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Akinkugbe AA, Chiu YHM, Kannan S, Bergink V, Wright RJ. Prenatal Iodine Intake and Maternal Pregnancy and Postpartum Depressive and Anhedonia Symptoms: Findings from a Multiethnic US Cohort. Nutrients 2024; 16:1771. [PMID: 38892704 PMCID: PMC11174687 DOI: 10.3390/nu16111771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Objective: Emerging evidence suggests that essential trace elements, including iodine, play a vital role in depressive disorders. This study investigated whether prenatal dietary iodine intake alone and in combination with supplemental iodine intake during pregnancy were associated with antepartum and postpartum depressive and anhedonia symptoms. Methods: The study population included 837 mothers in the PRogramming of Intergenerational Stress Mechanisms (PRISM) study. The modified BLOCK food frequency questionnaire was used to estimate prenatal dietary and supplemental iodine intake, while the 10-item Edinburg Postpartum Depression Scale (EPDS) ascertained depressive symptoms. Analyses considered the global EPDS score and the anhedonia and depressive symptom subscale scores using dichotomized cutoffs. Logistic regression estimating odds ratios and 95% confidence intervals (CIs) assessed associations of iodine intake in the second trimester of pregnancy and 6-month postpartum depressive and anhedonia symptoms considering dietary intake alone and combined dietary and supplementary intake in separate models. Results: Most women were Black/Hispanic Black (43%) and non-Black Hispanics (35%), with 39% reporting a high school education or less. The median (interquartile range, IQR) dietary and supplemental iodine intake among Black/Hispanic Black (198 (115, 337) µg/day) and non-Black Hispanic women (195 (126, 323) µg/day) was higher than the overall median intake level of 187 (116, 315) µg/day. Relative to the Institute of Medicine recommended iodine intake level of 160-220 µg/day, women with intake levels < 100 µg/day, 100-<160 µg/day, >220-<400 µg/day and ≥400 µg/day had increased adjusted odds of 6-month postpartum anhedonia symptoms (aOR = 1.74 (95% CI: 1.08, 2.79), 1.25 (95% CI: 0.80, 1.99), 1.31 (95% CI: 0.82, 2.10), and 1.47 (95% CI: 0.86, 2.51), respectively). The corresponding estimates for postpartum global depressive symptoms were similar but of smaller magnitude. Conclusions: Prenatal iodine intake, whether below or above the recommended levels for pregnant women, was most strongly associated with greater anhedonia symptoms, particularly in the 6-month postpartum period. Further studies are warranted to corroborate these findings, as dietary and supplemental iodine intake are amenable to intervention.
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Affiliation(s)
- Aderonke A. Akinkugbe
- Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Institute for Climate Change, Environmental Health and Exposomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yueh-Hsiu Mathilda Chiu
- Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Institute for Climate Change, Environmental Health and Exposomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Srimathi Kannan
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rosalind J. Wright
- Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Institute for Climate Change, Environmental Health and Exposomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Song Z, Zhang D, Yang L, Zhu P, Liu Y, Wang S, Zheng R. Factor structure and longitudinal invariance for the Chinese Mainland version of the Edinburgh postnatal depression scale during pregnancy. Midwifery 2024; 132:103963. [PMID: 38457994 DOI: 10.1016/j.midw.2024.103963] [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] [Received: 10/05/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND There are inconsistent results on the Edinburgh Postnatal Depression Scale's (EPDS) factor structure and longitudinal invariance among different cultures. Furthermore, limited relevant studies in Chinese pregnant women exist. PURPOSE To test the factor structure of the Chinese Mainland EPDS during pregnancy and conduct longitudinal invariance analyses. METHODS A national multi-centre cohort study was conducted among 1207 pregnant women selected consecutively by convenience sampling from five hospitals in Zhuhai, Taiyuan, Haidian, Changchun, and Shenzhen in China between August 2015 and October 2016. Depression was measured by the EPDS during gestational weeks 10-13, 15-18, 23-25, 30-32 and 36-37, respectively.s RESULTS: Three factors with eigenvalues nearly larger than 1.0 were optimal for the Chinese Mainland EPDS, labelled "anxiety," "anhedonia," and "depression," and contained items 3-5, 1-2, and 6-10, respectively. The confirmatory factor analysis results of standardized root mean square residual (SRMR) = 0.034, root mean square error of approximation (RMSEA) = 0.049, comparative fit index (CFI) = 0.968, Tucker-Lewis index (TLI) = 0.954, and χ2, p < 0.05 indicated good fit. For the longitudinal invariance tests, the configural invariance was met, with the CFI and TLI both higher than 0.90 and the RMSEA lower than 0.08 (CFI = 0.919, TLI = 0.908, and RMSEA = 0.034). The metric-, scalar-, and strict invariances were met. CONCLUSIONS The three-factor model of the Chinese Mainland EPDS is invariant in pregnancy, suggesting stability and comparability in identifying the women screened positive at different points during pregnancy and making the scale feasible to screen prenatal depression and anxiety simultaneously.
