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| ORIGINAL ARTICLE |
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| Year : 2017 | Volume
: 1
| Issue : 2 | Page : 109-113 |
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Perceived hassles and uplifts and their impact on perceived cognitive performance during pregnancy: A pilot study
Bhumika Shah1, Devavrat G Harshe2, Hetal Shah1, Nandini Shetty1, Ankita Shenoy1, Aparna Ramakrishnan3, Rashmin Cholera1, Sanjiv Kale1
1 Department of Psychiatry, D Y Patil School of Medicine, Nerul, Maharashtra, India
2 Department of Psychiatry, Dr. D Y Patil Medical College, Kolhapur, Maharashtra, India
3 Department of Psychiatry, J J Hospital, Mumbai, Maharashtra, India
| Date of Web Publication | 8-Dec-2017 |
Correspondence Address:
Devavrat G Harshe
Department of Psychiatry, Dr. D Y Patil Medical College, 839, E, Kasaba Bavada, Kolhapur.6, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/aip.aip_37_17
Context: Stress during pregnancy manifests as mood disorders and anxiety disorders. Recently, many studies have reported cognitive disturbances in pregnancy after subjective interviews as well as objective evaluation. Aims: The aim of the study was to assess pregnancy-specific distress and perceived cognitive functions in an urban sample of pregnant women. Methodology: Sixty working pregnant women, educated up to standard 12th or above, were evaluated cross-sectionally with pregnancy upscale-downscale scale and cognitive failure questionnaire. Results: Women identified events related to the infant's looks and appearances as most uplifting, whereas physical symptoms and consequences of pregnancy as most distressing. Women reported tasks involving recent and working memory to be most impaired, whereas tasks involving procedural memory, spatial memory, and long-term memory were least affected. Severity of hassles perceived by pregnant women was identified as the predictor of perceived cognitive decline in pregnancy. Conclusions: Events in a normal pregnancy can be perceived as either uplifting or distressing. Perceived distress affects the perception of one's own cognitive performance.
Keywords: Cognition, hassles, pregnancy, pregnancy-specific anxiety, stress, uplifts
How to cite this article:
Shah B, Harshe DG, Shah H, Shetty N, Shenoy A, Ramakrishnan A, Cholera R, Kale S. Perceived hassles and uplifts and their impact on perceived cognitive performance during pregnancy: A pilot study. Ann Indian Psychiatry 2017;1:109-13 |
How to cite this URL:
Shah B, Harshe DG, Shah H, Shetty N, Shenoy A, Ramakrishnan A, Cholera R, Kale S. Perceived hassles and uplifts and their impact on perceived cognitive performance during pregnancy: A pilot study. Ann Indian Psychiatry [serial online] 2017 [cited 2022 Sep 30];1:109-13. Available from: https://www.anip.co.in/text.asp?2017/1/2/109/220255 |
| Introduction | |  |
Pregnancy is an experience filled with feelings of delight, pride, warmth, and love. Not only the pregnant woman, but the entire family celebrates all the events associated with a normal pregnancy. Experiencing each of these events is a part and parcel of a normal pregnancy which brings immense joy to the pregnant women and her family.
Pregnancy imparts a significant physical, psychological, and emotional toll on the mother. This can manifest in many ways as depression and mood disorders and anxiety disorders with a prevalence of 8%–30%.[1] Anxiety can also arise from pregnancy-related events and developments, which has been labeled as pregnancy-specific anxiety (physical activity printarticle.asp?issn=2588-8358;year=2017;volume=1;issue=2;spage=109;epage=113;aulast=Shah).[2] Apart from mood and anxiety disorders, many studies [3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28] have demonstrated cognitive decline in pregnant women on subjective interviews as well as objective evaluations. A recent meta-analysis [29] supported these observations, limited to only a few domains of cognitive function. Mood and anxiety disorders can cause cognitive decline. Existing literature shows that cognitive decline in pregnancy may develop even in the absence of these disorders. Most of the studies, however, have evaluated the role of state and trait anxiety on cognitive functions during pregnancy; however, we could not find a study evaluating the impact of PA on subjective cognitive functions during pregnancy. This study was thereby conducted to evaluate the impact of PA on subjective perception of cognitive functions in pregnant women in an urban setting in Western India.
| Methodology | | |
Site and design
The study was conducted at the psychiatry and obstetrics-gynecology OPD at a tertiary care teaching hospital in India. Institutional Ethics Committee approval was obtained, and the study was conducted in a cross-sectional design.
