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Smith A, Twynstra J, Seabrook JA. Antenatal depression and offspring health outcomes. Obstet Med 2019; 13:55-61. [PMID: 32714436 DOI: 10.1177/1753495x19843015] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/18/2019] [Indexed: 12/11/2022] Open
Abstract
Background Depression is the most common mental disorder during pregnancy, with prevalence rates between 4% and 20%. The objective of this review was to synthesize the literature on the association between antenatal depression and offspring birth outcomes, as well as developmental, behavioral, and psychiatric outcomes. Methods A search of PubMed, Cochrane, and Medline databases was conducted for articles published until December 2017. Articles focusing on the effects of antenatal depression on the offspring were selected to be reviewed. Reference lists of all studies were examined for any missed articles. A total of 32 articles were included in this review. Results Antenatal depression is associated with preterm birth, excessive infant crying, and offspring mental health problems. Untreated antenatal depression is strongly associated with adverse effects on the infant nervous system. Conclusion Antenatal depression increases the likelihood of poor offspring health outcomes. Research should investigate whether medication use confounds this relationship.
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Affiliation(s)
- Alexandra Smith
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
| | - Jasna Twynstra
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Jamie A Seabrook
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada.,Department of Paediatrics, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Human Environments Analysis Laboratory, Western University, London, Ontario, Canada
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Leff Gelman P, Mancilla-Herrera I, Flores-Ramos M, Saravia Takashima MF, Cruz Coronel FM, Cruz Fuentes C, Pérez Molina A, Hernández-Ruiz J, Silva-Aguilera FS, Farfan-Labonne B, Chinchilla-Ochoa D, Garza Morales S, Camacho-Arroyo I. The cytokine profile of women with severe anxiety and depression during pregnancy. BMC Psychiatry 2019; 19:104. [PMID: 30943938 PMCID: PMC6446269 DOI: 10.1186/s12888-019-2087-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 03/21/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Controversial findings regarding the association between pro-inflammatory cytokines and depression have been reported in pregnant subjects. Scarce data about anxiety and its relationships with cytokines are available in pregnant women. To understand the association between anxiety and cytokines during pregnancy, we conducted the present study in women with or without depression. METHODS Women exhibiting severe depression (SD) and severe anxiety (SA) during the 3rd trimester of pregnancy (n = 139) and control subjects exhibiting neither depression nor anxiety (n = 40) were assessed through the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). Serum cytokines were measured by a multiplex bead-based assay. Correlation tests were used to analyze the data and comparisons between groups were performed. A general linear model of analysis of variance was constructed using the group as a dependent variable, interleukin concentrations as independent variables, and HDRS/HARS scores and gestational weeks as covariables. RESULTS The highest levels of Th1- (IL-6, TNF-α, IL-2, IFN-γ), Th17- (IL-17A, IL-22), and Th2- (IL-9, IL-10, and IL-13) related cytokines were observed in women with SD + SA. The SA group showed higher concentrations of Th1- (IL-6, TNF-α, IL-2, IFN-γ) and Th2- (IL-4, and IL-10) related cytokines than the controls. Positive correlations were found between HDRS and IL-2, IL-6, and TNF-α in the SA group (p < 0.03), and between HDRS and Th1- (IL-2, IL-6, TNF-α), Th2- (IL-9, IL-10, IL-13) and Th17- (IL-17A) cytokines (p < 0.05) in the SD + SA group. After controlling the correlation analysis by gestational weeks, the correlations that remained significant were: HDRS and IL-2, IL-6, IL-9, and IL-17A in the SD + SA group (p < 0.03). HARS scores correlated with IL-17A in the SA group and with IL-17A, IL-17F, and IL-2 in the SD + SA group (p < 0.02). The linear model of analysis of variance showed that HDRS and HARS scores influenced cytokine concentrations; only IL-6 and TNF-α could be explained by the group. CONCLUSIONS We found that the cytokine profiles differ when comparing pregnant subjects exhibiting SA with comorbid SD against those showing only SA without depression.
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Affiliation(s)
- P. Leff Gelman
- Instituto Nacional de Pernatologia, Isidro Espinosa de los Reyes, Montes Urales # 800, Col Lomas de Virreyes, 11000 (Mexico City), CD MX Mexico
| | - I. Mancilla-Herrera
- 0000 0001 2221 3638grid.414716.1Hospital General de México, Dr. Eduardo Liceaga, 06720 (Mexico City), CD MX Mexico
| | - M. Flores-Ramos
- 0000 0004 1776 9908grid.419154.cInstituto Nacional de Psiquiatría, 14370 CD MX, (Mexico City) Mexico ,0000 0004 0428 7635grid.418270.8Consejo Nacional de Ciencia y Tecnología/CONACyT, 03940 (Mexico City), CD MX Mexico
| | - M. F. Saravia Takashima
- 0000 0001 2221 3638grid.414716.1Hospital General de México, Dr. Eduardo Liceaga, 06720 (Mexico City), CD MX Mexico
| | - F. M. Cruz Coronel
- 0000 0001 2221 3638grid.414716.1Hospital General de México, Dr. Eduardo Liceaga, 06720 (Mexico City), CD MX Mexico
| | - C. Cruz Fuentes
- 0000 0004 1776 9908grid.419154.cInstituto Nacional de Psiquiatría, 14370 CD MX, (Mexico City) Mexico
| | - A. Pérez Molina
- 0000 0004 1776 9908grid.419154.cInstituto Nacional de Psiquiatría, 14370 CD MX, (Mexico City) Mexico
| | - J. Hernández-Ruiz
- 0000 0001 2221 3638grid.414716.1HIPAM-Unidad de Investigación en Medicina-UNAM, Hospital General de México Dr. Eduardo Liceaga, 06720 (Mexico City), CD MX Mexico
| | - F. S. Silva-Aguilera
- 0000 0001 2221 3638grid.414716.1HIPAM-Unidad de Investigación en Medicina-UNAM, Hospital General de México Dr. Eduardo Liceaga, 06720 (Mexico City), CD MX Mexico
| | - B. Farfan-Labonne
- Instituto Nacional de Pernatologia, Isidro Espinosa de los Reyes, Montes Urales # 800, Col Lomas de Virreyes, 11000 (Mexico City), CD MX Mexico
| | - D. Chinchilla-Ochoa
- Instituto Nacional de Pernatologia, Isidro Espinosa de los Reyes, Montes Urales # 800, Col Lomas de Virreyes, 11000 (Mexico City), CD MX Mexico
| | - S. Garza Morales
- Instituto Nacional de Pernatologia, Isidro Espinosa de los Reyes, Montes Urales # 800, Col Lomas de Virreyes, 11000 (Mexico City), CD MX Mexico
| | - I. Camacho-Arroyo
- 0000 0001 2159 0001grid.9486.3Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México, 04510 (Mexico City), CD MX Mexico
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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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Tsakiridis I, Dagklis T, Zerva C, Mamopoulos A, Athanasiadis A, Papazisis G. Depression in pregnant women hospitalized due to intrauterine growth restriction: Prevalence and associated factors. Midwifery 2018; 70:71-75. [PMID: 30584971 DOI: 10.1016/j.midw.2018.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 11/12/2018] [Accepted: 12/11/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Pregnancies complicated with intrauterine growth restriction (IUGR) may require hospitalization in a high-risk pregnancy unit (HRPU). A complicated pregnancy and hospital admission may negatively affect the pregnant woman's mental health. Several factors have been identified as possible risk factors for depression, which is proven to lead to several adverse perinatal outcomes. The purpose of this study was to screen for depression in women admitted to an HRPU due to IUGR pregnancy and also to identify associated risk factors. STUDY DESIGN All pregnant women admitted at ≥ 24 gestational weeks with the diagnosis of IUGR were eligible for the study. The Greek version of the Edinburgh Postnatal Depression Scale was used as screening tool on admission. A cut-off score ≥ 13 was used to identify depression, while possible risk factors were also investigated. RESULTS Overall, 73 women were eligible for the study and agreed to complete the questionnaire. The mean age of the pregnant women was 31.4 ± 6.7 years and the mean gestational week at admission was 33.6 ± 2.9 weeks. The prevalence of depressive symptoms (score ≥ 13) was 32.9% (24/73). In the multivariable model, depressive symptoms were significantly correlated with lower gestational age (OR: 3.459 95%CI: 1.124-10.648) and smoking during pregnancy (OR: 3.926 95% CI: 1.141-13.507). CONCLUSIONS About one third of pregnant women hospitalized in the HRPU with IUGR pregnancies showed signs of depression at the time of admission. Early-IUGR and smoking were found to be associated with antenatal depressive symptoms.
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Affiliation(s)
- Ioannis Tsakiridis
- 3rd Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Themistoklis Dagklis
- 3rd Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Christina Zerva
- 3rd Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece; Department of Clinical Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Apostolos Mamopoulos
- 3rd Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Apostolos Athanasiadis
- 3rd Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece.
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Psychometric Properties of the Spanish Version of the Pregnancy Related Anxiety Questionnaire (PRAQ). SPANISH JOURNAL OF PSYCHOLOGY 2018; 21:E64. [PMID: 30501656 DOI: 10.1017/sjp.2018.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although pregnancy increases the vulnerability to anxiety, no specific assessment instruments are usually used to detect it. The objective of this study was to adapt the Pregnancy Related Anxiety Questionnaire (PRAQ) to Spanish population, as well as analyze its validity and reliability. A sample of 367 nulliparous pregnant women with a normal risk status filled in a socio-demographic and obstetric-gynaecological questionnaire, the PRAQ, the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). After performing a factorial analysis, a five-factor model that explains 53.1% of the variance was obtained. Estimates of internal consistency reliability were adequate (range = .78 to .93) for the five factors included in the final confirmatory factor analysis, and for the total scale (.97). Significant correlation among PRAQ, EPDS, and STAI was found (p < .001). The 85th percentile (score 234 or more) was used as a cut-off point to identify those women with high pregnancy-specific anxiety. In accordance with the results obtained, the PRAQ can be considered a useful screening tool to evaluate pregnancy-related anxiety among the Spanish population.
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Van Ngo T, Gammeltoft T, Nguyen HTT, Meyrowitsch DW, Rasch V. Antenatal depressive symptoms and adverse birth outcomes in Hanoi, Vietnam. PLoS One 2018; 13:e0206650. [PMID: 30388162 PMCID: PMC6214542 DOI: 10.1371/journal.pone.0206650] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/17/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Antenatal depression is a significant health problem in low and middle- income countries. Although the condition is associated with severe adverse consequences for the mother and newborn, it remains a neglected problem. The purpose of this study was to describe the association between antenatal depressive symptoms and preterm birth (PTB), low birth weight (LBW), and small for gestation age (SGA). METHODS The study was conducted in Dong Anh District, Hanoi, Vietnam, among pregnant women of less than 24 weeks of gestation. Information on socioeconomic characteristics and reproductive history was collected at enrollment and ADS and experiences of intimate partner violence were assessed at week 32. Birth outcomes were determined at delivery. Bivariate and logistic regression analyses were applied to assess the associations between ADS and PTB, LBW, and SGA. RESULTS ADS was significantly associated with an increased risk of PTB (crude OR = 2.4; 95%; CI: 1.01-5.4 and adjusted OR = 2.4; 95% CI: 1.1-5.2, respectively) and a significantly increased risk for giving birth to an LBW infant (crude OR = 3.1; 95% CI: 1.4-7.0 and adjusted OR = 3.5; 95% CI: 1.6-7.6, respectively). In contrast, ADS was not statistically associated with small for gestation age. CONCLUSION ADS is associated with an increased risk of PTB and LBW but not associated with SGA.
