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Mongan D, Lynch J, Hanna D, Shannon C, Hamilton S, Potter C, Gorman C, McCambridge O, Morrow R, Mulholland C. Prevalence of self-reported mental disorders in pregnancy and associations with adverse neonatal outcomes: a population-based cross-sectional study. BMC Pregnancy Childbirth 2019; 19:412. [PMID: 31703644 PMCID: PMC6842147 DOI: 10.1186/s12884-019-2572-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/25/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Mental disorders in pregnancy are common causes of morbidity and mortality with associated risks of adverse neonatal outcomes. Our aims were to evaluate the prevalence of self-reported mental disorders in women presenting to maternity services and to determine the association between history of self-reported maternal mental disorder and adverse neonatal outcomes. METHODS Data on all singleton pregnancies known to maternity services in Northern Ireland over the period 2010 to 2015 were extracted from the Northern Ireland Maternity System (NIMATS), including frequency data for number of pregnancies where the mother reported a history of mental disorder. Odds ratios were derived from logistic regression analyses to determine the associations between self-reported maternal mental disorder and preterm birth, low infant birth weight and APGAR scores. RESULTS In total, 140,569 singleton pregnancies were registered using NIMATS over this period. In 18.9% of these pregnancies, the mother reported a history of at least one mental disorder. After adjustment for potential confounding factors, significant associations were demonstrated between self-reported maternal mental disorder and preterm birth (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.25-1.37), low infant birth weight (OR 1.29, 95% CI 1.21-1.38) and APGAR score < 7 at 1 min (OR 1.14, 95% CI 1.10-1.19) and 5 min (OR 1.23, 95% CI 1.12 to 1.34). CONCLUSIONS These findings emphasise the critical importance of routine enquiry regarding psychiatric history when women present to maternity services and the impact of maternal mental illnesses upon outcomes for their infants.
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Affiliation(s)
- David Mongan
- School of Medicine, Queen’s University Belfast, University Road, Belfast, BT7 1NN Northern Ireland
- RCSI Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Janine Lynch
- Belfast Health and Social Care Trust, Trust Headquarters, A Floor, Belfast City Hospital, Lisburn Road, Belfast, County Antrim BT9 7AB Northern Ireland
| | - Donncha Hanna
- School of Psychology, Queen’s University Belfast, University Road, Belfast, BT7 1NN Northern Ireland
| | - Ciaran Shannon
- Northern Health and Social Care Trust, Trust Headquarters, Bretten Hall, Bush Road, Antrim, County Antrim BT41 2RL Northern Ireland
| | - Shona Hamilton
- Northern Health and Social Care Trust, Trust Headquarters, Bretten Hall, Bush Road, Antrim, County Antrim BT41 2RL Northern Ireland
| | - Claire Potter
- Southern Health and Social Care Trust, Trust Headquarters, Bretten Hall, Bush Road, Antrim, County Antrim BT41 2RL Northern Ireland
| | - Colin Gorman
- Belfast Health and Social Care Trust, Trust Headquarters, A Floor, Belfast City Hospital, Lisburn Road, Belfast, County Antrim BT9 7AB Northern Ireland
| | - Orlagh McCambridge
- Southern Health and Social Care Trust, Trust Headquarters, Bretten Hall, Bush Road, Antrim, County Antrim BT41 2RL Northern Ireland
| | - Rachel Morrow
- Belfast Health and Social Care Trust, Trust Headquarters, A Floor, Belfast City Hospital, Lisburn Road, Belfast, County Antrim BT9 7AB Northern Ireland
| | - Ciaran Mulholland
- School of Medicine, Queen’s University Belfast, University Road, Belfast, BT7 1NN Northern Ireland
- Northern Health and Social Care Trust, Trust Headquarters, Bretten Hall, Bush Road, Antrim, County Antrim BT41 2RL Northern Ireland
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Hishikawa K, Kusaka T, Fukuda T, Kohata Y, Inoue H. Anxiety or Nervousness Disturbs the Progress of Birth Based on Human Behavioral Evolutionary Biology. J Perinat Educ 2019; 28:218-223. [PMID: 31728113 DOI: 10.1891/1058-1243.28.4.218] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In general, anxiety or nervousness in pregnant women increases the risk of dystocia. Pregnant women are easily susceptible to anxiousness or nervousness. To support a safe and healthy birthing process, childbirth educators, other health-care professionals, and pregnant women require an in-depth understanding about the disruptive effects of anxiety or nervousness on birth progress. Anxiety and nervousness are difficult to quantify and may be influenced by culture. Therefore, reports comparing anxiety or nervousness with dystocia must include various biases. It is difficult to find this issue by medical research. Here, we discuss links between anxiety or nervousness and disturbance in the progress of birth based on the adaptive standpoint of human behavioral evolutionary biology.
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Horsch A, Gilbert L, Lanzi S, Kang JS, Vial Y, Puder JJ. Prospective associations between maternal stress during pregnancy and fasting glucose with obstetric and neonatal outcomes. J Psychosom Res 2019; 125:109795. [PMID: 31421320 DOI: 10.1016/j.jpsychores.2019.109795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This prospective study investigated associations between maternal stress exposure and maternal psychological stress measures during pregnancy with obstetric and neonatal outcomes. We also tested whether any observed associations would be moderated by increasing glucose levels, as increased glycaemia is also associated with adverse obstetric and neonatal outcomes. METHODS 203 women between 24 and 30 weeks gestation completed validated questionnaires assessing pregnancy-related major events and major life events, maternal perceived stress, and depression, anxiety, and stress symptoms. Glucose was measured using fasting morning blood samples. Instrumental delivery represented an obstetric outcome. Neonatal outcomes included Apgar score, large and small for gestational age weight, cord blood pH, NICU hospitalization, and neonatal hypoglycaemia. RESULTS Regarding the obstetric outcome, pregnancy-related major life events OR = 1.346 (1.016-1.783; p = .016) were related to more incidences of instrumental delivery. Regarding neonatal outcomes, exposure to major life events in the last 12 months was associated with lower cord blood pH values B = -0.155 (-0.059 to -0.002; p = .036) and with more incidences of hypoglycaemia OR = 0.165 (0.012-0.169; p = .04). Maternal psychological stress measures were related to more incidences of instrumental delivery OR = 1.018 (1.003-1.032; p = .013). Maternal stress perception was associated with higher cord blood pH values B = 0.155 (0-0.003; p = .046) and fewer NICU hospitalisations OR = -0.170 (-0.009 to -0.001; p = .019). Some of these associations between life events and stress perceptions with neonatal outcomes were moderated by fasting glucose levels. CONCLUSION Maternal pregnancy events as well as stress, depression and anxiety symptoms have a negative impact on obstetric outcomes and maternal life events are associated with negative neonatal outcomes. Higher fasting glucose levels moderate some of the relationships between stress and neonatal outcomes.
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Affiliation(s)
- Antje Horsch
- Institute of Higher Education in Healthcare Research, University of Lausanne, Lausanne, Switzerland; Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
| | - Leah Gilbert
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefano Lanzi
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland; Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Switzerland
| | - Ji Seon Kang
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Yvan Vial
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Jardena J Puder
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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Hospital Outcomes in Antepartum Mental Disorders: A Study on 897,397 Pregnant Inpatients. Behav Sci (Basel) 2019; 9:bs9100105. [PMID: 31569495 PMCID: PMC6826408 DOI: 10.3390/bs9100105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/01/2019] [Accepted: 09/24/2019] [Indexed: 01/18/2023] Open
Abstract
Objective: To evaluate the impact of antepartum mental disorders (AMD) in medical and psychiatric comorbidities, and inpatient outcomes during hospitalizations for pregnancy/birth-related complications. Methods: We used the national inpatient sample (NIS) data and included 19,170,562 female patients (age, 12–40 years) with a principal diagnosis of pregnancy/birth-related complications and grouped by co-diagnoses of AMD (N = 897,397). We used a binomial logistic regression model to evaluate the odds ratio (OR) for major severity of illness and adjusted for demographic confounders. Results: The hospitalizations with AMD increased by 22.1% (p < 0.001) from 2010 to 2014. White females (66.1%) and those from low-income families (<25th percentile, 31.8%) majorly had comorbid AMD. Depression (43.8%) and drug abuse (27%) were prevalent psychiatric disorders in AMD inpatients. Comorbid AMD inpatients had a higher likelihood for major severity of illness (OR 2.475, 95% CI 2.459–2.491, p < 0.001). They also had a longer hospitalization stay with a mean difference of 0.486 days (95% CI 0.480–0.491) and higher total charges by $1889.420 per admission (95% CI 1852.670–1926.170) than non-AMD inpatients. Conclusions: AMD is associated with worsening of severity of illness in pregnancy/birth-related complications and require acute inpatient care. Mental health assessment and treatment of AMD, and education about efficacy and safety of psychiatric medications may help to improve outcomes in these patients.
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Jones A. Help Seeking in the Perinatal Period: A Review of Barriers and Facilitators. SOCIAL WORK IN PUBLIC HEALTH 2019; 34:596-605. [PMID: 31242074 DOI: 10.1080/19371918.2019.1635947] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Perinatal depression affects approximately 10 to 20 percent of women during pregnancy or the first 12 months postpartum. Increased attention has been given to the prevalence of and screening for perinatal depression, yet little research addresses help seeking for this issue. The overall barriers and facilitators of help seeking among these women have yet to be addressed in a systematic way. A systematic literature review was conducted to identify studies that focused on help seeking among women with perinatal depression. Nineteen articles met the inclusion criteria discussed below and were included in this review. Barriers to help seeking for women with perinatal depression include social (e.g. stigma), structural (e.g. provider unavailable) and instrumental factors (e.g. cost). Facilitators of help seeking for women with perinatal depression were limited in scope. Recommendations for policy and the role of social workers are discussed.
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Nasreen HE, Pasi HB, Rifin SM, Aris MAM, Rahman JA, Rus RM, Edhborg M. Impact of maternal antepartum depressive and anxiety symptoms on birth outcomes and mode of delivery: a prospective cohort study in east and west coasts of Malaysia. BMC Pregnancy Childbirth 2019; 19:201. [PMID: 31200677 PMCID: PMC6567652 DOI: 10.1186/s12884-019-2349-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antepartum depressive and anxiety symptoms (ADS and AAS) are prevalent in Malaysia. Prior evidence linking maternal ADS and AAS with adverse birth outcomes and caesarean section (CS) or instrumental delivery is conflicting. There is no research in Malaysia on the association between maternal mental disorders and adverse birth outcomes and mode of delivery. This study aims to investigate the independent effect of maternal ADS and AAS on low birth weight (LBW), preterm birth (PTB) and CS or instrumental delivery among women in east and west coasts of Malaysia. METHODS We used data from a prospective cohort study of 799 pregnant women from health clinics of two states in east and west coasts of Malaysia. Baseline data were measured at the third trimester of pregnancy on ADS, AAS, socioeconomic condition, anthropometric status, reproductive history and intimate partner violence. Birth outcomes and mode of delivery were determined at the time of delivery. Univariate and multiple Cox's regressions were applied to assess the association between ADS and AAS and LBW, PTB and CS or instrumental delivery. RESULTS ADS was significantly associated with an increased risk of giving birth to LBW babies in both east coast (RR = 3.64; 95% CI 1.79-7.40) and west coast (RR = 3.82; 95% CI 1.86-7.84), but not with PTB. AAS was associated with increased risk of both LBW (RR = 2.47; 95% CI 1.39-4.38) and PTB (RR = 2.49; 95% CI 1.16-5.36) in the east coast, but not in west coast. The risk of CS or instrumental delivery was evident among women with ADS (RR = 2.44; 95% CI 1.48-4.03) in west coast only. CONCLUSION ADS predicts LBW in both coasts, AAS predicts LBW and PTB in east coast, and ADS predicts CS or instrumental delivery in west coast. Policies aimed at detection and management of ADS and AAS during antenatal check-up in health clinics may help improve birth outcomes and reduce obstetric interventions.
