The neurobiological impact of postpartum maternal depression: prevention and intervention approaches

Efficacy of in-person versus digital mental health interventions for postpartum depression: meta-analysis of randomized controlled trials

AIM

This meta-analysis aimed to compare the efficacy of in-person and digital mental health interventions in addressing Postpartum Depression.

METHODS

Following PRISMA guidelines, the protocol for this meta-analysis was registered at the Open Science Framework (Retrieved from osf.io/wy3s4). This meta analysis included Randomized Controlled Trials (RCTs) conducted between 2013 and 2023. A comprehensive literature search identified 35 eligible RCTs from various electronic databases. Inclusion criteria focused on pregnant women over 18 years old, encompassing antenatal depression and up to two years postpartum. Diagnostic interviews or Edinburgh Postnatal Depression Scale (EPDS) were used to establish PPD. Digital interventions included telephonic, app-based, or internet-based approaches, while in-person interventions involved face-to-face sessions.

RESULTS

The meta-analysis revealed a moderate overall effect size of -0.69, indicating that psychological interventions are effective for PPD. Digital interventions (g = -0.86) exhibited a higher mean effect size than in-person interventions (g = -0.55). Both types of interventions displayed substantial heterogeneity (digital: I2 = 99%, in-person: I2 = 92%), suggesting variability in intervention content, delivery methods, and participant characteristics.

CONCLUSION

Digital mental health interventions show promise in addressing PPD symptoms, with a potentially greater effect size compared to in-person interventions. However, the high heterogeneity observed in both modalities underscores the need for further research to identify key drivers of success and tailor interventions to diverse populations. Additionally, the choice between digital and in-person interventions should consider individual needs and preferences. Ongoing research should further investigate and optimise intervention modalities to better serve pregnant women at risk of PPD.

Postpartum Psychosis: A Review of Risk Factors, Clinical Picture, Management, Prevention, and Psychosocial Determinants

Postpartum psychosis is rare, but is a serious clinical and social problem. On its own, it is not included in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) or ICD-10 (International Statistical Classification of Diseases and Related Health Problems) as a disease entity, and current diagnostic criteria equate it with other psychoses. This poses a serious legal problem and makes it difficult to classify. The disorder is caused by a complex combination of biological, environmental, and cultural factors. The exact pathophysiological mechanisms of postpartum psychosis remain very poorly understood. There is a need for further research and increased knowledge of the medical sector in the prevention and early detection of psychosis to prevent stigmatization of female patients during a psychiatric episode. It is necessary to regulate its position in the DSM5 and ICD-10. Attention should be paid to the social education of expectant mothers and their families. This article aims to review the current status of risk factors, prevention, and management of postpartum psychosis.

Psychological treatment of perinatal depression: a meta-analysis

BACKGROUND

Depression during pregnancy and after the birth of a child is highly prevalent and an important public health problem. Psychological interventions are the first-line treatment and, although a considerable number of randomized trials have been conducted, no recent comprehensive meta-analysis has evaluated treatment effects.

METHODS

We used an existing database of randomized controlled trials of psychotherapies for adult depression and included studies aimed at perinatal depression. Random effects models were used in all analyses. We examined the effects of the interventions in the short and long term, and also examined secondary outcomes.

RESULTS

Forty-three studies with 49 comparisons and 6270 participants between an intervention and control group were included. The overall effect size was g = 0.67 [95% confidence interval (CI) 0.45~0.89; numbers needed-to-be-treated = 4.39] with high heterogeneity (I² = 80%; 95% CI 75~85). This effect size remained largely unchanged and significant in a series of sensitivity analyses, although some publication bias was found. The effects remained significant at 6-12 months follow-up. Significant effects were also found for social support, anxiety, functional limitations, parental stress and marital stress, although the number of studies for each outcome was low. All results should be considered with caution because of the high levels of heterogeneity in most analyses.

CONCLUSIONS

Psychological interventions are probably effective in the treatment of perinatal depression, with effects that last at least up to 6-12 months and probably also have effects on social support, anxiety, functional impairment, parental stress, and marital stress.

The association between paternal childcare involvement and postpartum depression and anxiety among Chinese women-a path model analysis

Depression and anxiety are among the most common morbidities during the perinatal period. Very few studies have been conducted to examine the association between paternal childcare involvement and postpartum depression (PPD) and anxiety (PPA) in East Asian cultures. This study aims to examine the association between fathers' involvement in childcare and mothers' mental health and explores the potential mediating effects of the mother and child's health among a national sample of Chinese women. This is a cross-sectional, self-administered online survey of maternal women (N = 778) within 1 year after childbirth in China. The questionnaire comprised of sociodemographics, fathers' childcare involvement, child and mother's physical health, and mothers' postpartum mental health status. A path analysis model was constructed to examine the correlation between paternal childcare involvement and maternal depression and anxiety within 1-year postpartum. The mediating effect of the mother and child's physical health was also explored in the model. Paternal involvement in childcare was significantly associated with lower PPD (β =  - .36, p < 0.001) and PPA (β =  - .29, p < 0.001) levels of mothers after covariates were adjusted. Furthermore, women's physical health partially mediated the association between paternal involvement and PPD, and child's health partially mediated the association between paternal involvement and PPA and PPD. Our findings emphasize the essential role of father's childcare involvement and the need to promote culturally tailored intervention programs, which may improve the mental health status among Chinese postpartum mothers.

HIV-1 Integrase Strand Transfer Inhibitors and Neurodevelopment

Children born to mothers, with or at risk, of human immunodeficiency virus type-1 (HIV-1) infection are on the rise due to affordable access of antiretroviral therapy (ART) to pregnant women or those of childbearing age. Each year, up to 1.3 million HIV-1-infected women on ART have given birth with recorded mother-to-child HIV-1 transmission rates of less than 1%. Despite this benefit, the outcomes of children exposed to antiretroviral drugs during pregnancy, especially pre- and post- natal neurodevelopment remain incompletely understood. This is due, in part, to the fact that pregnant women are underrepresented in clinical trials. This is underscored by any potential risks of neural tube defects (NTDs) linked, in measure, to periconceptional usage of dolutegravir (DTG). A potential association between DTG and NTDs was first described in Botswana in 2018. Incidence studies of neurodevelopmental outcomes associated with DTG, and other integrase strand transfer inhibitors (INSTIs) are limited as widespread use of INSTIs has begun only recently in pregnant women. Therefore, any associations between INSTI use during pregnancy, and neurodevelopmental abnormalities remain to be explored. Herein, United States Food and Drug Administration approved ARVs and their use during pregnancy are discussed. We provide updates on INSTI pharmacokinetics and adverse events during pregnancy together with underlying mechanisms which could affect fetal neurodevelopment. Overall, this review seeks to educate both clinical and basic scientists on potential consequences of INSTIs on fetal outcomes as a foundation for future scientific investigations.