Sample
Sixty pregnant women were recruited by serial sampling, after obtaining a written informed consent. The inclusion criteria were (1) pregnant, working women between ages 18 and 35 years, (2) registered at the antenatal care clinic of the tertiary care teaching hospital, and (3) educated till higher secondary certificate examination (standard 12th) or above. Exclusion criteria included (1) women with a history of complicated pregnancy and/or congenital malformations in the child during current or past pregnancy and (2) women with general health questionnaire-12 (GHQ-12) score of higher than 3.
Methods
Tools
General health questionnaire-12
The general health questionnaire [30],[31] is often used as a screening tool in psychiatry to rule out comorbid psychiatric diagnosis. It contains 12-Likert type questions which assess the presence and severity of psychopathology. It has been used in Indian setting before with good validity and reliability.
Pregnancy Upscale-Downscale Scale
Pregnancy upscale-downscale scale (PUDS)[32] is a 41-item Likert type scale, which assesses the perceived pleasantness or unpleasantness of various experiences which are a part and parcel of pregnancy. The rater has to rate how uplifting or distressing each of those experiences is to them, on a spectrum of 0–3 with 0 being “not at all” and 3 being “a great deal.” We calculated (1) the frequency (number of hassles and uplifts reported), (2) the intensity (mean intensity score for hassles and uplifts), and (3) overall experience of the ongoing pregnancy (ratio of hassles:uplifts). A ratio ≥1 was indicating more hassles than uplifts, a ratio of ≤1 indicative of more uplifts than hassles. It has an advantage over other similar instruments [33] as it not only indicates whether a pregnant woman is perceiving more uplifts or more hassles, but it also enlists individual hassles and uplifts experienced by her.
Cognitive failure questionnaire
It is a 25-item Likert type scale [34] assessing self-reported problems in perception, memory and motor functions. The rater has to rate each item on a spectrum of 4-0 with 4 being “very often” and 0 being “never.” Higher the score on the cognitive failure questionnaire (CFQ), greater will be the perceived deficit or decline in performing a particular task. This assessment tool has been used in obstetric population in existing literature.[35],[36]
Statistical analysis
Descriptive statistics were used for sociodemographic factors. One-way ANOVA, independent samples t-test, and Mann–Whitney U-test were used for comparing quantitative variables where appropriate. Pearson's correlation was used to evaluate the relationship between variables. Statistical significance was assumed at P < 0.05.
| Results | | |
The sample of sixty showed a mean age of 26.36 ± 3.40 years (range 21–34 years). Seventy percent of the samples were educated till graduation or above and 66% of the samples were primigravidae [Table 1]. Duration from expected date of delivery (EDD) was 136.81 ± 65.78 days (median: 138 days and range: 34–274 days).
Pregnancy: Uplifting and distressing experiences
Mean score on PUDS was 23.60 ± 20.62 (median: 23.0, range: 0.63–70.0). Mean score was higher for uplifts (36.23 ± 16.28) than hassles (12.93 ± 8.49). Thirteen percent (8/60) participants showed a hassle-uplift ratio ≥1 whereas the rest had a hassle-uplift ratio of ≦1. There was no effect of education, occupation, and parity on frequency and severity of hassles and uplifts experienced by women during pregnancy [Table 2]. | Table 2: Pregnancy upscale-downscale scale subscale scores and outcome measures across demographic variables
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Distress and subjective cognitive decline during pregnancy
Mean CFQ score was 29.33 ± 14.91. There was no significant effect of education (F = 0.955, P = 0.391), occupation (t = 0.265, P = 0.792), and parity (F = 0.484, P = 0.619) on CFQ scores. There was no significant correlation between CFQ scores and age, education in years, number of pregnancies, and duration from EDD.
