center at BC Children’s Hospital and Associate Professor in the Department of Pediatrics at the University of British Columbia Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: April 21st, 2023

The COVID-19 pandemic has disproportionately impacted pregnant people. If a pregnant person is infected with SARS-CoV-2, the virus that causes COVID-19, they are at a higher risk of severe disease, hospitalization, intensive care unit admission, and death. COVID-19 infection in pregnant people can also cause poor pregnancy outcomes, such as preterm birth and impaired fetal growth. As found by UBC researchers through the CANCOVID-Preg surveillance program, even cases of mild COVID-19 infection not requiring hospitalization were significantly associated with a higher risk of preterm birth.  In short, COVID-19 is not only threatening to the mother, but to the unborn child as well. 

What did we know about the safety of COVID-19 vaccines in pregnancy?

COVID-19 vaccines have been available in Canada since December 2020. Experts recommended COVID-19 vaccines during pregnancy based on smaller studies of other mRNA vaccines in pregnancy and several decades of administering vaccines in pregnancy. Unfortunately, despite the continued recommendations from experts to get vaccinated, many pregnant people remained hesitant about the COVID-19 vaccines. In fact, recent studies suggest that 49% of pregnant women were accepting of COVID-19 vaccines. 

How did we conduct this study?

This study was conducted through the Canadian National Vaccine Safety (CANVAS) Network. The CANVAS Network is a national research platform that monitors the safety of vaccines, including COVID-19 vaccines, in Canada. This study, led by Dr. Manish Sadarangani, looked at the frequency and nature of severe health events following vaccination in pregnant people. Severe health events, as defined by this study and other CANVAS Network studies, are issues that arise following vaccination that are severe enough to prevent people from going to work or school, or required medical attention.

At the time this study was conducted, over 700,000 total participants and 5,500 pregnant individuals had enrolled from seven provinces and territories across Canada. We looked at female participants of reproductive age and compared how pregnant people reacted to their first and second doses of the COVID-19 vaccines in unvaccinated pregnant people and vaccinated non-pregnant people. 

Overall, this CANVAS Network study allowed us to better understand COVID-19 vaccine safety by looking at changes to health after vaccination for pregnant people and comparing their changes to those of similar vaccinated and unvaccinated groups. 

What did we learn? 

Our study’s findings confirmed that COVID-19 mRNA vaccines are safe to use in pregnancy. Additionally, other studies show them to be both effective and immunogenic, meaning they can protect both the mother and the child from COVID-19 infection. Here are three of our major safety findings: 

  1. COVID-19 mRNA vaccine reaction differences between pregnant and non-pregnant individuals: When we compared pregnant and non-pregnant vaccinated individuals, we found that pregnant people experienced fewer symptoms that prevented daily activities, prevented work, or required a medical visit than non-pregnant people. 
  2. COVID-19 mRNA vaccine reaction differences between vaccinated and unvaccinated pregnant individuals: There was no difference in hospitalization or pregnancy-related complications in these two groups, suggesting that vaccination did not have negative impacts on pregnancy. 
  3. Moderna vaccine: After a second dose of the Moderna mRNA vaccine, vaccinated pregnant people reported more symptoms than unvaccinated pregnant people, but reported similar symptoms to vaccinated non-pregnant people. Vaccinated pregnant people and unvaccinated pregnant people were also more likely to seek care for these symptoms than vaccinated non-pregnant people.

Overall, mRNA vaccines are safe and effective in pregnancy. As this study shows, getting vaccinated against COVID-19 does not increase the risk of miscarriages or other pregnancy complications. 

How can you use this information?

If you’re a health care worker, we hope that this study will provide some insight into the common symptoms that pregnant people may experience after vaccination. Common symptoms following vaccination include redness and pain at the injection site, fatigue, muscle aches, and headaches. This information, from Canada’s top vaccine researchers, can also be used to counter misinformation about vaccines that pregnant people may have encountered.

You can read a full summary of the study here, or check out the full context in the published journal article here. 

The bottom line? Get vaccinated against COVID-19 and protect yourself (and your child)!

