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Savitsky B, Radomislensky I, Frid Z, Gitelson N, Glasser S, Hendel T. Ethnic disparities in receiving benefits for disability following postpartum mental illness during first two years after delivery: an Israeli nationwide study. Isr J Health Policy Res 2020; 9:63. [PMID: 33168058 PMCID: PMC7650171 DOI: 10.1186/s13584-020-00407-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite relatively high rates of Postpartum Depression (PPD), little is known about the granting of social security benefits to women who are disabled as a result of PPD or of other postpartum mood and anxiety disorders (PMAD). This study aims to identify populations at risk for underutilization of social security benefits due to PMAD among Israeli women, with a focus on ethnic minorities. METHODS This retrospective cohort study is based on the National Insurance Institute (NII) database. The study population included a simple 10% random sample of 79,391 female Israeli citizens who gave birth during 2008-2016 (these women delivered a total of 143,871 infants during the study period), and who had not been eligible for NII mental health disability benefits before 2008. The dependent variable was receipt of Benefit Entitlement (BE) due to mental illness within 2 years following childbirth. Maternal age at delivery, population group, Socio-Economic Status (SES), family status, employment status of the mother and her spouse, and infant mortality were the independent variables. Left truncation COX proportional hazard model with time-dependent variables was used, and birth number served as a time discrete variable. RESULTS Bedouin and Arab women had significantly lower likelihood of BE (2.6 times lower and twice lower) compared with other ethnic groups (HR = 0.38; 95% CI: 0.26-0.56; HR = 0.47; 95% CI: 0.37-0.60 respectively). The probability of divorced or widowed women for BE was significantly higher compared to those living with a spouse (HR = 3.64; 95% CI: 2.49-5.33). Lack of employment was associated with higher likelihood of BE (HR = 1.54; 95% CI: 1.30-1.82). Income had a dose-response relationship with BE in multivariable analysis: lower income was associated with the nearly four-fold greater probability compared to the highest income quartile (HR = 3.83; 95% CI: 2.89-5.07). CONCLUSIONS Despite the exceptionally high prevalence of PMAD among ethnic minorities, Bedouins and Arabs had lowest likelihood of Benefit Entitlement. In addition to developing programs for early identification of postpartum emotional disorders among unprivileged ethnic groups, awareness regarding entitlement to a mental health disability allowance among ethnic minorities should be improved.
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Affiliation(s)
- Bella Savitsky
- Department of Nursing, Ashkelon Academic College, School of Health Sciences, Yitshak Ben Zvi 12, Ashkelon, Israel
| | - Irina Radomislensky
- Gertner Institute for Epidemiology and Public Health Policy, Sheba Medical Center Tel-Hashomer, Ramat Gan, Israel
| | - Zhanna Frid
- The National Insurance Institute of Israel, Research Center, Sderot Weizmann 13, Jerusalem, Israel
| | - Natalia Gitelson
- The National Insurance Institute of Israel, Research Center, Sderot Weizmann 13, Jerusalem, Israel
| | - Saralee Glasser
- Women & Children’s Health Research Unit Gertner, Institute for Epidemiology and Public Health Policy, Sheba Medical Center Tel-Hashomer, Ramat Gan, Israel
| | - Tova Hendel
- Department of Nursing, Ashkelon Academic College, School of Health Sciences, Yitshak Ben Zvi 12, Ashkelon, Israel
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152
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Asadi M, Noroozi M, Alavi M. Factors Affecting Women's Adjustment to Postpartum Changes: A Narrative Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:463-470. [PMID: 33747834 PMCID: PMC7968582 DOI: 10.4103/ijnmr.ijnmr_54_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/10/2020] [Accepted: 09/19/2020] [Indexed: 10/29/2022]
Abstract
Background Postpartum period is associated with stress and pressure, and the woman must adjust herself to these changes. This study aimed to review the factors affecting women's adjustment to postpartum changes in conducted studies. Materials and Methods This review was conducted by searching databases such as ISI Web of Science, Science Direct, Scopus, Cochrane, PubMed and Scientific Information Database (SID), Iranian Medical Articles Database (IranMedex), Iranian Research Institute for Information Science and Technology (IranDoc), and the Iranian Magazine Database (MagIran), as well as searching through Google Scholar (as a Web search engine) in December 2019. Publications from July 2004 to October 2019 were reviewed and limited to Persian and English. The keywords used included "Postpartum", "Women's needs", "Adjustment" and "Coping". After reviewing the articles, out of 60 original articles, 17 articles were selected for final evaluation. Results Factors affecting adjustment to postpartum changes were divided into personal and social factors. Personal factors included previous experiences, coping styles and strategies, personality traits, self-efficacy and awareness, and social factors included family and relatives, healthcare providers, cultural context, and laws and regulations. Conclusions Adjustment to postpartum changes depends on the personal and social factors that can interact with each other. Women's awareness enables them to use positive coping strategies in this critical situation. Educating women's spouse and family members can contribute to increase the women's social support. Additionally, the law support guarantees the implementation of many interventions in promoting the mother's health.
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Affiliation(s)
- Mahboobeh Asadi
- Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.,Faculty of Nursing and Midwifery, Department of Midwifery, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Mahnaz Noroozi
- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mousa Alavi
- Department of Psychiatric Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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153
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Gheorghe M, Varin M, Wong SL, Baker M, Grywacheski V, Orpana H. Symptoms of postpartum anxiety and depression among women in Canada: findings from a national cross-sectional survey. Canadian Journal of Public Health 2020; 112:244-252. [PMID: 33079328 PMCID: PMC7910326 DOI: 10.17269/s41997-020-00420-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study presents national estimates on symptoms consistent with postpartum anxiety (PPA) and postpartum depression (PPD) and the association between these conditions and possible risk and protective factors in women who gave birth in Canada. METHODS Data were collected through the Survey on Maternal Health, a cross-sectional survey administered in Canada's ten provinces between November 2018 and February 2019 among women who gave birth between January 1 and June 30, 2018. A total of 6558 respondents were included. Weighted prevalence estimates were calculated, and logistic regression was used to model the relationship between symptoms consistent with PPA, PPD, and potential risk factors. RESULTS Overall, 13.8% of women had symptoms consistent with PPA, while the prevalence of having symptoms consistent with PPD was 17.9%. Results of the logistic regression models indicated that women who had a history of depression were 3.4 times (95% CI 2.7-4.2) more likely to experience symptoms consistent with PPA and 2.6 times more likely to experience symptoms consistent with PPD (95% CI 2.2-3.2) compared with those who did not. Women who reported good, fair, or poor physical health were 2.4 times more likely to experience symptoms consistent with PPD (95% CI 2.0-2.9) and 2.0 times more likely to experience symptoms consistent with PPA (95% CI 1.7-2.4) compared with those who reported very good or excellent health. Maternal marital status, other postpartum maternal support, and sense of community belonging were also significant. CONCLUSION This study highlights that a history of depression and good, fair, or poor physical health are associated with an increased odds of symptoms consistent with PPA and PPD, while other maternal support and sense of community belonging are associated with a decreased odds of these conditions.
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Affiliation(s)
- Mihaela Gheorghe
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada.
| | - Mélanie Varin
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada
| | - Suzy L Wong
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada
| | - Melissa Baker
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada
| | - Vera Grywacheski
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada
| | - Heather Orpana
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada.,School of Epidemiology and Public Health, University of Ottawa, Alta Vista Campus, Room 101, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.,Royal Ottawa Institute for Mental Health Research, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
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154
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Maternal Separation Model of Postpartum Depression: Potential Role for Nucleus Accumbens Dopamine D1-D2 Receptor Heteromer. Neurochem Res 2020; 45:2978-2990. [PMID: 33057844 DOI: 10.1007/s11064-020-03145-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022]
Abstract
Postpartum depression is a mood disorder with a distinct neurobiological and behavioural profile occurring during and after the postpartum period. Dopamine pathways in the limbic regions of the brain such as the nucleus accumbens (NAc) have been shown to be involved in the etiology of depressive disorders. Selective activation of the dopamine D1-D2 receptor heteromer has been demonsrated to cause depressive- and anxiogenic-like behaviours in rats. The maternal separation model involving three hour daily maternal separation (MS) from pups on PPD 2-15 on anxiety-, depression- and anhedonia-like behaviors in the dams was investigated, together with plasma corticosterone, oxytocin and D1-D2 heteromer expression in the NAc core and shell in non-MS and MS dams. Depression, anxiety and anhedonia-like behaviours were measured using the forced swim test, elevated plus maze and sucrose preference test, respectively. In comparison to non-MS controls, MS dams displayed slightly higher depressive and anxiety-like behaviours with no difference in anhedonia-like behaviours. The MS dams displayed significantly increased care of pups after their retrieval with higher bouts of nursing, lower latency to nurse, lower bouts of out nest behaviour and decreased self-care. There was no significant alteration in D1-D2 heteromer expression in NAc core and shell between mothers of either group (MS, non-MS) or between postpartum rats and nonpregnant female rats, remaining higher than in male rats. This data provides evidence for the maternal separation model in producing a postpartum depression-like profile, but with maternal resilience able to modify behaviours to counteract any potential deleterious consequences to the pups.
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155
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Ponting C, Chavira DA, Ramos I, Christensen W, Guardino C, Schetter CD. Postpartum depressive symptoms in low-income Latinas: Cultural and contextual contributors. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2020; 26:544-556. [PMID: 32105108 PMCID: PMC7483184 DOI: 10.1037/cdp0000325] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Using a conceptual model of postpartum depression risk in Latinas including both contextual and cultural stressors, we tested contributions to depressive symptom levels and trajectories over the course of 1 year following birth in a community sample of Latinas. METHOD A multisite sample of low-income U.S.-born and foreign-born Latinas (n = 537; M age = 25.70) was interviewed on many topics including measures of stress and maternal health at 1, 6, and 12 months postpartum. Nested multilevel growth curve models were implemented to test associations of contextual stressors (poverty, domestic violence) with trajectories of depressive symptoms, adjusting for confounds. This model was compared to 1 that added cultural stress variables (everyday discrimination, foreign-born status, language preference, age at immigration) measured 1-month postpartum. RESULTS The best fitting model provided evidence for the independent effects of cultural and contextual stressors. Discrimination (β = .13 SE = .02, p = < .001) and domestic violence (β = .39 SE = .09, p = < .001) predicted trajectories with higher levels of depressive symptoms 1 month postpartum, but not linear change in symptoms over the year. CONCLUSIONS The present study provides evidence that discrimination, a cultural factor, and domestic violence, a contextual factor, each predict higher levels of early postpartum depressive symptoms. Interventions addressing discrimination and maternal safety are recommended. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Carolyn Ponting
- Department of Psychology, University of California, Los Angeles. Los Angeles, CA
| | - Denise A. Chavira
- Department of Psychology, University of California, Los Angeles. Los Angeles, CA
| | - Isabel Ramos
- Department of Psychology, University of California, Los Angeles. Los Angeles, CA
| | - Wendy Christensen
- Department of Psychology, University of California, Los Angeles. Los Angeles, CA
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156
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Zhao XH, Zhang ZH. Risk factors for postpartum depression: An evidence-based systematic review of systematic reviews and meta-analyses. Asian J Psychiatr 2020; 53:102353. [PMID: 32927309 DOI: 10.1016/j.ajp.2020.102353] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Postpartum depression (PPD) is the most common psychiatric condition after childbirth which not only effects the mother's health, but also might have impact on child's development and parenting behaviors. Because the etiology of PPD has not been fully cleared, the efforts towards identification of risk factors are crucial for both the children and mother's health. METHOD PubMed, EMBASE and PsycINFO databases were searched since inception until July 2019 to collect data about the risk factors of PPD and only systematic review and meta-analysis can be included. RESULT To identify the real risk factors, protective factors and controversial factors, nineteen parts of the interpretation were adopted. The risk factors are mainly concentrated in the following aspects: violence and abuse, immigration status, gestational diabetes, cesarean section, depressive history, vitamin D deficiency, obese and overweight, postpartum sleep disruption and poor postpartum sleep, lack of social support, traditional dietary pattern (Japanese, Indian, United Kingdom, and Brazilian dietary pattern), multiple births, preterm and low-birth-weight infants, postpartum anemia, negative birth experience. The controversial factors are serum level of cortisol, thyroid peroxidase autoantibodies status, acculturation, traditional confinement practices. Skin-to-skin care, higher concentrations of DHA in mothers' milk, greater seafood consumption, healthy dietary patterns, multivitamin supplementation, fish and PUFA intake, calcium, Vitamin D, zinc and possibly selenium are protective factors. CONCLUSION Thirteen risk factors were identified, but five factors still controversial due to the insufficient of the evidence. What's more, skin-to-skin care and some nutrition related factors are protective factors against PPD.
