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Teruyama R, Govar AA. Role of sexually dimorphic oxytocin receptor-expressing neurons in the anteroventral periventricular nucleus on maternal behavior. Peptides 2024; 180:171283. [PMID: 39142352 DOI: 10.1016/j.peptides.2024.171283] [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: 02/28/2024] [Revised: 07/12/2024] [Accepted: 08/11/2024] [Indexed: 08/16/2024]
Abstract
Oxytocin is a neuropeptide produced by magnocellular neurosecretory neurons located primarily in the supraoptic nucleus and paraventricular nucleus of the hypothalamus. The long axons of these neurons project to the neurohypophysis where oxytocin is released into the general circulation in response to the physiological demands. Oxytocin plays critical roles in female reproductive physiology, specifically in uterine contraction during labor and milk ejection while nursing. Oxytocin is also called "the love hormone" due to its modulatory roles in prosocial behaviors, including social recognition, maternal behavior, and pair bonding. Oxytocin influences behaviors by binding to oxytocin receptors (OXTR) located in various parts of the brain. Previously, we discovered a group of estrogen-dependent OXTR neurons that is exclusively present in the anteroventral periventricular nucleus (AVPV) of females but not of males. The female-specific expression of OXTR in the AVPV is a rare case of neurochemically-demonstrated, all-or-none sexual dimorphism in the brain. In this review, the cellular characterization and functional significance of the sexually dimorphic OXTR neurons in the AVPV as well as the clinical implications of the research will be discussed.
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Affiliation(s)
- Ryoichi Teruyama
- Department of Biological Sciences, Louisiana State University, LA, USA.
| | - Armita A Govar
- Department of Biological Sciences, Louisiana State University, LA, USA.
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2
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Li M. Is melanin-concentrating hormone in the medial preoptic area a signal for the decline of maternal care in late postpartum? Front Neuroendocrinol 2024; 75:101155. [PMID: 39222798 DOI: 10.1016/j.yfrne.2024.101155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/28/2024] [Accepted: 08/30/2024] [Indexed: 09/04/2024]
Abstract
This manuscript proposes that melanin-concentrating hormone (MCH) in the medial preoptic area (MPOA) is an neurochemical signal evolved to trigger the declining process of maternal care. MCH in the MPOA appears only after parturition and is progressively increased with the progression of lactation, while maternal behavior declines progressively. Intra-MPOA injection of MCH decreases active maternal responses. MCH is also highly responsive to infant characteristics and maternal condition. Behavioral changes induced by MCH in late postpartum period are conducive to the decline of infant-directed maternal behavior. The MPOA MCH system may mediate the maternal behavior decline by suppressing the maternal approach motivation and/or increasing maternal withdrawal via its inhibitory action onto the mesolimbic dopamine D1/D2 receptors and its stimulating action on serotonin 5-HT2C receptors in the ventral tegmental area. Research into the MCH maternal effects will enhance our understanding of the neurochemical mechanisms underlying the maternal behavior decline.
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Affiliation(s)
- Ming Li
- Department of Psychology, Nanjing University, Nanjing 210023, China.
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Bradshaw JL, Wilson EN, Gardner JJ, Mabry S, Tucker SM, Rybalchenko N, Vera E, Goulopoulou S, Cunningham RL. Pregnancy-induced oxidative stress and inflammation are not associated with impaired maternal neuronal activity or memory function. Am J Physiol Regul Integr Comp Physiol 2024; 327:R35-R45. [PMID: 38708544 PMCID: PMC11381002 DOI: 10.1152/ajpregu.00026.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/28/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
Pregnancy is associated with neural and behavioral plasticity, systemic inflammation, and oxidative stress, yet the impact of inflammation and oxidative stress on maternal neural and behavioral plasticity during pregnancy is unclear. We hypothesized that healthy pregnancy transiently reduces learning and memory and these deficits are associated with pregnancy-induced elevations in inflammation and oxidative stress. Cognitive performance was tested with novel object recognition (recollective memory), Morris water maze (spatial memory), and open field (anxiety-like) behavior tasks in female Sprague-Dawley rats of varying reproductive states [nonpregnant (nulliparous), pregnant (near term), and 1-2 mo after pregnancy (primiparous); n = 7 or 8/group]. Plasma and CA1 proinflammatory cytokines were measured with a MILLIPLEX magnetic bead assay. Plasma oxidative stress was measured via advanced oxidation protein products (AOPP) assay. CA1 markers of oxidative stress, neuronal activity, and apoptosis were quantified via Western blot analysis. Our results demonstrate that CA1 oxidative stress-associated markers were elevated in pregnant compared with nulliparous rats (P ≤ 0.017) but there were equivalent levels in pregnant and primiparous rats. In contrast, reproductive state did not impact CA1 inflammatory cytokines, neuronal activity, or apoptosis. Likewise, there was no effect of reproductive state on recollective or spatial memory. Even so, spatial learning was impaired (P ≤ 0.007) whereas anxiety-like behavior (P ≤ 0.034) was reduced in primiparous rats. Overall, our data suggest that maternal hippocampal CA1 is protected from systemic inflammation but vulnerable to peripartum oxidative stress. Peripartum oxidative stress elevations, such as in pregnancy complications, may contribute to peripartum neural and behavioral plasticity.NEW & NOTEWORTHY Healthy pregnancy is associated with elevated maternal systemic and brain oxidative stress. During postpregnancy, brain oxidative stress remains elevated whereas systemic oxidative stress is resolved. This sustained maternal brain oxidative stress is associated with learning impairments and decreased anxiety-like behavior during the postpregnancy period.
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Affiliation(s)
- Jessica L Bradshaw
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - E Nicole Wilson
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Jennifer J Gardner
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Steve Mabry
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Selina M Tucker
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Nataliya Rybalchenko
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Edward Vera
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, United States
| | - Styliani Goulopoulou
- Lawrence D. Longo Center for Perinatal Biology, Departments of Basic Sciences, Gynecology and Obstetrics, Loma Linda University, Loma Linda, California, United States
| | - Rebecca L Cunningham
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas, United States
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Zikic O, Stojanov J, Kostic J, Nikolic G, Tosic Golubovic S, Simonovic M, Djordjevic V, Binic I. Depression in the Perinatal Period: Course and Outcome of Depression in the Period from the Last Trimester of Pregnancy to One Year after Delivery in Primiparous Mothers. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:970. [PMID: 38929587 PMCID: PMC11206133 DOI: 10.3390/medicina60060970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/02/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: One of the most significant psychiatric problems in women is depression related to the perinatal period. Our study aims to determine the frequency and course of depressive symptomatology in the perinatal period with particular reference to objective rate and outcome of postpartum depression. Materials and Methods: One hundred and eighty-eight pregnant/postnatal women were included in a prospective, longitudinal, observational study during which the depressive symptomatology was estimated at the third trimester of pregnancy, and the first, sixth, and twelfth month' postpartum. All participants completed a semi-structured sociodemographic questionnaire constructed for research purposes, the Edinburgh Postnatal Depression Scale, Toronto Alexithymia Scale, Beck Anxiety Inventory, and The Mood Disorder Questionnaire at each time point. Postpartum depression diagnosis was confirmed by a trained and certified psychiatrist with long-standing experience. For a better understanding of the trajectory of depressive symptomatology and genuine postpartum depression, we classified depression into those with new-onset and those left over from the previous observation period. Results: In general, 48.9% of participants in the study were depressed at some point during the investigation. A total of 10.6% of women were depressed in the third trimester. The highest percentage of new-onset depression (25%) was in the first month after giving birth and was maintained for up to six months, after which the appearance was sporadic. Most of the postpartum depression resolved in the period from the first month to the sixth month after childbirth (20.7%). The episodes mainly had characteristics of unipolar depression. Conclusions: Our results imply that a new onset of depression is most intensive during the first six months, and after that, it is sporadic. Further studies are needed to explore whether all depressive symptomatology in the postnatal period is the same, or perhaps postpartum depression, classified in this way, has specific characteristics, etiology, and consequently different treatment and preventive options.
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Affiliation(s)
- Olivera Zikic
- Faculty of Medicine, Department of Psychiatry with Medical Psychology, University of Niš, Bul. dr Zorana Djindjića 81, 18000 Niš, Serbia; (J.K.); (G.N.); (S.T.G.); (M.S.); (V.D.); (I.B.)
- Center for Mental Health Protection, University Clinical Center Nis, Bul. dr Zorana Djindjića 48a, 18000 Niš, Serbia
| | - Jelena Stojanov
- Special Hospital for Psychiatric Diseases “Gornja Toponica”, 18202 Niš, Serbia;
| | - Jelena Kostic
- Faculty of Medicine, Department of Psychiatry with Medical Psychology, University of Niš, Bul. dr Zorana Djindjića 81, 18000 Niš, Serbia; (J.K.); (G.N.); (S.T.G.); (M.S.); (V.D.); (I.B.)
