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Wang JY, Xu JJ, Wu P, Ye YX, Lai YW, Wang YX, Dong YD, Zhao B, Hu YY, Liu G, Pan A, Pan XF. Association of trajectories and cumulative exposure of antenatal depression with high birth weight. J Affect Disord 2024:S0165-0327(24)00990-X. [PMID: 38925304 DOI: 10.1016/j.jad.2024.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 06/01/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Jing-Yi Wang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jia-Jing Xu
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ping Wu
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yi-Xiang Ye
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yu-Wei Lai
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yu-Xiang Wang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yi-Dan Dong
- Section of Epidemiology and Population Health & Department of Gynecology and Obstetrics, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children & National Medical Products Administration Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Bin Zhao
- Antenatal Care Clinics, Shuangliu Maternal and Child Health Hospital, Chengdu 610200, China
| | - Ya-Yi Hu
- Department of Obstetrics and Gynecology, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Xiong-Fei Pan
- Section of Epidemiology and Population Health & Department of Gynecology and Obstetrics, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children & National Medical Products Administration Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China; West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Shuangliu Institute of Women's and Children's Health, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan 610200, China.
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Davis EP, Demers CH, Deer L, Gallop RJ, Hoffman MC, Grote N, Hankin BL. Impact of prenatal maternal depression on gestational length: post hoc analysis of a randomized clinical trial. EClinicalMedicine 2024; 72:102601. [PMID: 38680516 PMCID: PMC11053273 DOI: 10.1016/j.eclinm.2024.102601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Background Shortened gestation is a leading cause of childhood morbidity and mortality with lifelong consequences for health. There is a need for public health initiatives on increasing gestational age at birth. Prenatal maternal depression is a pervasive health problem robustly linked via correlational and epidemiological studies to shortened gestational length. This proof-of-concept study tests the impact of reducing prenatal maternal depression on gestational length with analysis of a randomized clinical trial (RCT). Methods Participants included 226 pregnant individuals enrolled into an RCT and assigned to receive either interpersonal psychotherapy (IPT) or enhanced usual care (EUC). Recruitment began in July 2017 and participants were enrolled August 10, 2017 to September, 8 2021. Depression diagnosis (Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; DSM 5) and symptoms (Edinburgh Postnatal Depression Scale and Symptom Checklist) were evaluated at baseline and longitudinally throughout gestation to characterize depression trajectories. Gestational dating was collected based on current guidelines via medical records. The primary outcome was gestational age at birth measured dichotomously (≥39 gestational weeks) and the secondary outcome was gestational age at birth measured continuously. Posthoc analyses were performed to test the effect of reducing prenatal maternal depression on gestational length. This trial is registered with ClinicalTrials.gov (NCT03011801). Findings Steeper decreases in depression trajectories across gestation predicted later gestational age at birth, specifically an increase in the number of full-term babies born ≥39 gestational weeks (EPDS linear slopes: OR = 1.54, 95% CI 1.10-2.16; and SCL-20 linear slopes: OR = 1.67, 95% CI 1.16-2.42). Causal mediation analyses supported the hypothesis that participants assigned to IPT experienced greater reductions in depression symptom trajectories, which in turn, contributed to longer gestation. Supporting mediation, the natural indirect effect (NIE) showed that reduced depression trajectories resulting from intervention were associated with birth ≥39 gestational weeks (EPDS, OR = 1.65, 95% CI 1.02-2.66; SCL-20, OR = 1.85, 95% CI 1.16-2.97). Interpretation We used a RCT design and found that reducing maternal depression across pregnancy was associated with lengthened gestation. Funding This research was supported by the NIH (R01 HL155744, R01 MH109662, R21 MH124026, P50 MH096889).
