Association between pre-pregnancy tobacco smoking and postpartum depression: A nationwide cohort study

"A systematic review of risk factors of postpartum depression. Evidence from Asian culture "

OBJECTIVES

One of the largest health concerns, postpartum depression (PPD), has detrimental effects on new mothers, their child, and their family. Investigating under-researched risk factors for postpartum depression in Asian women is the goal of this review of the literature.

METHODS

The literature was searched using a number of electronic research databases. This review included studies that meet the following requirements: (a) they evaluated risk variables; (b) they were conducted in Asian countries using quantitative or qualitative methods; and (c) they were published in English in peer-reviewed journals between 2007 and 2023. A total of 90 studies from 14 different countries were reviewed, compiled, and synthesized.

RESULTS

In Asian countries, where rates ranged from 0.82 % to 93 %, South Korea and Japan had the lowest and highest rates of postpartum depression, respectively. The risk factors for postpartum depression were divided into five main categories: biological/physical (e.g., ABO blood group, oxytocin level), psychological (e.g., antenatal depression, body dissatisfaction, child care stress), obstetric/pediatric (e.g., loss of baby, abortions, pain), socio-demographic (e.g., low social support, poverty, loss of autonomy), and cultural (e.g., gender preference).

CONCLUSION

This phenomenon is prevalent in Asian cultures as it is in European Countries. The repercussions of untreated postpartum depression can lead to long-term psychological and developmental issues in children and strain the familial bonds essential for a nurturing environment. Moreover, understanding the specific risk factors faced by Asian women can pave the way for culturally sensitive interventions and support systems designed to address and mitigate these challenges effectively.

Association between postpartum depression and postpartum hemorrhage: A systematic review and meta-analysis

INTRODUCTION

Postpartum depression (PPD) is a growing mental health concern worldwide and has detrimental effects on the social and cognitive health of both mothers and infants. This review was performed to assess the risk of PPD in women with postpartum hemorrhage (PPH) and to identify potential moderators.

MATERIAL AND METHODS

The review protocol was registered in the PROSPERO database on June 17, 2023 (registration number: CRD42023432955). Two researchers independently performed a literature search of the PubMed, Embase, and Web of Science databases for articles published before May 25, 2023, with no filters and no language or location restrictions. Study quality was evaluated using the Newcastle-Ottawa Scale. The primary outcome was the odds ratio (OR) and 95% confidence interval (CI) of PPD in women with vs. without PPH. We performed sensitivity analyses and meta-regression analyses to resolve heterogeneity. Meta-regression analyses included the effects of age, maternal smoking, marital status, preterm labor, maternal education level, preeclampsia, anemia during pregnancy, and cesarean section.

RESULTS

In total, seven studies involving 540 558 participants met the eligibility criteria and were included in the meta-analysis. Women with PPH were at increased risk of PPD compared with women without PPH (OR 1.10; 95% CI 1.03-1.16), and heterogeneity was low (I2 = 23%; τ2 = 0.0007; p = 0.25). Moreover, the results of the sensitivity analyses showed that the I2 value decreased from 23% to 0% after excluding one particular study, which may have been a source of heterogeneity. In the meta-regression analyses, the OR of PPD was greatly affected by maternal smoking (OR -0.26; 95% CI -0.30 to -0.22; p < 0.001). However, we did not observe any effects for maternal age, marital status, preterm labor, maternal education level, preeclampsia, anemia during pregnancy, or cesarean section.

CONCLUSIONS

Women with PPH must be closely monitored because they have a higher risk of PPD than women without PPH. Early recognition and management of these patients will improve treatment outcomes, maternal health, and newborn development.

Association between history of hookah use and symptoms of postpartum depression: A population-based study

OBJECTIVE

Although several biologic, psychosocial, and behavioral factors have been linked to postpartum depressive symptoms, studies examining the association between non-cigarette tobacco products and symptoms of postpartum depression are currently lacking. This study examined the association between hookah use and postpartum depressive symptoms.