Postpartum depression and major depressive disorder: the same or not? Evidence from resting-state functional MRI

Background

Although postpartum depression (PPD) and non-peripartum major depressive disorder (MDD) occurring within and outside the postpartum period share many clinical characteristics, whether PPD and MDD are the same or not remains controversial.

Methods

The current study was devoted to identify the shared and different neural circuits between PPD and MDD by resting-state functional magnetic resonance imaging data from 77 participants (22 first-episodic drug-naïve MDD, 26 drug-naïve PPD, and 29 healthy controls (HC)).

Results

Both the PPD and MDD groups exhibited higher fractional amplitude of low-frequency fluctuation (fALFF) in left temporal pole relative to the HC group; the MDD group showed specifically increased degree centrality in the right cerebellum while PPD showed specifically decreased fALFF in the left supplementary motor area and posterior middle temporal gyrus (pMTG_L), and specifically decreased functional connectivities between pMTG and precuneus and between left subgeneual anterior cingulate cortex (sgACC_L) and right sgACC. Moreover, sgACC and left thalamus showed abnormal regional homogeneity of functional activities between any pair of HC, MDD, and PPD.

Conclusions

These results provide initial evidence that PPD and MDD have common and distinct neural circuits, which may facilitate understanding the neurophysiological basis and precision treatment for PPD.

Harm or protection? Two-sided consequences of females' susceptible responses to multiple threats

The target article presented a plausible argument that females' susceptibility to threats might be self-protection for staying alive, but some evidence requires scrutiny. We need to consider (1) the biases of narrative reviews, (2) subjective life quality, and (3) the shadow side of extreme reactions to threats before concluding that females' threat-based response is a self-protection mechanism that promotes survival.

Is Brain-Derived Neurotropic Factor Methylation Involved in the Association Between Prenatal Stress and Maternal Postnatal Anxiety During the COVID-19 Pandemic?

BACKGROUND

The COVID-19 pandemic is a collective trauma that may expose susceptible individuals to high levels of stress. Pregnant women represent a high-risk population, considering that pregnancy is a period of heightened neuroplasticity and susceptibility to stress through epigenetic mechanisms. Previous studies showed that the methylation status of the BDNF gene is linked with prenatal stress exposure. The goals of this study were (a) to assess the association between pandemic-related stress and postnatal anxiety and (b) to investigate the potential role of maternal BDNF methylation as a significant mediator of this association.

METHODS

In the present study, we report data on the association among pandemic-related stress during pregnancy, maternal BDNF methylation, and postnatal anxiety symptoms. Pandemic-related stress and postnatal anxiety were assessed through self-report instruments. BDNF methylation was estimated in 11 CpG sites in DNA from mothers' buccal cells. Complete data were available from 108 mothers.

RESULTS

Results showed that pandemic-related stress was associated with an increased risk of postnatal anxiety, r = 0.20, p < 0.05. CpG-specific BDNF methylation was significantly associated with both prenatal pandemic-related stress, r = 0.21, p < 0.05, and postnatal maternal anxious symptoms, r = 0.25, p = 0.01. Moreover, a complete mediation by the BDNF CpG6 methylation emerged between pandemic-related stress during pregnancy and postnatal maternal anxiety, ACME = 0.66, p < 0.05.

CONCLUSION

These findings suggest that BDNF epigenetic regulation by pandemic-related stress might contribute to increase the risk of anxiety in mothers. Policymakers should prioritize the promotion of health and wellbeing in pregnant women and mothers during the present healthcare emergency.

Altered Functional Connectivity Density and Couplings in Postpartum Depression with and Without Anxiety

Postpartum depression (PPD) is the most common psychological health issue among women, which often comorbids with anxiety (PPD-A). PPD and PPD-A showed highly overlapping clinical symptoms. Identifying disorder-specific neurophysiological markers of PDD and PPD-A is important for better clinical diagnosis and treatments. Here, we performed functional connectivity density (FCD) and resting-state functional connectivity (rsFC) analyses in 138 participants (45 unmedicated patients with first-episode PPD, 31 PDD-A patients and 62 healthy postnatal women, respectively). FCD mapping revealed specifically weaker long-range FCD in right lingual gyrus (LG.R) for PPD patients and significantly stronger long-range FCD in left ventral striatum (VS.L) for PPD-A patients. The follow-up rsFC analyses further revealed reduced functional connectivity between dorsomedial prefrontal cortex (dmPFC) and VS.L in both PPD and PPD-A. PPD showed specific changes of rsFC between LG.R and dmPFC, right angular gyrus and left precentral gyrus, while PPD-A represented specifically abnormal rsFC between VS.L and left ventrolateral prefrontal cortex. Moreover, the altered FCD and rsFC were closely associated with depression and anxiety symptoms load. Taken together, our study is the first to identify common and disorder-specific neural circuit disruptions in PPD and PPD-A, which may facilitate more effective diagnosis and treatments.

High quality social environment buffers infants' cognitive development from poor maternal mental health: Evidence from a study in Bhutan

Poor maternal mental health negatively impacts cognitive development from infancy to childhood, affecting both behavior and brain architecture. In a non-western context (Thimphu, Bhutan), we demonstrate that culturally-moderated factors such as family, community social support, and enrichment may buffer and scaffold the development of infant cognition when maternal mental health is poor. We used eye-tracking to measure early building blocks of cognition: attention regulation and social perception, in 9-month-old Bhutanese infants (N = 121). The cognitive development of Bhutanese infants in richer social environments was buffered from poor maternal mental health, while for infants in environments with lower rates of protective social environment factors, worse maternal mental health significantly predicted greater costs for infant attention, a fundamental building block cognition. International policies and interventions geared to improve maternal mental health and child health outcomes should incorporate each regions' unique family, cultural, and community support structures.