- Center for Mental Health Protection, University Clinical Center Nis, Bul. dr Zorana Djindjića 48a, 18000 Niš, Serbia
| | - Gordana Nikolic
- Faculty of Medicine, Department of Psychiatry with Medical Psychology, University of Niš, Bul. dr Zorana Djindjića 81, 18000 Niš, Serbia; (J.K.); (G.N.); (S.T.G.); (M.S.); (V.D.); (I.B.)
- Center for Mental Health Protection, University Clinical Center Nis, Bul. dr Zorana Djindjića 48a, 18000 Niš, Serbia
| | - Suzana Tosic Golubovic
- Faculty of Medicine, Department of Psychiatry with Medical Psychology, University of Niš, Bul. dr Zorana Djindjića 81, 18000 Niš, Serbia; (J.K.); (G.N.); (S.T.G.); (M.S.); (V.D.); (I.B.)
- Clinic for Psychiatry, University Clinical Center Nis, Bul. dr Zorana Djindjića 48a, 18000 Niš, Serbia
| | - Maja Simonovic
- Faculty of Medicine, Department of Psychiatry with Medical Psychology, University of Niš, Bul. dr Zorana Djindjića 81, 18000 Niš, Serbia; (J.K.); (G.N.); (S.T.G.); (M.S.); (V.D.); (I.B.)
- Center for Mental Health Protection, University Clinical Center Nis, Bul. dr Zorana Djindjića 48a, 18000 Niš, Serbia
| | - Vladimir Djordjevic
- Faculty of Medicine, Department of Psychiatry with Medical Psychology, University of Niš, Bul. dr Zorana Djindjića 81, 18000 Niš, Serbia; (J.K.); (G.N.); (S.T.G.); (M.S.); (V.D.); (I.B.)
- Center for Mental Health Protection, University Clinical Center Nis, Bul. dr Zorana Djindjića 48a, 18000 Niš, Serbia
| | - Iva Binic
- Faculty of Medicine, Department of Psychiatry with Medical Psychology, University of Niš, Bul. dr Zorana Djindjića 81, 18000 Niš, Serbia; (J.K.); (G.N.); (S.T.G.); (M.S.); (V.D.); (I.B.)
- Clinic for Psychiatry, University Clinical Center Nis, Bul. dr Zorana Djindjića 48a, 18000 Niš, Serbia
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Asante HA, Boyetey ST, Essaw E, Nyame CA, Mante B, Dziwornu L, Okyere P. Prevalence and factors associated with antepartum depression among adolescent women in the assin north district of Ghana: a cross-sectional study. BMC Womens Health 2024; 24:276. [PMID: 38711102 DOI: 10.1186/s12905-024-03111-1] [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: 11/10/2023] [Accepted: 04/23/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Globally, depression is a leading cause of disease-related disability among women. In low-and-middle-income countries (LMICs), the prevalence rate of antepartum depression is estimated to range between 15% and 57% and even higher in adolescent antepartum women. Although a number of studies have shown that depression is common in adolescent pregnancies and has a prevalence rate between 28% and 67% among adolescent mothers, there currently exists no literature on depression among adolescent pregnant women in Ghana. The study aimed to determine the prevalence of antepartum depression and identify the factors associated with it among pregnant adolescent women. METHODS A quantitative cross-sectional study design was adopted by randomly recruiting 220 adolescent pregnant women visiting antenatal clinics in five selected health facilities in five communities in the Assin North District of Ghana. Data were collected using the Edinburgh Postnatal Depression Scale (EPDS). Data analysis was performed using Stata version 14. Both descriptive and inferential analyses were performed. A chi-square analysis was conducted to identify the association between independent and dependent variables. A multivariate logistic regression analysis was carried out to identify the independent variables that were significantly associated with the dependent variable. In all analyses, p-values ≤ 0.05 were deemed statistically significant at a 95% confidence interval. RESULTS The results indicated prevalence of depression was 38.6% using the EPDS cut-off ≥ 13. Respondents who were cohabiting were less likely to experiencing antepartum depression compared to those who were single (AOR = 0.36, 95% CI: 0.20-0.64, p = 0.001). Also, Respondents who had completed Junior High School had a lower likelihood of experiencing antepartum depression compared to those who had no formal education (AOR = 0.19, 95% CI: 0.05-0.76, p = 0.019). Respondents who perceived pregnancy-related items to be costly had higher odds of experiencing antepartum depression (AOR = 2.05, 95% CI: 1.02-4.12, p = 0.042). Lastly, adolescent pregnant women who reported that pregnancy-related items are costly were likely to experience antepartum depression compared to those who did not report such costs (AOR = 2.12, 95% CI: 1.20-3.75, p < 0.001). CONCLUSION The results of this study highlight the importance of a multi-pronged strategy for combating antepartum depression in adolescents and improving the overall health and well-being of pregnant adolescents. Considering that adolescence is a transitional period occasioned by several bio-psycho-social challenges, setting up systems to ensure that young girls are motivated and supported to stay in school will enhance their economic prospects and improve their standards of life while providing psycho-social support will benefit their health and general well-being.
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Affiliation(s)
- Hannah Amoquandoh Asante
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Shadrach Tetteh Boyetey
- Department of Health Policy, Management and Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ebenezer Essaw
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Christopher Amoah Nyame
- Department of Occupational and Environmental Health and Safety, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bertha Mante
- Department of Real Estate and Land Management, University for Development Studies, Tamale, Ghana
| | - Louisa Dziwornu
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Paul Okyere
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Kondracki AJ, Attia JR, Valente MJ, Roth KB, Akin M, McCarthy CA, Barkin JL. Exploring a Potential Interaction Between the Effect of Specific Maternal Smoking Patterns and Comorbid Antenatal Depression in Causing Postpartum Depression. Neuropsychiatr Dis Treat 2024; 20:795-807. [PMID: 38586309 PMCID: PMC10999203 DOI: 10.2147/ndt.s450236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/10/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose To explore a potential interaction between the effect of specific maternal smoking patterns and the presence of antenatal depression, as independent exposures, in causing postpartum depression (PPD). Methods This case-control study of participants with singleton term births (N = 51220) was based on data from the 2017-2018 Pregnancy Risk Assessment Monitoring System. Multivariable log-binomial regression models examined the main effects of smoking patterns and self-reported symptoms of antenatal depression on the risk of PPD on the adjusted risk ratio (aRR) scale and tested a two-way interaction adjusting for covariates selected in a directed acyclic graph (DAG). The interaction effects were measured on the additive scale using relative excess risk due to interaction (RERI), the attributable proportion of interaction (AP), and the synergy index (SI). Causal effects were defined in a counterfactual framework. The E-value quantified the potential impact of unobserved/unknown covariates, conditional on observed covariates. Results Among 6841 women in the sample who self-reported PPD, 35.7% also reported symptoms of antenatal depression. Out of 3921 (7.7%) women who reported smoking during pregnancy, 32.6% smoked at high intensity (≥10 cigarettes/day) in all three trimesters and 36.6% had symptoms of antenatal depression. The main effect of PPD was the strongest for women who smoked at high intensity throughout pregnancy (aRR 1.65; 95% CI: 1.63, 1.68). A synergistic interaction was detected, and the effect of all maternal smoking patterns was augmented, particularly in late pregnancy for Increasers and Reducers. Conclusion Strong associations and interaction effects between maternal smoking patterns and co-occurring antenatal depression support smoking prevention and cessation interventions during pregnancy to lower the likelihood of PPD.
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Affiliation(s)
- Anthony J Kondracki
- Department of Community Medicine, Mercer University School of Medicine, Savannah and Macon, GA, USA
| | - John R Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Matthew J Valente
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Kimberly B Roth
- Department of Community Medicine, Mercer University School of Medicine, Savannah and Macon, GA, USA
| | - Marshall Akin
- Memorial Health University Medical Center, Savannah, GA, USA
| | | | - Jennifer L Barkin
- Department of Community Medicine, Mercer University School of Medicine, Savannah and Macon, GA, USA
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Gallitelli V, Franco R, Guidi S, Puri L, Parasiliti M, Vidiri A, Eleftheriou G, Perelli F, Cavaliere AF. Depression Treatment in Pregnancy: Is It Safe, or Is It Not? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:404. [PMID: 38673317 PMCID: PMC11049910 DOI: 10.3390/ijerph21040404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
Prenatal depression carries substantial risks for maternal and fetal health and increases susceptibility to postpartum depression. Untreated depression in pregnancy is correlated with adverse outcomes such as an increased risk of suicidal ideation, miscarriage and neonatal growth problems. Notwithstanding concerns about the use of antidepressants, the available treatment options emphasize the importance of specialized medical supervision during gestation. The purpose of this paper is to conduct a brief literature review on the main antidepressant drugs and their effects on pregnancy, assessing their risks and benefits. The analysis of the literature shows that it is essential that pregnancy be followed by specialized doctors and multidisciplinary teams (obstetricians, psychiatrists and psychologists) who attend to the woman's needs. Depression can now be treated safely during pregnancy by choosing drugs that have no teratogenic effects and fewer side effects for both mother and child. Comprehensive strategies involving increased awareness, early diagnosis, clear guidelines and effective treatment are essential to mitigate the impact of perinatal depression.
