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Dekel S, Papadakis JE, Quagliarini B, Pham CT, Pacheco-Barrios K, Hughes F, Jagodnik KM, Nandru R. Preventing posttraumatic stress disorder following childbirth: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:610-641.e14. [PMID: 38122842 PMCID: PMC11168224 DOI: 10.1016/j.ajog.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Women can develop posttraumatic stress disorder in response to experienced or perceived traumatic, often medically complicated, childbirth; the prevalence of these events remains high in the United States. Currently, no recommended treatment exists in routine care to prevent or mitigate maternal childbirth-related posttraumatic stress disorder. We conducted a systematic review and meta-analysis of clinical trials that evaluated any therapy to prevent or treat childbirth-related posttraumatic stress disorder. DATA SOURCES PsycInfo, PsycArticles, PubMed (MEDLINE), ClinicalTrials.gov, CINAHL, ProQuest, Sociological Abstracts, Google Scholar, Embase, Web of Science, ScienceDirect, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for eligible trials published through September 2023. STUDY ELIGIBILITY CRITERIA Trials were included if they were interventional, if they evaluated any therapy for childbirth-related posttraumatic stress disorder for the indication of symptoms or before posttraumatic stress disorder onset, and if they were written in English. METHODS Independent coders extracted the sample characteristics and intervention information of the eligible studies and evaluated the trials using the Downs and Black's quality checklist and Cochrane's method for risk of bias evaluation. Meta-analysis was conducted to evaluate pooled effect sizes of secondary and tertiary prevention trials. RESULTS A total of 41 studies (32 randomized controlled trials, 9 nonrandomized trials) were reviewed. They evaluated brief psychological therapies including debriefing, trauma-focused therapies (including cognitive behavioral therapy and expressive writing), memory consolidation and reconsolidation blockage, mother-infant-focused therapies, and educational interventions. The trials targeted secondary preventions aimed at buffering childbirth-related posttraumatic stress disorder usually after traumatic childbirth (n=24), tertiary preventions among women with probable childbirth-related posttraumatic stress disorder (n=14), and primary prevention during pregnancy (n=3). A meta-analysis of the combined randomized secondary preventions showed moderate effects in reducing childbirth-related posttraumatic stress disorder symptoms when compared with usual treatment (standardized mean difference, -0.67; 95% confidence interval, -0.92 to -0.42). Single-session therapy within 96 hours of birth was helpful (standardized mean difference, -0.55). Brief, structured, trauma-focused therapies and semi-structured, midwife-led, dialogue-based psychological counseling showed the largest effects (standardized mean difference, -0.95 and -0.91, respectively). Other treatment approaches (eg, the Tetris game, mindfulness, mother-infant-focused treatment) warrant more research. Tertiary preventions produced smaller effects than secondary prevention but are potentially clinically meaningful (standardized mean difference, -0.37; -0.60 to -0.14). Antepartum educational approaches may help, but insufficient empirical evidence exists. CONCLUSION Brief trauma-focused and non-trauma-focused psychological therapies delivered early in the period following traumatic childbirth offer a critical and feasible opportunity to buffer the symptoms of childbirth-related posttraumatic stress disorder. Future research that integrates diagnostic and biological measures can inform treatment use and the mechanisms at work.
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Affiliation(s)
- Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | | | | | - Christina T Pham
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Francine Hughes
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kathleen M Jagodnik
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rasvitha Nandru
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Guo W, Liu Z, Zou D, Liang A. New advances in perioperative care for mothers and newborns undergoing cesarean-section delivery. Asian J Surg 2024; 47:2035-2036. [PMID: 38245418 DOI: 10.1016/j.asjsur.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Affiliation(s)
- Wei Guo
- Department of Obstetrics and Gynecology, Chengdu BOE Hospital, Chengdu, Sichuan, 610041, China
| | - Zhen Liu
- Department of Obstetrics and Gynecology, Chengdu BOE Hospital, Chengdu, Sichuan, 610041, China
| | - Dan Zou
- Department of Obstetrics and Gynecology, Chengdu BOE Hospital, Chengdu, Sichuan, 610041, China
| | - Ailin Liang
- Department of Obstetrics and Gynecology, Chengdu BOE Hospital, Chengdu, Sichuan, 610041, China.