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Affiliation(s)
- Xiao-Hu Zhao
- Second Clinical Medical College, Anhui Medical University, Hefei, China
| | - Zhi-Hua Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.
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157
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Spedding M, Stein DJ, Naledi T, Myers B, Cuijpers P, Sorsdahl K. A task-sharing intervention for prepartum common mental disorders: Feasibility, acceptability and responses in a South African sample. Afr J Prim Health Care Fam Med 2020; 12:e1-e9. [PMID: 33054272 PMCID: PMC7564815 DOI: 10.4102/phcfm.v12i1.2378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 12/17/2022] Open
Abstract
Background Peripartum common mental disorders (CMD) are highly prevalent in low- and middle-income countries (LMIC) such as South Africa. With limited public mental health resources, task sharing approaches to treatment are showing promise. However, little is known about the feasibility and acceptability of, as well as responses associated with problem-solving therapy (PST) for the treatment of prepartum CMD symptoms in South African public health settings. Aim To investigate participants’ preliminary responses to a task sharing PST intervention, and to evaluate the feasibility and acceptability of the intervention. Setting A Midwife and Obstetrics Unit attached to a Community Health Centre in a Western Cape district. Methods Using mixed methods, 38 participants’ responses to a PST intervention, and their perceptions of its feasibility and acceptability, were explored. Primary outcomes included psychological distress (Self Reporting Questionnaire; SRQ-20) and depression symptoms (Edinborough Postnatal Depression Scale; EPDS). Semi-structured interviews were conducted three after the last session. Six stakeholders were also interviewed. Results Significant reductions were seen on EPDS (Cohen’s d = 0.61; Hedges g = 0.60) and SRQ-20 (Cohen’s d = 0.68; Hedges g = 0.67) scores. The intervention’s acceptability lay in the opportunity for confidential disclosure of problems; and in relieving staff of the burden of managing of patients’ distress. Barriers included lack of transport and work commitments. Conclusion Results support task sharing PST to Registered Counsellors to treat antenatal CMDs in perinatal primary health care settings. Research is needed on how such programmes might be integrated into public health settings, incorporating other non-specialists.
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Affiliation(s)
- Maxine Spedding
- Department of Psychology, Faculty of Humanities, University of Cape Town, Cape Town.
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158
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Ormsby SM, Smith CA, Dahlen HG, Hay PJ. The feasibility of acupuncture as an adjunct intervention for antenatal depression: a pragmatic randomised controlled trial. J Affect Disord 2020; 275:82-93. [PMID: 32658830 DOI: 10.1016/j.jad.2020.05.089] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/31/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Antenatal depression is common and associated with adverse consequences for mothers, babies, and future generations. Limitations with conventional approaches has resulted in additional therapies being considered. This study examined the feasibility and effectiveness of acupuncture for improving mental health. METHODS Fifty-seven pregnant women with depressive symptomologies were randomised to acupuncture (n=19) plus treatment as usual (TAU), progressive muscle relaxation (PMR, n=19) plus TAU or TAU (n=19). Treatments were conducted from 24 to 31 weeks gestation. Clinical assessments were performed throughout the intervention, as well as at a six-week postnatal follow-up. The primary outcome measure was depression. Secondary outcome measurements were stress, anxiety, psychological distress, quality of life and adjustment to mothering. Intention to treat (ITT), Linear Mixed Model (LMM) repeated measures and per protocol (PP) analyses were conducted. RESULTS At end-of-intervention there were significantly lower depression scores in the acupuncture group versus TAU and PMR respectively [ITT p<0.001, mean difference (MD) -5.84 (95% CI -9.10 to -2.58); MD -3.42 (95% CI -6.64 to -0.20)]. LMM repeated measures analysis (including postnatal follow-up) also demonstrated significantly lowered acupuncture group scores for stress (p=0.006) and psychological distress (p<0.001) when compared to PMR and TAU. Between group differences were not significant at six-weeks postnatal. No adverse events were reported. LIMITATIONS Main limitations are small sample size and the use of self-reported outcome measures. CONCLUSION Prenatal acupuncture reduced depression, stress and distress, whilst also being well-tolerated and free from adverse events. Further research is warranted.
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Affiliation(s)
- Simone M Ormsby
- Adjunct Fellow, NICM Health Research Institute, Level 1, Building J, Western Sydney University, Westmead Campus, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Caroline A Smith
- Professor of Clinical Research, NICM Health Research Institute, Level 1, Building J, Western Sydney University, Westmead Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Hannah G Dahlen
- Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline, Building EB, UWS Parramatta Campus, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Phillipa J Hay
- Professor of Mental Health, Translational Health Research Institute, School of Medicine Western Sydney University and Camden and Campbelltown Hospitals SWSLHD, Locked Bag 1797, Penrith, NSW 2751, Australia.
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159
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Cao S, Wei L. Predictive value of serum CRH/5-HT ratio for postpartum depression. Int J Gynaecol Obstet 2020; 151:438-442. [PMID: 32812654 DOI: 10.1002/ijgo.13351] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/20/2020] [Accepted: 08/17/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To analyze the changes in the serum levels of CRH and 5-HT in women with postpartum depression (PPD) and to study the value of the CRH/5-HT ratio for the prediction of PPD. METHODS This prospective study recruited pregnant women from the Fourth Affiliated Hospital, China Medical University between January 2017 and October 2019. Women were considered for inclusion if they had no history, or no current evidence, of a psychiatric disorder. All women were assessed at postpartum day 10 with the Edinburgh Postnatal Depression Scale (EPDS). Blood samples were obtained at 20 weeks of pregnancy and the levels of CRH and 5-HT were determined by radioimmunoassay and ELISA. Associations between EPDS score, the demographic variables, and hormone levels were identified using bivariate logistic regression models. RESULTS A total of 185 women were included. We found that the serum level of both CRH and 5-HT was significantly correlated with EPDS score; the AUC for CRH was 0.79, and 5-HT was 0.85, which indicated that both CRH and 5-HT are a reliable biomarker for PPD. The AUC, specificity, and sensitivity of CRH/5-HT were 0.92, 0.86, and 0.95, respectively, which were better than those of CRH or 5-HT individually. CONCLUSIONS We believe that the serum CRH/5-HT ratio is an excellent biomarker for the prediction of PPD.
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Affiliation(s)
- Shiyue Cao
- Department of Gynaecology and Obstetrics, the Fourth Affiliated Hospital, China Medical University, Shenyang, China
| | - Li Wei
- Department of Gynaecology and Obstetrics, the Fourth Affiliated Hospital, China Medical University, Shenyang, China
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160
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Majewska KA, Stanisławska-Kubiak M, Wiecheć K, Naskręcka M, Kędzia A, Mojs E. Maternal anxiety in relation to growth failure and growth hormone treatment in children. Medicine (Baltimore) 2020; 99:e22147. [PMID: 32925771 PMCID: PMC7489751 DOI: 10.1097/md.0000000000022147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Health disorders in mothers and their children are subject to mutual influences arising from the nature of mother-child relationship. The aim of the study was to analyze the issue of anxiety amongst mothers of short children in aspect of growth hormone (GH) therapy in Poland.The study was based on a group of 101 mothers of originally short-stature children: 70 with GH deficiency treated with recombinant human GH and 31 undergoing the diagnostic process, without any treatment. Collected medical data included the child's gender, height and weight, chronological age, bone age delay, and GH therapy duration. For all children the height SDS (standard deviation score of height) and BMI SDS (standard deviation score of body mass index) were calculated. The Spielberger State-Trait Anxiety Inventory (STAI) was used to evaluate anxiety levels among the recruited mothers. Obtained results revealed low trait anxiety levels in all mothers, with no statistically significant differences between the groups. State anxiety levels were significantly higher in mothers of children without diagnosis and treatment than in mothers of children receiving appropriate therapy. Significantly lower levels of maternal state anxiety were observed during the first stage of the GH therapy, and they were further reduced in mothers of children treated for more than 4 years.Growth failure in Polish children is not associated with high maternal anxiety as a personality trait, but lack of diagnosis and lack of appropriate treatment seem to generate high levels of anxiety as a transient state in mothers. The initiation of GH therapy induces a substantial reduction of maternal state anxiety, and the duration of this treatment causes its further decrease. Mothers of short children undergoing diagnostic process could benefit from psychological support, but it seems to be unnecessary when their children are treated with GH.
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Affiliation(s)
| | | | - Katarzyna Wiecheć
- Department of Clinical Psychology, Poznan University of Medical Sciences
| | - Monika Naskręcka
- Department of Mathematical Economics, Poznan University of Economics and Business, Poznań, Poland
| | | | - Ewa Mojs
- Department of Clinical Psychology, Poznan University of Medical Sciences
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161
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Forte Camarneiro AP, de Miranda Justo JMR. Emotional states and psychopathological symptoms in couples during pregnancy and post-partum. J Reprod Infant Psychol 2020; 40:384-398. [PMID: 32877260 DOI: 10.1080/02646838.2020.1814226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIMS Comparing depression, anxiety, stress and psychopathological symptomatology in: pregnancy vs. post-partum in men and in women, marital partners' (men vs. women) in pregnancy and in post-partum. BACKGROUND During perinatal period, couples undergo emotional changes and psychopathological symptoms. METHODS Descriptive-correlational-longitudinal study. Participants: Couples (n = 67; men and women = 134) interviewed in pregnancy and at 8 months post-partum. Women are younger and more educated than men. For 65.7% of couples, this was the first pregnancy. INSTRUMENTS Sociodemographic and Clinical Questionnaire; Depression Anxiety and Stress Scale-42; Brief Symptoms Inventory. RESULTS In pregnancy, women's scores were significantly higher than men's in anxiety and somatization. In post-natal period, women presented significantly higher scores in somatization. Between pre- and post-natal periods, women's scores (stress, obsessions-compulsions, interpersonal sensitivity, depression, hostility, paranoid ideation, psychoticism, global severity index, positive symptoms distress index) rose significantly. Men's positive symptoms distress index rose significantly. CONCLUSIONS In pregnancy, women show less stress and less psychopathological symptoms than in post-natal period. During pregnancy women are more anxious and somatise more than men. After birth, they keep somatising more. Also, in perinatal period, women's changes are more salient. The association of conjugality and motherhood-fatherhood development should be deepened in future investigation.