Relationship between pregnancy experience, distress, and perceived cognitive decline
There was a significant correlation between PUDS hassle subscale score with CFQ score (r = 0.417, P = 0.001). Hassles severity score during pregnancy was identified as the only significant predictor of perceived cognitive decline during pregnancy [Table 3]. | Table 3: Linear regression analysis between cognitive failures questionnaire scores and study variables
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| Discussion | | |
Pregnancy specific anxiety
Stress during pregnancy can be multifactorial in origin. As shown by existing literature, pregnancy-specific anxiety is an independent source of anxiety apart from biological, psychosocial, and cultural sources. A lot of research has been done and has shown a strong connection between psychosocial stress in pregnancy and low birth weight,[37],[38] health of the infant,[39] prematurity, and intrauterine growth restriction.[38] Only a handful studies have evaluated the role of anxiety and stress related to pregnancy-speci c events and development in maternal psychological health.[40],[41],[42] Pregnancy-specific stress or anxiety arises when events related to pregnancy are associated with emotional, physical, or sociocultural distress.[29] Being pregnant is a matter of immense pleasure and pride for a woman. Yet, numerous events and developments occurring during a normal pregnancy can precipitate distress in pregnant women. Events such as physical symptoms and discomforts, changes in physical appearance, and adjustments necessary in different domains of day-to-day life can be quite distressing to women. Concerns about the gender, appearance, health, and development of the yet unborn child can cause considerable anxiety. Participants in our study reported physical sequelae of pregnancy as the most distressing experiences. We were surprised to observe, in a country like India, where preference for a male child has skewed the sex ratio in almost every state,[43] thoughts regarding gender of the child were not in the top ve distressing or uplifting experiences! This could have been the result of selecting participants from an urban, working class of women who were highly educated. Another reason for this could have been the awareness created by the government and doctors toward preventing female feticide!
We observed that perceived distress due to events in pregnancy is independent of age, parity, education, occupation, and gestational age, similar to existing literature.[44],[45],[46],[47],[48],[49],[50],[51],[52],[53],[54] It can be hypothesized that different events occurring at different stages during pregnancy can be equally distressing or uplifting to a woman.
Subjective cognitive decline in pregnancy
This study observed that women do perceive a decline in cognitive functions and age, education, occupation, and parity do not affect the degree of this decline.
Pregnancy anxiety and subjective cognitive decline
Participants in this study reported that tasks related to working memory, recent memory, and attention span were most impaired, whereas tasks related to long-term memory, spatial memory, and procedural memory were relatively spared [Table 4]. These findings support the existing literature [2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16] which on the basis of objective assessment as well as subjective reports demonstrate a decline in verbal memory,[17] executive control,[17] declarative memory,[26] and relatively spared visual memory and procedural memory.[27] This study supports the existing literature in that domain. | Table 4: Perceived joy, distress and cognitive functions during pregnancy
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Pregnancy-specific anxiety and perceived cognitive functions
We also observed that severity of distress perceived by women during pregnancy was a significant predictor of perceived cognitive functions. Women with a higher level of distress reported more cognitive decline during pregnancy. Pregnancy anxiety has been associated with a higher mean cortisol secretion during gestational period.[42] This hypercortisolemic state can affect maternal [48] as well as fetal hypothalamus-pituitary-adrenal axis regulation [41] and can have widespread clinical and developmental consequences. Brett and Baxendale [16] have hypothesized that hypercortisolemia in pregnancy may have causal implications for pregnancy-related memory decline by causing hippocampal cell loss and affecting neuronal hyperexcitability. Stress, depression, and anxiety are known to affect cognitive functions. We tried to avoid these confounding factors by screening the participants on GHQ-12 before recruiting in the study. There are few studies in literature, which demonstrate cognitive de cits in pregnancy to be independent of mood, stress and anxiety [17],[18],[19],[20] who on objective evaluation observed that cognitive performance during pregnancy is independent of mood, stress, and anxiety. Higher pregnancy anxiety has already been associated with multiple developmental domains such as poorer cognitive.
