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Sargi J, Hachem C, Richa S, Amil CE. Prevalence of benzodiazepines use during pregnancy in Lebanon. L'ENCEPHALE 2024:S0013-7006(24)00097-6. [PMID: 38824048 DOI: 10.1016/j.encep.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/16/2024] [Accepted: 02/23/2024] [Indexed: 06/03/2024]
Abstract
Pregnancy is a period of heightened risk period for many psychiatric disorders, particularly anxiety disorders. However, there is limited knowledge regarding the usage of psychotropic medications during pregnancy. Over the past decade there has been a notable increase in the use of medications during pregnancy, with benzodiazepines being the primary choice for alleviating anxiety. It is important to note, though, that benzodiazepines have been associated with various risks for both pregnancy and newborns. In Lebanon, to date, there has been no study estimating the prevalence of the use of benzodiazepines during pregnancy. Our study aims to find the prevalence of benzodiazepines use in a population of pregnant women in Hôtel-Dieu Hospital, a tertiary care center in Beirut, and the medical center of Saint-Joseph University and to compare our results to international literature. To accomplish our objectives we administered questionnaires to over two hundred women who had recently given birth in the gynecology department. These forms encompassed inquiries about benzodiazepine consumption, as well as various medical and socio demographic details. In total, we interviewed 225 women who gave birth at the Hôtel-Dieu de France between the months of December 2019 and February 2020 and between the months of February 2021 and October 2021 in the gynecology department. The questionnaires included socio demographic, medical, and psychiatric information as well as questions about the use of benzodiazepines. We found a significantly lower prevalence of benzodiazepine use among these women compared to the figures reported in international literature. The approval of the ethics committee was obtained on December 19, 2019 after making sure that this study raised no ethical objections. (File number: CEHDF 1533).
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Affiliation(s)
- Juliana Sargi
- Department of Psychiatry, Faculty of Medicine, Saint-Joseph University, P.O. Box 17-5208, 11-5076, Beirut, Lebanon.
| | - Charline Hachem
- Department of Psychiatry, Faculty of Medicine, Saint-Joseph University, P.O. Box 17-5208, 11-5076, Beirut, Lebanon
| | - Sami Richa
- Department of Psychiatry, Faculty of Medicine, Saint-Joseph University, P.O. Box 17-5208, 11-5076, Beirut, Lebanon
| | - Chanel El Amil
- Department of Psychiatry, Faculty of Medicine, Saint-Joseph University, P.O. Box 17-5208, 11-5076, Beirut, Lebanon
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Urichuk M, Singh C, Zrinyi A, Lum Min SA, Keijzer R. Mental Health Outcomes of Mothers of Children With Congenital Gastrointestinal Anomalies Are Similar to Control Mothers: A Longitudinal Retrospective Cohort Study. J Pediatr Surg 2024; 59:918-923. [PMID: 38365470 DOI: 10.1016/j.jpedsurg.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Mothers of infants born with congenital gastrointestinal surgical anomalies experience a unique caregiving role. Whether these challenges result in more mental health diagnoses than the general population is unknown. This study assessed mental health diagnoses in mothers of children born with congenital surgical anomalies (CSA) compared to mothers of children without CSA. METHODS A total of 780 mothers of children with CSA (case-mothers) and 6994 control-mothers were included. Mental health diagnoses were obtained using International Classification of Diseases 9 codes from an administrative database. Multivariate hazard ratios (HR) of mental health diagnoses were determined for mothers following childbirth, controlling for socioeconomic status, mental health diagnoses prior to childbirth, and age at childbirth. Subgroup analyses were completed for anxiety, depression, and post-traumatic stress disorder (PTSD). The association between a woman's mental health history and becoming a case-mother was analyzed using risk ratios (RR). RESULTS Case-mothers were not at increased risk of mental health disorders compared to controls (HR = 1.00; CI95 = 0.92-1.09). In aggregate analysis, no increased risk of anxiety, depression, or PTSD was found. Subgroup analyses revealed that congenital diaphragmatic hernia case-mothers had an increased risk of depression (HR = 1.43; CI95 = 1.08-1.88). No other case-mothers were at increased risk of mental health diagnoses, anxiety, depression, or PTSD. Only omphalocele was associated with mental health diagnoses before childbirth (RR = 1.89; CI95 = 1.58-2.26). CONCLUSIONS Collectively, mothers of children with CSAs did not have a greater risk of a mental health disorder, anxiety, depression, or PTSD compared to control-mothers. Only mothers of children with congenital diaphragmatic hernia had an increased risk of depression. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Matthew Urichuk
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Charanpal Singh
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Anna Zrinyi
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Suyin A Lum Min
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Keijzer
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
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Hecht LM, Braciszewski JM, Miller-Matero LR, Ahmedani BK, Kerver JM, Loree AM. Adequacy of prenatal care utilisation and gestational weight gain among women with depression. J Reprod Infant Psychol 2024; 42:222-233. [PMID: 35582731 DOI: 10.1080/02646838.2022.2075544] [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: 01/19/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Depression is common during pregnancy, can elevate risk for excessive or inadequate gestational weight gain (GWG), and is associated with both underutilisation and overutilisation of prenatal care. Whether GWG is associated with adequacy of prenatal care among women with and without depression in the United States is unknown. This study evaluated whether adequacy of prenatal care differed by depression status and GWG. METHODS Data from the Pregnancy Risk Assessment Monitoring System from 1,379,870 women who were pregnant with a singleton and delivered at 37-42 weeks gestation during 2016 to 2018 were included. Depression was self-reported. The Kotelchuck index was used to evaluate adequacy of prenatal care. Maternal weight gain was compared to GWG guidelines. RESULTS Approximately 13.1% of the sample experienced depression during pregnancy. Although those with depression had increased odds of both inadequate and above adequate levels of prenatal care, this association was no longer significant after accounting for demographics, medical comorbidities, and socioeconomic factors. Individuals with inadequate levels of prenatal care with a normal pre-pregnancy body mass index gained less weight during pregnancy. CONCLUSIONS The association between depression and prenatal care utilisation seems driven by demographic, medical comorbidity, and socioeconomic variables. Weight outcomes were associated with inadequate prenatal care utilisation.
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Affiliation(s)
- Leah M Hecht
- Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI, USA
| | - Jordan M Braciszewski
- Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI, USA
- Henry Ford Health System, Behavioral Health, Detroit, MI, USA
| | - Lisa R Miller-Matero
- Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI, USA
- Henry Ford Health System, Behavioral Health, Detroit, MI, USA
| | - Brian K Ahmedani
- Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI, USA
- Henry Ford Health System, Behavioral Health, Detroit, MI, USA
| | - Jean M Kerver
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Amy M Loree
- Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI, USA
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Bloom M, Gjelsvik A, Amanullah S. Stress During Pregnancy Associated with Newborn Low Birth Weight: Experiences from the State of Rhode Island. Matern Child Health J 2024; 28:344-350. [PMID: 37955837 DOI: 10.1007/s10995-023-03845-8] [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] [Accepted: 11/04/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE Prenatal stress is a known risk for poor birth outcomes. This study specifically looked at reported stress during pregnancy and low birth weight (LBW) in Rhode Island. METHODS Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2016 to 2018 for the state of Rhode Island was utilized. Stress during most recent pregnancy was dichotomized as: 'none to minimal' and 'moderate to high.' LBW was defined as less than 2,500 g. Multivariable regression analysis was performed, accounting for complex survey design. RESULTS In this cohort, 24% of pregnant people reported moderate to high stress leading to an adjusted odds of 1.70 (95% CI 1.43-2.03) of having a LBW newborn compared to those with none to minimal stress. Primiparity, previous preterm birth, racism, smoking history, and history of chronic medical problems were also associated with LBW newborns. CONCLUSION We recommend screening and provision of support services for stress in all settings where pregnant people access care.