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Affiliation(s)
- Vitalba Gallitelli
- Division of Gynecology and Obstetrics, Isola Tiberina Gemelli Hospital, 00186 Rome, Italy; (V.G.); (L.P.); (M.P.); (A.V.); (A.F.C.)
| | - Rita Franco
- Division of Gynecology and Obstetrics, Isola Tiberina Gemelli Hospital, 00186 Rome, Italy; (V.G.); (L.P.); (M.P.); (A.V.); (A.F.C.)
| | - Sofia Guidi
- Division of Gynecology and Obstetrics, IRCSS Azienda Ospedaliera-Universitaria of Bologna, 40138 Bologna, Italy;
| | - Ludovica Puri
- Division of Gynecology and Obstetrics, Isola Tiberina Gemelli Hospital, 00186 Rome, Italy; (V.G.); (L.P.); (M.P.); (A.V.); (A.F.C.)
| | - Marco Parasiliti
- Division of Gynecology and Obstetrics, Isola Tiberina Gemelli Hospital, 00186 Rome, Italy; (V.G.); (L.P.); (M.P.); (A.V.); (A.F.C.)
| | - Annalisa Vidiri
- Division of Gynecology and Obstetrics, Isola Tiberina Gemelli Hospital, 00186 Rome, Italy; (V.G.); (L.P.); (M.P.); (A.V.); (A.F.C.)
| | | | - Federica Perelli
- Azienda USL Toscana Centro, Gynecology and Obstetrics Department, Santa Maria Annunziata Hospital, 50012 Florence, Italy;
| | - Anna Franca Cavaliere
- Division of Gynecology and Obstetrics, Isola Tiberina Gemelli Hospital, 00186 Rome, Italy; (V.G.); (L.P.); (M.P.); (A.V.); (A.F.C.)
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Bradshaw JL, Wilson EN, Gardner JJ, Mabry S, Tucker SM, Rybalchenko N, Vera E, Goulopoulou S, Cunningham RL. Pregnancy-associated oxidative stress and inflammation are not associated with impaired maternal neuronal activity or memory function. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.26.577461. [PMID: 38328246 PMCID: PMC10849653 DOI: 10.1101/2024.01.26.577461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Pregnancy is associated with neural and behavioral plasticity, systemic inflammation, and oxidative stress. Yet, the impact of systemic inflammation and oxidative stress on maternal neural and behavioral plasticity during pregnancy are unclear. We hypothesized that the maternal hippocampal CA1, a brain region associated with cognition, would be protected from pregnancy-associated systemic elevations in inflammation and oxidative stress, mediating stable peripartum cognitive performance. Cognitive performance was tested using novel object recognition (recollective memory), Morris water maze (spatial memory), and open field (anxiety-like) behavior tasks in female Sprague-Dawley rats of varying reproductive states [non-pregnant (nulliparous), pregnant (near term), and two months post-pregnancy (primiparous); n = 7-8/group]. Plasma and CA1 proinflammatory cytokines were measured using a MILLIPLEX® magnetic bead assay. Plasma oxidative stress was measured via advanced oxidation protein products (AOPP) assay. CA1 markers of oxidative stress, neuronal activity, and apoptosis were quantified via western blotting. Our results demonstrate CA1 oxidative stress-associated markers were elevated in pregnant compared to nulliparous rats ( p ≤ 0.017) but were equivalent levels in pregnant and primiparous rats. In contrast, reproductive state did not impact CA1 inflammatory cytokines, neuronal activity, or apoptosis. Likewise, there was no effect of reproductive state on recollective or spatial memory. Even so, spatial learning was impaired ( p ≤ 0.007) while anxiety-like behavior ( p ≤ 0.034) was reduced in primiparous rats. Overall, our data suggest maternal hippocampal CA1 is protected from systemic inflammation but vulnerable to peripartum oxidative stress. Thus, peripartum oxidative stress elevations, such as in pregnancy complications, may contribute to peripartum neural and behavioral plasticity.
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Gow ML, Lam YWI, Jebeile H, Craig ME, Susic D, Henry A. Antenatal diet quality and perinatal depression: the Microbiome Understanding in Maternity Study (MUMS) cohort. J Hum Nutr Diet 2023; 36:754-762. [PMID: 36106616 PMCID: PMC10947382 DOI: 10.1111/jhn.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous findings from research investigating the role of antenatal nutrition in preventing postpartum depression (PPD) are inconsistent. Our primary aim was to investigate the association between pregnancy diet quality and PPD. Our secondary aim was to investigate associations between (a) diet quality and depression during pregnancy and (b) depression during pregnancy and PPD. METHODS This analysis represents data from 73 women participating in the Microbiome Understanding in Maternity Study (MUMS) cohort in Sydney, Australia, which followed women from Trimester 1 of pregnancy to 1-year postpartum (PP). Participants' diet quality was assessed using the Australian Eating Survey at Trimester 1 and 3 to calculate diet quality, known as the Australian Recommended Food Score (lower diet quality defined as score <39; higher diet quality ≥39). Depression was assessed using the Edinburgh Depression Scale at Trimesters 1, 2, 3 and 6 weeks PP (defined as score ≥11). RESULTS Depression scores during pregnancy were significantly associated with depression score 6 weeks PP (Trimester 1: r = 0.66, Trimester 2: r = 0.69, Trimester 3: r = 0.67; all p < 0.001). Diet quality during pregnancy was not significantly correlated with 6-week PPD score. In unadjusted analysis, diet quality during pregnancy was not associated with pregnancy depression scores. When adjusted for age, parity and Trimester 1 body mass index, Trimester 1 physical activity levels and gestational weight gain, higher Trimester 3 diet quality was associated with reduced Trimester 3 depression only. CONCLUSIONS Depression scores during pregnancy were positively associated with PPD, highlighting the importance of screening for depression during pregnancy and postnatally. Larger longitudinal prospective studies may elucidate the association between diet quality and PPD.
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Affiliation(s)
- Megan L. Gow
- The University of Sydney Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- School of Women and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Women's and Children's HealthSt George HospitalKogarahNew South WalesAustralia
| | - Yei W. I. Lam
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Hiba Jebeile
- The University of Sydney Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Maria E. Craig
- The University of Sydney Children's Hospital Westmead Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
- School of Women and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Women's and Children's HealthSt George HospitalKogarahNew South WalesAustralia
- Institute of Endocrinology and DiabetesThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Daniella Susic
- School of Women and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Women's and Children's HealthSt George HospitalKogarahNew South WalesAustralia
| | - Amanda Henry
- School of Women and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Women's and Children's HealthSt George HospitalKogarahNew South WalesAustralia
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Terrone G, Bianciardi E, Fontana A, Pinci C, Castellani G, Sferra I, Forastiere A, Merlo M, Marinucci E, Rinaldi F, Falanga M, Pucci D, Siracusano A, Niolu C. Psychological Characteristics of Women with Perinatal Depression Who Require Psychiatric Support during Pregnancy or Postpartum: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085508. [PMID: 37107790 PMCID: PMC10138626 DOI: 10.3390/ijerph20085508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
Antenatal depression may be distinct from postpartum depression in terms of prevalence, severity of symptoms, comorbidities, prognosis, and risk factors. Although risk factors for perinatal depression have been identified, it is unclear whether there are differences in the onset of perinatal depression (PND). This study explored the characteristics of women requiring mental health support during pregnancy or postpartum. A sample of 170 women (58% in pregnancy; 42% postpartum) who contacted the SOS-MAMMA outpatient clinic was recruited. Clinical data sheets and self-report questionnaires (EPDS, LTE-Q, BIG FIVE; ECR; BSQ; STICSA) were administered, hypothesizing possible risk factors, such as personality traits, stressful life events, body dissatisfaction, attachment style, and anxiety. Hierarchical regression models were carried out in the pregnancy (F10;36 = 8.075, p < 0.001, adjR2 = 0.877) and postpartum groups (F10;38 = 3.082, p < 0.05, adjR2 = 0.809). Recent stressful life events and conscientiousness were associated with depression in both the pregnant (29.3%, 25.5% of variance) and postpartum groups (23.8%, 20.7% of variance). In pregnant women, "openness" (11.6%), body dissatisfaction (10.2%), and anxiety (7.1%) symptoms were predictive of depression. In the postpartum group, "neuroticism" (13.8%) and insecure romantic attachment dimensions (13.4%; 9.2%) were the strongest predictors. Perinatal psychological interventions should consider the differences between mothers with depression during pregnancy and postpartum.