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Affiliation(s)
- Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, CO, USA
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Catherine H. Demers
- Department of Psychology, University of Denver, Denver, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - LillyBelle Deer
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Robert J. Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
| | - M. Camille Hoffman
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Nancy Grote
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Benjamin L. Hankin
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Yang J, Qu Y, Zhan Y, Ma H, Li X, Man D, Wu H, Huang P, Ma L, Jiang Y. Trajectories of antepartum depressive symptoms and birthweight: a multicenter and prospective cohort study. Psychiatry Clin Neurosci 2023; 77:631-637. [PMID: 37632723 DOI: 10.1111/pcn.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Antepartum depression is a prevalent unhealthy mental health problem worldwide, particularly in low-income countries. It is a major contributor to adverse birth outcomes. Previous studies linking antepartum depression to birthweight have yielded conflicting results, which may be the reason that the depressive symptoms were only measured once during pregnancy. This study aimed to explore the associations between trajectories of antepartum depressive symptoms and birthweight. METHODS Depressive symptoms were assessed prospectively at each trimester in 3699 pregnant women from 24 hospitals across 15 provinces in China, using the Edinburgh Postpartum Depression Scale (EPDS). Higher scores of EPDS indicated higher levels of depressive symptoms. Associations between trajectories of depressive symptoms and birthweight were examined using group-based trajectory modeling (GBTM), propensity score-based inverse probability of treatment weighting (IPTW), and logistic regression. RESULTS GBTM identified five trajectories. Compared with the low-stable trajectory of depressive symptoms, only high-stable (OR = 1.35, 95% CI: 1.15-2.52) and moderate-rising (OR = 1.18, 95% CI: 1.12-1.85) had an increased risk of low birthweight (LBW) in the adjusted longitudinal analysis of IPTW. There was no significant increase in the risk of LBW in moderate-stable and high-falling trajectories. However, trajectories of depressive symptoms were not associated with the risk of macrosomia. CONCLUSION Antepartum depressive symptoms were not constant. Trajectories of depressive symptoms were associated with the risk of LBW. It is important to optimize and implement screening, tracking, and intervention protocols for antepartum depression, especially for high-risk pregnant women, to prevent LBW.
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Affiliation(s)
- Jichun Yang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yimin Qu
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongle Zhan
- School of Public Health, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Haihui Ma
- Department of Obstetrics, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing, China
| | - Xiaoxiu Li
- Department of Pediatric Gastroenterology, Dongguan Maternal and Child Health Care Hospital, Dongguan, China
| | - Dongmei Man
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Hongguo Wu
- Department of Perinatal Health, Jiaxian Maternal and Child Health Care Hospital, Jiaxian, China
| | - Ping Huang
- Department of Nutrition, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Liangkun Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Yu Jiang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Chen H, Chua TE, Lee TMY, Siak EJ, Hong LF, Ch'ng YC, Yasmin H, Chee CYI, Mok YM, Ong SH, Rajadurai VS, Teoh TG, Utravathy V, Tan KH, Tan LK. Consensus statement on Singapore Perinatal Mental Health Guidelines on Depression and Anxiety. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:467-475. [PMID: 38920193 DOI: 10.47102/annals-acadmedsg.2023148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Perinatal depression and anxiety are public health concerns affecting approximately 1 in 10 women in Singapore, with clear evidence of association with various adverse outcomes in mother and child, including low birthweight, preterm birth and negative impact on infant neurodevelopment, temperament and behaviour. A workgroup was formed to develop recommendations to address the perinatal mental health needs of women with depression and anxiety. The approach was broad-based and aimed to incorporate holistic methods that would be readily applicable to the network of care providers supporting childbearing women. Method The Grading and Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to draw these guidelines. Workgroup members-comprising experts in the field of perinatal mental health and obstetric medicine-deliberated on the public health needs of the target population, and reviewed literature published from 2001 to 2022 that were relevant to improve the well-being of women with depression and anxiety during the preconception and perinatal periods. Results A consensus meeting was held involving a wider professional network, including family physicians, paediatricians, psychiatrists, social services and the Health Promotion Board in Singapore. Conclusion Ten consensus statements were developed, focusing on the overall aim of achieving optimal perinatal mental health for women with depression and anxiety. They relate to awareness and advice on preconception mental health, screening and assessment, optimising care and treatment. Special considerations were recommended for women who suffered severe maternal events, tailoring care for adolescents and women with special needs, and addressing infant mental health needs.