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Affiliation(s)
- Molly Bloom
- Global Health/Faculty Development Fellow in the department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Annie Gjelsvik
- Department of Epidemiology, Director of MPH Program, Brown University School of Public Health, Providence, RI, USA
| | - Siraj Amanullah
- Department of Emergency Medicine, Pediatrics, and Health Services, Policy and Practice, Alpert Medical School of Brown University and Brown School of Public Health, Hasbro Children's Hospital/Rhode Island, Hospital/Providence Rhode Island, Providence, RI, USA
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Bottemanne H, Joly L, Javelot H, Ferreri F, Fossati P. Guide de prescription psychiatrique pendant la grossesse, le postpartum et l’allaitement. L'ENCEPHALE 2023:S0013-7006(22)00228-7. [PMID: 37031069 DOI: 10.1016/j.encep.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/16/2022] [Indexed: 04/09/2023]
Abstract
Perinatal psychopharmacology is an emerging specialty that is gradually developing alongside perinatal psychiatry. The management of psychiatric disorders during the perinatal period is a challenge for perinatal practitioners due to the multiple changes occurring during this crucial period. This little-known specialty still suffers from inappropriate considerations on the impact of psychotropic treatments on the mother and the infant during pregnancy and postpartum, which can promote a deficiency in perinatal psychic care. However, the risks associated with insufficient management of mental health are major, impacting both the mental and physical health of the mother and the infant. In this paper, we propose a perinatal psychopharmacology prescription guide based on available scientific evidence and international and national recommendations. We thus propose a decision-making process formalized on simple heuristics in order to help the clinician to prescribe psychotropic drugs during the perinatal period.
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Koire A, Nong YH, Cain CM, Greeley CS, Puryear LJ, Van Horne BS. Longer wait time after identification of peripartum depression symptoms is associated with increased symptom burden at psychiatric assessment. J Psychiatr Res 2022; 152:360-365. [PMID: 35785579 DOI: 10.1016/j.jpsychires.2022.06.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/07/2022] [Accepted: 06/24/2022] [Indexed: 11/26/2022]
Abstract
Untreated peripartum depression (PD) affects one in seven women and is associated with negative maternal outcomes. This retrospective observational study used health record data from an integrated health system in Texas to assess the extent to which time to access reproductive psychiatry influences the mental health of peripartum women. Women with at least one screening for depression symptoms conducted in obstetric or pediatric settings between May 2014 and October 2019 and subsequently seen by the reproductive psychiatry clinic (n=490) were included. Descriptive and inferential statistics were used to assess timing and factors related to psychiatry follow-up. Findings from this study demonstrated that the average time between a positive screen and a psychiatry assessment was 5 weeks. At psychiatry referral appointments, 85% of women continued to screen positive for PD symptoms. Depression symptom scores at the psychiatry appointment were significantly higher than scores precipitating the referral (p = 0.002). Wait time between initial positive screen and referral appointment was positively correlated with clinically meaningful increases in depression symptom scores (p < 0.001). Each week spent waiting for an appointment produced a 13% increase in odds of clinically meaningful worsening of PD scores and 9% increase in odds of developing new self-harm ideation. Given the findings that a longer period between primary care referral and subspecialty appointment has a negative impact on the mental health of women, this study supports the need for earlier psychiatric assessment to minimize decompensation. Expansion of reproductive psychiatry services are needed to support peripartum women and improve maternal outcomes.
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Affiliation(s)
- Amanda Koire
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Yen H Nong
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, MC A2275, Houston, TX, 77030, USA; Division of Public Health Pediatrics, Texas Children's Hospital, 6621 Fannin Street, MC A2275, Houston, TX, USA
| | - Cary M Cain
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, MC A2275, Houston, TX, 77030, USA; Division of Public Health Pediatrics, Texas Children's Hospital, 6621 Fannin Street, MC A2275, Houston, TX, USA
| | - Christopher S Greeley
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, MC A2275, Houston, TX, 77030, USA; Division of Public Health Pediatrics, Texas Children's Hospital, 6621 Fannin Street, MC A2275, Houston, TX, USA
| | - Lucy J Puryear
- Obstetrics and Gynecology, Menninger Department of Psychiatry, Baylor College of Medicine, 6651 Main Street, Houston, TX, 77030, USA
| | - Bethanie S Van Horne
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, MC A2275, Houston, TX, 77030, USA; Division of Public Health Pediatrics, Texas Children's Hospital, 6621 Fannin Street, MC A2275, Houston, TX, USA.
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Auger N, Low N, Lee GE, Ayoub A, Luu TM. Pregnancy Outcomes of Women Hospitalized for Physical Assault, Sexual Assault, and Intimate Partner Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP11135. [PMID: 33535860 DOI: 10.1177/0886260520985496] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Pregnancy outcomes of women with serious injuries due to violence receive limited attention. We examined the association of assault before and during pregnancy with maternal and infant outcomes at delivery. We performed a retrospective cohort study of 2,193,711 births in Quebec, Canada between 1989 and 2016. We identified women who were hospitalized for physical assault, sexual assault, and assault with documented intimate partner violence before and during pregnancy. We examined adverse outcomes at delivery, including preeclampsia, placental abruption, antepartum hemorrhage, stillbirth, preterm birth, low birthweight, and other disorders. In log-binomial regression models, we estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between violence hospitalization and adverse birth outcomes, adjusted for potential confounders. Compared with no exposure, violence before or during pregnancy was associated with the future risk of placental abruption (RR 1.49, 95% CI 1.23-1.82), antepartum hemorrhage (RR 1.43, 95% CI 1.19-1.71), stillbirth (RR 1.83, 95% CI 1.27-2.63), preterm birth (RR 1.70, 95% CI 1.54-1.87), and low birthweight (RR 1.78, 95% CI 1.58-2.00). Physical assault, sexual assault, and assault with documented intimate partner violence were all associated with adverse outcomes. The risk of adverse outcomes was elevated regardless of timing and number of violence admissions, although associations were stronger for women hospitalized twice or more. Physical assault, sexual assault, and intimate partner violence are important risk factors for adverse pregnancy outcomes. Screening for violence in women of childbearing age and closer follow-up during pregnancy may help improve birth outcomes.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
- University of Montreal, Montreal, Quebec, Canada
| | - Nancy Low
- McGill University, Montreal, Quebec, Canada
| | - Ga Eun Lee
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- University of Montreal, Montreal, Quebec, Canada
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Kurzeck AK, Dechantsreiter E, Wilkening A, Kumpf U, Nenov-Matt T, Padberg F, Palm U. Transcranial Direct Current Stimulation (tDCS) for Depression during Pregnancy: Results from an Open-Label Pilot Study. Brain Sci 2021; 11:brainsci11070947. [PMID: 34356180 PMCID: PMC8304475 DOI: 10.3390/brainsci11070947] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Depression is the most common morbidity during pregnancy. Available first-line therapy options are limited and depressive disorders in pregnant women are often untreated, leading to negative effects on maternal and fetal health. OBJECTIVES The aim of this open-label pilot study is to extend evidence on the use of transcranial direct current stimulation (tDCS) as a treatment of antenatal depression and to point out options for the use of tDCS in this population. METHODS Six drug-free female patients with major depressive disorder during pregnancy (later than 10th gestational week) were included in this pilot study. Patients were treated with twice-daily tDCS (2 mA, 30 min, anode: F3, cathode: F4) over ten days during inpatient stay (Phase 1) and with once-daily tDCS over 10 days during an optional outpatient stay (Phase 2). Clinical (HAMD-21, BDI) and neuropsychological ratings (Trail Making Test A/B) were performed at baseline, after two and four weeks as well as an obstetric examination. RESULTS Six right-handed females (23-43 years, 12-33. gestational week) completed Phase 1; four patients additionally joined in Phase 2. tDCS was well tolerated and no adverse effects occurred. Clinical ratings showed an improvement of mean baseline HAMD-21 from 22.50 ± 7.56 to 13.67 ± 3.93 after week 2, and to 8.75 ± 4.99 after week 4. The mean baseline BDI was 26.00 ± 13.90 and declined to 11.17 ± 5.46 after week 2, and to 9.25 ± 3.30 after week 4. CONCLUSIONS Statistically significant changes in HAMD-21 and BDI were observed after Phase 1. One patient achieved remission in terms of HAMD in Phase 1. Although this small-scale study lacks sham control, it shows clinical improvement and absence of adverse events in this critical population.
