School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenberg, Sweden.
Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden.
BMC Pregnancy Childbirth. 2023 Mar 4;23(1):145. doi: 10.1186/s12884-023-05457-0.
The COVID-19 pandemic has led to unprecedented mental stress to women after childbirth. In this study, we assessed the association of disrespectful care after childbirth and COVID-19 exposure before/during labour with postpartum depression symptoms assessed at 7 and 45 days in Nepal.
A longitudinal cohort study was conducted in 9 hospitals of Nepal among 898 women. The independent data collection system was established in each hospital to collection information on disrespectful care after birth via observation, exposure to COVID-19 infection before/during labour and other socio-demographic via interview. The information on depressive symptoms at 7 and 45 days was collected using the validated Edinburg Postnatal Depression Scale (EPDS) tool. Multi-level regression was performed to assess the association of disrespectful care after birth and COVID-19 exposure with postpartum depression.
In the study, 16.5% were exposed to COVID-19 before/during labour and 41.8% of them received disrespectful care after childbirth. At 7 and 45 days postpartum, 21.3% and 22.4% of women reported depressive symptoms respectively. In the multi-level analysis, at the 7th postpartum day, women who had disrespectful care and no COVID-19 exposure still had 1.78 higher odds of having depressive symptom (aOR, 1.78; 95% CI; 1.16, 2.72). In the multi-level analysis, at 45 postpartum day, women who had disrespectful care and no COVID-19 exposure had 1.37 higher odds of having depressive symptoms (aOR, 1.37; 95% CI; 0.82, 2.30), but not statistically significant.
Disrespectful care after childbirth was strongly associated with postpartum depression symptoms irrespective of COVID-19 exposure during pregnancy. Caregivers, even during the global pandemic, should continue to focus their attention for immediate breast feeding and skin-to-skin contact, as this might reduce the risk for depressive symptoms postpartum.
COVID-19 大流行给产妇带来了前所未有的精神压力。在这项研究中，我们评估了尼泊尔在产后 7 天和 45 天评估的产后抑郁症症状与产后不尊重护理和分娩前/期间 COVID-19 暴露之间的关联。
在尼泊尔的 9 家医院对 898 名妇女进行了一项纵向队列研究。在每家医院都建立了独立的数据收集系统，通过观察收集产后不尊重护理的信息，通过访谈收集分娩前/期间 COVID-19 感染暴露和其他社会人口统计学信息。使用经过验证的爱丁堡产后抑郁量表（EPDS）工具收集 7 天和 45 天的抑郁症状信息。采用多水平回归评估产后不尊重护理和 COVID-19 暴露与产后抑郁症的关系。
在这项研究中，16.5%的妇女在分娩前/期间接触过 COVID-19，其中 41.8%的妇女在分娩后受到不尊重的护理。产后 7 天和 45 天，分别有 21.3%和 22.4%的妇女报告有抑郁症状。在多水平分析中，产后 7 天，未接触 COVID-19 但受到不尊重护理的妇女出现抑郁症状的可能性要高出 1.78 倍（调整后的比值比，1.78；95%可信区间，1.16，2.72）。在多水平分析中，产后 45 天，未接触 COVID-19 但受到不尊重护理的妇女出现抑郁症状的可能性要高出 1.37 倍（调整后的比值比，1.37；95%可信区间，0.82，2.30），但无统计学意义。
产后不尊重护理与产后抑郁症症状密切相关，而与怀孕期间 COVID-19 暴露无关。护理人员，即使在全球大流行期间，也应继续关注立即进行母乳喂养和皮肤接触，因为这可能会降低产后出现抑郁症状的风险。