Strengths of this study are, to the best of our knowledge, this is the first study in an Indian sample evaluating perceived cognitive functions in pregnancy. This study highlights that pregnancy-specific anxiety or even hassles associated with normal pregnancy can affect the perceived cognition in pregnant women. This study also highlights the most uplifting and distressing experiences associated with pregnancy in women with an uncomplicated pregnancy with no psychiatric comorbidity. This study has a few limitations, first and foremost being the sample size. The study was designed to avoid the confounding factors such as comorbid anxiety and depression on perceived cognitive functions during pregnancy which excluded many potential participants from this study. We also set educational status as an inclusion criterion to include participants equipped with uniform intellectual and academic resources.
This study holds key importance for family physicians (FPs) and primary care physicians (PCP). Complains of memory and problems in day-to-day function can be distressing to a woman, especially during pregnancy. These symptoms can lead the family to doctor-shopping, unnecessary and unindicated investigations with a lot of financial and emotional burden. India has one medical doctor for every 1700 population, with the FP/PCP often providing health care in rural as well as urban settings. A FP/PCP is often considered a family member, and his opinion/guidance and inputs are often sought and decision-making in family matters. Thus, a FP/PCP informed about these symptoms, and their cause can evaluate the woman as well as her socio-occupational background, evaluate the domains which are precipitating any pregnancy-specific anxiety, and address those issues with the help of a family-based intervention (group counseling). They can educate the family members and the pregnant women about the transient nature of physical symptoms and clear their misunderstandings and address their anxieties related to the health of the fetus and labor-related complications if any.
| Conclusions | | |
A number of events, which constitute a normal pregnancy, can be perceived as distressing by the pregnant woman and be a source for pregnancy-specific anxiety. This anxiety is not affected by demographic factors and parity. Pregnancy anxiety predicts the subjective perception of memory disturbances even in women with no comorbid anxiety, mood, or other major psychiatric disorders.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Satyanarayana VA, Lukose A, Srinivasan K. Maternal mental health in pregnancy and child behavior. Indian J Psychiatry 2011;53:351-61.  [ PUBMED] [Full text] |
| 2. | Guardino CM, Schetter CD. Understanding Pregnancy Anxiety: Concepts, Correlates, and Consequences Zero To Three. University of California: Los Angeles; 2014. p. 12-21. |
| 3. | Armstrong D, Fry J, Armstrong P. Doctors' perceptions of pressure from patients for referral. BMJ 1991;302:1186-8. |
| 4. | Poser CM, Kassirer MR, Peyser JM. Benign encephalopathy of pregnancy. Preliminary clinical observations. Acta Neurol Scand1986;73:39-43. |
| 5. | Brindle PM, Brown MW, Brown J, Griffith HB, Turner GM. Objective and subjective memory impairment in pregnancy. Psychol Med 1991;21:647-53. |
| 6. | Burgoyne T. The brain drain. Nurs Stand 1994;8:44. |
| 7. | Buckelew SP, Hannay HJ. Relationships among anxiety, defensiveness, sex, task difficulty, and performance on various neuropsychological tasks. Percept Mot Skills 1986;63:711-8. |
| 8. | Jarrahi-Zadeh A, Kane FJ Jr., Van de Castlf RL, Lachenbruch PA, Ewing JA. Emotional and cognitive changes in pregnancy and early puerperium. Br J Psychiatry 1969;115:797-805. |
