Associations of anxiety disorders, depressive disorders and body weight with hypertension during pregnancy

Treatment of depression during pregnancy: a protocol for systematic review and meta-analysis

Introduction

Major Depressive Disorder (MDD) is a chronic, recurrent, and highly prevalent disease that is associated with significant functional disability. During pregnancy, the prevalence of the disease is approximately 20%, with 12% of these, requiring treatment to avoid important negative consequences for the mother-baby binomial. Risk-benefit assessment of the use of antidepressants during pregnancy is mandatory, in addition to knowledge of the long-term effects of prenatal exposure to these drugs in the offspring. In this study, we will perform an updated systematic review and meta-analysis to explore the treatment of depression during pregnancy, along with its effectiveness, safety, and possible harm to women and children.

Materials and methods

We will search for publications in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, Scopus, Lilacs, and PsycINFO. The reference lists of the included studies will be manually reviewed to identify potentially relevant studies. There will be no restrictions on language or date of publication. Quality assessment of the included studies will be performed independently according to the Cochrane Risk of Bias (RoB2) instrument. To assess the certainty of the findings' body of evidence, we will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. This study aimed to ascertain the efficacy and safety of antidepressants in pregnant women and children.

Ethics and dissemination

Ethical approval was not required as individual patient data were not collected. Dissemination: Plan to publish a systematic review in an open-access medical journal at the end of the process.

Systematic Review Registration

PROSPERO, CRD42023447694.

To Be Active or to Stop? A Cross-Sectional Retrospective Study Exploring Provider Advice and Patient Fears Surrounding Physical Activity in Pregnancies Complicated by Fetal Growth Restriction

Exercise guidance for women with pregnancies complicated by fetal growth restriction (FGR) is vague, despite the fact that physical activity during pregnancy improves placental development, placental blood flow, and encourages healthy fetal growth. The goal of this study is to test the hypothesis that women with pregnancies complicated by FGR are fearful of physical activity and are being given unclear or limited advice from healthcare providers. Participants (N = 78) (women who delivered an infant diagnosed with FGR within the past 5 years) took an electronic survey including demographic information, pregnancy information, provider advice recall, and other health-related information relevant to growth-restricted pregnancies. Quantitative and qualitative (post-positivism paradigm) methods were employed to analyze the data. When asked specifically about how the FGR diagnosis impacted their activity levels, nearly 50% of participants said the diagnosis led them to decrease their activity levels. Participants reported that healthcare providers who do discuss activity with pregnant patients with FGR suggest low-intensity activities or ceasing activity, although the majority of providers did not discuss activity at all. More fears surrounding physical activity were reported post-FGR diagnosis, including worrying about fetal growth and development and causing fetal harm when engaging in physical activity.

Comprehensive intervention during pregnancy based on short message service to prevent or alleviate depression in pregnant women: A quasi-experimental study

AIM

Women have an increased risk for developing depression during pregnancy, and depression has a serious negative impact on the mother and infant. This study explored the effectiveness and feasibility of a comprehensive intervention based on using a short message service (SMS) to reduce depressive symptoms and prevent depression during pregnancy.

METHODS

This quasi-experimental study was conducted in three public hospitals with similar levels of care and maternal origin in Jiangmen City, Guangdong Province. One of the three hospitals was randomly selected as the intervention hospital, and the others were control hospitals. There were 4501 pregnant women who participated in this study. Pregnant women in the intervention group received a comprehensive intervention based on SMS after enrollment. Data were collected using questionnaires from August 2016 to August 2018.

RESULTS

After the intervention, the Edinburgh Postnatal Depression Scale scores of the intervention group were lower than those of the control group (intervention group: 3.9 ± 3.9, control group: 5.2 ± 4.3, P < .001), and the proportion of subjects with positive depression screening results in the intervention group was also significantly lower than that in the control group (intervention group: 9.0%, control group: 16.1%, P < .001). Moreover, compared with women in the intervention group, women in the control group who did not receive the intervention were more likely to be positive for depression in the third trimester (AOR = 2.04, 95% CI = 1.62-2.58).

CONCLUSIONS

The SMS-based comprehensive intervention used in this study can effectively alleviate depressive symptoms and reduce the risk of depression during pregnancy.