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Affiliation(s)
- Grazia Terrone
- Department of History, Cultural Heritage, Education and Society, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Correspondence:
| | - Andrea Fontana
- Department of Human Sciences, Lumsa University of Rome, 00193 Rome, Italy
| | - Carolina Pinci
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giulia Castellani
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Irene Sferra
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Anna Forastiere
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Mattia Merlo
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Elicio Marinucci
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Fiamma Rinaldi
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Marina Falanga
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Daniela Pucci
- Department of Mental Health and Pathological Addictions (DSMDP), ASL ROMA 5, 00019 Tivoli (Rome), Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
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11
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Forest G, Sabourin C, Pétrin R, Robidoux R, De Koninck J. Dream content and depressive symptoms during pregnancy and postpartum. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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12
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Ghuman A, McEwen A, Tran KH, Mitchell N, Hanstock C, Seres P, Jhangri G, Burgess D, Baker G, Le Melledo JM. Prospective Investigation of Glutamate Levels and Percentage Gray Matter in the Medial Prefrontal Cortex in Females at Risk for Postpartum Depression. Curr Neuropharmacol 2022; 20:1988-2000. [PMID: 35236264 PMCID: PMC9886796 DOI: 10.2174/1570159x20666220302101115] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/19/2022] [Accepted: 02/27/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The substantial female hormone fluctuations associated with pregnancy and postpartum have been linked to a greater risk of developing depressive symptoms, particularly in high-risk women (HRW), i.e. those with histories of mood sensitivity to female hormone fluctuations. We have shown that glutamate (Glu) levels in the medial prefrontal cortex (MPFC) decrease during perimenopause, a period of increased risk of developing a major depressive episode. Our team has also demonstrated that percentage gray matter (%GM), another neural correlate of maternal brain health, decreases in the MPFC during pregnancy. OBJECTIVE To investigate MPFC Glu levels and %GM from late pregnancy up to 7 weeks postpartum in HRW and healthy pregnant women (HPW). METHODS Single-voxel spectra were acquired from the MPFC of 41 HPW and 22 HRW using 3- Tesla in vivo proton magnetic resonance spectroscopy at five different time points. RESULTS We observed a statistically significant interaction between time and group for the metabolite Glu, with Glu levels being lower for HRW during pregnancy and early postpartum (p<0.05). MPFC %GM was initially lower during pregnancy and then significantly increased over time in both groups (p<0.01). CONCLUSION This investigation suggests that the vulnerability towards PPD is associated with unique fluctuations of MPFC Glu levels during pregnancy and early postpartum period. Our results also suggest that the decline in MPFC %GM associated with pregnancy seems to progressively recover over time. Further investigations are needed to determine the specific role that female hormones play on the physiological changes in %GM during pregnancy and postpartum.
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Affiliation(s)
- Arjun Ghuman
- Address correspondence to these authors at the Department of Psychiatry, Room 1E7.14, 8440 112 street Walter Mackenzie Center, Edmonton, Alberta, Canada, T6G 2B7; Tel: 780-407-6578; Fax: 780-407-6672; E-mail:
| | - Alyssa McEwen
- Address correspondence to these authors at the Department of Psychiatry, Room 1E7.14, 8440 112 street Walter Mackenzie Center, Edmonton, Alberta, Canada, T6G 2B7; Tel: 780-407-6578; Fax: 780-407-6672; E-mail:
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13
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Melby TC, Sørensen NB, Henriksen L, Lukasse M, Flaathen EME. Antenatal depression and the association of intimate partner violence among a culturally diverse population in southeastern Norway: A cross-sectional study. Eur J Midwifery 2022; 6:44. [PMID: 35935753 PMCID: PMC9289962 DOI: 10.18332/ejm/150009] [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: 03/31/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Antenatal depression and intimate partner violence (IPV) are independently associated with adverse short- and long-term health effects for women and their children. The main aim of the study was to investigate the prevalence of antenatal depression and the association between symptoms of antenatal depression and physical, emotional and sexual abuse in a culturally diverse population attending antenatal care. METHODS A cross-sectional study was conducted with 1812 culturally diverse pregnant women from Safe Pregnancy, a randomized controlled trial to test the effect of an intimate partner violence intervention for abused women in southeastern Norway. RESULTS More than one in ten women (14%) reported symptoms of antenatal depression. Women with symptoms of antenatal depression were significantly younger and single, had lower educational level, more limited economic resources and were more likely to use tobacco and to report negative experiences regarding alcohol consumption, including that of her partner, compared to women with no symptoms of depression. A total of 15.4% of the women reported experiences of some form of IPV during their lifetime. Most women reported previous experiences of IPV rather than recent experiences. Women with a history of IPV were significantly more likely to report symptoms of antenatal depression, after adjusting for confounding factors (AOR=1.96; 95% CI: 1.35–2.83). CONCLUSIONS Women who reported symptoms of antenatal depression were significantly more likely to have experienced physical, emotional and sexual IPV than women with no history of IPV. It is important to identify women at risk of antenatal depression in order to offer appropriate services during pregnancy.
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Affiliation(s)
- Thea Cathrine Melby
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Nina Benedicte Sørensen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Lena Henriksen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Division of General Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Mirjam Lukasse
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Eva Marie E Flaathen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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14
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Falek I, Acri M, Dominguez J, Havens J, McCord M, Sisco S, Wilcox W, Hoagwood K. Management of depression during the perinatal period: state of the evidence. Int J Ment Health Syst 2022; 16:21. [PMID: 35468808 PMCID: PMC9036756 DOI: 10.1186/s13033-022-00531-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perinatal depression (PND) is a prevalent ailment that affects both the woman and her family. Addressing PND in primary health care, such as pediatrics and obstetric care settings, has been proposed as an effective way to identify and treat women. OBJECTIVE The purpose of this study is to examine best practices for management of PND in obstetric and pediatric settings, as well as investigate the evidence that supports the guidelines. METHODS Guidelines were identified through a literature search and discussion with experts in the field of perinatal depression, while evidence was examined through a literature search of reviews and thereafter experimental studies. RESULTS Twenty-five guidelines, across 17 organizations were retained for analysis. Findings suggest that there is little or varied guidance on the management of PND, as well as a lack of specificity. Treatment was the topic most frequently reported, followed by screening. However best practices vary greatly and often contradict one another. Across all areas, there is inadequate or contrasting evidence to support these guidelines. CONCLUSIONS Although there was consensus on the key steps in the pathway to care, the review revealed lack of consensus across guidelines on specific issues relating to identification and management of depression during the perinatal period. Clinicians may use these recommendations to guide their practice, but they should be aware of the limitations of the evidence supporting these guidelines and remain alert to new evidence. There is a clear need for researchers and policymakers to prioritize this area in order to develop evidence-based guidelines for managing perinatal depression.
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Affiliation(s)
- Idan Falek
- Department of Child & Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.
| | - Mary Acri
- Department of Child & Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Joanna Dominguez
- Department of Child & Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Jennifer Havens
- Department of Child & Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Mary McCord
- New York City Health and Hospitals Corporation, 55 Water St., New York, NY, 10041, USA
| | - Sarah Sisco
- New York City Health and Hospitals Corporation, 55 Water St., New York, NY, 10041, USA
| | - Wendy Wilcox
- New York City Health and Hospitals Corporation, 55 Water St., New York, NY, 10041, USA
| | - Kimberly Hoagwood
- Department of Child & Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
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15
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Hildingsson I, Rubertsson C. Depressive symptoms during pregnancy and after birth in women living in Sweden who received treatments for fear of birth. Arch Womens Ment Health 2022; 25:473-484. [PMID: 35190877 PMCID: PMC8921011 DOI: 10.1007/s00737-022-01213-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 02/09/2022] [Indexed: 01/19/2023]
Abstract
The aim of this study was to investigate the prevalence of depressive symptoms and associated factors in women who underwent treatments for fear of birth; internet-based cognitive therapy, counseling with midwives, continuity with a known midwife or standard care. A secondary analysis was performed using data collected from four samples of women identified with fear of birth and receiving treatment with different methods. A questionnaire was used to collect data in mid-pregnancy and at follow-up 2 months after birth. Depressive symptoms were assessed using the Edinburgh Postnatal Depressive Scale. In mid-pregnancy, 32% of the 422 women with fear of birth also reported a co-morbidity with depressive symptoms. At postpartum follow-up, 19% reported depressive symptoms 2 months after birth, and 12% showed continued or recurrent depressive symptoms identified both during pregnancy and postpartum. A history of mental health problems was the strongest risk factor for presenting with depressive symptoms. None of the treatment options in this study was superior in reducing depressive symptoms. This study showed a significant co-morbidity and overlap between fear of birth and depressive symptoms. Screening for depressive symptoms and fear of birth during pregnancy is important to identify women at risk and offer specific treatment.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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16
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Oliveira TA, Luzetti GGCM, Rosalém MMA, Mariani Neto C. Screening of Perinatal Depression Using the Edinburgh Postpartum Depression Scale. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:452-457. [PMID: 35253138 PMCID: PMC9948039 DOI: 10.1055/s-0042-1743095] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To detect depression during pregnancy and in the immediate postpartum period using the Edinburgh postpartum depression scale (EPDS). METHODS Cross sectional study of 315 women, aged between 14 and 44 years, who received perinatal care at the Leonor Mendes de Barros Hospital, in São Paulo, between July 1st, 2019 and October 30th, 2020. The cutoff point suggesting depression was ≥ 12. RESULTS The screening indicated 62 (19.7%) patients experiencing depression. Low family income, multiparity, fewer prenatal appointments, antecedents of emotional disorders, dissatisfaction with the pregnancy, poor relationship with the partner, and psychological aggression were all risk factors associated with depression in pregnancy or in the immediate postpartum period. Antecedents of depression and psychology aggression during pregnancy were significant variables for predicting perinatal depression in the multivariate analysis. CONCLUSION There is a significant association between the occurrence of perinatal depression and the aforementioned psychosocial factors. Screening patients with the EPDS during perinatal and postpartum care could facilitate establishing a line of care to improve the wellbeing of mother and infant.
