On 2014 Mar 05, David Reardon commented:

Dear Dr. Räisänen,

I recently read your paper on fear of childbirth as predictive of post-partum depression.

I have a couple questions and observations.

First, while you did examine history of pregnancy loss, including both miscarriage and termination, it seems that additional segregation of the findings relative to exposure to pregnancy loss would be very beneficial.

For example, in Table 2, you found higher rates of adverse perinatal outcomes associated with postpartum depression. The confounding factor here is that a history of pregnancy loss is itself a predictor of adverse perinatal outcomes. For example, the Finland data set has shown that induced abortion is associated with most of the adverse outcomes you list, and that there is a dose effect, with more abortions associated with more problems. (See: Birth outcomes after induced abortion: a nationwide register-based study of first births in Finland. Klemetti R, Gissler M, Niinimäki M, Hemminki E. Hum Reprod. 2012 Nov;27(11):3315-20. doi: 10.1093/humrep/des294. Epub 2012 Aug 29.)

With this information in mind, it would be very helpful if you could provide an expanded version of Table 2, showing 8 columns rather than 4, adding as "A history of pregnancy loss" or perhaps "A history of termination" as another breakdown. (To check for a dose effect, you might also consider a breakdown with "Number of terminations" with columns for 0, 1, 2 or more.)

Regarding your "fear of childbirth" variable, it would also be most helpful if you provided an analysis of whether women treated who had a fear of childbirth were significantly more likely to have had one or multiple prior pregnancy losses (miscarriage or induced abortion).

Based on clinical experience and self reports, it appears that women who have had a history of pregnancy loss may be significantly more likely to have fears surrounding childbirth. For example, some women with unresolved issues related to a past abortion report intense fear that they will be "punished" by God with an adverse outcome of a subsequent wanted pregnancy. While I know this to be true in isolated cases, I do not know of any studies which have examined whether this reported association between pregnancy loss and fears regarding childbirth are statistically significant. It appears you data could shed light on this question.

Thank you for any additional information you can provide.

On 2014 Mar 05, David Reardon commented:

Dear Dr. Räisänen,

I recently read your paper on fear of childbirth as predictive of post-partum depression.

I have a couple questions and observations.

First, while you did examine history of pregnancy loss, including both miscarriage and termination, it seems that additional segregation of the findings relative to exposure to pregnancy loss would be very beneficial.

For example, in Table 2, you found higher rates of adverse perinatal outcomes associated with postpartum depression. The confounding factor here is that a history of pregnancy loss is itself a predictor of adverse perinatal outcomes. For example, the Finland data set has shown that induced abortion is associated with most of the adverse outcomes you list, and that there is a dose effect, with more abortions associated with more problems. (See: Birth outcomes after induced abortion: a nationwide register-based study of first births in Finland. Klemetti R, Gissler M, Niinimäki M, Hemminki E. Hum Reprod. 2012 Nov;27(11):3315-20. doi: 10.1093/humrep/des294. Epub 2012 Aug 29.)

With this information in mind, it would be very helpful if you could provide an expanded version of Table 2, showing 8 columns rather than 4, adding as "A history of pregnancy loss" or perhaps "A history of termination" as another breakdown. (To check for a dose effect, you might also consider a breakdown with "Number of terminations" with columns for 0, 1, 2 or more.)

Regarding your "fear of childbirth" variable, it would also be most helpful if you provided an analysis of whether women treated who had a fear of childbirth were significantly more likely to have had one or multiple prior pregnancy losses (miscarriage or induced abortion).

Based on clinical experience and self reports, it appears that women who have had a history of pregnancy loss may be significantly more likely to have fears surrounding childbirth. For example, some women with unresolved issues related to a past abortion report intense fear that they will be "punished" by God with an adverse outcome of a subsequent wanted pregnancy. While I know this to be true in isolated cases, I do not know of any studies which have examined whether this reported association between pregnancy loss and fears regarding childbirth are statistically significant. It appears you data could shed light on this question.

Thank you for any additional information you can provide.