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Affiliation(s)
- Toan Van Ngo
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Tine Gammeltoft
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Hanh Thuy Thi Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Dan W. Meyrowitsch
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Rasch
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Keenan K, Hipwell AE, Class QA, Mbayiwa K. Extending the developmental origins of disease model: Impact of preconception stress exposure on offspring neurodevelopment. Dev Psychobiol 2018; 60:753-764. [PMID: 30144041 PMCID: PMC6342272 DOI: 10.1002/dev.21773] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 01/03/2023]
Abstract
The concept of the developmental origins of health and disease via prenatal programming has informed many etiologic models of health and development. Extensive experimental research in non-human animal models has revealed the impact of in utero exposure to stress on fetal development and neurodevelopment later in life. Stress exposure, however, is unlikely to occur de novo following conception, and pregnancy health is not independent of the health of the system prior to conception. For these reasons, the preconception period is emerging as an important new focus for research on adverse birth outcomes and offspring neurodevelopment. In this review, we summarize the existing evidence for the role of preconception stress exposure on pregnancy health and offspring neurodevelopment across species and discuss the implications of this model for addressing health disparities in obstetrics and offspring outcomes.
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Affiliation(s)
- Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
| | - Alison E Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Quetzal A Class
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois
| | - Kimberley Mbayiwa
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
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Abdelaal H, Mohamed MA, Aly H. Racial Disparity, Depression, and Birth Outcomes Among Pregnant Teens. Matern Child Health J 2018; 22:1400-1406. [PMID: 29557522 DOI: 10.1007/s10995-018-2519-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives To examine the risk of premature delivery (PD) and small for gestational age (SGA) among pregnant teens with depressive disorders (DD), and the impact of race/ethnicity on these birth outcomes. Design/Methods We examined the hospital discharge records of pregnant mothers between the age of 13-18 year old who gave birth in the years 1994, 2000, 2006, and 2012 in the National Inpatient Sample database. We calculated the risk for PD and SGA among pregnant teens with and without DD in the overall population and within each race/ethnicity. Results Weighted sample included 1,023,586 pregnant teenage women. Prevalence of DD among teens was 0.93%, with a significantly increasing trend from 0.29% in 1994 to 2.01% in 2012 (p < 0.001). Declining trend was observed in the proportion of pregnant younger teens from 1994 to 2012. Prevalence of depression among teenage mothers was highest among Caucasians compared to other races. Prevalence of SGA among pregnant teens was 2.23% that significantly increased from 1.63% in 1994 to 3.44% in 2012 (p < 0.001). African American teens with DD had decreased risk for PD compared to AA without DD (OR 0.70; CI 0.57 - 0.387, p < 0.001). Hispanic teens with DD had increased risk for SGA compared to Hispanics without DD (adjusted OR 1.53; CI 1.10-2.13, p < 0.001). Conclusions for Practice There is an increasing trend for diagnosing DD among pregnant teens. Less young teenage girls are giving birth in recent years. The impact of DD on PD and SGA differs according to race. More studies are warranted to examine underlining factors responsible for these findings.
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Affiliation(s)
- Hala Abdelaal
- The George Washington University Hospital, Newborn Services, 900 23rd St. N.W., Suite G-2092, Washington, DC, 20037, USA
| | - Mohamed A Mohamed
- The George Washington University Hospital, Newborn Services, 900 23rd St. N.W., Suite G-2092, Washington, DC, 20037, USA.
| | - Hany Aly
- The George Washington University Hospital, Newborn Services, 900 23rd St. N.W., Suite G-2092, Washington, DC, 20037, USA
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The Prevalence of Depression in Pregnant Iranian Women: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2018. [DOI: 10.5812/ijpbs.9975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Clinical effectiveness of family therapeutic interventions in the prevention and treatment of perinatal depression: A systematic review and meta-analysis. PLoS One 2018; 13:e0198730. [PMID: 29902211 PMCID: PMC6002098 DOI: 10.1371/journal.pone.0198730] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 05/24/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Family therapy is a potential strategy to increase family support for those suffering from perinatal depression. Family therapeutic interventions for this population typically target depressed women and their adult family members to improve family functioning and reduce depressive symptoms. OBJECTIVE This systematic review and meta-analysis is a synthesis of the current evidence on the usefulness of family therapy interventions in the prevention and treatment of perinatal depression and impacts on maternal depressive symptoms and family functioning. METHODS This study used the Cochrane Collaboration guidelines for systematic reviews and meta-analyses. Six electronic databases were searched for randomized controlled trials and cluster randomized trials. The primary outcomes included maternal depressive symptoms and family functioning. RESULTS Seven studies were included in the qualitative and quantitative analyses. Fixed effects models showed statistically significant reductions in depressive symptoms at post-intervention in intervention group mothers. Intervention intensity and level of family involvement moderated intervention impacts on maternal depression. A fixed effects model showed a trend in improving family functioning at post-intervention in intervention group couples. CONCLUSION Although a limited number of controlled trials on family therapeutic interventions for this population exist, the findings show that these types of interventions are effective in both the prevention and treatment of perinatal depression. Recommendations for future research are addressed. SYSTEMATIC REVIEW AND META-ANALYSIS PROTOCOL REGISTRATION PROSPERO, CRD42017075150.
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Paulzen M, Goecke TW, Kuzin M, Augustin M, Gründer G, Schoretsanitis G. Pregnancy exposure to quetiapine - Therapeutic drug monitoring in maternal blood, amniotic fluid and cord blood and obstetrical outcomes. Schizophr Res 2018; 195:252-257. [PMID: 28965779 DOI: 10.1016/j.schres.2017.09.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/24/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Abstract
RATIONALE This prospective study is the first to measure and correlate quetiapine concentrations in maternal blood, amniotic fluid and umbilical cord blood to account for the distribution of quetiapine. METHODS Concentrations of quetiapine are quantified in seven mother infant pairs at the time of delivery. Data are provided as median values, first (Q1) and third (Q3) quartiles and ranges. To account for the penetration ratio, the concentration of quetiapine in amniotic fluid and cord blood was divided by maternal concentrations. Correlations between daily dosage, maternal serum and umbilical cord blood concentrations were computed for seven patients while calculations for amniotic fluid were only available for six mother-infant pairs. RESULTS The median daily dosage of quetiapine was 300mg (Q1: 300mg, Q3: 600mg, range 200-800mg). There was a strong and significant correlation between maternal serum and cord blood concentrations (r=0.893, p=0.007). The median penetration ratio into fetal circulation was 0.18 (Q1: 0.16, Q3: 0.32; range 0.13-0.42), suggesting a low penetration. The median penetration ratio into amniotic fluid was 0.44 (Q1: 0.15, Q3: 0.96; range 0.09-1.70). CONCLUSIONS Quetiapine concentrations in amniotic fluid and cord blood give evidence that quetiapine is constantly accessible to the fetus with a relatively low penetration ratio. A high correlation between maternal serum and umbilical cord blood concentrations highlights a predictive role of quantifying drug concentrations in maternal serum for assessing drug concentrations in fetal circulation. Findings support the important role of therapeutic drug monitoring in supporting the efficacy and safety of psychopharmacological treatment strategies in highly vulnerable populations.
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Affiliation(s)
- Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; Alexianer Hospital Aachen, Germany; JARA - Translational Brain Medicine, Aachen, Germany.
| | - Tamme W Goecke
- Department of Gynecology and Obstetrics, RWTH Aachen University, Germany
| | - Maxim Kuzin
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Marc Augustin
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Gerhard Gründer
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; University Hospital of Psychiatry, Bern, Switzerland
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Lara-Cinisomo S, Swinford C, Massey D, Hardt H. Diabetes, Prenatal Depression, and Self-Rated Health in Latina Mothers. Diabetes Spectr 2018; 31:159-165. [PMID: 29773936 PMCID: PMC5951227 DOI: 10.2337/ds17-0031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Latinas in the United States have elevated rates of diabetes and prenatal depression (PND). The presence of diabetes and PND can also have a negative effect on women's self-rated health (SRH), a commonly used indicator of health that is consistent with objective health status and is a predictor of mortality. However, the associations between PND, diabetes, and SRH have not been tested, particularly among Latinas, who have elevated risk of both medical conditions. To address this gap, this pilot study tested the association between PND and diabetes using data from Latinas enrolled during their third trimester of pregnancy and explored whether these health conditions were associated with SRH in these women. METHODS For this study, the Edinburgh Postnatal Depression Scale was used to determine PND status, self-reported medical history to determine diabetes status, and SRH before and during the current pregnancy in a sample of 34 prenatal Latinas. Participants were invited to take part in the study in their third trimester of pregnancy. Bivariate analyses and logistic regressions were used to test associations between demographic variables, PND, diabetes, and SRH. RESULTS There was no significant association between PND and diabetes status in this sample of Latinas. There was a significant difference in SRH from pre-pregnancy to pregnancy, with worse ratings reported during pregnancy. Furthermore, women with PND or diabetes reported worse SRH, even after controlling for pre-pregnancy SRH. CONCLUSION SRH is an important and robust variable associated with PND and diabetes in prenatal Latinas, making it an important factor to assess when treating this high-risk group.
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Affiliation(s)
- Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Claire Swinford
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Danielle Massey
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Heidi Hardt
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
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Giurgescu C, Fahmy L, Slaughter-Acey J, Nowak A, Caldwell C, Misra DP. Can support from the father of the baby buffer the adverse effects of depressive symptoms on risk of preterm birth in Black families? AIMS Public Health 2018; 5:89-98. [PMID: 30083571 PMCID: PMC6070463 DOI: 10.3934/publichealth.2018.1.89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While maternal depressive symptoms during pregnancy have been linked to preterm birth (PTB; birth before 37 completed weeks of gestation), little has been reported on potential buffering factors, particularly specific to Black women who are at much higher risk. We examined the association between depressive symptoms and PTB in pregnant Black women, with father of the baby (FOB) support as a potential buffering factor. METHODS Data were obtained from the life-course influences on fetal environments study (2009-2011), a cohort of 1,410 Black women in metropolitan Detroit, Michigan (71% response rate) using maternal interviews and medical record abstraction collected during the postpartum hospitalization. The 20-item Center for Epidemiologic Studies Depression (CES-D) scale was used to measure depressive symptoms. The 14-item social networks in adult relations questionnaire was used to assess the mother's relationship with the FOB. Logistic regression was used to explore the interaction between CES-D and FOB support with regard to PTB risk. We adjusted for maternal advanced age, income, education level, smoking status, hypertension, prenatal care and BMI. RESULTS The PTB rate in this cohort was 17.7%. Among women with FOB scale < 60 (less support), the odd ratio (OR) of PTB for women with CES-D scores ≥ 23 (severe depressive symptoms) as compared to CES-D scores < 23 (no severe depressive symptoms) was 2.57 [95% confidence interval (CI): 1.68, 3.94; p < 0.001]. Among women with FOB scores ≥ 60 (more support), the odds of PTB in women with CES-D scores ≥ 23 did not significantly differ from the odds of PTB in women with CES-D scores < 23 (OR = 1.34; 95% CI: 0.74, 2.44; p = 0.3). After adjustment for covariates, among women with FOB scores < 60, the OR of PTB for women with CES-D scores ≥ 23 compared to < 23 was 2.79 (95% CI: 1.75, 4.45; p < 0.001). Among women with FOB scores ≥ 60, the odds of PTB in women with CES-D scores ≥ 23 was not statistically significantly different compared to the odds of PTB in women with CES-D scores < 23 (OR = 1.21; 95% CI: 0.62, 2.35; p = 0.6). The interaction term was statistically significant (p = 0.04). DISCUSSION/CONCLUSIONS The adverse effect of depressive symptoms on risk of PTB may be buffered by factors such as a supportive relationship with the FOB.
