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Ramlal M, van der Meer R, Bendien S. Treatable Traits in Pregnant Women with Asthma. Respiration 2024; 103:217-232. [PMID: 38471469 PMCID: PMC10997272 DOI: 10.1159/000536455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/19/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Asthma is the most common chronic respiratory disease in pregnancy, affecting approximately 8-10% of pregnant women. Uncontrolled asthma is associated with adverse perinatal outcomes, including low birth weight, preterm birth, and maternal complications such as pre-eclampsia. SUMMARY A current approach to the management of chronic airway diseases is based on targeting treatable traits. The aim of this review was to define treatable traits in pregnant women with asthma based on recent literature and to determine personalized treatment options according to these traits. Traits addressed in this review that may improve asthma control and pregnancy outcomes are fractional exhaled nitric oxide-based asthma monitoring and treatment, medication adherence and inhalation technique, impaired lung function, smoking cessation and comorbidity including psychological conditions (depression and anxiety), obesity, rhinitis, gastroesophageal reflux disease, chronic rhinosinusitis with or without nasal polyps, and sleep apnea. KEY MESSAGES All the treatable traits discussed have the potential to improve asthma control and pregnancy outcomes in pregnant women with asthma. Further research is needed to determine which management approaches are best to improve asthma control during pregnancy, to identify other relevant treatable traits, and to determine whether the treatable trait approach is feasible and beneficial in pregnant women with asthma.
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Affiliation(s)
- Meera Ramlal
- Department of Biomedical Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Renske van der Meer
- Department of Pulmonology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Sarah Bendien
- Department of Pulmonology, Haga Teaching Hospital, The Hague, The Netherlands
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2
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Rudzinskas SA, Goff AC, Mazzu MA, Schiller CE, Meltzer-Brody S, Rubinow DR, Schmidt PJ, Goldman D. Intrinsically dysregulated cellular stress signaling genes and gene networks in postpartum depression. Mol Psychiatry 2023; 28:3023-3032. [PMID: 36782063 PMCID: PMC10507674 DOI: 10.1038/s41380-023-01985-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 02/15/2023]
Abstract
Postpartum depression (PPD) is a leading cause of morbidity and mortality among women. Clinically, the administration and withdrawal of supraphysiologic estradiol and progesterone (E2 + P) can cause affective symptom reoccurrence in women with a history of PPD, but not matched controls. To investigate the cellular basis underlying this differential affective response, lymphoblastoid cell lines (LCLs) were derived from women with and without past PPD and compared transcriptomically in hormone conditions mimicking pregnancy and parturition: supraphysiologic E2 + P-addback; supraphysiologic E2 + P-withdrawal; and no added E2 + P (Baseline). RNA-sequencing identified unique differentially expressed genes (DEGs) in all hormone conditions, but the majority tended to be downregulated in PPD and observed in E2 + P-addback. Two of these DEGs were evolutionarily conserved cellular stress regulators: IMPACT, an integrative response protein maintaining translational homeostasis, and WWTR1, a transcriptional coactivator in the 'Hippo' pathway mediating cell proliferation and survival. Correspondingly, significant gene network modules were linked to cell cycle progression, estrogen response, and immune dysregulation, suggesting innate differences in intracellular signaling in PPD. In certain hormone conditions, PPD LCLs displayed increased GATA3 expression (an upstream regulator of IMPACT and WWTR1) and differentially phosphorylated eiF2α (the ultimate downstream target of IMPACT). Taken together, these transcriptomic data primarily implicate innately dysregulated cellular responses as potentially influencing mood and/or escalating PPD risk. Furthermore, the intrinsic downregulation of IMPACT's translation and WWTR1's transcription networks may suggest a novel link between PPD and a compromised ability to maintain homeostasis in the context of cellular stress occurring during pregnancy and parturition.
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Affiliation(s)
- Sarah A Rudzinskas
- Behavioral Endocrinology Branch, NIMH, Bldg. 10CRC, Room 25330, 10 Center Drive MSC 1277, Bethesda, 20892-1277, MD, USA
- Laboratory of Neurogenetics, NIAAA, Bethesda, MD, USA
| | - Allison C Goff
- Behavioral Endocrinology Branch, NIMH, Bldg. 10CRC, Room 25330, 10 Center Drive MSC 1277, Bethesda, 20892-1277, MD, USA
- Laboratory of Neurogenetics, NIAAA, Bethesda, MD, USA
| | - Maria A Mazzu
- Behavioral Endocrinology Branch, NIMH, Bldg. 10CRC, Room 25330, 10 Center Drive MSC 1277, Bethesda, 20892-1277, MD, USA
- Laboratory of Neurogenetics, NIAAA, Bethesda, MD, USA
| | | | | | - David R Rubinow
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Peter J Schmidt
- Behavioral Endocrinology Branch, NIMH, Bldg. 10CRC, Room 25330, 10 Center Drive MSC 1277, Bethesda, 20892-1277, MD, USA.
