Top

Published in:

01-03-2019 | Somatoform Disorder | Maternal-Fetal Medicine

Epidemiology of mental disorders during pregnancy and link to birth outcome: a large-scale retrospective observational database study including 38,000 pregnancies

Authors: Stephanie Wallwiener, Maren Goetz, Anne Lanfer, Andrea Gillessen, Marc Suling, Manuel Feisst, Christof Sohn, Markus Wallwiener

Published in: Archives of Gynecology and Obstetrics | Issue 3/2019

Abstract

Purpose

To investigate the real-life epidemiology of mental disorders during pregnancy and their impact on birth outcome in an unselected low-risk population in Germany.

Methods

Claims data of the Techniker Krankenkasse (TK) were analyzed as part of a retrospective observational study over a one-year period from 01/2008 to 12/2008 including 38,174 pregnant women. ICD-10 codes were clustered into four diagnostic groups: depression, anxiety disorders, somatoform/dissociative disorders and acute stress reactions. The relationship between mental disorders, birth mode and infant weight was tested using chi-squared tests and multivariate logistic regression. Main outcome measures included the prevalence of mental disorders during pregnancy, performed cesarean sections and infants born underweight.

Results

N = 16,639 cases with at least one diagnosis from the four mental disorder diagnostic groups were identified: 9.3% cases of depression, 16.9% cases with an anxiety disorder, 24.2% cases with a somatoform/dissociative disorder, and 11.7% cases of acute stress reactions. Women diagnosed with a mental disorder were more likely to deliver their child by cesarean section ([depression: OR =1.26 (95% CI 1.14–1.39); anxiety: OR 1.11 (95% CI 1.02–1.19); somatoform disorders: OR 1.12 (95% CI 1.05–1.20); acute stress reactions: OR 1.17 (95% CI 1.07–1.28)]. Furthermore, infants of women diagnosed with an ICD-10 code for depression during pregnancy were more likely to be underweight and/or delivered preterm [OR =1.34 (95% CI 1.06–1.69)].

Conclusions

We observed substantially high prevalence rates of mental disorders during pregnancy which urgently warrant more awareness for validated screening and adequate treatment options.

Gawlik S, Waldeier L, Muller M, Szabo A, Sohn C, Reck C (2013) Subclinical depressive symptoms during pregnancy and birth outcome–a pilot study in a healthy German sample. Arch Womens Ment Health 16(2):93–100. https://doi.org/10.1007/s00737-012-0320-0 CrossRefPubMed

Underwood L, Waldie K, D'Souza S, Peterson ER, Morton S (2016) A review of longitudinal studies on antenatal and postnatal depression. Arch Womens Ment Health 19(5):711–720. https://doi.org/10.1007/s00737-016-0629-1 CrossRefPubMed

Becker M, Weinberger T, Chandy A, Schmukler S (2016) Depression during pregnancy and postpartum. Curr Psychiatry Rep 18(3):32. https://doi.org/10.1007/s11920-016-0664-7 CrossRefPubMed

Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR (2004) Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 103(4):698–709. https://doi.org/10.1097/01.AOG.0000116689.75396.5f CrossRefPubMed

Techniker Krankenkasse (2016) Geburtenreport - Eine Routinedatenanalyse zu Kaiserschnitt und Frühgeburt.

Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM (2010) Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol 202(1):5–14. https://doi.org/10.1016/j.ajog.2009.09.007 CrossRefPubMedPubMedCentral

Martini J, Petzoldt J, Einsle F, Beesdo-Baum K, Hofler M, Wittchen HU (2015) Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: a prospective-longitudinal study. (1573-2517 (Electronic))

Shakeel N, Eberhard-Gran M, Sletner L, Slinning K, Martinsen EW, Holme I, Jenum AK (2015) A prospective cohort study of depression in pregnancy, prevalence and risk factors in a multi-ethnic population. (1471-2393 (Electronic)). doi:D - NLM: PMC4310137 EDAT- 2015/01/27 06:00 MHDA- 2016/01/07 06:00 CRDT- 2015/01/25 06:00 PHST- 2014/05/07 [received] PHST- 2014/12/09 [accepted] AID - 10.1186/s12884-014-0420-0 [doi] AID - s12884-014-0420-0 [pii] PST - epublish

O'Hara MW, McCabe JE (2013) Postpartum depression: current status and future directions. Ann Rev Clin Psychol 9:379–407. https://doi.org/10.1146/annurev-clinpsy-050212-185612 CrossRef

10.

