Antenatal and postnatal risk factors of postpartum depression symptoms in Thai women: A case-control study

Postpartum pain and the risk of postpartum depression: A meta-analysis of observational studies

OBJECTIVE

This meta-analysis of observational studies aimed to derive a more precise estimation of the relationship between postpartum pain and postpartum depression (PPD).

METHODS

A systematic literature search was completed in the following databases from inception to September 26, 2022: PubMed, Embase, and Web of Science. Quality evaluation of each study was achieved through Newcastle-Ottawa scale (NOS) assessment. Heterogeneity across studies was evaluated by Cochran's Q test and I2 test. Pooled estimates of odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were analyzed using fixed-effects model or random-effects model, according to heterogeneity. Subgroup analysis, sensitivity analysis, and Egger's test were also performed.

RESULTS

From the identified 1884 articles, a total of 8 studies involving 3973 participants were included in the final meta-analysis. Seven of the 8 studies were evaluated as high-quality, with NOS scores ≥7. A significant heterogeneity was observed (I2  = 66.5%, p = 0.004) among eight studies. Therefore, the performed random-effect model suggested a significant association between postpartum pain and PPD risk (OR 1.29, 95% CI 1.10-1.52, p = 0.002). However, the subgroup analyses did not define the source of heterogeneity. Moreover, the sensitivity analysis showed the stability of the pooled results, but the significant publication bias was identified (p = 0.009). The trim and fill method was performed and resulted in an OR of 1.14 (95% CI 0.95-1.37, p = 0.162).

CONCLUSIONS

This meta-analysis found a potential association between postpartum pain and PPD. Further researches are needed to provide more robust evidences.

Patterns of attentional bias in antenatal depression: an eye-tracking study

Introduction

One of the most common mental disorders in the perinatal period is depression, which is associated with impaired emotional functioning due to alterations in different cognitive aspects including thought and facial emotion recognition. These functional impairment may affect emerging maternal sensitivity and have lasting consequences for the dyadic relationship. The current study aimed to investigate the impact of depressive symptoms on the attention bias of infant stimuli during pregnancy.

Methods

Eighty-six pregnant women completed the Edinburgh Postnatal Depression Scale and an eye-tracking task comprising infant-related emotion images. All participants showed biased attention to infant-related images.

Results

First, compared to healthy pregnant women, pregnant women with depression symptoms initially directed their attention to infant-related stimuli more quickly (F (1, 84) = 6.175, p = 0.015, η2 = 0.068). Second, the two groups of pregnant women paid attention to the positive infant stimuli faster than the neutral infant stimuli, and the first fixation latency bias score was significantly smaller than that of the infant-related negative stimulus (p = 0.007). Third, compared with the neutral stimulus, the non-depression group showed a longer first gaze duration to the negative stimulus of infants (p = 0.019), while the depressive symptoms group did not show this difference.

Conclusion

We speculate that structural and functional changes in affective motivation and cognitive-attention brain areas may induce these attentional bias patterns. These results provide suggestions for the implementation of clinical intervention programs to correct the attention bias of antenatal depressed women.

Caffeinated non-alcoholic beverages on the postpartum mental health related to the COVID-19 pandemic by a cross-sectional study in Argentina

Purpose

This work aimed to study postpartum mental outcomes and determinants of the intake of caffeinated beverages during the pandemic in women from Argentina.

Methods

This cross-sectional study recruited 619 women who responded to online self-report questionnaires during the first and second waves of COVID-19, including validated instruments (Insomnia Severity Index, Perceived Stress Scale, Postpartum Depression Screening Scale, Memory Complaint Scale, and Breastfeeding Self-Efficacy Scale), and general data. Intake frequency and amount of caffeinated beverages were estimated. Multivariate regression and structural equation models identified associations and effects (p < 0.05).

Results

Women were under social restrictions for 60.39 days, with home and essential activities increasing caffeinated intake. They ingested (mL/d): yerba mate (1457.71), coffee (66.85), tea (67.61), and soft drinks (50.95), which provided 646.20 mg/d of caffeine. Intakes of coffee and yerba mate were higher than pre-pandemic ones. Coffee was positively associated with stress and insomnia, and indirectly linked to higher levels of depression and memory complaints, and lower breastfeeding self-efficacy. Tea showed a similar but weaker association. Yerba mate correlated inversely with depression (through direct pathways), insomnia, and memory complaints (through indirect pathways), promoting breastfeeding self-efficacy. Soft drinks and caffeine did not present significant associations.