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Affiliation(s)
- Helen Chen
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
- Duke-National University of Singapore, Singapore
| | - Tze-Ern Chua
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
- Duke-National University of Singapore, Singapore
| | - Theresa Mei Ying Lee
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
- Duke-National University of Singapore, Singapore
| | - Elizabeth Junpei Siak
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
- Duke-National University of Singapore, Singapore
| | - Lin Feng Hong
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
- Duke-National University of Singapore, Singapore
| | - Ying Chia Ch'ng
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
| | - Hassan Yasmin
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
| | | | - Yee Ming Mok
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Say How Ong
- Developmental Psychiatry, Institute of Mental Health, Singapore
| | | | - Tiong Ghee Teoh
- Obstetrics & Gynaecology, KK Women's and Children's Hospital, Singapore
| | | | - Kok Hian Tan
- Duke-National University of Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Lay Kok Tan
- Duke-National University of Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
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Waqas A, Nadeem M, Rahman A. Exploring Heterogeneity in perinatal depression: a comprehensive review. BMC Psychiatry 2023; 23:643. [PMID: 37667216 PMCID: PMC10478465 DOI: 10.1186/s12888-023-05121-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
Perinatal depression (PND) is a significant contributor to maternal morbidity globally. Recognized as a major cause of poor infant development, epidemiological and interventional research on it has increased over the last decade. Recently, studies have pointed out that PND is a heterogeneous condition, with variability in its phenotypes, rather than a homogenous latent entity and a concrete diagnosis, as previously conceptualized in psychometric literature and diagnostic systems. Therefore, it is pertinent that researchers recognize this to progress in elucidating its aetiology and developing efficacious interventions.This systematic review is conducted in accordance with the Meta-analysis of observational studies in epidemiology (MOOSE). It aims to provide an updated and comprehensive account of research on heterogeneity in phenotypes of PND and its implications in research, public health, and clinical practice. It provides a synthesis and quality assessment of studies reporting heterogeneity in PND using cutting-edge statistical techniques and machine learning algorithms. After reporting the phenotypes of PND, based on heterogeneous trajectories and symptom profiles, it also elucidates the risk factors associated with severe forms of PND, followed by robust evidence for adverse child outcomes. Furthermore, recommendations are made to improve public health and clinical practice in screening, diagnosis, and treatment of PND.
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Affiliation(s)
- Ahmed Waqas
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK.
| | | | - Atif Rahman
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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Poo ZX, Quah PL, Chen H, Wright A, Teoh TG, Tan LK, Tan KH. Knowledge, Attitude and Perceptions Around Perinatal Mental Health Among Doctors in an Obstetrics and Gynaecology Academic Department in Singapore. Cureus 2023; 15:e38906. [PMID: 37303430 PMCID: PMC10257555 DOI: 10.7759/cureus.38906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Background Frontline healthcare professionals who provide regular care to women in the antenatal and postnatal period play a critical role in the early detection and management of maternal perinatal mental health (PMH). This study aimed to assess the knowledge, attitudes, and perceptions of doctors around perinatal mental health in an obstetrics and gynaecology (O&G) department in Singapore. Methods Using an online survey, data was collected from 55 doctors who participated in the Doctor's Knowledge, Attitudes and Perceptions of Perinatal Mental Health (I-DOC) study. The survey questions assessed the knowledge, attitudes, perceptions and practices in relation to PMH among doctors in the O&G specialty. Descriptive data was presented as means and standard deviations (SDs), or frequency and percentages. Results Out of the 55 doctors, more than half (60.0%) were not aware of the adverse impacts of poor PMH; 83.7% of doctors were not confident in providing PMH advice and 65.5% did not routinely screen patients for PMH disorders. There was a lower percentage of doctors (10.9% vs. 34.5%, p<0.001) who discussed PMH issues in the antenatal period compared to the postnatal period and this was statistically significant. Majority of doctors (98.2%) agreed that having standardised PMH guidelines will be useful. All doctors agreed on the benefits of having PMH guidelines, education and routine screening for patients. Conclusion There is inadequate PMH literacy among O&G doctors and lack of emphasis on antenatal PMH disorder. The findings highlighted the need for increased education and development of perinatal mental health guidelines.
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Affiliation(s)
- Zi Xi Poo
- Department of Maternal Fetal Medicine, Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Phai Ling Quah
- Department of Maternal Fetal Medicine, Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Helen Chen
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore, SGP
| | - Ann Wright
- Department of Maternal Fetal Medicine, Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Tiong Ghee Teoh
- Department of Maternal Fetal Medicine, Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Lay Kok Tan
- Department of Maternal Fetal Medicine, Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
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Hong SA, Buntup D. Maternal Depression during Pregnancy and Postpartum Period among the Association of Southeast Asian Nations (ASEAN) Countries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5023. [PMID: 36981932 PMCID: PMC10049420 DOI: 10.3390/ijerph20065023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Identification of mothers with depression is important because untreated perinatal depression can have both short- and long-term consequences for the mother, the child, and the family. This review attempts to identify the prevalence of antenatal and postnatal depression (AD and PD, respectively) of mothers among the ASEAN member countries. A literature review was conducted using PubMed, Scopus, and the Asian Citation Index. The reviews covered publications in peer-reviewed journals written in the English language between January 2010 and December 2020. Of the 280 articles identified, a total of 37 peer-reviewed articles conducted in 8 out of 11 ASEAN member countries were included. The Edinburgh Postnatal Depression Scale (EPDS) was the most common instrument used to identify depression. This study showed the number of studies reporting the prevalence of AD was 18 in five countries. For PD, 24 studies in eight countries were included. The prevalence of AD ranged from 4.9% to 46.8%, and that of PD ranged from 4.4% to 57.7%. This first review among ASEAN countries showed very few studies conducted in lower-middle-income and substantial heterogeneity in prevalence among studies reviewed. Further research should be conducted to estimate the prevalence using a large representative sample with a validated assessment tool among the ASEAN countries.