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Affiliation(s)
- Anna Katharina Kurzeck
- Department of Psychiatry, Hospital of the University of Munich, 80336 Munich, Germany; (A.K.K.); (E.D.); (A.W.); (U.K.); (T.N.-M.); (F.P.)
| | - Esther Dechantsreiter
- Department of Psychiatry, Hospital of the University of Munich, 80336 Munich, Germany; (A.K.K.); (E.D.); (A.W.); (U.K.); (T.N.-M.); (F.P.)
| | - Anja Wilkening
- Department of Psychiatry, Hospital of the University of Munich, 80336 Munich, Germany; (A.K.K.); (E.D.); (A.W.); (U.K.); (T.N.-M.); (F.P.)
| | - Ulrike Kumpf
- Department of Psychiatry, Hospital of the University of Munich, 80336 Munich, Germany; (A.K.K.); (E.D.); (A.W.); (U.K.); (T.N.-M.); (F.P.)
| | - Tabea Nenov-Matt
- Department of Psychiatry, Hospital of the University of Munich, 80336 Munich, Germany; (A.K.K.); (E.D.); (A.W.); (U.K.); (T.N.-M.); (F.P.)
| | - Frank Padberg
- Department of Psychiatry, Hospital of the University of Munich, 80336 Munich, Germany; (A.K.K.); (E.D.); (A.W.); (U.K.); (T.N.-M.); (F.P.)
| | - Ulrich Palm
- Department of Psychiatry, Hospital of the University of Munich, 80336 Munich, Germany; (A.K.K.); (E.D.); (A.W.); (U.K.); (T.N.-M.); (F.P.)
- Medical Park Chiemseeblick, Hospital for Psychosomatics, Rasthausstr. 25, 83233 Bernau-Felden, Germany
- Correspondence:
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The relationship between the prevalence of postpartum depression and anxiety, and depression levels in the mothers of premature, and term newborns admitted to a pediatric emergency department. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.892101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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11
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Snoring and depression symptoms in pregnant women. Sleep Health 2021; 7:155-160. [PMID: 33582047 DOI: 10.1016/j.sleh.2020.12.007] [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] [Received: 07/19/2019] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Pregnant patients are vulnerable to both depression and sleep-disordered breathing, and both convey risks for maternal and fetal outcomes. Previous research has indicated that sleep-disordered breathing is associated with depression, but further information related to the risk of depression based on timing of onset of snoring is needed. DESIGN When presenting to clinic for their initial prenatal visit, pregnant patients completed a packet of questionnaires, which included measures related to depression (Edinburgh Postnatal Depression Scale) and snoring. Habitual snoring was defined as snoring 3 or more nights per week. RESULTS In total, 1367 women were included and 34.1% reported habitual snoring, either chronic (24.4%) or pregnancy-onset (9.8%), with increased frequency of pregnancy-onset habitual snoring in later stages of pregnancy. Unadjusted analyses suggested increased odds of depressive symptoms in chronic and pregnancy-onset habitual snoring groups relative to nonsnorers (odds ratio [OR]: 2.01, 95% confidence interval [CI]: 1.39, 2.92, P < .01; OR: 2.50, 95% CI: 1.54, 4.07, P < .01, respectively). These findings were maintained after adjusting for maternal age, marital status, gestational age, and parity (chronic habitual snoring OR: 1.69, 95% CI: 1.14, 2.53, P < .01; pregnancy-onset habitual snoring OR: 2.79, 95% CI: 1.35, 5.78, P < .01). CONCLUSIONS Maternal snoring may be a risk factor for prenatal depressive symptoms. Pregnancy-onset habitual snoring confers additional risk for depression compared to not snoring during pregnancy.
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Achtyes E, Keaton SA, Smart L, Burmeister AR, Heilman PL, Krzyzanowski S, Nagalla M, Guillemin GJ, Escobar Galvis ML, Lim CK, Muzik M, Postolache T, Leach R, Brundin L. Inflammation and kynurenine pathway dysregulation in post-partum women with severe and suicidal depression. Brain Behav Immun 2020; 83:239-247. [PMID: 31698012 PMCID: PMC6906225 DOI: 10.1016/j.bbi.2019.10.017] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/19/2019] [Accepted: 10/23/2019] [Indexed: 01/08/2023] Open
Abstract
Depression during pregnancy and the post-partum is common, with severe cases resulting in suicidal behavior. Despite the urgent and unmet medical need, the biological underpinnings of peri-partum depression remain unclear. It has been suggested that it is triggered by dynamic changes of the immune system during pregnancy and at delivery. Therefore, we investigated whether a pro-inflammatory status in plasma, together with changes in the kynurenine pathway activity, is associated with the development of severe depression and suicidal behavior in the post-partum. Our cross-sectional study targets a unique, understudied population in which the pronounced severity of symptoms required hospitalization. We analyzed plasma IL-1β, IL-2, IL-6, IL-8, TNF-α, tryptophan, serotonin, kynurenine, nicotinamide, quinolinic- and kynurenic acids in post-partum women diagnosed with peripartum onset depression (PPD) and healthy controls (n = 165). We assessed depression severity using the Edinburgh Postnatal Depression Scale and suicidality using the Columbia-Suicide Severity Rating Scale. We found that increased plasma IL-6 and IL-8 and reductions of serotonin, IL-2 and quinolinic acid were associated with the severity of depressive symptoms and increased the risk for PPD. Moreover, women with lower serotonin levels were at an increased risk for suicidal behavior, even when adjusting for depression severity, psychosocial factors, age BMI, and medication. Our results indicate that severe depression in the post-partum involves dysregulation of the immune response and the kynurenine pathway, with a concomitant reduction in serotonin levels. We propose that inflammatory cytokines and the kynurenine pathway are potential treatment targets in PPD, opening up the possibility of novel therapeutic strategies targeting the peripartum.
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Affiliation(s)
- Eric Achtyes
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA,Division of Psychiatry & Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Sarah A. Keaton
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI USA,Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - LeAnn Smart
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Amanda R. Burmeister
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI USA
| | - Patrick L. Heilman
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI USA
| | - Stanislaw Krzyzanowski
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI USA
| | - Madhavi Nagalla
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA,Division of Psychiatry & Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Gilles J. Guillemin
- Neuroinflammation Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | - Chai K. Lim
- Neuroinflammation Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Maria Muzik
- Department of Psychiatry, University of Michigan-Michigan Medicine, Ann Arbor, MI, USA
| | - Teodor Postolache
- Department of Psychiatry, University of Maryland Baltimore School of Medicine, Baltimore, MD, USA,Rocky Mountain MIRECC for Suicide Prevention, Aurora, CO, USA
| | - Richard Leach
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA,Department of Obstetrics, Gynecology and Women’s Health, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Lena Brundin
- Division of Psychiatry & Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA.
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Abstract
Brexanolone (ZULRESSO™) is an intravenously administered, small molecule, neuroactive steroid GABAA receptor positive allosteric modulator that was developed by Sage Therapeutics under license to the University of California for the treatment of postpartum depression (PPD). The formulation is a mixture of allopregnanolone, an endogenous inhibitory pregnane neurosteroid, and sulfobutylether-beta-cyclodextrin (a solubilizing agent). In mid-March 2019 brexanolone received its first global approval in the USA for the treatment of PPD in adult women. This article summarizes the milestones in the development of brexanolone leading to its first approval for the treatment of adult women with PPD.