Bruno A, Lagana AS, Leonardi V, Greco D, Merlino M, Vitale SG, Triolo O, Zoccali RA, Muscatello MRA (2018) Inside-out: the role of anger experience and expression in the development of postpartum mood disorders. J Maternal-Fetal Neonatal Med 31(22):3033–3038. https://doi.org/10.1080/14767058.2017.1362554 CrossRef

11.

Szegda K, Markenson G, Bertone-Johnson ER, Chasan-Taber L (2014) Depression during pregnancy: a risk factor for adverse neonatal outcomes? A critical review of the literature. J Maternal Fetal Neonatal Med 27(9):960–967. https://doi.org/10.3109/14767058.2013.845157 CrossRef

12.

Yonkers KA, Smith MV, Forray A, Epperson CN, Costello D, Lin H, Belanger K (2014) Pregnant women with posttraumatic stress disorder and risk of preterm birth. JAMA Psychiatry 71(8):897–904. https://doi.org/10.1001/jamapsychiatry.2014.558 CrossRefPubMedPubMedCentral

13.

Broekman BF, Chan Yh Fau - Chong Y-S, Chong Ys Fau - Kwek K, Kwek K Fau - Cohen SS, Cohen Ss Fau - Haley CL, Haley Cl Fau - Chen H, Chen H Fau - Chee C, Chee C Fau - Rifkin-Graboi A, Rifkin-Graboi A Fau - Gluckman PD, Gluckman Pd Fau - Meaney MJ, Meaney Mj Fau - Saw S-M, Saw SM (2014) The influence of anxiety and depressive symptoms during pregnancy on birth size. (1365-3016 (Electronic))

14.

Grigoriadis S, VonderPorten Eh Fau - Mamisashvili L, Mamisashvili L Fau - Tomlinson G, Tomlinson G Fau - Dennis C-L, Dennis Cl Fau - Koren G, Koren G Fau - Steiner M, Steiner M Fau - Mousmanis P, Mousmanis P Fau - Cheung A, Cheung A Fau - Radford K, Radford K Fau - Martinovic J, Martinovic J Fau - Ross LE, Ross LE (2013) The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. (1555-2101 (Electronic))

15.

Vitale SG, Lagana AS, Muscatello MR, La Rosa VL, Curro V, Pandolfo G, Zoccali RA, Bruno A (2016) Psychopharmacotherapy in pregnancy and breastfeeding. Obstet Gynecol Surv 71(12):721–733. https://doi.org/10.1097/ogx.0000000000000369 CrossRefPubMed

16.

Barnes TR (2011) Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. J Psychopharmacol Oxford Engl 25(5):567–620. https://doi.org/10.1177/0269881110391123 CrossRef

17.

Gilbert PL, Harris MJ, McAdams LA, Jeste DV (1995) Neuroleptic withdrawal in schizophrenic patients. A review of the literature. Arch Gener Psychiatry 52 (3):173−188

18.

Einarson A, Selby P, Koren G (2001) Discontinuing antidepressants and benzodiazepines upon becoming pregnant. Beware of the risks of abrupt discontinuation. Can Family Phys Med de famille Can 47:489–490

19.

Viguera AC, Nonacs R, Cohen LS, Tondo L, Murray A, Baldessarini RJ (2000) Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatry 157(2):179–184. https://doi.org/10.1176/appi.ajp.157.2.179 CrossRefPubMed

20.

Larsen ER, Saric K (2017) Pregnancy and bipolar disorder: the risk of recurrence when discontinuing treatment with mood stabilisers: a systematic review. Acta Neuropsychiatrica 29(5):259–266. https://doi.org/10.1017/neu.2016.60 CrossRefPubMed

21.