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162
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Nätt D, Öst A. Male reproductive health and intergenerational metabolic responses from a small RNA perspective. J Intern Med 2020; 288:305-320. [PMID: 32415866 DOI: 10.1111/joim.13096] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/10/2020] [Accepted: 04/23/2020] [Indexed: 02/06/2023]
Abstract
The world has recently experienced a decline in male reproductive (e.g. sperm counts and motility) and metabolic (e.g. obesity and diabetes) health. Accumulated evidence from animal models also shows that the metabolic health of the father may influence the metabolic health in his offspring. Vectors for such paternal intergenerational metabolic responses (IGMRs) involve small noncoding RNAs (sncRNAs) that often increase in spermatozoa during the last days of maturation in the epididymis. We and others have shown that the metabolic state - depending on factors such as diet, obesity and physical exercise - may affect sperm quality and sperm sncRNA. Together, this suggests that there are overlapping aetiologies between the male metabolic syndrome, male factor infertility and intergenerational responses. In this review, we present a theoretical framework for an overlap of these aetiologies by exploring the advances in our understanding of the roles of sncRNA in spermatogenesis and offspring development. A special focus will lie on novel findings about tRNA-derived small RNA (tsRNA), rRNA-derived small RNA (rsRNA) and small mitochondrial RNA (mitoRNA), and their emerging roles in intergenerational metabolic and reproductive health.
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Affiliation(s)
- D Nätt
- From the, Department of Clinical and Experimental Medicine, Linköping University, Linkoping, Sweden
| | - A Öst
- From the, Department of Clinical and Experimental Medicine, Linköping University, Linkoping, Sweden
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163
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Kang JY, Choi YJ. Effects of a psychological first aid simulated training for pregnant flood victims on disaster relief worker's knowledge, competence, and self-efficacy. Appl Nurs Res 2020; 57:151348. [PMID: 32893087 DOI: 10.1016/j.apnr.2020.151348] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 07/24/2020] [Accepted: 08/23/2020] [Indexed: 11/16/2022]
Abstract
AIMS To develop a simulation-based psychological first aid (PFA) education program for disaster relief workers and verify its impact on their PFA knowledge, PFA performance competence, and self-efficacy. BACKGROUND Relief workers should be provided with systematic education on their required knowledge and skills; however, PFA training for relief workers is lacking, which results in ineffective mental health support during disaster situations. METHODS This study adopted a non-equivalent control group pre-posttest quasi-experimental design. Thirty relief workers from mental health welfare centers in Seoul and Gyeonggi Province participated. The experimental group received a PFA lecture, a simulation-based PFA education program, and access to the Psychological Life Support (PLS) mobile application, which provides information on disaster situations and PFA techniques. The comparison group received a PFA lecture. The control group was provided with self-learning PFA materials. RESULTS Among the three groups, the experimental group showed the greatest improvement in PFA knowledge, PFA performance competence, and self-efficacy from pretest to posttest, which was statistically significant. CONCLUSIONS This study demonstrated the effectiveness of the simulation-based PFA education program combined with a PFA lecture and the PLS mobile app as complementary methods to assist relief workers in applying PFA in disaster situations.
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Affiliation(s)
- Ju-Yeon Kang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Yun-Jung Choi
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
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164
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Colucci P, De Castro V, Peloso A, Splendori M, Trezza V, Campolongo P. Perinatal exposure to omega-3 fatty acid imbalance leads to early behavioral alterations in rat pups. Behav Brain Res 2020; 392:112723. [DOI: 10.1016/j.bbr.2020.112723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 01/05/2023]
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165
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Evaluation of antenatal risk factors for postpartum depression: a secondary cohort analysis of the cluster-randomised GeliS trial. BMC Med 2020; 18:227. [PMID: 32703266 PMCID: PMC7379365 DOI: 10.1186/s12916-020-01679-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/23/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Maternal weight variables are important predictors of postpartum depression (PPD). While preliminary evidence points to an association between pre-pregnancy obesity and PPD, the role of excessive gestational weight gain (GWG) on PPD is less studied. In this secondary cohort analysis of the German 'healthy living in pregnancy' (GeliS) trial, we aimed to investigate associations between weight-related variables and PPD and to assess the influence of GWG on the risk for PPD. METHODS We included women with normal weight, overweight, and obesity (BMI 18.5-40.0 kg/m2). Symptoms of PPD were assessed 6-8 weeks postpartum using the Edinburgh Postnatal Depression Scale. Pre-pregnancy BMI was self-reported. During the course of pregnancy, weight was measured at gynaecological practices within regular check-ups. GWG was defined as the difference between the last measured weight before delivery and the first measured weight at the time of recruitment (≤ 12th week of gestation). Excessive GWG was classified according to the Institute of Medicine. Multiple logistic regression analyses were used to estimate the odds of PPD in relation to pre-pregnancy BMI, GWG, and excessive GWG adjusting for important confounders. RESULTS Of the total 1583 participants, 45.6% (n = 722) showed excessive GWG and 7.9% (n = 138) experienced PPD. Pre-pregnancy BMI (per 5-unit increase; OR = 1.23, 95% CI 1.08-1.41, p = 0.002) and pre-pregnancy overweight or obesity were significantly positively associated with the odds of developing PPD, particularly among women with an antenatal history of anxiety or depressive symptoms (overweight: OR = 1.93, 95% CI = 1.15-3.22, p = 0.01; obesity: OR = 2.11, 95% CI = 1.13-3.96, p = 0.02). Sociodemographic or lifestyle factors did not additively influence the odds of having PPD. In fully adjusted models, there was no significant evidence that GWG or the occurrence of excessive GWG increased the odds of experiencing PPD (excessive vs. non-excessive: OR = 3.48, 95% CI 0.35-34.94; GWG per 1 kg increase: OR = 1.16, 95% CI 0.94-1.44). CONCLUSION Pre-pregnancy overweight or obesity is associated with PPD independent of concurrent risk factors. History of anxiety or depressive symptoms suggests a stress-induced link between pre-pregnancy weight and PPD. TRIAL REGISTRATION NCT01958307 , ClinicalTrials.gov, retrospectively registered on 9 October 2013.
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166
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Wiciński M, Malinowski B, Puk O, Socha M, Słupski M. Methyldopa as an inductor of postpartum depression and maternal blues: A review. Biomed Pharmacother 2020; 127:110196. [DOI: 10.1016/j.biopha.2020.110196] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 12/18/2022] Open
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167
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Amodeo G, Laurenzi PF, Santucci A, Cuomo A, Bolognesi S, Goracci A, Rossi R, Beccarini Crescenzi B, Neal SM, Fagiolini A. Advances in treatment for postpartum major depressive disorder. Expert Opin Pharmacother 2020; 21:1685-1698. [PMID: 32584616 DOI: 10.1080/14656566.2020.1779702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Postpartum depressive disorder (PPD) is a burdensome medical condition. To date, only one treatment (Brexanolone) has undergone registrational trials and is approved in the United States with an indication for the treatment of PPD. However, other treatments are prescribed and have been tested for this condition. Herein, the authors review the available scientific evidence pertaining to the somatic treatments of PPD. Areas covered: The authors evaluate the published open-label and randomized controlled trials (RCTs), examine the biological mechanisms of PPD treatments, and evaluate how the available data translates into information that may be useful for clinical practice. Expert opinion: Antidepressants have long been the mainstay of PPD treatment, despite the limited evidence from randomized clinical trials that supports this practice. Brexanolone improves treatment options for women with PPD. However, the relatively burdensome administration and monitoring protocol, along with the high cost of the medication, limit the possibility for an extensive use of this medication. Large, randomized, controlled trials of hormonal treatments in patients with PPD are warranted. Also, treatment with mood stabilizers and/or antipsychotics in women with major depressive disorder, who meet the DSM-5 mixed features specifiers in the post-partum period, should be tested in controlled clinical trials.
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Affiliation(s)
- Giovanni Amodeo
- Department of Molecular and Developmental Medicine, University of Siena School of Medicine
| | | | - Aurora Santucci
- Department of Molecular and Developmental Medicine, University of Siena School of Medicine
| | - Alessandro Cuomo
- Department of Molecular and Developmental Medicine, University of Siena School of Medicine
| | - Simone Bolognesi
- Department of Molecular and Developmental Medicine, University of Siena School of Medicine
| | - Arianna Goracci
- Department of Molecular and Developmental Medicine, University of Siena School of Medicine
| | - Rodolfo Rossi
- Department of System Medicine (RR), Tor Vergata University , Rome, Italy.,Department of Mental Health & Drug Abuse, AUSL Modena , Modena, Italy
| | | | - Stephen M Neal
- Department of Psychiatry, West Virginia School of Osteopathic Medicine , Lewisburg, WV, USA
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, University of Siena School of Medicine
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168
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Lara-Cinisomo S, Akinbode TD. Research Recommendations on the Effects of Postpartum Depression and Pain on Infant Care and Development. J Obstet Gynecol Neonatal Nurs 2020; 49:416-422. [PMID: 32553591 DOI: 10.1016/j.jogn.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 11/29/2022] Open
Abstract
Postpartum depression is one of the most common complications of childbirth, and another is pain. A growing body of research shows that the severity and duration of postpartum pain can increase a woman's risk for postpartum depression. Postpartum depression and pain negatively affect maternal well-being, and postpartum depression has been associated with adverse outcomes in children. However, there is a dearth of information about the effects of postpartum depression and pain on infant care and development. The objectives of this commentary were to highlight the need to address this gap in the literature, offer a preliminary conceptual model to advance the field, and ignite new lines of inquiry to inform infant care and development.
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169
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Liu J, Meng F, Dai J, Wu M, Wang W, Liu C, Zhao D, Wang H, Zhang J, Li C. The BDNF-FoxO1 Axis in the medial prefrontal cortex modulates depressive-like behaviors induced by chronic unpredictable stress in postpartum female mice. Mol Brain 2020; 13:91. [PMID: 32532322 PMCID: PMC7291536 DOI: 10.1186/s13041-020-00631-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022] Open
Abstract
Postpartum depression (PPD) is a serious psychiatric disorder, affecting not only the childbearing women but also the health of their offsprings. The brain-derived neurotrophic factor (Bdnf) gene is an important target gene for the study of depression and antidepressant therapy. FoxO1, belonging to the FoxO subfamily is involved in the development of major depressive disorders. However, the role of BDNF and its functional brain regions involved in PPD remains unknown. Here, we report that chronic unpredictable stress (CUS) can produce depression-associated behaviors in postpartum female mice. CUS can decrease total Bdnf mRNA and exon specific mRNAs in the medial prefrontal cortex (mPFC), accompanied by reduced protein levels, that were correlated with depression-related behaviors. Moreover, postpartum, not virgin female mice showed increased susceptibility to subthreshold stress-induced depression-related behaviors. Selective deletion of BDNF in the mPFC induced anhedonia as indicated by reduced sucrose preference and increased latency to food in the novelty suppressed food test in postpartum, but not in virgin female mice. Furthermore, we found that FoxO1 is also decreased in CUS-treated postpartum female mice with a significant correlation with depression-related behaviors. BDNF-specific knockout in the mPFC decreased FoxO1 expression in female mice. Our results indicate that the BDNF-FoxO1 axis in mPFC can regulate depression-related behaviors and stress vulnerability in postpartum female mice.