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Affiliation(s)
| | - Lara Fahmy
- Department of Family Medicine & Public Health Sciences, School of Medicine, Wayne State University, Detroit
| | | | | | - Cleopatra Caldwell
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
| | - Dawn P Misra
- Department of Family Medicine & Public Health Sciences, School of Medicine, Wayne State University, Detroit
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Sømhovd MJ, Esbjørn BH, Hansen BM, Greisen G. Extremely prematurely born adolescents self-report of anxiety symptoms, and the mothers' reports on their offspring. Acta Paediatr 2018; 107:456-461. [PMID: 28921657 DOI: 10.1111/apa.14077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 07/24/2017] [Accepted: 09/13/2017] [Indexed: 11/30/2022]
Abstract
AIM To compare anxiety symptoms in adolescents born extremely prematurely to term-born controls. METHODS We had 96 preterm-born adolescents and 40 term-born controls from Denmark, and their mothers score the adolescents on the Revised Children Anxiety and Depression scale. We analysed group differences, cross-informant correlations and relative risks for elevated anxiety symptoms. RESULTS Self-reported anxiety symptoms did not significantly differ, although the upper confidence limit (95% CI: -3.3 to 5.1) supported an odds ratio of 2 for the preterm-born participants. Mothers of the preterm-born participants reported higher social anxiety symptoms than did mothers of controls (51.7 versus 46.8, p = 0.001). The relative risk for being above a threshold indicating distressing anxiety was small from self-reports (1.39; p = 0.60). From mother-reports, the relative risk was noticeable but not significant (4.58; p = 0.14). Cross-informant scores correlated significant for total anxiety and social anxiety for the preterm-born (rτ = 0.2, p = 0.001; rτ = 0.3, p ≤ 0.001). CONCLUSIONS Self-reports did not clearly indicate more anxiety in the preterm group, although confidence intervals supported a possible twofold increase. Mother- and self-reports correlated only for the preterm group, which may indicate increased sensitivity for their children's symptoms.
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Affiliation(s)
- M J Sømhovd
- Department of Psychology; University of Copenhagen; Copenhagen Denmark
| | - B H Esbjørn
- Department of Psychology; University of Copenhagen; Copenhagen Denmark
| | - B M Hansen
- Department of Paediatrics; Herlev Hospital; Herlev Denmark
| | - G Greisen
- Department of Neonatology; Rigshospitalet and Copenhagen University Hospital; Copenhagen Denmark
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Kang-Yi CD, Kornfield SL, Epperson CN, Mandell DS. Relationship Between Pregnancy Complications and Psychiatric Disorders: A Population-Based Study With a Matched Control Group. Psychiatr Serv 2018; 69:300-307. [PMID: 29137553 PMCID: PMC5937933 DOI: 10.1176/appi.ps.201700097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to identify whether pregnancy complications differ between women with and without a psychiatric disorder diagnosis prior to pregnancy. METHODS Women who gave birth between 2007 and 2009 in Pennsylvania and were enrolled in Medicaid from one year prior to their pregnancy until their delivery were included (N=9,930); those with psychiatric disorders were compared with a matched control group (N=4,965 for each). Logistic regression analysis estimated the odds of having a pregnancy complication among those with a psychiatric diagnosis prior to pregnancy, adjusting for demographic characteristics and chronic general medical conditions. RESULTS Compared with the control group, women with a psychiatric disorder prior to pregnancy had greater odds of having at least one pregnancy complication (odds ratio=1.48, 95% confidence interval=1.37-1.61). Compared with the control group, their odds of antepartum hemorrhage were 1.50 times higher, their odds of preterm labor were 1.45 times higher, and their odds of preterm birth were 1.61 times higher. CONCLUSIONS Women with psychiatric disorders prior to pregnancy were more likely to experience pregnancy complications, including pregnancy hemorrhage, preterm labor, and preterm birth, after the analysis controlled for age, race-ethnicity, and chronic illness status before and during pregnancy. The finding of an association between psychiatric disorders and a higher complication risk suggests the importance of population-based preconception interventions for women with psychiatric disorders and prenatal monitoring to reduce the risk of pregnancy complications in this group.
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Affiliation(s)
- Christina D Kang-Yi
- The authors are with the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sara L Kornfield
- The authors are with the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - C Neill Epperson
- The authors are with the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - David S Mandell
- The authors are with the Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Palmeiro-Silva YK, Orellana P, Venegas P, Monteiro L, Varas-Godoy M, Norwitz E, Rice G, Osorio E, Illanes SE. Effects of earthquake on perinatal outcomes: A Chilean register-based study. PLoS One 2018; 13:e0191340. [PMID: 29474413 PMCID: PMC5825031 DOI: 10.1371/journal.pone.0191340] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/03/2018] [Indexed: 12/30/2022] Open
Abstract
Background Natural disasters increase the level population stress, including pregnant women, who can experience prenatal maternal stress, affecting the fetus and triggering perinatal complications, such as low birth weight, smaller head circumference, etc. However, little is known about effects of earthquake on perinatal outcomes. Objective To evaluate the effect of earthquake occurred on February 27, 2010 and perinatal outcomes of Chilean pregnant women, and to examine these effects by timing of exposure during pregnancy and newborn gender. Methods A register-based study was performed using data collected from women who had a vaginal delivery in a large private health center in Santiago, Chile, during 2009 and 2010. The study population was categorized according to exposure to earthquake and timing during gestation. Primary perinatal outcomes were gestational age at birth, birth weight, length and head circumference. Analyses adjusted for gender, gestational age at exposure, parity, maternal age and income. Results A total of 1,966 eligible vaginal deliveries occurred during 2009 and 2,110 in 2010. Birth weight was not affected by the trimester of exposure; however, length, head circumference and gestational age at birth were significantly different according to trimester of exposure and gender of newborn. In multivariable analysis, newborns were shorter by 2 mm, 5 mm and 4.5 mm, if they were exposed during their first, second and third trimester, respectively. Furthermore, newborns had a smaller head circumference by 1.2 mm and 1.5 mm if they were exposed during first and second trimester of gestation. Conclusion In this cohort, exposure to the February 2010 earthquake resulted in earlier delivery and reduced length and head circumference in the offspring. This association varied according to trimester of exposure and fetal gender. Health workers should include exposed to high levels of stress associated with natural disasters when assessing pregnancy risk factors.
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Affiliation(s)
| | - Pelusa Orellana
- School of Education, Universidad de los Andes, Santiago, Chile
| | - Pia Venegas
- Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Lara Monteiro
- Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | | | - Errol Norwitz
- School of Medicine, Tufts University, Boston, Massachusetts, United States of America
| | - Gregory Rice
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Eduardo Osorio
- Department of Obstetrics and Gynecology, Clinica Dávila, Santiago, Chile
| | - Sebastián E. Illanes
- Faculty of Medicine, Universidad de los Andes, Santiago, Chile
- Department of Obstetrics and Gynecology, Clinica Dávila, Santiago, Chile
- * E-mail:
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Doktorchik C, Premji S, Slater D, Williamson T, Tough S, Patten S. Patterns of change in anxiety and depression during pregnancy predict preterm birth. J Affect Disord 2018; 227:71-78. [PMID: 29053978 DOI: 10.1016/j.jad.2017.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 08/28/2017] [Accepted: 10/01/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND To determine whether changes in anxiety and depression during pregnancy influence the risk of having a preterm birth (PTB), and whether chronic stress modifies this relationship. METHODS The data source for the current study is the All Our Babies prospective cohort (AOB). Anxiety and depression were measured at 17-24 weeks and again at 32-36 weeks' gestation using the Spielberg State Anxiety Scale and the Edinburgh Postnatal Depression Scale, respectively. Chronic stress was assessed at 17-24 weeks' gestation as a potential covariate, and was measured using the Perceived Stress Scale. Multivariable logistic regression modeling was used to assess each relationship RESULTS: Women who experienced an increase in anxiety scores, (time point 32-36 weeks, compared to the earlier time point 17-24 weeks), had 2.70 times higher odds of preterm delivery, compared to those with a reduction in anxiety scores (95% CI 1.28, 5.69). Consistent low or high depression scores did not significantly influence the odds of PTB compared to a decrease in depression scores. A co-occurring increase in anxiety and depression scores was not found to increase the risk of PTB, and chronic stress did not modify any of these relationships. LIMITATIONS This study was limited by a relatively small sample of women who delivered preterm, and therefore it was not possible to conduct additional analyses. Further, the analyses were limited to mostly late preterm infants (32-36 weeks' gestation). CONCLUSIONS These findings should be validated with additional cohorts and a larger sample size. Ultimately, primary prevention could address anxiety during pregnancy.
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Affiliation(s)
- Chelsea Doktorchik
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6.
| | - Shahirose Premji
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 293 Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1.
| | - Donna Slater
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 293 Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1; Departments of Physiology & Pharmacology and Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1.
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 293 Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6.
| | - Suzanne Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Room 293 Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1; Department of Pediatrics, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8.
| | - Scott Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6; Department of Psychiatry, Cumming School of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, Canada T2N 2T9.