Depressed mood and anxiety as risk factors for hypertensive disorders of pregnancy: a systematic review and meta-analysis

BACKGROUND

Psychosocial factors have been implicated as both a cause and consequence of hypertension in the general population but are less understood in relation to hypertensive disorders of pregnancy (HDP). The aims of this review were to (1) synthesize the existing literature examining associations between depression and/or anxiety in pregnancy and HDP and (2) assess if depression and/or anxiety in early pregnancy was a risk factor for HDP.

METHODS

A comprehensive search of Medline, Embase, CINAHL, and PsycINFO was conducted from inception to March 2020 using terms related to 'pregnancy', 'anxiety', 'depression', and 'hypertensive disorders'. English-language cohort and case-control studies were included if they reported: (a) the presence or absence of clinically significant symptoms of depression/anxiety, or a medical record diagnosis of depression or an anxiety disorder in pregnancy; (b) diagnosis of HDP; and/or (c) data comparing the depressed/anxious group to the non-depressed/anxious group on HDP. Data related to depression/anxiety, HDP, study characteristics, and aspects related to study quality were extracted independently by two reviewers. Random-effects meta-analyses of estimated pooled relative risks (RRs) were conducted for depression/anxiety in pregnancy and HDP.

RESULTS

In total, 6291 citations were retrieved, and 44 studies were included across 61.2 million pregnancies. Depression and/or anxiety were associated with HDP [RR = 1.39; 95% confidence interval (CI) 1.25-1.54].

CONCLUSIONS

When measurement of anxiety or depression preceded diagnosis of hypertension, the association remained (RR = 1.27; 95% CI 1.07-1.50). Women experiencing depression or anxiety in pregnancy have an increased prevalence of HDP compared to their non-depressed or non-anxious counterparts.

The safety and effectiveness of mind body interventions for women with pregnancy induced hypertension and or preeclampsia: A systematic review and meta-analysis

OBJECTIVES

To undertake a systematic review of the safety and effectiveness of mind body approaches for women with hypertensive disorders in pregnancy (HDP).

DESIGN

A search was undertaken of databases from inception to 2019 for randomised and quasi randomised controlled trials.

MAIN OUTCOME MEASURES

The primary outcome was a reduction in systolic and / or diastolic blood pressure for women with hypertension and or preeclampsia in pregnancy.

RESULTS

121 studies were identified and eight studies were included in this review. These included mind body interventions examining yoga, guided imagery, relaxation, music, and acupuncture for HDP. Two studies of relaxation found a reduction in systolic (MD -11.3, 95%CI -13.23 to -9.39) and diastolic blood pressure (MD -6.59, 95%CI -9.43 to -3.75) and reduced stress (MD -11.4, 95%CI -16.5 to -6.3). In one study of yoga, the risk of developing HDP was reduced (RR 0.28, 95% CI 0.09 to 0.91, 59 women) and a second study found a reduction in stress at the end of the intervention of yoga. One trial of guided imagery found a reduction in mean arterial blood pressure compared to the control (4.35, 95% -8.04 to -0.66, p=0.02). Overall there was no effect on the development of preeclampsia, use of anti-hypertensive medication and any neonatal outcomes from the interventions evaluated. Few trials reported on safety outcomes, one trial of acupuncture reported one case of placental abruption and three cases of acupuncture related side effects.

CONCLUSION

Few high quality trials have examined the effectiveness and safety of mind body interventions to manage HDP. Relaxation, yoga, guided imagery and music may have some potential benefit. Safety issues are completely unclear and thus the risk-benefit ratio of all interventions could not be determined. Further research is recommended.

Reduction in physical activity significantly increases depression and anxiety in the perinatal period: a longitudinal study based on a self-report digital assessment tool

PURPOSE

Physical activity can reduce pregnancy-related complications and contributes substantially to improving maternal mental health. A reduction in activity encompassing exercise and daily household tasks throughout the course of pregnancy increases the risk of depression and anxiety. The following research examines the longitudinal interaction between exercise, general physical activity, and mental health outcomes in pregnant women.

METHODS

This prospective longitudinal study was conducted at the maternity departments of two major university hospitals in Germany. Self-reported data of 597 women were digitally assessed every 4 weeks from the second trimester until birth as well as 3 and 6 months postnatally. Depressive and anxiety symptoms were assessed using the EPDS, PRAQ, and STAI and physical activity levels were measured using the PPAQ questionnaire. Cross-sectional and longitudinal analyses using Pearson's correlation coefficient and multiple regression models were conducted.

