Korean Journal of Family Medicine

Barriers to treatment-seeking behaviors among pregnant women with depression: a national cross-sectional study in Indonesia: Tri Wurisastuti, Rofingatul Mubasyiroh, Indri Yunita Suryaputri, Hayani Anastasia, Siti Isfandari, Rozana Ika Agustiya, Irmansyah , Aan Kurniawan, Yurika Fauzia Wardhani; Received April 12, 2024 Accepted January 26, 2025 Published online May 21, 2025; DOI: https://doi.org/10.4082/kjfm.24.0078 [Epub ahead of print]

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Background
Hormonal and physical changes during pregnancy affect mothers’ mental health. Because depression during pregnancy is closely associated with poor pregnancy outcomes, treatment is important for pregnant women with depression. This study aimed to identify barriers to treatment-seeking behaviors among pregnant women with depression in Indonesia.
Methods
Data from the 2018 Indonesian Basic Health Research were used, which focused on pregnant women aged 15–54 years who exhibited depressive symptoms. The Mini-International Neuropsychiatric Interview was used to assess depression. Logistic regression analysis was conducted to explore the factors affecting treatment-seeking behaviors.
Results
Among the pregnant women in Indonesia, 7.9% experienced depression; however, only 11.4% sought treatment. Higher transportation costs to the clinic were associated with 41% lower odds of seeking treatment (adjusted odds ratio [AOR], 0.59; 95% confidence interval [CI], 0.37–0.95; P=0.029). Women in their second and third trimesters had 48% (AOR, 0.52; 95% CI, 0.28–0.98; P=0.042) and 54% (AOR, 0.46; 95% CI, 0.24–0.89; P=0.022) lower odds of seeking treatment, respectively, than those in their first trimester.
Conclusion
Financial barriers and the challenges of late pregnancy hinder treatment-seeking behaviors for depression in pregnant women. Therefore, there is an urgent need for affordable and accessible mental health care for vulnerable populations.

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Usefulness of Glycated Albumin Levels in Predicting the Maternal or Neonatal Complications of Gestational Diabetes Mellitus during Late Pregnancy in South Korea: A Retrospective Study: Jihan Kim, Sami Lee, Jong Sung Kim; Received March 8, 2024 Accepted July 29, 2024 Published online November 12, 2024; DOI: https://doi.org/10.4082/kjfm.24.0048 [Epub ahead of print]

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Background
Gestational diabetes can lead to complications in pregnant women and neonates. Maternal glycated albumin levels during late pregnancy may help predict complications in both mothers and neonates.
Methods
This study was conducted in 120 singleton pregnant women diagnosed with gestational diabetes who visited Trinium Woman’s Hostipal between July 1, 2020, and June 30, 2022. In this study, the patients’ medical records were retrospectively analyzed. Gestational diabetes was diagnosed using a two-step testing method, and glycated albumin tests were performed during the third trimester of pregnancy. The optimal cutoff value of glycated albumin for predicting maternal complications during pregnancy and neonatal complications was determined using the receiver operating characteristic curve.
Results
A total of 45 patients developed maternal complications, with cesarean section (39 patients) due to fetal cephalopelvic disproportion being the most common. As for the neonatal complications, eight neonates were macrosomic or overweight, while 15 neonates required neonatal intensive care unit admission. Additionally, 13 patients had concurrent complications affecting both the mother and neonate. The glycated albumin level in patients with complications was 12.87%, which was significantly higher than that in patients without complications (glycated albumin, 11.67%) (P<0.001). The optimal cutoff value of glycated albumin for predicting maternal and neonatal complications was 12.45%. The sensitivity, specificity, and Youden index were 66.7 %, 86.7%, and 0.534, respectively.
Conclusion
The third trimester glycated albumin test in mothers with gestational diabetes provides limited predictive value for maternal and neonatal complications.