 

Perinatal Anxiety 101: An Introduction

Authors: Brynn Stagg, MSc Student, University of British Columbia; Claudia Cargnelli, MSc Student, University of British Columbia; Nichole Fairbrother, Ph.D., RPsych, Clinical Associate Professor & MSFHR Health Professional-Investigator, University of British Columbia | Editors: Romina Garcia de leon, Shayda Swann (Blog Coordinators) 

Published: February 24th, 2023

Are you pregnant, recently given birth, or know someone who has? If so, chances are you or someone you know has experienced anxiety during or after their pregnancy.

Anxiety is a normal human experience.

We all feel anxious, worried, or afraid some of the time. Often, anxiety serves a useful purpose. For example, when heights make us anxious, this feeling serves as a warning to be careful in this potentially dangerous situation. Because of this fear, we take precautions to protect ourselves.

When does anxiety become a problem? 

Sometimes, however, we become fearful of something that is not dangerous, or more fearful than we need to be. If anxiety becomes severe enough to cause significant distress or interference in a person’s life, it may have developed into an anxiety or anxiety-related disorder (AD). 

There are several different ADs, including panic disorder, generalized anxiety disorder, social anxiety disorder, and anxiety-related disorders like obsessive-compulsive disorder and posttraumatic stress disorder. Given the diversity of ADs, it is no surprise that these are important to diagnose – especially when you add in the everyday stress that comes with parenting! 

What about anxiety during pregnancy and the postpartum? 

Anxiety is especially common (and normal) among pregnant and postpartum people. Often, the anxiety experienced during this time is related to one’s pregnancy (will my baby be healthy?), the childbirth (will childbirth be painful?), and one’s newborn (what if something happens to my baby?). 

Although anxiety during the perinatal period is common, and in many cases, a normal and healthy part of becoming a parent, sometimes perinatal anxiety becomes a problem. If you are experiencing substantial anxiety and fear, and these feelings are making you upset or affecting your ability to parent and live your life, you may be experiencing symptoms that meet criteria for an AD. 

Most importantly, we want you to know that you are not alone! There are things you can do (like talking to your healthcare providers, for starters).

Why does perinatal anxiety matter?

Over one in five (21%) pregnant and postpartum people suffer from at least one AD during the perinatal period. Believe it or not, this number is more than postpartum depression – which, at most, 10-16% of birthing people experience. 

ADs, when they occur during pregnancy, have been associated with adverse obstetrical and neonatal outcomes, such as increased risks for pre-eclampsia, preterm birth, and low birth weight. These can have consequences for the infant and developing child.

What can be done?

It’s important to ask for help. You are not alone. Some treatments really work, including self-help materials, group or individualized therapy, and/or medication. 

Cognitive Behavioural Therapy (CBT) is the recommended first-line treatment for most ADs. It is the talk therapy for anxiety with the most scientific support. It’s safe, effective, and is often the treatment of choice for pregnant or postpartum parents as it works as well or better than medication does. 

CBT works to reframe thinking patterns and behaviour. In other words, CBT focuses on how you are thinking (cognitive), what you do about those thoughts (behavioural), and then works on changing these to help your feelings. Lots of research has been done on the effectiveness of CBT in general populations, and we hope to see even more studies focused on perinatal people in the future!

If talk therapy is not helping, individuals may benefit from medication instead of, or in combination with, talk therapy. Selective serotonin and selective norepinephrine reuptake inhibitors (SSRIs and SNRIs), also known as antidepressants, are used to treat anxiety. While many are hesitant and fearful of using medications while pregnant or breastfeeding, not treating more severe perinatal anxiety greatly overshadows the risks associated with using medication, so it’s important to weigh the pros and cons. 

If you think your anxiety has become a problem, you may want to speak to your primary healthcare provider. You can also seek the services of a psychologist. 

What’s next for this area?

The team at the Perinatal Anxiety Research Lab hopes that by spreading knowledge of anxiety during pregnancy and the postpartum, we can work to make sure that perinatal anxiety becomes easily recognized so everyone can get the support they need during such a stressful time. 

