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

Open Access 01-12-2020 | Mood Disorders | Research article

Antenatal depression and its potential causal mechanisms among pregnant mothers in Gondar town: application of structural equation model

Authors: Abel Fekadu Dadi, Emma R. Miller, Richard Woodman, Telake Azale Bisetegn, Lillian Mwanri

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

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Abstract

Background

Various forms of life stressors have been implicated as causes of antenatal depression. However, there is a lack of understanding of which forms of stress lead to antenatal depression and through what mechanisms. Modeling stress processes within a theoretical model framework can enhance an understanding of the mechanisms underlying relationships between stressors and stress outcomes. This study used the stress process model framework to explore the causal mechanisms underlying antenatal depression in Gondar, Ethiopia.

Methods

Questionnaires, using an Online Data collection Kit (ODK) tool were administered face-to-face in 916 pregnant women in their second and third trimesters. Pregnant women were included from six randomly selected urban districts in Gondar, Ethiopia during June and August 2018. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for antenatal depression. A Structural Equation Model (SEM) was employed to explore the direct, indirect, and total effect of stressors and mediators of antenatal depression.

Result

Sixty-three participants (6.9%) reported symptoms of depression. Of these, 16 (4.7%) and 47 (8.1%) were in their second and third trimesters, respectively. The SEM demonstrated several direct effects on antenatal depression scores including unplanned pregnancy (standardized β = 0.15), having a history of common mental health disorder (standardized β = 0.18) and fear of giving birth to the current pregnancy (standardized β = 0.29), all of which were associated with a higher depression score. Adequate food access for the last 3 months (standardized β = − 0.11) was associated with decreased depression score. Social support (β = − 0.21), marital agreement (β = − 0.28), and partner support (β = −.18) appeared to partially mediate the link between the identified stressors and the risk of antenatal depression.