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Putnick DL, Bell EM, Ghassabian A, Mendola P, Sundaram R, Yeung EH. Maternal antenatal depression's effects on child developmental delays: Gestational age, postnatal depressive symptoms, and breastfeeding as mediators. J Affect Disord 2023; 324:424-432. [PMID: 36565964 PMCID: PMC9885303 DOI: 10.1016/j.jad.2022.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Maternal antenatal depression experienced around conception or during pregnancy may adversely affect child development. This study explores three potential mechanisms of the effects of antenatal depression on children's developmental delays at 2-3 years: gestational age of the child, continued depressive symptoms postnatally, and interrupted breastfeeding practices. METHODS Mothers (N = 2888) of 3450 children, including 2303 singletons and 1147 multiples from the Upstate KIDS cohort provided data. Linked hospital discharge data was combined with mothers' reports to identify women with moderate to severe antenatal depression. Gestational age was extracted from birth certificates. Mothers completed a depression screener at 4 months postpartum, reported about their breastfeeding practices from 4 to 12 months postpartum, and completed a developmental delay screener when children were 24, 30, and 36 months. RESULTS In unadjusted path analysis models, mothers with antenatal depression had more postnatal depressive symptoms and breastfed fewer months, which translated into children being more likely to have developmental delays. Gestational age was not a mediator. Effects were similar across girls and boys and singletons and twins, and largely held when adjusting for covariates. LIMITATIONS Main limitations were the relatively advantaged sample and reliance on maternal report. CONCLUSIONS Maternal antenatal depression may impact child development through continued depressive symptoms in the postpartum period and through reduced breastfeeding duration suggesting additional targets for intervention.
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Affiliation(s)
- Diane L Putnick
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA.
| | - Erin M Bell
- Department of Environmental Health Sciences, University at Albany School of Public Health, USA
| | - Akhgar Ghassabian
- Departments of Pediatrics, Environmental Medicine, and Population Health, New York University Grossman School of Medicine, USA
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions, USA
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA
| | - Edwina H Yeung
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA
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Feng SV, van den Boom W, De Iorio M, Thng GJ, Chan JKY, Chen HY, Tan KH, Kee MZL. Joint modelling of mental health markers through pregnancy: a Bayesian semi-parametric approach. J Appl Stat 2023; 51:388-405. [PMID: 38283054 PMCID: PMC10810649 DOI: 10.1080/02664763.2022.2154329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/23/2022] [Indexed: 01/14/2023]
Abstract
Maternal depression and anxiety through pregnancy have lasting societal impacts. It is thus crucial to understand the trajectories of its progression from preconception to postnatal period, and the risk factors associated with it. Within the Bayesian framework, we propose to jointly model seven outcomes, of which two are physiological and five non-physiological indicators of maternal depression and anxiety over time. We model the former two by a Gaussian process and the latter by an autoregressive model, while imposing a multidimensional Dirichlet process prior on the subject-specific random effects to account for subject heterogeneity and induce clustering. The model allows for the inclusion of covariates through a regression term. Our findings reveal four distinct clusters of trajectories of the seven health outcomes, characterising women's mental health progression from before to after pregnancy. Importantly, our results caution against the loose use of hair corticosteroids as a biomarker, or even a causal factor, for pregnancy mental health progression. Additionally, the regression analysis reveals a range of preconception determinants and risk factors for depressive and anxiety symptoms during pregnancy.