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Affiliation(s)
- Jing Liu
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China
| | - Fantao Meng
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China
| | - Juanjuan Dai
- Cancer Research Institute, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China
| | - Min Wu
- Neurosurgery, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China
| | - Wentao Wang
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China
| | - Cuilan Liu
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China
| | - Di Zhao
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China
| | - Hongcai Wang
- Department of Neurology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China
| | - Jingyan Zhang
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China
| | - Chen Li
- Institute for Metabolic & Neuropsychiatric Disorders, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China.
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170
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Lasheras G, Farré-Sender B, Porta R, Mestre-Bach G. Risk factors for postpartum depression in mothers of newborns admitted to neonatal intensive care unit. J Reprod Infant Psychol 2020; 40:47-61. [DOI: 10.1080/02646838.2020.1775793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Gracia Lasheras
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain
| | - Borja Farré-Sender
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain
| | - Roser Porta
- Department of Pediatrics, Dexeus University Hospital, Barcelona, Spain
| | - Gemma Mestre-Bach
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, Logroño, La Rioja, Spain
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171
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Stiawa M, Müller-Stierlin A, Staiger T, Kilian R, Becker T, Gündel H, Beschoner P, Grinschgl A, Frasch K, Schmauß M, Panzirsch M, Mayer L, Sittenberger E, Krumm S. Mental health professionals view about the impact of male gender for the treatment of men with depression - a qualitative study. BMC Psychiatry 2020; 20:276. [PMID: 32493263 PMCID: PMC7268222 DOI: 10.1186/s12888-020-02686-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 05/20/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The underestimation of depression among men may result from atypical depression symptoms and male help-seeking behaviour. However, higher suicide rates among men than among women indicate a need for gender-specific services for men with depression. In order to develop gender-specific services, it is essential to examine professionals' attitudes towards men's depressive symptoms and treatment needs as well as barriers to and facilitators of treatment. This study examined gender-specific treatment needs in male patients and treatment approaches to male patients from a professional perspective. METHODS Semi-structured face-to-face interviews were conducted with 33 mental health professionals (MHPs) from five German psychiatric institutions. The study assessed the characteristics and attributes of male patients with depression risk factors for the development of depression among men, their condition at the beginning of treatment, male patients' depressive symptoms, the needs and expectations of male patients, the importance of social networks in a mental health context, and MHPs' treatment aims and treatment methods. Transcripts were analysed using qualitative content analysis. RESULTS The professionals' reference group of male patients were men who were characterised in accordance with traditional masculinity. Attributes reported as in line with this type of men were late initiations of inpatient treatment after crisis, suicidal ideation or attempted suicide, and high expectations towards treatment duration, success rate in recovery and therapeutic sessions. In contrast, male patients who deviate from these patterns were partially described with reference to female stereotypes. Professionals referred to psychosocial models in their explanations of the causes of depression and provided sociological explanations for the development of masculine ideals among men. The consequences of these for treatment were discussed against the background of normative expectations regarding the male gender. From the professionals' point of view, psychoeducation and the acceptance of depression (as a widespread mental illness) were the most important goals in mental health treatment. CONCLUSIONS In order to improve mental health among men, gender-specific services should be offered. Awareness of the role of gender and its implications on mental health treatment should be an integral part of MHPs' education and their daily implementation of mental health treatment practices.
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Affiliation(s)
- Maja Stiawa
- Department for Psychiatry and Psychotherapy II, Ulm University at BKH Guenzburg, Ludwig-Heilmeyer-Str. 2, 89312, Guenzburg, Germany.
| | - Annabel Müller-Stierlin
- grid.6582.90000 0004 1936 9748Department for Psychiatry and Psychotherapy II, Ulm University at BKH Guenzburg, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
| | - Tobias Staiger
- grid.6582.90000 0004 1936 9748Department for Psychiatry and Psychotherapy II, Ulm University at BKH Guenzburg, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
| | - Reinhold Kilian
- grid.6582.90000 0004 1936 9748Department for Psychiatry and Psychotherapy II, Ulm University at BKH Guenzburg, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
| | - Thomas Becker
- grid.6582.90000 0004 1936 9748Department for Psychiatry and Psychotherapy II, Ulm University at BKH Guenzburg, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
| | - Harald Gündel
- grid.6582.90000 0004 1936 9748Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Petra Beschoner
- grid.6582.90000 0004 1936 9748Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Achim Grinschgl
- Department for Psychosomatic Medicine and Psychotherapy, Günztalklinik Allgäu, Obergünzburg, Germany
| | - Karel Frasch
- grid.6582.90000 0004 1936 9748Department for Psychiatry and Psychotherapy II, Ulm University at BKH Guenzburg, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany ,Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, BKH Donauwörth, Donauwörth, Germany
| | - Max Schmauß
- grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Augsburg University, Augsburg, Germany
| | - Maria Panzirsch
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, BKH Donauwörth, Donauwörth, Germany
| | - Lea Mayer
- grid.6582.90000 0004 1936 9748Department for Psychiatry and Psychotherapy II, Ulm University at BKH Guenzburg, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
| | - Elisa Sittenberger
- grid.6582.90000 0004 1936 9748Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Silvia Krumm
- grid.6582.90000 0004 1936 9748Department for Psychiatry and Psychotherapy II, Ulm University at BKH Guenzburg, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany
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172
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Almanza-Sepulveda ML, Fleming AS, Jonas W. Mothering revisited: A role for cortisol? Horm Behav 2020; 121:104679. [PMID: 31927022 DOI: 10.1016/j.yhbeh.2020.104679] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/26/2022]
Abstract
This selective review first describes the involvement of the maternal hypothalamic-pituitary-adrenal (HPA) axis during pregnancy and the postpartum period, and the relation between peripartum HPA axis function and maternal behavior, stress reactivity and emotional dysregulation in human mothers. To provide experimental background to this correlational work, where helpful, animal studies are also described. It then explores the association between HPA axis function in mothers and their infants, under ongoing non-stressful conditions and during stressful challenges, the moderating role of mothers' sensitivity and behavior in the mother-child co-regulation and the effects of more traumatic risk factors on these relations. The overarching theme being explored is that the HPA axis - albeit a system designed to function during periods of high stress and challenge - also functions to promote adaptation to more normative processes, shown in the new mother who experiences both high cortisol and enhanced attraction and attention to and recognition of, their infants and their cues. Hence the same HPA system shows positive relations with behavior at some time points and inverse ones at others. However, the literature is not uniform and results vary widely depending on the number, timing, place, and type of samplings and assessments, and, of course, the population being studied and, in the present context, the state, the stage, and the stress levels of mother and infant.
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Affiliation(s)
- Mayra L Almanza-Sepulveda
- Department of Psychology, University of Toronto at Mississauga, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada
| | - Alison S Fleming
- Department of Psychology, University of Toronto at Mississauga, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada.
| | - Wibke Jonas
- Department of Women's and Children's Health, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18a, 171 77 Stockholm, Sweden.
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173
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Doi S, Fujiwara T, Isumi A, Mitsuda N. Preventing postpartum depressive symptoms using an educational video on infant crying: A cluster randomized controlled trial. Depress Anxiety 2020; 37:449-457. [PMID: 32058628 DOI: 10.1002/da.23002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/27/2019] [Accepted: 01/27/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the impact of watching an educational video on infant crying within 1 week of age after delivery at maternity wards to reduce the prevalence of postpartum depressive symptoms at 1 month after giving birth. METHODS The study design was a cluster randomized controlled trial. The intervention hospitals were randomly assigned, stratified by area and function of the hospital. Participants included 47 obstetrics hospitals or clinics out of 150 hospitals or clinics in Osaka Prefecture, Japan. In total, 44 hospitals or clinics completed the trial and 2,601 (intervention group = 1,040, control group = 1,561) caregivers responded to the questionnaire on postpartum depression (response rate: 55.1%). Mothers in the intervention group watched an educational video, within 1 week of age, during hospitalization at maternity wards. Primary outcome in this study was postpartum depression assessed by the Edinburgh Postnatal Depression Scale as 9+ and assessed via questionnaire at a 1-month health checkup. RESULTS In the intervention group, 142 (13.7%) mothers reported postpartum depression compared to 250 (16.0%) in the control group. Intention-to-treat analysis showed no significant difference in the prevalence of postpartum depression between the groups. However, among young mothers (<25 years), the analysis showed a 67.0% reduction in postpartum depression (odds ratio: 0.33, 95% CI: 0.15-0.72). CONCLUSIONS Watching an educational video on infant crying within 1 week after delivery at maternity wards did not reduce postpartum depression at 1 month after giving birth, but it was effective for young mothers aged <25 years.
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Affiliation(s)
- Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Aya Isumi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Nobuaki Mitsuda
- Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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174
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Varin M, Palladino E, Orpana HM, Wong SL, Gheorghe M, Lary T, Baker MM. Prevalence of Positive Mental Health and Associated Factors Among Postpartum Women in Canada: Findings from a National Cross-Sectional Survey. Matern Child Health J 2020; 24:759-767. [PMID: 32323116 PMCID: PMC7198477 DOI: 10.1007/s10995-020-02920-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives The objectives of this study were to compare the prevalence of three positive mental health (PMH) outcomes (self-rated mental health, life satisfaction, sense of community belonging) in postpartum women to the general population, and to examine the relationship between protective factors and the three PMH outcomes among postpartum women. Methods The national cross-sectional Survey on Maternal Health (n = 6558) was analyzed. Analyses were weighted and 95% confidence intervals were calculated. Three adjusted logistic regression models were generated. To compare this sample to the general population of women, estimates from the Canadian Community Health Survey—Annual Component (2018) were used. Results Compared to the general population of women, a larger proportion of postpartum women reported a strong sense of community belonging. The odds of postpartum women with high self-rated physical health having high self-rated mental health were approximately seven times greater (aOR 6.9, 95% confidence interval [CI] 5.9, 8.1) than postpartum women with lower self-rated physical health. The absence of symptoms of postpartum depression (PPD) or generalized anxiety disorder (GAD) and high self-rated physical health were significantly associated with all three PMH outcomes. Frequent availability of maternal support was associated with greater odds of high life satisfaction (aOR 1.6, 95% CI 1.4, 1.9) and sense of community belonging (aOR 1.4, 95% CI 1.2, 1.6). Conclusions Our study demonstrated that availability of maternal support, self-rated physical health and absence of symptoms of PPD or GAD were associated with PMH among postpartum women. As physical health had the strongest association with mental health, we encourage further examination of this relationship. Electronic supplementary material The online version of this article (10.1007/s10995-020-02920-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Elia Palladino
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, Canada
| | - Heather M Orpana
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Royal Institute of Mental Health Research, Ottawa, Canada
| | - Suzy L Wong
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, Canada
| | - Mihaela Gheorghe
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, Canada
| | - Tanya Lary
- Women and Gender Equality Canada, Gatineau, QC, Canada
| | - Melissa M Baker
- Public Health Agency of Canada, 785 Carling Avenue, Ottawa, Canada.