Conclusion

Both direct and indirect effects contributed to higher antenatal depression score in Ethiopian women. The three psychosocial resources namely marital agreement, social and partner support, mediated reduced antenatal depression scores. Early screening of antenatal depression and enhancing the three psychosocial resources would help to improve maternal resilience.
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Literature
1.
Wadhwa PD, Glynn L, Hobel CJ, Garite TJ, Porto M, Chicz-DeMet A, et al. Behavioral perinatology: biobehavioral processes in human fetal development. Regul Pept. 2002;108(2–3):149–57.CrossRefPubMed
2.
O’Keane V, Marsh MS. Depression during pregnancy. BMJ. 2007;334.
3.
Sheila M. Marcus. depression-during-pregnancy-rates-risks-and-consequences-motherisk-update-2008.pdf; 2008.
4.
Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry. 2004;26(4):289–95.CrossRefPubMed
5.
6.
Amiel Castro RT, Pinard Anderman C, Glover V, O’Connor TG, Ehlert U, Kammerer M. Associated symptoms of depression: patterns of change during pregnancy. Arch Women’s Ment Health. 2017;20(1):123–8.CrossRef
7.
Mukherjee S, Trepka M, Pierre-Victor D, Bahelah R, Avent T. Racial/ethnic disparities in antenatal depression in the United States: a systematic review. Matern Child Health J. 2016;20(9):1780–97.CrossRefPubMed
8.
Chatillon O, Even C. Antepartum depression: prevalence, diagnosis and treatment. Encephale. 2010;36(6):443–51.CrossRefPubMed
9.
Mitchell-Jones N, Gallos I, Farren J, Tobias A, Bottomley C, Bourne T. Psychological morbidity associated with hyperemesis gravidarum: a systematic review and meta-analysis. BJOG. 2017;124(1):20–30 Date of Publication: 01 Jan 2017.; 2017.CrossRefPubMed
10.
Lau Y. Risk factors associated with antenatal depressive symptomatology among Chengdu Chinese women. Merrick, Joav [Ed] (2013) Alternative medicine yearbook, 2011 (pp 107-121) xxx, 572 pp Hauppauge, NY, US: Nova Biomedical Books; US. 2013:107–21.
11.
Li J, Mao J, Du Y, Morris JL, Gong G, Xiong X. Health-related quality of life among pregnant women with and without depression in Hubei, China. Matern Child Health J. 2012;16(7):1355–63.CrossRefPubMed
12.
Bavle AD, Chandahalli AS, Phatak AS, Rangaiah N, Kuthandahalli SM, Nagendra PN. Antenatal depression in a tertiary care hospital. Indian J Psychol Med. 2016;38(1):31–5.CrossRefPubMedPubMedCentral
13.
Srinivasan N, Murthy S, Singh AK, Upadhyay V, Mohan SK, Joshi A. Assessment of burden of depression during pregnancy among pregnant women residing in rural setting of Chennai. J Clin Diagn Res. 2015;9(4):LC08–12.PubMedPubMedCentral
14.
Husain N, Cruickshank K, Husain M, Khan S, Tomenson B, Rahman A. Social stress and depression during pregnancy and in the postnatal period in British Pakistani mothers: a cohort study. J Affect Disord. 2012;140(3):268–76.CrossRefPubMedPubMedCentral
15.
Weng SC, Huang JP, Huang YL, Lee TS, Chen YH. Effects of tobacco exposure on perinatal suicidal ideation, depression, and anxiety. BMC Public Health. 2016;16:623.CrossRefPubMedPubMedCentral
16.
Abujilban SK, Abuidhail J, Al-Modallal H, Hamaideh S, Mosemli O. Predictors of antenatal depression among Jordanian pregnant women in their third trimester. Health Care Women Int. 2014;35(2):200–15.CrossRefPubMed
17.
Moshki M, Cheravi K. Relationships among depression during pregnancy, social support and health locus of control among Iranian pregnant women. Int J Soc Psychiatry. 2016;62(2):148–55.CrossRefPubMed
18.
Padmapriya N, Bernard JY, Liang S, Loy SL, Shen Z, Kwek K, et al. Association of physical activity and sedentary behavior with depression and anxiety symptoms during pregnancy in a multiethnic cohort of Asian women. Arch Women’s Ment Health. 2016;19(6):1119–28.CrossRef
19.
Shidhaye P, Shidhaye R, Phalke V. Association of gender disadvantage factors and gender preference with antenatal depression in women: a cross-sectional study from rural Maharashtra. Soc Psychiatry Psychiatr Epidemiol. 2017;09:09.