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Affiliation(s)
| | - Willem van den Boom
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - Maria De Iorio
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore, Singapore
- Department of Statistical Science, University College London, London, UK
| | - Gladi J. Thng
- Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - Jerry K. Y. Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Helen Y. Chen
- Duke-NUS Medical School, Singapore, Singapore
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Michelle Z. L. Kee
- Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore, Singapore
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Wang C, Hou J, Li A, Kong W. Trajectory of Perinatal Depressive Symptoms from the Second Trimester to Three Months Postpartum and Its Association with Sleep Quality. Int J Womens Health 2023; 15:711-723. [PMID: 37193223 PMCID: PMC10182768 DOI: 10.2147/ijwh.s408347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023] Open
Abstract
Purpose Few studies have explored the association between sleep quality and depressive symptoms in perinatal women from the second trimester to the postpartum period. This study aims to explore this relationship using a longitudinal design. Patients and Methods Participants were enrolled at 15 gestational weeks. Demographic information was collected. Perinatal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). Sleep quality was measured employing the Pittsburgh Sleep Quality Index (PSQI) at five timepoints from enrollment to three months postpartum. Overall, 1416 women completed the questionnaires at least thrice. A Latent Growth Curve (LGC) model was performed to identify the relationship between the trajectories of perinatal depressive symptoms and sleep quality. Results Of the participants, 23.7% screened positive at least once on the EPDS. The perinatal depressive symptoms trajectory, fitted by the LGC model, decreased at early pregnancy and increased from 15 gestational weeks to three months postpartum. The intercept of sleep trajectory positively affected the intercept of perinatal depressive symptoms' trajectory; the slope of sleep trajectory positively affected both the slope and the quadratic coefficient of perinatal depressive symptoms' trajectory. Conclusion The trajectory of perinatal depressive symptoms increased from 15 gestational weeks to three months postpartum following a quadratic trend. Poor sleep quality was associated with depression symptoms beginning at the onset of pregnancy. Moreover, rapidly declining sleep quality could be a significant risk factor for perinatal depression (PND). These findings call for greater attention to perinatal women who report poor and persistently deteriorating sleep quality. Additional sleep-quality evaluations, depression assessments, and referrals to mental health care providers may benefit these women and support PND prevention, screening, and early diagnosis.
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Affiliation(s)
- Chen Wang
- Department of Perinatal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
| | - Jinqin Hou
- Department of Special Education and Psychology, China National Academy of Educational Sciences, Beijing, People’s Republic of China
| | - Anning Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Weimin Kong
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
- Correspondence: Weimin Kong, Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, People’s Republic of China, Tel +8618611942798, Email
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Impact of the Timing of Maternal Peripartum Depression on Infant Social and Emotional Development at 18 Months. J Clin Med 2022; 11:jcm11236919. [PMID: 36498494 PMCID: PMC9735611 DOI: 10.3390/jcm11236919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
The study assessed how the timing of maternal perinatal depressive symptoms affects infant socio-emotional characteristics at age 18 months. The study was a longitudinal cohort study that included six assessment points from the third trimester of pregnancy up to age 18 months (±1 month). Assessment of mothers included the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory, while assessments of infant included the Infant Toddler Social and Emotional Assessment (ITSEA) at 18 months. Mothers were categorized into one of the following groups: mothers who presented postnatal depression only (n = 19); mothers who presented both prenatal and postnatal depression (n = 14), and mothers who never showed perinatal depression symptoms (n = 38). Mothers who presented both prenatal and postnatal depression showed significantly higher levels of depressive score, reactivity to stress and level of anxiety trait compared to mothers of the two other groups. Infants of prenatally and postnatally depressed mothers had higher scores on the internalizing subscore of the ITSEA. The number of depression episodes during the study period was positively correlated with the externalizing and internalizing subscores of the ITSEA. These findings support the need to provide specific screening to identify women with prenatal depression.
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12
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Kee MZ, Teh AL, Clappison A, Pokhvisneva I, MacIssac JL, Lin DT, Ramadori KE, Broekman BF, Chen H, Daniel ML, Karnani N, Kobor MS, Gluckman PD, Chong YS, Huang JY, Meaney MJ. Fetal sex-specific epigenetic associations with prenatal maternal depressive symptoms. iScience 2022; 25:104860. [PMID: 36046194 PMCID: PMC9421382 DOI: 10.1016/j.isci.2022.104860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/14/2022] [Accepted: 07/26/2022] [Indexed: 11/22/2022] Open
Abstract
Prenatal maternal mental health is a global health challenge with poorly defined biological mechanisms. We used maternal blood samples collected during the second trimester from a Singaporean longitudinal birth cohort study to examine the association between inter-individual genome-wide DNA methylation and prenatal maternal depressive symptoms. We found that (1) the maternal methylome was significantly associated with prenatal maternal depressive symptoms only in mothers with a female fetus; and (2) this sex-dependent association was observed in a comparable, UK-based birth cohort study. Qualitative analyses showed fetal sex-specific differences in genomic features of depression-related CpGs and genes mapped from these CpGs in mothers with female fetuses implicated in a depression-associated WNT/β-catenin signaling pathway. These same genes also showed enriched expression in brain regions linked to major depressive disorder. We also found similar female-specific associations with fetal-facing placenta methylome. Our fetal sex-specific findings provide evidence for maternal-fetal interactions as a mechanism for intergenerational transmission.