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Affiliation(s)
- Hashima E. Nasreen
- Department of Community Medicine, Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Hafizah Binti Pasi
- Department of Community Medicine, Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Sakinah Md Rifin
- Department of Family Medicine, Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Mohd Aznan Md Aris
- Department of Family Medicine, Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Jamalludin Ab Rahman
- Department of Community Medicine, Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Razman Mohd Rus
- Department of Community Medicine, Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Maigun Edhborg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, SE-141 83 Huddinge, Stockholm, Sweden
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Haight SC, Byatt N, Moore Simas TA, Robbins CL, Ko JY. Recorded Diagnoses of Depression During Delivery Hospitalizations in the United States, 2000-2015. Obstet Gynecol 2019; 133:1216-1223. [PMID: 31135737 PMCID: PMC6842065 DOI: 10.1097/aog.0000000000003291] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe national, state-specific, and sociodemographic trends in diagnoses of depressive disorders recorded during delivery hospitalizations. METHODS Data were analyzed from the National Inpatient Sample (2000-2015) and 31 publicly available State Inpatient Databases (2000-2015) of the Healthcare Cost and Utilization Project. Delivery hospitalizations were identified by using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic and procedure codes for obstetric delivery. Depressive disorders were identified from ICD-9-CM diagnoses codes classified as depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (291.89, 292.84, 293.83, 296.2-296.26, 296.3-296.36, 300.4, and 311). Prevalence rates and average annual rate change were calculated nationally and across 28 states with at least 3 years of data and age, payer source, and race or ethnicity. RESULTS The U.S. rate of depressive disorders recorded during delivery hospitalizations increased from 4.1 diagnoses per 1,000 hospitalizations in 2000 to 28.7 in 2015. Rates significantly increased in 27 of the 28 states. Recent (2014-2015) rates were lowest in Hawaii and Nevada (less than 14/1,000) and highest in Vermont, Minnesota, Oregon, and Wisconsin (greater than 49/1,000). Rates in 2015 were highest among those aged 35 years or older, public insurance recipients, and non-Hispanic white women (greater than 31/1,000). The highest annual rate increases were in Vermont and Maine (3.8/1,000 or greater). Non-Hispanic white women, those 35 years of age or older, and public insurance recipients showed the highest annual rate increases during 2000-2015 (1.7/1,000 or greater). CONCLUSION During 2000-2015, rates of depressive disorders recorded during delivery hospitalizations increased nationally, in 27 states with available data, and across all sociodemographic categories.
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Affiliation(s)
- Sarah C. Haight
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nancy Byatt
- University of Massachusetts Medical School, UMass Memorial Health Care, Worcester, Massachusetts
| | - Tiffany A. Moore Simas
- University of Massachusetts Medical School, UMass Memorial Health Care, Worcester, Massachusetts
| | - Cheryl L. Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean Y. Ko
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service Commissioned Corps, Rockville, Maryland
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Judd F, Lorimer S, Thomson RH, Hay A. Screening for depression with the Edinburgh Postnatal Depression Scale and finding borderline personality disorder. Aust N Z J Psychiatry 2019; 53:424-432. [PMID: 30309241 DOI: 10.1177/0004867418804067] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of the study was to explore the range of psychiatric diagnoses seen in pregnant women who score above the 'cut-off' on the Edinburgh Postnatal Depression Scale when this is used as a routine screening instrument in the antenatal period. METHOD Subjects were all pregnant women referred to and seen by the Perinatal Consultation-Liaison Psychiatry Team of a tertiary public hospital over a 14-month period. Edinburgh Postnatal Depression Scale score at maternity 'booking-in' visit, demographic and clinical data were recorded and diagnoses were made according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria following clinical interview(s) and review of documented past history. Data were analysed using descriptive statistics. RESULTS A total of 200 patients who had completed the Edinburgh Postnatal Depression Scale were seen for assessment; 86 (43%) scored ⩾13 on Edinburgh Postnatal Depression Scale. Of those scoring 13 or more on Edinburgh Postnatal Depression Scale, 22 (25.6%) had a depressive disorder. In total, 12 patients (14%) had an anxiety disorder, 14 (16.3%) had borderline personality disorder and 13 (15.1%) had a substance use disorder. An additional 23 women (26.7%) had two or more borderline personality traits. CONCLUSION Psychiatric assessment of women who scored 13 or more on the Edinburgh Postnatal Depression Scale at routine antenatal screening identified a significant number with borderline personality disorder or borderline personality traits rather than depressive or anxiety disorders. Clinical Practice Guidelines note the importance of further assessment for all women who score 13 or more on the Edinburgh Postnatal Depression Scale. The findings here suggest that this assessment should be made by a clinician able to identify personality pathology and organise appropriate and timely interventions.
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Affiliation(s)
- Fiona Judd
- 1 Tasmanian Health Service, Perinatal and Infant Mental Health Team, Child and Adolescent Mental Health Services-South, Hobart, TAS, Australia.,2 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,3 Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie Lorimer
- 1 Tasmanian Health Service, Perinatal and Infant Mental Health Team, Child and Adolescent Mental Health Services-South, Hobart, TAS, Australia
| | - Richard H Thomson
- 4 Monash Alfred Psychiatry Research Centre and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Angela Hay
- 1 Tasmanian Health Service, Perinatal and Infant Mental Health Team, Child and Adolescent Mental Health Services-South, Hobart, TAS, Australia
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Kott J, Brummelte S. Trick or treat? Evaluating contributing factors and sex-differences for developmental effects of maternal depression and its treatment. Horm Behav 2019; 111:31-45. [PMID: 30658054 DOI: 10.1016/j.yhbeh.2019.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/14/2018] [Accepted: 01/11/2019] [Indexed: 11/29/2022]
Abstract
Maternal depression and treatment with selective serotonin reuptake inhibitors (SSRIs), the most common form of pharmaceutical intervention, can both have an impact on infant development. As such, it is difficult for healthcare providers to recommend a course of treatment to expectant mothers suffering from depression, or to women on antidepressant medication prior to pregnancy. This review will discuss the existing research on the developmental impacts of maternal depression and its treatment with SSRIs, with a particular focus on contributing factors that complicate our attempt to disentangle the consequences of maternal depression and its treatment such as the timing or severity of the depression. We will explore avenues for translational animal models to help address the question of "Trick or Treat", i.e.: which is worse for offspring development: exposure to maternal depression, or the SSRI treatment? Further, we will explore sex-dependent outcomes for the offspring in human and animal studies as male and female offspring may react differently to the presence of maternal depression or antidepressant treatment. Without more clinical and preclinical data, it remains difficult for women to make an informed decision regarding their depression treatment before, during, and after their pregnancy.
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Affiliation(s)
- Jennifer Kott
- Department of Psychology, Wayne State University, Detroit, MI, USA
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East CE, Biro MA, Fredericks S, Lau R. Support during pregnancy for women at increased risk of low birthweight babies. Cochrane Database Syst Rev 2019; 4:CD000198. [PMID: 30933309 PMCID: PMC6443020 DOI: 10.1002/14651858.cd000198.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Studies consistently show a relationship between social disadvantage and low birthweight. Many countries have programmes offering special assistance to women thought to be at risk for giving birth to a low birthweight infant. These programmes, collectively referred to in this review as additional social support, may include emotional support, which gives a person a feeling of being loved and cared for, tangible/instrumental support, in the form of direct assistance/home visits, and informational support, through the provision of advice, guidance and counselling. The programmes may be delivered by multidisciplinary teams of health professionals, specially trained lay workers, or a combination of lay and professional workers. This is an update of a review first published in 2003 and updated in 2010. OBJECTIVES The primary objective was to assess the effects of programmes offering additional social support (emotional, instrumental/tangible and informational) compared with routine care, for pregnant women believed to be at high risk for giving birth to babies that are either preterm (less than 37 weeks' gestation) or weigh less than 2500 g, or both, at birth. Secondary objectives were to determine whether the effectiveness of support was mediated by timing of onset (early versus later in pregnancy) or type of provider (healthcare professional or lay person). SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) on 5 February 2018, and reference lists of retrieved studies. SELECTION CRITERIA Randomised trials of additional social support during at-risk pregnancy by either a professional (social worker, midwife, or nurse) or specially trained lay person, compared to routine care. We defined additional social support as some form of emotional support (e.g. caring, empathy, trust), tangible/instrumental support (e.g. transportation to clinic appointments, home visits complemented with phone calls, help with household responsibilities) or informational support (advice and counselling about nutrition, rest, stress management, use of alcohol/recreational drugs). DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS This updated review includes a total of 25 studies, with outcome data for 11,246 mothers and babies enrolled in 21 studies. We assessed the overall risk of bias of included studies to be low or unclear, mainly because of limited reporting or uncertainty in how randomisation was generated or concealed (which led us to downgrade the quality of most outcomes to moderate), and the impracticability of blinding participants.When compared with routine care, programmes offering additional social support for at-risk pregnant women may slightly reduce the number of babies born with a birthweight less than 2500 g from 127 per 1000 to 120 per 1000 (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.86 to 1.04; 16 studies, n = 11,770; moderate-quality evidence), and the number of babies born with a gestational age less than 37 weeks at birth from 128 per 1000 to 117 per 1000 (RR 0.92, 95% CI 0.84 to 1.01, 14 studies, n = 12,282; moderate-quality evidence), though the confidence intervals for the pooled effect for both of these outcomes just crossed the line of no effect, suggesting any effect is not large. There may be little or no difference between interventions for stillbirth/neonatal death (RR 1.11, 95% CI 0.88 to 1.41; 15 studies, n = 12,091; low-quality evidence). Secondary outcomes of moderate quality suggested that there is probably a reduction in caesarean section (from 215 per 1000 to 194 per 1000; RR 0.90, 95% CI 0.83 to 0.97; 15 studies, n = 9550), a reduction in the number of antenatal hospital admissions per participant (RR 0.78, 95% CI 0.68 to 0.91; 4 studies; n = 787), and a reduction in the mean number of hospitalisation episodes (mean difference -0.05, 95% CI -0.06 to -0.04; 1 study, n = 1525) in the social support group, compared to the controls.Postnatal depression and women's satisfaction were reported in different ways in the studies that considered these outcomes and so we could not include data in a meta-analysis. In one study postnatal depression appeared to be slightly lower in the support group in women who screened positively on the Edinbugh Postnatal Depression Scale at eight to 12 weeks postnatally (RR 0.74, 95% CI 0.55 to 1.01; 1 study, n = 1008; moderate-quality evidence). In another study, again postnatal depression appeared to be slightly lower in the support group and this was a self-report measure assessed at six weeks postnatally (RR 0.85, 95% CI 0.69 to 1.05; 1 study, n = 458; low-quality evidence). A higher proportion of women in one study reported that their prenatal care was very helpful in the supported group (RR 1.17, 95% CI 1.05 to 1.30; 1 study, n = 223; moderate-quality evidence), although in another study results were similar. Another study assessed satisfaction with prenatal care as being "not good" in 51 of 945 in the additional support group, compared with 45 of 942 in the usual care group.No studies considered long-term morbidity for the infant. No single outcome was reported in all studies. Subgroup analysis demonstrated consistency of effect when the support was provided by a healthcare professional or a trained lay worker.The descriptions of the additional social support were generally consistent across all studies and included emotional support, tangible support such as home visits, and informational support. AUTHORS' CONCLUSIONS Pregnant women need the support of caring family members, friends, and health professionals. While programmes that offer additional social support during pregnancy are unlikely to have a large impact on the proportion of low birthweight babies or birth before 37 weeks' gestation and no impact on stillbirth or neonatal death, they may be helpful in reducing the likelihood of caesarean birth and antenatal hospital admission.