| 9. | King GD, Hannay HJ, Masek BJ, Burns JW. Effects of anxiety and sex on neuropsychological tests. J Consult Clin Psychol 1978;46:375-6. |
| 10. | Parsons C, Redman S. Self-reported cognitive change during pregnancy. Aust J Adv Nurs 1991;9:20-9. |
| 11. | Sharp K, Brindle PM, Brown MW, Turner GM. Memory loss during pregnancy. Br J Obstet Gynaecol 1993;100:209-15. |
| 12. | Sunderland A, Harris JE, Baddeley A. Do laboratory tests predict everyday memory? J Verb Learn Verb Behav 1983;22:341-57. |
| 13. | Reifler BV, Larson E, Hanley R. Coexistence of cognitive impairment and depression in geriatric outpatients. Am J Psychiatry 1982;139:623-6. |
| 14. | Veiel HO. A preliminary profile of neuropsychological deficits associated with major depression. J Clin Exp Neuropsychol 1997;19:587-603. |
| 15. | Vermeulen J, Aldenkamp AP, Alpherts WC. Memory complaints in epilepsy: Correlations with cognitive performance and neuroticism. Epilepsy Res 1993;15:157-70. |
| 16. | Welch J. Labouring brains. BMJ 1991;303:253. |
| 17. | Brett M, Baxendale S. Motherhood and memory: A review. Psychoneuroendocrinology 2001;26:339-62. |
| 18. | Buckwalter JG, Stanczyk FZ, McCleary CA, Bluestein BW, Buckwalter DK, Rankin KP, et al. Pregnancy, the postpartum, and steroid hormones: Effects on cognition and mood. Psychoneuroendocrinology 1999;24:69-84. |
| 19. | Keenan PA, Yaldoo DT, Stress ME, Fuerst DR, Ginsburg KA. Explicit memory in pregnant women. Am J Obstet Gynecol 1998;179:731-7. |
| 20. | Casey P, Huntsdale C, Angus G, Janes C. Memory in pregnancy. II: Implicit, incidental, explicit, semantic, short-term, working and prospective memory in primigravid, multigravid and postpartum women. J Psychosom Obstet Gynaecol 1999;20:158-64. |
| 21. | Brand N, Jolles J. Information processing in depression and anxiety. Psychol Med 1987;17:145-53. |
| 22. | de Groot RH, Vuurman EF, Hornstra G, Jolles J. Differences in cognitive performance during pregnancy and early motherhood. Psychol Med 2006;36:1023-32. |
| 23. | de Groot RH, Hornstra G, Roozendaal N, Jolles J. Memory performance, but not information processing speed, may be reduced during early pregnancy. J Clin Exp Neuropsychol 2003;25:482-8. |
| 24. | Silber M, Almkvist O, Larsson B, Uvnäs-Moberg K. Temporary peripartal impairment in memory and attention and its possible relation to oxytocin concentration. Life Sci 1990;47:57-65. |
| 25. | Crawley RA, Dennison K, Carter C. Cognition in pregnancy and the first year post-partum. Psychol Psychother 2003;76:69-84. |
| 26. | Piccardi L, Verde P, Bianchini F, Morgagni F, Guariglia C, Strollo F. Deficits in visuo-spatial but not in topographical memory during pregnancy and the post-partum state in an expert military pilot: A case report. BMC Res Notes 2014;7:524. Available from: http://www.biomedcentral.com/1756-0500/7/524. [Last accessed on 2017 Jul 08]. |
| 27. | Mickes L, Wixted JT, Shapiro A, Scarff JM. The effects of pregnancy on memory: Recall is worse but recognition is not. J Clin Exp Neuropsychol 2009;31:754-61. |
| 28. | Wilson DL, Barnes M, Ellett L, Permezel M, Jackson M, Crowe SF. Reduced verbal memory retention is unrelated to sleep disturbance during pregnancy. Aust Psychol 2013;48:196-208. |
| 29. | Henry JD, Rendell PG. A review of the impact of pregnancy on memory function. J Clin Exp Neuropsychol 2007;29:793-803. |
| 30. | Goldberg D, Williams P. A User's Guide to the General Health Questionnaire. Windsor: Nfer-Nelson; 1988. |
| 31. | Jacob KS, Bhugra D, Mann AH. General health questionnaire -– 12: Psychometric properties and factor structure among Indian women living in the United Kingdom. Indian J Psychiatry 1997;39:196-9. [ PUBMED] [Full text] |
| 32. | DiPietro JA, Ghera MM, Costigan K, Hawkins M. Measuring the ups and downs of pregnancy stress. J Psychosom Obstet Gynaecol 2004;25:189-201. |