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Affiliation(s)
- Michelle Z.L. Kee
- Translation Neuroscience, Singapore Institute for Clinical Sciences, ASTAR, Singapore 117609, Singapore
| | - Ai Ling Teh
- Bioinformatics, Singapore Institute for Clinical Sciences, ASTAR, Singapore 117609, Singapore
| | - Andrew Clappison
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC H4H 1R3, Canada
| | - Irina Pokhvisneva
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC H4H 1R3, Canada
| | - Julie L. MacIssac
- Centre for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - David T.S. Lin
- Centre for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - Katia E. Ramadori
- Centre for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - Birit F.P. Broekman
- Translation Neuroscience, Singapore Institute for Clinical Sciences, ASTAR, Singapore 117609, Singapore
- Department of Psychiatry, Amsterdam UMC and OLVG, VU University, 1007 Amsterdam, the Netherlands
| | - Helen Chen
- Department of Psychological Medicine (Mental Wellness Service), KK Women’s and Children’s Hospital, Singapore 229899, Singapore
| | - Mary Lourdes Daniel
- Department of Child Development, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
| | - Neerja Karnani
- Translation Neuroscience, Singapore Institute for Clinical Sciences, ASTAR, Singapore 117609, Singapore
| | - Michael S. Kobor
- Centre for Molecular Medicine and Therapeutics, BC Children’s Hospital Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - Peter D. Gluckman
- Translation Neuroscience, Singapore Institute for Clinical Sciences, ASTAR, Singapore 117609, Singapore
- Centre for Human Evolution, Adaptation and Disease, Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Yap Seng Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Jonathan Y. Huang
- Translation Neuroscience, Singapore Institute for Clinical Sciences, ASTAR, Singapore 117609, Singapore
- Centre for Quantitative Medicine, Health Services and System Research Signature Research Programme, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Michael J. Meaney
- Translation Neuroscience, Singapore Institute for Clinical Sciences, ASTAR, Singapore 117609, Singapore
- Bioinformatics, Singapore Institute for Clinical Sciences, ASTAR, Singapore 117609, Singapore
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
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13
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Gustafsson HC, Young AS, Doyle O, Nagel BJ, Mackiewicz Seghete K, Nigg JT, Sullivan EL, Graham AM. Trajectories of perinatal depressive symptoms in the context of the COVID-19 pandemic. Child Dev 2021; 92:e749-e763. [PMID: 34448493 PMCID: PMC8652588 DOI: 10.1111/cdev.13656] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study sought to advance understanding of the potential long‐term consequences of the COVID‐19 pandemic for child development by characterizing trajectories of maternal perinatal depression, a common and significant risk factor for adverse child outcomes. Data came from 393 women (86% White, 8% Latina; mean age = 33.51 years) recruited during pregnancy (n = 247; mean gestational age = 22.94 weeks) or during the first year postpartum (n = 146; mean child age = 4.50 months; 55% female). Rates of depression appear elevated, relative to published reports and to a pre‐pandemic comparison group (N = 155). This study also provides evidence for subgroups of individuals who differ in their depressive symptom trajectories over the perinatal period. Subgroup membership was related to differences in maternal social support, but not to child birth outcomes.
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Affiliation(s)
| | - Anna S Young
- Oregon Health & Science University, Portland, Oregon, USA
| | - Olivia Doyle
- Oregon Health & Science University, Portland, Oregon, USA
| | - Bonnie J Nagel
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Joel T Nigg
- Oregon Health & Science University, Portland, Oregon, USA
| | - Elinor L Sullivan
- Oregon Health & Science University, Portland, Oregon, USA.,Oregon National Primate Research Center, Beaverton, Oregon, USA
| | - Alice M Graham
- Oregon Health & Science University, Portland, Oregon, USA
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14
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Fitzgerald E, Parent C, Kee MZL, Meaney MJ. Maternal Distress and Offspring Neurodevelopment: Challenges and Opportunities for Pre-clinical Research Models. Front Hum Neurosci 2021; 15:635304. [PMID: 33643013 PMCID: PMC7907173 DOI: 10.3389/fnhum.2021.635304] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Pre-natal exposure to acute maternal trauma or chronic maternal distress can confer increased risk for psychiatric disorders in later life. Acute maternal trauma is the result of unforeseen environmental or personal catastrophes, while chronic maternal distress is associated with anxiety or depression. Animal studies investigating the effects of pre-natal stress have largely used brief stress exposures during pregnancy to identify critical periods of fetal vulnerability, a paradigm which holds face validity to acute maternal trauma in humans. While understanding these effects is undoubtably important, the literature suggests maternal stress in humans is typically chronic and persistent from pre-conception through gestation. In this review, we provide evidence to this effect and suggest a realignment of current animal models to recapitulate this chronicity. We also consider candidate mediators, moderators and mechanisms of maternal distress, and suggest a wider breadth of research is needed, along with the incorporation of advanced -omics technologies, in order to understand the neurodevelopmental etiology of psychiatric risk.
