title: Factors influencing maternal distress among Dutch women with a healthy pregnancy.
abstract: BACKGROUND
  Maternal distress is a public health concern. Assessment of emotional wellbeing is not integrated in Dutch antenatal care. Midwives need to understand the influencing factors in order to identify women who are more vulnerable to experience maternal distress.
  
  
  OBJECTIVE
  To examine levels of maternal distress during pregnancy and to determine the relationship between maternal distress and aetiological factors.
  
  
  METHODS
  A cross-sectional study including 458 Dutch-speaking women with uncomplicated pregnancies during all trimesters of pregnancy. Data were collected with questionnaires between 10 September and 6 November 2012. Demographic characteristics and personal details were obtained. Maternal distress was measured with the Edinburgh Depression Scale (EDS), State-Trait Anxiety Inventory (STAI), and Pregnancy-Related Anxiety Questionnaire (PRAQ). Behaviour was measured with Coping Operations Preference Enquiry-Easy (COPE-Easy). Descriptive statistics and multiple linear regression analysis were used.
  
  
  RESULTS
  Just over 20 percent of the women in our sample (21.8%) had a heightened score on one or more of the EDS, STAI or PRAQ. History of psychological problems (B=1.071; p=.001), having young children (B=2.998; p=.001), daily stressors (B=1.304; p=<.001), avoidant coping (B=1.047, p=<.001), somatisation (B=.484; p=.004), and negative feelings towards the forthcoming birth (B=.636; p=<.001) showed a significant positive relationship with maternal distress. Self-disclosure (B=-.863; p=.004) and acceptance of the situation (B=-.542; p=.008) showed a significant negative relationship with maternal distress.
  
  
  CONCLUSIONS
  Maternal distress occurs among women with a healthy pregnancy and is significantly influenced by a variety of factors. Midwives need to recognise the factors that make women more vulnerable to develop and experience maternal distress in order to give adequate advice about how to best cope with this condition.
authors.affiliation: Midwifery Education & Studies Maastricht, ZUYD University, Research Centre for Midwifery Science, PO Box 1256, 6201 BG Maastricht, The Netherlands. Electronic address: j.a.c.a.fontein-kuipers@hr.nl.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Fontein-Kuipers
authors.affiliation: Midwifery Education & Studies Maastricht, ZUYD University, Research Centre for Midwifery Science, PO Box 1256, 6201 BG Maastricht, The Netherlands.
authors.forename: Marlein
authors.initials: M
authors.lastname: Ausems
authors.affiliation: Midwifery Education & Studies Maastricht, ZUYD University, Research Centre for Midwifery Science, PO Box 1256, 6201 BG Maastricht, The Netherlands.
authors.forename: Luc
authors.initials: L
authors.lastname: Budé
authors.affiliation: Maastricht University/CAPHRI, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: Van Limbeek
authors.affiliation: Midwifery Education & Studies Maastricht, ZUYD University, Research Centre for Midwifery Science, PO Box 1256, 6201 BG Maastricht, The Netherlands; Maastricht University/CAPHRI, PO Box 5800, 6202 AZ Maastricht, The Netherlands; Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 300 North Ingalis Street, Rm 7C27, Ann Arbor, MI 48109-5429, USA.
authors.forename: Raymond
authors.initials: R
authors.lastname: De Vries
authors.affiliation: Midwifery Education & Studies Maastricht, ZUYD University, Research Centre for Midwifery Science, PO Box 1256, 6201 BG Maastricht, The Netherlands.
authors.forename: Marianne
authors.initials: M
authors.lastname: Nieuwenhuijze
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000342:Affective Symptoms; D001007:Anxiety / Q000523:psychology; D003430:Cross-Sectional Studies; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000523:psychology*; D005260:Female; D006801:Humans; D009426:Netherlands; D036801:Parturition / Q000523:psychology*; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Anxiety; Depression; Health promotion; Maternal distress; Mental health; Midwifery; Pregnancy