Eighty-nine women signed informed consent to participate in the study. Of these, 43 were women with uneventful pregnancies and 46 had LT deliveries (Table 1). The study participants varied in age from 16 – 45 years, with almost a fifth of them being older than 36 years. Approximately a third of the women (n=15) in the life-threatening (LT) group experienced an intrauterine foetal demise.
A summary of the psychiatric sequelae identified at each time interval is presented in table 2 and notable psychiatric sequelae are elaborated on.
Table 1: Demographic information of mothers who experienced life threatening (LT) complications and uncomplicated pregnancies (UP) at 2 hospitals in the Tshwane region, Gauteng, South Africa
Age distribution
|
UP n (%)
|
LT n (%)
|
Total (%)
|
16-20
|
7 (16.3%)
|
6 (13.3%)
|
13 (14.8%)
|
21-25
|
10 (23.3%)
|
11 (24.4%)
|
21 (23.9%)
|
26-30
|
10 (23.3%)
|
11 (24.4%)
|
2 (23.9%)
|
31-35
|
8 (18.6%)
|
9 (20.0%)
|
17 (19.3%)
|
36-40
|
6 (14.0%)
|
7 (15.6%)
|
13 (14.8%)
|
41-45
|
2 (4.7%)
|
1 (2.2%)
|
3 (3.4%)
|
Population group
|
Black
|
37 (86.0%)
|
44 (95.7%)
|
81 (91.0%)
|
Mixed race
|
0 (0.0%)
|
1 (2.2%)
|
1 (1.1%)
|
Asian/Indian
|
0 (0.0%)
|
1 (2.2%)
|
1 (1.1%
|
White
|
6 (14.0%)
|
0 (0.0%)
|
6 (6.7%)
|
Relationship status
|
Married
|
13 (30.2%)
|
16 (34.8%)
|
29 (32.6%)
|
Single
|
13 (30.2%)
|
15 (32.6%)
|
28 (31.5%)
|
Living together
|
15 (34.9%)
|
8 (17.4%)
|
23 (25.8%)
|
Non-exclusive relation
|
2 (4.7%)
|
7 (15.2%)
|
9 (10.1%)
|
Employment status
|
Working full-time
|
12 (27.9%)
|
17 (37.0%)
|
29 (32.6%)
|
Working part-time
|
6 (14.0%)
|
7 (15.2%)
|
13 (14.6%)
|
Not-working(housewife)
|
6 (14.0%)
|
5 (10.9%)
|
11 (12.4%)
|
Student/Scholar
|
5 (11.6%)
|
3 (6.5%)
|
8 (9.0%)
|
Unemployed
|
14 (32.6%)
|
14 (30.4%)
|
28 (31.5%)
|
Living circumstances
|
Standalone house/structure
|
20 (46.5%)
|
20 (43.5%)
|
40 (44.9%)
|
Flat in block of flats
|
5 (11.6%)
|
5 (10.9%)
|
10 (11.2%)
|
House/flat/room in backyard
|
6 (14.0%)
|
5 (10.9%)
|
11 (12.4%)
|
Informal dwelling/shack
|
12 (27.9%)
|
16 (34.8%)
|
28 (31.5%)
|
Table 2:Summary of psychiatric sequelae observed in women who experience life threatening (LT) complications and uncomplicated pregnancies (UP). Assessments were conducted just after delivery (P1), at six weeks (P2), at three months (P3) and at six months (P4).