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Affiliation(s)
- Lesley J Scott
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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A practical guide to the use of psychotropic medications during pregnancy and lactation. Arch Psychiatr Nurs 2019; 33:254-266. [PMID: 31227078 DOI: 10.1016/j.apnu.2019.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022]
Abstract
The use of psychotropic medications during the perinatal period is often met with fear and discomfort on the part of both clinicians and patients. There is a great deal of misinformation about the risks of medication use during pregnancy and lactation. The risk of untreated or undertreated mental illness during this time is an important consideration when making treatment recommendations. This paper serves as a practical guide for clinicians who may be treating patients with psychotropic medication during the perinatal period. A heuristic tool for making treatment decisions will be introduced, and coverage of specific psychiatric disorders and medication classes will be provided.
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Abstract
To counsel women about risks and benefits of depression treatment during pregnancy, clinicians must appreciate the potential consequences of untreated depression on the mother and her unborn child. Many studies have demonstrated associations between untreated depression during pregnancy and a range of adverse outcomes, including low birth weight, preterm delivery, preeclampsia, emergent operative delivery, postpartum depression, and both cognitive and behavioral deficits in the child. Although most of these associations are marked by low odds ratios and a host of potential confounding issues, they collectively provide considerable rationale for identifying depression in pregnancy and offering treatment for mothers at risk.
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Postpartum depression and resilience predict parenting sense of competence in women with childhood maltreatment history. Arch Womens Ment Health 2018; 21:777-784. [PMID: 29860623 PMCID: PMC6240379 DOI: 10.1007/s00737-018-0865-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/17/2018] [Indexed: 10/14/2022]
Abstract
This study examines the effect of a history of childhood maltreatment (CM) on parenting sense of competence, taking into account the influence of resilience and postpartum depressive symptoms as moderators of this relationship. Participants (N = 131) were a community sample of women recruited into a larger study of maternal childhood maltreatment. Women completed questionnaires over the phone at 4 months postpartum and parenting sense of competence (PSOC) was assessed during a home visit at 6 months postpartum. A three-way interaction emerged; women with low depression and high resilience factors maintained high levels of PSOC, even when they had a CM history. In contrast, among women with one postpartum risk factor (depression or low resilience) CM was associated with decreased PSOC. Results suggest that a mother's well-being postpartum moderates the effect of a childhood maltreatment history on her parenting sense of competence. Reducing postpartum depressive symptoms and enhancing resilience may be important components for interventions that address parenting confidence with maltreated women.
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Büyük B, Yüncü M, Eralp A, İnalöz demir S. Gebe sıçanlarda kantaron otunun fetüse etkisi. FAMILY PRACTICE AND PALLIATIVE CARE 2018. [DOI: 10.22391/fppc.406844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Transcranial Direct Current Stimulation (tDCS) for Depression during Pregnancy: Scientific Evidence and What Is Being Said in the Media-A Systematic Review. Brain Sci 2018; 8:brainsci8080155. [PMID: 30110930 PMCID: PMC6119899 DOI: 10.3390/brainsci8080155] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/08/2018] [Accepted: 08/11/2018] [Indexed: 12/19/2022] Open
Abstract
Major depression is the most frequent morbidity in pregnancy. The first-line therapies, psychopharmacologic treatment and psychotherapy, are either insufficient or may cause severe or teratogenic adverse events. As a result of its local limitation to the patient’s brain, transcranial direct current stimulation (tDCS) could potentially be an ideal treatment for pregnant women with depression. A literature search was conducted in medical databases, globally published newspapers, search engines, and clinical trial registers to collect all articles on tDCS for the treatment of depression during pregnancy. The aim of this review was to investigate the scientific evidence of tDCS use for depression during pregnancy and to compare these results with the textual and emotional perception in the media as interventions during pregnancy are under particular surveillance. We detected 13 medical articles dealing with tDCS for depression in pregnancy. Overall, the scientific evidence as well as articles in the media for tDCS in pregnancy are sparse, but promising. Further studies are required in this specifically vulnerable population of pregnant women to generate evidence. It is likely that public interest will increase when the results of a pilot study in Canada are published.
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Szpunar MJ, Parry BL. A systematic review of cortisol, thyroid-stimulating hormone, and prolactin in peripartum women with major depression. Arch Womens Ment Health 2018; 21:149-161. [PMID: 29022126 PMCID: PMC5857206 DOI: 10.1007/s00737-017-0787-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/04/2017] [Indexed: 01/07/2023]
Abstract
Pregnancy and postpartum are periods of high susceptibility to major depression (MD) and other mood disorders. The peripartum period is also a time of considerable changes in the levels of hormones, including cortisol, thyroid-stimulating hormone (TSH), prolactin, gonadotropins, and gonadal steroids. To investigate the relationship between mood and hormonal changes during and after pregnancy, we reviewed published reports of hormonal measures during this time frame, searched via PubMed and Web of Science. Studies were included if women in the antepartum or postpartum periods were clinically diagnosed with MD, and if there were repeated measures of cortisol, TSH, or prolactin. For these three hormones, the numbers of human studies that met these criteria were 15, 7, and 3, respectively. Convergent findings suggest that morning cortisol is reduced in pregnant and postpartum women with MD. Evidence did not support changes in TSH as a marker of MD during the peripartum period, and evidence for changes in prolactin in peripartum MD was equivocal. Aside from reduced morning cortisol in peripartum women with MD, definitive evidence for an association between specific hormonal fluctuations and mood disorders in the peripartum period remains elusive.
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Affiliation(s)
- Mercedes J Szpunar
- UC San Diego Department of Psychiatry, La Jolla, CA, 92093, USA.
- Department of Psychiatry, UC San Diego School of Medicine, 9500 Gilman Dr., #9116A, La Jolla, CA, 92093, USA.
| | - Barbara L Parry
- UC San Diego Department of Psychiatry, La Jolla, CA, 92093, USA
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Polansky M, Singh H, Gao Y, Aaron E. Pregnancy planning, timing, happiness and depressive symptoms among low-income women living with and without HIV. J Reprod Infant Psychol 2018; 36:222-234. [PMID: 29562754 DOI: 10.1080/02646838.2018.1448373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study assessed associations of sociodemographic factors and pregnancy intent and wantedness with pregnancy happiness and prenatal depressive symptoms and the relationship between prenatal depressive symptoms and pregnancy happiness. BACKGROUND Depression is the leading cause of disability world-wide and more so for women. Women are most likely to experience depression in their child bearing years, including during pregnancy. Untreated prenatal depression, associated with unwanted pregnancies endangers the health and wellbeing of the mother and her child. Research on the association of prenatal depression with pregnancy happiness among women with low incomes in the U.S.A. is limited. For women living with HIV, associations among family planning factors, pregnancy feelings and prenatal depression have been understudied. METHODS Sixty-four women living with HIV and 194 HIV-negative low-income pregnant women receiving care in a public university-based ob-gyn clinic with integrated HIV-care in Philadelphia between 2009 and 2012 participated in the study. The women completed a questionnaire on sociodemographic and pregnancy factors and the Center for Epidemiological Studies Depression Scale (CES-D). The independent associations of sociodemographic and pregnancy factors with pregnancy happiness and associations of these factors and pregnancy happiness with the CES-D were assessed using multivariable linear regressions. RESULTS Women who felt the pregnancy was too soon were less happy being pregnant (p < 0.01). Prenatal depressive symptoms were inversely associated with happiness with being pregnant and completing high school (p < 0.001 for both). CONCLUSION Health care professionals need to provide reproductive counselling and mental health for prenatal depression should explore feelings about being pregnant and being a mother.