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Affiliation(s)
- Christine E East
- Monash UniversityMonash Nursing and MidwiferyWellington RoadClaytonVictoriaAustralia3800
| | | | - Suzanne Fredericks
- Ryerson UniversitySchool of NursingFaculty of Community Services350 Victoria StreetTorontoONCanadaM5B 2K3
| | - Rosalind Lau
- Monash UniversityMonash Nursing and MidwiferyWellington RoadClaytonVictoriaAustralia3800
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Smorti M, Ponti L, Tani F. Maternal depressive symptomatology during pregnancy is a risk factor affecting newborn's health: a longitudinal study. J Reprod Infant Psychol 2019; 37:444-452. [PMID: 30880451 DOI: 10.1080/02646838.2019.1581919] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Depression symptomatology in pregnant women is a condition that represents an important risk factor for the health of both women and children. Objectives: The aim of this study was to investigate the influence of women's depression symptomatology on the clinical aspects of their delivery, both directly and indirectly, through mothers' prenatal attachment to their unborn children. Moreover, we analysed whether these aspects affect the well-being of the newborn, assessed through the Apgar score. Methods: A longitudinal design was carried out on a total of 203 pregnant women. At weeks 31-32 of gestation, women filled out the Beck Depression Inventory and the Prenatal Attachment Inventory. The day of childbirth, hospital healthcare staff registered the clinical data of childbirth. Results: A woman's depressive symptomatology negatively affects prenatal attachment to her unborn child and positively affects the clinical aspects of the delivery, both directly and mediated by the quality of prenatal attachment. Moreover, the Apgar score was negatively influenced by the clinical aspects of the delivery and, indirectly, by the depressive symptomatology. Conclusion: Depressive symptomatology during pregnancy has negative outcomes, affecting the delivery experience of women, the first emotional bond with the child, and the well-being of the newborn.
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Affiliation(s)
- Martina Smorti
- a Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa , Pisa , Italy
| | - Lucia Ponti
- b Department of Health Sciences, University of Florence , Florence , Italy
| | - Franca Tani
- b Department of Health Sciences, University of Florence , Florence , Italy
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Abstract
To counsel women about risks and benefits of depression treatment during pregnancy, clinicians must appreciate the potential consequences of untreated depression on the mother and her unborn child. Many studies have demonstrated associations between untreated depression during pregnancy and a range of adverse outcomes, including low birth weight, preterm delivery, preeclampsia, emergent operative delivery, postpartum depression, and both cognitive and behavioral deficits in the child. Although most of these associations are marked by low odds ratios and a host of potential confounding issues, they collectively provide considerable rationale for identifying depression in pregnancy and offering treatment for mothers at risk.
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Treating Obsessive-Compulsive Disorder in the Postpartum Period: Diagnostic and Cultural Considerations. Harv Rev Psychiatry 2019; 26:82-89. [PMID: 28795979 DOI: 10.1097/hrp.0000000000000146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hicks LM, Swales DA, Garcia SE, Driver C, Davis EP. Does Prenatal Maternal Distress Contribute to Sex Differences in Child Psychopathology? Curr Psychiatry Rep 2019; 21:7. [PMID: 30729361 DOI: 10.1007/s11920-019-0992-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Prenatal maternal psychological distress is an established risk factor for the development of psychopathology in offspring. The purpose of this review is to evaluate whether sex differences in fetal responses to maternal distress contribute to sex differences in subsequent psychopathology. RECENT FINDINGS Male and female fetuses respond differently to stress signals. We review recent evidence that demonstrates a sex-specific pattern of association between prenatal maternal distress and pathways associated with risk for psychopathology including offspring hypothalamic pituitary adrenocortical (HPA) axis regulation, brain development, and negative emotionality. Prenatal maternal distress exerts sex-specific consequences on the fetus. These differences may contribute to the well-established sex differences in psychopathology and in particular to greater female vulnerability to develop internalizing problems.
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Affiliation(s)
- Laurel M Hicks
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA
| | - Danielle A Swales
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA
| | - Sarah E Garcia
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA
| | - Camille Driver
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA. .,Department of Psychiatry and Human Behavior, University of California Irvine, One University Drive, Orange, CA, 92866, USA.
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Hermon N, Wainstock T, Sheiner E, Golan A, Walfisch A. Impact of maternal depression on perinatal outcomes in hospitalized women-a prospective study. Arch Womens Ment Health 2019; 22:85-91. [PMID: 29968130 DOI: 10.1007/s00737-018-0883-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/22/2018] [Indexed: 11/24/2022]
Abstract
Scarce data exists regarding the prevalence of antenatal depression in hospitalized pregnant women, and its effect on perinatal outcome. We aimed to estimate the risk of maternal depression among women hospitalized in a high-risk pregnancy department, and to evaluate its potential association with adverse perinatal outcome. A depression screening self-questionnaire-based prospective study was performed, in which hospitalized pregnant women who screened positive for depression were compared to those who screened negative. The Edinburgh Postnatal Depression Scale (EPDS) was used for antenatal depression screening. Pregnancy course and perinatal outcome were compared between the groups. A multivariate logistic regression model was constructed to control for clinically relevant confounders. During the study period, 279 women met the inclusion criteria. Among them, 28.3% (n = 79) screened positive for depression (≥ 10 points on the EPDS). In the univariate analysis, a significantly higher incidence of preterm delivery (< 37 weeks), low birthweight (< 2500 g), low Apgar scores (at 1 and 5 min), and neonatal intensive care unit (NICU) admissions were noted among the screen positive group. In the multivariate regression model, controlled for maternal age, ethnicity, gestational diabetes mellitus, preeclampsia, past preterm delivery, and gestational age upon admission, maternal antenatal depression during hospitalization was noted as an independent risk factor for preterm delivery (adjusted OR 3.32, 95%CI 1.16-9.52, p = 0.026). Maternal antenatal depression during hospitalization is very common and appears to play a significant and independent role in the prediction of preterm delivery.
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Affiliation(s)
- Narkis Hermon
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Agneta Golan
- Neonatal Intensive Care Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Jacques N, de Mola CL, Joseph G, Mesenburg MA, da Silveira MF. Prenatal and postnatal maternal depression and infant hospitalization and mortality in the first year of life: A systematic review and meta-analysis. J Affect Disord 2019; 243:201-208. [PMID: 30245252 DOI: 10.1016/j.jad.2018.09.055] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/04/2018] [Accepted: 09/15/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Prenatal and postnatal depression have been well studied in recent decades, but few studies address their relationship with hospitalization and mortality in one-year-old children. OBJECTIVE Review the literature about the effects of maternal depression on hospitalization and mortality of the child from birth to one year of age and conduct a meta-analysis. METHODS A systematic search was performed in the PubMed and LILACS databases. We included original studies that evaluated the effect of prenatal and/or postnatal depressive symptoms on child hospitalization or mortality up to one year of age. Meta-analyses were conducted according to the outcome and stratified by prenatal and postnatal depression, using random effects models. RESULTS Six studies were included in this review (170,371). Children of mothers with prenatal and postnatal depressive symptoms or depression had 1.44 (CI95% 1.10 - 1.89) greater risk of hospitalization, and children of mothers with postnatal depressive symptoms or depression had 1.93 (CI95% 1.02-3.64) greater risk of death before one year of age than those whose mothers did not have the disorder. LIMITATIONS Small number of studies (n < 10), different instrument and cut points were used to evaluate maternal depressive symptoms or diagnose depression. CONCLUSION Maternal depressive symptoms or depression have an unfavorable effect on hospitalization and mortality in children up to one year of age. This finding is relevant to public health and should stimulate the systematic screening of prenatal and postnatal depressive symptoms, so that adequate care can be provided for women and their children.
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Affiliation(s)
- Nadège Jacques
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, n° 1160 3° andar, P.O. 96020-220, Pelotas, Rio Grande Do Sul, Brazil.
| | - Christian Loret de Mola
- Faculty of Nursing, Federal University of Pelotas, Rua Gomes Carneiro, 01 2° andar, P.O. 96010-610, Pelotas, Rio Grande Do Sul, Brazil.
| | - Gary Joseph
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160 3° andar, P.O. 96020-220, Pelotas, Rio Grande Do Sul, Brazil.
| | - Marilia Arndt Mesenburg
- Post-graduate Program in Epidemiology, Federal University of Pelotas, International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, n° 1160 3° andar, P.O. 96020-220, Pelotas, Rio Grande Do Sul, Brazil.
| | - Mariangela Freitas da Silveira
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, n° 1160 3° andar, P.O. 96020-220, Pelotas, Rio Grande Do Sul, Brazil.
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Nelson C, Lawford KM, Otterman V, Darling EK. Mental health indicators among pregnant Aboriginal women in Canada: results from the Maternity Experiences Survey. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2018; 38:269-276. [PMID: 30129714 DOI: 10.24095/hpcdp.38.7/8.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION There is little research done on mental health among pregnant Aboriginal women. Therefore, the purpose of the study was to examine the prevalence of postpartum depression (PPD) and its determinants, including pre-existing depression among non-Aboriginal and Aboriginal women in Canada. METHODS The Maternity Experiences Survey (MES) is a national survey of Canadian women's experiences and practices before conception, up to the early months of parenthood. Predictors of PPD were calculated using the Mantel-Haenszel correction method relative to the risk estimates based on the odds ratio from adjusted regression analysis. The analysis was conducted among women who self-identified as Aboriginal (Inuit, Métis or First Nations living off-reserve) and those who identified as non-Aboriginal. RESULTS The prevalence of pre-existing depression was higher among self-reported First Nations off-reserve and Métis women than non-Aboriginal women. Inuit women had the lowest prevalence of self-reported pre-existing depression, and Aboriginal women reported a higher prevalence of PPD than non-Aboriginal women. Pre-existing depression was not a predictor for PPD for Inuit or Métis women in this study but was a positive predictor among First Nations off-reserve and non-Aboriginal women. A disproportionally higher number of Aboriginal women reported experiencing abuse, as compared to non-Aboriginal women. CONCLUSION Our study demonstrated that common predictors of PPD including anxiety, experiencing stressful life events during pregnancy, having low levels of social support, and a previous history of depression were consistent among non-Aboriginal women. However, with the exception of the number of stressful events among First Nations offreserve, these were not associated with PPD among Aboriginal women. This information can be used to further increase awareness of mental health indicators among Aboriginal women.
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Affiliation(s)
- Chantal Nelson
- Public Health Agency of Canada, Ottawa, Ontario, Canada.,Institute of Population Health, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen M Lawford
- Department of Gender Studies, Queen's University, Kingston, Ontario, Canada
| | | | - Elizabeth K Darling
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Vitamin D deficiency and depressive symptoms in the perinatal period. Arch Womens Ment Health 2018; 21:745-755. [PMID: 29845325 DOI: 10.1007/s00737-018-0852-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/09/2018] [Indexed: 01/13/2023]
Abstract
Depression affects 1 in 7 women during the perinatal period. Women with vitamin D deficiency may be at an increased risk for depression. This study investigated the relationship between maternal and cord blood 25-hydroxyvitamin D (25OHD) and maternal depressive symptoms over the perinatal period. Study objectives were to examine variations and relationships between maternal and cord blood vitamin D levels and maternal depressive symptoms over the perinatal period. At a large medical center in southern California, pregnant women (N = 126) were recruited for this longitudinal cohort study. Depressive symptoms (Edinburgh Postnatal Depression Screen, EPDS) and vitamin D status (25OHD) were measured at three time points in the perinatal period: time 1 (T1; N = 125) EPDS and 25OHD were collected in early pregnancy; time 2 (T2; N = 96) EPDS was conducted in the third trimester with blood collected at time of delivery; and time 3 (T3; N = 88) was collected postpartum. A significant inverse relationship between vitamin D status and depressive symptoms was observed between 25OHD and EPDS scores at all time points in this sample (T1 = - 0.18, P = 0.024; T2 = - 0.27, P = 0.009; T3 = - 0.22, P = 0.019). This association remained after controlling for confounders. Low cord blood 25OHD levels were inversely associated with higher EPDS scores in the third trimester (r = - 0.22, P = 0.02). Clinicians may want to consider screening women diagnosed with vitamin D deficiency for depression and vice versa. Vitamin D may represent an important biomarker for pregnant and postpartum women diagnosed with depression. Further studies examining underlying mechanisms and supplementation are needed.