RESULTS

We found a significant reduction in general physical activity in the period from the 20th to 32nd gestational week. Women who reported a greater decline during pregnancy showed significantly higher depression and anxiety scores. In stratified analyses, only baseline mental health scores proved to be variables with stronger impact on postnatal depression and anxiety outcomes.

CONCLUSION

General physical activity and maternal mental health significantly influence each other during and after pregnancy. Both physical activity and the prevention of perinatal mental disorders should be systematically encouraged during perinatal care to prevent adverse maternal and fetal birth outcomes.

Do lifetime anxiety disorders (anxiety liability) and pregnancy-related anxiety predict complications during pregnancy and delivery?

BACKGROUND

Evidence suggests that maternal anxiety is associated with adverse pregnancy and delivery outcomes, such as preterm birth, vaginal bleedings and low birth weight.

AIMS

To examine the association of lifetime anxiety disorders and pregnancy-related anxiety and complications during pregnancy and delivery.

STUDY DESIGN

Prospective-longitudinal study (MARI).

SUBJECTS

N = 306 pregnant women who were investigated repeatedly during the peripartum period.

OUTCOME MEASURES

Information on lifetime anxiety disorders was assessed using a dimensional score (lifetime anxiety liability index) based on the standardized Composite International Diagnostic Interview for Women (CIDI-V). Pregnancy-related anxiety was surveyed with the Pregnancy and Childbirth Related Fears (PCF) questionnaire. Common pregnancy (e.g. vaginal bleedings) and delivery complications (e.g. labor induction) were assessed via medical records, interviews and questionnaires.

RESULTS

The global tests on the association between lifetime anxiety liability and pregnancy complications and on the association between pregnancy-related anxiety and pregnancy/delivery complications revealed significant associations. Further analyses revealed associations of lifetime anxiety liability with preterm labor (OR = 1.6, 95% CI = 1.2-2.0) as well as pregnancy-related anxiety with vaginal bleedings (OR = 1.4, 95% CI = 1.0-1.8), preterm labor (OR = 1.3, 95% CI = 1.0-1.7), gestational diabetes (OR 0.5, 95% CI = 0.2-0.9), labor induction (OR = 1.5, 95% CI = 1.1-1.9) and use of labor medication (OR = 1.6, 95% CI = 1.2-2.0). After adjustment for maternal age, maternal body mass index, maternal smoking, socioeconomic status (occupation, household income) and social support (cohabitation), the associations between pregnancy-related anxiety and labor induction as well as use of labor medication remained significant.

CONCLUSIONS

Pregnancy-related anxiety should be regularly assessed and, if necessary, treated during (early) pregnancy to minimize risks for complications during delivery.

The course of panic disorder during the peripartum period and the risk for adverse child development: A prospective-longitudinal study

BACKGROUND

Panic disorders during pregnancy and after delivery may have detrimental effects for mother and child, but no firm conclusions regarding the course and outcomes of peripartum panic disorders can be drawn from previous studies.

METHODS

N = 306 women were repeatedly interviewed with the Composite International Diagnostic Interview for Women. Social support and partnership quality, gestational outcomes, duration of breastfeeding, regulatory disorders, maternal bonding and parenting style were assessed via medical and maternal reports. Standardized observations of neuropsychological development, infant temperament and attachment were conducted 4 and 16 months after delivery.

RESULTS

Women reported heterogenous courses of panic disorders, and panic disorders/panic attacks were commonly observed during the early stages of pregnancy. Women with peripartum panic disorders presented with a worse psychosocial situation (e.g., lower social support). Clear behavioral differences (temperament, attachment) in infants of women with panic disorders as compared to women with no anxiety and depressive disorder could not be detected in this study, but differences concerning gestational outcomes, duration of breastfeeding, maternal parenting, and bonding as well as regulatory problems in infants were identified.

LIMITATIONS

This prospective-longitudinal multi-wave study is restricted by the relative small sizes of the particular groups that limit the power to detect group differences.

CONCLUSIONS

Heterogenous courses and outcomes of perinatal panic disorders require intensive monitoring of affected mother-infant-dyads who may benefit from early targeted interventions to prevent an escalation of dyadic problems.

Physical activity and blood pressure during pregnancy: Mediation by anxiety symptoms

BACKGROUND

During pregnancy, physiological systems and psychological perceptions vary across individuals. Prenatal physical activity has been linked to reduced anxiety symptoms and lower blood pressure values. However, whether anxiety symptoms can mediate the relationship between physical activity and blood pressure during pregnancy remains unclear.

