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Trajectories of social support in pregnancy and early postpartum: findings from the All Our Families cohort

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Abstract

Purpose

Low social support during the perinatal period can increase the risk of postpartum depression and anxiety after giving birth but little is known about women’s trajectories of social support during this time. This study will identify trajectories of social support among women from second trimester to 4-month postpartum, and the characteristics associated with different trajectories.

Methods

Data from the All Our Families longitudinal birth cohort was used to assess women’s perceived social support during their second trimester, third trimester, and at 4-month postpartum (n = 3387). Group-based trajectory modeling was used to determine the number of groups, shape of trajectories, and proportion of women with differing trajectories. Multinomial regression was used to compare probability of group membership.

Results

Six distinct trajectory groups were identified, with the majority of participants belonging to groups with stable, high social support (60.6%). Only 2.7% of women had consistently low levels of social support, and 2.3% had rising levels. Membership in groups with lower levels of social support was associated with lower incomes and minority ethnicity. Women whose support improved over time may be more likely to be employed in pregnancy than those whose support remained low.

Conclusion

Trajectories of social support are relatively stable in pregnancy and early postpartum. Socio-demographic indicators of vulnerability predict initial levels of support, and participating in the workforce may help improve perception of support over time.

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References

  1. Cutrona CE (1984) Social support and stress in the transition to parenthood. J Abnorm Psychol 93(4):378–390. https://doi.org/10.1037/0021-843X.93.4.378

    Article  PubMed  CAS  Google Scholar 

  2. Baker D, Taylor H (1997) The relationship between condition-specific morbidity, social support and material deprivation in pregnancy and early motherhood. ALSPAC Survey Team Avon Longitudinal Study of Pregnancy and Childhood. Soc Sci Med 45(9):1325–1336

    Article  CAS  Google Scholar 

  3. Bost KK, Cox MJ, Burchinal MR, Payne C (2002) Structural and supportive changes in couples’ family and friendship networks across the transition to parenthood. J Marriage Fam 64(2):517–531. https://doi.org/10.1111/j.1741-3737.2002.00517.x

    Article  Google Scholar 

  4. Hetherington E, Doktorchik C, Premji SS, McDonald SW, Tough SC, Sauve RS (2015) Preterm birth and social support during pregnancy: a systematic review and meta-analysis. Paediatr Perinat Epidemiol 29(6):523–535

    Article  Google Scholar 

  5. Orr ST (2004) Social support and pregnancy outcome: a review of the literature. Clin Obstet Gynecol 47(4):842–855

    Article  Google Scholar 

  6. Hetherington E, McDonald S, Williamson T, Patten SB, Tough SC (2018) Social support and maternal mental health at 4 months and 1 year postpartum: analysis from the All Our Families cohort. J Epidemiol Community Health 72(10):933–939

    Article  Google Scholar 

  7. Morikawa M, Okada T, Ando M, Aleksic B, Kunimoto S, Nakamura Y, Kubota C, Uno Y, Tamaji A, Hayakawa N, Furumura K, Shiino T, Morita T, Ishikawa N, Ohoka H, Usui H, Banno N, Murase S, Goto S, Kanai A, Masuda T, Ozaki N (2015) Relationship between social support during pregnancy and postpartum depressive state: a prospective cohort study. Science 5:10520. https://doi.org/10.1038/srep10520

    Article  Google Scholar 

  8. Lee LC, Halpern CT, Hertz-Picciotto I, Martin SL, Suchindran CM (2006) Child care and social support modify the association between maternal depressive symptoms and early childhood behaviour problems: a US national study. J Epidemiol Community Health 60(4):305–310. https://doi.org/10.1136/jech.2005.040956

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dennis C, Dowswell T (2013) Psychosocial and psychological interventions for preventing postpartum depression (Review). Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD001134.pub3

    Article  PubMed  Google Scholar 

  10. Small R, Taft AJ, Brown SJ (2011) The power of social connection and support in improving health: lessons from social support interventions with childbearing women. BMC Public Health 11(Suppl 5):S4

