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Moura MS, Lozano AFQ, Tavares BM, Figueiredo TM, Franco de Barros JW, Valencise L, de Grava Kempinas W. Prenatal exposure to sertraline, associated or not with stress, can negatively program somatic and neurobehavioral development of female rats, and dysregulate reproductive function in adulthood. Reprod Toxicol 2023; 116:108336. [PMID: 36669626 DOI: 10.1016/j.reprotox.2023.108336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are prescribed to pregnant women for treating mental illnesses. Among the drugs of this class, sertraline (ST) is the antidepressant therapy recommended most frequently. Therefore, this study aimed to evaluate the impact of gestational ST treatment on reproductive parameters and toxicological target organs of rat female offspring, as well as on somatic, reflex and neurobehavioral development, in a model of maternal adversity. Pregnant Wistar rats received vehicle (filtered water) or ST hydrochloride (20 mg/Kg/day diluted in vehicle) by oral gavage, associated or not with restraint stress for 1 h/day from gestational days 13-20. F1 female offspring was evaluated on reproductive parameters, body weight and somatic and reflex milestones from postnatal day (PND) 1. On PNDs 25 and 72, the elevated-plus-maze test was performed, while toxicological target organs were evaluated on PNDs 42 and 80. In utero exposure to ST, regardless of exposure to stress, reduced body weight at birth and affected the somatic development and estrous cycle. The absolute and relative thyroid weights were increased in Stress/ST group during puberty and adulthood, while the percentage of ovarian structures and the absolute uterine weight were altered in this group on PND 80. Prenatal exposure only to ST reduced initial body weight gain, delayed fur development and increased anxiety-like behavior on PND 25. Thus, this experimental study suggests that intrauterine exposure to ST disrupts the fetal environment and can negatively program serotonin-regulated processes. Furthermore, it impacts thyroid weight when associated with stress.
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Affiliation(s)
- Mayara Silva Moura
- Graduate Program in General and Applied Biology, São Paulo State University (UNESP), Institute of Biosciences, Botucatu, SP, Brazil; Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil.
| | - Ana Flávia Quiarato Lozano
- Graduate Program in General and Applied Biology, São Paulo State University (UNESP), Institute of Biosciences, Botucatu, SP, Brazil; Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Bruna Marques Tavares
- Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Thamíris Moreira Figueiredo
- Graduate Program in General and Applied Biology, São Paulo State University (UNESP), Institute of Biosciences, Botucatu, SP, Brazil; Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Jorge Willian Franco de Barros
- Graduate Program in General and Applied Biology, São Paulo State University (UNESP), Institute of Biosciences, Botucatu, SP, Brazil; Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Lethicia Valencise
- Graduate Program in General and Applied Biology, São Paulo State University (UNESP), Institute of Biosciences, Botucatu, SP, Brazil; Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Wilma de Grava Kempinas
- Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil
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Nicolás-López M, González-Álvarez P, Sala de la Concepción A, Giralt-López M, Lorente B, Velasco I, Wichner PSV, Ginovart G. Maternal mental health and breastfeeding amidst the Covid-19 pandemic: cross-sectional study in Catalonia (Spain). BMC Pregnancy Childbirth 2022; 22:733. [PMID: 36163015 PMCID: PMC9511438 DOI: 10.1186/s12884-022-05036-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Covid-19 pandemic became an unexpected stressor for the entire population and, particularly, for pregnant women and lactating mothers. The alarming infectious risk together with the lockdown period could affect the emotional state of mothers-to-be, as well as breastfeeding rates, mother-baby bonding, or neonatal weight gain. The aim of this study is to describe the impact of this world health emergency in mother-baby pairs right after the first wave of Sars-Cov-2 pandemic (from March to May 2020). Study design A prospective observational study was carried out in mother–child dyads from those women who gave birth between June and August 2020 in a tertiary hospital. 91 mother-baby pairs were initially enrolled and 56 of them completed the follow-up. The study design had two separate steps: i) Step one: A clinical interview plus three psychometric tests (EPDS: Edinburgh Postnatal Depression Scale, PBQ: Postpartum Bonding Questionnaire and STAI-S: State-Trait Anxiety Inventory); ii) Step two: mother–child dyads were followed using a round of three brief telephone interviews (conducted at the newborn’s 7, 14 and 28 days of age) to accurately depict the newborn’s outcome in the neonatal period. Results In terms of maternal mental health, 25% of the sample screens positively in the EPDS, requiring further evaluation to rule out depressive symptoms. STAI-state and PBQ detect no abnormalities in either anxiety levels or mother–child bonding in our sample, as 100% of the mothers score below the cut-off points in each test (34 and 26 respectively). When comparing feeding practices (breast/bottle feeding) in 2020 to those practices during pre-pandemic years (2017–2019), a significant increase in breastfeeding was found in pandemic times. All newborns in the sample showed an adequate weight gain during their first month of life. Conclusion Women and newborns in our sample did not experience an increase in adverse outcomes in the neonatal period in terms of maternal mental health, breastfeeding rates, bonding and further neonatal development. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05036-9.