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175
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Mikšić Š, Uglešić B, Jakab J, Holik D, Milostić Srb A, Degmečić D. Positive Effect of Breastfeeding on Child Development, Anxiety, and Postpartum Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2725. [PMID: 32326485 PMCID: PMC7216213 DOI: 10.3390/ijerph17082725] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND Postpartum depression is a psychiatric disorder that starts from the second to the sixth week after birth. Breastfeeding is considered a protective factor for postpartum mood swings. This paper aims to examine the effect of breastfeeding on postpartum depression and anxiety, and how it affects child development. METHODS The study included 209 pregnant women, 197 puerperea, and 160 women at the end of the third month after delivery, followed through three time-points. The instruments used in the study were the Edinburgh Postpartum Depression Scale (EPDS), Beck's Depression Inventory (BDI), and Beck's Anxiety Inventory (BAI). RESULTS Postpartum mothers with low risk of PPD breastfed their children more often than mothers with a mild or severe risk of perinatal depression. Mean values on the BDI scale three months after giving birth were higher in mothers who did not breastfeed their child (M = 3.53) than those who did breastfeed their child (M = 2.28). Postpartum anxiety measured by BAI was statistically negatively correlated (rs-, 430) with the duration of breastfeeding. CONCLUSION Nonbreastfeeding mothers are more depressed and anxious compared to breastfeeding mothers.
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Affiliation(s)
- Štefica Mikšić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31 000 Osijek, Croatia; (Š.M.); (D.H.); (A.M.S.)
| | - Boran Uglešić
- School of medicine, University of Split, Šoltanska 2, 21000 Split, Croatia;
- University Hospital Split, Spinčićeva 1, 21000 Split, Croatia
| | - Jelena Jakab
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31 000 Osijek, Croatia; (Š.M.); (D.H.); (A.M.S.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31 000 Osijek, Croatia;
| | - Dubravka Holik
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31 000 Osijek, Croatia; (Š.M.); (D.H.); (A.M.S.)
| | - Andrea Milostić Srb
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31 000 Osijek, Croatia; (Š.M.); (D.H.); (A.M.S.)
| | - Dunja Degmečić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31 000 Osijek, Croatia;
- University hospital Osijek, Josipa Huttlera 4, 31 000 Osijek, Croatia
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176
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Śliwerski A, Kossakowska K, Jarecka K, Świtalska J, Bielawska-Batorowicz E. The Effect of Maternal Depression on Infant Attachment: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2675. [PMID: 32295106 PMCID: PMC7216154 DOI: 10.3390/ijerph17082675] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
Abstract
Aims and objectives: The aim of this systematic review was to summarize the key findings of empirical studies assessing the influence of maternal depression on child attachment security measured before 24 months after birth. Method: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. A literature search was conducted on the EBSCO (Academic Search Complete; Health Source: Nursing/Academic Edition; MEDLINE; PsycARTICLES) and PubMed databases, with infant attachment AND depression as search terms with Boolean operators. Study design or sample size did not affect inclusion. After screening, 29 of the 1510 unique publications originally identified were included in the review. Results: The studies reveal an equivocal association between maternal depression and child attachment security. Our findings indicate that depression had a significant influence on the attachment style almost only when diagnosed by structured interview: Depression measured by self-descriptive questionnaires was unrelated to attachment style. Furthermore, postpartum depression was found to be significant only when measured up to six months after childbirth. Conclusion: The relationship between maternal depression and infant attachment is both complex and dynamic, and the possible negative effects of depression might be compensated by maternal involvement in childcare. Therefore, further studies in this area should employ a reliable methodology for diagnosing depression and a suitable time point for measuring it; they should also adopt a multifactorial and prospective approach. It is important to note that breastfeeding/formula feeding was omitted as a factor in the majority of studies.
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Affiliation(s)
- Andrzej Śliwerski
- Institute of Psychology, University of Lodz, 91-433 Lodz, Poland; (K.K.); (K.J.); (J.Ś.); (E.B.-B.)
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177
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Nidey N, Carnahan R, Carter KD, Strathearn L, Bao W, Greiner A, Jelliffee-Pawlowski L, Tabb KM, Ryckman K. Association of Mood and Anxiety Disorders and Opioid Prescription Patterns Among Postpartum Women. Am J Addict 2020; 29:463-470. [PMID: 32249527 DOI: 10.1111/ajad.13028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/24/2020] [Accepted: 03/20/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Postpartum women represent a large population with opioid exposure who also have an increased risk of experiencing mood and anxiety disorders. However, the effect that mood and anxiety disorders have on opioid use postpartum has received little attention in the literature. Therefore, the objective of this study was to examine the association of mood and anxiety disorders with filling opioid prescriptions within the first 3 months postpartum. METHODS A retrospective cohort study (n = 25 279) was completed using claims data for a sample of privately insured women who gave birth in the state of Iowa. The interactive effects of mood and anxiety disorders and delivery mode on filling at least one and two or more opioid prescriptions were examined in logistic regression models. RESULTS The presence of mood and anxiety disorders among women who delivered vaginally increased their odds of filling at least one opioid fill by nearly 50% (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.35-1.63) and by 20% (OR: 1.20, 95% CI: 1.00-1.43) among women with cesarean delivery. DISCUSSION AND CONCLUSION Postpartum women with mood and anxiety disorders were more likely to fill opioid prescriptions postpartum compared to women without these conditions. SCIENTIFIC SIGNIFICANCE This study extends prior research by examining the intersection of risk of mood and anxiety disorders and opioid use postpartum. Findings from this study support the need for future research to identify the drivers of increased opioid use among postpartum women with mood and anxiety disorders. (Am J Addict 2020;29:463-470).
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Affiliation(s)
- Nichole Nidey
- Department of Pediatrics, Division of Biostatistics and Epidemiology, Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ryan Carnahan
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | - Knute D Carter
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa
| | - Lane Strathearn
- Stead Family Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa.,Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Wei Bao
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | - Andrea Greiner
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Laura Jelliffee-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
| | - Karen M Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Kelli Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
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178
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Çelen Yoldaş T, Çelik HT, Özdemir G, Karakaya J, Özmert E. Do early parental postnatal depression, attachment style and perceived social support affect neurodevelopmental outcomes of premature infants? Infant Behav Dev 2020; 59:101444. [PMID: 32244071 DOI: 10.1016/j.infbeh.2020.101444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The birth of a premature infant is both a stressful event for both parents and associated with an increased rate of postnatal depression (PND). Additionally some mothers may have delayed feelings of attachment to their babies because of the medical procedures or possible medical complications. Social support is known as an important factor for well-being in the postnatal period. However there is scarce data about these factors for fathers. We aimed to identify the impact of parental PND, attachment style and social support on premature infant development considering the prematurity degree and risk groups. METHODS This prospective study was conducted by including 96 infants who were born preterm. Mothers and fathers were given Edinburgh Postnatal Depression Scale (EPDS), Adult Attachment Style Scale (AASS), and Multidimensional Scale of Perceived Social Support (MSPSS) to fill out when their infants' corrected age was 3 months. The developmental evaluation was conducted with Bayley III at the corrected 6 months and 18 months of age. RESULTS Postnatal depression scores were more in mothers than fathers, the rates of secure attachment and social support were similar between mothers and fathers. Factors associated with the neurodevelopmental outcomes including prematurity degree and risk groups, EPDS, AASS and MSPSS scores were analyzed for both parents. In multivariate analysis, fathers' depression scores were inversely associated with cognitive development (p = 0.030, R2 = 0.080, B=-0.283) and mothers' anxious/ambivalent attachment style was inversely associated with language development (p = 0.011, R2 = 0.108, B=-0.329) at the age of corrected 6 months old. CONCLUSIONS Our findings underscore that the efforts to improve developmental outcomes of premature infants should include parental well-being taking into account new fathers' depressive symptomatology and maternal anxious/ambivalent attachment.
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Affiliation(s)
- Tuba Çelen Yoldaş
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Ankara, Turkey.
| | - Hasan Tolga Çelik
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Ankara, Turkey
| | - Gökçenur Özdemir
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Ankara, Turkey
| | - Jale Karakaya
- Hacettepe University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Elif Özmert
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Ankara, Turkey
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179
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Labrague LJ, McEnroe-Petitte D, Tsaras K, Yboa BC, Rosales RA, Tizon MM, D'souza MS. Predictors of postpartum depression and the utilization of postpartum depression services in rural areas in the Philippines. Perspect Psychiatr Care 2020; 56:308-315. [PMID: 31355473 DOI: 10.1111/ppc.12428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 06/07/2019] [Accepted: 07/14/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study explored the prevalence and predictors of postpartum depression (PPD) as well as the utilization and evaluation of PPD services among postpartum women in rural areas of the Philippines. DESIGN AND METHODS A cross-sectional study was conducted. One hundred sixty-five women who visited maternal facilities in the rural areas of the Central Philippines completed the Edinburgh Postnatal Depression Scale (EPDS). FINDINGS The prevalence of PPD was 16.4% at the sixth postpartum week. Occupation and marital status had significant direct influences on PPD. PPD services were not routinely provided by doctors and nurses. PRACTICE IMPLICATIONS Our results highlight a greater need to intensify government programs relative to PPD services, specifically related to the early detection and screening of PPD among high-risk pregnancies.
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Affiliation(s)
- Leodoro J Labrague
- Department of Fundamentals and Administration, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | | | - Konstantinos Tsaras
- Department of Nursing, Technological Educational Institute of Thessaly, Larissa, Greece
| | - Begonia C Yboa
- College of Nursing and Health Sciences, Catbalogan, Philippines
| | | | - Maricel M Tizon
- College of Nursing and Health Sciences, Catbalogan, Philippines
| | - Melba S D'souza
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
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180
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Batt MM, Duffy KA, Novick AM, Metcalf CA, Epperson CN. Is Postpartum Depression Different From Depression Occurring Outside of the Perinatal Period? A Review of the Evidence. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:106-119. [PMID: 33162848 PMCID: PMC7587887 DOI: 10.1176/appi.focus.20190045] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Whether a major depressive episode occurring in the postpartum period (i.e., postpartum depression [PPD]) is sufficiently distinct from major depressive episodes occurring at other times (i.e., major depressive disorder) to warrant a separate diagnosis is a point of debate with substantial clinical significance. The evidence for and against diagnostic distinction for PPD is reviewed with respect to epidemiology, etiology, and treatment. Overall, evidence that PPD is distinct from major depressive disorder is mixed and is largely affected by how the postpartum period is defined. For depression occurring in the early postpartum period (variably defined, but typically with onset in the first 8 weeks), symptom severity, heritability, and epigenetic data suggest that PPD may be distinct, whereas depression occurring in the later postpartum period may be more similar to major depressive disorder occurring outside of the perinatal period. The clinical significance of this debate is considerable given that PPD, the most common complication of childbirth, is associated with immediate and enduring adverse effects on maternal and offspring morbidity and mortality. Future research investigating the distinctiveness of PPD from major depressive disorder in general should focus on the early postpartum period when the rapid decline in hormones contributes to a withdrawal state, requiring profound adjustments in central nervous system function.
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Affiliation(s)
- Melissa M Batt
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Korrina A Duffy
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Andrew M Novick
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Christina A Metcalf
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - C Neill Epperson
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
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181
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Rincón-Cortés M, Grace AA. Adaptations in reward-related behaviors and mesolimbic dopamine function during motherhood and the postpartum period. Front Neuroendocrinol 2020; 57:100839. [PMID: 32305528 PMCID: PMC7531575 DOI: 10.1016/j.yfrne.2020.100839] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/15/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
Abstract
Initiation and maintenance of maternal behavior is driven by a complex interaction between the physiology of parturition and offspring stimulation, causing functional changes in maternal brain and behavior. Maternal behaviors are among the most robust and rewarding motivated behaviors. Mesolimbic dopamine (DA) system alterations during pregnancy and the postpartum enable enhanced reward-related responses to offspring stimuli. Here, we review behavioral evidence demonstrating postpartum rodents exhibit a bias towards pups and pup-related stimuli in reward-related tasks. Next, we provide an overview of normative adaptations in the mesolimbic DA system induced by parturition and the postpartum, which likely mediate shifts in offspring valence. We also discuss a causal link between dopaminergic dysfunction and disrupted maternal behaviors, which are recapitulated in postpartum depression (PPD) and relevant rodent models. In sum, mesolimbic DA system activation drives infant-seeking behavior and strengthens the mother-infant bond, potentially representing a therapeutic target for reward-related deficits in PPD.