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Association between History of Pregnancy and Liver Fibrosis Using Fibrosis-4 Index in Korean Postmenopausal Women: A Nationwide Population-Based Study: Jae-Joon Ahn, Joo-Hyun Park, Do-Hoon Kim, Hyun-Jin Kim, Hyung-Seok Ko, Jun-Yeon Kwon, Young-Sang Koh, Jin-Hyung Jung, Gyu-Na Lee, Kyungdo Han; Korean J Fam Med 2022;43(6):388-395. Published online November 20, 2022; DOI: https://doi.org/10.4082/kjfm.21.0177

Abstract
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Background
The association between a history of pregnancy and liver fibrosis remains unclear. Herein, we investigated the association between reproductive factors, including a history of pregnancy and liver fibrosis, in postmenopausal Korean women.
Methods
This study used nationally representative, population-based data collected from the Korea National Health and Nutrition Examination Survey 2008–2017. Of 14,624 women with natural menopause, 11,085 with no previous history of any type of cancer, hepatitis, or chronic heavy alcohol consumption were enrolled. We investigated the reproductive factors, including a history of pregnancy, total reproductive years, age at menarche and menopause, and oral contraceptive use. Liver fibrosis was defined as a Fibrosis-4 index score ≥2.67 kg/m².
Results
Of the study participants, 372 (3.3%) had advanced liver fibrosis. Multivariable logistic regression analysis showed that women with a history of more than one pregnancy were associated with a lower risk of liver fibrosis compared to women who had never been pregnant, after adjusting for potential confounders (adjusted odds ratio, 0.30; 95% confidence interval, 0.15–0.59). The risk of liver fibrosis did not increase significantly with an increasing number of pregnancies (P for trend=0.135). Other reproductive factors, including total reproductive years, age at menopause and menarche, and oral contraceptive use, were not significantly associated with liver fibrosis.
Conclusion
Postmenopausal women who had experienced one or more pregnancies had a reduced risk of liver fibrosis. Our findings reveal a potential protective role of pregnancy against liver fibrosis.

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Maternal and Neonatal Outcomes during Dengue Infection Outbreak at a Tertiary National Hospital in Endemic Area of Indonesia: Ryan Saktika Mulyana, Evert Solomon Pangkahila, Tjokorda Gede Astawa Pemayun; Korean J Fam Med 2020;41(3):161-166. Published online April 21, 2020; DOI: https://doi.org/10.4082/kjfm.18.0154

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Background
Dengue infection is the most common mosquito-borne disease in Indonesia. Dengue incidence during pregnancy increases with its prevalence among women of reproductive ages. It potentially causes serious maternal and neonatal morbidity and mortality; however, its impact during a period of disease outbreak has not been described. We aimed to assess the outcomes of pregnancies affected by dengue infection during an outbreak in an endemic area of Indonesia.
Methods
We conducted a prospective observational study at Sanglah General Hospital, Bali, Indonesia from April 2016 to April 2017. All pregnant women with clinical symptoms of dengue infection who tested positive for dengue nonstructural protein 1-antigen or anti-dengue immunoglobulin M were included in the study. Clinical features and hematological and biochemical parameters were documented to assess their relationship with maternal and neonatal outcomes.
Results
Our study population consisted of 41 pregnant women. Most were multigravida (58.5%). Dengue infection without warning signs was observed in 31.7% of the cases, while 53.7% had dengue infection with warning signs, and 14.6% had dengue shock syndrome/severe dengue infection. Most pregnancies were in the third trimester (78%); five cases (12.2%) suffered clinical complications. Preterm delivery was observed in seven cases (17.1%). Most patients (75.6%) decided to seek medical treatment at a critical phase of dengue infection (days 3–6).
Conclusion
The high incidence of associated morbidity and mortality should warrant clinicians in endemic regions to consider diagnoses of dengue infection when treating pregnant women with clinical signs and symptoms. Patients should be treated at centers with adequate resources for monitoring and emergency procedures. A more intensive study is needed in the future aiming to make a more comprehensive guideline.

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BMJ Global Health.2025; 10(1): e015900. CrossRef
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Escitalopram-Induced Amenorrhea and False Positive Urine Pregnancy Test: Vithyalakshmi Selvaraj, Siv Hour, Palanikumar Gunasekar, Caron Gray, James F. Smith; Korean J Fam Med 2017;38(1):40-42. Published online January 18, 2017; DOI: https://doi.org/10.4082/kjfm.2017.38.1.40

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Escitalopram is a selective serotonin reuptake inhibitor antidepressant approved by the Food and Drug Administration for the treatment of major depressive disorder and generalized anxiety disorder. A 34-year-old female patient with major depressive disorder developed amenorrhea and had a false-positive urine pregnancy test after initiation of escitalopram treatment. To our knowledge, no published case report of amenorrhea and false-positive urine pregnancy tests in women taking escitalopram exists. This case report suggests that women of child-bearing age should be carefully monitored for amenorrhea while they are on an antidepressant treatment regimen.