The effects of psychological treatment of perinatal depression: an overview

Perinatal depression is an important public health problem. Psychological interventions play an essential role in the treatment of depression. In the current paper, we will present the results of a series of meta-analyses on psychological treatments of perinatal depression. We report the results of a series of meta-analyses on psychological treatments of depression, including perinatal depression. The meta-analyses are based on a database of randomized trials on psychotherapies for depression that has been systematically developed and updated every year. Psychological interventions are effective in the treatment of perinatal depression with a moderate effect size of g = 0.67, corresponding with a NNT of about 4. These effects were still significant at 12 months after the start of the treatment. These interventions also have significant effects on social support, anxiety, functional impairment, parental stress, and marital stress. Possibly the effects are overestimated because of the use of waiting list control groups, the low quality of the majority of trials and publication bias. Research on psychotherapies for depression in general has shown that there are no significant differences between the major types of therapy, except for non-directive counseling that may have somewhat smaller effects. CBT can also be delivered in individual, group, telephone, and guided self-help format. Interventions in subthreshold depression are also effective and may prevent the onset of a full-blown depressive disorder, while therapies may be less effective in chronic depression. Psychological interventions are effective and deserve their place as first-line treatment of perinatal depression.

Perinatal Depression, Birth Experience, Marital Satisfaction and Childcare Sharing: A Study in Russian Mothers

BACKGROUND

Over 300,000 women in Russia face perinatal depressive disorders every year, according to the data for middle-income countries. This study is the first attempt to perform a two-phase study of perinatal depressive disorders in Russia. The paper examines risk factors for perinatal depressive symptoms, such as marital satisfaction, birth experience, and childcare sharing.

METHODS

At 15-40 gestational weeks (M = 30.7, SD = 6.6), 343 Russian-speaking women, with a mean age of 32 years (SD = 4.4), completed the Edinburgh Postnatal Depression Scale, Couples Satisfaction Index, Birth Satisfaction Scale, and provided socio-demographic data. Two months after childbirth, 190 of them participated in the follow-up.

RESULTS

The follow-up indicated that 36.4% of participants suffered from prenatal depression and 34.3% of participants had postnatal depression. Significant predictors of prenatal depression were physical well-being during pregnancy (β = -0.25; p = 0.002) and marital satisfaction during pregnancy (β = -0.01; p = 0.018). Birth satisfaction (β = -0.08; p = 0.001), physical well-being at two months after delivery (β = -0.36; p < 0.01), and marital satisfaction during pregnancy (β = 0.01; p = 0.016) and after delivery (β = -0.02; p < 0.01) significantly predicted postnatal depression at 2 months after delivery.

CONCLUSION

Our study identified that physical well-being during pregnancy and marital satisfaction during pregnancy significantly predicted prenatal depression. Birth satisfaction, physical well-being at 2 months after delivery, and marital satisfaction during pregnancy and after delivery significantly predicted postnatal depression. To our knowledge, this is the first study of perinatal depressive disorders in the context of marital satisfaction and birth satisfaction in the Russian sample. The problem of unequal childcare sharing is widely spread in Russia. Adjusting spousal expectations and making arrangements for childcare may become the focus of psychological work with the family. The availability of psychological support during pregnancy and labor may be important in the context of reducing perinatal depression risks.

Perinatal Depression: Challenges and Opportunities

Perinatal depression (PND) is a major depressive episode during pregnancy or within 4 weeks after childbirth up to a year. Risk factors for PND include stressful life events, history of depression, poor social support, unplanned and unwanted pregnancies, poor relationship quality, current or previous abuse, and low socioeconomic status. This mental disorder has been shown to have negative effects on mothers' quality of life and their intimate relationships, birth outcomes, and breastfeeding likelihood, as well as long-term effects on children's cognitive and emotional development. To date, no nationally representative study has examined whether there are socioeconomic and/or racial/ethnic differences in PND. This study discusses the prevalence and risk factors for PND, as well as its health consequences for mothers and children, the reasons for its underreporting and undertreatment, the evidence for different screening instruments and different treatment options, and the existing supportive policies to address this disorder in the United States. We conclude with outlining next steps in addressing the gaps in the literature on PND.

Does the Psychopathology of the Parents Predict the Developmental-Emotional Problems of the Toddlers?

Introduction

Parental psychopathology has been defined in respect of psychopathological development in early childhood. This study aimed to investigate the effects of parental psychopathologies on social and emotional problems in the age range of 1-3 years and to determine children at risk.

Methods

The study data were obtained from the 2009 Early Childhood Mental Health Profile taking population distribution into consideration with the properties representing Turkey. The primary caregiver of the child completed the Psychiatric Evaluation Form for 1-3 years, the Brief Infant-Toddler Social Emotional Assessment (BITSEA), the Ages and Stages Questionnaire (ASQ), and the Brief Symptom Inventory (BSI) for themselves. Machine learning models used for prediction. The performance of prediction models was evaluated with the ten-fold cross-validation method. Area Under Curve (AUC) values were calculated with Receiver Operating Characteristic (ROC) curves to evaluate the performance of each model.

Results

The evaluation was made of the data of 2775 children, comprising 1507 (54.3%) males and 1268 (45.7%) females with a mean age of 26.19±9.11 months (range, 10-48 months). A total of 106 children were identified as at risk, as they were above the clinical cut-off point (1.5 standard deviations) of the BITSEA points and below the cut-off points of any one of the developmental areas of the ASQ. Modeling was applied to the data of these 106 children. The Support Vector Machines (SVM) model was selected for prediction with the automatically optimized highest AUC value. Weighting for the SVM algorithm showed mothers' BSI scores, fathers' education and health problems, duration of breastfeeding, unplanned pregnancy are significant for predicting BITSEA-problem scores in the model.

Conclusion

To be able to understand the complex relationship with parental psychopathology and behavioral problems, machine learning methods were used successfully in this study. Further studies with more massive data sets, more extended follow-up periods, and stronger algorithms will be able to identify risk groups earlier and allow early interventions to be implemented.

The feasibility of a multi-professional training to improve how health care professionals deliver different news to families during pregnancy and at birth

BACKGROUND

In the United Kingdom, pregnant women are offered foetal anomaly screening to assess the chance of their baby being born with eleven different conditions. How health care professionals (HCPs) deliver news about a child having a congenital anomaly affects how it is received and processed by parents. We refer to this news as different news.

METHODS

We conducted a mixed methods evaluation of a training intervention to improve how HCPs deliver different news. Twenty-six HCPs self-completed pretraining and posttraining questionnaires on skills, knowledge, and attitudes related to delivering different news. Qualitative interviews were conducted with eight HCPs. Quantitative data were analysed using descriptive statistics, the paired t test to compare the pre and post scores and estimate the difference between pre and post scores, and the 95% confidence interval. Qualitative data were analysed using framework analysis guided by the Theoretical Domains Framework (TDF).