Conclusion

Although findings do not imply causation, results suggest that beverages would exhibit caffeine-independent affective and cognitive roles, which might be anxiogenic in the case of coffee and tea (to a lesser extent). Yerba mate showed antidepressant potential. Given that breastfeeding might be compromised during the pandemic, yerba mate intake is promissory to protect postpartum mental health.

Assessing the Risk of Depression Tendency in Pregnancy and Puerperium during COVID-19 Pandemic in Poland

The aim of the study was to assess the risk and severity of depression tendency in pregnant and postpartum women and to determine the relative risk for selected psychosocial and obstetric variables. The study included 317 women in the perinatal period. The severity of depressive disorders was assessed using standard self-report scales: EPDS (Edinburgh Postnatal Depression Scale), BDI-II (Depression Inventory-Second Edition), and HADS (Hospital Anxiety and Depression Scale). High rates of depression tendency in women in the third trimester of pregnancy were reported in 48.05% of pregnant women (≥10 EPDS scores), 49.36% (≥12 BDI II scores), and 41.55% (≥8 HADS-D scores). In contrast, in women in the first week after delivery, respectively: 33.74%; 28.83%; 22.08%. In the EPDS assessment, 11.69% of pregnant women and 17.79% of postpartum women confirmed the presence of self-injurious thoughts. A woman's diagnosis of depressive disorder before pregnancy increases the risk of postpartum depression tendency 3.35 times according to the EPDS, 3.51 times according to the BDI-II, and 4.89 times according to the HADS-D. Depressive disorders were significantly more common in pregnant women compared to women in the first week of postpartum. Systematic screening can identify risk factors for prenatal and postpartum depression.

Serum oxytocin and corticotropin-releasing hormone levels in the third trimester of pregnancy for predicting postpartum depression in Thai women

PURPOSE

This prospective observational study aimed to determine whether serum oxytocin (OT) or corticotrophin-releasing hormone (CRH) levels in the third trimester of pregnancy (or late pregnancy) could prospectively predict postpartum depression (PPD) at six weeks after childbirth.

METHODS

We measured late pregnancy OT and CRH levels in Thai women, assessed depression using the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9), and collected mothers, labor, and newborn data. At six weeks postpartum, an EPDS score ≥ 11 or PHQ-9 score ≥ 10 was defined as the presence of PPD. Multivariable binary logistic regression analysis was performed to determine the predictors of PPD.

RESULTS

Of 200 participants, 136 (68.0%) were reassessed at six weeks postpartum, and 19 of them (14.0%) had PPD. Of the 19 participants with PPD, 9 met the EPDS criterion only, 3 met the PHQ-9 criterion only, and 7 met both criteria. OT levels were not significantly different between those with and without PPD (p = 0.35). CRH levels (aOR = 1.011, 95% CI = 1.001-1.023, p = 0.041), DASS-21 stress (aOR = 1.259, 95% CI = 1.132-1.400, p < 0.001), and APGAR at 1 min (aOR = 0.425, 95% CI = 0.240-0.752, p = 0.003) were significant predictors of PPD.

CONCLUSIONS

Only high CRH but not OT levels in late pregnancy may predict 6-week PPD. However, combining these CRH levels, late pregnancy stress, and newborn well-being immediately after birth seems to increase the accuracy of PPD prediction.

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

INTRODUCTION

In recent years, clinical studies have shown that perinatal pain could increase the risk of postpartum depression, while such a conclusion appears controversial. Therefore, we conducted this systematic review and meta-analysis to explore the association between perinatal pain and postpartum depression, and to evaluate the effectiveness of epidural labor analgesia in reducing the risk of postpartum depression.

METHODS

PubMed, Web of Science, Embase and Cochrane Library were searched from inception to Jan 30th, 2022. The effect size of the meta-analysis was calculated using odds ratio and 95 % confidence interval. Statistical analysis was performed using Stata 15.0 software.

