© Borgis - New Medicine 4/2014, s. 151-155
*Zsófia Szemes, Júlia Talabèr, Mátyásnè Bachorecz, Ildikó Baji
Effects of assisted reproductive treatments on pregnant women’s mental health
Department of Family Care Methodology, Institute of Health Promotion and Clinical Methodology, Faculty of Health Sciences, Semmelweis University, Budapest
Head of Faculty: prof. Zoltán Zsolt Nagy, PhD
Introduction. Childbirth is one of the most important period in women’s life. It gets an even bigger emphasis, if parents have to take some kind of assisted reproductive treatment for the conception. The number of cases when assisted reproductive treatments (ART) are used, is increasing, infertility affects 15-20% of couples. Premature birth and low birth weight is more frequent among pregnant women suffering from major depressive disorder (MDD). The literature does not have a uniform view on the mental health of artificially fertilized women.
Aim. The aim of our research is to submit and analyse particular mental health of women who become pregnant due to ART (ART group), and to compare ART group with spontaneously conceived group.
Material and methods. 985 pregnant women were examined between 01. October 2012 and 31. August 2013 at the 1st Department of Obstetrics and Gynaecology of Semmelweis University (Budapest, Hungary) with self-rated questionnaires.
We measured depression using EPDS test, the level of anxiety by the STAI test. We measured the quality of life with the WHO Quality of Life Bref questionnaire. We used our self-designed questionnaire to gather the socio-demographic data.
Results. 100 pregnant women out of 985 were conceived with help of the ART. The mean age was 35 years, their average gestational week was 32 weeks and about half of them (47%) had multiple pregnancy. 20.8% of the ART group reached the clinical level of depression, and 9% had a high anxiety level.
Conclusions. The frequency of mental disorders in the ART group does not show a big difference from the frequency of mental problems in case of spontaneously conceived group.
We talk about infertility, when no pregnancy occurs within a year in spite of regular, sexual life without contraception. Increasingly more couples have this problem nowadays: infertility affects 15-20% of couples (1).
Infertility in women can be caused by two main reasons: hormonal or organic abnormalities. Moreover, current health condition, lifestyle (especially smoking, and excessive alcohol consumption) or psychological factors also affect the development of infertility (2-4).
Infertile couples can choose from different forms of assisted reproductive technologies. Ovulation-induction, intrauterine insemination and in vitro fertilisation each belong to ART. In Hungary, 2% of all birth comes from ART pregnancies (5).
Pregnancy and depression
Major depressive disorder (MDD) is one of the most common psychiatric diseases. MDD’s lifetime prevalence is between 8.3 and 24.2% (6). According to WHO’s forecast by 2030 MDD will be the biggest economic burden for modern societies (7). Main symptoms of depression are depressed mood, decreasing ability of happiness, or in serious cases its full cessation (anhedonia). In addition, the typical symptoms are negative way of thinking, fatigue, low level of daily activities, decreased ability of concentration, decreased self-esteem, eating and sleeping disorders and suicidal symptoms. (DSM V) Depression is often associated with other psychiatric diseases most commonly with anxiety. 25-50% of patients suffering from depression have a suicide attempt at least one time, and 5-15% of them end their life with suicide (7).
Hormonal changes in a woman’s life are vulnerable periods in the aspect of psychiatric morbidity. During perinatal period the appearance of depression is increased. Although 25-30% of pregnant women show depressive symptoms, the number of threated cases is much less (8).
Premature birth and low birth weight is more frequent among pregnant women suffering from MDD (9, 10). In case of newborn babies of depressed mothers it is statistically proven that sleeping disorders, crying and later behaviour and emotional disorders are more frequent (11).
According to the results of Repokari’s et al. research anxiety level and appearance of depressive symptoms of ART women were lower than in the control group (12).
However, Monti et al. had a very different result: ART women had twice as many depressive points, than the spontaneously conceived group (13, 14).
In Hungary, Bödecs et al. performed a research among pregnant women in the first trimester. They also examined the connection between demographic data and the appearance of depression and anxiety. They found that 17.9% of the sample reached clinical level of depression, and 14.6% showed clinical level anxiety (15).
Research of mental status pregnant women taking ART in Hungary has not been performed yet.