20.
Fisher J, Tran T, Duc Tran T, Dwyer T, Nguyen T, Casey GJ, et al. Prevalence and risk factors for symptoms of common mental disorders in early and late pregnancy in Vietnamese women: a prospective population-based study. J Affect Disord. 2013;146(2):213–9.CrossRefPubMed
21.
Manikkam L, Burns JK. Antenatal depression and its risk factors: an urban prevalence study in KwaZulu-Natal. S Afr Med J. 2012;102.
22.
Målqvist M, Clarke K, Matsebula T, Bergman M, Tomlinson M. Screening for antepartum depression through community health outreach in Swaziland. J Community Health. 2016;41(5):946–52.CrossRefPubMedPubMedCentral
23.
Rwakarema M, Premji SS, Nyanza EC, Riziki P, Palacios-Derflingher L. Antenatal depression is associated with pregnancy-related anxiety, partner relations, and wealth in women in northern Tanzania: a cross-sectional study. BMC Womens Health. 2015;15:68.CrossRefPubMedPubMedCentral
24.
Thompson O, Ajayi I. Prevalence of antenatal depression and associated risk factors among pregnant women attending antenatal clinics in Abeokuta north local government area, Nigeria. Depression Res Treat. 2016;2016:4518979.
25.
Zegeye A, Alebel A, Gebrie A, Tesfaye B, Belay YA, Adane F, et al. Prevalence and determinants of antenatal depression among pregnant women in Ethiopia: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2018;18(1):462.CrossRefPubMedPubMedCentral
26.
National forum on early childhood program evaluation. Maternal Depression Can Undermine the Development of Young Children. Working Paper No 82009..
27.
Diego MA, Field T, Hernandez-Reif M, Schanberg S, Kuhn C, Gonzalez-Quintero VH. Prenatal depression restricts fetal growth. Early Hum Dev. 2009;85(1):65–70.CrossRefPubMed
28.
Toth SL, Rogosch FA, Manly JT, Cicchetti D. The efficacy of toddler-parent psychotherapy to reorganize attachment in the young offspring of mothers with major depressive disorder: a randomized preventive trial. J Consult Clin Psychol. 2006;74(6):1006–16.CrossRefPubMed
29.
Latendresse G, Wong B, Dyer J, Wilson B, Baksh L, Hogue C. Duration of maternal stress and depression. Nurs Res. 2015;64(5):331–41.CrossRefPubMed
30.
Deyessa N, Berhane Y, Emmelin M, Ellsberg MC, Kullgren G, Hogberg U. Joint effect of maternal depression and intimate partner violence on increased risk of child death in rural Ethiopia. Arch Dis Child. 2010;95(10):771–5.CrossRefPubMed
31.
Campbell SB, Brownell CA, Hungerford A, Spieker SI, Mohan R, Blessing JS. The course of maternal depressive symptoms and maternal sensitivity as predictors of attachment security at 36 months. Dev Psychopathol. 2004;16(2):231–52.CrossRefPubMed
32.
Bonari L, Pinto N, Ahn E, Einarson A, Steiner M, Koren G. Perinatal risks of untreated depression during pregnancy. Can J Psychiatr. 2004;49.
33.
Dayan J, Creveuil C, Herlicoviez M, Herbel C, Baranger E, Savoye C, et al. Role of anxiety and depression in the onset of spontaneous preterm labor. Am J Epidemiol. 2002;155.
34.
35.
Meltzer-Brody S. New insights into perinatal depression: pathogenesis and treatment during pregnancy and postpartum. Dialogues Clin Neurosci. 2011;13(1):89–100.PubMedPubMedCentral
36.
Gausia K, Fisher C, Ali M, Oosthuizen J. Antenatal depression and suicidal ideation among rural Bangladeshi women: a community-based study. Arch Womens Ment Health. 2009;12(5):351–8.CrossRefPubMed
37.
Mattes E, McCarthy S, Gong G, van Eekelen JA, Dunstan J, Foster J, et al. Maternal mood scores in mid-pregnancy are related to aspects of neonatal immune function. Brain Behav Immun. 2009;23(3):380–8.CrossRefPubMed
38.
Pawlby S, Hay DF, Sharp D, Waters CS, O'Keane V. Antenatal depression predicts depression in adolescent offspring: prospective longitudinal community-based study. J Affect Disord. 2009;113(3):236–43.CrossRefPubMed
39.
Dunkel SC. Psychological science on pregnancy: stress processes, biopsychosocial models, and emerging research issues. Annu Rev Psychol. 2011;62:531–58.CrossRef