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Affiliation(s)
- Millie Rincón-Cortés
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA 15217, United States.
| | - Anthony A Grace
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA 15217, United States
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182
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Quan C, Wang S, Duan K, Ma J, Yu H, Yang M, Hu N, Long G, Zeng G, Huang Z. The role of kynurenine pathway and kynurenic aminotransferase alleles in postpartum depression following cesarean section in Chinese women. Brain Behav 2020; 10:e01566. [PMID: 32101387 PMCID: PMC7177593 DOI: 10.1002/brb3.1566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES A growing body of data indicates that the kynurenine pathway may play a role in the pathogenesis of postpartum depressive symptoms (PDS). Kynurenic aminotransferase (KAT) is an important kynurenine pathway enzyme, catalyzing kynurenine (KYN) into kynurenic acid (KYNA). This study investigated as to whether genetic variations in KAT are associated with PDS. METHODS A cohort of 360 Chinese women scheduled to undergo cesarean delivery was enrolled into this study. PDS was determined by an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 13. A total of eight KAT single nucleotide polymorphisms (SNPs) were genotyped and their association with PDS investigated. Serum concentrations of KYN, KYNA, and quinolinic acid (QUIN) in women with or without PDS were also measured. This allowed the determination of the KYNA/KYN ratio, which is reflective of KAT activity. RESULTS Postpartum depressive symptoms incidence was 7.2%. Advanced maternal age, lower education, antenatal depression, and postpartum blues were risk factors for PDS (p < .05). Women with PDS, versus non-PDS, had heightened KYN levels one day prior to surgery (ante-d1) (p < .05), as well as having significantly lower KYNA and higher QUIN levels at postnatal day three (post-d3) (p < .05). Women with, versus without, PDS also had a significantly higher QUIN/KYNA ratio at post-d3 (p < .05). KAT activity was significantly lower in women with, versus without, PDS at ante-d3 (p < .05). No significant association was evident between the KAT SNPs and PDS. CONCLUSION Our data support a role for alterations in the kynurenine pathway in the pathogenesis of PDS, although no significant association was found for the eight tested KAT SNPs with PDS.
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Affiliation(s)
- Chengxuan Quan
- Department of Anesthesia, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Saiying Wang
- Department of Anesthesia, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Kaiming Duan
- Department of Anesthesia, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jiahui Ma
- Department of Anesthesia, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Heya Yu
- Department of Anesthesia, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Mi Yang
- Department of Anesthesia, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Na Hu
- Department of Anesthesia, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ge Long
- Department of Anesthesia, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Guang Zeng
- Department of Anesthesia, Changsha Taihe Hospital, Changsha, China
| | - Zhendong Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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183
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Rincón-Cortés M, Grace AA. Postpartum changes in affect-related behavior and VTA dopamine neuron activity in rats. Prog Neuropsychopharmacol Biol Psychiatry 2020; 97:109768. [PMID: 31655159 PMCID: PMC6910715 DOI: 10.1016/j.pnpbp.2019.109768] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/04/2019] [Accepted: 09/27/2019] [Indexed: 12/17/2022]
Abstract
The onset of motherhood is accompanied by alterations in emotional and affective behaviors. Many new mothers experience transient and mild depressive symptoms that typically resolve spontaneously (i.e. postpartum blues) but increase the risk for postpartum depression (PPD). There is little data regarding the neural adaptations occurring in response to parturition and shortly after birth that may be associated with these affective changes. Although the dopamine (DA) system is involved in affect, maternal motivation and PPD, little is known about postpartum DA function. We compared affective behavior in virgin and postpartum adult female rats at early and late time points. In vivo extracellular recordings of VTA DA neurons were performed to evaluate 3 parameters: number of active DA neurons (i.e. population activity), firing rate, and firing pattern. Compared with virgins, postpartum rats exhibited increased anxiety-like behavior in the elevated plus maze at 1-day postpartum; reduced social motivation at 1- and 3-days postpartum, reduced anxiety-like behavior in the novelty suppressed feeding test throughout the first week postpartum and increased forced swim test immobility at 1-day postpartum. 1- and 3-day postpartum females exhibited attenuated VTA population activity without changes in firing rate or pattern. None of these effects were observed in late postpartum females when compared with virgins. These data suggest that parturition induces time-dependent changes in a subset of affect-related behaviors and DA function during the postpartum period in rodents, with early postpartum females exhibiting depression-related phenotypes (i.e. low social motivation, higher immobility, blunted DA activity).
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Affiliation(s)
- Millie Rincón-Cortés
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA 15260, United States of America.
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184
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Stepanikova I, Acharya S, Abdalla S, Baker E, Klanova J, Darmstadt GL. Gender discrimination and depressive symptoms among child-bearing women: ELSPAC-CZ cohort study. EClinicalMedicine 2020; 20:100297. [PMID: 32300743 PMCID: PMC7152827 DOI: 10.1016/j.eclinm.2020.100297] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Depression is approximately two-fold more prevalent among women than men. Social theories suggest that discrimination is a pathway through which gender inequalities affect women's lives, but data are lacking. This cohort study evaluates whether perceived gender discrimination is linked to depressive symptoms among child-bearing women. METHODS Data were obtained from 4,688 participants enrolled in pregnancy in 1991-92 in the European Longitudinal Cohort Study of Pregnancy and Childhood, Czech Republic. Perceived gender discrimination was assessed in mid-pregnancy, year seven, and year eleven. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale at eight time-points between mid-pregnancy and year eleven post-delivery. Linear mixed error-component models of depressive symptoms were estimated. FINDINGS Perceived gender discrimination, reported by 10.7% of women, was related to higher depressive symptoms, both in the unadjusted analysis (b = 0.15 [95% confidence interval (CI): 0.12, 0.19], p < 0.001) and in the fully adjusted model (b = 0.12 [95% CI: 0.09, 0.16], p < 0.001). Covariates linked to higher depressive symptoms included financial hardship (b = 0.12 [95% CI: 0.10, 0.14], p < 0.001), childhood emotional/physical neglect (b = 0.18 [95% CI: 0.14, 0.22], p < 0.001), and childhood sexual abuse (b = 0.04 [95% CI: 0.03, 0.06], p < 0.001); an inverse relationship was evident for social support (-0.05 [95% CI: -0.07, -0.04], p < 0.001) and having a partner who performs female-stereotypical household tasks (b=-0.03 [95% CI: -0.05, -0.01], p = 0.001). INTERPRETATION The findings provide the first evidence that perceived gender discrimination is associated with depressive symptoms among child-bearing women. Social intervention programs aimed at reducing gender discrimination can potentially contribute to better mental health of women. FUNDING Bill and Melinda Gates Foundation.
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Affiliation(s)
- Irena Stepanikova
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
- Corresponding author at: Department of Sociology, University of Alabama at Birmingham, 1401 University Drive, Birmingham, Alabama, USA.
| | - Sanjeev Acharya
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Elizabeth Baker
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jana Klanova
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Gary L. Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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185
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Association between anemia and maternal depression: A systematic review and meta-analysis. J Psychiatr Res 2020; 122:88-96. [PMID: 31945502 DOI: 10.1016/j.jpsychires.2020.01.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/22/2019] [Accepted: 01/06/2020] [Indexed: 12/24/2022]
Abstract
Previous observational epidemiological studies have reported inconsistent findings regarding the association between anemia and the risk of maternal depression. In the present study, we investigated the relationship between anemia and the risk of maternal depression using a meta-analysis. We searched PubMed, EMBASE, and the bibliographies of relevant articles in May 2019. Three evaluators independently reviewed and selected the eligible studies based on the predetermined selection criteria. A random-effects model was employed to calculate meta-estimates of the association between anemia and maternal depression. Of the 1305 articles, 15 observational epidemiological studies (five case-control studies and 10 cohort studies) were included in the final analysis. A total of 32,792,378 women were included. Anemia was significantly associated with an increased risk of maternal depression in the random-effects meta-analysis of 15 studies (OR/RR: 1.53, 95% CI: 1.32-1.78). The association was consistent in both antepartum (OR/RR: 1.36, 95% CI: 1.07-1.72) and postpartum depression (OR/RR: 1.53, 95% CI: 1.32-1.78). Subgroup meta-analyses based on definition of anemia, definition of depression, and methodological quality reported consistent findings. The current meta-analysis showed that anemia was associated with an increased risk of maternal depression.
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186
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Punamäki R, Vänskä M, Quota SR, Perko K, Diab SY. Vocal emotion expressions in infant‐directed singing: The impact of war trauma and maternal mental health and the consequences on infant development. INFANT AND CHILD DEVELOPMENT 2020. [DOI: 10.1002/icd.2176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
| | - Mervi Vänskä
- Faculty of Social Sciences, PsychologyTampere University Tampere Finland
| | - Samir R. Quota
- Department of Education and Psychology, Islamic University of Gaza, IUG Gaza Palestine
- School of Social and Humanitarian StudiesDoha Institute for Graduate Students Doha Qatar
| | - Kaisa Perko
- Faculty of Social Sciences, PsychologyTampere University Tampere Finland
| | - Safwat Y. Diab
- Faculty of Social Sciences, PsychologyTampere University Tampere Finland
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The interaction between estradiol change and the serotonin transporter gene (5-HTTLPR) polymorphism is associated with postpartum depressive symptoms. Psychiatr Genet 2020; 29:97-102. [PMID: 31246736 DOI: 10.1097/ypg.0000000000000222] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although estrogenic fluctuation is considered a major risk factor for postpartum depression (PPD), the effects of the interactions between the genetic background and estradiol (E2) change on PPD are not well understood. Here, a cohort study with 437 postpartum women was carried out to evaluate the role of a serotonin transporter gene polymorphism (5-HTTLPR) and E2 change on the risk of PPD symptoms. The participants were assessed using the Edinburgh Postnatal Depression Scale and the Self-Rating Depression Scale at 1 and 6 weeks after delivery. The PCR-based restriction fragment length polymorphism method was utilized to examine the genotype distribution of the 5-HTTLPR polymorphism, and the serum levels of E2 were determined in individuals in the third trimester of pregnancy and at 1 week postpartum. A significant association was observed between E2 change and PPD susceptibility in the late postpartum period (6 weeks) [P = 0.002, odds ratio (OR) = 2.341, 95% confidence interval (CI) = 1.361-4.027], but it was not observed in the early postpartum period (1 week). There was no significant association between the 5-HTTLPR genotype and PPD risk at both the early and late postpartum periods (P > 0.05). However, the interaction between E2 change and the 5-HTTLPR polymorphism could reasonably influence PPD risk. The women who carried the SS genotype with large decreases in E2 showed a significantly higher risk for PPD at both the early (P = 0.002, OR = 2.525, 95% CI = 1.384-4.059) and late postpartum periods (P < 0.001, OR = 3.108, 95% CI = 1.562-4.436) compared with those who carried the SL/LL genotype. This study suggests that there is an association between E2 change in the perinatal period with the 5-HTTLPR genotype and the occurrence of PPD.