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Affiliation(s)
- Marta Nicolás-López
- Department of Pediatrics, Neonatal Unit, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain. .,Department of Pediatrics, Neonatal Unit, Hospital Universitari Germans Trias I Pujol, Badalona, Spain.
| | - Pablo González-Álvarez
- Department of Pediatrics, Neonatal Unit, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain
| | - Anna Sala de la Concepción
- Department of Pediatrics, Neonatal Unit, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain
| | - Maria Giralt-López
- Department of Paidopsychiatry, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Beatriz Lorente
- Department of Gynecology and Obstetrics, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Inés Velasco
- Department of Gynecology and Obstetrics, Hospital Universitari Germans Trias I Pujol, Badalona, Spain.,Research Institute Germans Trias I Pujol (IGPT), Badalona, Spain
| | - Paula Sol Ventura Wichner
- Department of Pediatrics, Neonatal Unit, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain.,Research Institute Germans Trias I Pujol (IGPT), Badalona, Spain
| | - Gemma Ginovart
- Department of Pediatrics, Neonatal Unit, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain.,Department of Pediatrics, Neonatal Unit, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
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Hu M, Zhou Y, Xue M, Ren Y, Li S, Wang R, Qi L, Zeng L, Liu Z, Qian W, Yang J, Zhou X, Chen L, Zhang X. The prevalence and correlates of peripartum depression in different stages of pregnancy during COVID-19 pandemic in China. BMC Pregnancy Childbirth 2022; 22:114. [PMID: 35148708 PMCID: PMC8832077 DOI: 10.1186/s12884-022-04428-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/26/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Peripartum depression in and after pregnancy are common, reported by 11.9% of women worldwide, and the proportion was even higher during the outbreak of coronavirus disease 2019 (COVID-19). We aimed to investigate the prevalence and risk factors of peripartum depression under the influence of COVID-19 in China. METHODS Using a cross-sectional design, 2026 pregnant and postpartum women residing in Beijing, Wuhan, and Lanzhou of China were recruited from February 28 to April 9, 2020. The Patient Health Questionnaire-9 was used to assess their depressive symptoms. The women were divided into four subgroups based on pregnancy stage, and a binary logistic regression analysis was conducted on each subgroup. RESULTS Under the influence of COVID-19, the prevalence rate of peripartum depression among Chinese women was 9.7%. It was 13.6, 10.8, 7.9 and 7.3% in the first, second, third trimester and puerperium, respectively. Regression analysis showed that the influence of current pregnancy status on movement (Mild vs. No, aORs were 3.89, P < 0.001, 2.92, P = 0.003, 1.58, P = 0.150 in the three trimesters, respectively; Severe vs. No, aORs were 13.00, 20.45, 5.38 in the three trimesters, respectively, all P < 0.05), and worries and fears about childbirth (aORs were 2.46, 2.96, 2.50 in the three trimesters, respectively, all P < 0.05) were associated with depression throughout pregnancy. CONCLUSIONS The prevalence rate of peripartum depression during the COVID-19 outbreak in China was not higher than usual. The influence of current pregnancy status on movement, as well as worries and fears about childbirth were independent risk factors for peripartum depression throughout pregnancy during COVID-19. The stage of pregnancy should be considered when implementing interventions.