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70
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Ng QX, Venkatanarayanan N, Ho CYX, Sim WS, Lim DY, Yeo WS. Selective Serotonin Reuptake Inhibitors and Persistent Pulmonary Hypertension of the Newborn: An Update Meta-Analysis. J Womens Health (Larchmt) 2018; 28:331-338. [PMID: 30407100 DOI: 10.1089/jwh.2018.7319] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Persistent pulmonary hypertension of the newborn (PPHN) is a serious condition associated with substantial mortality and morbidity. Previous studies have suggested a possible link between maternal selective serotonin reuptake inhibitor (SSRI) use and the risk of PPHN. This study aimed to provide an up-to-date review and meta-analysis of the topic. METHODS Using the search terms [SSRI OR SSRIs OR selective serotonin reuptake inhibitors OR antidepressant OR Prozac OR fluoxetine OR Lexapro OR escitalopram] AND [pregnancy OR maternal OR newborn OR persistent pulmonary hypertension OR PPHN OR neonat* OR fet*], a preliminary search on the PubMed, Medline, EMBASE, Web of Science, and Google Scholar database yielded 7327 articles published in English between January 1, 1960 and October 1, 2017. RESULTS A total of 9 cohort and case-control studies, with a total of 7,540,265 subjects were systematically reviewed. Random-effects meta-analysis of eight studies revealed a significantly increased risk of PPHN with maternal SSRI use during pregnancy, with a pooled OR of 1.516 (95% confidence interval: 1.035-1.997, p < 0.001). Overall, the absolute increase in risk of PPHN with SSRI use appears small, with an absolute risk difference of 0.619 per 1000 livebirths and a number needed to harm of 1615 women. CONCLUSIONS Current evidence suggests that there were significantly greater odds of PPHN with SSRI use during pregnancy. However, the clinical significance of this association remains modest and likely outweighed by the potential benefits of treatment of perinatal depression. The risk of PPHN associated with SSRI therapy might not warrant the recommendation to withdraw antidepressant therapy, as evidence from other studies show that untreated perinatal depression presents additional adverse maternal and fetal outcomes. Given the increasing prevalence of maternal depression and consequent use of antidepressant medications, further research with robust longitudinal or randomized, controlled studies and mechanistic investigations are needed.
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Affiliation(s)
- Qin Xiang Ng
- 1 National University Hospital, National University Health System , Singapore, Singapore .,2 MOH Holdings Pte Ltd. , Singapore, Singapore
| | - Nandini Venkatanarayanan
- 3 Queen's Medical Centre, Nottingham University Hospitals NHS Trust , Nottingham, United Kingdom
| | | | - Wen Shan Sim
- 4 Division of Obstetrics & Gynaecology, KK Women's and Children's Hospital , Singapore, Singapore
| | - Donovan Yutong Lim
- 5 Department of Child and Adolescent Psychiatry, Institute of Mental Health , Singapore, Singapore
| | - Wee-Song Yeo
- 1 National University Hospital, National University Health System , Singapore, Singapore
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71
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Prenatal depression, fetal neurobehavior, and infant temperament: Novel insights on early neurodevelopment from a socioeconomically disadvantaged Indian cohort. Dev Psychopathol 2018; 30:725-742. [PMID: 30068420 DOI: 10.1017/s0954579418000615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article extends the research focusing on the early origins of psychopathology into the prenatal period, by exploring the association between maternal prenatal depression and offspring (fetal and infant) neurobehavior. The sample is recruited from a rural population in South India where women in the third trimester of pregnancy were assessed for depression and the heart rate responses of their fetuses to extrinsically applied vibroacoustic stimuli were studied. At 2 months postbirth, infant temperament and cortisol responsivity to immunization were assessed. The association between maternal prenatal depression and fetal responsivity to vibroacoustic stimulation, and infant responsivity to immunization, was U shaped with higher levels of responsivity noted in the offspring of mothers with very high and very low depression scores, and lower levels noted in the offspring of mothers with moderate depression scores. Maternal prenatal depression was not associated with infant temperament. The findings highlight the importance of environmental influences in the developmental origins of neurobehavior, suggesting that such differences, not evident at baseline, may emerge upon exposure to stressors. The study also emphasizes the need for further investigation in low- and middle-income contexts by providing preliminary evidence of the differing patterns of association observed between high- and low-income populations.
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72
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Snapper LA, Hart KL, Venkatesh KK, Kaimal AJ, Perlis RH. Cohort study of the relationship between individual psychotherapy and pregnancy outcomes. J Affect Disord 2018; 239:253-257. [PMID: 30029152 PMCID: PMC9980714 DOI: 10.1016/j.jad.2018.05.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 04/18/2018] [Accepted: 05/21/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Antenatal depression is associated with poor obstetric outcomes, but it has not been determined if treatment improves these outcomes. We hypothesized that psychotherapy for antenatal depression would decrease rates of low Apgar score, preterm birth, low birthweight, and high maternal weight gain. METHODS Using longitudinal clinical data from the electronic health record (EHR) of a large academic medical center, we examined the association between exposure to psychotherapy during pregnancy among women with a history of major depressive disorder and obstetric outcomes. We compared outcomes between women with and without psychotherapy treatment during pregnancy, and included a dose response analysis. RESULTS Of 50,856 women with pregnancies between 1998 and 2013, 5413 had a lifetime diagnosis of depression (948 had a diagnosis of depression during pregnancy), and 536 received psychotherapy at least once during pregnancy. Women who received one or more psychotherapy sessions during pregnancy had increased odds of preterm delivery and decreased odds of high maternal weight gain (more than 40 pounds). Individuals who received four or more psychotherapy sessions during pregnancy had increased odds of preterm birth and low infant birth weight and decreased odds of high maternal weight gain. LIMITATIONS Patients may have pursued treatment outside of this hospital's EHR data, and we cannot control for the quality of treatment or type of psychotherapy. DISCUSSION Psychotherapy was associated with negative obstetric outcomes. While treatment of depression in pregnant women has been shown to benefit the mother, the absence of benefit in terms of pregnancy outcomes merits further investigation.
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Affiliation(s)
- Leslie A. Snapper
- Center for Experimental Drugs and Diagnostics, Center for Human Genetic Research and Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, Unites States
| | - Kamber L. Hart
- Center for Experimental Drugs and Diagnostics, Center for Human Genetic Research and Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, Unites States
| | - Kartik K. Venkatesh
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Brigham and Women’s Hospital, the Division of Maternal Fetal Medicine, Boston, MA 02114, Unites States
| | - Anjali J. Kaimal
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Brigham and Women’s Hospital, the Division of Maternal Fetal Medicine, Boston, MA 02114, Unites States
| | - Roy H. Perlis
- Center for Experimental Drugs and Diagnostics, Center for Human Genetic Research and Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, Unites States,Corresponding author at: Department of Psychiatry, Harvard Medical School, Simches Research Building 185 Cambridge St, Boston, MA 02114, Unites States. (R.H. Perlis)
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73
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Ongeri L, Wanga V, Otieno P, Mbui J, Juma E, Stoep AV, Mathai M. Demographic, psychosocial and clinical factors associated with postpartum depression in Kenyan women. BMC Psychiatry 2018; 18:318. [PMID: 30285745 PMCID: PMC6167779 DOI: 10.1186/s12888-018-1904-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 09/23/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Few longitudinal studies have examined associations between risk factors during pregnancy and mental health outcomes during the postpartum period. We used a cohort study design to estimate the prevalence, incidence and correlates of significant postpartum depressive symptoms in Kenyan women. METHODS We recruited adult women residing in an urban, resource-poor setting and attending maternal and child health clinics in two public hospitals in Nairobi, Kenya. A translated Kiswahili Edinburgh Postpartum Depression Scale was used to screen for depressive symptoms at baseline assessment in the 3rd trimester and follow up assessment at 6-10 weeks postpartum. Information was collected on potential demographic, psychosocial and clinical risk variables. Potential risk factors for postpartum depression were evaluated using multivariate logistic regression analysis. RESULTS Out of the 171 women who were followed up at 6-10 weeks postpartum, 18.7% (95% CI: 13.3-25.5) were found to have postpartum depression using an EPDS cut off of 10. In multivariate analyses, the odds of having postpartum depression was increased more than seven-fold in the presence of conflict with partner (OR = 7.52, 95% CI: 2.65-23.13). The association between antepartum and postpartum depression was quite strong but did not reach statistical significance (OR = 3.37, 95% CI: 0.98-11.64). CONCLUSIONS The high prevalence of significant postnatal depressive symptoms among Kenyan women underscores the need for addressing this public health burden. Depression screening and psychosocial support interventions that address partner conflict resolution should be offered as part of maternal health care.
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Affiliation(s)
- Linnet Ongeri
- Kenya Medical Research Institute, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
| | - Valentine Wanga
- University of Washington, Jefferson St. Seattle WA 98104, Nairobi, 908 Kenya
| | - Phelgona Otieno
- Kenya Medical Research Institute, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
| | - Jane Mbui
- Kenya Medical Research Institute, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
| | - Elizabeth Juma
- Kenya Medical Research Institute, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
| | - Ann Vander Stoep
- University of Washington, Jefferson St. Seattle WA 98104, Nairobi, 908 Kenya
| | - Muthoni Mathai
- University of Nairobi, P.O. Box 30197, Off Ngong Road, Nairobi, Kenya
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Zhong QY, Gelaye B, VanderWeele TJ, Sanchez SE, Williams MA. Causal Model of the Association of Social Support With Antepartum Depression: A Marginal Structural Modeling Approach. Am J Epidemiol 2018; 187:1871-1879. [PMID: 29617921 DOI: 10.1093/aje/kwy067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/19/2018] [Indexed: 12/16/2022] Open
Abstract
We used marginal structural models to evaluate associations of social support with antepartum depression in late pregnancy, if everyone had had high social support both before pregnancy and during early pregnancy, compared with having low social support at one of the 2 time points or low social support at both time points. In 2012-2014, pregnant Peruvian women (n = 3,336) were recruited into a prospective cohort study (at a mean gestational age of 9 weeks). A follow-up interview (n = 2,279) was conducted (at 26-28 weeks of gestation). Number of available support providers and satisfaction with social support were measured using Sarason Social Support Questionnaire-6. Depression was measured using the Edinburgh Postnatal Depression Scale. Low number of support providers at both time points was associated with increased risk of depression (odds ratio = 1.62, 95% confidence interval: 1.12, 2.34). The association for low satisfaction at both time points was marginally significant (odds ratio = 1.41, 95% confidence interval: 0.99, 1.99). Depression risk was not significantly higher for women who reported high social support at one of the 2 time points. Our study reinforces the importance of assessing social support before and during pregnancy and underscores the need for future interventions targeted at increasing the number of support providers to prevent antepartum depression.
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Affiliation(s)
- Qiu-Yue Zhong
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sixto E Sanchez
- Asociación Civil Proyectos en Salud, Lima, Peru
- Facultad de Medicina, Universidad Peruana de Ciencias Aplicados, Lima, Peru
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Ertekin Pinar S, Duran Aksoy O, Daglar G, Yurtsal ZB, Cesur B. Effect of stress management training on depression, stress and coping strategies in pregnant women: a randomised controlled trial. J Psychosom Obstet Gynaecol 2018; 39:203-210. [PMID: 28472901 DOI: 10.1080/0167482x.2017.1321632] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Pregnancy is a period of important biological and psychosocial changes and a period that carries high risk of experiencing anxiety and stress. It is important to reduce the depression and stress that is experienced in this period or to reduce the severity of the stress and to increase the stress coping power of the pregnant women. The research was conducted to examine the effect of stress management training on pregnant women's depression, stress and methods for coping with stress. METHODS Randomised controlled study of 202 pregnant women (experimental group: 103; control group: 99). The experimental group received stress management training and standard care; the control group received standard care. Data were collected using a Personal Information Form, the Beck Depression Inventory (BDI), Perceived Stress Scale (PSS) and ways of coping inventory (WCI). RESULTS Both groups showed a decrease in average BDI score during the study; the decrease was greater in the experimental group (p < 0.05). In the two assessments carried out after training the experimental group had lower average PSS scores than the control group (p < 0.05). At the second and third assessments the experimental group had higher scores than the control group on the self-confident approach and search for social support approach WCI subscales (ps < 0.05). DISCUSSION The average BDI and PSS scores of pregnant women in the experimental group decreased after training in coping with stress. Their scores on the self-confident approach, optimistic approach and search for social support WCI subscales increased. Stress management training is an effective method of encouraging pregnant women to take a positive approach to coping with stress.