Reck C, Zimmer K, Dubber S, Zipser B, Schlehe B, Gawlik S (2013) The influence of general anxiety and childbirth-specific anxiety on birth outcome. Arch Womens Ment Health 16(5):363–369. https://doi.org/10.1007/s00737-013-0344-0 CrossRefPubMed

22.

Mylonas I, Friese K (2015) Indications for and risks of elective cesarean section. Dtsch Arztebl Int 112(29–30):489–495. https://doi.org/10.3238/arztebl.2015.0489 CrossRefPubMedPubMedCentral

23.

Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM (2016) WHO statement on caesarean section rates. BJOG 123(5):667–670. https://doi.org/10.1111/1471-0528.13526 CrossRefPubMed

24.

Bundesamt Statistisches, (Destatis), (2017) Mehr Krankenhausentbindungen 2016 bei niedrigerer Kaiserschnittrate. Statistisches Bundesamt, Wiesbaden

25.

Mikolajczyk RT, Schmedt N Fau - Zhang J, Zhang J Fau - Lindemann C, Lindemann C Fau - Langner I, Langner I Fau - Garbe E, Garbe E Regional variation in caesarean deliveries in Germany and its causes. (1471-2393 (Electronic)). doi:D - NLM: PMC3652783 EDAT- 2013/05/03 06:00 MHDA- 2013/12/16 06:00 CRDT- 2013/05/03 06:00 PHST- 2012/12/24 [received] PHST- 2013/04/24 [accepted] AID - 1471-2393-13-99 [pii] AID - 10.1186/1471-2393-13-99 [doi] PST - epublish

26.

National Institute for Health and Clinical Excellence (2011) Caesarean section---NICE clinical guideline 132. 2nd edition

27.

Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (2010) Absolute und relative Indikationen zur Sectio caesarea (AWMF 015/054 (S1)) [derzeit in Überarbeitung]. https://www.dggg.de/fileadmin/documents/leitlinien/archiviert/federfuehrend/015054_Absolute_und_relative_Indikationen_zur_Sectio_caesarea/015054_2010.pdf. Accessed Aug 2010

28.

Kolip P, Nolting H-D, Zich K (2012) Faktenchek Gesundheit Kaiserschnitt: Kaiserschnittgeburten - Entwicklung und regionale Verteilung. Gütersloh

29.

AQUA (2015) Bundesauswertung zum Erfassungsjahr, (2014) 16/1 - Geburtshilfe Basisauswertung. Insitut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen, Göttingen

30.

Smaill FM, Grivell RM (2014) Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 10:Cd007482. doi:https://doi.org/10.1002/14651858.CD007482.pub3

31.

Bowring J, Fraser N, Vause S, Heazell AE (2006) Is regional anaesthesia better than general anaesthesia for caesarean section? J Obstet Gynaecol 26(5):433–434. https://doi.org/10.1080/01443610600720345 CrossRefPubMed

32.

Karlstrom A, Lindgren H, Hildingsson I (2013) Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case-control study. Bjog 120 (4):479-486. doi:https://doi.org/10.1111/1471-0528.12129. (discussion 486)

33.

Arikan I, Barut A, Harma M, Harma IM, Gezer S, Ulubasoglu H (2012) Cesarean section with relative indications versus spontaneous vaginal delivery: short-term outcomes of maternofetal health. Clin Exp Obstet Gynecol 39(3):288–292PubMed

34.

Riddell CA, Kaufman JS, Hutcheon JA, Strumpf EC, Teunissen PW, Abenhaim HA (2014) Effect of uterine rupture on a hospital's future rate of vaginal birth after cesarean delivery. Obstet Gynecol 124(6):1175–1181. https://doi.org/10.1097/aog.0000000000000545 CrossRef

35.

Smith D, Stringer E, Vladutiu CJ, Zink AH, Strauss R (2015) Risk of uterine rupture among women attempting vaginal birth after cesarean with an unknown uterine scar. Am J Obstet Gynecol 213(1):80.e81–85. https://doi.org/10.1016/j.ajog.2015.01.056 CrossRef

36.