| | - David Goldman
- Laboratory of Neurogenetics, NIAAA, Bethesda, MD, USA
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3
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Namazy JA, Schatz M. Chronic Management of Asthma During Pregnancy. Immunol Allergy Clin North Am 2023; 43:65-85. [PMID: 36411009 DOI: 10.1016/j.iac.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Asthma is one of the most common potentially serious medical problems to complicate pregnancy. Optimal management of asthma during pregnancy is thus important for both mother and baby. Treating asthmatic women requires understanding the effects of pregnancy on the course of asthma, and, conversely, the effects of asthma on pregnancy outcomes. Successful management also requires an understanding the barriers to asthma control in this population of patients. Evidence has shown that it is essential that the allergist-immunologist, obstetrician, and patient work as a team during pregnancy to achieve optimal maternal and neonatal outcomes.
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Affiliation(s)
- Jennifer A Namazy
- Department of Allergy and Immunology, Scripps Clinic, 7565 Mission Valley Road Suite 200, San Diego, CA 92108, USA.
| | - Michael Schatz
- Department of Allergy and Immunology, Kaiser Permanente, San Diego, CA, USA
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Abstract
Background: Asthma is a frequent and potentially life-threatening disease that complicates many pregnancies. There are extensive data with regard to the diagnosis and treatment of asthma during pregnancy. Medical providers require an up-to-date summary of the critical aspects of asthma management during pregnancy. Objective: This review aimed to summarize the available data from clinical trials, cohort studies, expert opinions, and guideline recommendations with regard to asthma in pregnancy. Methods: A search through PubMed was conducted by using keywords previously mentioned and MeSH (Medical Subject Headings) terminology. Clinical trials, observational studies, expert opinions, guidelines, and other reviews were included. The quality of the studies was assessed, and data were extracted and summarized. Results: Asthma worsens in ∼40% of pregnant women, which can be associated with maternal and fetal complications. Physiologic changes in the respiratory, cardiovascular, and immune systems during pregnancy play a critical role in the manifestations of asthma. The diagnosis and the treatment of asthma are similar to that of patients who are not pregnant. Nonetheless, concern for fetal malformations, preterm birth, and low birth weight must be considered when managing pregnant patients with asthma. Importantly, cornerstones of the pharmacotherapy of asthma seem to be safe during pregnancy. Conclusion: Asthma in pregnancy is associated with adverse outcomes. Roadblocks to management include associated comorbidities, medication nonadherence, atopy, lack of education, and smoking habits. These need to be acknowledged and addressed for successful asthma management during pregnancy.
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Murphy VE. Asthma in pregnancy - Management, maternal co-morbidities, and long-term health. Best Pract Res Clin Obstet Gynaecol 2022; 85:45-56. [PMID: 35871149 DOI: 10.1016/j.bpobgyn.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 12/14/2022]
Abstract
Asthma is the most prevalent chronic disease in pregnancy, and as symptoms can change with pregnancy, and exacerbations of asthma are common, regular review of asthma symptoms, the provision of self-management education, and appropriate medication use are the hallmarks of management. Co-morbidities are also prevalent among pregnant women with asthma, with obesity, gestational diabetes, hypertension, rhinitis, depression, and anxiety, more common among women with asthma than women without asthma. Less is known about reflux, obstructive sleep apnoea and vocal cord dysfunction, along with nutritional deficiencies to iron and vitamin D. Maternal asthma impacts the offspring's long-term health, particularly in increasing the risk of early life wheeze and asthma in childhood. While breastfeeding may modify the risk of infant wheeze, less is known about the mechanisms involved. More research is needed to further understand the relationship between asthma in pregnancy and the risk of poor neurodevelopmental outcomes, such as autism.
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Affiliation(s)
- Vanessa E Murphy
- School of Medicine and Public Health, University of Newcastle, and Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, NSW, Australia.