METHODS

In this prospective cohort study, 1275 pregnant women enrolled in Nanjing, China. Life behaviours and anxiety symptoms were investigated during the first trimester. Anxiety symptoms were measured by the Self-Rating Anxiety Scale. Blood pressure values were taken during the third trimester. Multivariate linear regression models were used to estimate the associations of physical activity with anxiety symptoms and blood pressure, and mediating effect models were used to detect the regulating effect by anxiety.

RESULTS

The participants were assigned to 3 groups based on their frequency and intensity of physical activity, and those who engaged in regular physical activity had lower blood pressure values. Anxiety symptoms were milder in the regular group than in the insufficient group. Partial mediating effect of anxiety on the association between regular physical activity and systolic blood pressure was significant after accounting for some confounders.

LIMITATIONS

The participants' physical activity and anxiety symptoms were self-reported, as well as the lack of details of physical activity during pregnancy may restrict the power of our findings.

CONCLUSIONS

Regular physical activity might be beneficial for anxiety and blood pressure. Physical activity likely stabilises systolic blood pressure by alleviating anxiety symptoms. Our research could provide a positive theoretical reference for guiding prenatal care.

Anxiety among women experiencing medically complicated pregnancy: A systematic review and meta-analysis

BACKGROUND

Symptoms of anxiety are common among pregnant and postpartum women, and 15%-20% of pregnancies are affected by medical complications. Despite this, little is known about the relationship of medical complications in pregnancy and women's experience of anxiety. The purpose of this research was to conduct a systematic review and meta-analysis of differences in anxiety symptom severity among women experiencing a medically complicated versus a medically uncomplicated pregnancy.

METHODS

This work was guided by the PRISMA reporting process. Electronic databases MEDLINE and PsycINFO were searched to identify studies that met the inclusion criteria. An adaptation of the Newcastle-Ottawa Quality Assessment Scale for case-control studies was used to perform a quality assessment review. A random-effects meta-analysis was used to calculate the estimated average standardized mean differences.

RESULTS

Based on the five studies which met our inclusion criteria, findings provide evidence of higher levels of anxiety symptoms among pregnant women experiencing a medically complicated versus a medically uncomplicated pregnancy. Despite considerable heterogeneity, all mean difference estimates are in the direction of greater anxiety in the high-risk groups.

CONCLUSIONS

Women experiencing a medically complex pregnancy report higher levels of anxiety symptoms compared to women experiencing a medically uncomplicated pregnancy.

Changes in psychopathological symptoms during pregnancy and after delivery: A prospective-longitudinal study in women with and without anxiety and depressive disorders prior to pregnancy

BACKGROUND

The role of anxiety and depressive disorders prior to pregnancy for changes in peripartum psychopathological symptoms has not been resolved yet.

METHODS

A regional-epidemiological sample of 306 women was prospectively followed in seven waves from early pregnancy until 16 months postpartum. Lifetime DSM-IV anxiety and depressive disorders were assessed at baseline with the CIDI-V. Psychopathological symptoms (somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism) were measured with the BSI three times during pregnancy and three times after delivery.

RESULTS

Multilevel analyses revealed that women with versus without lifetime anxiety (β=0.22 to β=0.32) and depressive (β=0.24 to β=0.34) disorders prior to pregnancy experienced higher peripartum psychopathological symptoms. All symptoms linearly decreased during pregnancy (β=-0.02 to β=-0.07 per month). Somatization (β=-0.46) was lower, whereas paranoid ideation (β=0.26) and obsession-compulsion (β=0.21) were higher after delivery than during pregnancy. Though, obsession-compulsion linearly decreased after delivery (β=-0.02). Lifetime anxiety disorders prior to pregnancy interacted with linear changes in anxiety (β=-0.04) and phobic anxiety (β=-0.05) during pregnancy. That is, only women with, but not without anxiety disorders prior to pregnancy experienced a linear decline in anxiety and phobic anxiety during pregnancy.

LIMITATIONS

Lifetime anxiety and depressive disorders were assessed in early pregnancy and might be biased.

CONCLUSIONS

Peripartum psychopathological symptoms are higher in women with versus without lifetime anxiety and depressive disorders prior to pregnancy, but symptom changes only slightly vary by lifetime diagnostic status.