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Pham D, Cormick G, Amyx MM, Gibbons L, Doty M, Brown A, Norwood A, Daray FM, Althabe F, Belizán JM. Factors associated with postpartum depression in women from low socioeconomic level in Argentina: A hierarchical model approach. J Affect Disord 2018; 227:731-738. [PMID: 29179143 PMCID: PMC5805649 DOI: 10.1016/j.jad.2017.11.091] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/02/2017] [Accepted: 11/17/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE to estimate the prevalence of depression at 4-week postpartum using the Edinburgh postpartum Depression Scale (EPDS) in women who delivered in a public maternity hospital in Argentina. METHODS This prospective cohort study was carried out from March to August 2016 in northwest Argentina. Eligibility included delivering a singleton live birth 28 weeks of gestational age or over, 18 years or older and resided within 1h from the maternity hospital. Women were excluded if they or their newborn were in the intensive care unit. We defined a positive screening as an EPDS score of 10 or higher or a positive response to item 10, which indicates thoughts of self-harm. RESULTS A total of 587 women were enrolled and 539 women completed the home visit interview and the EPDS. A total of 167 (31.0%, 95% CI 27.1-35.1) mothers screened positive in the EPDS using a score ≥ 10 and 99 (18.4%, 95% CI 15.1-21.6%) using a score ≥ 13, which indicate increased severity of depressive symptoms. In both cases, the 23 (4.3%) women that responded as having thoughts of self-harm were included. CONCLUSION Nearly a third of women who participated had depressive symptoms at four weeks postpartum in a public hospital in Tucumán, Argentina. Socio-demographic, particularly personal psychiatric history, factors and social and cultural influences can impact results. Our results highlight the need for improved screening and better diagnostic tool for women with postpartum depression in Argentina and to investigate the impact of postpartum depressive symptoms on women's health and their families.
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Affiliation(s)
- Diana Pham
- Medical School, University of Texas Southwestern Medical School, USA.
| | - Gabriela Cormick
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina; Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Melissa M Amyx
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA 70112, USA.
| | - Luz Gibbons
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina.
| | - Meitra Doty
- Medical School, University of Texas Southwestern Medical School, USA.
| | - Asia Brown
- Yale Center for Clinical Investigation, Yale University, USA.
| | - Angel Norwood
- Department of Psychology, Xavier University of Louisiana, USA.
| | - Federico M Daray
- University of Buenos Aires, School of Medicine, Institute of Pharmacology, Paraguay 2155, piso 9 (C1121ABG), Ciudad Autónoma de Buenos Aires, Argentina.
| | - Fernando Althabe
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina.
| | - José M Belizán
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina.
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Relationship Between Common Mental Disorder Symptoms During Pregnancy and Preterm Birth Among Chinese Women in Wuhan. Matern Child Health J 2017; 20:2121-9. [PMID: 27352288 DOI: 10.1007/s10995-016-2042-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objectives Few studies focus on the symptoms of common mental disorders during pregnancy (CMDP) and risk of preterm birth subtypes (PTB). The purpose of this study was to estimate the association between CMDP and PTB, and to examine whether or not the association between CMDP and PTB varies with the subtype of PTB in Chinese. Methods This population-based case control study, conducted in Wuhan, China, defined cases as every pregnant woman who had a PTB among all births in Wuhan, from June 10, 2011, to June 9, 2013. The same number of pregnant women who had term births was randomly selected as controls. The Electronic Perinatal Health Care Information System, a questionnaire designed for the study, provided data about the participants. Logistic regression analyses were used to model associations between CMDP and PTB, and to test associations between CMDP and two subtypes of PTB. Results The study recruited 8616 cases and an equal number of controls. We successfully collected maternal information on 6656 cases and controls for a response rate of 77.3 %. The incidence of PTB in Wuhan was 4.5 %. Spontaneous preterm births (SPTB) accounted for 60.1 %, and medically induced preterm births (IPTB) accounted for 39.9 % of preterm births. The prevalence rate of CMDP was 15.8 %. CMDP was slightly associated with PTB (crude OR 1.16, 95 % CI 1.01-1.32; adjusted OR 1.15, 95 % CI 1.00-1.32), further analyses showed CMDP was associated with IPTB (aOR 1.25, 95 % CI 1.04-1.50), but not with SPTB. Conclusion Our data suggest that CMDP is related to an increased risk of PTB, and that this association is primarily due to IPTB rather than SPTB.
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Yadav M, Verma MK, Chauhan NS. A review of metabolic potential of human gut microbiome in human nutrition. Arch Microbiol 2017; 200:203-217. [PMID: 29188341 DOI: 10.1007/s00203-017-1459-x] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/30/2017] [Accepted: 11/16/2017] [Indexed: 02/06/2023]
Abstract
The human gut contains a plethora of microbes, providing a platform for metabolic interaction between the host and microbiota. Metabolites produced by the gut microbiota act as a link between gut microbiota and its host. These metabolites act as messengers having the capacity to alter the gut microbiota. Recent advances in the characterization of the gut microbiota and its symbiotic relationship with the host have provided a platform to decode metabolic interactions. The human gut microbiota, a crucial component for dietary metabolism, is shaped by the genetic, epigenetic and dietary factors. The metabolic potential of gut microbiota explains its significance in host health and diseases. The knowledge of interactions between microbiota and host metabolism, as well as modification of microbial ecology, is really beneficial to have effective therapeutic treatments for many diet-related diseases in near future. This review cumulates the information to map the role of human gut microbiota in dietary component metabolism, the role of gut microbes derived metabolites in human health and host-microbe metabolic interactions in health and diseases.
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Affiliation(s)
- Monika Yadav
- Department of Biochemistry, Maharshi Dayanand University, Rohtak, Haryana, 124001, India
| | - Manoj Kumar Verma
- Department of Biochemistry, Maharshi Dayanand University, Rohtak, Haryana, 124001, India
| | - Nar Singh Chauhan
- Department of Biochemistry, Maharshi Dayanand University, Rohtak, Haryana, 124001, India.
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Ingstrup KG, Liu X, Gasse C, Debost JCP, Munk-Olsen T. Prescription drug use in pregnancy and variations according to prior psychiatric history. Pharmacoepidemiol Drug Saf 2017; 27:105-113. [DOI: 10.1002/pds.4355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/21/2017] [Accepted: 10/17/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Katja G. Ingstrup
- The National Center for Register-based Research, School of Business and Social Sciences; Aarhus University; Aarhus Denmark
- CIRRAU-Centre for Integrated Register-based Research, School of Business and Social Sciences; Aarhus University; Aarhus Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH; Aarhus Denmark
| | - Xiaoqin Liu
- The National Center for Register-based Research, School of Business and Social Sciences; Aarhus University; Aarhus Denmark
- CIRRAU-Centre for Integrated Register-based Research, School of Business and Social Sciences; Aarhus University; Aarhus Denmark
| | - Christiane Gasse
- The National Center for Register-based Research, School of Business and Social Sciences; Aarhus University; Aarhus Denmark
- CIRRAU-Centre for Integrated Register-based Research, School of Business and Social Sciences; Aarhus University; Aarhus Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH; Aarhus Denmark
| | - Jean-Christophe P. Debost
- The National Center for Register-based Research, School of Business and Social Sciences; Aarhus University; Aarhus Denmark
- CIRRAU-Centre for Integrated Register-based Research, School of Business and Social Sciences; Aarhus University; Aarhus Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH; Aarhus Denmark
| | - Trine Munk-Olsen
- The National Center for Register-based Research, School of Business and Social Sciences; Aarhus University; Aarhus Denmark
- CIRRAU-Centre for Integrated Register-based Research, School of Business and Social Sciences; Aarhus University; Aarhus Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH; Aarhus Denmark
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Mukherjee S, Trepka MJ, Pierre-Victor D, Bahelah R, Avent T. Racial/Ethnic Disparities in Antenatal Depression in the United States: A Systematic Review. Matern Child Health J 2017; 20:1780-97. [PMID: 27016352 DOI: 10.1007/s10995-016-1989-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objectives More than 10 % of pregnant women in the United States (U.S.) suffer from depression, which has far-reaching consequences on maternal and fetal well-being. There is conflicting evidence regarding the prevalence of antenatal depression among different race and ethnic groups. This systematic review aimed to summarize the existing literature concerning racial/ethnic disparities in the prevalence and correlates of antenatal depression in the U.S. Methods PubMed, CINAHL and PsycINFO databases were searched online for research studies published in English in peer-reviewed journals until March 2015, using a pre-designed search strategy. Eligibility was determined using pre-specified criteria; and quality was assessed. Results Forty-one (41) articles met the criteria; 13 were cross-sectional, and 21 were longitudinal studies. Overall, the prevalence of antenatal depression was 10-30 %; it was higher among non-Hispanic blacks (NHBs) and Hispanics, compared to non-Hispanic whites (NHWs). Few studies looked at the correlates of depression by race/ethnicity. Among employed women, higher depression scores were observed among NHBs, compared to NHWs; while there was no racial difference among unemployed women. Racial difference and race-employment interaction disappeared once discrimination was accounted for. In another study, higher parity, higher stress, and lower self-esteem were significant correlates of depression among NHBs, while less satisfaction with social support, and higher stress predicted higher depression scores among NHWs and Hispanics respectively. Conclusions The findings of our review suggest that not only is antenatal depression a major public health issue that needs to be addressed, but different racial/ethnic groups seem to differ in their vulnerability and risk factors.
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Affiliation(s)
- Soumyadeep Mukherjee
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Dudith Pierre-Victor
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Raed Bahelah
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Tenesha Avent
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
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Abstract
Breastfeeding is an experience that only a mother and her infant(s) can share. Infants who can feed from the breast receive not only the best nutrition but also, due to the close physical contact between mother and child, it is the optimal nurturance they can receive from their mother. When breastfeeding is trouble free, maternal well-being is uniquely heightened. However, breastfeeding remains a challenge for many mother-infant dyads and more so for those whose infants are born prematurely. This article introduces a conceptual model of the breastfeeding challenges facing preterm mother-infant dyads. It distinguishes between a maternal caregiving and an infant growth/development components. Within the maternal component, two primary elements are considered, that is, maternal behavioral and nutritional care. The two primary elements within the infant component include infant non-nutritional and nutritional growth/development. It is proposed that an improved understanding of the factors associated with these four elements and how they interplay with each other within individual dyads will facilitate the identification of the breastfeeding challenges facing these mother-infant entities. Due to the intimate relationships existing between a mother and her infant(s), it is further advanced that breastfeeding studies would be optimized if mother-infant pairs are studied as one entity rather than mother and infant separately. It is proposed that this conceptual model will assist health professionals develop personalized breastfeeding management plans for individual preterm mother-infant dyads, while furthering the development of evidence-based interventions to optimize their breastfeeding experiences.