METHODS

A cross-sectional study was conducted using data from the US Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System 2016-2020. Self-reported data on hookah use in the last 2 years and maternal mental health were captured using a structured questionnaire. Descriptive and inferential statistics were performed.

RESULTS

The final study sample consisted of 106 894 participants. Approximately 8.2% of the participants reported postpartum depressive symptoms and 4.1% reported hookah use in the past 2 years. Compared with those without postpartum depressive symptoms, participants with postpartum depressive symptoms were more likely to be hookah users (5.5% vs 4.0%, P < 0.001). After adjustment for confounders, the odds of having postpartum depressive symptoms were significantly higher among participants who used a hookah in the past 2 years compared with non-users; adjusted odds ratio (95% confidence interval) 1.20 (1.03-1.40); P = 0.022.

CONCLUSION

In a large, population-based sample of US women, hookah use in the past 2 years significantly increased the odds of having postpartum depressive symptoms, independent of potential confounders. This finding underscores the need for healthcare providers to communicate effectively about the health risks of hookah use.

Substance use during pregnancy and risk of postpartum depression: a systematic review and meta-analysis

Introduction

Postpartum depression (PPD) is a prevalent mental health condition affecting women globally within the first year following childbirth. Substance use during pregnancy has been associated with an increased risk of developing PPD, but the evidence remains inconclusive. This meta-analysis aims to comprehensively assess the effects of different substances on PPD risk, exploring potential modifiers and confounding factors.

Objectives

To examine the proportion of PPD among substance users during pregnancy, compared to non-users, and investigate the specific risk associated with different substances (tobacco, alcohol, and non-specified substance use/multiple substance use).

Methods

A systematic literature search was conducted from inception to November 2022 using the Web of Science database (Clarivate Analytics), incorporating Web of Science Core Collection, the BIOSIS Citation Index, the KCI-Korean Journal Database, MEDLINE®, the Russian Science Citation Index, the SciELO Citation Index, and the Cochrane Central Register of Reviews, and Ovid/PsycINFO databases. Inclusion criteria comprised original studies with pregnant women, using validated depression scales and substance use reporting.

Results

Among the 26 included studies, encompassing 514,441 women, the pooled prevalence of PPD among substance users during pregnancy was 29% (95% CI 25-33). Meta-analyzes revealed an overall odds ratio (OR) of 3.67 (95% CI 2.31-5.85, p < 0.01) indicating a significantly higher risk of PPD among substance users compared to non-users. Subgroup analyzes demonstrated a higher risk for women with non-specified or multiple substance use (OR 4.67, 95% CI 2.59-8.41; p < 0.01) and tobacco use (OR 4.01, 95% CI 2.23-7.20; p < 0.01). Alcohol use showed a trend toward higher risk that did not reach statistical significance (OR 1.88, 95% CI 1.00-3.55; p = 0.051).

Conclusion

This meta-analysis provides evidence of an increased risk of PPD among pregnant substance users, particularly those using multiple substances or tobacco. However, caution is needed in interpreting the association with alcohol use due to its non-significant result.

Systematic review registration

This study protocol was registered at PROSPERO (registration number: CCRD42022375500).

Nicotine Dependence and Postpartum Depression: A Multicenter Research Network Study

BACKGROUND

Many people who have recently delivered a baby (puerperae) experience postpartum depression. The aim of this study is to examine nicotine dependence within the 5 years prior to delivery (ND5y) as a factor.

METHODS

Data from TriNetX Research Network platform were used. Analysis involved determining risk ratios of postpartum depression among puerperae with/without ND5y in umatched cohorts and propensity score matched cohorts.

RESULTS

The unmatched sample included 1,460 (13.8%) postpartum puerperae with diagnosed ND5y and 9,138 (86.2%) postpartum puerperae without ND5yt. The matched sample included 1,362 participants with and 1,362 participants without ND5y diagnosis. The unmatched and matched risk ratios were 1.75 (95% Confidence Interval [CI]: 1.55, 1.98; p < 0.0001) and 0.68 (95% [CI]: 0.59, 0.79; p < 0.0001), respectively.