RESULTS

There were 19 studies included with a total of 96,378 patients. Among the included studies, 10 investigated the association between perinatal pain and the risk of postpartum depression, and 9 reported that between labor analgesia and the risk of postpartum depression. The results of meta-analysis showed that perinatal pain increased the risk of postpartum depression [OR = 1.43, 95% CI (1.23, 1.67), p<0.05], and epidural analgesia could reduce the risk of postpartum depression [OR = 0.42, 95% CI (0.33, 0.55), p < 0.05].

LIMITATIONS

Source of heterogeneity in the association between perinatal pain and PPD could not be identified due to the limitations of the original studies. There were mainly cohort studies included in the assessment for effectiveness of epidural analgesia in reducing the incidence of postpartum pain. Therefore, we look forward to more RCTs to confirm our results.

CONCLUSION

Perinatal pain is one of the risk factors for postpartum depression, and epidural analgesia could reduce the risk of PPD. This result might provide guidance for clinical practice. However, psychological health counseling should be combined with epidural analgesia for perinatal pain to reduce the risk of PPD.

The Effects of Breastfeeding on Maternal Mental Health: A Systematic Review

Background: Breastfeeding has many positive effects on the health of infants and mothers, however, the effect of breastfeeding on maternal mental health is largely unknown. The goal of this systematic review was to (1) synthesize the existing literature on the effects of breastfeeding on maternal mental health, and (2) inform breastfeeding recommendations. Materials and Methods: A literature search was conducted in electronic databases using search terms related to breastfeeding (e.g., breastfeeding, infant feeding practices) and mental health conditions (e.g., mental illness, anxiety, depression), resulting in 1,110 records. After reviewing article titles and abstracts, 339 articles were advanced to full-text review. Fifty-five articles were included in the final analysis. Results: Thirty-six studies reported significant relationships between breastfeeding and maternal mental health outcomes, namely symptoms of postpartum depression and anxiety: 29 found that breastfeeding is associated with fewer mental health symptoms, one found it was associated with more, and six reported a mixed association between breastfeeding and mental health. Five studies found that breastfeeding challenges were associated with a higher risk of negative mental health symptoms. Conclusions: Overall, breastfeeding was associated with improved maternal mental health outcomes. However, with challenges or a discordance between breastfeeding expectations and actual experience, breastfeeding was associated with negative mental health outcomes. Breastfeeding recommendations should be individualized to take this into account. Further research, specifically examining the breastfeeding experiences of women who experienced mental health conditions, is warranted to help clinicians better personalize breastfeeding and mental health counseling.

Prevalence and risk factors of postpartum depression in China: A hospital-based cross-sectional study

BACKGROUND

Postpartum depression (PPD) is a major public health problem worldwide, which adversely affects maternal and infant health. The purpose of this study was to determine the prevalence and related factors of postpartum depression in Chinese puerperium women.

METHODS

A cross-sectional study was conducted in Baoan Maternal and Child Health Hospital located in the west of Shenzhen, China. The Chinese version of the Edinburgh Postpartum Depression Scale (EPDS) was used to screen PPD. A score of ≥10 was used as the threshold of postpartum depression.

RESULTS

A total of 4813 puerperal women were included in this study, 11.5% of whom were considered to have PPD. Multivariate logistic regression analysis found that family history of mental illness (OR = 1.94; 95% CI, 1.05-3.57; P = 0.033), living with parents-in-law (OR = 1.41; 95% CI, 1.16-1.72; P < 0.001), anxiety during pregnancy (OR = 3.66; 95% CI, 2.97-4. 52; P < 0.001), depression during pregnancy (OR = 4.25; 95% CI, 3.28-5.50; P < 0.001), and stressful life events (OR = 1.50; 95% CI, 1.03-2.20; P = 0.036) were associated with the high prevalence of PPD.

LIMITATIONS

The cross-sectional survey cannot assess direct causality. EPDS is just a screening tool and not a diagnostic one.

CONCLUSION

Postpartum depression is a common disease in Chinese puerperal population. High-risk pregnant women with postpartum depression need routine screening and targeted intervention for PPD.

Unintended pregnancy and postpartum depression: A meta-analysis of cohort and case-control studies

OBJECTIVE

The majority of original studies showed that unintended pregnancy is related to adverse obstetric outcomes, however, up to now, the influence of unintended pregnancy on the risk of developing postpartum depression (PPD) remains unclear. This study aimed to assess the association between unintended pregnancy and the risk of developing PPD by conducting a meta-analysis of cohort and case-control studies.