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Affiliation(s)
| | - Ozlem Duran Aksoy
- a Faculty of Health Sciences , Cumhuriyet University , Sivas , Turkey
| | - Gulseren Daglar
- a Faculty of Health Sciences , Cumhuriyet University , Sivas , Turkey
| | - Z Burcu Yurtsal
- a Faculty of Health Sciences , Cumhuriyet University , Sivas , Turkey
| | - Busra Cesur
- a Faculty of Health Sciences , Cumhuriyet University , Sivas , Turkey
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Tuovinen S, Lahti-Pulkkinen M, Girchenko P, Lipsanen J, Lahti J, Heinonen K, Reynolds RM, Hämäläinen E, Kajantie E, Laivuori H, Pesonen AK, Villa PM, Räikkönen K. Maternal depressive symptoms during and after pregnancy and child developmental milestones. Depress Anxiety 2018; 35:732-741. [PMID: 29667739 DOI: 10.1002/da.22756] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/24/2018] [Accepted: 03/08/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Maternal depressive symptoms during and after pregnancy predict poorer child neurodevelopment. The effects of timing, symptom severity, and additive influences remain unclear. METHODS A total of 2,231 mothers of the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) study completed the Center for Epidemiological Studies Depression Scale biweekly up to 14 times during pregnancy and twice up to 12 months after pregnancy. At child's age 1.9-5.7 years, the mothers completed the Beck Depression Inventory-II on their concurrent depressive symptoms and Ages and Stages Questionnaire on child developmental milestones. RESULTS Higher mean maternal depressive symptoms, each biweekly score, and consistently clinically relevant symptomatology during pregnancy predicted lower total developmental milestones, fine and gross motor, communication, problem solving, and personal/social skills scores in children. Although maternal depressive symptoms up to 12 months after pregnancy and in early childhood also predicted lower developmental milestones scores, developmental milestones scores were the lowest in children whose mothers' depressive symptoms were above the clinical cutoff either only during pregnancy, both during and up to 12 months after pregnancy, or at each three time-points. CONCLUSION Maternal depressive symptoms during pregnancy, in the first year postpartum and in early childhood are associated with poorer child neurodevelopment. Our findings further suggest that antenatal and postpregnancy depression have additive effects on neurodevelopment. Children of mothers with the most chronic and severe depressive symptoms during pregnancy had the most neurodevelopmental disadvantages. Our findings emphasize the adverse effects of maternal depression during and after pregnancy and in early childhood on child neurodevelopment.
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Affiliation(s)
- Soile Tuovinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marius Lahti-Pulkkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.,National Institute for Health and Welfare, Helsinki, Finland
| | - Polina Girchenko
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Lipsanen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Helsinki Collegium for Advanced Studies, University of Helsinki, Helsinki, Finland
| | - Kati Heinonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Rebecca M Reynolds
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Esa Hämäläinen
- Department of Clinical Chemistry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eero Kajantie
- National Institute for Health and Welfare, Helsinki, Finland.,Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Hannele Laivuori
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute for Molecular Medicine Finland/HiLIFE, University of Helsinki, Helsinki, Finland
| | - Anu-Katriina Pesonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Pia M Villa
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Ogunyemi D, Jovanovski A, Liu J, Friedman P, Sugiyama N, Creps J, Madan I. The Contribution of Untreated and Treated Anxiety and Depression to Prenatal, Intrapartum, and Neonatal Outcomes. AJP Rep 2018; 8:e146-e157. [PMID: 29998037 PMCID: PMC6039295 DOI: 10.1055/s-0038-1661379] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/23/2018] [Indexed: 12/02/2022] Open
Abstract
Objective To determine independent perinatal associations of anxiety and depression in women who were and were not treated with psychotropic drugs in comparison to unaffected pregnancies. Study Design From 2013 to 2014, 978 (6.3%) cases of anxiety/depression, of which 35% used psychotropic drugs, were compared with 14,514 (93.7%) unaffected pregnancies using logistic regression. Results Subjects were more likely to be Non-Hispanic Whites, use tobacco and illegal substances, be unmarried, use public insurance, and have medical complications of pregnancy. For independent maternal outcomes, untreated anxiety/depression was associated with labor induction (adjusted odds ratio [aOR] = 2.02), cesarean deliveries (aOR = 1.69), longer length of stay (aOR = 1.96), readmission (aOR = 2.40), fever (aOR = 2.03), magnesium exposure (aOR = 1.82), and postpartum hemorrhage (aOR = 2.57), whereas treated cases were associated with increased blood transfusion (aOR = 4.81), severe perineal lacerations (aOR = 2.93), and postpartum hemorrhage (aOR = 3.85), but decreased risk of cesarean deliveries (aOR = 0.59). Independent neonatal outcomes included small for gestational age (aOR = 3.04), meconium-stained fluid (aOR = 1.85; 2.61), respiratory failure (aOR = 5.84), neonatal adaptation syndrome (aOR = 11; 10.2), and neonatal seizures (aOR = 12.3) in treated cases, whereas untreated cases were associated with hypoxia (aOR = 2.83), low Apgar score (aOR = 3.82), and encephalopathy (aOR = 18.3). Exposure to multiple psychotropic medications independently increased the risk of neonatal adaptation syndrome, neonatal length of stay, and hypoglycemia. Conclusion Untreated cases were associated with increased maternal adverse outcomes, whereas treated cases were associated with more adverse neonatal outcomes when compared with unaffected pregnancies.
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Affiliation(s)
- Dotun Ogunyemi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beaumont Hospital, Royal Oak, Michigan.,Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
| | - Andrew Jovanovski
- Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
| | - James Liu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beaumont Hospital, Royal Oak, Michigan.,Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
| | - Perry Friedman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beaumont Hospital, Royal Oak, Michigan.,Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
| | - Nathaniel Sugiyama
- University of Vermont Robert Larner College of Medicine, Burlington, Vermont
| | - James Creps
- Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
| | - Ichchha Madan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beaumont Hospital, Royal Oak, Michigan.,Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
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78
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Szegda K, Bertone-Johnson ER, Pekow P, Powers S, Markenson G, Dole N, Chasan-Taber L. Physical activity and depressive symptoms during pregnancy among Latina women: a prospective cohort study. BMC Pregnancy Childbirth 2018; 18:252. [PMID: 29925325 PMCID: PMC6011358 DOI: 10.1186/s12884-018-1839-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Latina women are at increased risk for antenatal depressive disorders, which are common during pregnancy and are associated with elevated risk for poor maternal health and birth outcomes. Physical activity is a potential mechanism to reduce the likelihood of depressive symptoms. The purpose of the study was to assess whether total and domain-specific physical activity in early pregnancy reduced risk for elevated antenatal depressive symptoms in mid-late pregnancy in a population of Latina women at high-risk for depression. METHODS Data from 820 Latina participants in the prospective cohort study Proyecto Buena Salud was examined using multivariable logistic regression. Total, moderate/vigorous, and domain-specific physical activity (household/caregiving, occupational, sports/exercise, transportation) were assessed using the Pregnancy Physical Activity Questionnaire. The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms and identify women with elevated symptoms indicative of at least probable minor depression and probable major depression. RESULTS A total of 25.9% of participants experienced at least probable minor depression and 19.1% probable major depression in mid-late pregnancy. After adjusting for important risk factors, no significant associations were observed between total physical activity (4th Quartile vs.1st Quartile OR = 1.02, 95% CI = 0.61, 1.71; p-trend = 0.62) or meeting exercise guidelines in pregnancy (OR = 0.96, 95% CI = 0.65, 1.41) and at least probable minor depression; similarly, associations were not observed between these measures and probable major depression. There was a suggestion of increased risk of probable major depression with high levels of household/caregiving activity (4th Quartile vs 1st Quartile OR = 1.51, 95% CI = 0.93, 2.46), but this was attenuated and remained not statistically significant after adjustment. When we repeated the analysis among women who did not have elevated depressive symptoms in early pregnancy (n = 596), findings were unchanged, though a nonsignificant protective effect was observed for sport/exercise activity and probable major depression in fully adjusted analysis (OR = 0.63, 95% CI = 0.30, 1.33). CONCLUSION Among Latina women at high-risk for antenatal depression, early pregnancy physical activity was not associated with elevated depressive symptoms in mid-to-late pregnancy.
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Affiliation(s)
- Kathleen Szegda
- Department of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, 414 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003-9304, USA. .,Baystate Medical Center, Springfield, MA, USA. .,Public Health Institute of Western Massachusetts, Springfield, MA, USA.
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, 414 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003-9304, USA
| | - Penelope Pekow
- Department of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, 414 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003-9304, USA
| | - Sally Powers
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | | | - Nancy Dole
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa Chasan-Taber
- Department of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, 414 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003-9304, USA
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Schürger N, Klein E, Hapfelmeier A, Kiechle M, Paepke D. Demand for integrative medicine among women in pregnancy and childbed: a German survey on patients' needs. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:187. [PMID: 29907100 PMCID: PMC6003184 DOI: 10.1186/s12906-018-2249-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/06/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although integrative medicine is gaining increasing attention and is claiming more and more its place in modern health care, it still plays a marginal role in conventional maternity care. The present study aims to examine the patterns of Complementary and Alternative Medicine (CAM) use and the demand for integrative therapies, including CAM, relaxation therapies, nutritional counseling, and psychological assistance, among women in pregnancy and childbed. METHODS The survey was conducted from April 2017 to July 2017 by means of a pseudo-anonymous 38-item questionnaire at the Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich. Eligible participants were women hospitalized due to pregnancy related complications and women in childbed. Descriptive statistics were generated to determine patterns of CAM use and demand for integrative therapeutic approaches. Univariate analysis was used to detect associations between patients' characteristics and their interest in the different integrative therapies. Furthermore, binary logistic regression was used to estimate the odds ratio of demand for CAM. RESULTS A total of 394 out of 503 patients participated in the survey (78%). 60% declared using CAM in general, 45% specifically in relation to their pregnancy or childbed. Most commonly used modalities were vitamins (31% of all patients), yoga (24%), and herbal supplements (23%). Most popular sources of recommendation of CAM use were midwives and gynecologists. Integrative therapy options patients would have wanted alongside conventional maternity care were CAM (64%), relaxation therapies (44%), dietary counseling (28%), and psychological counseling (15%). Furthermore, associations between patients' sociodemographic characteristics and their demand for integrative therapies were identified. CONCLUSIONS The results of this study demonstrate that there is a considerable demand for integrative medicine and widespread use of CAM among women during pregnancy and childbed in Germany. Maternity health care providers should be aware of these findings in order to be able to better address patients' needs and wishes. Our study findings should be interpreted with regard to patients in an hospital setting.
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80
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Nillni YI, Mehralizade A, Mayer L, Milanovic S. Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review. Clin Psychol Rev 2018; 66:136-148. [PMID: 29935979 DOI: 10.1016/j.cpr.2018.06.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 12/15/2022]
Abstract
Women with psychiatric disorders during pregnancy and the postpartum period (i.e., perinatal period) are at increased risk for adverse maternal and child outcomes. Effective treatment of psychiatric disorders during the perinatal period is imperative. This review summarizes the outcomes of 78 studies focused on the treatment of depression, anxiety, and trauma-related disorders during the perinatal period. The majority of studies focused on perinatal depression (n = 73). Of the five studies focused on anxiety or trauma-related disorders, only one was a randomized controlled trial (RCT). The most studied treatment was cognitive behavioral therapy (CBT; n = 22), followed by interpersonal psychotherapy (IPT; n = 13). Other interventions reviewed include other talk therapies (n = 5), collaborative care models (n = 2), complementary and alternative medicine approaches (n = 18), light therapy (n = 3), brain stimulation (n = 2), and psychopharmacological interventions (n = 13). Eleven studies focused specifically on treatment for low-income and/or minority women. Both CBT and IPT demonstrated a significant benefit over control conditions. However, findings were mixed when these interventions were examined in low-income and/or minority samples. There is some support for complementary and alternative medicine approaches (e.g., exercise). Although scarce, SSRIs demonstrated good efficacy when compared to a placebo. However, SSRIs did not outperform another active treatment condition (e.g., CBT). There is a tremendous need for more studies focused on treatment of perinatal anxiety and trauma-related disorders, as well as psychopharmacological effectiveness studies. Limitations and future directions of perinatal treatment research, particularly among low-income and/or minority populations, are discussed.