RESULTS

The training intervention was both feasible and acceptable. HCPs indicated that it enhanced or consolidated their knowledge and skills, covered topics relevant to their practice, and that they would recommend it to colleagues. Participants particularly valued integration of the voice of parents with lived experience in the training. Significant increase in mean scores were observed in confidence to deliver different news (2.81, 95% CI [2.43, 3.19] to 4.28, 95% CI [4.09, 4.47]; p < .001) and skills to deliver different news (3.00, 95% CI [2.64, 3.36] to 4.36, 95% CI [4.13, 4.59]; p < .001). HCPs reported feeling more confident in their ability to provide sensitive, responsive, balanced care to families.

CONCLUSIONS

The significant improvements in confidence and skills reported by HCPs suggest that the training may be effective in equipping HCPs to minimize the distress, anxiety, and depression associated with receiving different news. This represents a key aspect of the prevention of mental ill health across the life course.

Revisiting the roots of attachment: A review of the biological and psychological effects of maternal skin-to-skin contact and carrying of full-term infants

During the early period of hypothesis building and empirical testing of attachment theory, a major emphasis was placed on mother-infant physical contact. In spite of this, mother-infant contact has received scant attention amongst attachment and child development researchers in the past decades. Here, a brief theoretical framework for mother-infant contact is presented, drawing on animal studies as well as human studies of preterm infants and neonates. Salient mechanisms may include an extended sensitive period during early infancy, requiring specific somatosensory stimuli for bio-behavioral homeorhesis; oxytocinergic and epigenetic pathways; kinesthetic stimuli and face-to-face proximity allowing for increased social interaction. Studies of extended human mother-full-term infant physical contact have demonstrated positive effects in multiple domains. For infants, these include sleep organization, temperature and heart rate regulation, behavioral response, crying/colic, socio-emotional development, attachment quality, speech development opportunities and mother-child interactions. For mothers, studies demonstrate improved depressive symptomatology, physiological stress regulation, contingent responsivity, breastfeeding and mother-child interactions. Parent-infant attachment quality has gained prominence as a trauma-resilience factor as well as a predictor of adult physical health. The potential role of mother-infant contact as an attachment promoting intervention as well as future research subjects are discussed. Current evidence supports the original attachment research that early maternal touch provision may influence infant socio-emotional development and attachment quality, with positive implications for mother-child relationship functioning.

The oxytocinergic system in PTSD following traumatic childbirth: endogenous and exogenous oxytocin in the peripartum period

Birth experiences can be traumatic and may give rise to PTSD following childbirth (PTSD-FC). Peripartum neurobiological alterations in the oxytocinergic system are highly relevant for postpartum maternal behavioral and affective adaptions like bonding and lactation but are also implicated in the response to traumatic events. Animal models demonstrated that peripartum stress impairs beneficial maternal postpartum behavior. Early postpartum activation of the oxytocinergic system may, however, reverse these effects and thereby prevent adverse long-term consequences for both mother and infant. In this narrative review, we discuss the impact of trauma and PTSD-FC on normal endogenous oxytocinergic system fluctuations in the peripartum period. We also specifically focus on the potential of exogenous oxytocin (OT) to prevent and treat PTSD-FC. No trials of exogenous OT after traumatic childbirth and PTSD-FC were available. Evidence from non-obstetric PTSD samples and from postpartum healthy or depressed samples implies restorative functional neuroanatomic and psychological effects of exogenous OT such as improved PTSD symptoms and better mother-to-infant bonding, decreased limbic activation, and restored responsiveness in dopaminergic reward regions. Adverse effects of intranasal OT on mood and the increased fear processing and reduced top-down control over amygdala activation in women with acute trauma exposure or postpartum depression, however, warrant cautionary use of intranasal OT. Observational and experimental studies into the role of the endogenous and exogenous oxytocinergic system in PTSD-FC are needed and should explore individual and situational circumstances, including level of acute distress, intrapartum exogenous OT exposure, or history of childhood trauma.

The effectiveness of mHealth interventions on postpartum depression: A systematic review and meta-analysis

INTRODUCTION

Postpartum depression (PPD) is a common psychiatric condition during the postnatal period that negatively impacts the well-being of both the mother and her infant. This study describes a systematic review and preliminary meta-analysis to assess the efficacy of mobile health (mHealth) interventions, which is defined as the use of portable electronic devices to support public health and medical practice, in addressing depressive symptoms among postpartum women.

METHODS

Databases including PubMed, PsycINFO, the Cochrane Library, Embase and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) assessing the effectiveness of mHealth interventions on PPD from database inception to December 2019.

RESULTS

The initial search identified 754 studies, of which, 11 studies fulfilled the inclusion criteria. These studies evaluated four types of distinct mHealth interventions and involved 2424 participants across six countries. Pooled results demonstrated that compared to the controls, the Edinburgh Postnatal Depression Scale score decreased in the mHealth intervention group (mean difference: -1.09, 95% confidence interval: -1.39 to -0.79).

DISCUSSION

Our study suggested that mHealth interventions may be a promising tool to complement routine clinical care in the prevention and treatment of PPD, but the clinical effectiveness of mHealth interventions needs to be better established. While most studies focused on telephone-based interventions, recent researches have also suggested the superiority and effectiveness of short messaging service (SMS) and smartphone applications, but the exact efficacy needs further evaluation. Therefore, more high-quality RCTs on app-based and SMS-based interventions are needed before the large-scale roll-out of these interventions in clinical practice.

Rapid and Prolonged Antidepressant-like Effect of Crocin Is Associated with GHSR-Mediated Hippocampal Plasticity-related Proteins in Mice Exposed to Prenatal Stress

Prenatal stress (PNS) has a prolonged and adverse effect on offspring, leading to a significantly increased vulnerability to developing depression in their later life. Traditional therapies have delayed onset and limited efficacy; thus, it remains an urgent need to find novel medications with fast-onset and high-efficacy potentials. Crocin, with its structure clearly examined, has shown antidepressant-like effects. However, few studies extensively investigated its effect especially in mice exposed to PNS. Using an established PNS model, we tested whether crocin could have a rapid and persistent antidepressant-like effect in PNS mice. Growth hormone secretagogue receptor (GHSR) and phosphoinositide 3-kinase (PI3K) inhibitors were used to test their effects in antidepressant-like effect of crocin. Hippocampal GHSR-PI3K signaling was examined both in PNS mice treated with a single dose of crocin and in combination of GHSR inhibitor. PNS mice showed depression-like behaviors at juvenile and adulthood, and crocin induced an instant and persistent antidepressant-like response in PNS mice in a dose-dependent manner. Moreover, crocin increased the expression of hippocampal synaptic plasticity-associated proteins through the restoration of GHSR-PI3K signaling. Inhibitions of both GHSR and PI3K abolished the effect of crocin in alleviating depressive-like behaviors. More importantly, GHSR inhibitor JMV2959 blocked the enhanced expression of hippocampal plasticity-related proteins induced by crocin. The present study demonstrated that crocin induced a fast-onset and prolonged antidepressant effect in PNS mice and suggested that GHSR-PI3K signaling may play a key role in crocin's effect at least partially by a restoration of hippocampal synaptic plasticity-associated proteins.