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Affiliation(s)
- Eamon Fitzgerald
- Department of Psychiatry, Faculty of Medicine, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
| | - Carine Parent
- Department of Psychiatry, Faculty of Medicine, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
| | - Michelle Z. L. Kee
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Michael J. Meaney
- Department of Psychiatry, Faculty of Medicine, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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15
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Abstract
Perinatal maternal symptoms of depression and anxiety compromise psychosocial function and influence developmental outcomes in the offspring. The onset of symptoms remains unclear with findings that suggest a preconceptual origin. We addressed this issue with a prospective analysis of anxiety and depressive symptom profiles from preconception through to parturition. Women were recruited into a preconception study to assess (a) variation in symptom levels of depression and anxiety from pre- to post-conception and (b) if the symptom network profiles of depression and anxiety change from pre-conception to post-conception. A within-subject intraclass correlation analyses revealed that symptoms of depression or anxiety in the preconception phase strongly predicted those across pregnancy and into the early postnatal period. The symptom network analysis revealed that the symptom profiles remained largely unchanged from preconception into the second trimester. Our findings suggest that for a significant portion of women, maternal mental health remains stable from preconception into pregnancy. This finding highlights the need for early intervention studies on women's mental health to be targeted during the preconception period and to be extended across the population.
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16
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Yu M, Li H, Xu DR, Wu Y, Liu H, Gong W. Trajectories of perinatal depressive symptoms from early pregnancy to six weeks postpartum and their risk factors-a longitudinal study. J Affect Disord 2020; 275:149-156. [PMID: 32734901 DOI: 10.1016/j.jad.2020.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Few studies explored trajectories of depressive symptoms from early pregnancy and covered the whole perinatal period. This study aimed to explore the trajectories of perinatal depressive symptoms, their heterogeneity of onsets and peaks, and relations to demographic and psychological factors. METHOD A longitudinal study was conducted at two hospitals in China amongst 1,126 participants. Perinatal depression was measured using the Edinburgh Postnatal Depression Scale. Demographic and psychological factors were collected by self-developed questionnaire and Generalized Anxiety Disorder-7. Women completing at least three depression screens (n = 879) were included. Latent Growth Curve Model and Growth Mixture Model were performed to identify the depression trajectories and logistic regression was used to analyse factors of trajectories. RESULTS Three trajectories were identified: 90.0% of women never presented with depressive symptoms ("Low-throughout"); 5.1% presented with depressive symptoms mainly during the antenatal period ("Antenatal-high"); 4.9% presented with depressive symptoms mainly during the postpartum period ("Postpartum-high"). 52.4% of women experienced their first depressive symptoms during early pregnancy. Suffering from anxiety and being unsatisfied with their marriage were associated with the "Antenatal-high" and "Postpartum-high" trajectories, respectively. LIMITATIONS Response rate was not high. We also do not have information on clinical diagnoses or changes in some variables over time. CONCLUSIONS We identified three trajectories and heterogeneity existed concerning the timing of their peaks. Women should be considered for depression screening and intervention in early pregnancy. Factors associated with each trajectory were different, raising the potential of individualized intervention to reduce the occurrence of depression.
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Affiliation(s)
- Min Yu
- Xiangya School of Public Health, Central South University, Hunan, China
| | - Hui Li
- School of Mathematics and Statistics, University of Birmingham, UK
| | - Dong Roman Xu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangdong, China
| | - Yinglan Wu
- Department of Maternal Health Care, Hunan Provincial Maternal and Child Health Hospital, Hunan, China
| | - Hua Liu
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital in Ziyang district of Yiyang city, Hunan, China
| | - Wenjie Gong
- Xiangya School of Public Health, Central South University, Hunan, China.