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Affiliation(s)
- Zhijiao Song
- Department of Epidemiology, Center of Clinical Epidemiology and Evidence Based Medicine, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, Shanxi 030001, China; Department of Health Education, Shanxi Women and Children Health Hospital, Taiyuan 030013, China
| | - Daming Zhang
- Department of Child and Adolescent, School of Public health, Shanxi Medical University, Taiyuan 030001, China; Department of Mental Health, Shanxi Women and Children Health Hospital, Taiyuan 030013, China
| | - Li Yang
- Department of Women's Health, National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No.12 Dahui Road, Haidian District, Beijing 100081, China
| | - Pengfei Zhu
- Center of Reproductive Medicine, Shanxi Women and Children Health Hospital, Taiyuan, 030013, China
| | - Yan Liu
- Cancer prevention and control office, Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, China
| | - Suping Wang
- Department of Epidemiology, Center of Clinical Epidemiology and Evidence Based Medicine, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, Shanxi 030001, China.
| | - Ruimin Zheng
- Department of Women's Health, National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No.12 Dahui Road, Haidian District, Beijing 100081, China.
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Koerner R, Rechenberg K, Rinaldi K, Duffy A. Are Providers Adequately Screening for Anxiety Symptoms During Pregnancy? Nurs Womens Health 2024; 28:109-116. [PMID: 38278513 DOI: 10.1016/j.nwh.2023.09.007] [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] [Received: 07/21/2023] [Revised: 09/19/2023] [Accepted: 12/06/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE To examine the difference in prevalence of self-reported anxiety symptoms throughout pregnancy compared to clinical diagnosis of an anxiety disorder by a provider. DESIGN Secondary data analysis of a prospective cohort study of 50 pregnant individuals. SETTING/LOCAL PROBLEM Pregnant individuals commonly experience heightened anxiety symptoms, which are associated with adverse perinatal outcomes. However, a diagnosis of an anxiety disorder by a health care provider is less common, which may result in insufficient mental health intervention. PARTICIPANTS Pregnant individuals were recruited at their first prenatal appointment and followed until birth. INTERVENTION/MEASUREMENTS We examined anxiety symptoms using the Edinburgh Postnatal Depression Scale Anxiety subscale. We conducted a medical record review to examine if pregnant individuals were clinically diagnosed with an anxiety disorder. RESULTS Based on an Edinburgh Postnatal Depression Scale Anxiety subscale cutoff score of ≥5, 40% (n = 20) of individuals experienced anxiety symptoms during pregnancy. However, only 16% (n = 8) of participants were diagnosed with an anxiety disorder by a health care provider. CONCLUSION Anxiety symptoms are prevalent throughout pregnancy and may be underdiagnosed by health care providers. An intervention to increase clinical diagnosis of an anxiety disorder and subsequent referral to a mental health specialist may be indicated.