Postpartum Bleeding in Pregnant Women Receiving SSRIs/SNRIs: New Insights From a Descriptive Observational Study and an Analysis of Data from the FAERS Database

PURPOSE

To date, the available data on the relationship between the use of selective serotonin reuptake inhibitors (SSRIs) or the serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine and postpartum hemorrhage (PPH) are conflicting and have not been extensively investigated, especially in terms of plasma drug concentrations. We performed data mining of antidepressant-induced PPH reported to the US Food and Drug Administration's Adverse Event Reporting System database, to assess the strength of the potential association between antidepressant pharmacotherapy and PPH in pregnant women. Concurrently, we carried out a descriptive observational population (pregnant women) analysis of the correlation between the plasma concentrations of SSRIs/SNRIs used during pregnancy and the extent of bleeding at delivery.

METHODS

A disproportionality analysis of individual case study reports of PPH associated with SSRIs or venlafaxine in pregnant women was performed. Reporting odds ratio was used as a measure of disproportionality analysis. Pregnant women treated with an SSRI or SNRI (venlafaxine) for depressive or anxiety disorder and who consented to plasma drug concentration monitoring at the time of delivery were recruited. Plasma drug concentration assay was performed according to validated LC-MS/MS. Based on plasma drug concentrations, patients were classified into 1 of 2 groups, in therapeutic range or below therapeutic range for the drug administered, in accordance with the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie guideline, and correlations with blood loss were identified, with PPH defined as a blood loss of >500 mL.

FINDINGS

Only 43 Individual Case Safety Reports (ICSRs) reported at least one SSRIs or venlafaxine as suspect drug in 14 years (database analyses). Forty-three women were enrolled in the study population (observational study). In 24 patients (55.8%) the plasma drug concentration was below the therapeutic threshold. Unexpectedly, the mean blood loss in the below-range group was significantly higher than that in the in-range group. PPH occurred in 30% of women: in 9.3% and in 20.7% of patients in the in-range and below-range groups, respectively.

IMPLICATIONS

Although preliminary, these data indicate a rather good tolerability profile of SSRIs/SNRIs regarding postpartum bleeding. Moreover, they suggest that keeping the plasma levels of SSRIs/SNRIs low as a precautionary measure does not reduce postpartum bleeding, which was higher in the below-range group. The findings from this study suggest that the use of therapeutic drug monitoring in pregnancy, a period in which multiple variables affect drug metabolism, may allow for better treatment customization, with subsequent advantages in terms of tolerability and efficacy of treatment.

Depression, Antidepressants and Hypertensive Disorders of Pregnancy: A Systematic Review

Background:

Hypertensive disorders of pregnancy including gestational hypertension, preeclampsia and eclampsia are conditions that cause significant perinatal and maternal morbidity and mortality. </P><P> Objective: This is a systematic review of the current evidence examining the relationship between both depression and antidepressants on pregnancy-related hypertensive conditions. </P><P> Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, six databases were searched for articles published between January 1990 and December 2017 (PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, MEDLINE and ClinicalTrials. gov). Randomized control trials, cohort studies and case-control studies were included in this review. Studies that measured the following exposures were included: Antidepressant exposure or diagnosis of depression. Studies that measured the following outcomes were included: Gestational hypertension, preeclampsia or eclampsia. A combination of keywords, as well as Medical Subject Headings (MeSH) index terms, was used for three general categories: antidepressants, depression and hypertensive disorders of pregnancy. A total of 743 studies were identified and 711 were excluded based on relevance to the research question. Twenty studies were included in the final systematic review. </P><P> Results: Of the twenty relevant studies, ten specifically examined the relationship between depression and hypertension in pregnancy. Only two of these did not find a significant association. Of the ten studies that concentrated on antidepressant medications, all except one found an association with hypertension in pregnancy to varying degrees. </P><P> Conclusion: Review of the literature suggests a possible association between depression and antihypertensive medications with pregnancy-related hypertension, but further studies are needed.</P>

Gestational weight gain, physical activity, sleep problems, substance use, and food intake as proximal risk factors of stress and depressive symptoms during pregnancy

Background

Because maternal depressive symptoms and stress during pregnancy are strongly associated with poor health of the mother and the developing child, understanding the predictors of women’s mental health problems is important to prevent complications in the perinatal period. Therefore, this study sought to examine the association between six risk factors – gestational weight gain (GWG), low physical activity, sleep problems, alcohol use, cigarette smoking and snack food intake – and mental health problems during pregnancy. We hypothesized that risk factors would predict mental health problems while adjusting for socio-demographic characteristics and pregnancy intention, both cross-sectionally and longitudinally.

