Catastrophizing pain in the perinatal period in postnatal maternal psychological outcomes: scoping review

Carmo, Anne Caroline Nunes; Machado, Paula Muniz; Funez, Mani Indiana

doi:10.5935/2595-0118.20240045-en

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REVIEW ARTICLE • BrJP 7 • 2024 • https://doi.org/10.5935/2595-0118.20240045-en copy

Catastrophizing pain in the perinatal period in postnatal maternal psychological outcomes: scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

The catastrophization of pain is related to worse postnatal maternal psychological outcomes.

The outcomes found are maternal blues, social adjustment, depressive symptoms and less mother-baby reciprocity.

Early identification of pregnant women with catastrophizing can help with risk classification and the necessary referrals in the prenatal and postnatal periods.

ABSTRACT

BACKGROUND AND OBJECTIVES:

There are several conditions that can influence the experience of parturition and experiences related to labor pain. These aspects can result in important psychological outcomes in the postpartum period. Painful responses are mediated in different ways, and catastrophizing is one of the related variables. The objective of the present study was to map the evidence about the impact of pain catastrophizing in the perinatal period on postnatal maternal psychological outcomes, such as baby blues, anxiety disorders, postpartum depression and psychosis, up to three months after delivery.

A literature scope review, was carried out with the following question: “What is the impact of pain catastrophizing in the perinatal period on postnatal maternal psychological outcomes”? The search for studies that made up the sample was carried out on July 31, 2023, using the Pubmed, Cochrane Library, Virtual Health Library and Science Direct databases. 113 documents were identified and based on the selection, four articles were included in the sample, all of them prospective/observational studies. The impact of catastrophizing on outcomes was evaluated: state-trait anxiety, postpartum depression, perceived stress, mother-infant interactions, maternal blues and social functioning.

CONCLUSION:

It was shown that the catastrophizing of pain in the perinatal period is related to worse postnatal maternal psychological outcomes.

Keywords:
Catastrophization; Depression postpartum; Labor pain; Parturition; Puerperal disorders

Identification	Year/country	Author(s)	Type of study and level of evidence and methodological quality	Sample size	Objective	Instruments/evaluation time*	Association of catastrophizing with psychological outcomes
A1	2005 Israel	Ferber, Granot and Zimmer³⁰30 Ferber SG, Granot M, Zimmer EZ. Catastrophizing labor pain compromises later maternity adjustments. Am J Obstet Gynecol. 2005;192(3):826-31.	Observational/prospective Level: 3 High quality	n=82	To determine whether the catas-trophizing of childbirth pain is associated with the level of maternal blues and social functioning n the short-term postpartum period.	Active phase of labor: - VAS 1 - PCS 1 Two weeks postpartum: - VAS 2 - PCS 2 - EPDS Six weeks postpartum: - Social functioning - SF36 Survey.	Maternal blues on the 2nd postpartum day and social functioning 6 weeks after delivery were predicted by scores above 9 on the catastrophizing scale (p<0.0001). Looking specifically at the three components of the PCS 1, it was found that rumination (p=0.003), helplessness (p=0.005) and enlargement (p=0.012) were significant predictors of maternal blues, while helplessness was significant in predicting social functioning at 6 weeks.
A2	2005 Israel	Ferber and Feldman³¹31 Ferber SG, Feldman R. Delivery pain and the development of mother-infant interaction. Infancy. 2005;8(1):43-62.	Prospective observational Level: 3 High quality	n=81	To examine whether the experience of pain during labor has a long-term effect on the development of the mother-baby relationship.	On admission to the delivery room: - PCS - VAS - STAI - EPDS Six weeks postpartum: - PCS - VAS - CIB	Greater catastrophizing of pain was associated with older age, less schooling, less use of analgesia, greater pain intensity and greater depression. The three aspects of pain catastrophizing - rumination (p<0.0001), feelings of helplessness (p<0.0001) and the tendency to amplify pain (p<0.0001) -are each independently related to lower levels of mother-baby reciprocity.
A3	2020 USA	Lim et al.³²32 Lim G, LaSorda KR, Farrell LM, McCarthy AM, Facco F, Wasan AD. Obstetric pain correlates with postpartum depression symptoms: a pilot prospective observational study. BMC Pregnancy Childbirth. 2020;20(1):240.	Prospective cohort Level:3 High quality	n=72	To evaluate psychological, psychosocial and perinatal pain factors predictive of depression symptoms. In exploratory analyses, to investigate the moderator-mediator effects between these factors.	Third quarter: - EPDS - PCS - BPI - STAI - Resilience During labor: - VAS - PTSS 1st and 2nd day postpartum: - BPI (short form) - PSS 6 weeks and 3 months postpartum: - EPDS - BPI (short form)	The scores for levels of prenatal catastrophizing in the cohort did not meet the criteria for selecting variables for multivariate modeling.
A4	2020 Singa - pore	Zeng et al.³³33 Zeng Y, Tan CW, Sultana R, Chua TE, Chen HY, Sia ATH, Sng BL. Association of pain catastrophizing with postnatal depressive states in nulliparous parturients: a prospective study. Neuropsychiatr Dis Treat. 2020;16:1853-62.	Prospective cohort Level: 3 High quality	n=518	To investigate whether high pre-partum pain catastrophizing is associated with the binary variable of postpartum Edinburgh Postnatal Depression Scale (EPDS) scores (a cut-off point ≥10) as the primary outcome. To identify whether prepartum factors were associated with increased changes in postpartum EPDS scores as a secondary outcome, and to determine prepartum factors that were associated with high prepartum pain catastrophizing status.	During labor: - PCS - EPDS - PSS - STAI 5 to 9 weeks postpartum: - EPDS - STAI	Compared to the low pain catastrophizing group, high pain catastrophizing was associated with increased pre-block pain scores on a 0-10 numerical rating scale (p =0.0094), more anesthesiologists needed for epidural analgesia (p =0.0082) and the presence of irruptive pain (p = 0.0075). In the high pain catastrophizing group, all the subcomponents of prepartum PCS (rumination, amplification, helplessness) were significantly higher than in the low catastrophizing group (p<0.0001). Similarly, during the prepartum survey, the high catastrophizing group showed greater perceived stress, (p<0.0001), state-trait anxiety (p<0.0001) and postpartum depression (p<0.0001), compared to the low catastrophizing group. Specifically, the high pain catastrophizing group was associated with an increased level of postpartum depression (p=0.0033).

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[1] Correspondence to: Mani Indiana Funez E-mail:mani@unb.br

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Catastrophizing pain in the perinatal period in postnatal maternal psychological outcomes: scoping review

HIGHLIGHTS

ABSTRACT

BACKGROUND AND OBJECTIVES:

CONTENTS:

CONCLUSION: