Browsing by Author "Tomfohr-Madsen, Lianne M."

Now showing 1 - 7 of 7
  • Thumbnail Image
    ItemOpen Access
    Cardiovascular Consequences of Hypertensive Disorders of Pregnancy
    (2020-01) Wen, Chuan; Anderson, Todd J.; Nerenberg, Kara A.; Metcalfe, Amy; Johnson, Jo-Ann M.; Signal, Ronald J.; Tomfohr-Madsen, Lianne M.; McDonald, Sarah
    Hypertensive disorders of pregnancy (HDP), including preeclampsia and gestational hypertension (GHTN), are independently associated with increased maternal cardiovascular risk. Endothelial dysfunction is one of the crucial pathophysiology of preeclampsia and might be the connection between preeclampsia and future cardiovascular risk. The postpartum period offers a time window to identify and begin to manage modifiable cardiovascular risk factors. However, limited studies have focused on the first years postpartum and the opportunity for early cardiovascular prevention may be lost. Few studies have longitudinally observed the changes of vascular function by different measures. The aims of this study were to detect: Subsequent hypertension, diabetes and dyslipidemia in women with/without HDP over the first years postpartum by linking three administrative databases. The alterations of vascular function during pregnancy by using flow-mediated vasodilation (FMD), hyperemic velocity-time integral (VTI) and peripheral artery tonometry (PAT), and the relationship between vascular function indices and utero-placental ultrasonographic and biochemical markers. Our results highlighted women with HDP had higher odds of hypertension (GHTN adjusted OR [aOR]: 5.82[4.96-6.83]; preeclampsia: aOR: 4.97[3.63-6.81]), dyslipidemia (GHTN: aOR: 2.22[1.47-3.35]; preeclampsia: aOR: 1.41[1.10-1.80]), and diabetes (GHTN: aOR: 2.26[1.50, 13.4]; PE: 2.02[0.91, 4.46]) during 4 years postpartum than the normotensive pregnancy. Half of the women with HDP had no lipid testing. They were not more likely to be tested than normotensive women after adjusting for confounders. Women with GHTN and preeclampsia had less favorable and more atherogenic lab results than the normal controls. Non-significant changes of FMD and hyperemic VTI over pregnancy were detected. The PAT index declined consistently during pregnancy and this may have been related to vasodilator changes of baseline pulse wave amplitude. The uterine artery pulsatility index (UtA-PI) was not correlated with the standard measures of endothelial function. There were mild correlations between UtA-PI and baseline flow, sFlT-1 and ln(sFlt-1/PlGF ratio) with baseline flow and baseline VTI in the first trimester. Our study implies the needs of early postpartum screening for hypertension, dyslipidemia and dysglycemia in women with HDP. FMD, hyperemic VTI and PAT index might not be directly used as markers to represent the macrovascular and microvascular function during pregnancy.
  • Thumbnail Image
    ItemOpen Access
    Effect of Remote Peer-Counsellor- delivered Behavioral Activation and Peer-support for Antenatal Depression on Gestational Age at Delivery: a single-blind, randomized control trial
    (2023-03-30) Chaput, Kathleen H.; Freeman, Makayla; McMorris, Carly; Metcalfe, Amy; Cameron, Emily E.; Jung, James; Tough, Suzanne; Hicks, Laurel M.; Dimidjian, Sona; Tomfohr-Madsen, Lianne M.
    Abstract Background Antenatal depression (AD) is the most common complication of pregnancy in developed countries and increases the risk of preterm birth (PTB). Many pregnant individuals with AD do not obtain treatment due in part to risks associated with antidepressant medications, the expense and wait times for psychological services, and perceived stigma. Accessible and timely treatment of antenatal depression is crucial to minimize foetal impacts and associated long-term child health outcomes. Previous studies show that behavioural activation and peer support are promising avenues of treatment for perinatal depression. Additionally, remote and paraprofessional counselling interventions show promise as more accessible, sustainable, and cost-effective treatment avenues than traditional psychological services. The primary aim of this trial is to test the effectiveness of a remote, behavioural activation and peer support intervention, administered by trained peer para-professionals, for increasing gestational age at delivery among those with antenatal depression. The secondary aims are to evaluate the effectiveness for treating AD prior to delivery, with persistence into the postpartum; improving anxiety symptoms; and improving parenting self-efficacy compared to controls. Methods A two-arm, single-blinded, parallel groups randomized controlled trial (RCT) with repeated measures will be conducted. Participants scoring >10 on the Edinburgh Postnatal Depression Scale will be recruited from the larger P3 cohort and invited to enroll. Assessments will be conducted prior to 27 weeks’ gestation at trial intake (T1), post-intervention, prior to delivery (T2), 5–6 months postpartum (T3), and 11–12 months postpartum (T4) and will include self-report questionnaires and linked medical records. Discussion Our remote, peer paraprofessional-delivered behavioural activation plus peer support intervention has the potential to successfully reduce symptoms of AD, which may in turn decrease the risk of PTB and subsequent health impacts. The current trial builds on previous findings and uses a patient-oriented approach to address priorities for patient care and to provide a cost-effective, accessible, and evidence-based treatment to pregnant individuals with AD. Trial registration International Standard Randomised Controlled Trial Number (ISRCTN) registry (ISRCTN51098220) ISRCTN51098220. Registered on April 7, 2022.
  • Thumbnail Image
    ItemOpen Access
    Insomnia During Pregnancy
    (2020-07-16) Sedov, Ivan; Tomfohr-Madsen, Lianne M.; Dobson, Keith; Noel, Melanie; Green, Sheryl; Kopala-Sibley, Daniel
    The problem: Sleep has long been noted to be disturbed during pregnancy; however, investigations of insomnia as it occurs during the prenatal period have been limited. The goal of this dissertation was to develop the existing knowledge base of prenatal insomnia prevalence, course, and risk factors.Methods: A meta-analysis of prenatal insomnia literature was conducted to establish a prevalence of insomnia and moderating variables including trimester, gestational age, maternal age, depression, and anxiety. Additionally, 142 women were recruited in early-pregnancy and followed until early-postpartum. Measures of insomnia symptoms as well as mental health variables were taken every 10 weeks for a total of 40 weeks. Semiparametric group-based modeling was used to construct trajectories of insomnia symptomology over the course of pregnancy. Cross-lagged panel analysis was used to test the strength of the relationship between generalized anxiety and insomnia symptoms.Results: The results of the meta-analysis indicated that 36.7% of pregnant women reported clinically significant insomnia symptoms. Trimester moderated the prevalence such that the prevalence of insomnia symptoms was higher during the third relative to the second trimester. The trajectory analysis resulted in three groups: stable-low (42.2%), dynamic-medium (44.3%), and decreasing-high (13.4%). Women in the decreasing-high group reported clinically elevated symptoms through the course of pregnancy which decreased slightly in the postpartum. The stable-low group demonstrated consistently low insomnia symptoms. The dynamic-medium group demonstrated sub-clinical insomnia symptoms that worsened in the third trimester before decreasing in the postpartum. Anxiety and depression symptoms at baseline were predictive of trajectory membership. Additionally, experiencing consistently high insomnia symptoms throughiiithe course of pregnancy was related to higher symptoms of anxiety and depression in the postpartum. The cross-lagged panel analysis indicated that generalized anxiety symptoms predicted subsequent insomnia symptoms but not vice versa. Anxiety symptoms in late-pregnancy were not predictive of insomnia symptoms in early-postpartum.General conclusion: Insomnia symptoms are prevalent during pregnancy and characterized by several different trajectory patterns. Generalized anxiety symptoms are an important predictor of subsequent insomnia symptoms. This body of work helps to develop the current understanding of insomnia as it occurs during pregnancy.
  • Thumbnail Image
    ItemOpen Access
    Mindfulness-based cognitive therapy for psychological distress in pregnancy: study protocol for a randomized controlled trial
    (Springer Nature, 2016-10-13) Giesbrecht, Gerald F.; Dimidjian, Sona; Madsen, Joshua W.; Carlson, Linda E.; Letourneau, Nicole L.; Tomfohr-Madsen, Lianne M.; Campbell, Tavis S.
    Clinically significant psychological distress in pregnancy is common, with epidemiological research suggesting that between 15 and 25 % of pregnant women experience elevated symptoms of stress, anxiety, and depression. Untreated psychological distress in pregnancy is associated with poor obstetrical outcomes, changes in maternal physiology, elevated incidence of child physical and psychological disorders, and is predictive of maternal postpartum mood disorders. Despite the wide-ranging impact of antenatal psychological distress on mothers and their children, there is a gap in our knowledge about the most effective treatments that are available for psychological distress experienced in pregnancy. Additionally, no trials have focused on potential physiological changes that may occur as a result of receiving mindfulness training in pregnancy. The proposed trial will determine the effectiveness of an 8-week modified Mindfulness-based Cognitive Therapy (MBCT) intervention delivered during pregnancy.
  • Thumbnail Image
    ItemOpen Access
    Sleep Disturbances and Fatigue in Survivors of Pediatric Acute Lymphoblastic Leukemia and their Siblings
    (2019-08-19) Russell, Karleen Brooke; Tomfohr-Madsen, Lianne M.; Schulte, Fiona S. M.; Noel, Melanie; Brooks, Brian L.; Laing, Catherine M.
    Sleep disturbances and fatigue have been identified by patients with cancer as common and distressing. Conflicting evidence about the prevalence of these outcomes, however, exists for survivors of childhood cancers. Additionally, little is known about how the cancer trajectory might impact survivor siblings’ sleep and fatigue. The current study compared sleep and fatigue in survivors of acute lymphoblastic leukemia (ALL) (2-7 years off therapy) and their siblings to healthy control sibling dyads. We hypothesized that survivors would have less total sleep time (TST), greater wake after sleep onset (WASO), poorer sleep efficiency (SE), and higher ratings of fatigue than controls. Participants (survivors, n=45; survivor siblings, n=27; controls, n=45; control siblings, n=41; 58% male) aged 8-18 (m=11.64, SD=2.62) completed the PedsQL Multidimensional Fatigue Scale, a 7-day sleep diary, and 7-consecutive days of actigraphy. Parents (n=90) completed the Children’s Sleep Habits Questionnaire for each of their children. No between-group differences were found on measures of fatigue, sleep diaries, or actigraphy. Parents reported that survivor siblings had significantly poorer sleep habits than survivors or controls. For survivors, greater time off treatment and younger age at diagnosis were significantly related to poorer outcomes via actigraphy on TST, WASO, and SE, as well as sleep-onset latency (SOL) via sleep diaries. This research suggests that poorer sleep in later survivorship from childhood cancer may be related to late-effects, which may account for variability in these findings in the broader literature, and that siblings of survivors of childhood cancer may be at risk for sleep problems.
  • Thumbnail Image
    ItemEmbargo
    Trajectories of Paternal Postpartum Depression
    (2020-07-30) Cameron, Emily; Tomfohr-Madsen, Lianne M.; Dobson, Keith S.; Benzies, Karen Marie; Kopala-Sibley, Daniel C.; Da Costa, D.
    Background: New fathers are nearly twice as likely to experience depression than men in the general population. The majority of studies examining risk factors for paternal postpartum depression (PPD) have used cross-sectional data, while extant longitudinal studies are often limited in the time that fathers are followed as well as the frequency of assessments. There is a dearth of research that examines risk and protective factors related to differing trajectories of depression. Analysis of trajectories is advantageous as it does not assume that all fathers will experience the same course of depression and allows for unique predictors of each trajectory to be evaluated. Method: The current study recruited 160 fathers in the third trimester. Each participant completed a larger baseline survey followed by a depressive symptom questionnaire at 1, 3, 6, 9, and 12 months postpartum. Group-based semiparametric modelling was used to identify trajectories of paternal PPD; multinomial logistic regression was used to evaluate prenatal predictors of each trajectory. Results: A four trajectory solution was considered the best fitting model and most clinically informative. Higher insomnia symptoms, higher anxiety, and experiencing pregnancy complications predicted group membership in the “moderate-increasing symptoms” trajectory group, while lower insomnia symptoms, lower anxiety, and experiencing an unremarkable pregnancy were protective factors predicting group membership in the “no or minimal symptoms” group. Preliminary analysis of the “clinical-increasing symptoms” group suggested that higher anxiety and maternal anxiety significant predicted group membership when controlling for Type I error (p < .01). Discussion: The current study is the first to describe trajectories of PPD in Canadian men. These findings have the capacity to aide prenatal screening measures for men transitioning to parenthood, as well as early intervention strategies.
  • Thumbnail Image
    ItemEmbargo
    Working Memory and Processing Speed Training in Schizophrenia: A Randomized Controlled Trial
    (2018-06-11) Cassetta, Briana Diane; Tomfohr-Madsen, Lianne M.; Addington, Jean; Goldberg, Joel; Sears, Christopher R.; Ewashen, Carol J.
    Individuals with schizophrenia are generally found to experience cognitive deficits in most domains of cognition. Moreover, greater cognitive deficits have been associated with poorer daily functioning in schizophrenia. Given these findings, cognitive training has been a burgeoning area of research in recent years, with some evidence suggesting that cognitive training programs may improve cognition for individuals with schizophrenia. However, the state of the literature remains unclear as to which domains of cognition should be targeted to produce the most widespread benefits for individuals with schizophrenia. One suggestion is that targeting lower-level cognitive processes that are important for higher-level and more complex aspects of cognition may produce the most widespread and durable benefits in cognition and everyday functioning. In particular, working memory (WM) and processing speed (PS) have been named as two key areas of deficit in schizophrenia, and two domains of cognition that may be linked to higher-order cognition and daily functioning. This study aimed to investigate the near-transfer (transfer of gains to related contexts), far-transfer (transfer of gains to unrelated contexts), and real-world gains associated with WM and PS training in schizophrenia. To this end, 83 participants with schizophrenia or schizoaffective disorder were recruited and randomly assigned to computerized WM training, PS training, or a no-training control group. Results showed that PS training led to significant gains in untrained PS tasks as well as gains in far-transfer tasks that required speed of processing, relative to the other groups. WM training did not lead to gains in untrained WM tasks, and showed inconsistent effects on some far-transfer tasks. These results suggest that there can be benefits of domain-specific cognitive training, specifically PS training, in schizophrenia. Far-transfer of gains to other cognitive domains and to real-world functioning may not occur after targeted WM or PS training, though non-specific effects (e.g., through behavioural activation, increased motivation) may lead to improvements on some cognitive tasks. Future studies should continue to investigate the mechanisms by which cognitive training may lead to enhancements in cognition and functioning in schizophrenia.