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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

01-12-2020 | Mood Disorders | Study protocol

The Rajarata Pregnancy Cohort (RaPCo): study protocol

Authors: Thilini Chanchala Agampodi, Nuwan Darshana Wickramasinghe, Rampathige Indika Ruwan Prasanna, Malawara Kankanamalage Lasandha Irangani, Jayasundara Mudiyanselage Samarakoon Banda, Pradana Mudiyanselage Bandula Jayathilake, Ayesh Hettiarachchi, Gayani Amarasinghe, Imasha Jayasinghe, Iresha Koralagedara, Sajaan Praveena Gunarathne, Sujanthi Wickramage, Janith Warnasekara, Niroshan Lokunarangoda, Vasana Mendis, Ajith Kumara Dissanayaka, Jagath Premadasa, Nandana Hettigama, Dayaratne Koralagedara, Manjula Weerasinghe, Krishanthi Malawanage, Hemali Jayakodi, Anuprabha Wickramasinghe, Suneth Buddhika Agampodi

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

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Abstract

Background

Ending preventable maternal deaths remains a global priority and in the later stages of obstetric transition, identifying the social determinants of maternal health outcomes is essential to address stagnating maternal mortality rates. Countries would hardly achieve the Sustainable Development Goal (SGD) targets on maternal health, unless the complex and context-specific socio-economic aetiologies associated with maternal mental health and suicide are identified. The Rajarata Pregnancy Cohort (RaPCo) is a prospective cohort study, designed to explore the interactions between social determinants and maternal mental health in determining pregnancy and new-born outcomes.

Methods

The study will recruit all eligible pregnant women in the maternal care programme of Anuradhapura district, Sri Lanka from July to September 2019. The estimated sample size is 2400. We will assess the socio-demographic and economic status, social capital, gender-based violence and mental health, including a clinical examination and biochemical investigations during the first trimester. Participants will undergo four follow-ups at 2nd and 3rd trimesters, at delivery and in early postpartum. The new-borns will be followed up at birth, neonatal period, at 6 six months and at 1 year. Pregnancy and child outcome data will be collected using direct contact. Qualitative studies will be carried out to understand the complex social factors and behavioural dimensions related to abortion, antenatal depression, maternal deaths and near misses.