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Affiliation(s)
- Marcia Polansky
- a Department of Epidemiology & Biostatistics , Dornsife School of Public Health, Drexel University , Philadelphia , USA
| | - Hardeep Singh
- b Division of Infectious Diseases & HIV Medicine , Drexel University College of Medicine , Philadelphia , USA
| | - Yang Gao
- a Department of Epidemiology & Biostatistics , Dornsife School of Public Health, Drexel University , Philadelphia , USA
| | - Erika Aaron
- b Division of Infectious Diseases & HIV Medicine , Drexel University College of Medicine , Philadelphia , USA
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Antenatal depressive symptoms in Jamaica associated with limited perceived partner and other social support: A cross-sectional study. PLoS One 2018; 13:e0194338. [PMID: 29554107 PMCID: PMC5858785 DOI: 10.1371/journal.pone.0194338] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 03/01/2018] [Indexed: 11/30/2022] Open
Abstract
Background Antenatal depression is associated with adverse maternal and infant well-being. However, compared to postpartum depression, it has been less frequently explored globally or in Jamaica. This study aimed to determine the prevalence of, and factors associated with, antenatal depressive symptoms among Jamaican women in order to inform policy and build interventions that could improve their management and reduce their negative consequences. Methods This secondary analysis of data from the second Jamaican Birth Cohort Study (JA-Kids Birth Cohort) included 3,517 women enrolled during pregnancy. Information was extracted from interviewer-administered questionnaires which recorded social, demographic, medical and obstetric information during pregnancy. The Edinburgh Postnatal Depression scale (EPDS) was used to screen for depression, with scores ≥13 considered indicative of a high likelihood of depression. Bivariate analysis examined associations between depressive symptoms and: age, income, financial difficulties, perceived social support, perceived partner infidelity, previous child-bearing unions and children with the current partner. Obstetric factors were also explored and included gravidity, prior adverse pregnancy outcome and complications from previous pregnancies. Variables that predicted the likelihood of depression based on an EPDS cut score of 13 were evaluated using logistic regression. Results One in five participants (19.6%; 95% CI 18.3–20.9%) had a high likelihood of antenatal depression (EPDS ≥13). Significant predictors of high depressive symptom severity included four indicators of poor perceived social and partner support [ORs (95% CI) ranged from: 1.61 (1.07–2.43); p = 0.024 to 3.14(1.69–5.84); p< 0.001], perceived partner infidelity [1.86 (1.36, 2.54); p<0.001], exposure to violence [2.36 (1.66–3.38); p<0.001] and financial difficulties [1.39 (1.07, 1.80); p = 0.013]. Conclusions Women’s perceived social and partner support were strongly associated with depressive symptom severity. Within the Jamaican cultural context of unstable reproductive unions, efforts are needed to involve fathers in the antenatal care process to strategically improve the psychological well-being of new mothers which may positively influence long term developmental outcomes for their babies.
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Can exercise or physical activity help improve postnatal depression and weight loss? A systematic review. Arch Womens Ment Health 2017; 20:595-611. [PMID: 28702773 DOI: 10.1007/s00737-017-0750-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 06/16/2017] [Indexed: 01/29/2023]
Abstract
Despite exercise or physical activity (PA) being effective on depression and weight management generally, its effectiveness remains uncertain during postpartum. This systematic review aimed to determine the efficacy of exercise or PA interventions on postnatal depression (PND) and weight loss, with a subsequent aim to identify more effective intervention approaches. Using PRISMA guidelines, data searches conducted across six databases. Nine studies fulfilled our inclusion criteria. Based on identified studies (some with high-quality RCT designs), there was inconsistency as to whether exercise or PA simultaneously reduced PND symptoms and assisted weight loss (or related body composition indices). Two (22.2%) identified changes in both outcomes with small effect sizes. Four studies (44.4%) reported changes in one outcome, typically PND with variable effect sizes, while three studies (33.3%) reported no effect. Studies implemented different exercise/PA modalities (commonly walking) and incorporated various support strategies to assist intervention participation and adherence. Studies identified as most likely to associate with PND and/or weight loss changes were those with supervision (1-1, group), structure (weekly frequency, scheduled durations and moderate intensity), which adhered to specific exercise/PA guidelines over an extended postpartum period (e.g. 12 weeks +) and were supplemented by several psycho-social support strategies (e.g. educational information, exercise/PA advice, and counselling). Future studies need to carefully address prior study methodological weaknesses (e.g. study design, inclusion criteria, measurement, reporting, assessing confounding factors), further examine proposed more beneficial exercise/PA intervention approaches, and consider how exercise/PA could be best delivered in practice to benefit women's postpartum health.
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Evans EC, Deutsch NL, Drake E, Bullock L. Nurse-Patient Interaction as a Treatment for Antepartum Depression: A Mixed-Methods Analysis [Formula: see text]. J Am Psychiatr Nurses Assoc 2017; 23:347-359. [PMID: 28459182 DOI: 10.1177/1078390317705449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The U.S. Preventative Services Task Force guidelines recommend pregnant women be screened for depression and adequate systems be in place to treat this condition. OBJECTIVE This study examines a nurse-delivered telephone support intervention provided to low-income, pregnant women living in rural settings. DESIGN This study had a complementary mixed-methods design, using secondary data. Peplau's theory of interpersonal relations was used as a framework to guide the study. RESULTS The phases of Peplau's theory of interpersonal relations were evident in the interactions. Underserved women at high risk for depression appreciated this type of support, with the women at highest risk for depression utilizing more of the nursing support provided. On average, Mental Health Index-5 scores improved from 45 to 66. CONCLUSION A nurse-delivered telephone support intervention, modeled around Peplau's theory of interpersonal relations, may be an effective way of providing support to underserved women and has the potential to treat or offset antepartum depression.
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Affiliation(s)
- Emily C Evans
- 1 Emily C. Evans, PhD, NP, RN, University of Virginia, Charlottesville, VA, USA
| | - Nancy L Deutsch
- 2 Nancy L. Deutsch, PhD, University of Virginia, Charlottesville, VA, USA
| | - Emily Drake
- 3 Emily Drake, PhD, RN, CNL, FAAN, University of Virginia, Charlottesville, VA, USA
| | - Linda Bullock
- 4 Linda Bullock, PhD, RN, FAAN, University of Virginia, Charlottesville, VA, USA
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Sreeraj VS, Bose A, Shanbhag V, Narayanaswamy JC, Venkatasubramanian G, Benegal V. Monotherapy With tDCS for Treatment of Depressive Episode During Pregnancy: A Case Report. Brain Stimul 2016; 9:457-458. [DOI: 10.1016/j.brs.2016.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 03/05/2016] [Accepted: 03/07/2016] [Indexed: 11/27/2022] Open
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Aktas S, Yesilcicek Calik K. Factors Affecting Depression During Pregnancy and the Correlation Between Social Support and Pregnancy Depression. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e16640. [PMID: 26473071 PMCID: PMC4601205 DOI: 10.5812/ircmj.16640] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 11/25/2014] [Accepted: 01/28/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women are seriously subjected to psychiatric diseases during pregnancy and depression is the most prevailing one among these diseases. There is a relation between the social support and depression in pregnancy whose predisposing factors are genetic, psychological, biological, environmental, and hormonal. OBJECTIVES This study aimed to determine the frequency of depression symptoms, and its risk factors. Also it studied the correlation between social support and pregnancy depression. PATIENTS AND METHODS This research is a descriptive cross-sectional study. It was conducted on 266 pregnant women selected by simple random method from all pregnant women admitted at the Maternity Hospital of Trabzon, Turkey from May 21 to June 13, 2008. The data were collected with a questionnaire form, the Beck depression inventory (BDI), and the multidimensional scale of perceived social support (MSPSS). RESULTS The mean BDI score of the pregnant women was 11.12 ± 6.65. According to the BDI, 46.2% of the pregnant women had no depression symptoms, 34.59% of them had mild, 13.91% had moderate, and 4.89% had severe level of depression symptoms. It was found that such factors as the educational level of the pregnant women and their husbands, having an undesired pregnancy, suffering from a chronic disease before pregnancy, presence of pregnancy-related problems, having a child with disability or having relatives whose children had disability, and smoking during pregnancy were the risk factors affecting the severity of the depression symptoms and these results were statistically significant (P < 0.05). On the other hand, the mean MSPSS score was 67.89 ± 14.26 and it was found that the pregnant women got the highest social support from their husbands. It was found that there was a significant correlation between BDI and MSPSS total score and its subscale scores (P < 0.05). CONCLUSIONS According to this study, one-fifth of pregnant women were found to experience depressive symptoms, which require treatment during pregnancy, and the factors such as having no support from relatives was found to be associated with the severity of depressive symptoms during pregnancy.