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Alyssia Venna, Marie-Therese Valovska, Carlos R. Estrada, Joseph G. Borer, Caleb P. Nelson
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Mesut Işik, Faruk Kurhan, Tuba Ülkevan, Pinar Güzel Özdemir
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The Effect of Prepregnancy Body Mass Index and Weight Gain during Pregnancy on Infant Birth Weight.: Jung Lim Kim, Hyun Ah Park, Kwang Jong Park, Yong Hyun Ann, Han Jin Lee; J Korean Acad Fam Med 2002;23(12):1462-1469. Published online December 10, 2002

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A prospective study for weight changes associated with pregnancy.: Sang Man Kim, Jean Lee, Byung Hun Ahn, Sat Byul Park, Kwang Min Kim, Hang Su Kim, Duck Joo Lee; J Korean Acad Fam Med 2001;22(6):895-903. Published online June 1, 2001

Abstract
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Background
: This prospective study was performed to evaluate factors influencing weight changes pregnancy period and postpartum period.

Methods : A total of 195 women followed by prenatal care of the department of OBGY at Ajou University hospital. Suwon, Korea, between march, 1998 and march, 2000. Parity, activity, alcohol, smoking, age of menarche, and age of first and last pregnancy were recorded for prenatal information. Anthropometric measurements was checked at regular visits until 6 weeks after delivery and by telephone call at 6 months and 1 year postpartum.
Rerults : Mean age was 30.1 years old and mean body mass index was 21.1 ㎏/㎡, Mean total weight gain during pregnancy was 13.6±4.63 ㎏ and wide range was at third trimester. It shows that weight reduced gradually until 6 months postpartum but increased after that time. 1 year postpartum weight gain had high correlation(R=0.999, p<0.01) with 6 months postpartum weight gain. Total pregnancy weight gain, weight retention on 6 week postpartum were not significantly correlated with 1 year postpartum Weight gain. OR for becoming overweight on 1 year postpartum(≥5.2 ㎏) with excessive rate of gain on 6 months postpartum(≥2.9 ㎏) was 5.41(95% CI 2.20-13.31) adjusted by multiple logistic regression analysis (age, activity level, parity). OR for becoming overweight on 1 year postpartum with excessive rate of Total pregnancy weight gain(≥13.6 ㎏ was 4.4895% CI 1.84-10.89) by multiple logistic regression analysis.

Conclusion : 1 year postpartum weight gain had the correlation with only 6 months postpartum weight gain.

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Prepregnancy weight, maternal weight gain, and birth weight.: Kang Hyun Lee, Jae Chun Kim, Seock Hwan Lee; J Korean Acad Fam Med 1999;20(2):194-200. Published online February 1, 1999

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Background
: Low birth weight and high birth weight are closely related to prenatal complications. The purpose of this study is to estimate the association of prepregnancy weight, maternal weight gain and infant birth weight.

Methods : The effect on birth weight in 724 live births after 38~42 weeks gestation was studied at Taegu Medical Center, between January, 1997, and August, 1998. Pregnant women with hypertension, diabetes mellitus, multiple pregnancy and drug abuse were excluded because of their possible influence on birth weight. To study the effect on infant birth weight, multiple regression analysis was carried out.

Results : We evaluated 724 pregnant women and their babies. Mean prepregnancy weight was 52.2±6.9kg, mean maternal weight gain was 13.0±4.6kg, and mean BMI(Body Mass Index) was 20.5±w.5kg/m². Mean gestational age was 278±7.3days and mean birth weight was 3,320.5±405.2gm. Cor-relation coefficient between birth weight and prepregnancy weight was 0.347(p<0.01), and maternal weight gain was 0.248(p<0.01), and BMI(Body Mass Index) was 0.261(p<0.01). Birth weight was significantly correlated with prepregnancy weight(p<0.01) and maternal weight gain(p<0.01), but prepregnancy weight was not significantly correlated with maternal weight gain(p≥0.05). Prepregnancy weight had most apparent influence on birth weight.

Conclusion : Prepregnancy weight and maternal weight gain was positively related to birth weight. These results suggest that there are good effects of properly controlling prepregnancy weight and maternal weight gain in pregnant women and their babies.