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Affiliation(s)
- Chantal Lau
- Department of Pediatrics/Neonatology, Baylor College of Medicine , Houston, Texas
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Pregnancy exposure to citalopram - Therapeutic drug monitoring in maternal blood, amniotic fluid and cord blood. Prog Neuropsychopharmacol Biol Psychiatry 2017; 79:213-219. [PMID: 28663113 DOI: 10.1016/j.pnpbp.2017.06.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 01/20/2023]
Abstract
RATIONALE Aim of the study was to measure and correlate citalopram concentrations in maternal blood, amniotic fluid and umbilical cord blood to account for the distribution of the drug between these three compartments. METHODS Concentrations of citalopram were measured in twelve mother infant pairs at the time of delivery. Data are provided as median values, first (Q1) and third (Q3) quartiles as well as ranges. To account for the penetration ratio into amniotic fluid and cord blood, the concentration of citalopram in was divided by the concentration in maternal serum. Correlations between daily dosage, maternal serum concentrations and umbilical cord blood concentrations were computed for twelve patients. As amniotic fluid was only available for nine mother infant pairs, appropriate calculations are provided for these mother-infant pairs. RESULTS The median daily dosage of citalopram was 20mg (Q1: 10mg, Q3: 20mg; range 10-40mg). The relation between the daily dosage of citalopram and its concentrations in maternal serum was highly significant (r=0.667, p=0.018). Maternal serum concentrations and cord blood concentrations were positively correlated (r=0.790, p=0.002) with a median penetration ratio into the fetal circulation of 0.78 (Q1: 0.52, Q3: 1.16, range 0.46-1.66). The median penetration ratio into amniotic fluid was 1.8 (Q1: 1.07, Q3: 2.64; range 0.52-6.97). CONCLUSIONS Citalopram concentrations in amniotic fluid and cord blood give evidence that maternally administered citalopram is constantly accessible to the fetus via amniotic fluid. A high correlation between maternal serum concentrations of citalopram and umbilical cord blood concentrations highlights a predictive role of quantifying drug concentrations in maternal serum for assessing drug concentrations in the fetal circulation. Findings support the important role of therapeutic drug monitoring in maintaining the safety of pregnant women and exposed infants.
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75
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Sidebottom AC, Hellerstedt WL, Harrison PA, Jones-Webb RJ. Prenatal care: associations with prenatal depressive symptoms and social support in low-income urban women. Arch Womens Ment Health 2017; 20:633-644. [PMID: 28578453 DOI: 10.1007/s00737-017-0730-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
Abstract
We examined associations of depressive symptoms and social support with late and inadequate prenatal care in a low-income urban population. The sample was prenatal care patients at five community health centers. Measures of depressive symptoms, social support, and covariates were collected at prenatal care entry. Prenatal care entry and adequacy came from birth certificates. We examined outcomes of late prenatal care and less than adequate care in multivariable models. Among 2341 study participants, 16% had elevated depressive symptoms, 70% had moderate/poor social support, 21% had no/low partner support, 37% had late prenatal care, and 29% had less than adequate prenatal care. Women with both no/low partner support and elevated depressive symptoms were at highest risk of late care (AOR 1.85, CI 1.31, 2.60, p < 0.001) compared to women with both good partner support and low depressive symptoms. Those with good partner support and elevated depressive symptoms were less likely to have late care (AOR 0.74, CI 0.54, 1.10, p = 0.051). Women with moderate/high depressive symptoms were less likely to experience less than adequate care compared to women with low symptoms (AOR 0.73, CI 0.56, 0.96, p = 0.022). Social support and partner support were negatively associated with indices of prenatal care use. Partner support was identified as protective for women with depressive symptoms with regard to late care. Study findings support public health initiatives focused on promoting models of care that address preconception and reproductive life planning. Practice-based implications include possible screening for social support and depression in preconception contexts.
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Affiliation(s)
- Abbey C Sidebottom
- Care Delivery Research, Allina Health, MR 15521, 800 East 28th Street, Minneapolis, MN, 55407-3799, USA.
| | - Wendy L Hellerstedt
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, USA
| | - Patricia A Harrison
- Minneapolis Health Department, 250 4th Street South, Minneapolis, MN, 55415-1384, USA
| | - Rhonda J Jones-Webb
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, USA
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Hernández-Díaz S, McElrath TF, Pennell PB, Hauser WA, Yerby M, Holmes LB. Fetal growth and premature delivery in pregnant women on antiepileptic drugs. Ann Neurol 2017; 82:457-465. [DOI: 10.1002/ana.25031] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Sonia Hernández-Díaz
- Department of Epidemiology; Harvard T. H. Chan School of Public Health; Boston MA
| | - Thomas F. McElrath
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital; Boston MA
| | - Page B. Pennell
- Divisions of Epilepsy and Women's Health, Department of Neurology, Brigham and Women's Hospital; Boston MA
| | - W. Allen Hauser
- College of Physicians and Surgeons and Mailman School of Public Health; Columbia University; New York NY
| | - Mark Yerby
- Oregon Health and Science University; Portland OR
| | - Lewis B. Holmes
- North American Antiepileptic Drug Pregnancy Registry, MassGeneral Hospital for Children; Boston MA
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Ornoy A, Koren G. Selective Serotonin Reuptake Inhibitors during Pregnancy: Do We Have Now More Definite Answers Related to Prenatal Exposure? Birth Defects Res 2017; 109:898-908. [DOI: 10.1002/bdr2.1078] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/17/2017] [Accepted: 06/06/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology; Hebrew University Hadassah Medical School Jerusalem and Maccabi Research Institute and Tel Aviv University; Tel Aviv Israel
| | - Gideon Koren
- Laboratory of Teratology, Department of Medical Neurobiology; Hebrew University Hadassah Medical School Jerusalem and Maccabi Research Institute and Tel Aviv University; Tel Aviv Israel
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78
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Li Y, Long Z, Cao D, Cao F. Social support and depression across the perinatal period: A longitudinal study. J Clin Nurs 2017; 26:2776-2783. [PMID: 28334472 DOI: 10.1111/jocn.13817] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To report changes in the prevalence of depression and the level of social support at three different time points in the perinatal period (late pregnancy, 1 week postpartum and 4 weeks postpartum) and to examine the relationship between depression and social support at these points in time. BACKGROUND Social support is a modifiable factor for depression. Existing research is limited to examining social support at a single time point in relation to antepartum or postpartum depression. DESIGN A longitudinal study. METHODS In total, 240 pregnant women were recruited from the prenatal clinic at a general hospital in China between June-September 2013. The Edinburgh Postnatal Depression Scale and Perceived Social Support Scale were used to measure the risk of depression and perceived social support at late pregnancy, within the first week postpartum, and at 4 weeks postpartum. RESULTS The Perceived Social Support Scale scores within the first week after birth were higher than scores at the late pregnancy and postpartum week 4, while the Edinburgh Postnatal Depression Scale scores at late pregnancy were higher than scores at the two postpartum times. Women who had higher Perceived Social Support Scale scores at late pregnancy had less likelihood of developing antepartum depression, and women with higher Perceived Social Support Scale scores at postpartum week 4 were less likely to have postpartum depression. However, the Perceived Social Support Scale scores at late pregnancy did not predict the risk of postpartum depression. CONCLUSION The study revealed that social support perceived by women changed over the perinatal period. Social support at each stage of the perinatal period was an important buffer against depression at this stage. RELEVANCE TO CLINICAL PRACTICE An increased focus on the relationship between social support and depression at each stage of the perinatal period is necessary for future research and practice.
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Affiliation(s)
- Yang Li
- School of Nursing, Shandong University, Jinan, Shandong, China
| | - Zhouting Long
- School of Nursing, Shandong University, Jinan, Shandong, China
| | - Danfeng Cao
- Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Fenglin Cao
- School of Nursing, Shandong University, Jinan, Shandong, China
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Karakasi MV, Markopoulou M, Tentes IK, Tsikouras PN, Vasilikos E, Pavlidis P. Prepartum Psychosis and Neonaticide: Rare Case Study and Forensic-Psychiatric Synthesis of Literature. J Forensic Sci 2017; 62:1097-1106. [DOI: 10.1111/1556-4029.13365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/25/2016] [Accepted: 10/03/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Maria-Valeria Karakasi
- Adult Psychiatry, Psychiatric Department; G. Papanikolaou General Hospital of Thessaloniki; Exohi, Asvestoxori GR 57010 Thessaloniki Greece
| | - Maria Markopoulou
- Department of Forensic Psychiatry; Psychiatric Hospital of Thessaloniki; GR 56429 Stavroupolis, Thessaloniki Greece
| | - Ioannis K. Tentes
- Department of Biochemistry; School of Medicine; Democritus University of Thrace; GR 68100 Alexandroupolis Greece
| | - Panagiotis N. Tsikouras
- Department of Obstetrics and Gynecology; University General Hospital of Evros; School of Medicine; Democritus University of Thrace; GR 68100 Alexandroupolis Greece
| | - Epameinondas Vasilikos
- Adult Psychiatry, Psychiatric Department; G. Papanikolaou General Hospital of Thessaloniki; Exohi, Asvestoxori GR 57010 Thessaloniki Greece
| | - Pavlos Pavlidis
- Laboratory of Forensic Sciences; School of Medicine; Democritus University of Thrace; GR 68100 Alexandroupolis Greece
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Preciado A, D'Anna-Hernandez K. Acculturative stress is associated with trajectory of anxiety symptoms during pregnancy in Mexican-American women. J Anxiety Disord 2017; 48:28-35. [PMID: 27780654 PMCID: PMC5737703 DOI: 10.1016/j.janxdis.2016.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/05/2016] [Accepted: 10/05/2016] [Indexed: 02/01/2023]
Abstract
Over half of pregnant women report anxiety symptoms and these symptoms may be precipitated by stressful experiences. Anxiety rates may be higher in Mexican-American women who experience sociocultural stressors, such as acculturation, acculturative stress and discrimination. However, the role of such stressors on the trajectory of anxiety symptoms across pregnancy is not yet known. Mexican-American women (n=151) completed surveys across pregnancy about acculturation, acculturative stress, perceived discrimination, and state anxiety. Multilevel modeling found that acculturation (Anglo orientation, b=0.050, SE=0.379, t (137.561)=0.134, p=0.894; Mexican orientation, b=0.775, SE=0.692, t (133.424)=1.121, p=0.264) and perceived discrimination (b=-1.259, SE=0.921, t (137.489)=-1.367, p=0.174) were not associated with the trajectory of anxiety symptoms. However, acculturative stress, even while controlling for perceived stress, was associated with high levels of anxiety symptoms that were elevated early in pregnancy (b=-0.045, SE=0.022, t (135.749)=-2, p=0.047). This work highlights the unique role of acculturative stress in risk for prenatal anxiety in early pregnancy.
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Affiliation(s)
- Andrea Preciado
- Department of Psychology, California State University San Marcos, United States.
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81
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A randomized controlled trial: effects of a prenatal depression intervention on perinatal outcomes among Chinese high-risk pregnant women with medically defined complications. Arch Womens Ment Health 2017; 20:333-344. [PMID: 28058505 DOI: 10.1007/s00737-016-0712-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/26/2016] [Indexed: 12/21/2022]
Abstract
UNLABELLED Prenatal psychosocial health has been linked with health behaviors, maternal health, and birth outcomes. This randomized controlled trial evaluated the effects of a prenatal depression intervention on birth outcomes and maternal physical and psychological status at 42 days postpartum. Three hundred fifty-two high-risk pregnant women exposed to obstetric complications with an Edinburgh Postnatal Depression Scale (EPDS) ≥ 9 or a Postpartum Depression Screening Scale (PDSS) ≥ 60 were randomly assigned to the intervention group (n = 176) and control group (n = 176). The intervention group underwent a six-session couple-separated psycho-educational program; the control group received the usual care. All participants were asked to complete questionnaires at late pregnancy (>28 weeks), 3 days postpartum, and 42 days postpartum. The intervention group had a significantly lower cesarean rate and shorter third stage of labor (p < .05). At 42 days after delivery, only 5.1% of participants were lost to follow-up, and the intervention group had significantly less minor and major depression, more sleep time, more satisfaction with their husband and other family members, less concern about taking care of baby, and less breast milk insufficiency than the control group (p < .05). A prenatal psychological intervention model for high-risk pregnant women holds potential as a preventive program that addresses maternal health and birth outcomes. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR-IOR-15006433), http://www.chictr.org.cn/enIndex.aspx (retrospectively registered).