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Affiliation(s)
- Songul Aktas
- Obstetrics and Gynecology Nursing Department, Faculty of Health Science, Karadeniz Technical University, Trabzon, Turkey
| | - Kiymet Yesilcicek Calik
- Obstetrics and Gynecology Nursing Department, Faculty of Health Science, Karadeniz Technical University, Trabzon, Turkey
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Çapik A, Pasinlioglu T. Validity and reliability study of the Tilburg Pregnancy Distress Scale into Turkish. J Psychiatr Ment Health Nurs 2015; 22:260-9. [PMID: 25912270 DOI: 10.1111/jpm.12211] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/29/2022]
Abstract
This study was conducted to adapt the Tilburg Pregnancy Distress Scale (TPDS) into Turkish and test its validity and reliability. The study was conducted in six Family Health Center regions in the province of Kars between 20 February and 10 April 2013. A total of 275 pregnant women, who met the study criteria and agreed to participate in the study, constituted the sample group of the study. For validity and reliability analysis of the scale, content validity analysis, explanatory and confirmatory factor analysis, and Cronbach's alpha coefficient were used. It was found that the two-factor structure of the scale was valid and its fit indices were appropriate. The total Cronbach's alpha coefficient of the scale was 0.83. The cut-off point of the scale was specified as 28 for its total score. As a consequence, the adaptation of the TPDS into Turkish was determined to be a valid and reliable measurement instrument. Assessment of distress levels of pregnant women constitutes an important area for both midwives and mental health nursing.
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Affiliation(s)
- A Çapik
- Faculty of Health Sciences, Department of Midwifery, Atatürk University, Erzurum, Turkey
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Sabri Y, Nabel H. The impact of anxiety and depression during pregnancy on fetal growth and the birth outcome. ACTA ACUST UNITED AC 2015. [DOI: 10.4103/1110-1105.158117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Quispel C, Bangma M, Kazemier BM, Steegers EA, Hoogendijk WJ, Papatsonis DN, Paarlberg KM, Lambregtse-Van Den Berg MP, Bonsel GJ. The role of depressive symptoms in the pathway of demographic and psychosocial risks to preterm birth and small for gestational age. Midwifery 2014; 30:919-25. [DOI: 10.1016/j.midw.2014.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/24/2014] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
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Hanley GE, Mintzes B. Patterns of psychotropic medicine use in pregnancy in the United States from 2006 to 2011 among women with private insurance. BMC Pregnancy Childbirth 2014; 14:242. [PMID: 25048574 PMCID: PMC4223368 DOI: 10.1186/1471-2393-14-242] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/08/2014] [Indexed: 02/01/2023] Open
Abstract
Background Psychiatric disorders are equally common during pregnancy as among non-pregnant women, and many of these conditions are treated with psychotropic medicines. Relatively little is known about patterns of use of many these agents during pregnancy, and specifically of how rates may have shifted during the last decade. We aimed to quantify the rate of pregnancy related exposures to categories of psychotropic medicines stratified according to the primary indication for use (antidepressants, antipsychotics, anxiolytics, and psychostimulants), trimester of pregnancy, trends over time and region, and indication for use. Methods We conducted a retrospective cohort study of pregnancies among women in the Truven Health MarketScan database (source population 70 million Americans), which captures person-specific clinical use and includes detailed information on filled prescriptions, hospitalizations and outpatient visits for all privately insured employees and their dependents. We classified psychotropic medicines of interest using ATC level 3 accordingly: antipsychotics (N05A); anxiolytics (N05B); antidepressants (N06A); psychostimulants, agents used for ADHD and cognitive enhancement (N06B). We also examined temporal and regional trends in use. Results We included 343,299 women who had a live birth between Jan 1, 2006 and Dec 31, 2011, of whom 10.3% were dispensed one or more psychotropic medicines during pregnancy. This rate varied from 6% to 15% between states. The rate of use of psychotropic medicines was relatively stable between 2006 and 2011. The most commonly used psychotropic medicines were selective serotonin reuptake inhibitors (5.1%) and benzodiazepine or benzodiazepine-like medicines (3.9%). Among psychotropic users, the most commonly associated psychiatric diagnosis was depression (25.0%), followed by anxiety disorders (24.4%). Approximately 1.6% of women used more than one category of psychotropic medicine in pregnancy, most commonly an antidepressant and an anxiolytic medicine (1.2%). Conclusions Given this relatively high rate of use, the lack of evidence that the most frequently used medications improve birth outcomes and the safety concerns associated with both early and late pregnancy use for many frequently-used medications, there is a need for further study of factors driving psychotropic medication use during pregnancy.
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Affiliation(s)
| | - Barbara Mintzes
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
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Neuman G, Colantonio D, Delaney S, Szynkaruk M, Ito S. Bupropion and Escitalopram During Lactation. Ann Pharmacother 2014; 48:928-931. [DOI: 10.1177/1060028014529548] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To report a case of seizure-like symptoms in an infant exposed to bupropion and escitalopram through breastfeeding. Case Summary: A 6.5-month-old female infant, breastfed by a mother treated with bupropion XL 150 mg/d and escitalopram 10 mg/d for depression, presented to our hospital with severe emesis and tonic seizure-like symptoms. The symptoms resolved with supportive therapy. Urine toxicology screen in the infant revealed bupropion and escitalopram. Bupropion, and its active metabolite, hydroxybupropion, were analyzed and quantified both in the infant’s serum and in the breast milk. Diagnostic workup for seizure etiologies was otherwise negative. After being asymptomatic for 48 hours, her discharge diagnosis was adverse events associated with bupropion and escitalopram in lactation. An objective causality assessment (Naranjo assessment) revealed that this adverse effect was probable. Discussion: The adverse events in our case were associated with serum concentrations of bupropion and hydroxybupropion that are lower than the reported therapeutic range, perhaps suggesting that infants, compared with adults, may have a higher susceptibility to the epileptogenic effects of bupropion and/or hydroxybupropion. Furthermore, although we do not have escitalopram serum concentrations, this drug interaction may have had a contributing role in this case, possibly because of cytochrome P4502D6 inhibition by bupropion and metabolites. Conclusion: As the number of reproductive-aged women requiring polytherapy to control their depression is increasing, further research is needed to establish the safety of combined antidepressants, such as selective serotonin reuptake inhibitors and bupropion, during lactation.