In our study, we presumed that the mental status is worst in case of pregnant women who became pregnant due to ART (henceforth: ART group), than in the spontaneously conceived group (henceforth: spontaneous group). More studies confirm that pregnant women taking ART need to face more mental problems, which hardly ever appear in spontaneous pregnancies (13, 16-19).
In case of ART pregnancies we presumed that the quality of life is better, than in case of the spontaneous group because ART group planned the pregnancy, their partnership is stable, their life circumstances are more secure and their somatic health is more balanced.
We also presumed that within the ART group, in case of twin pregnancies there is a higher depression and anxiety level than in case of singleton pregnancies. Twin pregnancy itself is an endangered pregnancy (20, 21).
The principal aim of our research is to submit and analyse particular mental health of the ART group, and to compare ART group with spontaneous group.
On the other hand our aim is also to ascertain, whether singleton or twin pregnancies within the ART group have an effect on mental health, especially on the appearance of the major depression.
MATERIAL AND METHODs
Our research is going on at the 1st Department of Obstetrics and Gynaecology of the Semmelweis University in Budapest, Hungary. Data gathering happened between 01. October 2012 and 31. August 2013. The whole sample included 985 pregnant women, who were between 22st and 40st gestational week. The participation was voluntary.
The mean age of our sample was 32.9 years and the average gestational week was 34.6 weeks. 91.0% lived in a relationship, 2.7% was divorced, and 6.3% was single.
According to the conception we compared two groups: ART group and spontaneous group. 885 women belong to spontaneous group and 100 women belong to ART group.
The mean age in the spontaneous group was 32.6 years. The average gestational week was 34.6 weeks. 86.7% of the spontaneous group lived in a relationship, 2.9% was divorced and 6.7% was single. In the spontaneous group 835 women had a singleton pregnancy, and 50 women had a multiple pregnancy.
The mean age of ART group was 35.2 years, average gestational week was 32.6 weeks. 98.0% of this group lived in a relationship, 1.0% was divorced and 1.0% was single.
In the ART group there were 47 multiple pregnancies out of the 100 pregnancy, therefore we examined this group separated to multiple and singleton pregnancies.
53 pregnant women belonged to singleton, ART group, their mean age was 35.6 years and the average gestational week was 34.8 weeks. 92.8% of this group lived in a relationship and 7.2% was single. 47 pregnant women belonged to multiple, ART group. Their mean age was 34.7 years, the average pregnancy period was 30.2 weeks. All members lived in a relationship (tab. 1).
Table 1. Socio-demographic data of the total sample.
| ||Spontaneous group|
(n = 885)
(n = 100)
|Singleton, ART group|
(n = 53)
|Twin, ART group|
(n = 47)
|Mean age (year)||32.6||35.2||35.6||34.7|
|Average pregnancy period (week)||34.6||32.6||34.8||30.2|
|Lived in a relationship (%)||86.7||98.0||92.8||100.0|
We measured the mental state of pregnant women with standardized, validated self-rated scales, widely used in Hungary.
We measured the level of depression with the Edinburgh Postnatal Depression Scale (EPDS). The questionnaire contains 10 items, the total score, (ranging from 0 to 30) is determined as the sum of the scores for each of the 10 items. The cut-off score was 9, implying that a woman reaching 9 points or above is likely to suffer from clinical level of depression (22).
We used the Spielberger State-Trait Anxiety Inventory questionnaires to measure anxiety. It has two parts. The State-part of the questionnaires shows the current level of anxiety, where the total score, ranging from 20 to 80, is calculated as the sum of the scores for 20 questions. The cut-off point was 50, implying that 50 or more points indicate a clinical level of anxiety. The second part (Trait) shows the general level of anxiety, again with 20 questions, scores between 20 and 80, the cut-off score was 50 (23).
We measured the quality of life with the 26-item WHO Quality of Life Bref questionnaire. This is shortened version of the original 100-items questionnaire. Minimum 104, maximum 520 points could be reached. Higher scores shows better quality of life (24).
We used our self-designed questionnaire to collect the socio-demographic data.
Statistical analysis, we used Statistica 12 program, Chi2 tests and multinomial logistic regression models.
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