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188
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Zoubovsky SP, Hoseus S, Tumukuntala S, Schulkin JO, Williams MT, Vorhees CV, Muglia LJ. Chronic psychosocial stress during pregnancy affects maternal behavior and neuroendocrine function and modulates hypothalamic CRH and nuclear steroid receptor expression. Transl Psychiatry 2020; 10:6. [PMID: 32066677 PMCID: PMC7026416 DOI: 10.1038/s41398-020-0704-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/09/2019] [Accepted: 12/20/2019] [Indexed: 02/06/2023] Open
Abstract
Postpartum depression (PPD) affects up to 20% of mothers and has negative consequences for both mother and child. Although exposure to psychosocial stress during pregnancy and abnormalities in the hypothalamic pituitary adrenal (HPA) axis have been linked to PPD, molecular changes in the brain that contribute to this disease remain unknown. This study utilized a novel chronic psychosocial stress paradigm during pregnancy (CGS) to investigate the effects of psychosocial stress on maternal behavior, neuroendocrine function, and gene expression changes in molecular regulators of the HPA axis in the early postpartum period. Postpartum female mice exposed to CGS display abnormalities in maternal behavior, including fragmented and erratic maternal care patterns, and the emergence of depression and anxiety-like phenotypes. Dysregulation in postpartum HPA axis function, evidenced by blunted circadian peak and elevation of stress-induced corticosterone levels, was accompanied by increased CRH mRNA expression and a reduction in CRH receptor 1 in the paraventricular nucleus of the hypothalamus (PVN). We further observed decreased PVN expression of nuclear steroid hormone receptors associated with CRH transcription, suggesting these molecular changes could underlie abnormalities in postpartum HPA axis and behavior observed. Overall, our study demonstrates that psychosocial stress during pregnancy induces changes in neuroendocrine function and maternal behavior in the early postpartum period and introduces our CGS paradigm as a viable model that can be used to further dissect the molecular defects that lead to PPD.
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Affiliation(s)
- Sandra P Zoubovsky
- Center for the Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Molecular and Developmental Biology Graduate Program, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sarah Hoseus
- Center for the Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Shivani Tumukuntala
- Center for the Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jay O Schulkin
- Department of Neuroscience, Georgetown University, Washington, DC, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Michael T Williams
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Charles V Vorhees
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Louis J Muglia
- Center for the Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Molecular and Developmental Biology Graduate Program, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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189
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Fan Q, Long Q, De Silva V, Gunarathna N, Jayathilaka U, Dabrera T, Lynn H, Østbye T. Prevalence and risk factors for postpartum depression in Sri Lanka: A population-based study. Asian J Psychiatr 2020; 47:101855. [PMID: 31733601 DOI: 10.1016/j.ajp.2019.101855] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies in Sri Lanka have shown a high prevalence of postpartum depression (PPD). Postpartum depression screening using the Edinburgh Postnatal Depression Scale (EPDS) has been validated and included in routine postnatal care in 2012. OBJECTIVES This study aimed to estimate the prevalence of PPD at 10 days and 4 weeks postpartum in 2017 in two medical officer of health (MOH) areas in Sri Lanka, and to assess the association between risk factors and postpartum depression. METHODS An EPDS total score higher than 9 was used to estimate the prevalence of postpartum depression. PPD outcomes were assessed by mothers' responses to the EPDS. Potential risk factors were extracted from routine paper-based medical records. The associations were examined using simple and multivariable linear regression and multivariate logistic regression models. RESULTS A total of 1349 mothers in the two areas, 523 from Dankotuwa and 826 from Bope Poddala, were included. The prevalence of PPD was 15.5% and 7.8% among mothers assessed 10 days postpartum (in Dankotuwa) and 4 weeks postpartum (in Bope Poddala), respectively. EPDS total scores were positively related to delivery age of mothers. Presence of postpartum depression was significantly associated with delivery age over 35, having more than 4 living children and mothers' diseases. Mothers who attended prenatal sessions and whose partners were employed were less likely to report postpartum depression. CONCLUSION The prevalence of PPD in Sri Lanka was 15.5% at 10 days and 7.8% at 4 weeks postpartum. Future studies on the effect of time since delivery on postpartum depression screening outcomes are warranted.
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Affiliation(s)
- Qiping Fan
- Duke University, Durham, North Carolina, United States; Global Health Research Center, Duke Kunshan University, Jiangsu, China.
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, Jiangsu, China.
| | - Vijitha De Silva
- Duke University, Durham, North Carolina, United States; Global Health Research Center, Duke Kunshan University, Jiangsu, China; Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
| | | | | | - Thushani Dabrera
- Regional Director of Health Service Office, Puttalam, Sri Lanka.
| | - Henry Lynn
- School of Public Health, Fudan University, Shanghai, China.
| | - Truls Østbye
- Duke University, Durham, North Carolina, United States; Global Health Research Center, Duke Kunshan University, Jiangsu, China.
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190
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Grattan DR, Ladyman SR. Neurophysiological and cognitive changes in pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 171:25-55. [PMID: 32736755 DOI: 10.1016/b978-0-444-64239-4.00002-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The hormonal fluctuations in pregnancy drive a wide range of adaptive changes in the maternal brain. These range from specific neurophysiological changes in the patterns of activity of individual neuronal populations, through to complete modification of circuit characteristics leading to fundamental changes in behavior. From a neurologic perspective, the key hormone changes are those of the sex steroids, estradiol and progesterone, secreted first from the ovary and then from the placenta, the adrenal glucocorticoid cortisol, as well as the anterior pituitary peptide hormone prolactin and its pregnancy-specific homolog placental lactogen. All of these hormones are markedly elevated during pregnancy and cross the blood-brain barrier to exert actions on neuronal populations through receptors expressed in specific regions. Many of the hormone-induced changes are in autonomic or homeostatic systems. For example, patterns of oxytocin and prolactin secretion are dramatically altered to support novel physiological functions. Appetite is increased and feedback responses to metabolic hormones such as leptin and insulin are suppressed to promote a positive energy balance. Fundamental physiological systems such as glucose homeostasis and thermoregulation are modified to optimize conditions for fetal development. In addition to these largely autonomic changes, there are also changes in mood, behavior, and higher processes such as cognition. This chapter summarizes the hormonal changes associated with pregnancy and reviews how these changes impact on brain function, drawing on examples from animal research, as well as available information about human pregnancy.
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Affiliation(s)
- David R Grattan
- Centre for Neuroendocrinology and Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.
| | - Sharon R Ladyman
- Centre for Neuroendocrinology and Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
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191
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Beluska-Turkan K, Korczak R, Hartell B, Moskal K, Maukonen J, Alexander DE, Salem N, Harkness L, Ayad W, Szaro J, Zhang K, Siriwardhana N. Nutritional Gaps and Supplementation in the First 1000 Days. Nutrients 2019; 11:E2891. [PMID: 31783636 PMCID: PMC6949907 DOI: 10.3390/nu11122891] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 12/23/2022] Open
Abstract
Optimized nutrition during the first 1000 days (from conception through the 2nd birthday) is critical for healthy development and a healthy life for the newborn. Pregnancy and the postpartum period are accompanied by physiological changes, increased energy needs, and changing requirements in the nutrients critical for optimal growth and development. Infants and toddlers also experience physiological changes and have specific nutritional needs. Food and nutrition experts can provide women of childbearing age with adequate dietary advice to optimize nutrition, as well as guidance on selecting appropriate dietary supplements. Considering the approaching 2020-2025 Dietary Guidelines for Americans (DGA) will be making specific recommendations for children, it is important to provide accurate scientific information to support health influencers in the field of nutrition. The purpose of this review is to summarize the nutrition and supplementation literature for the first 1000 days; to highlight nutritional and knowledge gaps; and to educate nutrition influencers to provide thoughtful guidance to mothers and families. Optimal nutrition during pregnancy through early childhood is critical for supporting a healthy life. Nutrition influencers, such as dietitians, obstetricians/gynecologists, and other relevant health professionals, should continue guiding supplement and food intake and work closely with expectant families and nutrition gatekeepers.
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Affiliation(s)
- Katrina Beluska-Turkan
- Church & Dwight, Co., Inc., Product Development Nutritional Sciences, Princeton, NJ 08540, USA; (K.B.-T.); (K.M.); (L.H.); (W.A.); (J.S.); (K.Z.)
| | - Renee Korczak
- Premier Nutrition, LLC, Bernardsville, NJ 07924, USA;
| | - Beth Hartell
- PearTree Nutrition, LLC, Seattle, WA 98115, USA;
| | - Kristin Moskal
- Church & Dwight, Co., Inc., Product Development Nutritional Sciences, Princeton, NJ 08540, USA; (K.B.-T.); (K.M.); (L.H.); (W.A.); (J.S.); (K.Z.)
| | | | | | - Norman Salem
- DSM Nutritional Products, Columbia, MD 21045, USA;
| | - Laura Harkness
- Church & Dwight, Co., Inc., Product Development Nutritional Sciences, Princeton, NJ 08540, USA; (K.B.-T.); (K.M.); (L.H.); (W.A.); (J.S.); (K.Z.)
| | - Wafaa Ayad
- Church & Dwight, Co., Inc., Product Development Nutritional Sciences, Princeton, NJ 08540, USA; (K.B.-T.); (K.M.); (L.H.); (W.A.); (J.S.); (K.Z.)
| | - Jacalyn Szaro
- Church & Dwight, Co., Inc., Product Development Nutritional Sciences, Princeton, NJ 08540, USA; (K.B.-T.); (K.M.); (L.H.); (W.A.); (J.S.); (K.Z.)
| | - Kelly Zhang
- Church & Dwight, Co., Inc., Product Development Nutritional Sciences, Princeton, NJ 08540, USA; (K.B.-T.); (K.M.); (L.H.); (W.A.); (J.S.); (K.Z.)
| | - Nalin Siriwardhana
- Church & Dwight, Co., Inc., Product Development Nutritional Sciences, Princeton, NJ 08540, USA; (K.B.-T.); (K.M.); (L.H.); (W.A.); (J.S.); (K.Z.)
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192
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Ramsauer B, Mühlhan C, Lotzin A, Achtergarde S, Mueller J, Krink S, Tharner A, Becker-Stoll F, Nolte T, Romer G. Randomized controlled trial of the Circle of Security-Intensive intervention for mothers with postpartum depression: maternal unresolved attachment moderates changes in sensitivity. Attach Hum Dev 2019; 22:705-726. [PMID: 31726954 DOI: 10.1080/14616734.2019.1689406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Postpartum depression is related to inadequately sensitive caregiving, putting infants at risk for insecure attachment. Therefore, promoting sensitive maternal caregiving and secure child attachment is particularly important in postpartum depressed mothers and their infants. In this randomized-controlled-trial, we evaluated the efficacy of the Circle of Security-Intensive (COS-I)-intervention in supporting maternal sensitivity and mother-infant-attachment compared to treatment-as-usual (TAU) with unresolved-maternal attachment as a moderator of treatment effect. Eligible mothers with infants (N=72) 4-9 months-old were randomly assigned to treatment (n=36 dyads). Infant attachment was rated at follow-up (child age 16-18 months) (Strange-Situation-procedure). Maternal sensitivity was measured at baseline and follow-up (Mini-Maternal-Behavior-Q-sort). Maternal-unresolved-attachment was assessed at baseline (Adult-Attachment-Interview). We found no significant differences between treatments in infant attachment nor changes in mothers' sensitivity. However, in COS-I, unresolved-mothers exhibited significantly more change in sensitivity than non-unresolved-mothers, whereas in TAU, the opposite was true. These findings may help to optimize clinical use of COS-I.