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Xu J, Zhang H, Chen D, Xu K, Li Z, Wu H, Geng X, Wei X, Wu J, Cui W, Wei S. Looking for a Beam of Light to Heal Chronic Pain. J Pain Res 2024; 17:1091-1105. [PMID: 38510563 PMCID: PMC10953534 DOI: 10.2147/jpr.s455549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
Chronic pain (CP) is a leading cause of disability and a potential factor that affects biological processes, family relationships, and self-esteem of patients. However, the need for treatment of CP is presently unmet. Current methods of pain management involve the use of drugs, but there are different degrees of concerning side effects. At present, the potential mechanisms underlying CP are not completely clear. As research progresses and novel therapeutic approaches are developed, the shortcomings of current pain treatment methods may be overcome. In this review, we discuss the retinal photoreceptors and brain regions associated with photoanalgesia, as well as the targets involved in photoanalgesia, shedding light on its potential underlying mechanisms. Our aim is to provide a foundation to understand the mechanisms underlying CP and develop light as a novel analgesic treatment has its biological regulation principle for CP. This approach may provide an opportunity to drive the field towards future translational, clinical studies and support pain drug development.
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Affiliation(s)
- Jialing Xu
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Hao Zhang
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Dan Chen
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Kaiyong Xu
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Zifa Li
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Hongyun Wu
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Xiwen Geng
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Xia Wei
- NMPA Key Laboratory for Research and Evaluation of Generic Drugs, Shandong Institute for Food and Drug Control, Ji’nan, Shandong, People’s Republic of China
| | - Jibiao Wu
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Wenqiang Cui
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Sheng Wei
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
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Danoff JS, Carter CS, Gordevičius J, Milčiūtė M, Brooke RT, Connelly JJ, Perkeybile AM. Maternal oxytocin treatment at birth increases epigenetic age in male offspring. Dev Psychobiol 2024; 66:e22452. [PMID: 38533486 PMCID: PMC10963051 DOI: 10.1002/dev.22452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/26/2023] [Indexed: 03/28/2024]
Abstract
Exogenous oxytocin (OT) is widely used to induce or augment labor with little understanding of the impact on offspring development. In rodent models, including the prairie vole (Microtus ochrogaster), it has been shown that oxytocin administered to mothers can affect the nervous system of the offspring with long lasting behavioral effects especially on sociality. Here, we examined the hypothesis that perinatal oxytocin exposure could have epigenetic and transcriptomic consequences. Prairie voles were exposed to exogenous oxytocin, through injections given to the mother just prior to birth, and were studied at the time of weaning. The outcome of this study revealed increased epigenetic age in oxytocin-exposed animals compared to the saline-exposed group. Oxytocin exposure led to 900 differentially methylated CpG sites (annotated to 589 genes), and 2 CpG sites (2 genes) remained significantly different after correction for multiple comparisons. Differentially methylated CpG sites were enriched in genes known to be involved in regulation of gene expression and neurodevelopment. Using RNA-sequencing we also found 217 nominally differentially expressed genes (p<0.05) in nucleus accumbens, a brain region involved in reward circuitry and social behavior; after corrections for multiple comparisons 6 genes remained significantly differentially expressed. Finally, we found that maternal oxytocin administration led to widespread alternative splicing in the nucleus accumbens. These results indicate that oxytocin exposure during birth may have long lasting epigenetic consequences. A need for further investigation of how oxytocin administration impacts development and behavior throughout the lifespan is supported by these outcomes.