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Affiliation(s)
- Gal Neuman
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | - Shinya Ito
- The Hospital for Sick Children, Toronto, ON, Canada
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Jonas W, Mileva-Seitz V, Girard AW, Bisceglia R, Kennedy JL, Sokolowski M, Meaney MJ, Fleming AS, Steiner M. Genetic variation in oxytocin rs2740210 and early adversity associated with postpartum depression and breastfeeding duration. GENES BRAIN AND BEHAVIOR 2013; 12:681-94. [PMID: 23941164 DOI: 10.1111/gbb.12069] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/17/2013] [Accepted: 08/06/2013] [Indexed: 12/11/2022]
Abstract
Mothers vary in duration of breastfeeding. These individual differences are related to a variety of demographic and individual maternal factors including maternal hormones, mood and early experiences. However, little is known about the role of genetic factors. We studied single-nucleotide polymorphisms (SNPs) in the OXT peptide gene (rs2740210; rs4813627) and the OXT receptor gene (OXTR rs237885) in two samples of mothers from the Maternal adversity, Vulnerability and Neurodevelopment study (MAVAN), a multicenter (Hamilton and Montreal, Canada) study following mothers and their children from pregnancy until 7 years of age. Data from the Hamilton site was the primary sample (n = 201) and data from Montreal was the replication sample (n = 151). Breastfeeding duration, maternal mood (measured by the CES-D scale) and early life adversity (measured by the CTQ scale) were established during 12 months postpartum. In our primary sample, polymorphisms in OXT rs2740210, but not the other SNPs, interacted with early life adversity to predict variation in breastfeeding duration (overall F8,125 = 2.361, P = 0.021; interaction effect b = -8.12, t = -2.3, P = 0.023) and depression (overall F8,118 = 5.751, P ≤ 0.001; interaction effect b = 6.06, t = 3.13, P = 0.002). A moderated mediation model showed that higher levels of depression mediated the inverse relation of high levels of early life adversity to breastfeeding duration, but only in women possessing the CC genotype [effect a' = -3.3401, 95% confidence interval (CI) = -7.9466 to -0.0015] of the OXT SNP and not in women with the AA/AC genotype (a' = -1.2942, ns). The latter findings (moderated mediation model) were replicated in our Montreal sample (a' = -0.277, 95% CI = -0.7987 to -0.0348 for CC; a' = -0.1820, ns for AA/AC).
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Affiliation(s)
- W Jonas
- Department of Psychology, University of Toronto, Toronto, Canada; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Gordon AL, Mikocka-Walus A, Grzeskowiak LE, Jayasekara RS. Antidepressants for depression during pregnancy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Andrea L Gordon
- School of Pharmacy and Medical Sciences; University of South Australia; Adelaide Australia
| | | | - Luke E Grzeskowiak
- School of Pharmacy and Medical Sciences; University of South Australia; Adelaide Australia
| | - Rasika S Jayasekara
- School of Nursing and Midwifery; University of South Australia; Adelaide Australia
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O'Brien LM, Owusu JT, Swanson LM. Habitual snoring and depressive symptoms during pregnancy. BMC Pregnancy Childbirth 2013; 13:113. [PMID: 23679132 PMCID: PMC3660222 DOI: 10.1186/1471-2393-13-113] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/13/2013] [Indexed: 01/02/2023] Open
Abstract
Background Depression is frequently observed in patients with untreated sleep-disordered breathing (SDB) in the general population. Pregnant women are particularly vulnerable since pregnancy increases the risk of both SDB and depressive symptoms. However, no study has investigated whether SDB symptoms prior to or in early pregnancy are associated with such mood problems. Methods A retrospective chart review of pregnant women. Women were included if they attended prenatal clinics between June 2007 and July 2010, were ≥18 years old, pregnant with a single fetus, and had been screened for habitual snoring as well as depressive symptoms using the Edinburgh Postnatal Depression Scales (EPDS). Results In total, 362 women were included and 32.3% reported habitual snoring. Twenty-nine percent of women had an EPDS score ≥10. Significantly more snoring women, compared to non-snorers, had an EPDS score ≥10 (42.7% vs. 22.9%, p < 0.001) despite the mean EPDS values not reaching statistical significance (6.1 ± 4.9 vs. 5.4 ± 5.0, p = 0.2). In a logistic regression model controlling for parity, the presence of pre-pregnancy obesity, presence of a partner, sleep quality, African American race, maternal educational level, pre-eclampsia, and diabetes, snoring was independently associated with a prenatal EPDS score ≥10 (O.R. 2.0, 95%CI 1.13-3.46; p = 0.023). Conclusion Maternal snoring may be a risk factor for prenatal depressive symptoms. Further investigation of the temporal relationship between maternal snoring and depressive symptoms is warranted.
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Maloni JA, Przeworski A, Damato EG. Web recruitment and internet use and preferences reported by women with postpartum depression after pregnancy complications. Arch Psychiatr Nurs 2013; 27:90-5. [PMID: 23540519 DOI: 10.1016/j.apnu.2012.12.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 10/26/2012] [Accepted: 12/05/2012] [Indexed: 11/29/2022]
Abstract
Nearly one million women each year have pregnancy complications that cause antepartum and postpartum anxiety and depression. This exploratory study determined 1) feasibility of using social media to recruit women with depressive symptoms following high risk pregnancy, 2) women's barriers to treatment, 3) use of online resources for assistance with PPD, and 4) preferences for internet treatment. Among a national sample of 53 women, nearly 70% had major depression. Common barriers were lack of time and stigma. Over 90% of women would use the internet to learn coping strategies for PPD. Women expressed interest in web-based PPD treatment and identified desired characteristics of an intervention.
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Affiliation(s)
- Judith A Maloni
- Case Western Reserve University Bolton School of Nursing, Cleveland, OH, USA.
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Evans EC, Bullock LFC. Optimism and other psychosocial influences on antenatal depression: a systematic review. Nurs Health Sci 2012; 14:352-61. [PMID: 22762538 DOI: 10.1111/j.1442-2018.2012.00700.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Antenatal depression is a debilitating experience for many women with significant personal and familial sequelae. Low-income pregnant women living in rural settings are especially vulnerable because of isolation, decreased resources, and stressful living environments. This systematic review summarizes what is known about antenatal depression and synthesizes the evidence regarding the role psychosocial variables could play in the development of safe, effective, and culturally-acceptable non-pharmacological interventions. Searches of the CINAHL, MEDLINE, PSYCHINFO, and ERIC databases, as well as the Cochrane Library, were conducted in September 2010 to identify articles relevant to our topic of study. Psychosocial variables have a significant association with antenatal depression. Optimism has been shown to be inversely correlated with depression, and directly correlated with improved birth outcomes. Optimism is a potentially modifiable variable that could be used to design antenatal prevention and treatment programs. As depression continues to increase in prevalence, and treatment options for pregnant women remain limited, effective interventions must be developed that address the psychosocial variables examined in this review.
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Affiliation(s)
- Emily C Evans
- School of Nursing, University of Virginia, Charlottesville, Virginia 22908-0826, USA.
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Walfisch A, Sermer C, Matok I, Einarson A, Koren G. Perception of teratogenic risk and the rated likelihood of pregnancy termination: association with maternal depression. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:761-7. [PMID: 22152645 DOI: 10.1177/070674371105601208] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Women are often exposed to various medications and medical conditions during pregnancy. Unrealistically high maternal teratogenic risk perception, related to these exposures, may lead to abrupt discontinuation of therapy and (or) termination of a wanted pregnancy. The association between maternal depression and the teratogenic risk perception has not been studied, nor were the actions resulting from this perception. Our objectives were to explore the association between maternal depression, teratogenic risk perception, and the rated likelihood to terminate pregnancy. Additionally, we evaluated possible benefits of counselling. METHODS We administered the Edinburgh Postnatal Depression Scale (EPDS) to all women who attended the Motherisk Clinic between October 2007 and April 2010. A visual analogue scale was used to determine maternal risk perception in relation to the specific exposure, and the rated likelihood to terminate the pregnancy, before and after counselling. RESULTS We analyzed data from 413 women. Maternal teratogenic risk perception and the rated likelihood to terminate the pregnancy were significantly lower following counselling. An EPDS score of 13 or more was significantly associated with a higher rated likelihood to terminate the pregnancy (P = 0.03). In a multivariable regression analysis, an EPDS score of 13 or more was found to be an independent predictor of a higher personal teratogenic risk perception (P = 0.03). CONCLUSIONS Both maternal depression and exposure-directed counselling are associated with maternal risk perception and the rated likelihood to terminate pregnancy. Appropriate counselling may reduce fear of teratogenicity and the likelihood of pregnancy termination.