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Affiliation(s)
- Tenilson Amaral Oliveira
- Hospital Maternidade Leonor Mendes de Barros, São Paulo, SP, Brazil.,Universidade Cidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brazil
| | | | - Márcia Maria Auxiliadora Rosalém
- Hospital Maternidade Leonor Mendes de Barros, São Paulo, SP, Brazil.,Universidade Cidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brazil
| | - Corintio Mariani Neto
- Hospital Maternidade Leonor Mendes de Barros, São Paulo, SP, Brazil.,Universidade Cidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brazil
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17
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Bind RH. Immunological and other biological correlates of the impact of antenatal depression on the mother-infant relationship. Brain Behav Immun Health 2022; 20:100413. [PMID: 35112090 PMCID: PMC8790630 DOI: 10.1016/j.bbih.2022.100413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 01/07/2023] Open
Abstract
Antenatal depression affects up to 20% of pregnancies, yet research has historically focused on postnatal depression and its effects on mothers and their offspring. Studies are now emerging highlighting the impact that depression in pregnancy can also carry on both members of the dyad, including difficulties with psychological, physical, and social functioning. More specifically, researchers have begun to examine whether antenatal depression may lead to difficulties in the developing mother-infant relationship and subsequent infant attachment. While much of the research on this has explored psychosocial mechanisms behind the pathway from antenatal depression to a disrupted relationship in the postpartum, few studies have looked at biological underpinnings of this process. Of the literature that exists, it has been found that mothers with depression in pregnancy have lower levels of oxytocin and increased levels of inflammatory markers, plausibly creating difficulties in the mother-infant bonding process, leading to impaired mother-infant interactions and non-secure infant attachment. Furthermore, infants with non-secure attachments are at risk of entering a proinflammatory state due to a dysregulated stress response system. Overall, the literature on the neurobiology of mother-infant interactions and infant attachment in the context of antenatal depression is sparse, thus warranting future research.
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Affiliation(s)
- Rebecca H. Bind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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18
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Gunduz‐Bruce H, Takahashi K, Huang M. Development of neuroactive steroids for the treatment of postpartum depression. J Neuroendocrinol 2022; 34:e13019. [PMID: 34462985 PMCID: PMC9285576 DOI: 10.1111/jne.13019] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 01/25/2023]
Abstract
Postpartum depression (PPD) is a common major depressive episode surrounding childbirth, with estimated rates ranging from 5.5% to 23.5% of all live births across Europe and the USA based on the presence of key symptoms. PPD has been associated with significant impairments in both maternal functioning and mother-infant attachment, and these impairments can have lasting effects on the emotional and cognitive development of children. Although the precise pathophysiology of PPD is unknown, preclinical findings suggest that large fluctuations in neurosteroid hormone levels can induce physiological plasticity in the expression of functional GABAA receptors during pregnancy and the postpartum period, and that deficits in this plasticity may underpin a biological mechanism that contributes to the manifestation of depressive symptoms. Here, we review the controlled clinical trials to date that have assessed the efficacy of pharmacological treatments for PPD, including oestradiol, selective serotonin reuptake inhibitors, brexanolone (an iv formulation of allopregnanolone) and an investigational neuroactive steroid and GABAA positive allosteric modulator, zuranolone. Coupled with the GABAergic deficits implicated in major depressive disorder, these findings highlight not only the potential role of GABAA receptor plasticity in the pathophysiology of PPD, but also the novel therapeutic approach of using positive allosteric modulators targeting GABAergic transmission to treat women affected by PPD.
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Martinez CA, Marteinsdottir I, Josefsson A, Sydsjö G, Theodorsson E, Rodriguez-Martinez H. Prenatal stress, anxiety and depression alter transcripts, proteins and pathways associated with immune responses at the maternal-fetal interface†. Biol Reprod 2021; 106:449-462. [PMID: 34935902 PMCID: PMC8934694 DOI: 10.1093/biolre/ioab232] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/15/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
During pregnancy, the immune system is modified to allow developmental developmental tolerance of the semi-allogeneic fetus and placenta to term. Pregnant women suffering from stress, anxiety and depression show dysfunctions of their immune system that may be responsible for fetal and/or newborn disorders, provided that provided that placental gene regulation is compromised. The present study explored the effects of maternal chronic self-perceived stress, anxiety and depression during pregnancy on the expression of immune related-genes and pathways in term placenta. Pregnancies were clinically monitored with the Beck's Anxiety Inventory (BAI) and Edinburgh Postnatal Depression Scale (EPDS). A cutoff threshold for BAI/EPDS of 10 divided patients into two groups: Index group (≥10, n = 11) and a Control group (<10, n = 11), whose placentae were sampled at delivery. The placental samples were subjected to RNA-Sequencing, demonstrating that stress, anxiety and depression during pregnancy induced a major downregulation of placental transcripts related to immune processes such as T-cell regulation, interleukin and cytokine signaling or innate immune responses. Expression differences of main immune related genes such as CD46, CD15, CD8α & β ILR7α and CCR4 among others, were found in the index group (P < 0.05). Moreover, the key immune-like pathway involved in humoral and cellular immunity named "Primary immunodeficiency" was significantly downregulated in the index group compared to controls. Our results show that mechanisms ruling immune system functions are compromised at the maternal-fetal interface following self-perceived depressive symptoms and anxiety during pregnancy. These findings may help unveil mechanisms ruling the impact of maternal psychiatric symptoms and lead to new prevention/intervention strategies in complicated pregnancies.
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Affiliation(s)
- Cristina A Martinez
- Department of Biomedical & Clinical Sciences, Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Ina Marteinsdottir
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Hus Vita, Kalmar, Sweden
| | - Ann Josefsson
- Department of Biomedical & Clinical Sciences, Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Biomedical & Clinical Sciences, Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Elvar Theodorsson
- Division of Clinical Chemistry, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Heriberto Rodriguez-Martinez
- Department of Biomedical & Clinical Sciences, Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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20
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Glutamate levels in the medial prefrontal cortex of healthy pregnant women compared to non-pregnant controls. Psychoneuroendocrinology 2021; 133:105382. [PMID: 34419762 DOI: 10.1016/j.psyneuen.2021.105382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/20/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022]
Abstract
Very little is known about maternal cerebral changes during pregnancy. Since there is an increased risk for major depression during pregnancy and postpartum, it is important to understand the structural and neurochemical changes that occur in the brain during pregnancy. Using proton magnetic resonance spectroscopy (1H-MRS) (3 T field strength), glutamate (Glu) levels were measured in the medial prefrontal cortex (MPFC) of 21 healthy gravid subjects 2-3 weeks before their due date (6.74 ± 1.39), and in 14 non-pregnant healthy controls during their follicular phase (8.53 ± 1.55). Water quantified MPFC Glu levels were decreased in pregnant women (p < 0.01). We also observed a 13.9% decrease in percentage grey matter (%GM) (p < 0.01) in our MPFC voxel. As Glu is mostly found in GM, we repeated the statistical analysis after adjustment for %GM and found that the difference in Glu levels was no longer statistically significant when adjusted for %GM (p = 0.10). This investigation is the only systematic direct investigation of brain tissue composition and Glu levels in pregnant women. The main finding of this investigation is the decreased %GM in healthy pregnant women compared to non-pregnant women. These findings of decreased %GM in pregnancy may be responsible for the frequent complaints by pregnant women of cognitive difficulties also described as pregnesia.