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Pan Y, Xu J. Can EPDS and EPDS-3A be used to replace GAD-7 to screen the anxiety of pregnant women during pregnancy examination? Int J Gynaecol Obstet 2024; 164:902-911. [PMID: 37559497 DOI: 10.1002/ijgo.15053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 07/20/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To examine the screening ability and cut-off scores of the Edinburgh Postnatal Depression Scale (EPDS) and EPDS-3A for pregnancy anxiety in pregnancy examination. METHODS This was a prospective repetitive measurement study. A follow-up survey was performed in Chinese pregnant women with the EPDS, the 7-item Generalized Anxiety Disorder (GAD-7) scale and a basic information questionnaire. A total of 609 women participated in all surveys at three trimesters, and all data were complete with no missing values. Receiver operating characteristic curves, Cohen's kappa and cross-tabulation were used to test the single and combined screening ability of EPDS and EPDS-3A for pregnancy anxiety. RESULTS The areas under the curves of EPDS and EPDS-3A were close to or more than 0.90. EPDS scores greater than 14 in the first trimester and greater than 13 in the second and third trimesters could be used as the cut-off values. EPDS-3A score greater than 4 could be used as the cut-off value in each trimester. Adding the EPDS-3A to the EPDS would lead to correct identification of an additional 6.33%, 6.35%, and 7.25% of anxious women and misdiagnosis of an additional 6.60%, 2.56%, and 2.41% of normal women in each trimester, respectively. CONCLUSION The EPDS and EPDS-3A can be used alone or in combination for initially screening of pregnancy anxiety. Under certain conditions, they can even be used to replace GAD-7 for anxiety screening to reduce the adverse influence of excessive screening on pregnant women, and improve the quality of survey data and efficiency of clinical services.
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Affiliation(s)
- Yingming Pan
- Department of Psychology, Weifang Medical University, Weifang, China
| | - Jihong Xu
- Human Genetic Resource Center, National Research Institute for Family Planning, Beijing, China
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Wang D, Huang CQ, Jiang RZ, Fan YJ. Associated factors of depression in primiparas with hypothyroidism during pregnancy. Medicine (Baltimore) 2024; 103:e36418. [PMID: 38306536 PMCID: PMC10843380 DOI: 10.1097/md.0000000000036418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/10/2023] [Indexed: 02/04/2024] Open
Abstract
This cross-sectional study aimed to explore the associated factors of depression in primiparas with hypothyroidism during pregnancy. The research subjects were 200 primiparas with hypothyroidism during pregnancy who were admitted to our hospital between December 2016 and December 2019. Self-rating depression scale scores were used to evaluate the depression, and the incidence of depression were examined. The data from all the subjects were collected to compare the differences between primiparas with hypothyroidism during pregnancy with and without depression. A logistic regression equation was used to analyze the influencing factors of depression in these patients. Of the 200 primiparas who took part in this study, 27 suffered from depression, accounting for 13.50%. There were differences in age, education level, economic income, sleep quality, and conjugal relations between the depressed and the nondepressed participants. When the above factors were included in the logistic regression equation, it was found that the odds ratio values for these factors were all >1, which indicated that they had an influence on maternal depression in primiparas with hypothyroidism during pregnancy. This study demonstrated that pregnancy-associated hypothyroidism in primiparas is affected by age, education level, economic income, sleep quality, and conjugal relations, all of which increase the incidence of depression. Relevant preventive measures should be provided in clinical practice to avoid the occurrence of depression.
