Construction and validation of a personalized prediction model for postpartum anxiety in pregnant women with preeclampsia

BACKGROUND Preeclampsia is a pregnancy-specific multi-system disease with multi-factor and multi-mechanism characteristics.The cure for preeclampsia is to terminate the pregnancy and deliver the placenta.However,it will reduce the perinatal survival rate,prolong the pregnancy cycle,and increase the incidence of maternal complications.With relaxation of the birth policy,the number of elderly pregnant women has increased significantly,and the prevalence rate of preeclampsia has increased.Inappropriate treatment can seriously affect the normal postpartum life of pregnant women.Studies have shown that postpartum anxiety in women with preeclampsia can affect physical and mental health,as well as infant growth and development.AIM To analyze the factors influencing preeclampsia in pregnant women complicated with postpartum anxiety,and to construct a personalized predictive model.METHODS We retrospectively studied 528 pregnant women with preeclampsia who delivered in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between January 2018 and December 2021.Their basic data were collected,and various physiological and biochemical indicators were obtained by laboratory examination.The self-rating anxiety scale was used to determine whether the women had postpartum anxiety 42 d after delivery.The independent factors influ-encing postpartum anxiety in early pregnant women with eclampsia were analyzed with multifactor logistic regression and a predictive model was constructed.The Hosmer-Lemeshow test and receiver operating characteristic(ROC)curve were used to evaluate the calibration and discrimination of the predictive model.Eighty pregnant women with preeclampsia admitted to our hospital from January 2022 to May 2022 were retrospectively selected to verify the prediction model.RESULTS We excluded 46 of the 528 pregnant women with preeclampsia because of loss to follow-up and adverse outcomes.A total of 482 cases completed the assessment of postpartum anxiety 42 d after delivery,and 126(26.14%)had postpartum anxiety.Bad marital relationship,gender discrimination in family members,hematocrit(Hct),estradiol(E2)hormone and interleukin(IL)-6 were independent risk factors for postpartum anxiety in pregnant women with preeclampsia(P<0.05).Prediction model:Logit(P)=0.880×marital relationship+0.870×gender discrimination of family members+0.130×Hct-0.044×E2+0.286×IL-6-21.420.The area under the ROC curve of the model was 0.943(95%confidence interval:0.919-0.966).The threshold of the model was-1.507 according to the maximum Youden index(0.757),the corresponding sensitivity was 84.90%,and the specificity was 90.70%.Hosmer-Lemeshowχ^(2)=5.900,P=0.658.The sensitivity,specificity and accuracy of the model were 81.82%,84.48%and 83.75%,respectively.CONCLUSION Poor marital relationship,family gender discrimination,Hct,IL-6 and E2 are the influencing factors of postpartum anxiety in preeclampsia women.The constructed prediction model has high sensitivity and specificity.

Mediating effect of mindfulness level on the relationship between marital quality and postpartum depression among primiparas

BACKGROUND Postpartum depression refers to a depressive episode or depressive symptoms up to 12 mo after delivery.Trait mindfulness has presented a protective factor for postpartum depressive symptoms and proved efficient in improving relationship satisfaction among couples.AIM To investigate the correlations among mindfulness,marital quality,anxiety,and depression in a large city in western China during the post-corona virus infectious disease-2019 era and determine whether trait mindfulness mediates the relationship between marital quality and postpartum anxiety and depression among primiparas.METHODS A cross-sectional study was conducted.The self-administered questionnaire was submitted online through smartphones.The levels of mindfulness,anxiety,depression,and marital quality were respectively investigated by the mindful attention awareness scale(MAAS),the self-rating anxiety scale(SAS),the selfrating depression scale(SDS),and the marriage perception scale(MPS)in these enrolled Han and Tujia primiparas.RESULTS No statistical significance was observed in the prevalence of postpartum anxiety and depression,nor scores of MAAS and MPS-Total in different regions or ethnicities(P>0.05).However,MPSMarital interaction(P<0.05),MPS-Family relationship(MPS-FR)(P<0.01),and MPS-Marital conflict(MPS-MC)(P<0.01)scores of urban primiparas were higher than those of rural primiparas.The MPS-MC score of Han primiparas was higher than that of Tujia primiparas(P<0.05).Negative correlations were observed between MAAS and SAS(r=-0.457,P<0.01),and MAAS and SDS(r=-0.439,P<0.01).SAS has revealed a highly positive correlation with SDS(r=0.720,P<0.01)and a weak negative correlation with MPS(r=-0.200,P<0.05).Besides,a weak negative correlation was observed between MAAS and MPS-MC(r=-0.184,P<0.05),and a weak positive correlation was noticed between SAS and MPS-MC(r=-0.225,P<0.01).Mediation analysis demonstrated a full mediation effect of mindfulness level on the relationship between MPS-FR and postpartum anxiety(P<0.05,95%CI:-0.384 to 0.033),MPS-MC and postpartum anxiety(P<0.01,95%CI:0.027-0.193),MPS-FR and postpartum depression(P<0.05,95%CI:-0.365 to 0.031),and MPS-MC and postpartum depression(P<0.01,95%CI:0.022-0.206).CONCLUSION Mindfulness demonstrates negative correlations with marital conflict,postpartum anxiety and depression,and it may have cross-ethnic and trans-regional characteristics.Although the mindfulness levels have revealed no significant mediating effect between the total score of marital quality and postpartum depression in this study,it demonstrates a full mediation effect on the relationships between family relationships,marital conflict,and postpartum anxiety and depression.

Lateral habenula neurocircuits mediate the maternal disruptive effect of maternal stress: A hypothesis

Up to 20%of women experience stress-related disorders during the postpartum period;however,little is known about the specific neural circuitry by which maternal stress exerts its negative impacts on mental health and maternal caregiving behavior.Theoretically,such a circuitry should serve as an interface between the stress response system and maternal neural network,transmitting stress signals to the neural circuitry that mediates maternal behavior.In this paper,I propose that the lateral habenula(LHb)serves this interface function.Evidence shows that the LHb plays a key role in encoding stress-induced effects and in the pathophysiology of major depression and stressrelated anxiety,and thus may play a role in maternal behavior as part of the maternal brain network.I hypothesize that maternal stress acts upon the LHb and two of its major downstream targets,i.e.,ventral tegmental area(VTA)and dorsal raphe nucleus(DRN),compromising the maternal care and contributing to postpartum mental disorders.This hypothesis makes three predictions:(1)maternal stress enhances LHb neuronal activity;(2)activation of DRN-and VTA-projecting neurons in the LHb mimics the detrimental effects of maternal stress on maternal behavior;and(3)suppression of DRN-and VTA-projecting neurons in the LHb attenuates the detrimental effects of maternal stress on maternal care in stressed mothers.Confirmation of this hypothesis is expected to enhance our understanding of the neurocircuit mechanisms mediating stress effects on maternal behavior.