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21
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Johansson M, Nordström T, Svensson I. Depressive symptoms, parental stress, and attachment style in mothers and fathers two and a half years after childbirth: Are fathers as affected as mothers? J Child Health Care 2021; 25:368-378. [PMID: 32668953 PMCID: PMC8422774 DOI: 10.1177/1367493520942050] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The study aimed to determine the prevalence of depressive symptoms and whether parental stress and attachment style affected depression in mothers and fathers two and a half years after the birth of a child. The parents completed several questionnaires including the Edinburgh Postnatal Depression Scale, the Swedish Parenthood Stress Questionnaire and the Relationship Questionnaire. The prevalence rate of depressive symptoms in mothers was 14.9%, while for fathers it was 11.5%. Differences between the parents identified as depressed and those without depressive symptoms were also analysed. There were no significant differences between depressed and non-depressed parents on the secure, avoidant and fearful attachment styles. However, there was a significant difference between groups on the preoccupied subscale. The final aim was to calculate if attachment style contributed to the level of depression while accounting for the impact of parental stress. Parental stress (incompetence, social isolation and spouse relationship problems) was the best predictor for mothers' depressive symptoms, while parental stress (social isolation and health) and the preoccupied attachment style were the best predictors for such symptoms in fathers. The findings indicated that parental stress and depressive symptoms are closely related and can explain the difficulties parents face.
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Affiliation(s)
- Maude Johansson
- Department of Psychology, Linnaeus University, Sweden,Maude Johansson, Department of Psychology, Linnaeus University Faculty of Health and Life Sciences, Trummenvägen 11, Växjö 391 51, Sweden.
| | | | - Idor Svensson
- Department of Psychology, Linnaeus University, Sweden
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22
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Thomson KC, Romaniuk H, Greenwood CJ, Letcher P, Spry E, Macdonald JA, McAnally HM, Youssef GJ, McIntosh J, Hutchinson D, Hancox RJ, Patton GC, Olsson CA. Adolescent antecedents of maternal and paternal perinatal depression: a 36-year prospective cohort. Psychol Med 2021; 51:2126-2133. [PMID: 32340651 DOI: 10.1017/s0033291720000902] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Rates of common mental health problems (depression/anxiety) rise sharply in adolescence and peak in young adulthood, often coinciding with the transition to parenthood. Little is known regarding the persistence of common mental health problems from adolescence to the perinatal period in both mothers and fathers. METHODS A total of 393 mothers (686 pregnancies) and 257 fathers (357 pregnancies) from the intergenerational Australian Temperament Project Generation 3 Study completed self-report assessments of depression and anxiety in adolescence (ages 13-14, 15-16, 17-18 years) and young adulthood (ages 19-20, 23-24, 27-28 years). The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms at 32 weeks pregnancy and 12 months postpartum in mothers, and at 12 months postpartum in fathers. RESULTS Most pregnancies (81%) in which mothers reported perinatal depression were preceded by a history of mental health problems in adolescence or young adulthood. Similarly, most pregnancies (83%) in which fathers reported postnatal depression were preceded by a preconception history of mental health problems. After adjustment for potential confounders, the odds of self-reporting perinatal depression in both women and men were consistently higher in those with a history of persistent mental health problems across adolescence and young adulthood than those without (ORwomen 5.7, 95% CI 2.9-10.9; ORmen 5.5, 95% CI 1.03-29.70). CONCLUSIONS Perinatal depression, for the majority of parents, is a continuation of mental health problems with onsets well before pregnancy. Strategies to promote good perinatal mental health should start before parenthood and include both men and women.
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Affiliation(s)
- Kimberly C Thomson
- Deakin University Geelong, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, The Royal Children's Hospital Campus, Parkville Victoria, Australia
| | - Helena Romaniuk
- Deakin University, Faculty of Health, Biostatistics Unit, Geelong, Australia
| | - Christopher J Greenwood
- Deakin University Geelong, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
| | - Primrose Letcher
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, The Royal Children's Hospital Campus, Parkville Victoria, Australia
| | - Elizabeth Spry
- Deakin University Geelong, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
| | - Jacqui A Macdonald
- Deakin University Geelong, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, The Royal Children's Hospital Campus, Parkville Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
| | - Helena M McAnally
- University of Otago, Department of Preventive and Social Medicine, Dunedin, New Zealand
| | - George J Youssef
- Deakin University Geelong, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
| | - Jennifer McIntosh
- Deakin University Geelong, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, The Royal Children's Hospital Campus, Parkville Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
- La Trobe University, Department of Psychology, The Bouverie Centre, Melbourne, Victoria, Australia
| | - Delyse Hutchinson
- Deakin University Geelong, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, The Royal Children's Hospital Campus, Parkville Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Robert J Hancox
- University of Otago, Department of Preventive and Social Medicine, Dunedin, New Zealand
| | - George C Patton
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, The Royal Children's Hospital Campus, Parkville Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
| | - Craig A Olsson
- Deakin University Geelong, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, The Royal Children's Hospital Campus, Parkville Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
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Bashiri H, Houwing DJ, Homberg JR, Salari AA. The combination of fluoxetine and environmental enrichment reduces postpartum stress-related behaviors through the oxytocinergic system and HPA axis in mice. Sci Rep 2021; 11:8518. [PMID: 33875712 PMCID: PMC8055994 DOI: 10.1038/s41598-021-87800-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023] Open
Abstract
Gestational stress can increase postpartum depression in women. To treat maternal depression, fluoxetine (FLX) is most commonly prescribed. While FLX may be effective for the mother, at high doses it may have adverse effects on the fetus. As environmental enrichment (EE) can reduce maternal stress effects, we hypothesized that a subthreshold dose of FLX increases the impact of EE to reduce anxiety and depression-like behavior in postpartum dams exposed to gestational stress. We evaluated this hypothesis in mice and to assess underlying mechanisms we additionally measured hypothalamic-pituitary-adrenal (HPA) axis function and brain levels of the hormone oxytocin, which are thought to be implicated in postpartum depression. Gestational stress increased anxiety- and depression-like behavior in postpartum dams. This was accompanied by an increase in HPA axis function and a decrease in whole-brain oxytocin levels in dams. A combination of FLX and EE remediated the behavioral, HPA axis and oxytocin changes induced by gestational stress. Central administration of an oxytocin receptor antagonist prevented the remediating effect of FLX + EE, indicating that brain oxytocin contributes to the effect of FLX + EE. These findings suggest that oxytocin is causally involved in FLX + EE mediated remediation of postpartum stress-related behaviors, and HPA axis function in postpartum dams.
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Affiliation(s)
- Hamideh Bashiri
- Neuroscience Research Center, Institute of Neuropharmacology, Department of Physiology and Pharmacology, Kerman University of Medical Sciences, Kerman, Iran
- Sirjan School of Medical Sciences, Sirjan, Iran
| | - Danielle J Houwing
- Department of Cognitive Neuroscience, Center for Medical Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith R Homberg
- Department of Cognitive Neuroscience, Center for Medical Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ali-Akbar Salari
- Salari Institute of Cognitive and Behavioral Disorders (SICBD), Karaj, Alborz, Iran.
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Speyer LG, Hall HA, Ushakova A, Murray AL, Luciano M, Auyeung B. Links between perinatal risk factors and maternal psychological distress: A network analysis. Acta Obstet Gynecol Scand 2021; 100:917-926. [PMID: 33253415 DOI: 10.1111/aogs.14056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION This paper explores a range of perinatal risk factors that may increase maternal vulnerability to postnatal psychological distress in a sample of 17 531 women participating in the Millennium Cohort Study, a diverse British, longitudinal birth cohort study. MATERIAL AND METHODS Using a graphical network modeling framework, this study models the links between postnatal psychological distress and perinatal risk factors, while controlling for sociodemographic factors and history of depression and anxiety. Postnatal psychological distress was assessed at 9 months postpartum using the Rutter Malaise Inventory. RESULTS Results of the graphical network models indicate that lower levels of happiness about the pregnancy (Edge weight [w] = 0.084, 95% CI = 0.069-0.100, b = 0.095), smoking during pregnancy (w = 0.026, 95% CI = -0.009-0.060, b = 0.029), infection during pregnancy (w = 0.071, 95% CI = 0.024-0.118, b = 0.090), hyperemesis gravidarum (w = 0.068, 95% CI = 0.013-0.123, b = 0.083), baby in special care (w = 0.048, 95% CI = -0.004-0.099, b = 0.062), not being white (w = 0.101, 95% CI = 0.062-0.140, b = 0.118), being from a more deprived area (w = -0.028, 95% CI = -0.051 to -0.005, b = -0.039), lower income (w = -0.025, 95% CI = -0.055-0.005, b = -0.036), and history of depression or anxiety (w = 0.574, 95% CI = 0.545-0.603, b = 0.764) were associated with increased psychological distress. CONCLUSIONS Some perinatal risk factors may be directly associated with postnatal psychological distress, but many risk factors appear to be primarily associated with demographic factors. This emphasizes the importance of taking a holistic approach when evaluating an individual's risk of developing postnatal psychological distress.