METHODS

PubMed, Web of Science, Embase, and Cochrane Library were searched up to December 31, 2019 to identify relevant studies evaluating the association between unintended pregnancy and PPD. Meta-analysis was performed using RevMan software and Stata software. Potential heterogeneity source was explored by subgroup and sensitivity analyses, and potential publication bias was tested using Begg's funnel plots and Begg's linear regression test.

RESULTS

A total of thirty studies involving 65,454 participants were included in our meta-analysis. Overall, women who get pregnant unintendedly compared with those who are intending to be pregnant were at a significantly higher risk of developing PPD (odds ratio [OR] = 1.53; 95% confidence interval [CI]: 1.35-1.74; P < 0.00001).

CONCLUSIONS

Unintended pregnancy is significantly associated with the risk of developing PPD. These findings highlight the necessity of screening for pregnancy intention and integrating family planning and personalized mental health services into primary healthcare to promote maternal mental health.

Perinatal depression and anxiety of primipara is higher than that of multipara in Japanese women

The proportion of women who experience a depressive state after delivery differs between primiparas and multiparas, so it is important to clarify the different factors related to depression between the two groups. In this study, we confirmed the differences in depressive states, the perinatal period, and social support between primiparas and multiparas, and clarified their characteristics. Data were extracted from a prospective cohort questionnaire survey conducted on pregnant women in Japan that included sociodemographic questions, the Edinburgh Postnatal Depression Scale, and the Japanese version of the Social Support Questionnaire. We carried out the chi-square test, Student's t-test, and analysis of covariance to compare responses between primiparas and multiparas. A total of 1138 primiparas and 380 multiparas provided valid responses. We found that primiparas had higher rates of experiencing maternity blues and postpartum depression than multiparas. We also found that primiparas had higher anxiety scores than multiparas. Primiparas with postpartum depression perceived a lower number of persons available to provide social support than primiparas without postpartum depression. These findings suggest that it is important to provide pregnant women, especially for primiparas, with information that allows them to increase the number of people who can provide them with support.

Gender of infant and risk of postpartum depression: a meta-analysis based on cohort and case-control studies

BACKGROUND

It is inconclusive nowadays for the association between infant's gender and their mothers' risk of developing postpartum depression (PPD). In addition, a complete overview is missing. A meta-analysis of cohort and case-control studies was performed to address the question of whether women who gave birth to a female infant were at an increased risk of developing PPD, compared with those giving birth to a male infant.

METHODS

Unrestricted searches were conducted, with an end date parameter of 31 January 2018, of PubMed, Embase, Google Scholar, Cochrane Libraries, and Chinese databases, to identify studies that met pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates.

RESULTS

Twenty-three studies involving 119,736 women were included for analysis. Overall, mothers who gave birth to a female infant experienced a significantly increased risk of developing PPD compared with the reference group (OR = 1.15, 95%CI: 1.01-1.31; p = .03). However, substantial heterogeneity (p < .00001; I² = 75%) was observed across studies. Relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded consistent results. No evidence of publication bias was observed.

CONCLUSIONS

Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, the present study suggests women giving birth to a girl are associated with a higher risk of developing PPD when compared with those giving birth to a boy. Improving family and social communication and reducing gender preference should be important components of any such interventions.Statement of significanceProblem or issue Interestingly, the known risk factors leading to PPD are basically the same in different regions and cultures, but the gender of the infant seems to be an exception.What is already known Some studies conducted in traditional western countries indicated that there is a weak or null association between infant's gender and risk of PPD, while others suggested a positive association. In contrast, studies conducted in Nigeria, India, Turkey and China showed that mothers giving birth to a female infant were at a higher risk of developing PPD.What this paper adds Today, the association between infant's gender and risk of developing postpartum depression (PPD) is still uncertain; additionally, a complete overview is missing. Our study represents the first meta-analysis of risk of PPD associated with infant's gender.

Prevalence and risk factors of postpartum depression, general depressive symptoms, anxiety and stress (PODSAS) among mothers during their 4-week postnatal follow-up in five public health clinics in Perak: A study protocol for a cross-sectional study

INTRODUCTION

Postpartum depression, general depressive symptoms, anxiety and stress (PODSAS) are often overlooked, and may cause morbidity to new mothers, their babies and families. This study aims to determine the point prevalence of depression (post partum and general), anxiety and stress among mothers in five public health clinics in Perak at 4 weeks postdelivery and identify their associated risk factors. Findings from this study will be used to identify the needs for early screening and detection, encourage development of interventions to reduce its occurrence and support mothers with PODSAS.