Condition
|
P1
|
|
|
P2
|
|
|
P3
|
|
|
P4
|
|
|
|
LT (46)
|
U (43)
|
p-
value
|
LT (29)
|
U (24)
|
p-
value
|
LT (21)
|
U (11)
|
p-
value
|
LT (12)
|
U (8)
|
p-
value
|
Depression
|
14
(30.4%)
|
8
(18.6%)
|
0,196
|
19
(65.5%)
|
7
(29.2%)
|
0,008
|
10(
(47.6%)
|
2
(18,2%)
|
0,102
|
2
(16.7%)
|
1
(12.5%)
|
0,798
|
Mania
|
1
(2.2%)
|
1
(2.3%)
|
0,962
|
1
(3.4%)
|
2
(8.3%)
|
0,444
|
0
|
0
|
|
0
|
0
|
|
Anxiety
|
14
(30.4%)
|
3
(7.0%)
|
0,005
|
16
(55.2%)
|
5
(20.8%)
|
0,011
|
9
(42.9%)
|
2
(18.2%)
|
0,163
|
1
(8.3%)
|
1
(12.5%)
|
0,761
|
Anger
|
2
(4.3%)
|
1
(2.3%)
|
0,597
|
5
(17.2%)
|
1
(4.2%)
|
0,135
|
3
(14.3%)
|
0
|
0,188
|
0
|
0
|
|
Somatic
|
13
(28.3%)
|
2
(4.7%)
|
0,003
|
11
(37.9%)
|
3
(12.5%)
|
0,037
|
1
(4.8%)
|
1
(9.1%)
|
0,631
|
0
|
0
|
|
Sleep
|
13
(28.3%)
|
3
(7.0%)
|
0,009
|
18
(62.1%)
|
6
(25.0%)
|
0,007
|
8
(38.1%)
|
2
(18.2%)
|
0,248
|
1
(8.3%)
|
0
|
0,402
|
Memory
|
7
(15.2%)
|
1
(2.3%)
|
0,034
|
10
(34.5%)
|
2
(8.3%)
|
0,024
|
5
(23.8%)
|
1
(9.1%)
|
0,311
|
0
|
0
|
|
Psychosis
|
3
(6.5%)
|
1
(2.3%)
|
0,34
|
2
(6.9)
|
1
(4.2%)
|
0,669
|
0
|
1
(9.1%)
|
0,16
|
0
|
0
|
|
Substance
|
1
(2.2%)
|
2
(4.7%)
|
0,518
|
1
(3.4%)
|
3
(12.5%)
|
0,214
|
1
(4.8%)
|
0
|
0,462
|
0
|
0
|
|
Depressive symptoms
At six weeks, almost two-thirds (65.5%, n=19) of women in the LT-group presented with depressive symptoms, compared to women in the UP-group (29.2%, n=7) (p=0.08, OR 4.91). At three months, fewer women experienced depressive symptoms, but more women (47.6%, n=10) in the LT-group still presented with depressive symptoms, compared to women in the UP-group (18.2%, n=2) (p=0.102, OR 4.09). At six months, 16.7%, (n=2) of women in the LT-group and 12.5% (n=1) of the UP-group continued to experience residual depressive symptoms (p=0.798, OR 1.40).
At delivery, 12 (13.5%) women had Becks depression (BDI) scores of more than 18 indicating moderate to severe depression. Of these, 9 (75%) women had LT deliveries and 3 (25%) had UP deliveries. At six weeks, 29 women (62.1%) of women in the LT group presented with BDI scores of more than 18. At the three-months, 11 women (23.8%) in the LT-group had a BDI score of more than 18, while at 6 months only one participant had a BDI score of more than 18.
Anxiety symptoms
At the first assessment, just after delivery, 14 (30.4%) of women in the LT-group presented with anxiety symptoms, compared to 3 (7%) women in the UP-group (p=0.005, OR 5.83). More women presented with anxiety symptoms at the six-week assessment, remaining more prevalent in the LT-group (n=16, 55.2%) compared to the UP-group (n=5, 20.8%) (p=0,011, OR 4.6). Fewer women experienced anxiety symptoms at three months (LT: n=9, 42.9%; UP: n=2, 18.2%, p=0,163, OR 3.38). At six months, only one woman in each group presented with residual symptoms of anxiety. At delivery, 17.6% (n=16) of women had moderate to severe symptoms of anxiety with HAM-A scores of greater than 18. At six weeks, 32.1% (n=29) women had HAM-A scores of greater than 18, and of these, 75% (n=22) were women who had LT deliveries. Of these 22, only 10 (36.4%) women presented with anxiety symptoms at three months.
Somatic symptoms
Participants also presented with mild to moderate somatic symptoms (Table 2). At the first assessment, more women in the LT-group (n=13, 28.3%) presented with somatic symptoms, compared with women in the UP-group (n=2, 4.7%) (p= 0.003, OR 8.08). This difference was maintained at six weeks (LT: n=11, 37.9%; UP: n=3, 12.5%, p=0.037, OR 4,28).
Sleep disturbances
At the first assessment, more women in the LT-group (n=13, 28.3%) reported sleep disturbances compared to women in the UP-group (n=3, 7.0%) (p=0.009, OR 5.25,). More women from both groups reported sleep disturbances at the six-week interview (LT: n=18, 62%; UP: n=6, 25%, p=0.007, OR 4.91). Sleep disturbances improved over time.
Cognitive and memory disturbances
At the first assessment, more women in the LT-group (n=7, 15.2%) reported memory disturbances compared to women in the UP-group (n=1, 2.3%) (p=0.034, OR 7.54,). At six weeks, this difference intensified with, 34.5% (n=10) and 8.3% (n=2) in LT-group and UP-group respectively presenting with memory disturbances (p=0.024, OR 5.79).
Psychotic symptoms:
At the first assessment, 6.5% (n=3) of women in the LT-group and 2.3% (n=1) of women in the UP-group experienced psychotic symptoms (p=0.340, OR 2.93). At delivery, 4.5% (n=4) women presented with a Brief psychiatric rating score of more than 31, indicating moderate to marked illness. At six weeks and at three months, 3.7% (n=2) and 3.1% (n=1) of participants, respectively, were moderately ill with a BPRS score of 38.