Laura Mosconi

Introduction: Termination of pregnancy for fetal anomaly is associated with profound psychological distress for parents and can be emotionally demanding for healthcare professionals. Evidence on professionals’ knowledge, practices, and support needs in Italy remains limited. We aimed to...

Purpose: Perinatal loss is associated with a high risk of persistent psychological distress, including prolonged grief, depression, anxiety, and post-traumatic stress symptoms. Cognitive processes such as rumination may play a crucial role in maintaining and amplifying distress following loss, yet their specific contribution in perinatal bereavement remains underexplored. Methods: The CARING (Cognitive Analysis and Rumination INvestigation in perinatal Grief) study employed a cross-sectional design involving 298 parents who experienced perinatal loss within the previous five years. Participants completed an anonymous online survey including measures of depressive rumination (Ruminative Response Scale, RRS), angry rumination (Anger Rumination Scale, ARS), perinatal grief (Perinatal Grief Scale, PGS), general psychopathology (SCL-90), and post-traumatic stress symptoms (NSESSS). Non-parametric analyses were conducted to examine associations between rumination patterns and psychological outcomes. Results: Higher levels of rumination were significantly associated with greater perinatal grief, depressive and anxiety symptoms, and post-traumatic stress. Depressive rumination showed consistently stronger associations with all outcomes compared to angry rumination. Participants presenting both depressive and angry rumination exhibited the highest levels of grief intensity, psychological distress, and PTSD symptoms, suggesting a graded relationship between rumination patterns and severity of distress. Rumination levels were not significantly associated with gestational age at loss or with having received psychological support. Conclusions: Rumination, particularly in its depressive form, appears to function as a transdiagnostic cognitive vulnerability factor in perinatal bereavement. These findings highlight rumination as a potential target for early screening and tailored psychological interventions aimed at reducing long-term distress following perinatal loss.

Background: The Perinatal Grief Scale (PGS) is a widely used instrument for assessing grief following pregnancy loss, yet no study has validated it specifically in men despite documented use in several studies. This gap is critical given fathers’ persistent underrepresentation in perinatal bereavement research and the absence of empirically supported screening thresholds for this population. Methods: This cross-sectional validation study used data from the OPALE project (Observatory on PerinatAL hEalth) conducted by the CiaoLapo Foundation in Italy. Among 276 fathers who experienced stillbirth or miscarriage, we examined criterion validity by testing the association between PGS scores and trauma-related symptomatology assessed via three validated instruments: the Revised Impact of Event Scale (RIES, n=103), National Stressful Events Survey Short Scale (NSESSS, n=95), and SCL-90 (n=173). We systematically tested multiple threshold combinations to identify optimal discriminative performance. Results: The PGS demonstrated excellent criterion validity. The optimal threshold (PGS ≥92) showed sensitivity 81.0%, specificity 81.8%, and Youden’s J index 0.628. Fathers scoring ≥92 had 19.12 times the odds of high trauma symptoms (95% CI: 9.35–39.14, p<0.001). ROC analysis yielded AUC=0.829 (95% CI: 0.778–0.880). Associations remained robust across all three trauma instruments in stratified analyses and after adjusting for time since loss, father’s age, living children, and loss type. Conclusion: This is the first men-specific validation of the PGS, demonstrating strong criterion validity and establishing a clinically meaningful screening threshold (≥92) for identifying fathers at elevated risk following perinatal loss.

Background: Pregnancies following perinatal loss present emotional and clinical challenges that require individualized care. While awareness of the psychological vulnerability of bereaved parents is increasing, the perspectives and preparedness of healthcare professionals (HCPs) are still under-investigated. Methods: The UNSURENESS study involved a national cross-sectional web-based survey conducted between August 2023 and February 2024. The questionnaire explored sociodemographic data, professional experience, training in perinatal loss care, communication approaches, and clinical decision making. Results: Two hundred female HCPs participated (midwives 78.0%). One-third had received specific training on managing pregnancies after perinatal loss. On a 0–4 Likert scale, participants emphasized the importance of addressing the previous loss (M = 3.82; SD = 0.03) and building a trusting relationship with parents (M = 3.78; SD = 0.04). Providing comprehensive information (M = 3.59; SD = 0.05) and promoting shared decision making (M = 3.72; SD = 0.04) followed closely. The most challenging tasks included responding to parental fears (M = 3.37; SD = 0.75) and offering reassurance (M = 3.06; SD = 1.06). Clinical decisions were primarily driven by continuity of care (M = 3.70; SD = 0.56) and parental preferences (M = 3.63; SD = 0.57), rather than national guidelines (M = 3.16; SD = 0.82) or research evidence (M = 2.86; SD = 0.94). Conclusions: HCPs are aware of the psychosocial complexity involved in these pregnancies but often lack specific training. There is a clear need for trauma-informed interventions and national guidelines to better support both professionals and bereaved families.