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Affiliation(s)
- Dan Wang
- Department of Obstetrics, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Cui-Qin Huang
- Department of Obstetrics, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Rong-Zhen Jiang
- Department of Obstetrics, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Ya-Jing Fan
- Department of Obstetrics, Shanghai Sixth People’s Hospital, Shanghai, China
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Silverwood VA, Bullock L, Turner K, Chew-Graham CA, Kingstone T. The approach to managing perinatal anxiety: A mini-review. Front Psychiatry 2022; 13:1022459. [PMID: 36590629 PMCID: PMC9797985 DOI: 10.3389/fpsyt.2022.1022459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Perinatal Anxiety (PNA) is defined as anxiety occurring during pregnancy and up to 12 months post-partum and is estimated to affect up to 20% of women. Risk factors for PNA are multiple and can be classed as psychological, social and biological. PNA negatively impacts on the mother, child and family. PNA is not well-recognized and diagnosis of PNA can be challenging for clinicians. There is currently no validated case-finding or diagnostic test available for PNA. PNA has been less extensively researched than perinatal depression (PND). Clinical guidance currently recommends pharmacological and psychological therapies for the management of women with PNA, however the limited research available suggests that other intervention types may also be effective with some evidence on the effectiveness of non-pharmacological interventions in primary care for PNA. This article provides a mini-review of PNA, summarizing current evidence around PNA including risk factors, the impact of PNA, the process of diagnosis of PNA and focussing predominantly on available management options for PNA.
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Affiliation(s)
| | - Laurna Bullock
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Katrina Turner
- Centre of Academic Primary Health Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Carolyn A. Chew-Graham
- School of Medicine, Keele University, Staffordshire, United Kingdom
- Midlands Partnership NHS Foundation Trust, Trust Headquarters, St George's Hospital, Stafford, United Kingdom
- Applied Research Collaboration (ARC) West Midlands, Keele University, Staffordshire, United Kingdom
| | - Tom Kingstone
- School of Medicine, Keele University, Staffordshire, United Kingdom
- Midlands Partnership NHS Foundation Trust, Trust Headquarters, St George's Hospital, Stafford, United Kingdom
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Kleine I, Vamvakas G, Lautarescu A, Falconer S, Chew A, Counsell S, Pickles A, Edwards D, Nosarti C. Postnatal maternal depressive symptoms and behavioural outcomes in term-born and preterm-born toddlers: a longitudinal UK community cohort study. BMJ Open 2022; 12:e058540. [PMID: 36581974 PMCID: PMC9438072 DOI: 10.1136/bmjopen-2021-058540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To examine the association between maternal depressive symptoms in the immediate postnatal period and offspring's behavioural outcomes in a large cohort of term-born and preterm-born toddlers. DESIGN AND PARTICIPANTS Data were drawn from the Developing Human Connectome Project. Maternal postnatal depressive symptoms were assessed at term-equivalent age, and children's outcomes were evaluated at a median corrected age of 18.4 months (range 17.3-24.3). EXPOSURE AND OUTCOMES Preterm birth was defined as <37 weeks completed gestation. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS). Toddlers' outcome measures were parent-rated Child Behaviour Checklist 11/2-5 Total (CBCL) and Quantitative Checklist for Autism in Toddlers (Q-CHAT) scores. Toddlers' cognition was assessed with the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III). RESULTS Higher maternal EPDS scores were associated with toddlers' higher CBCL (B=0.93, 95% CI 0.43 to 1.44, p<0.001, f2=0.05) and Q-CHAT scores (B=0.27, 95% CI 0.03 to 0.52, p=0.031, f2=0.01). Maternal EPDS, toddlers' CBCL and Q-CHAT scores did not differ between preterm (n=97; 19.1% of the total sample) and term participants. Maternal EPDS score did not disproportionately affect preterm children with respect to CBCL or Q-CHAT scores. CONCLUSIONS Our findings indicate that children whose mothers reported increased depressive symptoms in the early postnatal period, including subclinical symptoms, exhibit more parent-reported behavioural problems in toddlerhood. These associations were independent of gestational age. Further research is needed to confirm the clinical significance of these findings.
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Affiliation(s)
- Ira Kleine
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - George Vamvakas
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alexandra Lautarescu
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Shona Falconer
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Andrew Chew
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Serena Counsell
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Edwards
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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