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Affiliation(s)
- Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, United States; Department of Psychiatry, Boston University School of Medicine, United States.
| | | | - Laura Mayer
- Department of Psychiatry, Boston University School of Medicine, United States
| | - Snezana Milanovic
- Department of Psychiatry, Boston University School of Medicine, United States
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81
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Ångerud K, Annerbäck EM, Tydén T, Boddeti S, Kristiansson P. Adverse childhood experiences and depressive symptomatology among pregnant women. Acta Obstet Gynecol Scand 2018; 97:701-708. [PMID: 29431859 DOI: 10.1111/aogs.13327] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 02/06/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Adverse childhood experiences (ACE) result in somatic and mental health disturbances. Their influence on antenatal depression is scarcely studied. This study examined the association between experience of ACE and antenatal depressive symptomatology. MATERIAL AND METHODS 1257 women from 172 antenatal clinics in Sweden were surveyed during pregnancy and 1 year after delivery. Demographics, previous medical history and Edinburgh Postpartum Depression Scale (EPDS) were collected in pregnancy and postpartum and ACE 1 year postpartum. ACEs were partitioned into 10 categories. Statistical analyses used linear and logistic regression with EPDS score as main outcome measure. RESULTS 736 (58.6%) women reported at least one ACE category and 88 women (7%) reported five or more ACE categories. An EPDS score of ≥13, which qualifies for a probable depression diagnosis, was reported by 277 (23%) women. In simple regression analyses the EPDS score was positively associated with the number of ACEs, cigarette smoking before pregnancy, body mass index and psychiatric disorders, whereas education level was inversely associated. In a multiple regression analysis, ACEs, education level and psychiatric disorder remained associated to the EPDS score. Among women with an ACE score ≥5, the odds ratio of having an EPDS score indicating probable depression was 4.2 (CI 2.5-7.0). CONCLUSIONS ACE was commonly reported. ACE and depressive symptomatology in late pregnancy were strongly associated in a dose-response manner. Women with several ACEs had high odds of depressive symptomatology in late pregnancy and were more likely to report depressive symptoms both in late pregnancy and postpartum.
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Affiliation(s)
- Katja Ångerud
- General Practice unit, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Eva-Maria Annerbäck
- General Practice unit, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Center for Clinical Research in Sörmland, Eskilstuna, Sweden
| | | | - Santosh Boddeti
- General Practice unit, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Per Kristiansson
- General Practice unit, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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82
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Capron LE, Ramchandani PG, Glover V. Maternal prenatal stress and placental gene expression of NR3C1 and HSD11B2: The effects of maternal ethnicity. Psychoneuroendocrinology 2018; 87:166-172. [PMID: 29100173 DOI: 10.1016/j.psyneuen.2017.10.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Prenatal stress is associated with altered fetal and infant development. Previous studies have suggested that these effects may be mediated in part via altered functioning of placental enzymes and receptors involved in the HPA-axis, including the glucocorticoid receptor (NR3C1) and HSD11B2, the enzyme which metabolises cortisol. However, previous studies have not examined the potential ethnicity effects on these associations. This study aimed to characterise the association between maternal prenatal stress and placental genes expression and subsequently, any potential effect of maternal ethnicity. METHOD Pregnant women(n=83) were recruited prior to elective caesarean section and assessed for trait anxiety, depression and life events. Placentas were collected and placental gene expression of NR3C1 and HSD11B2 were analysed. We examined associations between maternal prenatal stress and placental gene expression, and the tested for a possible moderating effect of maternal ethnicity(59.0% Caucasian;41.0% non-Caucasian:12.0% South Asian;6.0% African/African-American;14.4% Other;8.4% Mixed). RESULTS Analyses demonstrated a trend in the association between both maternal trait anxiety and depression symptoms with placental gene expression of NR3C1(adj.β=0.220,p=0.067;adj.β=0.212,p=0.064 respectively). We found a significant interaction with maternal ethnicity(β=0.249;p=0.033). In Caucasian women only prenatal trait anxiety and depressive symptoms were associated with an increase in placental NR3C1 expression(adj.β=0.389,p=0.010;adj.β=0.294;p=0.047 respectively). Prenatal life events were associated with a down regulation of HSD11B2(adj.β=0.381;p=0.008), but only in Caucasians. CONCLUSION These results support previous findings of an association between maternal prenatal stress and the expression of placental genes associated with the HPA-axis, but only in Caucasians. These ethnic specific findings are novel and require replication in different populations.
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Affiliation(s)
- Lauren E Capron
- Section of Women's Mental Health, King's College London, London, UK.
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83
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Moghaddam Hosseini V, Nazarzadeh M, Jahanfar S. Interventions for reducing fear of childbirth: A systematic review and meta-analysis of clinical trials. Women Birth 2017; 31:254-262. [PMID: 29126794 DOI: 10.1016/j.wombi.2017.10.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/22/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Fear of childbirth is a problematic mental health issue during pregnancy. But, effective interventions to reduce this problem are not well understood. OBJECTIVES To examine effective interventions for reducing fear of childbirth. MATERIAL AND METHODS The Cochrane Central Register of Controlled Trials, PubMed, Embase and PsycINFO were searched since inception till September 2017 without any restriction. Randomised controlled trials and quasi-randomised controlled trials comparing interventions for treatment of fear of childbirth were included. The standardized mean differences were pooled using random and fixed effect models. The heterogeneity was determined using the Cochran's test and I2 index and was further explored in meta-regression model and subgroup analyses. RESULTS Ten studies inclusive of 3984 participants were included in the meta-analysis (2 quasi-randomized and 8 randomized clinical trials). Eight studies investigated education and two studies investigated hypnosis-based intervention. The pooled standardized mean differences of fear for the education intervention and hypnosis group in comparison with control group were -0.46 (95% CI -0.73 to -0.19) and -0.22 (95% CI -0.34 to -0.10), respectively. CONCLUSIONS Both types of interventions were effective in reducing fear of childbirth; however our pooled results revealed that educational interventions may reduce fear with double the effect of hypnosis. Further large scale randomized clinical trials and individual patient data meta-analysis are warranted for assessing the association.
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Affiliation(s)
| | - Milad Nazarzadeh
- The Collaboration Center of Meta-Analysis Research, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| | - Shayesteh Jahanfar
- School of Health Sciences, Health Professions Building, Central Michigan University, Mount Pleasant, MI 48859, USA.
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84
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Obstetric outcomes in pregnant women with and without depression: population-based comparison. Sci Rep 2017; 7:13937. [PMID: 29066809 PMCID: PMC5655038 DOI: 10.1038/s41598-017-14266-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/06/2017] [Indexed: 12/31/2022] Open
Abstract
This study used insurance claims data to evaluate obstetric outcomes in pregnant women with and without depression because population study for Asian women on the issue is limited. We identified 5,064 women with depression at pregnancy in 2005–2013, and 20,024 pregnant women without depression, frequency matched by age, pregnant year and parity. Obstetric events during pregnancy and deliveries were evaluated. The depression group had more events than comparisons for hyperemesis (39.3 vs. 35.5%), abortion (3.3 vs. 2.6%), malpresentation (12.3 vs. 10.3%), C-section (40.2 vs. 34.6%) and intrauterine fetal demise (0.7 vs. 0.4%); risks of these events were significant for childbearing depressed women, not for the 35+ years subgroup. These incidences were higher in depressed women taking antidepressant than those without the medication, but were significant in childbearing depressed subgroup for hyperemesis and C-section with odds ratios of 1.18 (95% confidence intervals (CI), 1.02–1.36) and 1.29 (95% CI, 1.11–1.49), respectively. Incident preterm and low birth weight births were also higher in the depression group than in comparisons, but weren’t significant. In conclusion, women with depression during pregnancy may develop more adverse events than comparisons and are more likely to have a C-section delivery.
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85
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Beevi Z, Low WY, Hassan J. The Effectiveness of Hypnosis Intervention for Labor: An Experimental Study. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2017; 60:172-191. [PMID: 28891771 DOI: 10.1080/00029157.2017.1280659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hypnosis has been shown to help pregnant women experience improved labor and postpartum periods. The present study compares the differences between experimental (n = 23) and control groups (n = 22) on specific variables measured both during labor and 24 hr postpartum. The participants in the experimental group received the hypnosis intervention at weeks 16, 20, 28, and 36 of pregnancy, while those in the control group received only routine antenatal care. The data collected at the labor stage describe the length of the labor stage, pain relief used during labor, the method of delivery, and the type of assisted vaginal delivery. Within 24 hr of delivery, data on neonatal birth weight, neonatal Apgar scores, and self-reported pain were obtained. The labor stage results showed no significant differences in the length of the second and third stages of labor. Although the participants in the experimental group reported higher pain levels immediately prior to, during, and immediately after delivery, their use of pethidine during labor was significantly lower than the control group participants. None of the experimental group participants opted for an epidural, and they had a greater number of assisted vaginal deliveries than the control group participants. The 24 hr postpartum results showed that the neonates of the experimental group participants had nonsignificantly higher Apgar scores than those of the women in the control group. Group differences in neonatal weight were not significant. The results of the present study indicate that hypnosis is useful for assisting pregnant women during labor and the postpartum period.
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Affiliation(s)
- Zuhrah Beevi
- Heriot-Watt University Malaysia, Putrajaya, Malaysia
| | - Wah Yun Low
- University of Malaya, Kuala Lumpur, Malaysia
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86
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Liu Y, Zhuo L, Zhu B, He MY, Xu Y, Wang TT, Hu B, Xu JC. [Association between depression during pregnancy and low birth weight in neonates: a Meta analysis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:994-998. [PMID: 28899470 PMCID: PMC7403062 DOI: 10.7499/j.issn.1008-8830.2017.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To study the association between depression during pregnancy and low birth weight in neonates, and to provide a scientific basis for the prevention of low birth weight. METHODS Cohort studies on the association between depression during pregnancy and low birth weight were collected and a Meta analysis was performed. Data were extracted independently by two investigators, and quality assessment was performed according to Newcastle-Ottawa Scale. The Egger's test was used to evaluate publication bias. RESULTS A total of 12 cohort studies with 37 192 samples were included. The results of the Meta analysis showed that depression during pregnancy was associated with low birth weight (Z=2.08, P=0.038), and the neonates whose mothers had depression during pregnancy tended to have a high risk of low birth weight (RR=1.303, 95%CI: 1.015-1.672). The sensitivity analysis showed that the results of this Meta analysis were stable and reliable, and the Egger's test showed no publication bias. CONCLUSIONS Depression during pregnancy may be a risk factor for low birth weight in neonates.
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Affiliation(s)
- Yi Liu
- School of Public Health of Xuzhou Medical University, Xuzhou, Jiangsu 221004, China.
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87
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Ferraro AA, Rohde LA, Polanczyk GV, Argeu A, Miguel EC, Grisi SJFE, Fleitlich-Bilyk B. The specific and combined role of domestic violence and mental health disorders during pregnancy on new-born health. BMC Pregnancy Childbirth 2017; 17:257. [PMID: 28764678 PMCID: PMC5540537 DOI: 10.1186/s12884-017-1438-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/24/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Addressing impaired foetal growth is recognized as a public health priority. Certain risk factors for this condition, such as poor nutritional status at birth, have been found to be highly correlated with poverty. However, the role of psychosocial factors, specifically the mother's mental health and exposure to violence during pregnancy, have yet to be further explored. Our objective was to determine if there is a measurable association between combined psychosocial factors, specifically domestic violence and mental disorders, and birth outcomes, specifically birth nutritional status and preterm delivery. METHODS We followed 775 women from an underserved, urban area, beginning their 28th week of gestation. Diagnostic interviews were performed to determine if any of the mothers had any of the following disorders: mood disorder, anxiety, obsessive-compulsive disorder (OCD), substance dependence, psychotic disorder, or anti-social personality disorder. Physical, psychological, and sexual domestic violence were also assessed. RESULTS Domestic violence and mental disorders were highly correlated in our sample. About 27.15% of the women in our study experienced domestic violence, and about 38.24% of them were diagnosed with mental disorders. The main association we found between combined psychosocial factors and neonate outcomes was between anxiety (IRR = 1.83; 95%CI = 1.06-3.17)/physical violence (IRR = 1.95; 95%CI = 1.11-3.42) and the rate of small-for-gestational age (SGA) in new-borns. More specifically, the combination of anxiety (beta = -0.48; 95%CI = -0.85/-0.10) and sexual violence (beta = -1.58; 95%CI = -2.61/-0.54) was also associated with birth length. Maternal risk behaviours such as smoking, drinking, inadequate prenatal care, and inadequate weight gain could not sufficiently explain these associations, suggesting that these psychosocial factors may be influencing underlying biological mechanisms. CONCLUSION Domestic violence against women and mental disorders amongst pregnant women are extremely prevalent in under-resourced, urban areas and ultimately, have detrimental effects on birth outcomes. It is imperative that actions be taken to prevent violence and improve mental health during pregnancy.