Background. In the aftermath of perinatal loss, the physiological onset of lactation presents a complex array of emotional responses for women, including grief and despair. Effective lactation management is essential for maternal health, yet it is often inadequately ad-dressed by healthcare professionals, potentially compromising the physical and psy-chological recovery of the bereaved mother. Aim. The aim of this study is to investigate how Italian HCPs support mothers in managing lactation after a perinatal loss. Methods. This study is web-based and cross sectional. HCPs involved in perinatal bereavement care were asked to answer a survey consisting of three areas: sociodemographic information, knowledge and experience about perinatal loss and about lactation after perinatal loss. Findings. In this study, 1,227 healthcare professionals participated. A significant majority, 60.2%, had received formal training on perinatal loss care, expressing high satisfaction with an average score of 4.7 out of 5. However, less than half, at 42.5%, reported having a protocol for bereavement care in their workplace. A notable 25% of the respondents did not provide lactation information when possible. Discussions predominantly centred on pharmacological suppression of lactation in cases of stillbirth (89.5%) and neonatal death (83.8%), as well as complications associated with these events. Post-discharge follow-up was reported as lacking by 78.2% of the sample. Conclusion. The discrepancy between HCPs' training and their practice reveals a critical need for enhancing the implementation of bereavement care protocols and follow-up support, reflecting the importance of inte-grating lactation management into the perinatal loss care continuum.

Purpose: To assess the knowledge, clinical experience, and attitudes of Italian midwives toward perinatal depression (PND) and to explore how these factors impact the quality of care. Methods: We conducted a cross-sectional online survey among 152 midwives employed in public hospitals across Italy. The questionnaire covered a range of topics, including demographic data, professional experience, knowledge of PND symptoms, risk factors, and clinical management, as well as communication skills and personal experiences with PND cases. Results: A concerning 76.3% of midwives displayed inadequate knowledge of PND based on current scientific literature. Those with a more comprehensive understanding were notably more confident in their practice, expressing significantly fewer apprehensions about communicating with mothers (25.8% vs 74.2%) and lesser concerns about the mothers’ future well-being (38.9% vs 62.95%). The survey results also emphasised the midwives’ call for specialised guidelines and formal training in PND management and underscored the value of communication skills, continuity of care, and family engagement in supporting affected mothers. Conclusion: This inaugural study sheds light on the current state of knowledge and attitudes among Italian midwives regarding PND. It pinpoints crucial areas for educational enhancement and practice improvement, suggesting that elevated levels of midwife expertise in PND could significantly elevate the standard of care and expedite early diagnosis and treatment.

The COVID-19 pandemic affected the perinatal emotional landscape in Italy, a country that had high mortality and implemented a strict lockdown during the pandemic. This study explores the emotions and challenges of pregnant and postpartum women during the pandemic, using AI-based mixed methods. The study analyzed 1774 women from the national survey COVID-ASSESS: 1136 pregnant and 638 postpartum women. The survey had qualitative questions on emotions and feelings related to birth, communication with healthcare professionals, media, and peers and family. We used natural language processing and machine learning to classify emotions, identify themes, and extract citations from the data. Fear and anxiety replaced joy as dominant emotions during the pandemic: trust and joy decreased by 49.3% and 36.4%, respectively, while sadness and fear increased by 52.3% and 49.3%, respectively. The pandemic also induced loneliness, isolation, frustration, and anger. Women faced challenges related to birth, communication with HCPs, media, and peers and family. They also used coping strategies such as self-care, news limitation, and trying to cultivate gratitude and hope. This study provides a comprehensive exploration of the perinatal emotional landscape of Italian women during the pandemic. The findings underscore the significant psychological impact of the pandemic and also highlight women’s resilience and coping strategies.

The COVID-19 pandemic affected the perinatal emotional landscape in Italy, a country with high mortality and strict lockdown. This study explored the emotions and challenges of pregnant and post-partum women during the pandemic, using AI-based mixed-methods. The study analyzed 1774 women from the national survey COVID-ASSESS: 1136 pregnant and 638 post-partum. The survey had qualitative questions on emotions and feelings related to birth, communication with healthcare professionals, media, and peers and family. We used natural language processing and machine learning to classify emotions, identify themes, and extract citations from the data. Fear and anxiety replaced joy as dominant emotions during the pandemic: trust and joy decreased by 49.3% and 36.4%, respectively, while sadness and fear increased by 52.3% and 49.3%, respectively. The pandemic also induced loneliness, isolation, frustration, and anger. Women faced challenges related to birth, communication with HCPs, media, and peers and family. They also used coping strategies such as self-care, news limitation, and tried to cultivate gratitude and hope. The study provides a comprehensive exploration of the perinatal emotional landscape of Italian women during the pandemic. The findings underscore the significant psychological impact of the pandemic, and also highlights women’s resilience and coping strategies.