Coming up, we will teach you about some important steps that are crucial in making sure parents are getting the support and resources they need. Stay tuned for our next feature on Screening for Perinatal Anxiety Disorders. 

Reflecting & Resources

If you are pregnant or have been pregnant, what has your experience been like? Did you know anxiety is this common during the perinatal period? Is there someone that could benefit from this knowledge? 

Let us know your thoughts, questions, or ideas for future posts in our Perinatal Anxiety 101 feature at womenshealth.blog@ubc.ca.

Click here for resources and additional support!

 

Behind the Science: Empowering Women Through Maternal Health Research In Iran


Interviewee: Madelyn Sedehi, Bachelor of Science (Midwifery)  Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinator).

Published: February 10, 2023

Could you please tell us more about the work that you’ve done in women’s health in Iran?

I was educated and worked as a midwife on a multidisciplinary maternity ward at a Golestan Province Hospital, affiliated with the Golestan University of Medical Sciences. I worked in different parts of a maternity ward, including the admission and labour and delivery rooms, and also as a unit manager in the women’s ward. Following that, I worked at a congenital anomaly research centre with a team of gynecologists, pediatricians, and a genetic specialist. We collaborated together to find many different risk factors that may be involved in the development of birth defects. The purpose of our work was to determine how to have a healthy pregnancy and to evaluate how these risk factors are affecting pregnancy outcomes in our area. Some of the areas we worked on were maternal nutrition, pregnancy complications, mortality and morbidity in newborns, maternal knowledge of pregnancy –  especially in youth and young women who were pregnant. We also studied nutrient absorption and even underlying diseases like diabetes or gestational diabetes, as well as conducted experimental research at the university. We’ve published nine articles from this research, three of which I was the first author.

It sounds like you were looking at many different factors in your work. Can you tell us more about that? 

Yes, we worked in a very wide field by working with many different specialists and especially by having an affiliation with the university. We were able to gather and collect data from all over the province to generate a data bank about birth defects, studying related and unrelated factors in our area. 

What led you to become interested in maternal and child health?

I would say it was working as a midwife and being involved with pregnant mothers in many complicated cases, especially the ones who were very young when they got pregnant, based on the culture and traditions in our country, to elevate their level of knowledge toward themselves to be more healthy. I was, and I am, and I always will be passionate about women’s health in the different parts of their life. Women have a very significant role in society, in the family, and for themselves. Being able to educate them as much as we can and give them a chance to know about their body and how they can take care of themselves at different stages of their life is amazing. That’s going to have many different benefits for their family, for themselves, for society, for the government – and, I believe, for everyone. And it starts with research. That’s why it’s great that research opens a gate to accomplish these advancements in different areas of human health and well-being.  

Now that you’re in Canada, what kind of research are you interested in?

I’m very much a newcomer! I would really love to get connected with research here, especially in midwifery, and different areas of pregnancy health and outcomes. However, I’m open to pursuing research related to different areas of women’s health, such as depression, maternity care, vaccination, and even psychology. When you have love, passion, hard work, and organization, you can do well as a researcher. When I first started, I didn’t have any experience as a researcher so I learned by myself, and then the university reached out to me and they wanted me to do more. I believe if you love your job and do your best, that keeps you going. Then, you can help other people gain knowledge and skills. I’m very interested in being connected to the research field here! 

Madelyn Sedehi is currently looking to be involved in women’s health research in Vancouver. If you are interested in contacting Madelyn to join your research team, please reach out to her at ml7.sedehi@gmail.com

Behind the Science: Designing for Pregnancy After Loss, With and Through Technology

Interviewee: Kamala Payyapilly Thiruvenkatanathan, PhD candidate, Pennsylvania State University. Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinator).

Published: October 21tst 2022. 

Could you briefly explain your research?