Methods

Hierarchical linear regression analyses were conducted in a population-based sample of N = 463 pregnant women during their 2^nd trimester (gestational age: 23 to 28 weeks) of whom n = 349 were reassessed during their 3^rd trimester (gestational age: 33 to 38 weeks). Women had a mean age of 29.8 ± 4.2 years and a mean pregravid body mass index of 23.5 ± 4.3 kg/m². Data were collected by the ‘Leipzig Research Center for Civilization Diseases’ via the Patient Health Questionnaire, Pittsburgh Sleep Quality Index, Food Frequency Questionnaire, self-report items on physical activity and substance use, and objectively measured anthropometrics.

Results

Cross-sectionally, while a higher snack food intake and sleep problems predicted depressive symptoms and stress during the 2^nd trimester, gestational weight gain predicted stress only. Longitudinally, sleep problems positively predicted depressive symptoms during the 3^rd trimester. All results remained significant after controlling for age, pregravid body mass index, and pregnancy intention. GWG and significant longitudinal effects became insignificant when controlling for gestational age or baseline depressive symptoms and stress, respectively.

Conclusions

The results showed that sleep problems were associated with maternal mental health problems during pregnancy. Longitudinal studies using standardized measures, particularly diagnostic interviews and physiological or biochemical markers, are warranted to confirm patterns of risk factors, their association with depressive symptoms and stress during the course of pregnancy, and their effects on mother’s and child’s health.

Electronic supplementary material

The online version of this article (10.1186/s12884-019-2328-1) contains supplementary material, which is available to authorized users.

Correlation between maternal anxiety, reactivity of fetal cerebral circulation to auditory stimulation, and birth outcome in normotensive and gestational hypertensive women

This study investigated the correlation between maternal anxiety and blood flow changes through the fetal middle cerebral artery (MCA) after defined acoustic stimulation in 43 normotensive (C) and 40 gestational hypertensive (GH) subjects. Neonatal outcomes (gestational age at birth, Apgar score, birth weight) in the C and GH groups were analyzed. State (STAI-S) and trait (STAI-T) anxiety was assessed using Spielberger's questionnaire. The MCA blood flow was assessed once between 28 and 41 weeks of gestation using color Doppler ultrasound before and after application of defined acoustic stimulus. Relative size of the Pulsatility index (Pi) change (RePi) was calculated. The general hypotheses were: (1) women in GH group would have higher anxiety; (2) higher anxiety correlates with higher RePi change and poorer neonatal outcome; (3) fetuses from the GH group would have poorer neonatal outcome. Subjects from the GH group had higher STAI-T and RePi compared to the C group. A positive correlation between RePi and STAI-S, STAI-T, and systolic/diastolic blood pressure was found in both groups. There were more preterm deliveries in the GH group compared to the C group. A significant effect of STAI-T on body weight was observed in the C and GH group. There was a predictive effect of STAI-T and RePi on the C group, and STAI-S, STAI-T, diastolic blood pressure, and RePi on the GH group in terms of neonatal body weight. This study demonstrates an association between antenatal anxiety in GH women and increased fetal cerebral circulation in response to defined auditory stimulation.

Therapist-Supported Internet-Based Cognitive Behavior Therapy for Stress, Anxiety, and Depressive Symptoms Among Postpartum Women: A Systematic Review and Meta-Analysis

Background

A growing number of meta-analyses have supported the application of therapist-supported Internet-based cognitive behavior therapy (iCBT) for psychological disorders across different populations, but relatively few meta-analyses have concentrated on postpartum women.

Objective

This meta-analysis evaluated the efficacy of therapist-supported iCBT in improving stress, anxiety, and depressive symptoms among postpartum women.

Methods

A total of 10 electronic databases were used to search for published and unpublished trials. Cochrane Collaboration tool for assessing risk of bias was utilized to measure methodological quality. Meta-analysis was performed using the RevMan software (Review Manager version 5.3 for Windows from the Nordic Cochrane Centre, the Cochrane Collaboration, 2014). Among the 789 studies identified, 8 randomized controlled trials were selected, involving 1523 participants across 6 countries.