Discussion

This is the first reported maternal cohort in Sri Lanka focusing on social determinants and mental health. As a country in stage four of obstetric transition, these findings will provide generalizable evidence on achieving SGD targets in low- and middle-income countries. The study will be conducted in a district with multi-cultural, multi-ethnic and diverse community characteristics; thus, will enable the evidence generated to be applied in many different contexts. The study also possesses the strength of using direct participant contact, data collection, measurement, examination and biochemical testing to minimise errors in routinely collected data. The RaPCo study will be able to generate evidence to strengthen policies to further reduce maternal deaths in the local, regional and global contexts particularly focusing on social factors and mental health, which are not optimally addressed in the global agenda.
Appendix
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Literature
1.
Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN maternal mortality estimation inter-agency group. Lancet. 2016;387(10017):462–74.PubMed
2.
Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards millennium development goal 5. Lancet. 2010;375(9726):1609–23.PubMed
3.
World Health Organization. Strategies towards ending preventable maternal mortality (EPMM). Geneva: World Health Organization; 2015.
4.
Bonanni P, Bechini A, Pesavento G, Boccalini S, Tiscione E, Graziani G, et al. Implementation of the plan for elimination of measles and congenital rubella infection in Tuscany: evidence of progress towards phase II of measles control. J Prev Med Hyg. 2005;46(3):111–7.
5.
Souza J, Tunçalp Ö, Vogel J, Bohren M, Widmer M, Oladapo O, et al. Obstetric transition: the pathway towards ending preventable maternal deaths. BJOG An Int J Obstet Gynaecol. 2014;121:1–4.
6.
7.
World Health Organization, UNICEF, UNFPA, Bank TW. Trends in maternal mortality: 1990 to 2010 WHO, UNICEF, UNFPA and The World Bank estimates. 1st ed. Geneva: World Health Organization; 2012. p. 59.
8.
Putnam RD. Bowling alone: the collapse and revival of American community. New York: Simon and Schuster; 2001. p. 544.
9.
Hanifan L. The rural school community Centre. Ann Am Acad Pol Soc Sci. 1916;67:130–8.
10.
Portes A. Social capital: its origins and applications in modern sociology. Annu Rev Sociol. 1998;24(1):1–24.
11.
12.
Ehsan AM, Silva MJ De. Social capital and common mental disorde: a systematic review. J Epidemiol Commun Health. 2015;1021–8.
13.
Kawachi I, Berkman L. Social cohesion, social capital, and health. In: Social epidemiology; 2014. p. 290–319.
14.
15.
Ahn S, Youngblut JAM. Predictors of women’s postpartum health status in the first 3 months after childbirth. Asian Nurs Res (Korean Soc Nurs Sci). 2007;1(2):136–46.
16.
Elsenbruch S, Benson S, Rucke M, Rose M, Dudenhausen J, Pincus-Knackstedt MK, et al. Social support during pregnancy: effects on maternal depressive symptoms, smoking and pregnancy outcome. Hum Reprod. 2007;22(3):869–77.PubMed
17.
Kritsotakis G, Vassilaki M, Melaki V, Georgiou V, Philalithis AE, Bitsios P, et al. Social capital in pregnancy and postpartum depressive symptoms: a prospective mother-child cohort study (the Rhea study). Int J Nurs Stud. 2013;50(1):63–72.PubMed
18.
Agampodi TC, Rheinländer T, Agampodi SBSB, Glozier N, Siribaddana S. Social capital and health during pregnancy; an in-depth exploration from rural Sri Lanka. Reprod Health. 2017;14(1):89.PubMedPubMedCentral
19.
Ma O, Ma O. Suicide: the leading cause of maternal death. Br J Psychiatry. 2003;183(4):279–81.
20.
21.
22.
Yusuf HR, Akhter HH, Chowdhury ME, Rochat RW. Causes of death among women aged 10-50 years in Bangladesh, 1996-1997. J Health Popul Nutr. 2007;25(3):302–11.PubMedPubMedCentral
23.
Gelaye B, Kajeepeta S, Williams MA. Suicidal ideation in pregnancy: An epidemiological review. Arch Womens Ment Health. 2016;19(5):741–51.PubMedPubMedCentral
24.
Fisher J, Cabral de Mello M, Patel V, Rahman A, Tran T, Holton S, et al. WHO | Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ. 2012;90(2):139–149H World Health Organization.
25.
Hendrick V, Altshuler L, Cohen L, Stowe Z. Evaluation of mental health and depression during pregnancy: position paper. Psychopharmacol Bull. 1998;34(3):297–9.PubMed
26.
Marcus SM. Depression during pregnancy: rates, risks and consequences--Motherisk update 2008. Can J Clin Pharmacol. 2009;16(1):e15–22.PubMed
27.
Agampodi SB, Agampodi TC. Antenatal depression in Anuradhapura, Sri Lanka and the factor structure of the Sinhalese version of Edinburgh post partum depression scale among pregnant women. PLoS One United States. 2013;8(7):e69708.
28.
O’hara MW, Swain AM. Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatry. 1996;8(1):37–54.
29.
Wadhwa PD, Sandman CA, Porto M, Dunkel-Schetter C, Garite TJ. The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. Am J Obstet Gynecol. 1993;169(4):858–65.PubMed