My research is situated at the intersection of women’s health and technology with a specific focus on pregnancy after loss. There has been a rising emphasis on designing technology for women’s health and this has led to the growth of the FemTech industry. FemTech is an abbreviation for “Female Technology” and is inclusive of a plethora of women’s health systems ranging from menstrual and fertility trackers to smart wearables that track women’s intimate health data to artificial intelligence based diagnostic devices. Among women’s health issues addressed, there has been an increasing focus on the pregnant body as a site of research and intervention. And yet, the pregnant and the maternal body are used interchangeably, neglecting a common but an unpleasant outcome of pregnancy loss and the associated felt experiences of women navigating pregnancy after loss. Pregnancy loss which encompasses miscarriage and stillbirth is incredibly common and approximately 80% of women get pregnant again after loss. However, their pregnancy journey is never the same given the physical and the emotional trauma they experienced during pregnancy loss. Attending to the rising interest in designing interventions for pregnancy and maternal health, alongside the ongoing call to question the stigmatization of women’s bodies, my research centers a common but tabooed experience of pregnancy after loss.

What got you interested in this research?

As a human, I seek fulfillment in making a positive impact in the lives of the underserved, those who are truly in need. At a young age, I was not aware of a career that allowed me to embrace my personal value of wanting to serve the underserved. Parking it aside, I decided to step into a typical, professional career journey that would eventually fetch me a job. Before setting foot into my doctoral path, I was a trained computer science engineer, with my understanding of technology limited to its functionality. I considered my ability to comprehend technology’s inner workings as my strength. A few years later, during my attempt to make a career detour in search of fulfillment, I was introduced to the domain of Human Computer Interaction (HCI). I always had a passion for design and HCI revealed ways through which I could combine my technological strength with that of design. More importantly, HCI rekindled my yearning to help those in need, by exposing me to the world of humanistic research. Reflecting on my personal values and my positionality as a woman led to the pursuit of research on women’s health, acknowledging women’s lived bodily experiences. My stumbling upon the world of FemTech by chance also enabled ways to reinforce my ability to comprehend (and perhaps design) technology. My observations along with a critical reflection of my personal values, of wanting to design for the margins, motivated me to design for the neglected felt experiences of women navigating pregnancy after loss, with and through technology.

What impact do you hope to see with this work years from now?

The ultimate goal of my research is to bring to the forefront the lived bodily experiences of women navigating pregnancy after loss. Discussing pregnancy loss and pregnancy after loss continues to be a taboo. I hope for my research to contribute to the emancipatory research agenda within women’s health in HCI, bringing to the fore a stigmatized and yet common experience of pregnancy loss. Additionally, as a part of my research process, I aim to design with women that could lead to concrete design implications on tangible FemTech systems that employ emerging technologies to support the unique needs of women experiencing pregnancy after loss. Ultimately, I hope for my work to contribute to the de-stigmatization of pregnancy loss and reimagining the pregnant body, considering unique unheard experiences of women navigating pregnancy after loss. 

 Can you tell us about any barriers you’ve faced advocating for women’s health in the human-computer interaction field? 

Despite a growing trend in HCI towards experience, embodied interactions, and leisure technologies, some topics related to the body, such as women’s health and human sexuality, remain to be a taboo. Given the taboos associated with designing for women’s bodies, it takes extra efforts and often an activist stance, to invoke discussions related to the need to design considering women’s embodied, lived experiences. Additionally, with the emergence of women’s health technologies, there is a need to understand how technology conditions women’s bodies and generate implications towards designing better women’s health technologies. However, as a woman, my own subjectivity and positionality often meddles with my interpretation and critique of women’s health technologies and it often gets challenging to convey the same in an acceptable form, to the research community.

What is the best way for people to learn more about your work?

You can find more about my work on my website. 

 

How to Set Yourself and Baby up for Breastfeeding Success During COVID-19

 

Author: Carrie Miller, Ph.D., RN, CNE, CHSE, IBCLC, Seattle University-College of Nursing | Editors: Negin Nia, Arrthy Thayaparan (Blog Coordinators), and Kiranjot Jhajj (Blog Reviewer) 

Published: May 6th, 2022

We exist because someone fed us when we were born. In the beginning of our lives, our caregivers make the best decisions possible on our behalf. A newborn is influenced by the environment that they are born in, and COVID-19 can impact that, whether they like it or not. So, how can the breastfeeding relationship thrive as we continue to battle the COVID-19 pandemic? 