40.
Ayano G, Tesfaw G, Shumet S. Prevalence and determinants of antenatal depression in Ethiopia: a systematic review and meta-analysis. PLoS One. 2019;14(2):e0211764.CrossRefPubMedPubMedCentral
41.
Ayele TA, Azale T, Alemu K, Abdissa Z, Mulat H, Fekadu A. Prevalence and associated factors of antenatal depression among women attending antenatal Care Service at Gondar University Hospital, Northwest Ethiopia. Plos One. 2016;11(5):e0155125.CrossRefPubMedPubMedCentral
42.
Belay YA, Moges NA, Hiksa FF, Arado KK, Liben ML. Prevalence of antenatal depression and associated factors among pregnant women attending antenatal Care at Dubti Hospital: a case of pastoralist region in Northeast Ethiopia. Depress Res Treat. 2018;2018:1659089.PubMedPubMedCentral
43.
Biratu A, Haile D. Prevalence of antenatal depression and associated factors among pregnant women in Addis Ababa, Ethiopia: a cross-sectional study. Reprod Health. 2015;12:99.CrossRefPubMedPubMedCentral
44.
Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet (London). 2014;384(9956):1775–88.CrossRef
45.
Pearlin LI. The stress process revisited. In: Aneshensel CS, Phelan JC, editors. Handbook of the sociology of mental health. Boston: Springer US; 1999. p. 395–415.
46.
Li Y, Zeng Y, Zhu W, Cui Y, Li J. Path model of antenatal stress and depressive symptoms among Chinese primipara in late pregnancy. BMC Pregnancy Childbirth. 2016;16(1):180.CrossRefPubMedPubMedCentral
47.
Liu S, Yan Y, Gao X, Xiang S, Sha T, Zeng G, et al. Risk factors for postpartum depression among Chinese women: path model analysis. BMC Pregnancy Childbirth. 2017;17(1):133.CrossRefPubMedPubMedCentral
48.
CSA. Population and Housing Census Report: Ethiopia. Addis Ababa: Central Statistical Agency; 2007.
49.
Ministry of urban development and construction. Background of gondar town administration. 2016.
50.
Gondar town health office. Zonal health office health service plan of 2010 EC (2016/2017GC). Unpublished document. 2016..
51.
Australian government health and research cauncle. National Statement on Ethical Conduct in Human Research 2007 (Updated May 2015). 2015.
52.
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry. 1987;150:782–6.CrossRefPubMed
53.
54.
55.
Hanlon C, Medhin G, Alem A, Araya M, Abdulahi A, Hughes M, et al. Detecting perinatal common mental disorders in Ethiopia: validation of the self-reporting questionnaire and Edinburgh postnatal depression scale. J Affect Disord. 2008;108(3):251–62.CrossRefPubMed
56.
Töreki A, Andó B, Keresztúri A, Sikovanyecz J, Dudas RB, Janka Z, et al. The Edinburgh postnatal depression scale: translation and antepartum validation for a Hungarian sample. Midwifery. 2013;29(4):308–15.CrossRefPubMed
57.
Su KP, Chiu TH, Huang CL, Ho M, Lee CC, Wu PL, et al. Different cutoff points for different trimesters? The use of Edinburgh postnatal depression scale and Beck depression inventory to screen for depression in pregnant Taiwanese women. Gen Hosp Psychiatry. 2007;29(5):436–41.CrossRefPubMed
58.
Stewart RC, Umar E, Tomenson B, Creed F. Validation of screening tools for antenatal depression in Malawi-a comparison of the Edinburgh postnatal depression scale and self reporting questionnaire. J Affect Disord. 2013;150(3):1041–7.CrossRefPubMed
59.
Pereira AT, Bos SC, Marques M, Maia BR, Soares MJ, Valente J, et al. The postpartum depression screening scale: is it valid to screen for antenatal depression? Arch Women’s Ment Health. 2011;14(3):227–38.CrossRef
60.
Chorwe-Sungani G, Chipps J. A systematic review of screening instruments for depression for use in antenatal services in low resource settings. BMC Psychiatry. 2017;17(1).
61.
Tesfaye M, Hanlon C, Wondimagegn D, Alem A. Detecting postnatal common mental disorders in Addis Ababa, Ethiopia: validation of the Edinburgh postnatal depression scale and Kessler scales. J Affect Disord 2010;122(1–2):102–8.
62.