Testing competing mediators of the association between pre-conception maternal depression and child health-related quality of life: the MatCH study

Maternal depression is a potent risk factor for poor child development across a number of domains but the mechanisms of transmission are poorly understood. This study aimed to test competing mediators of the association between pre-conception maternal depression and child psychosocial functioning. In 2016, mothers in the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health were asked to be part of the Mothers and their Children's Health study and to complete surveys on the health of their three youngest children under 13 years. The current study includes children aged 0-12 years (N = 5532, M = 6.99 years, SD = 3.22 years) and their mothers (N = 2917). We used the CESD-10 to measure depression and the PedsQL to measure psychosocial functioning, and used multilevel structural equation modeling to test hypotheses. Pre-conception maternal depression was associated with poorer maternal mental health and parenting after birth. The effect of pre-conception maternal depression was mediated by post-birth maternal depression in children aged 0-4 years (unstandardized regression coefficient (B) = - 0.26, 95%CI - 0.38, - 0.13) and children aged 5-12 years (B = - 0.25, 95%CI - 0.34, - 0.16), and by post-birth maternal stress (B = - 0.04, 95%CI - 0.08, - 0.01), and parenting (B = - 0.03, 95%CI - 0.04, - 0.02) in children aged 5-12 years. Post-birth maternal depression was the strongest mediator. Pre-conception is the optimal time for depression intervention. Post-birth interventions should include a focus on reducing depression and improving negative parenting aspects such as hostility and discipline.

Effect of sertraline on central serotonin and hippocampal plasticity in pregnant and non-pregnant rats

One of the most frequently prescribed selective serotonin reuptake inhibitor medications (SSRIs) for peripartum mood and anxiety disorders is sertraline (Zoloft®). Sertraline can help alleviate mood and anxiety symptoms in many women but it is not known how sertraline, or SSRIs in general, affect the neurobiology of the brain particularly when pregnant. The aim of this study was to investigate how sertraline affects plasticity in the hippocampus, a brain area integral in depression and SSRI efficacy (particularly in males), during late pregnancy and whether these effects differ from the effects of sertraline in non-pregnant females. To do this pregnant and age-matched non-pregnant female Sprague-Dawley rats were used. For the last half of pregnancy (10 days), and at matched points in non-pregnant females, rats were given sertraline (2.5 mg/kg/day or 10 mg/kg/day) or vehicle (0 mg/kg/day). Brains were used to investigate effects on the serotonergic system in the hippocampus and prefrontal cortex and measures of neuroplasticity in the hippocampus. Results show that pregnant females have significantly higher serum levels of sertraline compared to non-pregnant females but that rates of serotonin turnover in the hippocampus and PFC are similar between pregnant and non-pregnant females. Sertraline increased synaptophysin density in the dentate gyrus and CA3 and was associated with a decrease in cell proliferation in the dentate gyrus of non-pregnant, but not pregnant, females. During late pregnancy the hippocampus showed significant reductions in neurogenesis and increases in synaptophysin density. This research highlights the need to consider the unique effect of reproductive state on the neuropharmacology of SSRIs.

Perinatal Depression in Low-Income Women: A Literature Review and Innovative Screening Approach

PURPOSE OF REVIEW

This paper reviews literature on perinatal depression prevalence, consequences, and screening among low-income women and women of color. We introduce the Warm Connections program's innovative perinatal depression screening protocol and explore perinatal depression patterns among WIC participants.

RECENT FINDINGS

Perinatal depression negatively impacts maternal and child outcomes. Research shows mixed findings of perinatal depression prevalence rates among low-income women and women of color. The Warm Connections program supports the ability of WIC staff to administer the EPDS to WIC participants. Perinatal depression rates appeared lower in the Warm Connections program than in studies using less specific perinatal depression screening instruments with similar samples. Future research should continue to explore perinatal depression patterns among low-income women and women of color. Partnering with community-based settings such as WIC provides innovative opportunities to provide screening, referral, and treatment for low income women and women of color.

Parenting and perinatal depression: meeting women's needs

Introduction: Symptoms of depression during pregnancy and the postpartum period can negatively impact parenting. It is important to understand the parenting experiences of women with depression, and what parenting support they need. Methods: This is a mixed methods analysis of data (demographic data, depression outcomes, patient survey results, and transcripts of patient and care manager focus groups) from an open treatment trial of the feasibility of delivering perinatal depression treatment using collaborative care in a rural obstetric setting. Results: Patients who attended focus groups did not differ significantly from those who did not. Qualitative analysis of focus groups revealed the following themes: Maternal mood and parenting difficulties are interrelated; Access to depression treatment is complicated by expectations for the perinatal period and by factors related to parenting; Women want parenting support in the context of treatment for perinatal depression. Conclusion: Women receiving perinatal depression treatment experience unique parenting challenges and desire parenting support. Healthcare providers caring for these women should be mindful of their patients' parenting needs. Future research should explore ways to integrate parenting interventions with depression treatments. Mother-infant interaction is a key determinant of optimal infant development and integrating parenting support with perinatal depression treatments can have significant public health impact.

Postpartum depression screening in the first year: A cross-sectional provider analysis in Oregon

BACKGROUND AND PURPOSE

Postpartum depression (PPD) has significant sequelae for mother and child. To aid diagnosis, PPD screening should continue throughout the postpartum year. In primary care, there may be a lack of consistency in how screening is applied. In Oregon, with a reported PPD rate of 18.2%, it is important to determine whether screening is reaching all women. The purpose of this study was to explore primary care provider screening practices in the postpartum year and determine if there are barriers to meeting PPD guidelines.

