Abstract Objective: To identify predictors as free-text markers for mental ill-health from an electronic perinatal record (EMR) system and the association for emergency cesarean section (CS) in nulliparous women. Design: Population-based study using an EMR system. Setting: The catchment area of Malmö University Hospital in Sweden. Population: 6 467 women with complete perinatal electronic records (EMR) were selected of 10 662 nulliparous women presenting with a singleton cephalic baby for vaginal delivery between 2001 and 2006. Methods: Free-text search of markers for mental ill-health and multivariate logistic regression. Main Outcome Measures: Eleven markers for mental ill-health were tested with Cohen’s kappa for agreement and used as exposure variables. Odds ratios (OR) with 95% confidence interval (CI) were calculated for emergency CS, and adjusted for maternal age, diabetes, epidural anesthesia, and gestational weeks <37 and >41 by a multivariate logistic regression model with vaginal delivery as the reference. Results: Three markers identified from the EMR system reached statistically significant associations with an increased risk for emergency CS in nulliparous women: stress adjusted OR 1.66 (95% CI 1.34–2.06), sleep adjusted OR 1.57 (1.14–2.16), and worry adjusted OR 1.41 (1.10–1.79). Conclusions: Free-text words in medical records, indicating stress, sleep disturbances, or worry predicted increased adjusted OR for emergency CS in first-time mothers. Recognizing pregnant women’s reporting of their mental health status could have a predictive bearing on delivery outcomes.

This study of 17,443 childbearing women, investigated the relationship between hospital admissions 5 years prior to index birth, type of mental disorders and risk factors for mode of delivery. Hospital based electronic perinatal medical records between 2001 and 2006, were linked with the Swedish National Inpatient Care Registry 1996–2006. Of all the women, 39.3% had had inpatient care prior to index birth (27.3% had had obstetric, 10.1% somatic, and 1.9% psychiatric inpatient care). Diagnoses of mental disorders at psychiatric admission (n = 333) were categorized into five groups: personality/behavioral/unspecified disorder (30.9%), affective disorders and ‘suicide attempt’ (28.9%), neurotic/somatoform disorders (18.9%), substance use (17.1%) and schizophrenia (4.2%). Women with history of psychiatric care were more often smokers, below age 24 and single (p < 0.001, respectively), had more markers of mental ill-health in pregnancy records (p ≤ 0.001), compared to women without such previous care, and fewer were nulliparous (p < 0.001). The results show that women with prior psychiatric inpatient care and those with identified mental ill-health in pregnancy records, were associated with increased adjusted risks of cesarean sections. Identifying a woman’s mental health status in pregnancy may predict and prevent emergency cesarean section.

Objectives. To describe mental health status in native and non-native Swedish-speaking pregnant women and explore risk factors of depression and of posttraumatic stress symptoms. Design and setting. A cross-sectional questionnaire study was conducted at midwife-based antenatal clinics in Southern, Sweden. Sample. A non-selected group of women in mid-pregnancy participated. Methods. Participants completed a questionnaire including background characteristics, social support, life events, mental health variables and the short Edinburgh Depression Scale. Main outcome measures. Depressive symptoms during last week and posttraumatic stress symptoms during past year. Results. Out of 1003 women, 21.4% reported another language than Swedish as their mother tongue and were defined as non-native. These women were more likely to be younger, have fewer years of education, potential financial problems, and lack of social support. More non-native speakers self-reported depressive, posttraumatic stress, anxiety and, psychosomatic symptoms, and fewer had had consultations with a psychiatrist or psychologist. Of all women 13.8% had depressive symptoms defined by Edinburgh Depression Scale as 7 or above. Non-native status was associated with statistically increased risks of depressive symptoms and having ≥ 1 posttraumatic stress symptom compared to native speaking women. Multivariate modeling including all selected factors resulted in adjusted OR for depressive symptoms of 1.75 (95% CI: 1.11-2.76) and of 1.56 (95% CI: 1.10-2.34) for posttraumatic stress symptoms in non-native Swedish speakers. Conclusion. Non-native Swedish-speaking women had a more unfavorable mental health status than native speakers. In spite of this, non-native speaking women had sought less mental health care.

Objectives This study aims to describe the prevalence of emotional, physical, and sexual abuse and analyze associations with symptoms of depression and posttraumatic stress (PTS) in pregnancy, by ethnic background. Study design This is a cross-sectional study of the Swedish data from the Bidens cohort study. Ethnicity was categorized as native and non-native Swedish-speakers. Women completed a questionnaire while attending routine antenatal care. The NorVold Abuse Questionnaire (NorAQ) assessed a history of emotional, physical or sexual abuse. The Edinburgh Depression Scale-5 measured symptoms of depression. Symptoms of Posttraumatic Stress (PTS) included intrusion, avoidance and numbness. Results Of 1003 women, 78.6% were native and 21.4% were non-native Swedish-speakers. Native and non-native Swedish-speakers experienced a similar proportion of lifetime abuse. Moderate emotional and physical abuse in childhood was significantly more common among non-native Swedish-speakers. Sexual abuse in adulthood was significantly more prevalent among native Swedish-speakers. Emotional and sexual abuse were significantly associated with symptoms of depression for both natives and non-natives. Physical abuse was significantly associated with symptoms of depression for non-natives only. All types of abuse were significantly associated with symptoms of PTS for both native and non-native Swedish-speakers. Adding ethnicity to the multiple binary regression analyses did not really alter the association between the different types of abuse and symptoms of depression and PTS. Conclusion The prevalence of lifetime abuse did not differ significantly for native and non-native Swedish-speakers but there were significant differences on a more detailed level. Abuse was associated with symptoms of depression and PTS. Being a non-native Swedish-speaker did not influence the association much.