METHODS AND ANALYSIS

This cross-sectional study will recruit 459 postpartum mothers during their 4-week postnatal follow-up in five selected public health clinics in Perak from September 2019 to May 2020. Participants will be mothers aged 18 years and above at 4 weeks postdelivery who are able to understand the English and Malay languages. Non-Malaysians and mothers with known diagnosis of psychotic disorders will be excluded from the study. Sociodemographic information and possible risk factors of the participants will be captured via a set of validated questionnaires, postpartum depression (PPD) will be measured using the Edinburgh Postpartum Depression Scale questionnaire and general depressive symptoms, anxiety and stress will be measured using the 21-item Depression, Anxiety and Stress Scale. Data analysis will be conducted using SPSS V.25.0 (IBM). Besides descriptive statistics, multivariable regression analyses will be done to identify possible risk factors and their independent associations with depression (PPD and general depressive symptoms, combined and separately), anxiety and stress.

ETHICS AND DISSEMINATION

The study protocol was reviewed and approved by the Medical Research Ethics Committee, Ministry of Health Malaysia on 7 August 2019. Results of this study will be reported and shared with the local health stakeholders and disseminated through conference proceedings and journal publications.

REGISTRATION NUMBER

This study is registered in the Malaysian National Medical Research Register with the ID: NMRR-19-868-47647.

The uterine-chemokine-brain axis: menstrual cycle-associated symptoms (MCAS) are in part mediated by CCL2, CCL5, CCL11, CXCL8 and CXCL10

OBJECTIVE

To examine associations between chemokines and menstrual cycle associated symptoms (MCAS).

METHODS

Forty-one women completed the Daily Record of Severity of Problems (DRSP) rating scale during 28 consecutive days of the menstrual cycle. MCAS is diagnosed when the total daily DRSP score during the menstrual cycle is > 0.666 percentile. We assayed plasma CCL2, CCL5, CCL11, CXCL8, CXCL10, EGF, IGF-1, and PAI-1 at days 7, 14, 21 and 28 of the menstrual cycle.

RESULTS

CCL2, CCL5, CCL11 and EGF are significantly higher in women with MCAS than in those without. Increased CCL2, CXCL10, CXCL8, CCL11 and CCL5 levels are significantly associated with DRSP scores while CCL2 is the most significant predictor explaining 39.6% of the variance. The sum of the neurotoxic chemokines CCL2, CCL11 and CCL5 is significantly associated with the DRSP score and depression, physiosomatic, breast-craving and anxiety symptoms. The impact of chemokines on MCAS symptoms differ between consecutive weeks of the menstrual cycle with CCL2 being the most important predictor of increased DRSP levels during the first two weeks, and CXCL10 or a combination of CCL2, CCL11 and CCL5 being the best predictors during week 3 and 4, respectively.

DISCUSSION

The novel case definition "MCAS" is externally validated by increased levels of uterus-associated chemokines and EGF. Those chemokines are involved in MCAS and are regulated by sex hormones and modulate endometrium functions and brain neuro-immune responses, which may underpin MCAS symptoms. As such, uterine-related chemokines may link the uterus with brain functions via a putative uterine-chemokine-brain axis.

Correlation between postpartum depression and spousal support and factors affecting postpartum depression

This study was conducted to investigate the relationship between postpartum depression (PPD) and women's perceived spousal support during the early postpartum period and the prevalence of PPD and affecting factors. Data were collected using a Personal Information Form, the Edinburgh Postpartum Depression Scale (EPDS) and the Perceived Spousal Support among Women in Early Postpartum Period Scale (PSSAWEPP). The study was completed with 181 women. The prevalence of PPD was found as 28.2%. A significant negative correlation was found between the total EPDS score and total PSSAWEPP score and subscale scores of emotional support, social support and physical support (p < 0.01). It was also found that as spousal support perceived by women increased, PPD risk decreased. In our study, it was observed that spousal violence (aOR = 5.69, 95% CI: 1.65-19.55) and having an unintended pregnancy (aOR = 0.24, CI: 0.11-0.54) were two factors that significantly affected PPD.