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Affiliation(s)
- Joshua S Danoff
- Department of Psychology, University of Virginia, Charlottesville, VA
- Department of Molecular Biology and Biochemistry, Rutgers University, Piscataway, NJ
| | - C Sue Carter
- Department of Psychology, University of Virginia, Charlottesville, VA
- Kinsey Institute, Indiana University, Bloomington IN
| | | | | | | | | | - Allison M Perkeybile
- Department of Psychology, University of Virginia, Charlottesville, VA
- Kinsey Institute, Indiana University, Bloomington IN
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Dekel S, Papadakis JE, Quagliarini B, Jagodnik KM, Nandru R. A Systematic Review of Interventions for Prevention and Treatment of Post-Traumatic Stress Disorder Following Childbirth. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.17.23294230. [PMID: 37693410 PMCID: PMC10485880 DOI: 10.1101/2023.08.17.23294230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Objective Postpartum women can develop post-traumatic stress disorder (PTSD) in response to complicated, traumatic childbirth; prevalence of these events remains high in the U.S. Currently, there is no recommended treatment approach in routine peripartum care for preventing maternal childbirth-related PTSD (CB-PTSD) and lessening its severity. Here, we provide a systematic review of available clinical trials testing interventions for the prevention and indication of CB-PTSD. Data Sources We conducted a systematic review of PsycInfo, PsycArticles, PubMed (MEDLINE), ClinicalTrials.gov, CINAHL, ProQuest, Sociological Abstracts, Google Scholar, Embase, Web of Science, ScienceDirect, and Scopus through December 2022 to identify clinical trials involving CB-PTSD prevention and treatment. Study Eligibility Criteria Trials were included if they were interventional, evaluated CB-PTSD preventive strategies or treatments, and reported outcomes assessing CB-PTSD symptoms. Duplicate studies, case reports, protocols, active clinical trials, and studies of CB-PTSD following stillbirth were excluded. Study Appraisal and Synthesis Methods Two independent coders evaluated trials using a modified Downs and Black methodological quality assessment checklist. Sample characteristics and related intervention information were extracted via an Excel-based form. Results A total of 33 studies, including 25 randomized controlled trials (RCTs) and 8 non-RCTs, were included. Trial quality ranged from Poor to Excellent. Trials tested psychological therapies most often delivered as secondary prevention against CB-PTSD onset (n=21); some examined primary (n=3) and tertiary (n=9) therapies. Positive treatment effects were found for early interventions employing conventional trauma-focused therapies, psychological counseling, and mother-infant dyadic focused strategies. Therapies' utility to aid women with severe acute traumatic stress symptoms or reduce incidence of CB-PTSD diagnosis is unclear, as is whether they are effective as tertiary intervention. Educational birth plan-focused interventions during pregnancy may improve maternal health outcomes, but studies remain scarce. Conclusions An array of early psychological therapies delivered in response to traumatic childbirth, rather than universally, in the first postpartum days and weeks, may potentially buffer CB-PTSD development. Rather than one treatment being suitable for all, effective therapy should consider individual-specific factors. As additional RCTs generate critical information and guide recommendations for first-line preventive treatments for CB-PTSD, the psychiatric consequences associated with traumatic childbirth could be lessened.
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Affiliation(s)
- Sharon Dekel
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joanna E. Papadakis
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Beatrice Quagliarini
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathleen M. Jagodnik
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rasvitha Nandru
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Cong S, Fan X, Yu P, Zhou C, Wang L, Wang R, Song X, Feng J, Sun X, Sha L, Zhu Z, Zhang A. Spontaneous behaviors during breast crawling and factors influencing self-locating mothers' breasts in newborns: A cross-sectional study. Heliyon 2023; 9:e16440. [PMID: 37260903 PMCID: PMC10227327 DOI: 10.1016/j.heliyon.2023.e16440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/29/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
Abstract
Breast crawling in newborns to propel themselves to their mothers' breasts normally occurs upon skin-to-skin contact with mothers immediately after birth but is often missed by the neglect of hospital staff and insufficient evidence support. Hence, this study described the behavioral characteristics of 135 newborns from China during breast crawling and further explored the factors influencing newborns' self-locating mothers' breasts (measured by whether fail to experience the familiarization stage, initial time and duration of the familiarization stage) using multivariable analysis. The findings supported and extended previous studies that newborns could emerge in nine instinctive stages and corresponding spontaneous behaviors early in life. Moreover, abnormal fetal heart rate during labor appeared to interfere with newborns experiencing the familiarization stage (aOR = 9.27, 95% CI: 1.41 to 61.07, P = 0.021), while using synthetic oxytocin (β = 5.94, 95% CI: 0.35 to 11.54, P = 0.037), using antibiotics (β = 11.09, 95% CI: 4.11 to 18.07, P = 0.002), and newborns' gender (β = -5.69, 95% CI: 11.26 to -0.12, P = 0.045) would alter the initial time of the familiarization stage. Finally, this study proposes evidence-based strategies to prevent abnormal fetal heart rates and improve medication use.
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Affiliation(s)
- Shengnan Cong
- Department of Nursing, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Xuemei Fan
- Department of Nursing, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Ping Yu
- Department of Nursing, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Chunxiu Zhou
- Department of Nursing, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Lingzhi Wang
- Department of Nursing, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Rui Wang
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Xiaowei Song
- Department of Neurosurgery, Sir Run Run Hospital, Nanjing Medical University, Jiangsu, China
| | - Jingyi Feng
- Faculty of Science, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiaoqing Sun
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Lijuan Sha
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Zhu Zhu
- Department of Nursing, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Aixia Zhang
- Department of Nursing, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
- School of Nursing, Nanjing Medical University, Jiangsu, China
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