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Affiliation(s)
- Manji Hu
- Shanghai Pudong New Area Mental Health Centre, Shanghai, China
| | - Yongjie Zhou
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Mei Xue
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Yali Ren
- Department of Medical Affairs, Liyuan Hospital of Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Road, Wuchang District, Wuhan, 430077, Hubei, China.
| | - Shen Li
- Department of Psychiatry, College of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Qi
- School of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | - Lingyun Zeng
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Wei Qian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jiezhi Yang
- Shenzhen Health Development Research Center, Shenzhen, China
| | - Xin Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Lijuan Chen
- School of Literature, Journalism & Communication, South-Central University for Nationalities, Wuhan, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Bonatti ADT, Roberto APDSC, Oliveira TD, Jamas MT, Carvalhaes MADBL, Parada CMGDL. Do depressive symptoms among pregnant women assisted in Primary Health Care services increase the risk of prematurity and low birth weight? Rev Lat Am Enfermagem 2021; 29:e3480. [PMID: 34495191 PMCID: PMC8432585 DOI: 10.1590/1518-8345.4932.3480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/17/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: to investigate associations between depressive symptoms during pregnancy, low birth weight, and prematurity among women with low-risk pregnancies assisted in public Primary Health Care services. Method: prospective cohort with 193 pregnant women, using the Edinburgh Postnatal Depression Scale, telephone interviews, and medical records available in the health services. Associations of interest were obtained using the Cox regression model. Results: the participants were aged 24.9 years old (median) and had 11 years of schooling (median); 82.4% lived with their partners, and gestational age at the birth was 39 weeks (median). Twenty-five percent of the participants scored ≥13 on the Edinburgh scale. Depressive symptoms did not appear associated with low birth weight (RR=2.06; CI95%=0.56-7.61) or prematurity (RR=0.86; CI95%=0.24-3.09) in the adjusted analysis. However, premature labor increased the risk of low birth weight (RR=4.81; CI95%=1.01-23.0) and prematurity (RR=7.70; CI95%=2.50-23.7). Additionally, each week added to gestational age decreased the risk of low birth weight (RR=0.76; CI95%=0.61-0.95). Conclusion: the presence of depressive symptoms among women with low-risk pregnancies was not associated with low birth weight or prematurity.
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Affiliation(s)
- Anelise de Toledo Bonatti
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil.,Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | | | - Thais de Oliveira
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
| | - Milena Temer Jamas
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
| | | | - Cristina Maria Garcia de Lima Parada
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil.,Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
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Hillyard M, Sinclair M, Murphy M, Casson K, Mulligan C. The impact of COVID-19 on the physical activity and sedentary behaviour levels of pregnant women with gestational diabetes. PLoS One 2021; 16:e0254364. [PMID: 34415931 PMCID: PMC8378749 DOI: 10.1371/journal.pone.0254364] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to understand how physical activity and sedentary behaviour levels of pregnant women with gestational diabetes in the UK have been affected by COVID-19. Methods An online survey exploring physical activity and sedentary behaviour levels of pregnant women with gestational diabetes during COVID-19 was distributed through social media platforms. Women who had been pregnant during the COVID-19 outbreak and had gestational diabetes, were resident in the UK, were 18 years old or over and could understand written English were invited to take part. Results A total of 724 women accessed the survey, 553 of these met the eligibility criteria and took part in the survey. Sedentary time increased for 79% of the women during the pandemic. Almost half of the women (47%) were meeting the physical activity guidelines pre COVID-19 during their pregnancy, this dropped to 23% during the COVID-19 pandemic. Fear of leaving the house due to COVID-19 was the most commonly reported reason for the decline. Significant associations were found between meeting the physical activity guidelines during COVID-19 and educational attainment, fitness equipment ownership and knowledge of how to exercise safely in pregnancy. Conclusions and implications These results show the impact of COVID-19 on physical activity and sedentary behaviour levels and highlight the need for targeted public health initiatives as the pandemic continues and for future lockdowns. Women with gestational diabetes need to know how it is safe and beneficial to them to engage in physical activity and ways to do this from their homes if fear of leaving the house due to COVID-19 is a barrier for them. Online physical activity classes provided by certified trainers in physical activity for pregnant women may help them remain active when face-to-face appointments are reduced and limited additional resources are available.