    Article  Google Scholar 

  11. Small R, Watson L, Gunn J, Mitchell C, Brown S (2014) Improving population-level maternal health: A hard nut to crack? Long term findings and reflections on a 16-community randomised trial in Australia to improve maternal emotional and physical health after birth. PLoS One 9(2):e88457

    Article  CAS  Google Scholar 

  12. Taft AJ, Small R, Hegarty KL, Watson LF, Gold L, Lumley JA (2011) Mothers’ AdvocateS In the Community (MOSAIC)-non-professional mentor support to reduce intimate partner violence and depression in mothers: a cluster randomised trial in primary care. BMC Public Health 11:178. https://doi.org/10.1186/1471-2458-11-178

    Article  PubMed  PubMed Central  Google Scholar 

  13. Berkman LF, Glass T, Brissette I, Seeman TE (2000) From social integration to health: Durkheim in the new millennium. Soc Sci Med 51(6):843–857. https://doi.org/10.1016/s0277-9536(00)00065-4

    Article  PubMed  CAS  Google Scholar 

  14. Chien LY, Tai CJ, Yeh MC (2012) Domestic decision-making power, social support, and postpartum depression symptoms among immigrant and native women in Taiwan. Nurs Res 61(2):103–110. https://doi.org/10.1097/NNR.0b013e31824482b6

    Article  PubMed  Google Scholar 

  15. Eastwood JG, Jalaludin BB, Kemp LA, Phung HN, Barnett BE (2013) Immigrant maternal depression and social networks. A multilevel Bayesian spatial logistic regression in South Western Sydney, Australia. Spat Spatiotemporal Epidemiol 6:49–58. https://doi.org/10.1016/j.sste.2013.04.003

    Article  PubMed  Google Scholar 

  16. Jesse D, Swanson MS (2007) Risks and resources associated with antepartum risk for depression among rural southern women. Nurs Res 56(6):378–386. https://doi.org/10.1097/01.NNR.0000299856.98170.19

    Article  PubMed  Google Scholar 

  17. Kingston D, Heaman M, Chalmers B, Kaczorowski J, O’Brien B, Lee L, Dzakpasu S, O’Campo P, Maternity Experiences Study Group of the Canadian Perinatal Surveillance System Public Health Agency of Canada (2011) Comparison of maternity experiences of Canadian-born and recent and non-recent immigrant women: findings from the Canadian Maternity Experiences Survey. J Obstetr Gynaecol Canada 33(11):1105–1115

    Article  Google Scholar 

  18. Sword W, Watt S, Krueger P (2006) Postpartum health, service needs, and access to care experiences of immigrant and Canadian-born women. J Obstet Gynecol Neonatal Nurs 35(6):717–727

    Article  Google Scholar 

  19. Van Hulst A, Seguin L, Zunzunegui MV, Velez MP, Nikiema B (2011) The influence of poverty and social support on the perceived health of children born to minority migrant mothers. Ethnicity Health 16(3):185–200. https://doi.org/10.1080/13557858.2011.559536

    Article  PubMed  Google Scholar 

  20. Barrera M Jr (1986) Distinctions between social support concepts, measures, and models. Am J Community Psychol 14(4):413–445

    Article  Google Scholar 

  21. Ensel WM, Lin N (1991) The life stress paradigm and psychological distress. J Health Soc Behav 32(4):321–341

    Article  CAS  Google Scholar 

  22. Shaw E, Levitt C, Wong S, Kaczorowski J, McMaster Univ Postpartum Res G (2006) Systematic review of the literature on postpartum care: effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health. Birth 33(3):210–220. https://doi.org/10.1111/j.1523-536X.2006.00106.x

    Article  PubMed  Google Scholar 

  23. Ickovics JR, Reed E, Magriples U, Westdahl C, Schindler Rising S, Kershaw TS (2011) Effects of group prenatal care on psychosocial risk in pregnancy: results from a randomised controlled trial. Psychol Health 26(2):235–250. https://doi.org/10.1080/08870446.2011.531577