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82
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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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Paulzen M, Goecke TW, Stickeler E, Gründer G, Schoretsanitis G. Sertraline in pregnancy - Therapeutic drug monitoring in maternal blood, amniotic fluid and cord blood. J Affect Disord 2017; 212:1-6. [PMID: 28129551 DOI: 10.1016/j.jad.2017.01.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/16/2017] [Accepted: 01/19/2017] [Indexed: 12/11/2022]
Abstract
RATIONALE This study is the first to measure and correlate sertraline concentrations in maternal blood, amniotic fluid and umbilical cord blood and account for distribution of the drug between these three compartments. METHODS Concentrations of sertraline were measured in six mother infant pairs at the time of delivery. Data are provided as median values, first and third quartiles as well as ranges. To account for the penetration ratio into amniotic fluid and cord blood, the concentration of sertraline in both environments was divided by the concentration in maternal serum. Daily doses were correlated with maternal serum- and umbilical cord blood-concentrations, and serum levels were correlated with levels in amniotic fluid. RESULTS The median daily dose of sertraline was 75mg (Q1: 43.75mg, Q3: 100mg; range 25-100mg). Amniotic fluid concentrations of sertraline strongly correlated with the daily dose (r=0.833, p=0.039) while neither maternal serum concentrations nor cord blood concentrations correlated with the daily dose (p>0.05). The median penetration ratio for sertraline into amniotic fluid was 0.57 (Q1: 0.28, Q3: 0.75; range: 0.22-0.88). The median penetration ratio into the fetal circulation, calculated on the basis of umbilical cord blood-concentrations, was found to be 0.36 (Q1: 0.28, Q3: 0.49; range: 0.17-0.65). CONCLUSIONS Sertraline concentrations in amniotic fluid gave evidence that maternally administered sertraline is constantly accessible to the fetus via amniotic fluid in a manner not previously appreciated. A relatively low penetration into fetal circulation may contribute to a sufficient safety profile of sertraline during pregnancy although in our study APGAR Scores were relatively low in three infants. Our data support the important role of therapeutic drug monitoring in maintaining the safety of pregnant women and exposed infants.
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Affiliation(s)
- Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, JARA - Translational Brain Medicine, Aachen, Germany.
| | - Tamme W Goecke
- Department of Gynecology and Obstetrics, RWTH Aachen University, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, RWTH Aachen University, Germany
| | - Gerhard Gründer
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, JARA - Translational Brain Medicine, Aachen, Germany
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, JARA - Translational Brain Medicine, Aachen, Germany; University Hospital of Psychiatry, Bern, Switzerland
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84
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Huizink A, Menting B, De Moor M, Verhage ML, Kunseler F, Schuengel C, Oosterman M. From prenatal anxiety to parenting stress: a longitudinal study. Arch Womens Ment Health 2017; 20. [PMID: 28634716 PMCID: PMC5599437 DOI: 10.1007/s00737-017-0746-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to explore how maternal mood during pregnancy, i.e., general anxiety, pregnancy-specific anxiety, and depression predicted parenting stress 3 months after giving birth, thereby shaping the child's early postnatal environmental circumstances. To this end, data were used from 1073 women participating in the Dutch longitudinal cohort Generations2, which studies first-time pregnant mothers during pregnancy and across the transition to parenthood. Women filled out the State Trait Anxiety Inventory (STAI), Pregnancy-Related Anxiety Questionnaire-revised (PRAQ-R), and Beck Depression Index (BDI) three times during pregnancy: at 12, 22, and 32 weeks gestational age. Three months postpartum, a parenting stress questionnaire was filled out yielding seven different parenting constructs. Latent scores were computed for each of the repeatedly measured maternal mood variables with Mplus and parenting stress constructs were simultaneously regressed on these latent scores. Results showed that trait anxiety and pregnancy-specific anxiety were uniquely related to almost all parenting stress constructs, taking depression into account. Early prevention and intervention to reduce maternal anxiety in pregnancy could hold the key for a more advantageous trajectory of early postnatal parenting.
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Affiliation(s)
- A.C. Huizink
- Department of Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands ,Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - B. Menting
- Department of Clinical Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands ,Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, The Netherlands
| | - M.H.M. De Moor
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - M. L. Verhage
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - F.C. Kunseler
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - C. Schuengel
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - M. Oosterman
- Section of Clinical Child and Family Studies, Department of Educational and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands ,EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
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85
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Giurgescu C, Engeland CG, Templin TN. Symptoms of Depression Predict Negative Birth Outcomes in African American Women: A Pilot Study. J Midwifery Womens Health 2016; 60:570-7. [PMID: 26461192 DOI: 10.1111/jmwh.12337] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION African American women have higher rates of preterm birth and low-birth-weight infants compared with non-Hispanic white women. Symptoms of depression have also been related to these negative birth outcomes. Lower levels of social support and higher levels of avoidance coping and cortisol have been related to more symptoms of depression in pregnant women. The purpose of this pilot study was to examine the relationships among symptoms of depression, social support, avoidance coping, cortisol, and negative birth outcomes (ie, preterm birth, low-birth-weight infants) in a sample of African American women. METHODS This study used a prospective design. A convenience sample of 90 African American women completed questionnaires and had blood drawn in the second trimester of pregnancy. Birth data were collected from medical records. RESULTS Based on the Center for Epidemiological Studies-Depression (CES-D) Scale scores, 28% of women were at increased risk for clinical depression (CES-D ≥ 16). Compared to women who gave birth at term, women who had preterm birth had higher CES-D scores (11.67 and 19.0, respectively) and used avoidance coping more often (7.98 and 13.14, respectively). Compared to women with normal-birth-weight infants, women with low-birth-weight infants had higher levels of cortisol (61.75 mcg/dL and 89.72 mcg/dL, respectively). Women at increased risk for clinical depression were 16 times more likely to have preterm birth and 4 times more likely to have low-birth-weight infants. Women with plasma cortisol levels in the top 25th percentile were 7 times more likely to have low-birth-weight infants. Preeclampsia during pregnancy also predicted preterm birth and low-birth-weight infants. DISCUSSION Symptoms of depression in pregnancy may predict adverse birth outcomes. Interventions that have the potential to improve the mental health of pregnant women and ultimately birth outcomes need to be explored.
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86
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Gariepy AM, Lundsberg LS, Miller D, Stanwood NL, Yonkers KA. Are pregnancy planning and pregnancy timing associated with maternal psychiatric illness, psychological distress and support during pregnancy? J Affect Disord 2016; 205:87-94. [PMID: 27423065 PMCID: PMC5048515 DOI: 10.1016/j.jad.2016.06.058] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/26/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pregnancy planning and timing may be associated with psychiatric illness, psychological distress and support during pregnancy. METHODS We performed secondary analyses of a prospective cohort of 2654 pregnant women evaluating the impact of depression on preterm birth. We used multivariable logistic regression to test associations between pregnancy planning ("Was this pregnancy planned? Yes/No") and/or timing ("Do you think this is a good time for you to be pregnant?") with Composite International Diagnostic Interview generated psychiatric diagnoses and measures of psychological distress and support. RESULTS 37% and 13% of participants reported an unplanned or poorly timed pregnancy, respectively. Unplanned pregnancies were associated with a Major Depressive Episode (MDE) (adjusted odds ratio (aOR) 1.69, 95%CI 1.23-2.32) and the Cohen Perceived Stress Scale's (CPSS) highest quartile (aOR 1.74, 95%CI 1.40-2.16). Poorly timed pregnancies were associated with a MDE (aOR 3.47, 95%CI 2.46-4.91) and the CPSS's highest quartile (aOR 5.20, 95%CI 3.93-6.87). Poorly timed pregnancies were also associated with General Anxiety Disorder (GAD; aOR 1.60, 95%CI 1.07-2.40), and the modified Kendler Social Support Inventory's (MKSSI) lowest quartile (aOR 1.64, 95%CI 1.25-2.16). Psychiatric conditions were strongly associated with planned pregnancies that were subsequently deemed poorly timed (MDE=aOR 5.08, 95%CI 2.52-10.25; GAD=aOR 2.28, 95%CI 1.04-5.03); high CPSS=aOR 6.48, 95%CI 3.59-11.69; and low MKSSI=aOR 3.19, 95%CI 1.81-5.62. LIMITATIONS Participant characteristics may limit generalizability of findings. CONCLUSIONS Pregnancy timing was a stronger predictor of maternal psychiatric illness, psychological distress and low social support than pregnancy planning in our cohort.
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Affiliation(s)
- Aileen M Gariepy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States.
| | - Lisbet S Lundsberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | - Devin Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | - Nancy L Stanwood
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | - Kimberly A Yonkers
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
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87
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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: 609] [Impact Index Per Article: 76.1] [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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88
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Kim JJ, Silver RK, Elue R, Adams MG, La Porte LM, Cai L, Kim JB, Gibbons RD. The experience of depression, anxiety, and mania among perinatal women. Arch Womens Ment Health 2016; 19:883-90. [PMID: 27188618 DOI: 10.1007/s00737-016-0632-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/30/2016] [Indexed: 10/21/2022]
Abstract
We assessed differential item functioning (DIF) based on computerized adaptive testing (CAT) to examine how perinatal mood disorders differ from adult psychiatric disorders. The CAT-Mental Health (CAT-MH) was administered to 1614 adult psychiatric outpatients and 419 perinatal women with IRB approval. We examined individual item-level differences using logistic regression and overall score differences by scoring the perinatal data using the original bifactor model calibration based on the psychiatric sample data and a new bifactor model calibration based on the perinatal data and computing their correlation. To examine convergent validity, we computed correlations of the CAT-MH with contemporaneously administered Edinburgh Postnatal Depression Scales (EPDS). The rate of major depression in the perinatal sample was 13 %. Rates of anxiety, mania, and suicide risk were 5, 6, and 0.4 %, respectively. One of 66 depression items, one of 69 anxiety items, and 15 of 53 mania items exhibited DIF (i.e., failure to discriminate between high and low levels of the disorder) in the perinatal sample based on the psychiatric sample calibration. Removal of these items resulted in correlations of the original and perinatal calibrations of r = 0.983 for depression, r = 0.986 for anxiety, and r = 0.932 for mania. The 91.3 % of cases were concordantly categorized as either "at-risk" or "low-risk" between the EPDS and the perinatal calibration of the CAT-MH. There was little evidence of DIF for depression and anxiety symptoms in perinatal women. This was not true for mania. Now calibrated for perinatal women, the CAT-MH can be evaluated for longitudinal symptom monitoring.