Walfisch A, Beloosesky R, Shrim A, Hallak M (2014) Adhesion prevention after cesarean delivery: evidence, and lack of it. Am J Obstet Gynecol 211(5):446–452. https://doi.org/10.1016/j.ajog.2014.05.027 CrossRefPubMed

37.

Lyell DJ (2011) Adhesions and perioperative complications of repeat cesarean delivery. Am J Obstet Gynecol 205(6 Suppl):S11–18. https://doi.org/10.1016/j.ajog.2011.09.029 CrossRefPubMed

38.

Evers EC, McDermott KC, Blomquist JL, Handa VL (2014) Mode of delivery and subsequent fertility. Hum Reprod Oxford Eng 29(11):2569–2574. https://doi.org/10.1093/humrep/deu197 CrossRef

39.

Gurol-Urganci I, Bou-Antoun S, Lim CP, Cromwell DA, Mahmood TA, Templeton A, van der Meulen JH (2013) Impact of Caesarean section on subsequent fertility: a systematic review and meta-analysis. Hum Reprod Oxford Engl 28(7):1943–1952. https://doi.org/10.1093/humrep/det130 CrossRef

40.

Thavagnanam S, Fleming J, Bromley A, Shields MD, Cardwell CR (2008) A meta-analysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy 38(4):629–633. https://doi.org/10.1111/j.1365-2222.2007.02780.x CrossRefPubMed

41.

Bager P, Wohlfahrt J, Westergaard T (2008) Caesarean delivery and risk of atopy and allergic disease: meta-analyses. Clin Exp Allergy 38(4):634–642. https://doi.org/10.1111/j.1365-2222.2008.02939.x CrossRefPubMed

42.

Papathoma E, Triga M, Fouzas S, Dimitriou G (2016) Cesarean section delivery and development of food allergy and atopic dermatitis in early childhood. Pediatric Allergy Immunol 27(4):419–424. https://doi.org/10.1111/pai.12552 CrossRef

43.

Brandao HV, Vieira GO, de Oliveira Vieira T, Camargos PA, de Souza Teles CA, Guimaraes AC, Cruz AA, Cruz CMS (2016) Increased risk of allergic rhinitis among children delivered by cesarean section: a cross-sectional study nested in a birth cohort. BMC Pediatrics 16:57. https://doi.org/10.1186/s12887-016-0594-x CrossRefPubMedPubMedCentral

44.

Cardwell CR, Stene LC, Joner G, Cinek O, Svensson J, Goldacre MJ, Parslow RC, Pozzilli P, Brigis G, Stoyanov D, Urbonaite B, Sipetic S, Schober E, Ionescu-Tirgoviste C, Devoti G, de Beaufort CE, Buschard K, Patterson CC (2008) Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia 51(5):726–735. https://doi.org/10.1007/s00125-008-0941-z CrossRefPubMed

45.

Franz MB, Husslein PW (2010) Obstetrical management of the older gravida. Women's Health Lond Engl 6(3):463–468. https://doi.org/10.2217/whe.10.26 CrossRef

46.

Guihard P, Blondel B (2001) Trends in risk factors for caesarean sections in France between 1981 and 1995: lessons for reducing the rates in the future. BJOG 108(1):48–55PubMed

47.

Huang L, Sauve R, Birkett N, Fergusson D, van Walraven C (2008) Maternal age and risk of stillbirth: a systematic review. CMAJ Can Med Assoc J 178 (2):165-172. doi:10.1503/cmaj.070150

48.

Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, Saade GR, Eddleman KA, Klugman S, Dugoff L, Timor-Tritsch IE, Craigo SD, Carr SR, Wolfe HM, Bianchi DW, D'Alton M (2005) Impact of maternal age on obstetric outcome. Obstet Gynecol 105(5 Pt 1):983–990. https://doi.org/10.1097/01.aog.0000158118.75532.51 CrossRefPubMed

49.

Luke B, Brown MB (2007) Elevated risks of pregnancy complications and adverse outcomes with increasing maternal age. Hum Reprod Oxford Engl 22(5):1264–1272. https://doi.org/10.1093/humrep/del522 CrossRef

50.