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kenyon S, Jolly K, Hemming K, Hope L, Blissett J, Dann S-A, Lilford R, MacArthur C (2016) Lay support for pregnant women with social risk: a randomised controlled trial. BMJ Open 6(3):e009203

    Article  Google Scholar 

  25. Navaie-Waliser M, Martin SL, Tessaro I, Campbell MK, Cross AW (2000) Social support and psychological functioning among high-risk mothers: the impact of the Baby Love Maternal Outreach Worker Program. Public Health Nurs 17(4):280–291

    Article  CAS  Google Scholar 

  26. Brugha T, Wheatley S, Taub N, Culverwell A, Friedman T, Kirwan P, Jones D, Shapiro D (2000) Pragmatic randomized trial of antenatal intervention to prevent post-natal depression by reducing psychosocial risk factors. Psychol Med 30(6):1273–1281. https://doi.org/10.1017/S0033291799002937

    Article  PubMed  CAS  Google Scholar 

  27. Villar J, Farnot U, Barros F, Victora C, Langer A, Belizan JM (1992) A randomized trial of psychosocial support during high-risk pregnancies. The Latin American Network for Perinatal and Reproductive Research. N Engl J Med 327(18):1266–1271

    Article  CAS  Google Scholar 

  28. Gale NK, Kenyon S, MacArthur C, Jolly K, Hope L (2018) Synthetic social support: theorizing lay health worker interventions. Soc Sci Med 196:96–105

    Article  Google Scholar 

  29. Hether HJ, Murphy ST, Valente TW (2014) It’s better to give than to receive: the role of social support, trust, and participation on health-related social networking sites. J Health Commun 19(12):1424–1439

    Article  Google Scholar 

  30. Antonucci TC, Akiyama H (1987) Social networks in adult life and a preliminary examination of the convoy model. J Gerontol 42(5):519–527

    Article  CAS  Google Scholar 

  31. Heberlein EC, Picklesimer AH, Billings DL, Covington-Kolb S, Farber N, Frongillo EA (2015) The comparative effects of group prenatal care on psychosocial outcomes. Arch Women’s Mental Health 19(2):259–269. https://doi.org/10.1007/s00737-015-0564-6

    Article  Google Scholar 

  32. Kawachi I, Berkman L (2014) Social capital, social cohesion, and health. In: Berkman LF, Kawachi I, Glymour M (eds) Social epidemiology, vol 2. Oxford University Press, Oxford, pp 290–319

    Google Scholar 

  33. Howard MC, Hoffman ME (2017) Variable-centered, person-centered, and person-specific approaches: where theory meets the method. Organ Res Methods 21(4):846–876

    Article  Google Scholar 

  34. Nagin DS, Odgers CL (2010) Group-based trajectory modeling in clinical research. Annu Rev Clin Psychol 6:109–138

    Article  Google Scholar 

  35. Tough SC, McDonald SW, Collisson BA, Graham SA, Kehler H, Kingston D, Benzies K (2017) Cohort Profile: the All Our Babies pregnancy cohort (AOB). Int J Epidemiol 46(5):1389–1390k

    Article  Google Scholar 

  36. Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32(6):705–714. https://doi.org/10.1016/0277-9536(91)90150-b

    Article  PubMed  CAS  Google Scholar 

  37. Calgary Co (2011) Family and Community Support Services Policy. http://www.calgary.ca/CSPS/CNS/Documents/fcss/csps008.pdf. Accessed 20 Nov 2015

  38. Nagin D (2005) Group-based modeling of development. Harvard University Press, Cambridge

    Book  Google Scholar 

  39. Jones BL, Nagin DS (2013) A note on a Stata plugin for estimating group-based trajectory models. Sociol Methods Res 42(4):608–613

    Article  Google Scholar 

  40. Frankfurt S, Frazier P, Syed M, Jung KR (2016) Using group-based trajectory and growth mixture modeling to identify classes of change trajectories. Couns Psychol 44(5):622–660