Bisetegn TA, Mihretie G, Muche T. Prevalence and predictors of depression among pregnant women in debretabor town, northwest Ethiopia. PLoS One. 2016;11(9).
63.
Dibaba Y, Fantahun M, Hindin MJ. The association of unwanted pregnancy and social support with depressive symptoms in pregnancy: evidence from rural southwestern Ethiopia. BMC Pregnancy Childbirth. 2013;13.
64.
Meltzer H. Evelopment of a common instrument for mental health. In: Nosikov A, Gudex C, editors. EUROHIS: developing common instruments for health surveys. Amsterdam: IOS Press; 2003.
65.
Bitew T, Hanlon C, Kebede E, Medhin G, Fekadu A. Antenatal depressive symptoms and maternal health care utilisation: a population-based study of pregnant women in Ethiopia. BMC Pregnancy Childbirth. 2016;16(1):301.CrossRefPubMedPubMedCentral
66.
M-t V, Antierens A, Sackl A, Staderini N, Captier V. Which Anthropometric Indicators Identify a Pregnant Woman as Acutely Malnourished and Predict Adverse Birth Outcomes in the Humanitarian Context? PLoS Curr. 2013;5 ecurrents.dis.54a8b618c1bc031ea140e3f2934599c8.
67.
68.
69.
70.
Yali AM, Lobel M. Coping and distress in pregnancy: an investigation of medically high risk women. J Psychosom Obstet Gynaecol. 1999;20(1):39–52.CrossRefPubMed
71.
Yali AMLM. Stress-resistance resources and coping in pregnancy. Anxiety Stress Coping. 2002;15(3):289–309.CrossRef
72.
Dean AG, Sullivan KM, Soe MM. Epi info and OpenEpi in epidemiology and clinical medicine: health applications of free software: CreateSpace; 2010.
73.
Hox JJ, Bechger TM. An introduction to structural equation modeling; 1998.
74.
Hox JJ, Moerbeek M, Van de Schoot R. Multilevel analysis: techniques and applications: Routledge; 2017.
75.
Little TD, Cunningham WA, Shahar G, Widaman KF. To parcel or not to parcel: exploring the question, weighing the merits. Struct Equ Model. 2002;9(2):151–73.CrossRef
76.
Matsunaga M. Item parceling in structural equation modeling: a primer. Commun Methods Meas. 2008;2(4):260–93.CrossRef
77.
Satorra A, Bentler PM. A scaled difference chi-square test statistic for moment structure analysis. Psychometrika. 2001;66(4):507–14.CrossRef
78.
Norman GR. Path analysis and structural equation modeling. Biostatistics. 2008:211–28.
79.
Kline RB. Principles and practice of structural equation modeling. 2nd ed: Guilford Publications; 2005.
80.
Pearlin LI, Menaghan EG, Lieberman MA, Mullan JT. The stress process. J Health Soc Behav. 1981;22(4):337–56.CrossRefPubMed
81.
Woldetensay YK, Belachew T, Biesalski HK, Ghosh S, Lacruz ME, Scherbaum V, et al. The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community based birth cohort study. BMC Pregnancy Childbirth. 2018;18(1):374.CrossRefPubMedPubMedCentral
82.
Assefa GW. Prevalence and factors associated with antenatal depression among women following antenatal care at Shashemane health facilities, South Ethiopia. Ann Global Health. 2015;81(1):90.
83.
Mossie TB, Sibhatu AK, Dargie A, Ayele AD. Prevalence of antenatal depressive symptoms and associated factors among pregnant women in Maichew, North Ethiopia: an institution based study. Ethiop J Health Sci. 2017;27(1):59–66.CrossRefPubMedPubMedCentral
84.
Sahile MA, Segni MT, Awoke T, Bekele D. Prevalence and predictors of antenatal depressive symptoms among women attending Adama hospital antenatal clinic, Adama, Ethiopia. Int J Nurs Midwifery. 2017;9(5):58–64.CrossRef
85.
Macharia P, Muluve E, Lizcano J, Cleland C, Cherutich P, Kurth A, editors. Open data kit, a solution implementing a mobile health information system to enhance data management in public health. 2013 IST-Africa Conference & Exhibition; 2013 29–31 May 2013.
86.
Chou F-H, Kuo S-H, Wang R-H. A Longitudinal Study of Nausea and Vomiting, Fatigue and Perceived Stress in, and Social Support for, Pregnant Women Through the Three Trimesters. Kaohsiung J Med Sci. 24(6):306–14.
87.
Fisher J, Cabral de Mello M, Patel V, Rahman A, Tran T, Holton S, et al. 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):139–49H.CrossRef