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Affiliation(s)
- Medbh Hillyard
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland
| | - Marlene Sinclair
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland
- * E-mail:
| | - Marie Murphy
- Sport and Exercise Sciences Research Institute, Ulster University, Newtownabbey, Northern Ireland
| | - Karen Casson
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland
| | - Ciara Mulligan
- Ulster Hospital, Dundonald, South Eastern Health and Social Services Trust, Newtownabbey, Northern Ireland
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6
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Nishimura A, Furugen A, Umazume T, Kitamura S, Soma M, Noshiro K, Takekuma Y, Sugawara M, Iseki K, Kobayashi M. Benzodiazepine Concentrations in the Breast Milk and Plasma of Nursing Mothers: Estimation of Relative Infant Dose. Breastfeed Med 2021; 16:424-431. [PMID: 33449825 DOI: 10.1089/bfm.2020.0259] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: Benzodiazepines are common therapies for mental illness and insomnia, and are used during pregnancy and lactation. Although benzodiazepines have been shown to be transferred into breast milk, the amount transferred is small and compatible with breastfeeding. However, information is not available for all drugs. Therefore, we aimed to determine the milk to plasma (M/P) ratio and relative infant dose (RID), which are used as indicators of drug transfer to breast milk, to determine the safety of such drugs for lactating women and breastfeeding infants. Methods: The study comprised of 11 pregnant women who visited the obstetrics department of Hokkaido University Hospital (approval number: 017-0131) and Tenshi Hospital (approval number: 103) for childbirth. The samples were analyzed using liquid chromatography-tandem mass spectrometry, and the M/P ratio and RID were calculated. The condition of the mother and baby at 1 month after delivery was determined from the clinical information. The target benzodiazepines were alprazolam, brotizolam, clonazepam, clotiazepam, etizolam, ethyl loflazepate, flunitrazepam, and lorazepam. Results: For all drugs, the M/P ratios were <1 and remained constant over time. For drugs other than ethyl loflazepate, the RID values were <10%, which are considered safe; however, even with ethyl loflazepate, it was only slightly >10%. No abnormalities were found in breastfeeding infants whose mothers were receiving these medications. Conclusions: The RID results of this study suggest that drug exposure through breast milk is small; thus, maternal drug treatment and breastfeeding are compatible.
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Affiliation(s)
- Ayako Nishimura
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
| | - Ayako Furugen
- Laboratory of Clinical Pharmaceutics & Therapeutics, Division of Pharmasciences, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Takeshi Umazume
- Department of Obstetrics, Hokkaido University Hospital, Sapporo, Japan
| | - Seika Kitamura
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
| | - Mayuko Soma
- Department of Pharmacy, Tenshi Hospital, Sapporo, Japan
| | - Kiwamu Noshiro
- Department of Obstetrics, Hokkaido University Hospital, Sapporo, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan.,Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Ken Iseki
- Laboratory of Clinical Pharmaceutics & Therapeutics, Division of Pharmasciences, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Masaki Kobayashi
- Laboratory of Clinical Pharmaceutics & Therapeutics, Division of Pharmasciences, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan.,Education Research Center for Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
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7
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Trajectories of Depressive Symptoms and Anxiety during Pregnancy and Associations with Pregnancy Stress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052733. [PMID: 33800371 PMCID: PMC7967460 DOI: 10.3390/ijerph18052733] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/19/2022]
Abstract
The purposes of this study were to investigate the trajectory groups of depressive symptoms and anxiety in women during pregnancy and to identify the factors associated with those groups. Participants were recruited from the outpatient clinic of a women's health hospital in Seoul, Korea. Pregnant women (n = 136) completed a survey questionnaire that included questions on depressive symptoms, anxiety, and pregnancy stress; additionally, their saliva was tested for cortisol hormone levels three times during their pregnancies. The group-based trajectory modeling approach was used to identify latent trajectory groups. Ordinal logistic regressions were used to explore the association of latent trajectory groups with sociodemographic factors and pregnancy stress. Three trajectory groups of depressive symptoms were identified: low-stable (70%), moderate-stable (25%), and increased (5%). Four trajectory groups of anxiety were identified: very low-stable (10%), low-stable (67%), moderate-stable (18%), and high-stable (5%). The only factor associated with both the depressive symptoms and anxiety trajectory groups was pregnancy stress (p < 0.001). Most participants showed stable emotional status; however, some participants experienced higher levels of depressive symptoms and anxiety related to higher pregnancy stress. These pregnant women may need additional care from healthcare providers to promote their wellbeing during pregnancy.