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Ren T, Chen J, Yu Y, He H, Zhang J, Li F, Svendsen K, Obel C, Wang H, Li J. The association of asthma, atopic dermatitis, and allergic rhinitis with peripartum mental disorders. Clin Transl Allergy 2021; 11:e12082. [PMID: 34962724 PMCID: PMC8805685 DOI: 10.1002/clt2.12082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/24/2021] [Accepted: 11/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Atopic diseases are characterized by dysregulated inflammatory response, which may incur the onset of peripartum mental disorders, but the impact remains unknown. This study examined whether and to what extent the history of atopic diseases is associated with newly onset peripartum mental disorders. METHODS Using population-based registries, we identified all primiparous women who gave birth to live singletons in Denmark during 1978-2016 (n = 937,422). The exposure was hospital contact due to the three major types of atopic diseases-asthma, atopic dermatitis, and allergic rhinitis-before conception. The primary outcome was any hospital contact for mental disorder during pregnancy and 1-year postpartum, which was further classified into affective disorders, neurotic, stress-related and somatoform disorders, and substance abuse. The follow-up started from the date of conception and ended at the date of the first diagnosis of mental disorders, 1-year postpartum, death, emigration, or December 31, 2016, whichever came first. Cox regression was used, adjusted for calendar year, age at childbirth, education, residence, and Charlson comorbidity index. RESULTS A total of 24,016 (2.6%) women received diagnosis of at least one of the three atopic diseases before conception (asthma, 1.7%; atopic dermatitis, 0.6%; and allergic rhinitis, 0.8%). Exposure to asthma, atopic dermatitis, or allergic rhinitis was associated with a 37% increased overall risk of peripartum mental disorders (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.27-1.49). Higher risks were observed among women with more frequent hospital contacts for atopic disease (HR, 1.80; 95% CI, 1.37-2.35; ≥5 times), and with recent hospital contacts for atopic disease (HR, 1.74; 95% CI, 1.48-2.06; within 2 years before conception). Specific associations were observed between asthma and neurotic, stress-related and somatoform disorders (HR, 1.40; 95% CI, 1.21-1.62), and between atopic dermatitis and substance abuse (HR, 1.62; 95% CI, 1.12-2.34). CONCLUSIONS History of asthma, atopic dermatitis, and allergic rhinitis before conception was associated with increased risks of peripartum mental disorders. Women who have atopic diseases before pregnancy may benefit from systematic mental health monitoring.
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Affiliation(s)
- Tai Ren
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Clinical Medicine and Epidemiology, Aarhus University, Aarhus, Denmark
| | - Jiawen Chen
- Department of Dermatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongfu Yu
- Department of Biostatistics, Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, China
| | - Hua He
- Department of Developmental and Behavioural Paediatric & Child Primary Care, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Li
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Developmental and Behavioural Paediatric & Child Primary Care, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Carsten Obel
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Hui Wang
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiong Li
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Clinical Medicine and Epidemiology, Aarhus University, Aarhus, Denmark
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7
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Yang ZC, Wang LX, Yu Y, Lin HY, Shih LC. Increased Risk of Postpartum Depression in Women With Allergic Rhinitis During Pregnancy: A Population-Based Case-Control Study. Ann Otol Rhinol Laryngol 2021; 131:1137-1143. [PMID: 34779274 DOI: 10.1177/00034894211058135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Allergic rhinitis (AR) is associated with increased risk of major depression in the general population, however, no previous study has evaluated its role among pregnant women. We aimed to investigate the potential impact of AR during pregnancy on the development of postpartum depression (PPD). METHODS This is a population-based case-control study. Data were retrieved from the National Health Insurance Research Database (NHIRD). Medical records of a total of 199 470 deliveries during 2000 and 2010 were identified. Among which, 1416 women with PPD within 12 months after delivery were classified as the case group, while 198 054 women without PPD after delivery formed the control group. Univariate and multivariate regression analyses were conducted to determine the associations between AR during pregnancies and other study variables with PPD. RESULTS AR during pregnancy was found in 9.53% women who developed PPD and 5.44% in women without PPD. After adjusting for age at delivery, income level, various pregnancy and delivery-related conditions, asthma, atopic dermatitis and other medical comorbidities in the multivariate analysis, AR was significantly associated with increased odds of PPD (aOR: 1.498, 95% CI: 1.222-1.836). CONCLUSION AR during pregnancy was independently and significantly associated with an approximately 50% increased risk of PPD among women giving birth. Closely monitoring of AR is warranted in the future in order to optimize mother and child outcomes after delivery.
