To date, although numbers of studies about CI were found, perinatal mood disorders rates had not been evaluated. Because women suffer from CI often lose their babies in the second trimester, they would be under greater psychological pressure in the same stage of their next pregnancy. Therefore, in our study, 2 groups of pregnant women were included to evaluate perinatal mood disorders in second trimester pregnant women with CI.
Results of the present study showed that the SAS, SDS score in second trimester pregnant women with CI is significantly higher than those in normal second trimester pregnant women. Meanwhile, the incidence rate of anxiety and depression was much higher than normal pregnant women. Of the CI group, 100% of pregnant women have previous spontaneous pregnancy loss and the average time of abortion was 21.14 ± 3.52 weeks. Previous negative pregnancy outcomes can have profound and lasting influence upon women, both physiologically and psychologically. The closer they were to the “critical week”, the greater psychological pressure they have, not just from themselves but also from families and societies, which increases the probability of perinatal mood disorders. Besides, we also discovered that anxiety and depression ubiquitously happened in pregnant women with CI, no matter once or several times of abnormal pregnancy they had. These results indicate that in daily clinical work, we should not assess women’s risk of developing perinatal mood disorders by abnormal pregnancy times, since once they had previous pregnancy loss, they are far more likely to have anxiety and depression than common pregnant women. Doctors and nurses should attach great importance to this situation and try to intervene earlier.
In the present study, multivariate logistic regression analysis showed that educational experience is an independent protective factor for depression disorder in second trimester pregnant women with CI. The poorer education experience they have, the more likely they develop perinatal depression. Larry and Errol(5) reported that CI may be present in only 0.1%~2% of obstetric populations. After those low-education women had their fetal loss, they were more unlikely to seek help from doctors, but kept trying to get pregnant, and finally came up with many times of abnormal pregnancy. The lack of knowledge about CI made them miss the opportunity of early intervention and surgical treatment. However, women with higher education experience may learn for relative knowledge via network, medical platform or other ways after their first pregnant loss and seek for help or treatment more actively, therefore reducing the impairment from CI and decrease their psychological pressure. Meanwhile, they have more channels to understand the relative knowledge of gestation well and they can better regulate their emotions during pregnancy, thus decreasing the occurrence of perinatal depression.
Table 1 shows that the self-paying rate and unemployment rate in CI group is significantly higher than the normal group, both with a P value < 0.001. Due to their history of unexplained spontaneous abortions, especially some of them had a history of pregnancy loss after emergency cervical cerclage, everything becomes extremely careful in their next gestation. Our study showed that over half of women in CI group were unemployed at home and their husbands’ earnings took up a large proportion of family income. Among CI group, 45.92% of women had a family income lower than 10000 yuan monthly while it just took about 23.49% of women in normal group. On an equal basis of medical treatment, patients with lower income had to endure larger proportion of medical expenses to total income and this would increase their financial burden, as well as mental stress. So, it’s very important for our doctors and nurses to pay close attention to CI women with low family income in daily work, particularly give them more anti-anxiety and anti-depression care and support.
To reduce perinatal mood disorders, members of our group kept in touch with those pregnant women in CI group until six weeks after delivery and provided one-to-one profession guidance. We created a group chat named “Circle of Life” on the internet with doctors and nurses in our hospital and communicated with pregnant women to help them. Online maternity schools were also founded to provide knowledge about health care, physical exercise and diet during pregnancy. All pregnant women could get support and communicate with doctors directly from the group chat and maternity school. In addition, we also print some brochure about laparoscopic cervical cerclage, containing all the details from pathogenesis to psychological counseling until postpartum recovery. Everything we did was aim to alleviate their psychological pressure and avoid perinatal mood disorders, including anxiety and depression. Until now, 81 women of CI group have delivered successfully, with a live-birth rate of 91.36%, average gestational age at delivery of 36.69 weeks and average birth weight of 2.79 kilograms, and none of them develops into serious adverse events associated with perinatal mood disorders.
For the first time, our study tries to focus on perinatal mood disorders in second trimester pregnant women with CI and explore its risk factors, so as to provide guidance for psychological caring and counseling in clinic work. Pregnant women undergoing laparoscopic cervical cerclage will return home after surgery and perinatal mood disorders such as anxiety and depression will become difficult to identify. Once these negative emotions can not be detected timely, serious adverse effects can happen soon. Therefore, we suggest a conventionally evaluation on psychological conditions for pregnant women during their second trimester, especially their “critical week”. Appropriate assessment and early intervention can improve life quality during pregnancy and promote both maternal and infant’s health.
However, there were some limitations in the present study. Firstly, relevant factors and mental status were obtained by self-report questionnaire, therefore measurement error caused by subjective factors may exist. Secondly, since the mid-trimester abortion often occurred in maternity wards of different hospitals, it is difficult to know the psychological statements of pregnant women after their latest pregnancy loss. Lastly, participants of the present study were from different provinces all over China, our findings may not generalize to the population in other countries. Extrapolation of this study requires careful consideration.