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Affiliation(s)
- Brigitte Ramsauer
- Medical School Hamburg MSH, University of Applied Sciences and Medical University , Hamburg, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Christine Mühlhan
- Medical School Hamburg MSH, University of Applied Sciences and Medical University , Hamburg, Germany
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Sandra Achtergarde
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Jessica Mueller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Stephanie Krink
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Anne Tharner
- Department of Clinical Child and Family Studies, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands
| | | | | | - Georg Romer
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
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193
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Nidey N, Tabb KM, Carter KD, Bao W, Strathearn L, Rohlman DS, Wehby G, Ryckman K. Rurality and Risk of Perinatal Depression Among Women in the United States. J Rural Health 2019; 36:9-16. [PMID: 31602705 DOI: 10.1111/jrh.12401] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Rural populations may experience more frequent and intense risk factors for perinatal depression than their urban counterparts. However, research has yet to examine rural versus urban differences in a population-based study in the United States. Therefore, this study examined differences in risk of perinatal depression between women living in rural versus urban areas in the United States. METHOD Using 2016 data from the Pregnancy Risk Assessment Monitoring System, we examined the association between rural-urban status and the risk of depression during the perinatal time period. The total analytical sample included 17,229 women from 14 states. The association between rural-urban status and risk of perinatal depression was estimated using logistic regression, adjusting for race/ethnicity, maternal age, and state of residence. A second model adjusted for maternal education, health insurance status, and Women, Infants, and Children Special Supplemental Nutrition Program (WIC). RESULTS Odds of perinatal depression risk were higher by 21% among rural versus urban women (OR = 1.21, 95% CI: 1.05-1.41) adjusted for race, ethnicity, and maternal age. This risk difference became smaller and not significant when adding maternal education, health insurance coverage, and WIC participation. CONCLUSION Findings suggest a rural-urban inequality in perinatal depression risk. Reducing this inequality may require improving socioeconomic conditions and reducing associated risk factors among rural women.
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Affiliation(s)
- Nichole Nidey
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, Ohio.,Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Karen M Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Knute D Carter
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Lane Strathearn
- Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa.,Division of Developmental and Behavioral Pediatrics, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Diane S Rohlman
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa
| | - George Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Kelli Ryckman
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
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194
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Ergen AM, Yalçın SS. Unexpected drug residuals in human milk in Ankara, capital of Turkey. BMC Pregnancy Childbirth 2019; 19:348. [PMID: 31604458 PMCID: PMC6788077 DOI: 10.1186/s12884-019-2506-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 09/12/2019] [Indexed: 12/20/2022] Open
Abstract
Background Breast milk is a natural and unique nutrient for optimum growth and development of the newborn. The aim of this study was to investigate the presence of unpredictable drug residues in mothers’ milk and the relationship between drug residues and maternal-infant characteristics. Methods In a descriptive study, breastfed infants under 3 months of age and their mothers who applied for child health monitoring were enrolled for the study. Information forms were completed for maternal-infant characteristics, breastfeeding problems, crying and sleep characteristics of infants. Maternal and infant anthropometric measurements and maternal milk sample were taken. Edinburgh Postpartum Depression Scale was applied to mothers. RANDOX Infiniplex kit for milk was used for residual analysis. Results Overall, 90 volunteer mothers and their breastfed infants were taken into the study and the mean age of the mothers and their infants was 31.5 ± 4.2 years and 57.8 ± 18.1 days, respectively. Anti-inflammatory drug residues in breast milk were detected in 30.0% of mothers and all had tolfenamic acid. Overall, 94.4% had quinolone, 93.3% beta-lactam, 31.1% aminoglycoside and 13.3% polymycin residues. Drugs used during pregnancy or lactation period were not affected by the presence of residues. Edinburgh postpartum depression scores of mothers and crying and sleeping problems of infants were similar in cases with and without drug residues in breast milk. When controlling confounding factors, maternal body mass index alterations were detected to be significantly lower in mothers with anti-inflammatory drug residues in breast milk than in their counterparts (p = 0.017). Conclusions Our study suggests that there are unpredictable drug residues in the milk of many mothers. Anti-inflammatory drug exposure might affect maternal weight change during the postpartum period. Further studies are required to evaluate the impact of drug residues on maternal and infant health.
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Affiliation(s)
- Ayşe Meltem Ergen
- Department of Family Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sıddıka Songül Yalçın
- Unit of Social Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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195
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Gomez J, Haas NA, Schwarz JM. An IL-6 receptor antagonist attenuates postpartum anhedonia, but has no effect on anhedonia precipitated by subchronic stress in female rats. Psychopharmacology (Berl) 2019; 236:2983-2995. [PMID: 30830260 DOI: 10.1007/s00213-019-05194-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
RATIONALE Nearly 60-80% of women experience some form of sadness, anxiety, or anhedonia in the weeks following the birth of a child (Patel et al. 23(2):534-42, 2012; Degner 10: 359;j4692, 2017); however, the exact mechanisms that precipitate these changes in mood postpartum are still unknown. It is well-known that the function of the peripheral immune system is significantly altered during pregnancy in order to protect the developing fetus from being rejected by the maternal immune system (Fallon et al. 17(1):7-17, 2002), and we have recently found a dramatic change in the central immune system during and just after pregnancy in female rats (Sherer et al. 66:201-209, 2017). We observed anhedonia in Sprague-Dawley rat dams on the day of birth that is associated with an increase in interleukin (IL)-6 expression in the brain on the day of birth (Posillico and Schwarz 298(Pt B):218-28, 2016). OBJECTIVES The goal of the current experiments was to determine whether inhibiting the IL-6 receptor could prevent onset of this postpartum anhedonia, or anhedonia precipitated by subchronic stress in non-pregnant females. RESULTS Treatment with an IL-6 receptor antibody attenuated postpartum anhedonia as characterized by a decrease in sucrose preference. In contrast, this antibody had no effect on the decrease in sucrose preference induced following a week of forced swim stress in non-pregnant female rats. CONCLUSIONS The results of these studies suggest that the molecular mechanisms that underlie the onset of anhedonia following birth or mild stress in female rats may be distinct.
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Affiliation(s)
- Julie Gomez
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA.
| | - Nicole A Haas
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA
| | - Jaclyn M Schwarz
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA
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196
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Amiel Castro R, Pataky E, Ehlert U. Associations between premenstrual syndrome and postpartum depression: A systematic literature review. Biol Psychol 2019; 147:107612. [DOI: 10.1016/j.biopsycho.2018.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 12/17/2022]
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197
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Obregon E, Litt JS, Patel P, Ziyeh T, McCormick MC. Health related quality of life (HRQoL) in mothers of premature infants at NICU discharge. J Perinatol 2019; 39:1356-1361. [PMID: 31417142 DOI: 10.1038/s41372-019-0463-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 06/21/2019] [Accepted: 07/01/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Premature delivery and a potential Neonatal Intensive Care Unit admission may be associated with the risk of poor maternal health. We aimed to examine the mothers' health-related quality of life (HRQoL) at the time of infant discharge. STUDY DESIGN Fifty mothers completed the Medical Outcomes Study-Short Form 12. It has a Physical Component Score (PCS) and Mental Component Score (MCS), both with a mean of 50 and standard deviation of 10. Analysis included infant, maternal, and pregnancy-related characteristics. RESULTS In multivariable analyses, a household income of <150K lowered the PCS by 10 points (p = 0.003) compared to those with higher incomes. Marginal significance was noted in GA, for every week gained the PCS score was lower by 1.5 points. CONCLUSION Several risk factors are associated with lower physical health ratings in mothers of preterm infants at discharge. This information can be used to inform providers in their anticipatory guidance to the family and follow-up plans.
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Affiliation(s)
- Evelyn Obregon
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jonathan S Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Division of Newborn Medicine Harvard Medical School, Boston, MA, USA
| | - Palak Patel
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | | | - Marie C McCormick
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Division of Newborn Medicine Harvard Medical School, Boston, MA, USA. .,Department of Social Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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198
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Yang WJ, Bai YM, Qin L, Xu XL, Bao KF, Xiao JL, Ding GW. The effectiveness of music therapy for postpartum depression: A systematic review and meta-analysis. Complement Ther Clin Pract 2019; 37:93-101. [PMID: 31541788 DOI: 10.1016/j.ctcp.2019.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Wen-Jiao Yang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Yong-Mei Bai
- School of Public Health, Capital Medical University, Beijing, 10069, China
| | - Lan Qin
- School of Mathematics and Statistics, Lanzhou University, Lanzhou, 730000, China
| | - Xin-Lan Xu
- School of Mathematics and Statistics, Lanzhou University, Lanzhou, 730000, China
| | - Kai-Fang Bao
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Jun-Ling Xiao
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Guo-Wu Ding
- School of Public Health, Lanzhou University, Lanzhou, 730000, China.
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199
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Maternal perinatal mental health: Associations with bonding, mindfulness, and self‐criticism at 18 months’ postpartum. Infant Ment Health J 2019; 41:69-81. [DOI: 10.1002/imhj.21827] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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200
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Lowenhoff C, Davison-Fischer J, Pike N, Appleton JV. Using the TIDieR checklist to describe health visitor support for mothers with mental health problems: Analysis of a cross-sectional survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e824-e836. [PMID: 31293024 DOI: 10.1111/hsc.12790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/17/2019] [Accepted: 05/12/2019] [Indexed: 06/09/2023]
Abstract
At least half of the 20% of mothers who experience mental health problems (MHPs) during pregnancy or after birth are not receiving the help they need that will lead to recovery. In order to identify where improvements need to be made, it is necessary to describe exactly what is being done and the barriers and facilitators that compromise or enhance optimal care. The majority of mothers experience mild to moderate anxiety or depression. The expectation is that primary care professionals, such as health visitors (HVs), can provide the support they need that will lead to recovery. The aim of this study was to explore the views of HVs regarding the content and purpose of an intervention to support mothers with MHPs, described as 'listening visits' (LVs). A link to an online survey was offered to the members and champions of the Institute of Health Visiting (n = 9,474) March-May 2016. The survey was completed by 1,599 (17%) of the target population, of whom 85% were offering LVs. The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a framework to describe commonalities and variations in practice. There appeared to be a shared understanding of the rationale for LVs but a lack of agreement about what the intervention should be called, the techniques that should be used and the duration, frequency and expected outcomes of the intervention. Contextual factors such as staff shortages; conflicting priorities; the needs and circumstances of mothers; the capability and motivation of HVs; inadequate training and supervision; and the absence of clear guidance contributed to variations in perceptions and practice. There are many ways in which the HV contribution to the assessment and management of mothers with MHPs could be improved. The intervention delivered by HVs needs to be more clearly articulated. The contextual factors influencing competent and consistent practice also need to be addressed.
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Affiliation(s)
- Catherine Lowenhoff
- Oxford Brookes University, Oxford, UK
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
- European Academy of Nursing Studies, Brussels, Belgium
| | | | - Nick Pike
- Oxford Brookes University, Oxford, UK
| | - Jane V Appleton
- Oxford Brookes University, Oxford, UK
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
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