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Affiliation(s)
- J Jo Kim
- NorthShore University HealthSystem, 2650 Ridge Avenue, Walgreen Suite 1507, Evanston, IL, 60201, USA. .,University of Chicago, Chicago, USA.
| | - Richard K Silver
- NorthShore University HealthSystem, 2650 Ridge Avenue, Walgreen Suite 1507, Evanston, IL, 60201, USA.,University of Chicago, Chicago, USA
| | - Rita Elue
- NorthShore University HealthSystem, 2650 Ridge Avenue, Walgreen Suite 1507, Evanston, IL, 60201, USA
| | - Marci G Adams
- NorthShore University HealthSystem, 2650 Ridge Avenue, Walgreen Suite 1507, Evanston, IL, 60201, USA
| | - Laura M La Porte
- NorthShore University HealthSystem, 2650 Ridge Avenue, Walgreen Suite 1507, Evanston, IL, 60201, USA
| | - Li Cai
- University of California Los Angeles, Los Angeles, USA
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89
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Leff-Gelman P, Mancilla-Herrera I, Flores-Ramos M, Cruz-Fuentes C, Reyes-Grajeda JP, García-Cuétara MDP, Bugnot-Pérez MD, Pulido-Ascencio DE. The Immune System and the Role of Inflammation in Perinatal Depression. Neurosci Bull 2016; 32:398-420. [PMID: 27432060 PMCID: PMC5563787 DOI: 10.1007/s12264-016-0048-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/23/2016] [Indexed: 01/01/2023] Open
Abstract
Major depression during pregnancy is a common psychiatric disorder that arises from a complex and multifactorial etiology. Psychosocial stress, sex, hormones, and genetic vulnerability increase the risk for triggering mood disorders. Microglia and toll-like receptor 4 play a crucial role in triggering wide and varied stress-induced responses mediated through activation of the inflammasome; this leads to the secretion of inflammatory cytokines, increased serotonin metabolism, and reduction of neurotransmitter availability along with hypothalamic-pituitary-adrenal axis hyperactivity. Dysregulation of this intricate neuroimmune communication network during pregnancy modifies the maternal milieu, enhancing the emergence of depressive symptoms and negative obstetric and neuropsychiatric outcomes. Although several studies have clearly demonstrated the role of the innate immune system in major depression, it is still unclear how the placenta, the brain, and the monoaminergic and neuroendocrine systems interact during perinatal depression. Thus, in the present review we describe the cellular and molecular interactions between these systems in major depression during pregnancy, proposing that the same stress-related mechanisms involved in the activation of the NLRP3 inflammasome in microglia and peripheral myeloid cells in depressed patients operate in a similar fashion in the neuroimmune placenta during perinatal depression. Thus, activation of Toll-like receptor 2 and 4 signaling and the NLRP3 inflammasome in placental immune cells may promote a shift of the Th1/Th2 bias towards a predominant Th1/Th17 inflammatory response, associated with increased secretion of pro-inflammatory cytokines, among other secreted autocrine and paracrine mediators, which play a crucial role in triggering and/or exacerbating depressive symptoms during pregnancy.
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Affiliation(s)
| | | | - Mónica Flores-Ramos
- National Institute of Psychiatry, Mexico City, Mexico
- National Council of Science and Technology, Mexico City, Mexico
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90
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Barcelona de Mendoza V, Harville E, Theall K, Buekens P, Chasan-Taber L. Effects of acculturation on prenatal anxiety among Latina women. Arch Womens Ment Health 2016; 19:635-44. [PMID: 26790686 PMCID: PMC4956601 DOI: 10.1007/s00737-016-0605-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 01/09/2016] [Indexed: 12/16/2022]
Abstract
Anxiety in pregnancy has been associated with adverse birth outcomes. Relatively few studies have investigated how acculturation affects mental health in pregnancy among Latinas. The goal of this study was to determine if acculturation was associated with anxiety over the course of pregnancy in a sample of predominantly Puerto Rican women. Women were recruited in pregnancy for participation in Proyecto Buena Salud, a prospective cohort study of Latina women (n = 1412). Acculturation was measured via the Psychological Acculturation Scale (PAS), language preference and generation in the USA. Anxiety was measured using the State-Trait Anxiety Instrument. Linear and logistic multivariable regressions were used to investigate associations. After adjustment, women with bicultural identification had significantly lower trait anxiety scores in early pregnancy (β = -3.62, SE = 1.1, p < 0.001) than low acculturated women. Women with higher levels of acculturation as indicated by English-language preference (β = 1.41, SE = 0.7, p = 0.04) and second or third generation in the USA had significantly higher trait anxiety scores in early pregnancy (β = 1.83, SE = 0.6, p < 0.01). Bicultural psychological acculturation was associated with lower trait anxiety in early pregnancy, while English-language preference and higher generation in the USA were associated with higher trait anxiety in early pregnancy.
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Affiliation(s)
- Veronica Barcelona de Mendoza
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA.
- Yale University School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA.
| | - Emily Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA
| | - Katherine Theall
- Department of Global Community Health and Behavioral Science, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA
| | - Pierre Buekens
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA, 70112, USA
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, University of Massachusetts School of Public Health and Health Sciences, 405 Arnold House, 715 N Pleasant Street, Amherst, MA, 01003, USA
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91
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Zhao Y, Kane I, Mao L, Shi S, Wang J, Lin Q, Luo J. The Prevalence of Antenatal Depression and its Related Factors in Chinese Pregnant Women who Present with Obstetrical Complications. Arch Psychiatr Nurs 2016; 30:316-21. [PMID: 27256935 DOI: 10.1016/j.apnu.2015.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/20/2015] [Accepted: 11/22/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The psychological status of Chinese pregnant women who present with obstetrical complications is concerning to Chinese health professionals. This study aimed to investigate the prevalence of antenatal depression and analyzed related risk factors in a population of high-risk Chinese women. DESIGN A large sample size, cross-sectional study. METHODS A total of 842 pregnant women with complications completed the Chinese version of the Postpartum Depression Screen Scale (PDSS) in this cross-sectional study. t-Test, ANOVA and Binary logistic regression tests were used in data analysis of antenatal depression and risk factors. RESULTS The prevalence of major or minor depression in high-risk Chinese pregnant women during antenatal period was 8.3% and 28.9%, respectively. Independent-sample t-test and two-way analysis of variance (ANOVA) indicated significant differences in age, education, occupation and the number of complications (P<0.05). Binary logistic regression analysis indicated a significant negative association between depression and education (P<0.01) with lower educational level (OR: 0.590; 95% CI: 0.424-0.820) associated with a higher risk for depression. A significant positive association was observed between depression and age (P<0.05) with higher age (OR: 1.338; 95% CI: 1.008-1.774) correlated with a higher risk for depression. CONCLUSIONS Women who experienced obstetric complications presented with higher PDSS depression scores. Screening for antenatal depression in high-risk pregnant women to promote early detection of depression and reduce health risks for universal health promotion is recommended.
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Affiliation(s)
- Ying Zhao
- School of Nursing, Fudan University, Shanghai PR China; Psychiatry Department, Fudan University affiliated Huashan Hospital, Shanghai, PR China
| | - Irene Kane
- University of Pittsburgh, School of Nursing, Pittsburgh, PA
| | - Liping Mao
- Fudan University affiliated Women's Hospital, Shanghai, PR China.
| | - Shenxun Shi
- Psychiatry Department, Fudan University affiliated Huashan Hospital, Shanghai, PR China
| | - Jing Wang
- Fudan University affiliated Women's Hospital, Shanghai, PR China
| | - Qiping Lin
- Fudan University affiliated Women's Hospital, Shanghai, PR China.
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, PR China
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92
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Prenatal Maternal Anxiety as a Risk Factor for Preterm Birth and the Effects of Heterogeneity on This Relationship: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8312158. [PMID: 27298829 PMCID: PMC4889802 DOI: 10.1155/2016/8312158] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 04/03/2016] [Indexed: 01/28/2023]
Abstract
Background. Systematic reviews (SR) and meta-analyses (MA) that previously explored the relationship between prenatal maternal anxiety (PMA) and preterm birth (PTB) have not been comprehensive in study inclusion, failing to account for effects of heterogeneity and disagree in their conclusions. Objectives. This SRMA provides a summary of the published evidence of the relationship between PMA and PTB while examining methodological and statistical sources of heterogeneity. Methods. Published studies from MEDLINE, CINAHL, PsycINFO, and EMBASE, until June 2015, were extracted and reviewed. Results. Of the 37 eligible studies, 31 were used in this MA; six more were subsequently excluded due to statistical issues, substantially reducing the heterogeneity. The odds ratio for PMA was 1.70 (95% CI 1.33, 2.18) for PTB and 1.67 (95% CI 1.35, 2.07) for spontaneous PTB comparing higher levels of anxiety to lower levels. Conclusions. Consistent findings indicate a significant association between PMA and PTB. Due to the statistical problem of including collinear variables in a single regression model, it is hard to distinguish the effect of the various types of psychosocial distress on PTB. However, a prenatal program aimed at addressing mental health issues could be designed and evaluated using a randomised controlled trial to assess the causal nature of different aspects of mental health on PTB.
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93
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Abstract
PURPOSE This study examined the relationships among father of the baby involvement during pregnancy, depressive symptoms, and psychological well-being in African American women. STUDY DESIGN AND METHODS Using a prospective study design, a sample of 95 pregnant African American women receiving prenatal care at a medical center in Chicago completed the self-report instruments about father of the baby involvement, depressive symptoms, and psychological well-being twice during pregnancy, once at between 15 and 25 weeks and once between 25 and 37 weeks. RESULTS Eighty percent of women reported that the father of the baby was involved during their pregnancy. Twenty-eight percent of women had clinically relevant depressive symptoms (CES-D scores ≥16) at the first data collection and 25% of women had clinically relevant depressive symptoms at the second data collection. Compared with women who reported no father involvement during pregnancy, women who reported father involvement during pregnancy had lower levels of depressive symptoms and higher levels of psychological well-being. CLINICAL IMPLICATIONS Fathers' involvement is important during pregnancy; nurses should encourage fathers to participate at prenatal visits and ask questions, and educate fathers on pregnancy process and procedures during prenatal care.