CONCLUSION

Postpartum depression was associated with ND5y in the unmatched sample analysis, but not in the matched sample analysis. As a potential mechanism is unknown, it is possible that some of the matched variables have a shared mechanism with post-partum depression and matching may have masked the true relationship. Therefore, both the unmatched and propensity matched analyses are presented as both have important relevance and may spur future research with non-clinical-based data.

Associations of lifestyle with mental health and well-being in Chinese adults: a nationwide study

Background

A healthy lifestyle is beneficial to individuals' health. However, little is known about the associations of lifestyle factors with mental health and well-being. This study examined the associations of lifestyle factors with mental health (i.e., depression, anxiety, loneliness, perceived pressure, and self-rated health status) and well-being in Chinese adults.

Methods

A nationally representative survey was conducted in China from 20 June 2022 to 31 August 2022. Data from the survey were analyzed using multiple linear regression to determine the associations of lifestyle with mental health and well-being in Chinese adults. Standardized regression coefficients (β) and 95% confidence intervals (CIs) were estimated using multiple linear regression.

Results

The survey included 28,138 Chinese adults. Multiple linear regression results showed that there were significant negative associations of lifestyle scores with scores of depression (β = -0.93, 95% CI: -0.98, -0.88), anxiety (β = -0.71, 95% CI: -0.76, -0.67), loneliness (β = -0.23, 95% CI: -0.24, -0.21), and perceived pressure (β = -0.19, 95% CI: -0.22, -0.16). Moreover, there were significant positive associations of lifestyle with self-rated health status (β = 1.99, 95% CI: 1.79, 2.20) and well-being (β = 0.96, 95% CI: 0.91, 1.02).

Conclusion

This study provides insight into the associations of lifestyle factors with mental health and well-being and highlights the importance of improving and maintaining healthy lifestyle behaviors for favorable mental health and well-being.

Postpartum Depression: Screening and Collaborative Management

Perinatal mood disorders are a leading cause of disability worldwide and suicide is a leading cause of maternal death in the first year after giving birth. The three categories of perinatal mood disorders are postpartum blues, postpartum depression, and postpartum psychosis. Identifying risk factors may allow clinicians to provide patients with interventions to potentially prevent development of these disorders. Universal screening for perinatal mood disorders can lead to earlier identification and treatment. Collaborative care methods, incorporating the entire family into treatment, therapy service, and providing support services are recommended as first-line intervention strategies before moving on to pharmacologic management.

Impact of Age-Related Macular Degeneration and Related Visual Disability on the Risk of Depression: A Nationwide Cohort Study

PURPOSE

To evaluate the prospective association of age-related macular degeneration (AMD) and related visual disability (VD) with the risk of depression.

DESIGN

This nationwide population-based cohort study used authorized clinical data provided by the Korean National Health Insurance Service.

PARTICIPANTS

A total of 3 599 589 individuals older than 50 years participated in the Korean National Health Screening Program in 2009.

METHODS

Age-related macular degeneration diagnosis and the presence of accompanying VD were verified using diagnostic codes and disability registration data. Data on covariates, including age, sex, income level, residential area, systemic comorbidities, and behavioral factors, were collected from health screening results and claims data. Patients were followed up until December 2019, and incident cases of depression were identified using registered diagnostic codes. The prospective association of AMD and related VD with new-onset depression was investigated using the multivariable-adjusted Cox proportional hazard model.

MAIN OUTCOME MEASURES

Hazard ratios and 95% confidence intervals (CIs) for depression development according to the presence of AMD and VD.

RESULTS

During an average follow-up period of 8.52 years, 1 037 088 patients received new diagnoses of depression. Patients with previous diagnoses of AMD showed a greater risk of new-onset depression, with a hazard ratio of 1.15 (95% CI, 1.13-1.17) compared with the control group in the fully adjusted model. Patients with AMD and accompanying VD showed a further increased risk of depression, with a hazard ratio of 1.23 (95% CI, 1.16-1.30).

CONCLUSIONS

Individuals with a diagnosis of AMD have a higher risk of depression developing in the future. The risk of depression is increased further in patients with AMD who demonstrate VD.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.