88.
Sparling TM, Henschke N, Nesbitt RC, Gabrysch S. The role of diet and nutritional supplementation in perinatal depression: a systematic review. Mat Child Nutr. 2017;13(1).
89.
90.
O’Hara MW, Segre LS. Psychological disorders of pregnancy and the post partum. In R.S. Gibbs, B.Y. Karlan, A.F. Haney, & I. Nygaard (Eds.), Danforth’s obstetrics and gynecology 10. Philadelphia: Lippincott, Williams & Wilkins. 2008.
91.
Golberstein E. The effects of income on mental health: evidence from the social security notch. J Ment Health Policy Econ. 2015;18(1):27–37.PubMedPubMedCentral
92.
Getinet W, Amare T, Boru B, Shumet S, Worku W, Azale T. Prevalence and risk factors for antenatal depression in Ethiopia: systematic review. Depress Res Treat. 2018;2018:3649269.PubMedPubMedCentral
93.
Shyn SI, Hamilton SP. The genetics of major depression: moving beyond the monoamine hypothesis. Psychiatric Clin North Am. 2010;33(1):125–40.CrossRef
94.
Montgomery E, Pope C, Rogers J. The re-enactment of childhood sexual abuse in maternity care: a qualitative study. BMC Pregnancy Childbirth. 2015;15:194.CrossRefPubMedPubMedCentral
95.
Leeners B, Stiller R, Block E, Görres G, Rath W, Tschudin S. Prenatal care in adult women exposed to childhood sexual abuse. J Perinat Med. 2013:365.
96.
Izadirad H, Niknami S, Zareban I, Hidarnia A. Effects of social support and self-efficacy on maternal prenatal cares among the first-time pregnant women, Iranshahr, Iran. J Family Reprod Health. 2017;11(2):67–73.PubMedPubMedCentral
97.
Roomruangwong C, Epperson CN. Perinatal depression in Asian women: prevalence, associated factors, and cultural aspects. Asian Biomed. 2011;5(2):179–93.CrossRef
98.
Underwood L, Waldie K, D’Souza S, Peterson ER, Morton S. A review of longitudinal studies on antenatal and postnatal depression. Arch Women’s Ment Health. 2016;19(5):711–20.CrossRef
99.
Underwood L, Waldie KE, D’Souza S, Peterson ER, Morton SMB. A longitudinal study of pre-pregnancy and pregnancy risk factors associated with antenatal and postnatal symptoms of depression: evidence from growing up in New Zealand. Matern Child Health J. 2017;21(4):915–31.CrossRefPubMed
100.
Duko B, Ayano G, Bedaso A. Depression among pregnant women and associated factors in Hawassa city, Ethiopia: an institution-based cross-sectional study. Reprod Health. 2019;16(1):25.CrossRefPubMedPubMedCentral
101.
Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry. 2016;3(10):973–82.CrossRefPubMedPubMedCentral
102.
Liabsuetrakul T, Vittayanont A, Pitanupong J. Clinical applications of anxiety, social support, stressors, and self-esteem measured during pregnancy and postpartum for screening postpartum depression in Thai women. J Obstet Gynaecol Res. 2007;33(3):333–40.CrossRefPubMed
103.
Ford E, Ayers S. Stressful events and support during birth: the effect on anxiety, mood and perceived control. J Anxiety Disord. 2009;23(2):260–8.CrossRefPubMed
104.
Jeong H-G, Lim J-S, Lee M-S, Kim S-H, Jung I-K, Joe S-H. The association of psychosocial factors and obstetric history with depression in pregnant women: focus on the role of emotional support. Gen Hosp Psychiatry. 2013;35(4):354–8.CrossRefPubMed
105.
Aktan NM. Social support and anxiety in pregnant and postpartum women: a secondary analysis. Clin Nurs Res. 2012;21(2):183–94.CrossRefPubMed
106.
Little TD, Card NA, Bovaird JA, Preacher KJ, Crandall CS. Structural equation modeling of mediation and moderation with contextual factors. Model Contextual Effect longitudinal Stud. 2007;1:207–30.
Metadata
Title
Antenatal depression and its potential causal mechanisms among pregnant mothers in Gondar town: application of structural equation model
Authors
Abel Fekadu Dadi
Emma R. Miller
Richard Woodman
Telake Azale Bisetegn
Lillian Mwanri
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/s12884-020-02859-2

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