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94
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Venkatesh KK, Riley L, Castro VM, Perlis RH, Kaimal AJ. Association of Antenatal Depression Symptoms and Antidepressant Treatment With Preterm Birth. Obstet Gynecol 2016; 127:926-933. [PMID: 27054941 PMCID: PMC10034858 DOI: 10.1097/aog.0000000000001397] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the association of antenatal depression symptoms with preterm birth and small for gestational age (SGA). METHODS This was an observational cohort study conducted among women who completed Edinburgh Postnatal Depression Scale screening and delivered at 20 weeks of gestation or greater. The primary outcomes were preterm birth and an SGA neonate at birth (less than 10th percentile for gestational age); the primary predictor was an Edinburgh Postnatal Depression Scale antepartum score of 10 or greater, indicating symptoms of depression. Logistic regression models were used with and without consideration of antidepressant exposure during pregnancy. RESULTS Among 7,267 women, 831 (11%) screened positive for depression. In multivariable analyses adjusting for maternal age, race, income, body mass index, tobacco use, lifetime diagnosis of major depression and anxiety, diabetes, hypertension, and preeclampsia, women who screened positive for depression experienced an increased risk of preterm birth (less than 37 weeks of gestation) (adjusted odds ratio [OR] 1.27, 95% confidence interval [CI] 1.04-1.55) and very preterm birth (less than 32 weeks of gestation) (adjusted OR 1.82, 95% CI 1.09-3.02) as well as of having an SGA neonate (adjusted OR 1.28, 95% CI 1.04-1.58). In secondary analyses, among women who were treated with an antidepressant during pregnancy (19% of those who screened positive and 5% of those who screened negative), depressive symptoms were not associated with a significantly increased risk of preterm and very preterm birth or an SGA neonate. CONCLUSIONS In a large cohort of women screened for depression antepartum, those with depressive symptoms had an increased likelihood of preterm and very preterm delivery as well having an SGA neonate. Such risk was not apparent among women who were treated with an antidepressant medication.
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Affiliation(s)
- Kartik K Venkatesh
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Brigham and Women's Hospital, the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, and the Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, and the Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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95
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Liou SR, Wang P, Cheng CY. Effects of prenatal maternal mental distress on birth outcomes. Women Birth 2016; 29:376-80. [PMID: 27079210 DOI: 10.1016/j.wombi.2016.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/18/2016] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Adverse effects of maternal mental distress during pregnancy have been extensively investigated, but the impact of prenatal maternal mental distress at various time periods during pregnancy on birth outcomes is rarely discussed. By understanding the relationship between maternal mental distress and unfavourable birth outcomes throughout pregnancy, appropriate evidence-based preventative care or intervention may be adopted in a timely manner. AIM This study intended to investigate the effects of maternal stress, anxiety, and depressive symptoms across pregnancy on preterm birth and low birth weight. METHODS With a prospective longitudinal design, this study used the 10-item Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and Zung Self-reported Anxiety Scale to investigate 197 participants who, at greater than 24 gestational weeks, completed the self-administered questionnaires during regular checkups in a hospital in southern Taiwan. Descriptive statistics, Mann-Whitney U test/Kruskal-Wallis test, and hierarchical logistic regression were applied for data analysis. FINDINGS The study found that anxiety and depressive symptoms at 25-29 gestational weeks could predict preterm birth, and that anxiety at greater than 30 gestational weeks was able to predict low birthweight. However, stress was not able to predict any kind of negative birth outcomes. CONCLUSION Adverse birth outcomes were somewhat predictable by maternal mental distress; therefore, we suggested that prenatal visits incorporate psychological assessment for early detection and management to prevent possible adverse birth outcomes.
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Affiliation(s)
- Shwu-Ru Liou
- College of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan
| | - Panchalli Wang
- Department of Obstetrics and Gynecology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Taiwan
| | - Ching-Yu Cheng
- College of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan.
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96
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Accortt EE, Cheadle ACD, Dunkel Schetter C. Prenatal depression and adverse birth outcomes: an updated systematic review. Matern Child Health J 2016; 19:1306-37. [PMID: 25452215 DOI: 10.1007/s10995-014-1637-2] [Citation(s) in RCA: 210] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Complications related to preterm birth (PTB) and low birth weight (LBW) are leading causes of infant morbidity and mortality. Prenatal depression is a hypothesized psychosocial risk factor for both birth outcomes. The purpose of this systematic review was to examine evidence published between 1977 and 2013 on prenatal depression and risks of these primary adverse birth outcomes. A systematic search of the PUBMED and PsycINFO databases was conducted to identify studies testing the associations between prenatal depressive symptoms, or diagnoses of depression, and risk of PTB or LBW. We systematically selected 50 published reports on PTB and length of gestation, and 33 reports on LBW and BW. Results were reviewed by two independent reviewers and we evaluated the quality of the evidence with an established systematic review method, the Newcastle Ottawa Scale. We then undertook a narrative synthesis of the results following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Less than a quarter of 50 published reports found that prenatal depression was significantly associated with PTB or gestational age. In contrast, slightly more than half of the 33 reports found that prenatal depression was associated with LBW or BW. When weighing methodological features, we determined that the effects of prenatal depression on LBW are more consistent than effects on length of gestation or PTB. Although the evidence may not be strong enough to support routine depression screening for risk of adverse outcomes, screening to enable detection and timely treatment to reduce risk of postpartum depression is warranted. Further rigorous research on prenatal depression and adverse birth outcomes is needed.
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Affiliation(s)
- Eynav Elgavish Accortt
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA,
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97
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Giurgescu C, Murn NL. Church Member Support Benefits Psychological Well-Being of Pregnant African American Women. J Christ Nurs 2016; 33:87-91. [PMID: 27119803 PMCID: PMC4849137 DOI: 10.1097/cnj.0000000000000256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Depression during pregnancy is common, and pregnant African American (AA) women are more likely to experience depressive symptoms compared with pregnant non-Hispanic white women. This study explored AA women's experience of church attendance, church member support, depressive symptoms, and psychological well-being at 15-25 weeks' gestation. Nurses need to be aware of the importance of church support and encourage clergy and church members to be supportive of pregnant women.
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98
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László KD, Li J, Olsen J, Vestergaard M, Obel C, Cnattingius S. Maternal bereavement and the risk of preterm delivery: the importance of gestational age and of the precursor of preterm birth. Psychol Med 2016; 46:1163-1173. [PMID: 26646988 DOI: 10.1017/s0033291715002688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Maternal stress during pregnancy may increase the risk of preterm delivery (PD), but the associations between stress and subtypes of PD are not clear. We investigated maternal loss of a close relative and risks of very and moderately PD (<32 and 32-36 weeks, respectively) and spontaneous and medically indicated PD. METHOD We studied 4 940 764 live singleton births in Denmark (1978-2008) and Sweden (1973-2006). We retrieved information on death of women's family members (children, partner, siblings, parents), birth outcomes and maternal characteristics from nationwide registries. RESULTS Overall, the death of a close family member the year before pregnancy or in the first 36 weeks of pregnancy was associated with a 7% increased risk of PD [95% confidence interval (CI) 1.04-1.10]. The highest hazard ratios (HR) for PD were found for death of an older child [HR (95% CI) 1.20 (1.10-1.31)] and for death of a partner [HR (95% CI) 1.31 (1.03-1.66)]. These losses were associated with higher risks of very preterm [HR (95% CI) 1.61 (1.29-2.01) and 2.07 (1.15-3.74), respectively] than of moderately preterm [HR (95% CI) 1.14 (1.03-1.26) and 1.22 (0.94-1.58), respectively] delivery. There were no substantial differences in the association between death of a child or partner and the risk of spontaneous v. medically indicated PD. CONCLUSIONS Death of a close family member the year before or during pregnancy was associated with an increased risk of PD, especially very PD. Possible mechanisms include both spontaneous and medically indicated preterm birth.
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Affiliation(s)
- K D László
- Clinical Epidemiology Unit, Department of Medicine,Karolinska University Hospital and Karolinska Institute,Stockholm,Sweden
| | - J Li
- Section for Epidemiology,Department of Public Health,Aarhus University,Aarhus,Denmark
| | - J Olsen
- Section for Epidemiology,Department of Public Health,Aarhus University,Aarhus,Denmark
| | - M Vestergaard
- Research Unit for General Practice,Department of Public Health,Aarhus University,Aarhus,Denmark
| | - C Obel
- Research Unit for General Practice,Department of Public Health,Aarhus University,Aarhus,Denmark
| | - S Cnattingius
- Clinical Epidemiology Unit, Department of Medicine,Karolinska University Hospital and Karolinska Institute,Stockholm,Sweden
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99
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Scheyer K, Urizar GG. Altered stress patterns and increased risk for postpartum depression among low-income pregnant women. Arch Womens Ment Health 2016; 19:317-28. [PMID: 26275372 PMCID: PMC4754170 DOI: 10.1007/s00737-015-0563-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 07/30/2015] [Indexed: 12/29/2022]
Abstract
Postpartum depression (PPD) has been associated with a number of negative maternal and infant health outcomes. Despite these adverse health effects, few studies have prospectively examined patterns of pre- and postnatal stress that may increase a woman's risk for PPD. The current study examined whether the timing of altered salivary cortisol patterns and perceived stress levels during pregnancy and at 3 months postpartum was associated with PPD symptoms among 100 low-income mothers. Higher levels of PPD were found among women with a lower cortisol awakening response (first and second trimester), lower average daily cortisol (second trimester), a flatter diurnal cortisol pattern (second and third trimester and at 3 months postpartum), and a less abrupt drop in both cortisol and perceived stress from the third trimester to 3 months postpartum. These results support the need for early screening and regulation of stress levels to promote depression prevention efforts in at-risk populations.
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Affiliation(s)
- Kathryn Scheyer
- Department of Psychology, California State University, 1250 Bellflower Blvd, Long Beach, CA, 90840-0901, USA
| | - Guido G Urizar
- Department of Psychology, California State University, 1250 Bellflower Blvd, Long Beach, CA, 90840-0901, USA.
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Alibekova R, Huang JP, Lee TSH, Au HK, Chen YH. Effects of smoking on perinatal depression and anxiety in mothers and fathers: A prospective cohort study. J Affect Disord 2016; 193:18-26. [PMID: 26766030 DOI: 10.1016/j.jad.2015.12.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/14/2015] [Accepted: 12/19/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Considerable concern persists on tobacco use during perinatal periods. No study has simultaneously investigated the longitudinal association of paternal smoking with maternal and paternal depressive and anxiety symptoms during perinatal periods. METHODS In this prospective study, 533 couples (pregnant women and their husbands) completed 5 self-report instruments from early pregnancy until 6 months postpartum. Generalized estimating equations were used for the analyses. RESULTS We found that fathers who smoked in the mother's presence had higher depressive (regression coefficient=1.0, 95% confidence interval (CI) 0.3-1.8) and anxiety symptoms (3.0, 95% CI=1.2-4.7) during perinatal periods compared with nonsmoking fathers. Paternal smoking in the mother's presence also increased maternal disturbances, especially for depression during pregnancy (1.2, 95% CI=0.1-2.3) and anxiety during the postpartum period (3.4, 95% CI=0.6-6.3). No significant association was found between paternal smoking but not in the mother's presence and maternal emotional disturbances. Paternal smoking but not in the mother's presence affected only paternal anxiety, especially in the postpartum period (regression coefficient 2.7, 95% CI 0.7-4.7) compared with nonsmokers. LIMITATIONS Self-report measures were used. The effects of maternal smoking could not be estimated because of the small sample of pregnant women who disclosed their smoking status. CONCLUSIONS These findings imply a necessity to combine strategies for smoking cessation with interventions for affective disturbances in fathers. We also stress the importance of at least restricting the father's smoking in the presence of the pregnant wife during perinatal periods if smoking cessation is tentatively unattainable.
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Affiliation(s)
- Raushan Alibekova
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Education, National Taiwan Normal University, Taipei, Taiwan
| | - Heng-Kien Au
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
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