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Affiliation(s)
- Alexandre Archanjo Ferraro
- Department of Pediatrics, School of Medicine, Universidade de Sao Paulo, Av Dr Eneas Carvalho Aguiar, 647, Sao Paulo, 05403-900, Brazil.
| | - Luis Augusto Rohde
- Department of Psychiatry, School of Medicine, Universidade de Sao Paulo, Sao Paulo, Brazil.,Department of Psychiatry and Legal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Adriana Argeu
- Department of Psychiatry, School of Medicine, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Bacy Fleitlich-Bilyk
- Department of Psychiatry, School of Medicine, Universidade de Sao Paulo, Sao Paulo, Brazil
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88
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Heller HM, Ravelli ACJ, Bruning AHL, de Groot CJM, Scheele F, van Pampus MG, Honig A. Increased postpartum haemorrhage, the possible relation with serotonergic and other psychopharmacological drugs: a matched cohort study. BMC Pregnancy Childbirth 2017; 17:166. [PMID: 28577352 PMCID: PMC5457563 DOI: 10.1186/s12884-017-1334-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/18/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Postpartum haemorrhage is a major obstetric risk worldwide. Therefore risk factors need to be investigated to control for this serious complication. A recent systematic review and meta-analysis revealed that the use of both serotonergic and non-serotonergic antidepressants in pregnancy are associated with a higher risk of postpartum haemorrhage. However, use of antidepressants in pregnancy is often necessary because untreated depression in pregnancy is associated with adverse maternal and neonatal outcome, such as postpartum depression, preterm birth and dysmaturity. Therefore it is of utmost importance to unravel the possible association between postpartum haemorrhage and the use of serotonergic and other psychopharmacological medication during pregnancy. METHODS We performed a matched cohort observational study consecutively including all pregnant women using serotonergic medication (n = 578) or other psychopharmacological medication (n = 50) visiting two teaching hospitals in Amsterdam between 2010 and 2014. The incidence of postpartum haemorrhage in women using serotonergic medication or other psychopharmacological medication was compared with the incidence of postpartum haemorrhage in 641,364 pregnant women not using psychiatric medication selected from the database of the Netherlands Perinatal Registry foundation (Perined). Matching took place 1:5 for nine factors, i.e., parity, maternal age, ethnicity, socioeconomic status, macrosomia, gestational duration, history of postpartum haemorrhage, labour induction and hypertensive disorder. RESULTS Postpartum haemorrhage occurred in 9.7% of the women using serotonergic medication. In the matched controls this was 6.6% (p = 0.01). The adjusted odds ratio (aOR) before matching was 1.6 (95% CI 1.2-2.1) and after matching 1.5 (95% CI 1.1-2.1). Among the women using other psychopharmacological medication, the incidence of postpartum haemorrhage before matching was 12.0% versus 6.1% (p = 0.08) with OR 2.1 (95% CI 0.9-4.9), and after matching 12.1% versus 4.4% (p = 0.03) with aOR of 3.3 (95% CI 1.1-9.8). CONCLUSIONS Pregnant women using serotonergic medication have an increased risk of postpartum haemorrhage, but this high risk is also seen in pregnant women using other psychopharmacological medication. We suggest that this higher risk of postpartum haemorrhage could not only be explained by serotonin, but also by other mechanisms. An additional explanation could be the underlying psychiatric disorder.
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Affiliation(s)
- Hanna M Heller
- Department of Hospital Psychiatry, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Anita C J Ravelli
- Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Andrea H L Bruning
- Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Fedde Scheele
- Department of Obstetrics and Gynaecology, OLVG Hospital (West), Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Maria G van Pampus
- Department of Obstetrics and Gynaecology, OLVG Hospital (East), Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Hospital Psychiatry, OLVG Hospital (West), Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
- Department of Hospital Psychiatry, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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89
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Tuthill EL, Pellowski JA, Young SL, Butler LM. Perinatal Depression Among HIV-Infected Women in KwaZulu-Natal South Africa: Prenatal Depression Predicts Lower Rates of Exclusive Breastfeeding. AIDS Behav 2017; 21:1691-1698. [PMID: 27752868 DOI: 10.1007/s10461-016-1557-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Exclusive breastfeeding (EBF) provides infants with optimal nutrition, and together with appropriate antiretroviral therapy has also been shown to decrease mother-to-child transmission of HIV from 45 to less than 1 %. However, rates of EBF are particularly low in South Africa, where rates of HIV are some of the highest in the world. Although perinatal depression has been identified as a potential barrier to EBF, little is known about its impact on EBF among HIV-infected women. A cohort study was conducted as part of a pilot randomized controlled trial (RCT) examining the effect of an Information, Motivation and Behavioral skills-based intervention promoting EBF among South African women living with HIV in their third trimester (28-42 weeks) of pregnancy. At baseline and follow-up, participants were interviewed on depression symptoms (PHQ-9), and breastfeeding intentions and behavior. Multivariate logistic regressions were conducted to determine predictors of EBF at 6-weeks postpartum. A total of 68 women were enrolled and 58 women completed both baseline and follow-up assessments. Most (80.9 %) of the sample reported at least some symptoms of depression prenatally. Rates of depression were lower postpartum (47.1 %). In multivariate models, higher prenatal depression scores significantly predicted lower likelihood of EBF at 6-weeks postpartum after adjusting for demographics, condition, and intentions (AOR = 0.68, p < 0.05). Postpartum depression was not a significant predictor of EBF rates (AOR = 0.99, p = 0.96). These findings demonstrate the negative impact of prenatal depression on breastfeeding behavior. Future interventions focused on depression are warranted to identify those at risk for sub-optimal EBF. Improving maternal psychosocial well-being could be a new frontier to improving infant and young child feeding and reducing pre/postnatal transmission.
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Affiliation(s)
- Emily L Tuthill
- UCSF School of Nursing, University of California San Francisco, 2 Koret Way, Box 0608, San Francisco, CA, 94143-0608, USA.
| | - Jennifer A Pellowski
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sera L Young
- Department of Anthropology, Institute for Policy Research Northwestern University, Evanston, IL, USA
| | - Lisa M Butler
- Department of Pediatrics, Harvard Medical School, Boston, USA
- Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, USA
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90
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McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, Green L, Gregoire A, Howard LM, Jones I, Khalifeh H, Lingford-Hughes A, McDonald E, Micali N, Pariante CM, Peters L, Roberts A, Smith NC, Taylor D, Wieck A, Yates LM, Young AH. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol 2017; 31:519-552. [PMID: 28440103 DOI: 10.1177/0269881117699361] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, owing to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk. These consensus guidelines aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.
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Affiliation(s)
- R Hamish McAllister-Williams
- 1 Institute of Neuroscience, Newcastle University, Newcastle, UK.,2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David S Baldwin
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,4 University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Abby Easter
- 6 Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eilish Gilvarry
- 2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,7 Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Vivette Glover
- 8 Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Lucian Green
- 9 Ealing, Hounslow, Hammersmith & Fulham Perinatal Mental Health Service, West London Mental Health Trust, London, UK
| | - Alain Gregoire
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,10 Hampshire Perinatal Mental Health Service, Winchester, UK
| | - Louise M Howard
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | - Ian Jones
- 13 National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Hind Khalifeh
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Elizabeth McDonald
- 15 Royal College of Psychiatrists, London, UK.,16 East London Foundation Trust, London, UK.,17 Tavistock and Portman NHS Foundation Trust, London, UK
| | - Nadia Micali
- 18 Behavioural and Brain Sciences Unit, GOSH Institute of Child Health, University College London, London, UK
| | - Carmine M Pariante
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Ann Roberts
- 20 St Martin's Healthcare Services CIC, Leeds, UK.,21 Hertfordshire Partnership University NHS Foundation Trust, Hatfield, Hertfordshire, UK.,22 Postgraduate School of Medicine, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Natalie C Smith
- 23 Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, County Durham, UK
| | - David Taylor
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,24 Institute of Pharmaceutical Science, King's College London, London, UK
| | - Angelika Wieck
- 25 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,26 University of Manchester, Manchester, UK
| | - Laura M Yates
- 27 UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,28 Institute of Genetic Medicine, Newcastle University, Newcastle, UK
| | - Allan H Young
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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91
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Yang S, Yang R, Liang S, Wang J, Weaver NL, Hu K, Hu R, Trevathan E, Huang Z, Zhang Y, Yin T, Chang JJ, Zhao J, Shen L, Dong G, Zheng T, Xu S, Qian Z, Zhang B. Symptoms of anxiety and depression during pregnancy and their association with low birth weight in Chinese women: a nested case control study. Arch Womens Ment Health 2017; 20:283-290. [PMID: 28013409 DOI: 10.1007/s00737-016-0697-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Abstract
This study is a nested case control study from a population-based cohort study conducted in Wuhan, China. The aim is to estimate the association between symptoms of depression during pregnancy (DDP), anxiety during pregnancy(ADP), and depression with anxiety during pregnancy (DADP) and low birth weight (LBW) and to examine the extent to which preterm birth (PTB) moderates these associations. Logistic regression analyses were used to model associations between DDP, ADP, and DADP and LBW. Models were stratified by the presence or absence of PTB to examine moderating effects. From the cohort study, 2853 had a LBW baby (cases); 5457 pregnant women served as controls. Women with DDP or ADP only were not at higher risk of having a LBW baby, but DADP was associated with increased risk of LBW (crude OR 1.41, 95% CI 1.17-1.70; adjusted OR 1.29, 95% CI 1.07-1.57), and the significant association was particularly evident between DADP and LBW in PTB, but not in full-term births. Our data suggests that DADP is related to an increased risk of LBW and that this association is most present in PTBs.
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Affiliation(s)
- Shaoping Yang
- Wuhan Medical and Health Center for Women and Children, 100 Hongkong Road, Wuhan, Hubei, 430015, China
| | - Rong Yang
- Wuhan Medical and Health Center for Women and Children, 100 Hongkong Road, Wuhan, Hubei, 430015, China
| | - Shengwen Liang
- Wuhan Environmental Monitoring Center, 422 Xinhua Road, Wuhan, Hubei, China, 430015
| | - Jing Wang
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Nancy L Weaver
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Ke Hu
- Wuhan Environmental Monitoring Center, 422 Xinhua Road, Wuhan, Hubei, China, 430015
| | - Ronghua Hu
- Wuhan Medical and Health Center for Women and Children, 100 Hongkong Road, Wuhan, Hubei, 430015, China
| | - Edwin Trevathan
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Zhen Huang
- Wuhan Environmental Monitoring Center, 422 Xinhua Road, Wuhan, Hubei, China, 430015
| | - Yiming Zhang
- Wuhan Medical and Health Center for Women and Children, 100 Hongkong Road, Wuhan, Hubei, 430015, China
| | - Ting Yin
- Wuhan Environmental Monitoring Center, 422 Xinhua Road, Wuhan, Hubei, China, 430015
| | - Jen Jen Chang
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Jinzhu Zhao
- Wuhan Medical and Health Center for Women and Children, 100 Hongkong Road, Wuhan, Hubei, 430015, China
| | - Longjiao Shen
- Wuhan Environmental Monitoring Center, 422 Xinhua Road, Wuhan, Hubei, China, 430015
| | - Guanghui Dong
- School of Public Health, Sun Yat-Sen University, 135 Xingang Xi Road, Guangzhou, 510080, China
| | - Tongzhang Zheng
- School of Public Health, Brown University, Providence, RI, 02912, USA
| | - Shunqing Xu
- Tongji Medical College, Huazhong University of Science and Technology, 13 Hang Kong Road, Wuhan, Hubei, 430030, China
| | - Zhengmin Qian
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA.
| | - Bin Zhang
- Wuhan Medical and Health Center for Women and Children, 100 Hongkong Road, Wuhan, Hubei, 430015, China.