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Affiliation(s)
- Zhi-Chao Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Li-Xin Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yang Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Huan-Yu Lin
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung
| | - Liang-Chun Shih
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung
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8
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Aker AM, Vigod SN, Dennis CL, Kaster T, Brown HK. The association between asthma and perinatal mental illness: a population-based cohort study. Int J Epidemiol 2021; 51:964-973. [PMID: 34379748 DOI: 10.1093/ije/dyab160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Asthma is a risk factor for mental illness, but few studies have explored this association around the time of pregnancy. We studied the association between asthma and perinatal mental illness and explored the modifying effects of social and medical complexities. METHODS In a population-based cohort of 846 155 women in Ontario, Canada, with a singleton live birth in 2005-2015 and no recent history of mental illness, modified Poisson regression models were constructed to examine the association between asthma diagnosed before pregnancy and perinatal mental illness, controlling for socio-demographics and medical history. We explored the modifying effects of social and medical complexities using relative excess risk due to interaction. Additional analyses examined the association between asthma and perinatal mental illness by timing and type of mental illness. RESULTS Women with asthma were more likely than those without asthma to have perinatal mental illness [adjusted relative risk (aRR) 1.14; 95% (confidence interval) CI: 1.13, 1.16]. Asthma was associated with increased risk of diagnosis of mental illness prenatally (aRR 1.11; 95% CI: 1.08, 1.13) and post-partum (aRR 1.17; 95% CI: 1.15, 1.19) and specifically diagnoses of mood and anxiety disorders (aRR 1.14; 95% CI: 1.13, 1.16), psychotic disorders (aRR 1.20; 95% CI: 1.10, 1.31) and substance- or alcohol-use disorders (aRR 1.24; 95% CI: 1.14, 1.36). There was no effect modification related to social or medical complexity for these outcomes. CONCLUSIONS Women with asthma predating pregnancy are at slightly increased risk of mental illness in pregnancy and post-partum. A multidisciplinary management strategy may be required to ensure timely identification and treatment.
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Affiliation(s)
- Amira M Aker
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.,ICES, Toronto, Canada
| | - Simone N Vigod
- ICES, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tyler Kaster
- ICES, Toronto, Canada.,Centre for Addiction & Mental Health, Toronto, Canada
| | - Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.,ICES, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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9
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Yousif A, Dault R, Courteau M, Blais L, Cloutier AM, Lacasse A, Vanasse A. The validity of diagnostic algorithms to identify asthma patients in healthcare administrative databases: a systematic literature review. J Asthma 2020; 59:152-168. [PMID: 32990481 DOI: 10.1080/02770903.2020.1827425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To review the available evidence supporting the validity of algorithms to identify asthma patients in healthcare administrative databases. METHODS A systematic literature search was conducted on multiple databases from inception to March 2020 to identify studies that reported the validity of case-finding asthma algorithms applied to healthcare administrative data. Following an initial screening of abstracts, two investigators independently assessed the full text of studies which met the pre-determined eligibility criteria. Data on study population and algorithm characteristics were extracted. A revised version of the Quality Assessment of Diagnostic Accuracy Studies tool was used to evaluate the risk of bias and generalizability of studies. RESULTS A total of 20 studies met the eligibility criteria. Algorithms which incorporated ≥1 diagnostic code for asthma over a 1-year period appeared to be valid in both adult and pediatric populations (sensitivity ≥ 85%; specificity ≥ 89%; PPV ≥ 70%). The validity was enhanced when: (1) the time frame to capture asthma cases was increased to two years; (2) ≥2 asthma diagnostic codes were considered; and (3) when diagnoses were recorded by a pulmonologist. Algorithms which integrated pharmacy claims data appeared to correctly identify asthma patients; however, the extent to which asthma medications can improve the validity remains unclear. The quality of several studies was high, although disease progression bias and biases related to self-reported data was observed in some studies. CONCLUSIONS Healthcare administrative databases are adequate sources to identify asthma patients. More restrictive definitions based on both asthma diagnoses and asthma medications may enhance validity, although further research is required to confirm this hypothesis.