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17
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Lim HA, Chua TE, Malhotra R, Allen JC, Chern BSM, Tan KH, Chen H. Trajectories of antenatal maternal psychological stress and their association with gestational age and neonatal anthropometry: A prospective cohort study of multi-ethnic Asian women in an urban setting. Asian J Psychiatr 2020; 48:101923. [PMID: 31896435 DOI: 10.1016/j.ajp.2019.101923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/26/2019] [Accepted: 12/26/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine common temporal change patterns (i.e., trajectories) of perceived antenatal psychological stress throughout the pregnancy, and to examine associations between these identified trajectories and neonatal birth outcomes. METHODS 926 participants from a prospective cohort study of multi-ethnic Asian women from an urban setting with uncomplicated singleton pregnancies completed the Perceived Stress Scale in their first, second, and third trimesters, and just prior to parturition. Gestational age, neonatal weight, length, and head circumference were recorded at birth. Longitudinal trajectories of antenatal psychological stress were characterized with group-based trajectory modelling; associations between trajectories and neonatal outcomes were assessed with analyses of covariance and covariate-adjusted linear regressions. RESULTS Three distinct non-fluctuating trajectories of antenatal psychological stress were identified, with 43 % of women experiencing significant levels of stress throughout the pregnancy. Women in this persistently-higher stress trajectory delivered neonates who were 57.5 g lighter and with head circumferences of 20 mm less than their counterparts in the other trajectories. Each one-point increase on the Perceived Stress Scale was associated with a decrease of 5.64 g in birthweight and a decrease of 0.4 mm in head circumference. CONCLUSIONS This study delineated three meaningful trajectories of antenatal psychological stress. The persistently-higher antenatal psychological stress trajectory, experienced by two in five women, was associated with lower birthweight and possibly smaller head circumference. While further research is needed to better appreciate the clinical relevance of these findings, it highlights the importance of psychosocial support even for healthy pregnant women with uncomplicated pregnancies in Asian settings.
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Affiliation(s)
| | | | | | | | | | - Kok Hian Tan
- Duke-NUS Medical School, Singapore; KK Women's and Children's Hospital, Singapore
| | - Helen Chen
- Duke-NUS Medical School, Singapore; KK Women's and Children's Hospital, Singapore.
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18
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Zeng Y, Tan CW, Sultana R, Chua TE, Chen HY, Sia ATH, Sng BL. Association of Pain Catastrophizing with Postnatal Depressive States in Nulliparous Parturients: A Prospective Study. Neuropsychiatr Dis Treat 2020; 16:1853-1862. [PMID: 32982241 PMCID: PMC7492715 DOI: 10.2147/ndt.s256465] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/13/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Postnatal depression (PND) is associated with maternal morbidity and socioeconomic burden. Recent studies have shown an association between pain catastrophizing, increased labor pain, and subsequent adverse postnatal adjustment; however, little is known on its role in PND development. We aimed to investigate the association between pain catastrophizing and probable PND. METHODS Parturients planning to undergo epidural labor analgesia were recruited. Predelivery questionnaires, including the Pain Catastrophizing Scale (PCS) and Edinburgh Postnatal Depression Scale (EPDS), were administered during early labor. A phone survey at 5- 9 weeks postdelivery was conducted to determine postdelivery EPDS and Spielberger's State-Trait-Anxiety Inventory scores. The primary outcome was a binary variable of postdelivery EPDS with cutoff of ≥10, whereas the secondary outcome was a continuous variable on increases in EPDS score. RESULTS Probable PND (EPDS ≥10) occurred in 10.5% (95% CI 8.0%-13.5%, 55 of 525) of women who underwent epidural labor analgesia. We found that high pain catastrophizing (PCS ≥25) was associated with increased postdelivery EPDS scores (adjusted β estimate 0.36, 95% CI 0.15-0.57; p=0.0008), but did not meet significance for increased risk of probable PND (p=0.1770). Additionally, presence of breakthrough pain during epidural analgesia (adjusted β estimate 0.24, 95% CI 0.02-0.46; p=0.0306) and lower BMI at term (adjusted β estimate -0.04, 95% CI -0.07 to -0.01; p=0.0055) were associated with increased postdelivery EPDS scores. CONCLUSION No significant association was found between high pain catastrophizing and probable PND; however, high predelivery pain catastrophizing, presence of breakthrough pain during epidural analgesia, and lower BMI at term were associated with increased postdelivery EPDS scores. Further research will be needed to validate this association in the context of the risk of PND development.
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Affiliation(s)
- Yanzhi Zeng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Chin Wen Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Tze-Ern Chua
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.,Paediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Helen Yu Chen
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.,Paediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Alex Tiong Heng Sia
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Ban Leong Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.,Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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