Voigt M, Zygmunt M, Henrich W, Straube S, Carstensen M, Briese V (2008) Analysis of subgroup of pregnant women in Germany. Geburtshilfe Frauenheilkd 68(08):794–800CrossRef

51.

Ehrenberg HM, Durnwald CP, Catalano P, Mercer BM (2004) The influence of obesity and diabetes on the risk of cesarean delivery. Am J Obstet Gynecol 191(3):969–974. https://doi.org/10.1016/j.ajog.2004.06.057 CrossRefPubMed

52.

Gorgal R, Goncalves E, Barros M, Namora G, Magalhaes A, Rodrigues T, Montenegro N (2012) Gestational diabetes mellitus: a risk factor for non-elective cesarean section. J Obstet Gynaecol Res 38(1):154–159. https://doi.org/10.1111/j.1447-0756.2011.01659.x CrossRefPubMed

53.

Al-Qahtani S, Heath A, Quenby S, Dawood F, Floyd R, Burdyga T, Wray S (2012) Diabetes is associated with impairment of uterine contractility and high Caesarean section rate. Diabetologia 55(2):489–498. https://doi.org/10.1007/s00125-011-2371-6 CrossRefPubMed

54.

Bayrampour H, Salmon C, Vinturache A, Tough S (2015) Effect of depressive and anxiety symptoms during pregnancy on risk of obstetric interventions. (1447-0756 (Electronic))

55.

Kottmel A, Hoesli I, Traub R, Urech C, Huang D, Leeners B, Tschudin S (2012) Maternal request: a reason for rising rates of cesarean section? Arch Gynecol Obstet 286(1):93–98. https://doi.org/10.1007/s00404-012-2273-y CrossRefPubMed

56.

Stjernholm YV, Petersson K, Eneroth E (2010) Changed indications for cesarean sections. Acta Obstet Gynecol Scand 89(1):49–53. https://doi.org/10.3109/00016340903418777 CrossRefPubMed

57.

Howard LM, Ryan EG, Trevillion K, Anderson F, Bick D, Bye A, Byford S, O'Connor S, Sands P, Demilew J, Milgrom J, Pickles A (2018) Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy. Br J Psychiatry 212(1):50–56. https://doi.org/10.1192/bjp.2017.9 CrossRefPubMedPubMedCentral

58.

Reck C, Struben K, Backenstrass M, Stefenelli U, Reinig K, Fuchs T, Sohn C, Mundt C (2008) Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders. Acta Psychiatr Scand 118(6):459–468. https://doi.org/10.1111/j.1600-0447.2008.01264.x CrossRefPubMed

59.

Yildiz PD, Ayers S, Phillips L (2017) The prevalence of posttraumatic stress disorder in pregnancy and after birth: a systematic review and meta-analysis. J Affect Disord 208:634–645. https://doi.org/10.1016/j.jad.2016.10.009 CrossRefPubMed

60.

Sydsjo G, Moller L, Lilliecreutz C, Bladh M, Andolf E, Josefsson A (2015) Psychiatric illness in women requesting Caesarean section. BJOG 122(3):351–358. https://doi.org/10.1111/1471-0528.12714 CrossRefPubMed

61.

Schoepf D, Heun R, Weiffenbach O, Herrmann S, Maier W (2003) The 4-week prevalence of somatoform disorders and associated psychosocial impairment. Der Nervenarzt 74(3):245–251. https://doi.org/10.1007/s00115-001-1241-8 CrossRefPubMed

62.

Jarde A, Morais M, Kingston D, Giallo R, MacQueen GM, Giglia L, Beyene J, Wang Y, McDonald SD (2016) Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiatry 73(8):826–837. https://doi.org/10.1001/jamapsychiatry.2016.0934 CrossRefPubMed

63.

Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ (2010) A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry 67(10):1012–1024. https://doi.org/10.1001/archgenpsychiatry.2010.111 CrossRefPubMedPubMedCentral

64.