Trajectories of maternal depressive symptoms from the antenatal period to 24-months postnatal follow-up: findings from the 2015 Pelotas birth cohort

BACKGROUND

Maternal depression may be chronic and recurrent, with negative effects both on the health of mothers and children. Many studies have shown trajectories of postnatal depressive symptoms but few studies in low- and middle-income countries have evaluated the trajectories of depressive symptoms starting during pregnancy. This study aims to identify the different trajectories of depressive symptoms among mothers in the Pelotas 2015 birth cohort, from pregnancy to the second year of the child's life.

METHODS

This study used data from the 2015 Pelotas Birth Cohort, a longitudinal study of all live births occurred in 2015 in Pelotas, Brazil. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Mothers who completed the EPDS on at least three follow-up visits beginning to the antenatal follow-up visit were included in the analyses. The trajectory of maternal depressive symptoms was estimated through group-based trajectory modeling.

RESULTS

A total of 3040 women were included in the present analysis. We identified five groups of maternal depressive symptoms trajectories, with 23.4% of the mothers presenting persistent depressive symptoms and 3.9% showing chronic high depressive symptoms throughout the study period. The probability of having persistent depressive symptoms increased among mothers with greater socioeconomic vulnerability.

CONCLUSIONS

This study shown the persistence of maternal depressive symptoms since pregnancy until 2 years postnatal. Additionally, alongside the known risk factors, pre-gestational depression and antenatal depressive symptoms are important risk factors for the persistence and severity of depressive symptoms. These findings support the need to provide mental health evaluation and care for women from pregnancy to the late postnatal period.

Precision medicine in perinatal depression in light of the human microbiome

Perinatal depression is the most common complication of pregnancy and affects the mother, fetus, and infant. Recent preclinical studies and a limited number of clinical studies have suggested an influence of the gut microbiome on the onset and course of mental health disorders. In this review, we examine the current state of knowledge regarding genetics, epigenetics, heritability, and neuro-immuno-endocrine systems biology in perinatal mood disorders, with a particular focus on the interaction between these factors and the gut microbiome, which is mediated via the gut-brain axis. We also provide an overview of experimental and analytical methods that are currently available to researchers interested in elucidating the influence of the gut microbiome on mental health disorders during pregnancy and postpartum.

History of premenstrual syndrome and development of postpartum depression: A systematic review and meta-analysis

BACKGROUND

Premenstrual syndrome (PMS) is thought to be a risk factor for postpartum depression (PPD), but results from studies examining the association have been mixed.

OBJECTIVES

To estimate the association between pre-pregnancy history of PMS and development of PPD and evaluate the risk of bias of included evidence.

SEARCH STRATEGY

PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Library, CNKI, Wanfang Data, and reference lists of relevant papers were searched.

SELECTION CRITERIA

Observational studies that collected pre-pregnancy history of PMS and measured PPD status between one week and one year after delivery were included.

DATA COLLECTION AND ANALYSIS

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effect models were used to calculate pooled odds ratios (ORs) with 95% confidence interval (CI). Small study effect was analysed by funnel plot. Risk of bias was assessed using the Risk of Bias Instrument for Non-Randomized Studies of Exposures (ROBINS-E).

MAIN RESULTS

Our meta-analysis included 19 studies. Overall, women with a pre-pregnancy history of PMS had more than double the odds of PPD compared to those without PMS (OR: 2.20, 95% CI: 1.81-2.68). However, the quality of evidence was low: five studies had moderate risk, eleven studies had serious risk, and three studies had critical risk of bias.

CONCLUSIONS

Current evidence supports a significant association between history of PMS and development of PPD. Well-designed prospective studies are needed to further investigate this relationship.

Perinatal depressive symptoms among Thai women: A hospital-based longitudinal study

The authors of this longitudinal study investigated risk factors for postpartum depressive symptoms and differences in depressive symptoms at late pregnancy and at 1 and 3 months postpartum. In Sakhonnakhon Province, in northeastern Thailand, 449 women were recruited during late pregnancy and followed at 1 and 3 months postpartum with the use of psychosocial factors. Depressive symptom scores were measured using the Edinburgh Postnatal Depression Scale (EPDS). The scores were compared using dependent-samples t-tests, and multiple linear regression analyses were used to identify risk factors for depressive symptoms at 1 and 3 months postpartum. EPDS scores decreased from late pregnancy to 1 month postpartum and remained on the same level until 3 months postpartum. Low psychological well-being scores and low personal monthly income were risk factors for increased EPDS scores at 1 and 3 months postpartum. Pregnant women in Thailand who have a low income, have limited social support, and report low psychological well-being are at increased risk for postpartum depression. Results of this study suggest they should be screened for depressive symptoms during pregnancy, referred for diagnosis, and provided treatment to reduce the risk of ongoing depressive symptoms during the postpartum period.