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González-Fernández D, Sahajpal R, Chagüendo JE, Ortiz Martínez RA, Herrera JA, Scott ME, Koski KG. Associations of History of Displacement, Food Insecurity, and Stress With Maternal-Fetal Health in a Conflict Zone: A Case Study. Front Public Health 2020; 8:319. [PMID: 32903835 PMCID: PMC7438926 DOI: 10.3389/fpubh.2020.00319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/11/2020] [Indexed: 12/12/2022] Open
Abstract
Background: In populations with a history of conflict, early identification of pregnant women who are at risk of adverse pregnancy outcomes is challenging, especially if sonography is not available. We evaluated the performance of symphysis-fundal height (SFH) for identification of high-risk pregnancies and investigated if food security and diet quality, clinical biomarkers, and stress were associated with SFH and two known indicators of maternal-fetal well-being, sonography-estimated fetal weight and amniotic fluid index (AFI). Methods: For this cross-sectional study, 61 women with high-risk pregnancies were recruited after referral to the obstetrics and gynecology unit at San José Hospital in Popayán, Colombia. Multiple stepwise linear and ordered logistic regressions were used to identify associations of SFH, sonography-estimated fetal weight and AFI classification with history of displacement, food insecurity, post-traumatic stress symptoms as well as biopsychosocial risk evaluated through the Colombian risk scale. Results: History of displacement was associated with lower SFH Z-scores, but higher hemoglobin, taking iron supplements and a higher diastolic blood pressure were associated with higher SFH Z-scores. SFH was also associated with AFI but not with sonography-estimated fetal weight. Stress indicators were associated with a higher AFI. In contrast family support, an element of the Colombian biopsychosocial risk assessment, was associated with a higher sonography-estimated fetal weight, whereas more hours of sleep/day were associated with lower sonography-estimated fetal weight. Conclusion: SFH was not only associated with biological factors known to affect maternal/fetal health but also with history of displacement, thus validating its use in conflict areas for pregnancy assessment. Associations of biopsychosocial stressors with maternal-fetal outcomes highlight the need for a systematic assessment of stress in pregnant women from conflict zones.
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Affiliation(s)
- Doris González-Fernández
- School of Human Nutrition, McGill University (Macdonald Campus), Sainte-Anne-de-Bellevue, QC, Canada
| | - Revathi Sahajpal
- School of Human Nutrition, McGill University (Macdonald Campus), Sainte-Anne-de-Bellevue, QC, Canada
| | - José E Chagüendo
- Obstetrics and Gynecology Unit, San José Hospital, University of Cauca, Popayán, Colombia
| | | | - Julián A Herrera
- Department of Family Medicine, School of Medicine, University of Valle, Cali, Colombia
| | - Marilyn E Scott
- Institute of Parasitology, McGill University (Macdonald Campus), Sainte-Anne-de-Bellevue, QC, Canada
| | - Kristine G Koski
- School of Human Nutrition, McGill University (Macdonald Campus), Sainte-Anne-de-Bellevue, QC, Canada
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9
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Konstantinou GN, Vigod SN, Mehta S, Daskalakis ZJ, Blumberger DM. "A systematic review of non-invasive neurostimulation for the treatment of depression during pregnancy". J Affect Disord 2020; 272:259-268. [PMID: 32553366 DOI: 10.1016/j.jad.2020.03.