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Affiliation(s)
- Asnat Walfisch
- The Motherisk Program, The Hospital for Sick Children, Toronto, Ontario
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Sexton MB, Flynn HA, Lancaster C, Marcus SM, McDonough SC, Volling BL, Lopez JF, Kaciroti N, Vazquez DM. Predictors of recovery from prenatal depressive symptoms from pregnancy through postpartum. J Womens Health (Larchmt) 2011; 21:43-9. [PMID: 22060255 DOI: 10.1089/jwh.2010.2266] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Identifying predictors of the course of depressive symptoms from pregnancy through postpartum is important to inform clinical interventions. METHODS This longitudinal study investigated predictors of recovery from prenatal elevated depressive symptoms in the postpartum period. Forty-one pregnant women completed demographic, interpersonal, and psychosocial self-report assessment measures at 32 weeks of gestation and again 12 weeks postpartum. RESULTS Of those with elevated depressive symptoms, defined as a Beck Depression Inventory-II (BDI-II) score ≥10, at the prenatal baseline, 39% (n=16) recovered to nonelevated symptom levels postpartum, whereas 61% (n=25) experienced sustained elevated symptoms. Women who recovered evidenced significantly lower baseline depression severity and more frequent engagement in physical activity and cohabitated with a romantic partner. In multiparous women (n=25), history of past postpartum depression (PPD) differentiated between those with transient and those with persisting symptoms, although history of lifetime depression did not. None of the additional demographic, interpersonal, or psychosocial variables investigated differentiated between groups. Logistic regression analysis showed prenatal depression severity and exercise frequency as predictors of recovery postpartum. CONCLUSIONS Results suggest most women will not experience spontaneous recovery. Women with prenatal heightened symptom severity and previous experiences with PPD are acutely vulnerable to experience sustained symptoms. In contrast, having a cohabitating partner and engagement in prenatal exercise predicted symptom improvement. Physical exercise may be an important clinical recommendation, as it may improve mood. Given the small sample size, these results are preliminary. Implications and future research recommendations are discussed.
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Affiliation(s)
- Minden B Sexton
- Psychiatry Department, University of Michigan, Ann Arbor, Michigan, USA.
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Walfisch A, Matok I, Sermer C, Koren G. Weight-depression association in a high-risk maternal population. J Matern Fetal Neonatal Med 2011; 25:1017-20. [PMID: 21854131 DOI: 10.3109/14767058.2011.614653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Both maternal depression and overweight carry potential adverse effects on perinatal health and are inter-related. We explored the relationship between weight and depressive symptoms in a high-risk maternal population. METHODS We administered the Edinburgh Postnatal Depression Scale (EPDS) to all women attending the Motherisk Clinic at The Hospital for Sick Children between October 2007 and April 2010. We explored possible associations between the EPDS scores, maternal weight and other characteristics. RESULTS The study population consisted of 352 women, 43.7% of whom were pregnant, with a variety of exposures. Twenty seven percent of the study population had diagnosed depression. Depressed women had a significantly higher body weight compared to non-depressed women (p = 0.016). The same finding remained significant in the pregnant sub-group. The EPDS score, for the entire study population, was significantly correlated with body weight (p = 0.027). Use of antidepressants was an independent predictor of maternal weight in a multivariate regression analysis. CONCLUSIONS There is a strong association between maternal weight and depressive symptoms, whether diagnosed or not. Antidepressant therapy is an independent predictor of maternal weight. Since both depression and maternal overweight may adversely affect pregnancy outcome, and are treatable, addressing both is essential for optimal pregnancy management.
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Affiliation(s)
- Asnat Walfisch
- The Motherisk Program, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Goodman JH, Santangelo G. Group treatment for postpartum depression: a systematic review. Arch Womens Ment Health 2011; 14:277-93. [PMID: 21720793 DOI: 10.1007/s00737-011-0225-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 06/16/2011] [Indexed: 01/03/2023]
Abstract
Postpartum depression (PPD) is a serious public health problem affecting 10% to 15% of women during the first year after delivery with negative consequences for both mother and infant. There is a need for evidence-based interventions to treat this disorder. Thus, the purpose of this study was to systematically review the literature regarding group treatment for PPD to determine the current state of knowledge regarding the efficacy of this treatment modality for reducing depressive symptoms in postpartum women. A systematic search of published and unpublished literature using the electronic databases Medline, CINAHL, PsycINFO, Cochrane Database, Cochrane Central Register of Controlled Trials, Current Controlled Trials, and Dissertation Abstracts through March 2011, supplemented by hand searches, identified 11 studies which met inclusion criteria: six were randomized controlled trials and five were non-randomized trials which utilized non-equivalent control or comparison groups. All but one study showed statistically significant improvement in depression scores from pretreatment to post-treatment, suggesting that group treatment is effective in reducing PPD symptoms. The review provides initial support for the role of group therapy in the treatment of PPD; however, caution is advised in making generalized interpretations of the findings as there was considerable heterogeneity of the studies included and the quality of the studies was mixed. Overall, the review reveals significant gaps in the current evidence base for group treatment for PPD and recommendations for further research is discussed.
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Affiliation(s)
- Janice H Goodman
- MGH Institute of Health Professions, School of Nursing, 36 1st Ave, Boston, MA 02129, USA.
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Walfisch A, Sermer C, Matok I, Koren G, Einarson A. Screening for depressive symptoms. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2011; 57:777-778. [PMID: 21753099 PMCID: PMC3135441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
QUESTION Several of my female patients of reproductive age seem to be depressed. Is there a simple tool I can use to screen them? ANSWER Motherisk is using the Edinburgh Postnatal Depression Scale to screen for depression. This simple questionnaire is filled out by women while in the waiting room. Using this tool has helped us identify large numbers of women who are at risk of, but have not been diagnosed with, depression. We believe family physicians should use this screening tool extensively with women of reproductive age.
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Affiliation(s)
- Asnat Walfisch
- Motherisk Team, Hospital for Sick Children in Toronto, Ont
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Identification of antenatal depression in obstetric care. Arch Gynecol Obstet 2011; 284:1403-9. [PMID: 21424404 DOI: 10.1007/s00404-011-1872-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 02/25/2011] [Indexed: 12/12/2022]
Abstract
PURPOSE Detection rates of depression in obstetric care are generally low, and many women remain undiagnosed and do not receive adequate support. In many obstetric settings, screening tools for depression are not applied routinely and there is a great need to sensitize health care professionals for the patient at risk for enhanced levels of depression. The present study aimed at identifying commonly assessed patient characteristics that are associated with antenatal depression. METHODS One hundred and thirty seven women were screened using the Edinburgh Postnatal Depression Scale (EPDS) at the beginning of the second trimester at the outpatient department of a Tertiary University Hospital. Women were identified as at high risk for depression if scores were above a cut-off score of twelve. Obstetric history and outcome were extracted from patient files after delivery. RESULTS Twenty one percent of the sample screened as depression positive. Logistic regression with backwards elimination showed that the triad of nausea during pregnancy, reports of (premature) contractions and consumption of analgesics during pregnancy significantly predicted high depression scores with a positive predictive value of 84.3%. The relative risk for a depressed pregnant woman to regularly take analgesics during pregnancy was fourfold higher than for non-depressed women. CONCLUSIONS If depression screening is not part of routine prenatal care, systematic assessment of depression should be targeted for patients presenting with the markers identified in this study.
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Abstract
Both depression and diabetes are common in the perinatal period and result in serious consequences for mother and fetus. Although the association between depression and diabetes is well established, few studies have examined the association between these disorders during the perinatal period, when the etiology of depression and diabetes may differ from other periods over the life course. This article reviews the four most relevant epidemiologic papers that examined the association between depression and diabetes in the perinatal period and makes recommendations for future studies about how best to examine the association between these disorders during the perinatal period.
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Affiliation(s)
- Laura J Rasmussen-Torvik
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Suite 300, Minneapolis, MN 55454-1015, USA
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Einarson A. Antidepressants and pregnancy: complexities of producing evidence-based information. CMAJ 2010; 182:1017-8. [PMID: 20513775 DOI: 10.1503/cmaj.100507] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Adrienne Einarson
- The Motherisk Program, The Hospital for Sick Children, Division of Clinical Pharmacology, University ofToronto, Toronto, Canada.
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