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Affiliation(s)
| | | | - Anastasia Ushakova
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Department of Psychology, University of Lancaster, Lancaster, UK
| | | | - Michelle Luciano
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Bonnie Auyeung
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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El Sayed S, Aljehani Y, Alanzi M, Aljehani S, Saleem A, Alraddadi SR, Alblowi R, Aly H. Impact of pregnancy outcomes on postpartum depression among women attending primary health-care centers in Al-Madina Al-Munawarah, Saudi Arabia. SAUDI JOURNAL FOR HEALTH SCIENCES 2021. [DOI: 10.4103/sjhs.sjhs_247_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Salomonsson B, Kornaros K, Sandell R, Nissen E, Lilliengren P. Short-term psychodynamic infant-parent interventions at Child health centers: Outcomes on parental depression and infant social-emotional functioning. Infant Ment Health J 2020; 42:109-123. [PMID: 33155706 DOI: 10.1002/imhj.21893] [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: 11/10/2022]
Abstract
Randomized controlled trials (RCTs) demonstrate efficacy of parent-infant psychotherapy, but its applicability and effectiveness in public health care are less known. The method followed is Naturalistic study evaluating Short-term Psychodynamic Infant-Parent Interventions at Child Health Centers (SPIPIC) in Stockholm, Sweden. One hundred distressed mothers with infants were recruited by supervised nurses. Six therapists provided 4.3 therapy sessions on average (SD = 3.3). Sessions typically included the mothers, often with the baby present, while fathers rarely attended sessions. The Edinburgh Postnatal Depression Scale (EPDS) and the Ages and Stages Questionnaire: Social-Emotional (ASQ: SE) were distributed at baseline and at 3 and 9 months later. Data from a nonclinical group were collected simultaneously to provide norm data. Multilevel growth models on the mothers' questionnaire scores showed significant decreases over time on both measures. Nine months after baseline, 50% achieved a reliable change on the EPDS and 14% on the ASQ: SE. Prepost effect-sizes (d) were 0.70 and 0.40 for EPDS and ASQ: SE, figures that are comparable to results of other controlled studies. Psychotherapists integrated with public health care seem to achieve good results when supporting distressed mothers with brief interventions in the postnatal period. SPIPIC needs to be compared with other modalities and organizational frameworks.
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Affiliation(s)
- Björn Salomonsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Katarina Kornaros
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Rolf Sandell
- Department of Psychology, Lund University, Lund, Sweden
| | - Eva Nissen
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Peter Lilliengren
- Department of Health Care Sciences, St. Lukas Educational Institute, ErstaBräckeSköndal University College, Stockholm, Sweden
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27
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Matsuoka H, Iwami S, Maeda M, Suizu A, Fujii T. Edinburgh Postnatal Depression Scale scores at 2-week post-partum may reflect those at 4-week post-partum: A single-center retrospective observational study. J Obstet Gynaecol Res 2020; 47:508-514. [PMID: 33145872 DOI: 10.1111/jog.14540] [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] [Received: 05/20/2020] [Revised: 09/12/2020] [Accepted: 10/16/2020] [Indexed: 11/27/2022]
Abstract
AIM Most Japanese institutions screen for post-partum depression (PPD) using the Edinburgh Postnatal Depression Scale (EPDS) at outpatient visits conducted at 2- and 4-week post-partum, but there are no published data on the usefulness of EPDS scores 2-week post-partum. In the present study, relationships between 2-week post-partum EPDS scores and 4-week post-partum EPDS scores were investigated to determine whether 2-week scores may facilitate early intervention in high-risk mothers. METHODS A retrospective analysis of 451 deliveries from 2017 to 2019 was conducted at a single institution. EPDS scores were obtained using the Japanese EPDS 2- and 4-week post-partum, in conjunction with other perinatal data from medical records. RESULTS In total, 334 of 451 mothers (74.1%) completed the EPDS at both 2- and 4-week post-partum and were included in the analysis. Of 48 who had higher scores 2-week post-partum, 21 (43.8%) continued to be at high risk of PPD. Of 284 who had lower scores 2-week post-partum, 9 (3.2%) transitioned to scores indicating high risk. Women considered high-risk 4-week post-partum tended to have exhibited higher scores 2-week post-partum. Women who had experienced more deliveries tended to exhibit lower scores, and psychiatric illness was strongly associated with higher EPDS scores (odds ratio 11.2, 95% confidence interval 3.7-33.8, P < 0.01). CONCLUSION Two-week EPDS scores closely reflected 4-week scores, and may facilitate early intervention to prevent PPD. Primiparous mothers and those with a history of psychiatric illness should be followed-up closely.
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Affiliation(s)
- Hideki Matsuoka
- Department of Gynecology and Obstetrics, Kyoto Katsura Hospital, Kyoto, Japan
| | - Shuichiro Iwami
- Department of Gynecology and Obstetrics, Kyoto Katsura Hospital, Kyoto, Japan
| | - Marisa Maeda
- Department of Gynecology and Obstetrics, Kyoto Katsura Hospital, Kyoto, Japan
| | - Ai Suizu
- Department of Gynecology and Obstetrics, Kyoto Katsura Hospital, Kyoto, Japan
| | - Tsuyoshi Fujii
- Department of Gynecology and Obstetrics, Rakuwakai Otowa Hospital, Kyoto, Japan
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Arach AAO, Nakasujja N, Nankabirwa V, Ndeezi G, Kiguli J, Mukunya D, Odongkara B, Achora V, Tongun JB, Musaba MW, Napyo A, Zalwango V, Tylleskar T, Tumwine JK. Perinatal death triples the prevalence of postpartum depression among women in Northern Uganda: A community-based cross-sectional study. PLoS One 2020; 15:e0240409. [PMID: 33048971 PMCID: PMC7553273 DOI: 10.1371/journal.pone.0240409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/26/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Deaths during the perinatal period remain a big challenge in Africa, with 38 deaths per 1000 pregnancies in Uganda. The consequences of these deaths can be detrimental to the women; some ending up with postpartum depression. We examined the association between perinatal death and postpartum depression among women in Lira district, Northern Uganda. METHODS We conducted a community-based cross-sectional study of 1,789 women. Trained research assistants screened women for postpartum depressive symptoms on day 50 postpartum using the Edinburgh postpartum depression scale (EPDS). Socio-demographic, economic, birth and survival status of the neonate were collected during pregnancy and within one week postpartum. We used generalized estimating equation for the Poisson family with a log link using Stata to estimate the prevalence ratio of the association between postpartum depressive symptoms (EPDS scores ≥14) and perinatal death. Mothers who lost their babies between 7-49 days postpartum were excluded. RESULTS Of the 1,789 participants symptomatically screened for postpartum depression, 377 (21.1%) [95% confidence interval (95%CI): 17.2%, 23.0%] had probable depressive symptoms. The prevalence of postpartum depressive symptoms among the 77 women who had experienced perinatal death (37 stillbirths and 40 early neonatal deaths (≤7 days of life)) was 62.3% [95% CI: 50.8%, 72.6%] compared to 19.2% [95% CI: 17.4%, 21.2%], among 1,712 with live infants at day 50 postpartum. Women who had experienced a perinatal death were three times as likely to have postpartum depressive symptoms as those who had a live birth [adjusted prevalence ratio 3.45 (95% CI: 2.67, 4.48)]. CONCLUSIONS The prevalence of postpartum depressive symptoms, assessed by EPDS, was high among women who had had a perinatal death in Northern Uganda. Women experiencing a perinatal death need to be screened for postpartum depressive symptoms in order to intervene and reduce associated morbidity.
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Affiliation(s)
- Anna Agnes Ojok Arach
- Faculty of Health Sciences, Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Victoria Nankabirwa
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Kiguli
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Beatrice Odongkara
- Department of Paediatrics and Child Health, Gulu University, Gulu, Uganda
| | - Vincentina Achora
- Department of Obstetrics and Gynaecology, Gulu University, Gulu, Uganda
| | - Justin Bruno Tongun
- Department of Paediatrics and Child Health, University of Juba, Juba, South Sudan
| | - Milton Wamboko Musaba
- Faculty of Health Sciences, Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
| | - Agnes Napyo
- Faculty of Health Sciences, Department of Public Health, Busitema University, Tororo, Uganda
| | - Vivian Zalwango
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - James K. Tumwine
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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29
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Rexelius N, Lindgren A, Torstensson T, Kristiansson P, Turkmen S. Sexuality and mood changes in women with persistent pelvic girdle pain after childbirth: a case-control study. BMC WOMENS HEALTH 2020; 20:201. [PMID: 32928204 PMCID: PMC7488986 DOI: 10.1186/s12905-020-01058-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/26/2020] [Indexed: 11/22/2022]
Abstract
Background Pelvic girdle pain is a common problem during pregnancy. For most women, the symptoms cease within the first 3–6 months of giving birth, but in some women the pain persists. In this study we investigate the sexuality and frequency of depressive symptoms in women with persistent pelvic girdle pain after childbirth and in healthy women. Methods We conducted a case–control study of women with persistent pelvic girdle pain after childbirth and a control group of healthy women. The frequency of depressive symptoms and sexuality were measured using the self-rating version of the Montgomery–Asberg Depression Rating Scale and the McCoy Female Sexuality Questionnaire. Results Forty-six women with persistent pelvic girdle pain and thirty-nine healthy women were enrolled. The frequency of depressive symptoms and the total score on female sexuality did not differ between the groups. However, pain during intercourse was more frequent (P < 0.001) in women with persistent pelvic girdle pain and caused them to avoid sexual intercourse frequently (P < 0.001). In multiple linear regression a higher frequency of depressive symptoms was reversely correlated with a lower score on female sexuality (β= − 0,41, p < 0,001 95% CI -0,6 - -0,22) This association remained after adjusting for obstetric variables and individual characteristics. Conclusion Depressive symptoms and female sexuality were similar between women with persistent pelvic girdle pain after childbirth and healthy controls. However, pain during intercourse and avoidance of sexual intercourse were more frequent among women with pelvic girdle pain.