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/20/2020] [Accepted: 03/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Antidepressant use in pregnancy is associated with high levels of decision-making difficulty for patients, and psychotherapy may not be effective for severe symptoms. Alternative treatment options are needed. We conducted a systematic review of the clinical effects and tolerability of non-invasive neurostimulation: repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), trigeminal nerve stimulation (TNS), and transcutaneous vagus nerve stimulation (tVNS) for the treatment of antenatal depression. METHODS We searched PubMed, Google Scholar and Scopus for published articles in English (1990 to June 2019). Two reviewers reviewed full-text articles, assessed quality, and extracted data on maternal psychiatric, pregnancy and neonatal outcomes. RESULTS Of 565 articles, 21 met inclusion criteria: two RCTs (1 rTMS; 1 tDCS), four open-label studies (3 rTMS; 1 tDCS), three case series (3 rTMS), and twelve case reports (9 rTMS; 1 tDCS; 1 tACS; 1 TNS). In all but one published study (1 rTMS), non-invasive neurostimulation resulted in either response or remission of antenatal depression. Minor maternal side effects were reported in rTMS and tDCS studies, but not in other modalities. Fetal adverse effects were not reported in any intervention. A small proportion of participants dropped out of treatment (rTMS, tDCS). LIMITATIONS Very few randomized trials have been conducted and there is significant heterogeneity in the parameters of the modalities that have been studied. CONCLUSIONS Non-invasive neurostimulation holds promise as a potentially effective and feasible alternative treatment for antenatal depression. Strategies to enhance recruitment of pregnant women into non-invasive neurostimulation trials that have longitudinal follow-up are needed.
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Affiliation(s)
- Gerasimos N Konstantinou
- Department of Psychiatry, University of Toronto; Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Shobha Mehta
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto; Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, University of Toronto; Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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Zhang L, Yang X, Zhao J, Zhang W, Cui C, Yang F, Ma R, Jia Y. Prevalence of Prenatal Depression Among Pregnant Women and the Importance of Resilience: A Multi-Site Questionnaire-Based Survey in Mainland China. Front Psychiatry 2020; 11:374. [PMID: 32435211 PMCID: PMC7218063 DOI: 10.3389/fpsyt.2020.00374] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/15/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Prenatal depression is associated with adverse maternal and fetal health consequences, yet it has not raised sufficient concerns in China. Psychological worries and stress may lead to prenatal depression, but resilience could relieve some of the negative effects of worries and stress and mitigate prenatal depression. AIMS This study aimed to assess the prevalence of prenatal depression and explore its associated factors. METHOD A multisite cross-sectional study was conducted that included 605 pregnant women from three hospitals in two provincial capitals (Shenyang and Zhengzhou) and one municipality (Chongqing). A smartphone questionnaire was employed to assess prenatal depression using the Center for Epidemiologic Studies Depression Scale (CES-D). Multivariate logistic regression analysis was performed to explore factors associated with prenatal depression. RESULTS The prevalence of prenatal depression (CES-D≥16) among Chinese pregnant women was 28.4%. Logistic regression analyses revealed that prenatal depression was positively associated with worries about appearance (odds ratio [OR] 1.666, 95% confidence interval [CI] 1.043-2.661) and perceived stress (OR 1.156, 95% CI 1.104-1.211) and negatively associated with monthly income, relationship with mother (OR 0.287, 95% CI 0.103-0.796), and resilience (OR 0.935, 95% CI 0.918-0.953). CONCLUSION These findings revealed that Chinese pregnant women suffered from high levels of prenatal depression (28.4%). Worries about appearance and perceived stress were risk factors for prenatal depression, whereas a pregnant woman's harmonious relationship with her own mother and resilience could relieve the negative impacts of pregnancy that can lead to prenatal depression. Improving resilience and maintaining harmonious relationships with mothers should be emphasized in order to reduce the detrimental effects of pregnancy and improve the mental well-being of pregnant women.