METHODS

A descriptive, cross-sectional survey was conducted with primary care providers in Oregon. Data were sought on screening practices and timing, as well as potential barriers. To aid comparison, screening was compared against both the American Academy of Pediatrics (AAP) and National Association of Pediatric Nurse Practitioner (NAPNAP)/US Preventative Services Task Force guidelines. Data were analyzed using R statistical computing and Pearson chi-square tests.

RESULTS

Of the 55 respondents, 29% followed the AAP recommendations and screened at well-child visits; 64% followed the NAPNAP recommendations and screened at least once in the postpartum year; and 31% did not meet any screening guidelines. The most common screening barriers were limited knowledge and/or availability of referral services. Physicians were more likely to meet any recommended guidelines than nurse practitioners (NPs) (p = .023).

IMPLICATIONS FOR PRACTICE

A notable number of women may not be receiving PPD screening. It is concerning that most of those not screening were NPs, given the focus of their practice on disease prevention and health management. Further research is warranted to confirm whether women are missing opportunities for early intervention and whether strategies can be established to standardize the approach in primary care.

The maternal reward system in postpartum depression

The experience of motherhood is most often emotionally positive and rewarding, but for many new mothers suffering from postpartum depression (PPD), this is not the case. Preclinical and clinical research has sought to uncover brain changes underlying PPD in order to gain a better understanding of how this disorder develops. This review focuses on the mesolimbic dopamine system, particularly the ventral tegmental area-nucleus accumbens pathway which has been implicated in the regulation of critical functions disrupted in PPD including mood, motivation, and mothering. Specifically, we discuss normative changes in the mesolimbic system during motherhood in both rodents and humans and how these are impacted in PPD. We also consider modulation of mesolimbic dopamine by the hypothalamic neuropeptide oxytocin and how oxytocin-dopamine interactions regulate mood and mothering during the postpartum period. In addition to providing an overview of reward mechanisms in PPD, our goal is to highlight open questions which warrant further research.

A role for the microbiome in mother-infant interaction and perinatal depression

Perinatal depression is a significant public health problem, due to its negative impact on maternal well-being and long-term adverse effects for children. Mother-infant interaction and maternal responsiveness and sensitivity are a hypothesized mechanism by which perinatal depression effects child development, and increasing research in the microbiota-gut-brain axis may provide a new avenue of investigation. There is limited efficacy for treatment of perinatal depression for improving the mother-infant relationship and child outcomes. The maternal microbiota may be the basis of child outcomes through foetal programming and sharing of microbes between mother and infant. There is evidence that less diversity of the intestinal microbial community is associated with neuropsychiatric disorders, including depression and anxiety in mothers and offspring. Assessing the maternal and child's microbial communities may be an important missing component in mother-infant attachment-based therapies during treatment of perinatal depression. Probiotics and prebiotics require further research as additions to mother-infant interventions. Further research may enable identification of bacterial genes that indicate specific pathways that could be targeted to improve outcomes for mother and child.

"I'll look after the kids while you go and have a shower": an evaluation of a service to address mild to moderate maternal perinatal mental health problems

BACKGROUND

Perinatal mental health (PMH) problems are a major public health concern because they may impair parenting ability which potentially has an immediate and long-term impact on the physical, cognitive and emotional health of the child.

AIMS

We evaluated a Perinatal Support Service (PSS) which supports positive attachment between mothers with PMH problems and their child, to evidence its impact on maternal mental health and maternal-infant interaction.

METHOD

Using a mixed-methods approach, anonymised pre- and post-service outcomes data from 123 clients, 14 interviews and a focus group discussion were analysed.

RESULTS

We found significant improvement in anxiety (t (55) = 6.96, p < 0.01, 95% CI [3.15, 5.70]), and depression (t (55) = 6.58, p < 0.01, 95% CI [3.03, 5.68]) on the HADS, and on the GAD-7 (t (12) = 4.541, p = 0.001, 95% CI [3.48, 9.90]) after the PSS. Anxiety post service (M = 9.08, SD = 4.96) was lower than baseline anxiety (M = 15.77, SD = 4.68). Receiving emotional and practical support contributed to improvements in mental health and mother-child interaction.

CONCLUSION

Given the paucity of PMH services in the UK, it is imperative that services such as the PSS continue to receive funding to address unmet PMH needs.

Browne J, Austin J, M. Myers M, Welch MG. The Welch Emotional Connection Screen: validation of a brief mother-infant relational health screen

AIM

The Welch Emotional Connection Screen (WECS), assesses mother-infant Emotional Connection in clinical settings. It includes: Attraction, Vocal Communication, Facial Communication, Sensitivity/Reciprocity and clinical decision of Emotional Connection (yes/no). We tested concurrent and construct validity of the WECS and associations with behavioural and physiological measures in preterm infants.

METHODS

Videos from 76 mothers-infants (gestational age 36 weeks) during an in-NICU caregiving paradigm were coded for maternal caregiving behaviour. Videos of mothers-infants were also obtained at 4 months during 10 minutes of face-to-face play (coded with WECS and for maternal positivity and infant social engagement) and the still-face paradigm (coded for infant behavioural approach towards mother; infant electrocardiogram acquired in vivo).

RESULTS

WECS maternal scores were positively associated with maternal sensitivity and quality of vocal contact at 36 weeks (caregiving) and maternal positivity at 4 months (face-to-face). WECS infant scores positively correlated with infant social engagement and maternal positivity during face-to-face interactions at 4 months. Infants from emotionally not connected dyads (vs. emotionally connected dyads) displayed autonomic dysregulation and less approach-seeking behaviour towards mother during interactive/play sessions of the still-face paradigm.

CONCLUSION

This preliminary evidence supports the WECS as a valid screen for rating mother-preterm infant emotional connection associated with healthier infant biobehavioural stress responding.

The dynamic serotonin system of the maternal brain

Many pregnant and postpartum women worldwide suffer from high anxiety and/or depression, which can have detrimental effects on maternal and infant well-being. The first-line pharmacotherapies for prepartum and postpartum affective disorders continue to be the selective serotonin reuptake inhibitors (SSRIs), despite the lack of large well-controlled studies demonstrating their efficacy in reproducing women and the potential for fetal/neonatal exposure to the drugs. Prepartum or postpartum use of SSRIs or other drugs that modulate the brain's serotonin system is also troubling because very little is known about the typical, let alone the atypical, changes that occur in the female central serotonin system across reproduction. We do know from a handful of studies of women and female laboratory rodents that numerous aspects of the central serotonin system are naturally dynamic across reproduction and are also affected by pregnancy stress (a major predisposing factor for maternal psychopathology). Thus, it should not be assumed that the maternal central serotonin system being targeted by SSRIs is identical to non-parous females or males. More information about the normative and stress-derailed changes in the maternal central serotonin system is essential for understanding how serotonin is involved in the etiology of, and the best use of SSRIs for potentially treating, affective disorders in the pregnant and postpartum populations.