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92
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Vismara L. Perspectives on perinatal stressful and traumatic experiences. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2017. [DOI: 10.1016/j.ejtd.2017.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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93
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Interventions to treat mental disorders during pregnancy: A systematic review and multiple treatment meta-analysis. PLoS One 2017; 12:e0173397. [PMID: 28358808 PMCID: PMC5373816 DOI: 10.1371/journal.pone.0173397] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND For women suffering from an antepartum mental disorder (AMD), there is lack of evidence-based treatment algorithms due to the complicated risk-benefit analysis for both mother and unborn child. We aimed to provide a comprehensive overview of pharmacological and non-pharmacological interventions to treat AMD and performed a meta-analysis of the estimated treatment effect on the psychiatric symptoms during pregnancy. METHODS MedLine, PsycINFO and Embase databases were searched by two independent reviewers for clinical trials with a control condition on treatment of women with AMD, i.e. major depressive (MDD), anxiety, psychotic, eating, somatoform and personality disorders. We inventoried the effect of the treatment, i.e. decrease of psychiatric symptoms at the end of the treatment or postpartum. We adhered to the PRISMA-protocol. FINDINGS Twenty-nine trials were found involving 2779 patients. Trials studied patients with depressive disorders (k = 28), and anxiety disorders (k = 1). No pharmacological trials were detected. A form of psychotherapy, like Cognitive Behavioural Therapy (g = -0.61; 95%CI:-0.73 to -0.49, I2 = 0%; k = 7) or Interpersonal Psychotherapy (g = -0.67; 95%CI:-1.27 to -0.07; I2 = 79%; k = 4), holds robust benefit for pregnant women with MDD. Body-oriented interventions (g = -0.43; 95%CI:-0.61 to -0.25; I2 = 17%; k = 7) and acupuncture (g = -0.43; 95%CI:-0.80 to -0.06; I2 = 0%; k = 2) showed medium sized reduction of depressive symptoms. Bright light therapy (g = -0.59; 95%CI:-1.25 to 0.06; I2 = 0%; k = 2), and food supplements (g = -0.51; 95%CI:-1.02 to 0.01; I2 = 20%; k = 3) did not show significant treatment effects. One study was found on Integrative Collaborative Care. CONCLUSIONS This meta-analysis found a robust moderate treatment effect of CBT for MDD during pregnancy, and to a lesser extent for IPT. As an alternative, positive results were found for body-oriented interventions and acupuncture. No evidence was found for bright light therapy and food supplements. Only non-pharmacological trials on women with MDD were found. Research on a wider range of AMD is needed.
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94
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Roomruangwong C, Epperson CN. Perinatal depression in Asian women: prevalence, associated factors, and cultural aspects. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0502.024] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background and Objective: Although perinatal depression is a worldwide problem, most of the studies related to this issue have been conducted in Western countries. This paper summarizes the literature on the prevalence as well as associated factors among Asian countries where the cultural attitudes, customs, and norms are considerably different from those in Western countries.
Methods: We conducted a literature search using MEDLINE (PubMed) from 1968, PsychINFO from 1970, and SCOPUS database from 1982 using keywords “depression”, “antenatal”, “antepartum”, “pregnancy”, “postnatal”, “postpartum”, “perinatal”, “after childbirth” and “Asia”. Only the articles published in English were included.
Results: The overall prevalence of depression during pregnancy and postnatal period are about 20% and 21.8%, respectively. The factors related to perinatal depression can be grouped into the following categories, individual characteristics, husband/marital relationship, pregnancy-related, infant-related, and other psychosocial issues. While there is considerable overlap between Asian and Western countries with respect to risk factors for perinatal depression, premarital pregnancy, conflict with mother in-law, and dissatisfaction with infant’s gender are more specific to Asian cultures.
Conclusions: Studies conducted in Asian countries suggest that the prevalence of perinatal depression is slightly higher than in Western countries. There are several unique culturally related issues that clinicians treating pregnant and postpartum Asian women should be aware as they contribute to an increased risk of depression in these women.
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Affiliation(s)
- Chutima Roomruangwong
- MD, Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - C. Neill Epperson
- Department of Psychiatry and Obstetrics/ Gynecology, University of Pennsylvania School of Medicine United States of America
- The Penn Center for Women’s Behavioral Wellness, Pennsylvania 19107, United States of America
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95
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Mirghafourvand M, Sehhati Shafaie F, Mohammad-Alizadeh-Charandabi S, Jabbari B. Effect of Vocalization of the Holy Quran With and Without Translation on Pregnancy Outcomes: A Randomized Clinical Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017; 18:e35421. [PMID: 28144462 PMCID: PMC5253461 DOI: 10.5812/ircmj.35421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 04/02/2016] [Accepted: 04/17/2016] [Indexed: 11/23/2022]
Abstract
Background During recent decades, research in Iran in the area of the Quran and medical science has been seriously engaged in. With respect to the tendency toward spirituality and alternative medicine, we tried to find other aspects of the influence of the Quran. Objectives This study aimed to determine the effect of vocalizations of the Holy Quran with and without translation on the consequences of pregnancy (the prevalence of preterm delivery, caesarean delivery, and neonatal anthropometric indices) in women admitted to health care centers in Urmia, Iran. Materials and Methods This was a three-armed parallel-group randomized clinical trial in which 168 pregnant women (25-28 weeks) in their first and second pregnancies were divided into three groups of 56 (Holy Quran with translation, Holy Quran without translation, and control group) by randomized blocking. The intervention was implemented once a week for three weeks in the health center, and on other days of the week, the participants listened at home to a CD they were given. The intervention and the control groups all received routine pregnancy care once a week. These mothers were tracked during their labor. Outcomes including gestational age at delivery, delivery type, and neonatal anthropometric indices were recorded based on the mother’s records. Results There was no statistically significant difference between the groups in terms of demographic and obstetric characteristics before the intervention. In comparison with the control group, the probability of preterm delivery was lower in the Holy Quran with translation group (odds ratio: 0.3, CI 95%: 0.1-1.2) and in the Holy Quran without translation group (0.6, 0.2-1.9) as compared to the control group. However, this difference was not statistically significant. Similarly, the probability of caesarean delivery was lower in the Holy Quran with translation group (0.6, 0.3-1.4) and the Holy Quran without translation group (0.5, 0.2-1.2) as compared to the control group. Based on one-way ANOVA, there was no statistically significant difference between the study groups regarding the infants’ anthropometric indices. Conclusions Based on the results of this study, despite the lower prevalence of preterm labor and caesarean section in the intervention groups as compared to the control group, no statistically significant effect was seen. This was apparently due to the small sample size.
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Affiliation(s)
| | | | - Sakineh Mohammad-Alizadeh-Charandabi
- Social Determinants of Health Research Center, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Batoul Jabbari
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding Author: Batoul Jabbari, MSc of Midwifery, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-9143478379, E-mail:
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96
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Choi KW, Sikkema KJ. Childhood Maltreatment and Perinatal Mood and Anxiety Disorders: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2016; 17:427-453. [PMID: 25985988 DOI: 10.1177/1524838015584369] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Perinatal mood and anxiety disorders (PMADs) compromise maternal and child well-being and may be influenced by traumatic experiences across the life course. A potent and common form of trauma is childhood maltreatment, but its specific impact on PMADs is not well understood. A systematic review was undertaken to synthesize empirical literature on the relationship between maternal histories of childhood maltreatment and PMADs. Of the 876 citations retrieved, 35 reports from a total of 26,239 participants met inclusion criteria, documenting substantial rates of childhood maltreatment and PMADs. Robust trends of association were observed between childhood maltreatment and perinatal depression, as well as post-traumatic stress disorder, but findings for anxiety were less consistent. Examining multivariate results suggested that childhood maltreatment predicts PMADs above and beyond sociodemographic, psychiatric, perinatal, and psychosocial factors, but may also be partially mediated by variables such as later victimization and moderated by protective early relationships. Future research should test mediating and moderating pathways using prospective cohorts, expanding to cross-cultural settings and other disorder outcomes. Treatment and prevention of childhood maltreatment and its sequelae may help mitigate risk for perinatal psychopathology and its impact on maternal and child outcomes.
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Affiliation(s)
- Karmel W Choi
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kathleen J Sikkema
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
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Abstract
Objective: To evaluate the literature assessing the neonatal risks of antepartum paroxetine use. Data Sources: MEDLINE (1966–August 2006) and International Pharmaceutical Abstracts (1970–August 2006) searches were performed. Key search terms included paroxetine, SSRI, pregnancy, malformations, neonate, and fetus. Data Synthesis: Selective serotonin-reuptake inhibitors (SSRIs) are associated with neonatal withdrawal symptoms such as respiratory distress, irritability, lethargy, and tremors. In a cohort study, 30% of infants exposed to SSRIs had poor neonatal adaptation, compared with 9% of controls (p = 0.018). Some reports indicate that paroxetine is more commonly associated with neonatal withdrawal than other SSRIs. Recently, paroxetine was associated with a 1.82-fold (95% CI 1.17 to 2.82) increased risk of congenital malformations compared with other antidepressants. Other SSRIs were also associated with an increased risk of congenital malformations; however, the results were not statistically significant. Literature supporting these findings includes case reports and case–control or cohort studies. The Food and Drug Administration recommendations regarding paroxetine use during pregnancy have been added to the labeling information. Conclusions: Paroxetine may cause adverse outcomes in the neonate when used during pregnancy and should be discontinued in women who are pregnant or trying to become pregnant. The risks and benefits of other antidepressant use should be analyzed on an individual basis.
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Affiliation(s)
- Genine M Thormahlen
- Department of Pharmacy Practice, The University of Montana Drug Information Service, 32 Campus Dr., #1522, Missoula, MT 59812-1522, USA.
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98
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Underwood L, Waldie KE, D’Souza S, Peterson ER, Morton SMB. A Longitudinal Study of Pre-pregnancy and Pregnancy Risk Factors Associated with Antenatal and Postnatal Symptoms of Depression: Evidence from Growing Up in New Zealand. Matern Child Health J 2016; 21:915-931. [DOI: 10.1007/s10995-016-2191-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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99
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Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry 2016; 3:973-982. [PMID: 27650773 PMCID: PMC5155709 DOI: 10.1016/s2215-0366(16)30284-x] [Citation(s) in RCA: 596] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 12/11/2022]
Abstract
Maternal depression, a non-psychotic depressive episode of mild to major severity, is one of the major contributors of pregnancy-related morbidity and mortality. Maternal depression (antepartum or post partum) has been linked to negative health-related behaviours and adverse outcomes, including psychological and developmental disturbances in infants, children, and adolescents. Despite its enormous burden, maternal depression in low-income and middle-income countries remains under-recognised and undertreated. In this Series paper, we systematically review studies that focus on the epidemiology of perinatal depression (ie, during antepartum and post-partum periods) among women residing in low-income and middle-income countries. We also summarise evidence for the association of perinatal depression with infant and childhood outcomes. This review is intended to summarise findings from the existing literature, identify important knowledge gaps, and set the research agenda for creating new generalisable knowledge pertinent to increasing our understanding of the prevalence, determinants, and infant and childhood health outcomes associated with perinatal depression. This review is also intended to set the stage for subsequent work aimed at reinforcing and accelerating investments toward providing services to manage maternal depression in low-income and middle-income countries.
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Affiliation(s)
- Bizu Gelaye
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Marta B Rondon
- Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
| | - Ricardo Araya
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Michelle A Williams
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
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100
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Schnyer RN, Manber R, Fitzcharles AJ. Acupuncture Treatment for Depression During Pregnancy: Conceptual Framework and Two Case Reports. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1076167502238384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Severe depression is common during pregnancy. It is associated with more negative pregnancy outcome and is a risk factor for postpartum depression. Treatment options available for depressed women during pregnancy are limited. Preliminary data suggest acupuncture as an effective treatment for depression. This article presents a systematic and standardized approach to acupuncture treatment, and its implementation is demonstrated using two case reports selected from a larger pool of participants in an ongoing study testingthe efficacy of acupuncture in treating depression during pregnancy. Baseline characteristics and outcome are presented from the integrated perspective of Western psychiatry and Chinese medicine.
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Affiliation(s)
- Rosa N. Schnyer
- Department of Psychology and the Department of Pediatrics at the University of Arizona and the New England School of Acupuncture
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