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Affiliation(s)
- Lijuan Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoshi Yang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Jinfeng Zhao
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Weiyu Zhang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Can Cui
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Fengzhi Yang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Ruqing Ma
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Yajing Jia
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
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Salgado IV, Mendoza JLM, Zerón HM. Mexican pregnant women show higher depression and anxiety with rising age and in the case of being single. Acta Med Litu 2020; 26:227-236. [PMID: 32355461 DOI: 10.6001/actamedica.v26i4.4208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Pregnancy is an important predisposition period to develop anxiety and depression, with a direct impact on the woman's offspring. The aim of this study was to report the correlation between depression and anxiety in pregnant women and its association with the marital status and age. Materials A descriptive, retrospective and cross-sectional study was conducted in the outpatient care of the Psychology Service at the "Mónica Pretelini Sáenz" Maternal Perinatal Hospital (HMPMPS), Toluca, Mexico, from June 2012 to March 2019. As routine, the Beck Depression Inventory (BDI-II) and the Beck Anxiety Inventory-Trait (BAIT), were applied to all women seeking attention at the HMPMPS. Only pregnant patients were selected for this study, with the women referred for the first time to the external Psychology Clinic as inclusion criteria. Pearson's correlation coefficient and the frequency of cases for age, BDI-II, and BAIT were obtained using the IBM SPSS Statistics ® v.23 software. Results The study included 2947 pregnant patients with a mean age of 28.6 ± 6.9 years. Of these, 2616 (88.8%) presented with mild anxiety, 269 (9.1%) with moderate, and 62 (2.1%) with severe anxiety. On the other hand, 2149 (72.9%) patients presented with minimal depression, 341 (11.6%) mild depression, 268 (9.1%) moderate depression, and 189 (6.4%) had severe depression. The correlations between age and BDI-II was -0.026 (P = 0.152), between age and BAI was -0.038 (P = 0.037), and between BAIT and BDI-II 0.650 (P ≤ 0.001). Conclusions The age group with the highest frequency of depression and anxiety was from 20 to 29 years. The absence of a stable partner represented an important risk factor for anxiety and depression during pregnancy.
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Affiliation(s)
| | | | - Hugo Mendieta Zerón
- Psychology Department, "Mónica Pretelini Sáenz" Maternal-Perinatal Hospital.,Faculty of Medicine, Autonomous University of the State of México (UAEMex)
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Trifu S, Vladuti A, Popescu A. THE NEUROENDOCRINOLOGICAL ASPECTS OF PREGNANCY AND POSTPARTUM DEPRESSION. ACTA ENDOCRINOLOGICA-BUCHAREST 2019; 15:410-415. [PMID: 32010366 DOI: 10.4183/aeb.2019.410] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Ties between the endocrine system and mental health are undeniably a consistent point of interest in modern day medicine. Furthermore, mental disturbances due to hormonal changes following childbirth have been mentioned in medical literature since Hippocrates. Considering the dramatic endocrine, paracrine and autocrine changes that occur during gestation, labour and postnatal phase, hormonal theories are not to be ignored in the treatment of postpartum disorders. Results Reproductive hormones are known to modulate behavioural, emotional and cognitive response, therefore rapid changes in estradiol and progesterone plasma concentrations during pregnancy and labour create a vulnerable terrain leading towards postpartum disorders. New research shows that women suffering from postpartum disorders have abnormal neural responses, suggesting a neuroendocrine explanation for postpartum syndromes. Conclusion To facilitate further research in this area, we present new information on several hormonal interactions and the psychiatric response involved in pregnancy and labour, offering an interdisciplinary outlook on pregnancy and postpartum disorders. There is enough evidence to suggest that estradiol, progesterone, oxytocin, cortisol and thyroid hormones are some of many hormones involved in postpartum syndromes and tackling their perinatal imbalance with pharmacological substituents or antagonists could be useful as an adjuvant form of treatment in future patients.
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Affiliation(s)
- S Trifu
- "Carol Davila" University of Medicine and Pharmacy - Dept. of Neurosciences, Bucharest, Romania
| | - A Vladuti
- University of Bucharest Faculty of Psychology and Educational Sciences - Dept. of Psychology, Bucharest, Romania
| | - A Popescu
- "Alex. Obregia" Clinical Hospital for Psychiatry - Dept. of Psychiatry, Bucharest, Romania
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