Be a Mom, a Web-Based Intervention to Prevent Postpartum Depression: The Enhancement of Self-Regulatory Skills and Its Association With Postpartum Depressive Symptoms

Aim: Be a Mom is a self-guided, web-based intervention to prevent persistent postpartum depression symptoms [PPD], targeting both at-risk postpartum women and/or women presenting early-onset postpartum depressive symptoms (selective/indicated preventive intervention). Be a Mom is grounded on the principles of Cognitive-Behavior Therapy and incorporates the recent contributions of acceptance and compassion-based approaches (third-wave approaches) applied to the perinatal context. This study aimed to explore the processes underlying therapeutic change in the Be a Mom intervention, by: (1) exploring whether participation in the Be a Mom promotes the enhancement of self-regulatory skills (emotion regulation abilities, psychological flexibility and self-compassion) in comparison with women who did not participate in the program; and (2) exploring whether changes in self-regulatory skills are associated with changes in depressive symptoms, among women who participated in the Be a Mom program. Methods: A pilot randomized, two-arm controlled trial was conducted. Eligible women (presenting PPD risk-factors and/or early-onset PPD symptoms) were enrolled in the study and were randomly assigned to the intervention group (Be a Mom, n = 98) or to the waiting-list control group (n = 96). Participants in both groups completed baseline (T1) and post-intervention assessments (T2), including measures of depressive symptoms, emotion regulation abilities, psychological flexibility and self-compassion. Results: From baseline to post-intervention assessment, women in the intervention group showed a significantly greater decrease in the levels of emotion regulation difficulties (p < 0.001) and a significant greater increase in the levels of self-compassion (p < 0.001) compared to the control group. No significant differences were found concerning psychological flexibility. Moreover, a greater decrease in difficulties in emotion regulation and greater increase in self-compassion levels were significantly associated with a greater decrease in depressive symptoms, among women in the intervention group. Discussion: Be a Mom promotes the enhancement of women's emotion regulation abilities and self-compassion, and this seems to exert a protective effect in the presence of PPD risk factors (or early-onset symptoms) because it led to a reduction of depressive symptoms. By providing some insights into the processes that underlie treatment response to Be a Mom, this study highlights the important role of the targeted third-wave processes applied to the perinatal context.

Course of a major postpartum depressive episode: A prospective 2 years naturalistic follow-up study

BACKGROUND

Survival methodology has not already been used in studies about postpartum depression (PPD) course. The aims of the present study were to estimate the duration of a Major Postpartum Depressive Episode (MPDE) during 2 years, as well as to explore factors associated with the course.

METHOD

This was a prospective, naturalistic, longitudinal study with a cohort of 165 women with a MPDE (DSM-IV criteria). Potential predictors of prognosis were recorded at baseline. Follow-up was conducted using the Longitudinal Interval Follow-up Evaluation (LIFE).

RESULTS

Of the total sample, 110 (66.7%) completed the 2 years follow-up. The mean time to full remission was 49.4 weeks (95% CI: 44.0-59.8). The probability of recovering was 30.2% (95% CI: 22.1%-37.4%) at 6 months of follow-up, 66.3% (95% CI: 57.4%-73.4%) at 12 months of follow-up, and 90.3% (95% CI: 79.8%-95.4%) at 24 months of follow-up. Mothers with financial difficulties, onset of depressive episode previous to birth, and those with prior treated depressive episodes took longer in achieving full remission.

LIMITATIONS

Results are only generalizable to mothers with PPD treated in a psychiatric outpatient setting. Psychopharmacological treatment was uncontrolled and personality was not assessed.

CONCLUSIONS

Our findings suggest that PPD could become a chronic disorder, particularly in mothers with an onset of the episode previous to birth, with a history of depression or with financial problems. Knowledge of these factors may help to improve the guidelines of depression management and treatment during the perinatal period.

Course of major depressive disorder after pregnancy and the postpartum period

BACKGROUND

Maternal major depressive disorder (MDD) has an adverse effect on child development and increases risk for child psychopathology. It is paramount to understand the course of maternal depression during the childhood years particularly before, during, and after pregnancy.

OBJECTIVE

To follow the course of MDD in women with prior histories of depression followed during an index pregnancy.

METHODS

Subjects were women with histories of MDD who had participated in prior prospective, observational studies during pregnancy. In the follow-up, participants completed a structured interview that addressed (1) the course of MDD since their index pregnancy, (2) new psychiatric diagnoses, and (3) the course of MDD and treatment across subsequent pregnancies.

RESULTS

Out of 129 eligible women, 48.8% participated (N = 63) with an average/mean time of 12.9 years (SD = 1.9, 8.8-16.7) elapsed since participation in the prior pregnancy studies. Although approximately one third reported sustained remission from MDD since the pregnancy during which they had been originally followed, of the remaining two thirds of women who reported subsequent depressive episodes, almost one fifth (∼12% of the total sample) endorsed depression more than 50% of the time following their index pregnancy. A total of 6.3% of the women with previous validated diagnoses of MDD reported new diagnoses of bipolar disorder. Women reported similar treatment choices regarding the use of antidepressants during pregnancies subsequent to the one followed in the previous study.

CONCLUSION

Women with MDD experienced high rates of recurrent depression across the childbearing years. This represents a critical variable for clinical care and research.

Is cognitive behavioral therapy a better choice for women with postnatal depression? A systematic review and meta-analysis

The present study evaluated the combined effectiveness of cognitive behavioral therapy (CBT) for postnatal depression. A systematic search was conducted across databases including PubMed, Embase, and the Cochrane library to identify the randomized controlled trials (RCTs) that assessing CBT versus control for postnatal depression until March 2017. Data was extracted by two reviewers, independently. The Review Manager 5.3 and Stata 11.0 were used to calculate the synthesized effect of CBT on depression, and anxiety. A total of 20 RCTs involving 3623 participants were included. The results of meta-analysis showed that CBT was associated with a better Edinburgh Postnatal Depression Scale (EPDS) than control in short-term (mean difference = -2.86, 95% CI: -4.41--1.31; P<0.05) and long-term (mean difference = -1.68, 95% CI: -1.81-1.56; P<0.05). CBT also improved short-term (mean difference = -6.30, 95% CI: -11.32--1.28; P<0.05) and long-term (mean difference = -4.31, 95% CI: -6.92--1.70; P<0.05) Beck Depression Inventory (BDI). Subgroup analysis based on intervention types showed that in-home and telephone-based therapy exhibited significant reductions in EPDS scores (P<0.05 for all). CBT significantly improved the short-term [odds ratio (OR) = 6.57, 95% CI: 1.84-23.48; P<0.05] and long-term (OR = 2.00, 95% CI: 1.61-2.48; P<0.05) depressive symptomatology as compared to control. CBT also reduced the score of Depression Anxiety Stress Scales (DASS), though without significance. In conclusion, CBT effectively improved the symptoms and progression of postnatal depression.