Andersen JT, Andersen NL, Horwitz H, Poulsen HE, Jimenez-Solem E (2014) Exposure to selective serotonin reuptake inhibitors in early pregnancy and the risk of miscarriage. Obstet Gynecol 124(4):655–661. https://doi.org/10.1097/aog.0000000000000447 CrossRefPubMed

65.

Kjaersgaard MI, Parner ET, Vestergaard M, Sorensen MJ, Olsen J, Christensen J, Bech BH, Pedersen LH (2013) Prenatal antidepressant exposure and risk of spontaneous abortion - a population-based study. PLoS ONE 8(8):e72095. https://doi.org/10.1371/journal.pone.0072095 CrossRefPubMedPubMedCentral

66.

Palmsten K, Setoguchi S, Margulis AV, Patrick AR, Hernandez-Diaz S (2012) Elevated risk of preeclampsia in pregnant women with depression: depression or antidepressants? Am J Epidemiol 175(10):988–997. https://doi.org/10.1093/aje/kwr394 CrossRefPubMedPubMedCentral

67.

Kieviet N, Dolman KM, Honig A (2013) The use of psychotropic medication during pregnancy: how about the newborn? Neuropsychiatric disease and treatment 9:1257–1266. https://doi.org/10.2147/NDT.S36394 CrossRefPubMedPubMedCentral

68.

Coughlin CG, Blackwell KA, Bartley C, Hay M, Yonkers KA, Bloch MH (2015) Obstetric and neonatal outcomes after antipsychotic medication exposure in pregnancy. Obstet Gynecol 125(5):1224–1235. https://doi.org/10.1097/aog.0000000000000759 CrossRefPubMedPubMedCentral

69.

Veiby G, Daltveit AK, Engelsen BA, Gilhus NE (2014) Fetal growth restriction and birth defects with newer and older antiepileptic drugs during pregnancy. J Neurol 261(3):579–588. https://doi.org/10.1007/s00415-013-7239-x CrossRefPubMed

70.

Chisolm MS, Payne JL (2016) Management of psychotropic drugs during pregnancy. BMJ 352:h5918. https://doi.org/10.1136/bmj.h5918 CrossRef

71.

Alder J, Fink N, Bitzer J, Hosli I, Holzgreve W (2007) Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Maternal Fetal Neonatal Med 20(3):189–209. https://doi.org/10.1080/14767050701209560 CrossRef

72.

Meyer G, Neumann K, Badenhoop K, Linder R (2014) Increasing prevalence of Addison's disease in German females: health insurance data 2008–2012. Eur J Endocrinol 170(3):367–373. https://doi.org/10.1530/eje-13-0756 CrossRefPubMed

Title: Epidemiology of mental disorders during pregnancy and link to birth outcome: a large-scale retrospective observational database study including 38,000 pregnancies
Authors: Stephanie Wallwiener
Maren Goetz
Anne Lanfer
Andrea Gillessen
Marc Suling
Manuel Feisst
Christof Sohn
Markus Wallwiener
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Keywords: Somatoform Disorder
Mood Disorders
Anxiety Disorder
Somatoform Disorder
Dissociative Disorder
Sectio Ceasarea
Affective Disorder
Anxiety
Sectio Caesarea
Published in: Archives of Gynecology and Obstetrics / Issue 3/2019
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-019-05075-2

At a glance: The STEP trials

Springer Medicine

Epidemiology of mental disorders during pregnancy and link to birth outcome: a large-scale retrospective observational database study including 38,000 pregnancies

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2019

Gestational age-specific risk of stillbirth during term pregnancy according to maternal age

Assessing the reporting quality of systematic reviews of observational studies in preeclampsia

Hysterectomy and risk of ovarian cancer: a systematic review and meta-analysis

Modified cesarean hysterectomy technique for management of cases of placenta increta and percreta at a tertiary referral hospital in Egypt

Demographic changes and effects on the mode of delivery: a retrospective analysis of a large birth registry containing 27,729 singleton deliveries in a level I center

Can early βhCG change and baseline progesterone level predict treatment outcome in patients receiving single dose Methotrexate protocol for tubal ectopic pregnancy?