30.
31.
Hashim TJ, Moawed SA. The relation of low birth weight to psychosocial stress and maternal anthropometric measurements. Saudi Med J. 2000;21(7):649–54.
32.
Bernard-Bonnin A-C. Maternal depression and child development. Paediatr Child Health. 2004;9(8):575–98.
33.
Cohn JF, Tronick E. Specificity of infants’ response to mothers’ affective behavior. J Am Acad Child Adolesc Psychiatry. 1989;28(2):242–8.PubMed
34.
Tronick E, Reck C. Infants of depressed mothers. Harv Rev Psychiatry. 2009;17(2):147–56.PubMed
35.
Singer J, Fagen J. Negative affect, emotional expression, and forgetting in young infants. Dev Psychol. 1992;28(1):48–57.
36.
Hammen C, Burge D, Burney E, Adrian C. Longitudinal study of diagnoses in children of women with unipolar and bipolar affective disorder. Arch Gen Psychiatry. 1990;47(12):1112–7.PubMed
37.
Lesesne CA, Visser SN, White CP. Attention-deficit/hyperactivity disorder in school-aged children: association with maternal mental health and use of health care resources. Pediatrics. 2003;111(5):1232–7.PubMed
38.
Faisal-Cury A, Menezes PR. Antenatal depression strongly predicts postnatal depression in primary health care. Rev Bras Psiquiatr. 2012;34(4):446–50.PubMed
39.
Leigh B, Milgrom J. Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry. 2008;8:24.PubMedPubMedCentral
40.
Rahman A, Creed F. Outcome of prenatal depression and risk factors associated with persistence in the first postnatal year: prospective study from Rawalpindi, Pakistan. J Affect Disord. 2007;100(1–3):115–21.PubMedPubMedCentral
41.
World Health Organization, Organization WH. The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD-MM. Geneva: World Health Organization; 2012. p. 1–67.
42.
Agampodi S, Wickramage K, Agampodi T, Thennakoon U, Jayathilaka N, Karunarathna D, et al. Maternal mortality revisited: the application of the new ICD-MM classification system in reference to maternal deaths in Sri Lanka. Reprod Health England. 2014;11(1):17.
43.
Agampodi TC, Agampodi SB, Wickramasinghe WA, Adhikari AM, Chathurani HK. Post partum depression - a problem that needs urgent attention. Ceylon Med J. 2011;56(4):183–4.
44.
Family Health Bureau. MCH statistics 2016. 2018.
45.
Medical Statistics Unit Ministry of Health Nutrition and Indigenous Medicine. Annual Health Statistics 2016. Colombo: Ministry of Health, Nutrition and Indigenous Medicine; 2016.
46.
Department of Census and Statistics Ministry of National Policies and Economic Affairs. Sri Lanka Demographic and Health Survey 2016. Colombo; 2017.
47.
Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012–24.PubMedPubMedCentral
48.
49.
Rowel D, Jayawardena P, Fernando N. Validation of the Sinhala translation of Edinburgh postnatal depression scale. Ceylon Med J. 2008;53(1):10–3.PubMed
50.
Parker B, McFarlane J. Identifying and helping battered pregnant women. MCN Am J Matern Child Nurs. 1991;16(3):161–4.PubMed
51.
Agampodi S, Agampodi T, Wickramasinghe N, Fernando S, Chathurani U, Adhikari W, et al. Productivity cost due to maternal ill health in Sri Lanka. PLoS One. 2012;7(8):1–5 Public Library of Science.
52.
Gosling SD, Rentfrow PJ, Swann WB. A very brief measure of the big-five personality domains. J Res Pers. 2003;37(6):504–28.
53.
54.
Abeysena H, Jayawardana P, Peiris U, Rodrigo A. Validation of the Sinhala version of the 12-item general health questionnaire. J Postgrad Inst Med. 2014;1(1):1–7.
55.
Perez Escamilla R, Dessalines M, Finnigan M, Pacho H. Household Food Insecurity Is Associated with Childhood Malaria in Rural Haiti 1 , 2. 2009;(7).
56.
Sumathipala A, Murray J. New approach to translating instruments for cross-cultural research: a combined qualitative and quantitative approach for translation and consensus generation. Int J Methods Psychiatr Res. 2000;9(2):87–95.
57.
Department of census and Statistics. Literacy Rates by District and Sex (Population of Age 10 Years and Over).
58.
World Health Organization. Waist circumference and waist-hip ratio: report of a WHO expert consultation, Geneva, 8-11 December 2008. Geneva; 2011.
Metadata
Title
The Rajarata Pregnancy Cohort (RaPCo): study protocol
Authors
Thilini Chanchala Agampodi
Nuwan Darshana Wickramasinghe
Rampathige Indika Ruwan Prasanna
Malawara Kankanamalage Lasandha Irangani
Jayasundara Mudiyanselage Samarakoon Banda
Pradana Mudiyanselage Bandula Jayathilake
Ayesh Hettiarachchi
Gayani Amarasinghe
Imasha Jayasinghe
Iresha Koralagedara
Sajaan Praveena Gunarathne
Sujanthi Wickramage
Janith Warnasekara
Niroshan Lokunarangoda
Vasana Mendis
Ajith Kumara Dissanayaka
Jagath Premadasa
Nandana Hettigama
Dayaratne Koralagedara
Manjula Weerasinghe
Krishanthi Malawanage
Hemali Jayakodi
Anuprabha Wickramasinghe
Suneth Buddhika Agampodi
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-03056-x

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