    Article  Google Scholar 

  41. Nagin DS (1999) Analyzing developmental trajectories: a semiparametric, group-based approach. Psychol Methods 4(2):139

    Article  Google Scholar 

  42. Van De Schoot R, Sijbrandij M, Winter SD, Depaoli S, Vermunt JK (2017) The GRoLTS-checklist: guidelines for reporting on latent trajectory studies. Struct Equ Model Multidisc J 24(3):451–467

    Article  Google Scholar 

  43. Brown MA (1986) Social support during pregnancy: a unidimensional or multidimensional construct? Nurs Res 35(1):4–9

    Article  CAS  Google Scholar 

  44. Negron R, Martin A, Almog M, Balbierz A, Howell EA (2013) Social support during the postpartum period: mothers’ views on needs, expectations, and mobilization of support. Matern Child Health J 17(4):616–623. https://doi.org/10.1007/s10995-012-1037-4

    Article  PubMed  PubMed Central  Google Scholar 

  45. Lanes A, Kuk JL, Tamim H (2011) Prevalence and characteristics of postpartum depression symptomatology among Canadian women: a cross-sectional study. BMC Public Health 11(1):302

    Article  Google Scholar 

  46. Hancock KJ, Cunningham NK, Lawrence D, Zarb D, Zubrick SR (2015) Playgroup participation and social support outcomes for mothers of young children: a longitudinal cohort study. PLoS One 10(7):e0133007

    Article  CAS  Google Scholar 

  47. Matthews S, Stansfeld S, Power C (1999) Social support at age 33: the influence of gender, employment status and social class. Soc Sci Med 49(1):133–142

    Article  CAS  Google Scholar 

  48. Gjerdingen D, McGovern P, Attanasio L, Johnson PJ, Kozhimannil KB (2014) Maternal depressive symptoms, employment, and social support. J Am Board Fam Med 27(1):87–96. https://doi.org/10.3122/jabfm.2014.01.130126

    Article  PubMed  Google Scholar 

  49. Preisner K, Neuberger F, Posselt L, Kratz F (2018) Motherhood, employment, and life satisfaction: trends in Germany between 1984 and 2015. J Marriage Fam 80(5):1107–1124

    Article  Google Scholar 

  50. Cooklin AR, Rowe HJ, Fisher JR (2007) Employee entitlements during pregnancy and maternal psychological well-being. Aust N Z J Obstet Gynaecol 47(6):483–490

    Article  Google Scholar 

  51. Kenyon S, Jolly K, Hemming K, Ingram L, Gale N, Dann SA, Chambers J, MacArthur C (2012) Evaluation of Lay Support in Pregnant women with Social risk (ELSIPS): a randomised controlled trial. BMC Pregnancy Childbirth 12:11. https://doi.org/10.1186/1471-2393-12-11

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We are extremely grateful to all the families who took part in this study and the All Our Families research team. We are extremely grateful to the investigators, coordinators, research assistants, graduate and undergraduate students, volunteers, clerical staff and managers. We would like to thank Dr. Scott Patten for his helpful feedback on drafts of this work. This study was funded by Alberta Children’s Hospital Foundation, Alberta Innovates Health Solutions, Interdisciplinary Team Grant #200700595. EH receives scholarship funding from the University of Calgary, Alberta Innovates Health Solutions, and the Canadian Institutes for Health Research Vanier Scholarship.

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Correspondence to Erin Hetherington.

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Ethical approval

Ethical approval for this study was granted by the Conjoint Health Research Ethics Board of the University of Calgary and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All participants gave their informed consent prior to their inclusion in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Data access

Data used in this study are available upon request from https://policywise.com/sage/.

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Hetherington, E., McDonald, S., Williamson, T. et al. Trajectories of social support in pregnancy and early postpartum: findings from the All Our Families cohort. Soc Psychiatry Psychiatr Epidemiol 55, 259–267 (2020). https://doi.org/10.1007/s00127-019-01740-8

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