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Affiliation(s)
- Alia Yousif
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.,Research Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada
| | - Roxanne Dault
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mireille Courteau
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.,Research Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada
| | - Anne-Marie Cloutier
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Alain Vanasse
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Research Center, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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Lin SC, Tyus N, Maloney M, Ohri B, Sripipatana A. Mental health status among women of reproductive age from underserved communities in the United States and the associations between depression and physical health. A cross-sectional study. PLoS One 2020; 15:e0231243. [PMID: 32267903 PMCID: PMC7141664 DOI: 10.1371/journal.pone.0231243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 03/06/2020] [Indexed: 01/19/2023] Open
Abstract
Background In 2017, 46.6 million U.S. adults aged 18 or older self-reported as having mental illness of which 52.0% or 24.2 million are women age 18–49. Perinatal depression and anxiety are linked to adverse outcomes concerning pregnancy, maternal functioning, and healthy child development. Methods and findings Using the 2014 Health Center Patient Survey (HCPS), the objectives of the cross-sectional study are to assess the prevalence of self-reported mental health conditions among female patients of reproductive age and to examine the association between depression and physical health. Physical health conditions of interest included self-rated health, obesity, hypertension, smoking, and diabetes, which all have established associations with potential pregnancy complications and fetal health. The study found 40.8% of patients reported depression; 28.8% reported generalized anxiety; and 15.2% met the criteria for serious psychological distress on the Kessler 6 scale. Furthermore, patients with depression had two to three times higher odds of experiencing co-occurring physical health conditions. Conclusions This study expands the discourse on maternal mental health, throughout the preconception, post-partum, and inter-conception care periods to improve understanding of the inter-correlated physical and mental health issues that could impact pregnancy outcomes and life course trajectory. From 2014 to 2018, the Health Resources and Services Administration (HRSA) has supported investments of nearly $750 million to improve and expand access to mental health and substance use disorder services for prevention, treatment, health education and awareness through comprehensive primary care integration. Moving forward, HRSA will implement strategic training and technical assistance (T/TA) framework that is designed to accelerate the adoption of science driven solutions in primary care in addressing depression for patients with co-occurring chronic conditions and advancing positive maternal outcomes.
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Affiliation(s)
- Sue C. Lin
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
- * E-mail:
| | - Nadra Tyus
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
| | - Maura Maloney
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
| | - Bonnie Ohri
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
| | - Alek Sripipatana
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
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11
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Schatz M, Sicherer SH, Khan DA, Zeiger RS. The Journal of Allergy and Clinical Immunology: In Practice 2019 Highlights. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:912-936. [PMID: 31980411 DOI: 10.1016/j.jaip.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
This article provides highlights of the clinically impactful original studies and reviews published in The Journal of Allergy and Clinical Immunology: In Practice in 2019 on the subjects of anaphylaxis, asthma, dermatitis, drug allergy, food allergy, immunodeficiency, immunotherapy, rhinitis/sinusitis, and urticaria/angioedema/mast cell disorders. Within each topic, practical aspects of diagnosis and management are emphasized. Treatments discussed include lifestyle modifications, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We designed this review to help readers consolidate and use this extensive and practical knowledge for the benefit of their patients.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
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Whalen OM, Campbell LE, Murphy VE, Lane AE, Gibson PG, Mattes J, Collison A, Mallise CA, Woolard A, Karayanidis F. Observational study of mental health in asthmatic women during the prenatal and postnatal periods. J Asthma 2019; 57:829-841. [PMID: 31148493 DOI: 10.1080/02770903.2019.1621888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective: We aimed to examine the prevalence and severity of psychological distress of women with asthma in both the prenatal and postnatal periods, and to determine whether asthmatic women with and without mental health problems differ in self-management, medications knowledge, and asthma symptoms.Methods: We assessed spirometry performance and asthma symptoms in 120 women (mean age 29.8 years) before 23 weeks gestation, as part of the Breathing for Life Trial (Trial ID: ACTRN12613000202763). Prenatal depression data was obtained from medical records. At 6 weeks postpartum, we assessed general health, self-reported asthma control, depression symptoms (with the Edinburgh Postnatal Depression Scale) and adaptive functioning (with the Achenbach System of Empirically Based Assessment scales).Results: Twenty percent of our sample reported having a current mental health diagnosis, 14% reported currently receiving mental health care, while 47% reported having received mental health care in the past (and may/may not have received a diagnosis). The sample scored high on the Aggressive Behavior, Avoidant Personality, and Attention Deficit/Hyperactivity scales. Poorer self-reported postnatal asthma control was strongly correlated with elevated somatic complaints, externalizing problems, antisocial personality problems, and greater withdrawal. Prenatal spirometry or asthma severity and control were largely not associated with measures of psychopathology.Conclusions: These findings indicate that pregnant women with asthma frequently report issues with psychopathology during the prenatal and postnatal periods, and that the subjective perception of asthma control may be more related to psychopathology than objective asthma measures. However, due to sample bias, these findings are likely to be understated.
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Affiliation(s)
- Olivia M Whalen
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Linda E Campbell
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa E Murphy
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alison E Lane
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Peter G Gibson
- Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia.,Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia
| | - Joerg Mattes
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Adam Collison
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Carly A Mallise
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Alix Woolard
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Frini Karayanidis
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia
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