Results

More than half (65%) of the eligible studies had a low risk of bias with no heterogeneity. Results revealed that therapist-supported iCBT significantly improved stress (d=0.84, n=5), anxiety (d=0.36, n=6), and depressive symptoms (d=0.63, n=8) of the intervention group compared with those of the control group at post-intervention.

Conclusions

This review revealed that therapist-supported iCBT significantly improves stress, anxiety, and depressive symptoms among postpartum women with small to large effects. Future effectiveness studies should establish the essential components, format, and approach of iCBT with optimal levels of human support to maximize a long-term effect.

Depression and Anxiety During Pregnancy: Evaluating the Literature in Support of Clinical Risk-Benefit Decision-Making

Depression and anxiety during pregnancy are common, and patients and providers are faced with complex decisions regarding various treatment modalities. A structured discussion of the risks and benefits of options with the patient and her support team is recommended to facilitate the decision-making process. This clinically focused review, with emphasis on the last 3 years of published study data, evaluates the major risk categories of medication treatments, namely pregnancy loss, physical malformations, growth impairment, behavioral teratogenicity, and neonatal toxicity. Nonpharmacological treatment options, including neuromodulation and psychotherapy, are also briefly reviewed. Specific recommendations, drawn from the literature and the authors' clinical experience, are also offered to help guide the clinician in decision-making.

Caesarean section by maternal age group among singleton deliveries and primiparous Japanese women: a secondary analysis of the WHO Global Survey on Maternal and Perinatal Health

Background

The rising caesarean section rate is an important public health concern that in turn increases maternal and perinatal risks of adverse effects, unnecessary medical consumption, and inequities in worldwide access. The aim of this study was to investigate caesarean section indications by maternal age group and examine the association between age and caesarean section in primiparous Japanese women with singleton births.

Methods

We analyzed the Japanese data of primiparous women with singleton births from the WHO Global Survey on Maternal and Perinatal Health to compare maternal and neonatal characteristics and outcomes between groups with and without caesarean section. Women were divided into 3 maternal age groups (≤29, 30 to 34 and ≥35 years). We performed multivariable logistic-regression analysis to identify characteristics associated with caesarean section.

Results

Of the 3245 women with singleton births were included in the Japanese data, 610 women (18.8 %) delivered by caesarean section, half of whom (n = 305) were nulliparous. We included singleton nulliparous women (1747 deliveries) in our analysis. The maternal age 35 years old was associated with higher risks for all caesarean section (adjusted odds ratio [AOR] 1.89, 95 % CI 1.28–2.78) and emergency antepartum caesarean section (AOR 2.26, 95 % CI 1.49–3.40). Intrapartum caesarean section, which is mainly performed for obstetric indications, was not higher among the older maternal age group.

Conclusion

In Japan, advanced maternal age significantly increased the risk for caesarean section; however, intrapartum caesarean section was not higher risk among the older age group. Management of maternal complications would help to reduce the rate of caesarean sections and associated unnecessary medical consumption.

Maternal Uncontrolled Anxiety Disorders Are Associated With the Increased Risk of Hypertensive Disorders in Japanese Pregnant Women

Background

We examined the risk of hypertensive disorders in relation to maternal depressive and anxiety disorders which were diagnosed before or during early pregnancy in Japanese women.

Methods

We reviewed the obstetric records of all Japanese singleton deliveries at ≥ 22 weeks’ gestation managed at the Japanese Red Cross Katsushika Maternity Hospital between 2009 and 2014. Potential risk factors for hypertensive disorders with maternal depressive and anxiety disorders were selected as follows: maternal age, parity, medications, self-interruption of medications and economic problems.

Results

The incidence of hypertensive disorders did not increase in the pregnant women with depressive disorders compared with that in the normal control pregnant women (P = 0.96). However, the incidence of hypertensive disorders in the women with anxiety disorders was higher than that in the control women (odds ratio (OR): 2.61, 95% confidence interval (CI): 1.4 - 5.0, P < 0.01). In the women with anxiety disorders, 19% performed self-interruption of medications during pregnancy, and it was associated with the increased risk of hypertensive disorders (vs. no medication group, OR: 7.50, 95% CI: 1.5 - 38, P = 0.03; vs. medication group, OR: 16.0, 95% CI: 2.4 - 110, P < 0.01).

Conclusions

Maternal uncontrolled anxiety disorders due to self-interruption of medications seemed to be associated with the increased risk of hypertensive disorders in Japanese pregnant women.