Lowered Plasma Steady-State Levels of Progesterone Combined With Declining Progesterone Levels During the Luteal Phase Predict Peri-Menstrual Syndrome and Its Major Subdomains

BACKGROUND

It is unknown whether lowered steady state levels of sex hormones coupled with changes in those hormones during the menstrual cycle are associated with premenstrual syndrome (PMS).

OBJECTIVE

To examine associations between levels of progesterone and oestradiol during the menstrual cycle and PMS considering different diagnostic criteria for PMS.

METHODS

Forty-one women aged 18-45 years with a regular menstrual cycle completed the Daily Record of Severity of Problems (DRSP) for all 28 consecutive days of the menstrual cycle. Blood was sampled at days 7, 14, 21, and 28 to assay oestradiol and progesterone.

RESULTS

We developed a new diagnosis of peri-menstrual syndrome, which is characterized by increased DRSP severity in pre and post-menstrual periods and increased scores on the major DRSP dimensions, i.e., depression, physio-somatic symptoms, breast tenderness and appetite, and anxiety. This new diagnosis performed better than classical diagnoses of PMS, including that of the American College of Obstetricians and Gynecologists (ACOG). Lowered steady state levels of progesterone, when averaged over the menstrual cycle, together with declining progesterone levels during the luteal phase predict severity of peri-menstrual symptoms. Steady state levels of oestradiol and declining oestradiol levels during the cycle are also related to DRSP severity although most of these effects appeared to be mediated by progesterone.

CONCLUSION

A significant increase in menstrual-cycle related symptoms can best be conceptualized as "peri-menstrual syndrome" and may result from insufficient progesterone production (relative corpus luteum insufficiency), which, in part may result from lowered oestradiol production indicating suboptimal pre-ovulatory follicular development.

A Comprehensive Analysis of Post-partum Depression Risk Factors: The Role of Socio-Demographic, Individual, Relational, and Delivery Characteristics

Postpartum depression is a common and complex phenomenon that can cause relevant negative outcomes for children, women and families. Existing literature highlights a wide range of risk factors. The main focus of this paper is to jointly investigate different types of risk factors (socio-demographic, psychopathological, relational, and related to labor and birth experience) in post-partum depression onset in women during first-child pregnancy, identifying which of these are the most important predictors. A cohort longitudinal study was conducted on 161 Italian nulliparous low-risk women (M_age = 31.63; SD = 4.88) without elective cesarean. Data was collected at three different times: Socio-demographic, prenatal anxiety and depression, and quality of close relationship network (with mother, father and partner, and the prenatal attachment to child) were assessed at T1 (week 31–32 of gestation); clinical data on labor and childbirth (mode and typology of delivery, duration of labor, duration of eventual administration of epidural analgesia, and child's APGAR index at birth) were registered at T2 (the day of childbirth); and the degree of post-natal depression symptomatology was measured at T3 (1 month after birth). Postpartum depression is associated with several risk factors (woman's age, woman's prenatal psychopathological characteristics, the level of prenatal attachment to child, the quality of romantic relationship, and some clinical delivery difficulties). Overall, the level of prenatal attachment to child was the most important predictor of post-partum depression. These findings emphasize the very important role of prenatal attachment for the onset of postpartum depression and the need to promote adequate and targeted prevention interventions. Limitations, strengths, and theoretical and clinical implications are discussed.

Development, Psychometric Assessment, and Predictive Validity of the Postpartum Childcare Stress Checklist

BACKGROUND

Childcare stress has been shown to predict postpartum depression; however, there is little research exploring and validating the dimensions of childcare stress instruments such that preventive interventions can be created.

OBJECTIVES

The aim of this study was to develop and psychometrically test an instrument to measure parental perceptions of postpartum childcare stress.