| 33. | Pop VJ, Pommer AM, Pop-Purceleanu M, Wijnen HA, Bergink V, Pouwer F, et al. Development of the Tilburg pregnancy distress scale: The TPDS. BMC Pregnancy Childbirth 2011;11:80. |
| 34. | Broadbent DE, Cooper PF, FitzGerald P, Parkes KR. The cognitive failures questionnaire (CFQ) and its correlates. Br J Clin Psychol 1982;21(Pt 1):1-6. |
| 35. | Gross H, Pattison H. Cognitive failure during pregnancy. J Reprod Infant Psychol 1995;13:17-32. |
| 36. | Postma IR, de Groot JC, Aukes AM, Aarnoudse JG, Zeeman GG. Cerebral white matter lesions and perceived cognitive dysfunction: The role of pregnancy. Am J Obstet Gynecol 2014;211:257.e1-5. |
| 37. | Gennaro S, Hennessy MD. Psychological and physiological stress: Impact on preterm birth. J Obstet Gynecol Neonatal Nurs 2003;32:668-75. |
| 38. | Rondó PH, Ferreira RF, Nogueira F, Ribeiro MC, Lobert H, Artes R, et al. Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation. Eur J Clin Nutr 2003;57:266-72. |
| 39. | Phelan AL, DiBenedetto MR, Paul IM, Zhu J, Kjerulff KH. Psychosocial stress during first pregnancy predicts infant health outcomes in the first postnatal year. Matern Child Health J 2015;19:2587-97. |
| 40. | 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;169:858-65. |
| 41. | Entringer S, Epel ES, Lin J, Buss C, Shahbaba B, Blackburn EH, et al. Maternal psychosocial stress during pregnancy is associated with newborn leukocyte telomere length. Am J Obstet Gynecol 2013;208:134.e1-7. |
| 42. | Kramer MS, Lydon J, Séguin L, Goulet L, Kahn SR, McNamara H, et al. Stress pathways to spontaneous preterm birth: The role of stressors, psychological distress, and stress hormones. Am J Epidemiol 2009;169:1319-26. |
| 43. | Mitra A. Son preference in India: Implications for gender development. J Econ Issues 2014;48:1021-37. |
| 44. | Arch JJ. Pregnancy-specific anxiety: Which women are highest and what are the alcohol-related risks? Compr Psychiatry 2013;54:217-28. |
| 45. | Da Costa D, Larouche J, Dritsa M, Brender W. Variations in stress levels over the course of pregnancy: Factors associated with elevated hassles, state anxiety and pregnancy-specific stress. J Psychosom Res 1999;47:609-21. |
| 46. | Standley K, Soule B, Copans SA. Dimensions of prenatal anxiety and their influence on pregnancy outcome. Am J Obstet Gynecol 1979;135:22-6. |
| 47. | Levin JS. The factor structure of the pregnancy anxiety scale. J Health Soc Behav 1991;32:368-81. |
| 48. | Mancuso RA, Schetter CD, Rini CM, Roesch SC, Hobel CJ. Maternal prenatal anxiety and corticotropin-releasing hormone associated with timing of delivery. Psychosom Med 2004;66:762-9. |
| 49. | Dominguez TP, Dunkel-Schetter C, Glynn LM, Hobel C, Sandman CA. Racial differences in birth outcomes: The role of general, pregnancy, and racism stress. Health Psychol 2008;27:194-203. |
| 50. | Gurung RA, Dunkel-Schetter C, Collins N, Rini C, Hobel CJ. Psychosocial predictors of prenatal anxiety. J Soc Clin Psychol 2005;24:497-519. |
| 51. | Rini CK, Dunkel-Schetter C, Wadhwa PD, Sandman CA. Psychological adaptation and birth outcomes: The role of personal resources, stress, and sociocultural context in pregnancy. Health Psychol 1999;18:333-45. |
| 52. | Burstein I, Kinch RA, Stern L. Anxiety, pregnancy, labor, and the neonate. Am J Obstet Gynecol 1974;118:195-9. |
| 53. | Glazer G. Anxiety levels and concerns among pregnant women. Res Nurs Health 1980;3:107-13. |
| 54. | Saisto T, Salmela-Aro K, Nurmi JE, Halmesmäki E. Psychosocial characteristics of women and their partners fearing vaginal childbirth. BJOG 2001;108:492-8. |
[Table 1], [Table 2], [Table 3], [Table 4]
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