Birth Practices

The goal is for labour to be as safe as possible for the birthing parent and the baby. No matter how delivery occurs, it is essential there is time for the baby and parent to bond, feel safe, and protected. Birth practices vary globally, and giving birth is intimate, personal, and remembered forever. Hospital and Birthing Center policies are intended to protect and maintain safety, but we have to carefully consider the impact of these practices. 

In March 2020, COVID-19 was declared a pandemic. Birthing parents were isolated without adequate labour support because of fear of transmission. Parents and newborns were separated if the parent was COVID-19 positive or suspected to have the virus. Hospitals and Birth Centers scrambled to change policies out of safety concerns. COVID-19 policies removed trusted support from the labouring person’s side and reduced their ability to be part of the overall decision-making process.

There are four tenets any parent needs to consider before giving birth: being able to know what to expect during labour and delivery, having trusted support persons in attendance, being cared for by skilled and competent caregivers, and being part of the decision-making process. So, what is essential to get breastfeeding off to the best start with COVID-19 around?

Golden Hour

The first moments of life set the tone for the next several days, weeks, and months. The Golden Hour is when a medically stable infant is placed on the birthing parents’ chest right after birth. Throughout Golden Hour, a newborn will self-regulate heart rate and respiratory rate and stay warm against a birth parents’ chest. The first feeding at the breast can also take place during this time. During the height of COVID-19, babies were separated from their birth parents if there was a confirmed or suspected diagnosis. 

If a parent is COVID-19 positive, an infant can still be placed on the birthing parent’s chest if the parent is well enough. Currently, the Centers for Disease Control and Prevention recommends being masked if an infant is placed skin-to-skin.The American Academy of Pediatrics recommends maintaining normal couplet care [parent-infant dyad] with confirmed or suspected COVID-19 status. However, policies are constantly changing given the evolving knowledge around COVID-19.

Breastfeeding

The current recommendations recognize the importance of providing human milk to infants during COVID-19. The World Health Organization’s current recommendation is to initiate breastfeeding no matter what the COVID-19 status is. The Centers for Disease Control and Prevention reports breastmilk is not likely to spread the virus to infants. If a lactating parent chooses to breastfeed, handwashing and wearing a mask is strongly recommended. 

Furthermore, if a parent chooses to provide pumped milk, a trusted caregiver should provide the pumped milk to the infant if the lactating parent is COVID-19 positive. Parents can also discuss options with caregivers about protective practices. These include having someone help to care for the infant if needed, rooming-in with the infant, using good handwashing, wearing a mask when providing care to the infant, and staying six feet away whenever possible.  

The possibility of transmitting COVID-19 through breastfeeding is uncertain. However, multiple studies such as ones by the American Academy of Pediatrics and Reproductive Health Journal suggest that the risk is low. The science also reveals that the benefits of breastfeeding outweigh the risk of not breastfeeding. Breast milk provides antibodies to protect a newborn against disease. The first feedings with colostrum establish the immune system, which is what protects the baby from the beginning well into childhood and ultimately adulthood. Colostrum contains the key immunologic components to establish the immune system and gut as it is rich in protein and nutrient-dense. 

The first feedings to the newborn are small. The newborn has a tummy the size of a cranberry for the first few days, so a teaspoon can be a full feeding on day one. By day three of life, the newborn has a tummy as big as a ping pong ball and can most likely take about an ounce in a feeding. A newborn does not eat on a schedule either, so one must watch for feeding cues. A newborn may eat 6 to 8 times on the first day and may want to eat 12 times on the second day. 

So, what can you do if a birthing parent needs to be separated from a newborn? Well, you can hand express or pump breastmilk. Even if you are COVID-19 positive, your colostrum and breastmilk are essential for a baby to have a good start. 

Conclusion

A nourished newborn sets the tone for the future. Providing colostrum and human milk to an infant can create a pathway to a healthy start. The journey may be different than planned, but having a solid start is possible, no matter the circumstances. Even with COVID-19, the breastfeeding relationship can thrive if you take the right steps.