METHODS

Using research based on postpartum stress and childcare stress, the Postpartum Childcare Stress Checklist (PCSC) was developed, and content validity was judged by experts. The PCSC was psychometrically assessed in a cohort of 541 women in a health region near Vancouver, Canada, who were followed to 8 weeks postpartum in 2002. The psychometric assessment analyses comprised internal consistency, exploratory factory analysis, concurrent validity, and predictive validity.

RESULTS

The 19-item PCSC had good internal consistency (Kuder-Richardson Formula 20 coefficient: 0.81). Exploratory factor analysis revealed the following dimensions: (a) relationship with the partner, (b) caring for the infant, (c) maternal social interactions, and (d) establishing a new routine. Predictive validity analyses showed that PCSC total and subscale scores at 4 weeks were positively correlated with depressive symptomatology, anxiety, and perceived stress and negatively correlated with global and partner support at 8 weeks postpartum.

DISCUSSION

The PCSC is a measure of childcare stress with excellent reliability and validity. Upon further testing, it may be used to identify women and couples in need of greater support, individualize postpartum care, and evaluate the effectiveness of preventive interventions.

A neuro-immune, neuro-oxidative and neuro-nitrosative model of prenatal and postpartum depression

A large body of evidence indicates that major affective disorders are accompanied by activated neuro-immune, neuro-oxidative and neuro-nitrosative stress (IO&NS) pathways. Postpartum depression is predicted by end of term prenatal depressive symptoms whilst a lifetime history of mood disorders appears to increase the risk for both prenatal and postpartum depression. This review provides a critical appraisal of available evidence linking IO&NS pathways to prenatal and postpartum depression. The electronic databases Google Scholar, PubMed and Scopus were sources for this narrative review focusing on keywords, including perinatal depression, (auto)immune, inflammation, oxidative, nitric oxide, nitrosative, tryptophan catabolites (TRYCATs), kynurenine, leaky gut and microbiome. Prenatal depressive symptoms are associated with exaggerated pregnancy-specific changes in IO&NS pathways, including increased C-reactive protein, advanced oxidation protein products and nitric oxide metabolites, lowered antioxidant levels, such as zinc, as well as lowered regulatory IgM-mediated autoimmune responses. The latter pathways coupled with lowered levels of endogenous anti-inflammatory compounds, including ω3 polyunsaturated fatty acids, may also underpin the pathophysiology of postpartum depression. Although increased bacterial translocation, lipid peroxidation and TRYCAT pathway activation play a role in mood disorders, similar changes do not appear to be relevant in perinatal depression. Some IO&NS biomarker characteristics of mood disorders are found in prenatal depression indicating that these pathways partly contribute to the association of a lifetime history of mood disorders and perinatal depression. However, available evidence suggests that some IO&NS pathways differ significantly between perinatal depression and mood disorders in general. This review provides a new IO&NS model of prenatal and postpartum depression.

Kangaroo care and postpartum depression: The role of oxytocin

Problem

Postpartum depression occurs in about 10–22% of women after birth and adversely affects their health and the health of their newborn. Kangaroo care is known to have many health-related benefits for both the mother and her newborn.

Purpose

The aim of this review was to gather the evidence linking the effects of kangaroo care with postpartum depression, specifically focusing on the proposed underlying mechanism involving the release of oxytocin.

Method

The literature review was conducted by targeting PubMed, CINAHL, and Google Scholar databases. The search terms used were postpartum depression, postnatal depression, oxytocin, oxytocin hormone, postpartum depression, kangaroo care, and skin-to-skin contact.

Results

Kangaroo care was found to play an important role in decreasing the risk for postpartum depression. Skin-to-skin contact during kangaroo care was found to trigger the release of oxytocin, which is hypothesized to minimize the risk for depressive symptoms as well as decrease maternal stress. The oxytocinergic system regulates the release of oxytocin, which is an effect that is opposite that which occurs with the human stress response, in which the sympathetic nervous system is activated to release catecholamines in response to harmful or threatening stimuli. The oxytocinergic system regulates calmness, connection, and socialization processes. During kangaroo care, oxytocin blocks the stress response and decreases the circulation of catecholamines, yielding positive outcomes that include maternal stress reduction and prevention of postpartum depression.

Conclusion

Kangaroo care can be used as a non-pharmacological intervention to prevent or decrease the risk of postpartum depression.