Mothers' Perspectives on Managing the Developmental Delay of a Child With Considerations for Contextual Influences and Maternal Functioning

Developmental delay in very young children is trending upward. Maternal depressive symptoms are known to negatively impact child development and may also impact family management of the child's condition. Research on family management guided this second phase of a sequential mixed methods study. The purpose of this study was to explore mothers' perceptions of family management of their children's developmental delays. Mothers of very young children who received early intervention services were interviewed. A team-based content analysis approach revealed key findings: (a) views of the child that were not holistic, (b) condition management ability was informed by what the mother thought her child needed, (c) views of condition impact were related to adapting to possible child outcomes and experiences of isolation, and (d) parental/caregiver mutuality was impaired by conflict. Understanding perceptions of family management and influence of depressive symptoms in this context is essential to extend assessment and intervention.

Concern for mortality in the neonatal intensive care unit (NICU): parent and physician perspectives

OBJECTIVE

The objectives of this study are as follows: (1) to determine the incidence of parental concern for mortality (PCM) and any potential predictors for it among parents of infants admitted to the Neonatal Intensive Care Unit (NICU), and (2) to explore physicians' perspectives with respect to PCM in the NICU and to examine current practices of addressing it.

STUDY DESIGN

Separate questionnaires were distributed to members of the AAP Section on Perinatal-Neonatal Medicine District I and to NICU parents post discharge, to gather perspectives from each group. A χ²-analysis and linear regression were performed.

RESULTS

Response rate was 29% for the physician survey and 63% for the parent survey. Physician respondents believed that PCM increased with decreasing gestational age (GA) and reported having fewer discussions with parents of older infants about PCM. Parental report of PCM incidence was 48% overall. PCM was not associated with GA. PCM was associated with infant length of stay and occurrence of at least one discussion about PCM with physicians. Fifty-three percent of parents reported never having a discussion regarding PCM.

CONCLUSION

Although physicians believe that PCM increases with decreasing GA, parental report suggests that PCM is not associated with GA. Parents of full-term infants in particular may experience more PCM and desire for discussion than is currently recognized.

Influence of adjuvant detached mindfulness and stress management training compared to pharmacologic treatment in primiparae with postpartum depression

Ten to 15% of mothers experience postpartum depression (PPD). If untreated, PPD may negatively affect mothers' and infants' mental health in the long term. Accordingly, effective treatments are required. In the present study, we investigated the effect of detached mindfulness (DM) and stress management training (SMT) as adjuvants, compared to pharmacologic treatment only, on symptoms of depression in women with PPD. Forty-five primiparae (mean age: M = 24.5 years) with diagnosed PPD and treated with an SSRI (citalopram; CIT) took part in the study. At baseline, they completed questionnaires covering socio-demographic data and symptoms of depression. Experts rated also symptoms of depression. Next, participants were randomly assigned to one of the following study conditions: adjuvant detached mindfulness (CIT+DM); adjuvant stress management training (CIT+SMT); control condition (CIT). Self- and experts' ratings were completed at the end of the study 8 weeks later, and again at 8 weeks follow-up. Symptoms of depression decreased significantly over time, but more so in the CIT+DM and CIT+SMT group, compared to the control condition. The pattern of results remained stable at follow-up. In primiparae with PPD and treated with a standard SSRI, adjuvant psychotherapeutic interventions led to significant and longer-lasting improvements.

Perceptions of partner support among pregnant plurisexual women: A qualitative study

Although partner support is an established determinant of mental health, we know little about bisexual and other plurisexual people's experiences of support from their partners. Further, very limited research has examined how bisexual or plurisexual people experience partner support during pregnancy, a significant life stage for many couples. This paper draws from semi-structured interviews with 29 plurisexual women partnered with different-gender (i.e., cisgender male or transgender) partners to examine women's perceptions of partner support during pregnancy. While participants reported many of the same partner support issues and dynamics that have been described in research with monosexual childbearing women, their experiences as plurisexual women were unique in two regards: a) unconditional acceptance from partners was connected to the partner's support for their plurisexual identities/histories; and b) social integration support often included shared integration into social networks related to their plurisexual experiences, including sexual networks. These findings offer important implications for sexual and relationship therapists, who can play an important role in helping to foster these plurisexual-specific forms of partner support, and in so doing, improve outcomes for women during this significant life stage.

The Neurobiology of Postpartum Anxiety and Depression

Ten to twenty percent of postpartum women experience anxiety or depressive disorders, which can have detrimental effects on the mother, child, and family. Little is known about the neural correlates of these affective disorders when they occur in mothers, but they do have unique neural profiles during the postpartum period compared with when they occur at other times in a woman's life. Given that the neural systems affected by postpartum anxiety and depression overlap and interact with the systems involved in maternal caregiving behaviors, mother-infant interactions are highly susceptible to disruption. Thus, there is an intricate interplay among maternal mental health, the mother-infant relationship, and the neurobiological mechanisms mediating them that needs to be the focus of future study.

History of violence and subjective health of mother and child

OBJECTIVE

To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child's health.

SETTING AND SUBJECTS

In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5-6 months after delivery. Data were collected by postal questionnaires.

MAIN OUTCOME MEASURES

Women's reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child's perceived health.

RESULTS

In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p < 0.001), compared to those who did not report violence. Their pregnancies were more frequently unplanned (p < 0.001), deliveries more often by caesarean section (p < 0.05), and their self-perceived health was worse (p < 0.001). They reported more mental and somatic health complaints, and their use of antidepressant drugs was higher (p < 0.001). Furthermore, women with a history of violence considered their child's general health as worse (p = 0.008).

CONCLUSIONS

Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18-24 months after birth. KEY POINTS   Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.   • The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.   • Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.   • Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.   • The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.