Recruitment and procedure
A population-based cross-sectional study of healthy pregnant women was carried out from April 2016 to February 2017. Recruitment of a convenience sample of women in the third trimester of a singleton pregnancy took place at the Non-Stress Test laboratory of the Department of Obstetrics and Gynecology, Hungary.
Inclusion criteria were to be able to speak and read Hungarian, and to have their mother within reach. Women who had a history of drug abuse and/or were suffering from any major psychiatric disorder were excluded from the study.
Of the 400 pregnant women invited, 380 agreed to participate after having given informed and written consent. They were then given a booklet of questionnaires and asked to return it at the subsequent check-up one week later. Information on the birth circumstances was obtained from participants’ biological mothers.
The socio-demographic and obstetric checklist included questions about participntas’age, educational level, occupational status, any economic hardship, marital status, place of residence, number of pregnancies, gestational age, history of miscarriage(s), whether this pregnancy was a result of previouse planning or not.
Peri and postnatal events
Mother’s Birth Circumstances Questioner(MBCQ) was mapped by questions about the date of birth (due date, preterm or postterm), mode of birth (vaginal or cesarean section), interventions during labor (administration of oxytocin, amniotomy, epidural analgesia, instrumental delivery, and episiotomy), the early life care of infants (the presence of their father during their birth, immediate skin-to-skin contact with their mother, having been breastfed during the first few hours, early rooming-in), and late life care of infants ( having been breastfed over the first two years).
Prenatal Mental Health
The Humgarien Version of Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ A) that consists of 30 items was used to measure prenatal fear of childbirth. All items of this instrument are assessed on a six-point Likert scale with a range score of 0 for ‘not at all’ to 5 for ‘extremely’, according to the degree of agreement, ranging a total score from 0 to 150 (20). The Cronbach alpha in the present study accounted for 0.88.
- Beck Anxiety Inventory (BAI) consists of 21 items was used to measure prenatal anxeity. Each item is measured on a four-point likert scale ranging from 0 (“not at all”) to 3 (“severely”). The total possible score for this instrument ranges between 0 (indicating low level of anxiety ) and 63 ( an indication of a high level of anxiety) (21). The Cronbach alpha in the present study accounted for 0.89.
- Beck Depression Inventory-Short Form (BDI-SF) consists of 9 items was used to measure prenatal depression.. Each item is assessed on a four-point likert scale (from 0 to 3), with a total possible score ranging from 0 to 27. The Cronbach alpha for this study tool was 0.71.
Potential confounding variable
- Multidimensional Scale of Perceived Social Support (MSPSS) consists of 12 items was used to measure social support as a potential confounder. This instrument measures both the perceived availability and adequacy of emotional and instrumental social support from three sources of support, including family, friends, and significant others. Each item is assessed on a seven-point scale, ranging from 1 (very strongly disagree) to 7 (very strongly agree) (22). In this study, the Cronbach alpha of .86 was found for total score.
The present study was the secondary analysis of participants data recruited for the Ph.D. thesis project of the corresponding author approved by The Regional and Institutional Committee of Science and Research Ethics (No. 5923). The research was performed in accordance with the Declaration of Helsinki.
Descriptive statistics was performed to describe socio-demographic and obstetric features of participants, and psychological outcomes. Firstly, we employed Univariate linear regression model to define the association of birth circumstances with each outcome namely prenatal fear of childbirth, depression, and anxiety, independently. After that, multivariate regression models were performed to adjust obtained models for maternal age, maternal education, parity, economic status, and social support as potential confounders using stepwise method.
All estimates were reported with 95% confidence intervals (95% CI) and statistical significance was considered at the level of P< 0.05. IBM SPSS® version 22.0 was used for the analyses.