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Affiliation(s)
- Niklas Rexelius
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 90185, Umeå, Sweden. .,Department of Obstetrics and Gynecology, Sundsvall County Hospital, 851 86, Sundsvall, SE, Sweden.
| | - Anne Lindgren
- Department of Public Health and Caring Sciences, Uppsala University, SE-75622, Uppsala, Sweden
| | - Thomas Torstensson
- Department of Public Health and Caring Sciences, Uppsala University, SE-75622, Uppsala, Sweden
| | - Per Kristiansson
- Department of Public Health and Caring Sciences, Uppsala University, SE-75622, Uppsala, Sweden
| | - Sahruh Turkmen
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 90185, Umeå, Sweden
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30
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Amygdala-Prefrontal Structural Connectivity Mediates the Relationship between Prenatal Depression and Behavior in Preschool Boys. J Neurosci 2020; 40:6969-6977. [PMID: 32788182 DOI: 10.1523/jneurosci.0481-20.2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 01/18/2023] Open
Abstract
Prenatal depression is common, underrecognized, and undertreated. It has negative consequences on child behavior and brain development, yet the relationships among prenatal depression, child behavior, and children's brain structure remain unclear. The aim of this study was to determine whether altered brain connectivity mediates relationships between prenatal maternal depressive symptoms and child behavior. This study included 54 human mother-child pairs. Mothers completed the Edinburgh Postnatal Depression Scale during the second and third trimesters of pregnancy and 3 months postpartum. Their children had diffusion MRI at age 4.1 ± 0.8 years, and children's behavior was assessed using the Child Behavior Checklist within 6 months of their MRI scan. Structural brain connectivity of the amygdala, fornix, uncinate fasciculus, and cingulum was assessed using fractional anisotropy and mean diffusivity and analyzed with maternal prenatal depressive symptoms as well as child behavior. Third trimester maternal Edinburgh Postnatal Depression Scale scores were positively associated with mean diffusivity in the amygdala-frontal tract and the cingulum, controlling for postpartum depression. Externalizing behavior had a sex interaction in the amygdala-frontal pathway; weaker connectivity (lower fractional anisotropy, higher mean diffusivity) was associated with worse behavior in boys. Amygdala-frontal connectivity mediated the relationship between third trimester depressive symptoms and child externalizing behavior in males. These findings suggest that altered brain structure is a mechanism via which prenatal depressive symptoms can impact child behavior, highlighting the importance of both recognition and intervention in prenatal depression.SIGNIFICANCE STATEMENT Understanding how prenatal maternal depression impacts child behavior is critical for appropriately treating prenatal maternal mental health problems and improving child outcomes. Here, we show white matter changes in young children exposed to maternal prenatal depressive symptoms. Children of mothers with worse depressive symptoms had weaker white matter connectivity between areas related to emotional processing. Furthermore, connectivity between the amygdala and prefrontal cortex mediated the relationship between maternal depressive symptoms and externalizing behavior in boys, showing that altered brain structure is a possible mechanism via which maternal prenatal depression impacts children's behavior. This provides important information for understanding why children of depressed mothers may be more vulnerable to depression themselves and may help shape future guidelines on maternal prenatal care.
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Expression of Stress-Mediating Genes is Increased in Term Placentas of Women with Chronic Self-Perceived Anxiety and Depression. Genes (Basel) 2020; 11:genes11080869. [PMID: 32752005 PMCID: PMC7463995 DOI: 10.3390/genes11080869] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 01/04/2023] Open
Abstract
Anxiety, chronical stress, and depression during pregnancy are considered to affect the offspring, presumably through placental dysregulation. We have studied the term placentae of pregnancies clinically monitored with the Beck’s Anxiety Inventory (BAI) and Edinburgh Postnatal Depression Scale (EPDS). A cutoff threshold for BAI/EPDS of 10 classed patients into an Index group (>10, n = 23) and a Control group (<10, n = 23). Cortisol concentrations in hair (HCC) were periodically monitored throughout pregnancy and delivery. Expression differences of main glucocorticoid pathway genes, i.e., corticotropin-releasing hormone (CRH), 11β-hydroxysteroid dehydrogenase (HSD11B2), glucocorticoid receptor (NR3C1), as well as other key stress biomarkers (Arginine Vasopressin, AVP and O-GlcNAc transferase, OGT) were explored in medial placentae using real-time qPCR and Western blotting. Moreover, gene expression changes were considered for their association with HCC, offspring, gender, and birthweight. A significant dysregulation of gene expression for CRH, AVP, and HSD11B2 genes was seen in the Index group, compared to controls, while OGT and NR3C1 expression remained similar between groups. Placental gene expression of the stress-modulating enzyme 11β-hydroxysteroid dehydrogenase (HSD11B2) was related to both hair cortisol levels (Rho = 0.54; p < 0.01) and the sex of the newborn in pregnancies perceived as stressful (Index, p < 0.05). Gene expression of CRH correlated with both AVP (Rho = 0.79; p < 0.001) and HSD11B2 (Rho = 0.45; p < 0.03), and also between AVP with both HSD11B2 (Rho = 0.6; p < 0.005) and NR3C1 (Rho = 0.56; p < 0.03) in the Control group but not in the Index group; suggesting a possible loss of interaction in the mechanisms of action of these genes under stress circumstances during pregnancy.
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32
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Ye Z, Wang L, Yang T, Chen LZ, Wang T, Chen L, Zhao L, Zhang S, Luo L, Qin J. Gender of infant and risk of postpartum depression: a meta-analysis based on cohort and case-control studies. J Matern Fetal Neonatal Med 2020; 35:2581-2590. [PMID: 32635787 DOI: 10.1080/14767058.2020.1786809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Ziwei Ye
- Central South University, Changsha, China
| | - Lesan Wang
- Central South University, Changsha, China
| | - Tubao Yang
- Central South University, Changsha, China
| | | | | | - Letao Chen
- Central South University, Changsha, China
| | | | | | - Liu Luo
- Central South University, Changsha, China
| | - Jiabi Qin
- Central South University, Changsha, China
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Aparicio M, Browne PD, Hechler C, Beijers R, Rodríguez JM, de Weerth C, Fernández L. Human milk cortisol and immune factors over the first three postnatal months: Relations to maternal psychosocial distress. PLoS One 2020; 15:e0233554. [PMID: 32437424 PMCID: PMC7241837 DOI: 10.1371/journal.pone.0233554] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/07/2020] [Indexed: 02/07/2023] Open
Abstract
Background Many biologically active factors are present in human milk including proteins, lipids, immune factors, and hormones. The milk composition varies over time and shows large inter-individual variability. This study examined variations of human milk immune factors and cortisol concentrations in the first three months post-partum, and their potential associations with maternal psychosocial distress. Methods Seventy-seven healthy mothers with full term pregnancies were enrolled, of which 51 mothers collected morning milk samples at 2, 6 and 12 weeks post-delivery. Maternal psychosocial distress was assessed at 6 weeks post-delivery using questionnaires for stress, anxiety, and depressive symptoms. Immune factors were determined using multiplex immunoassays and included innate immunity factors (IL1β, IL6, IL12, IFNγ, TNFα), acquired immunity factors (IL2, IL4, IL10, IL13, IL17), chemokines (IL8, Groα, MCP1, MIP1β), growth factors (IL5, IL7, GCSF, GMCSF, TGFβ2) and immunoglobulins (IgA, total IgG, IgM). Cortisol was quantified using liquid chromatography-tandem mass spectrometry. A linear mixed effects model was fit to test whether stress, anxiety, and depressive symptoms individually predicted human milk cortisol concentrations after accounting for covariates. Repeated measurement analyses were used to compare women with high (n = 13) versus low psychosocial distress (n = 13) for immune factors and cortisol concentrations. Results Virtually all immune factors and cortisol, with the exception of the granulocyte-macrophage colony-stimulating factor (GMCSF), were detected in the human milk samples. The concentrations of the immune factors decreased during the first 3 months, while cortisol concentrations increased over time. No correlation was observed between any of the immune factors and cortisol. No consistent relationship between postnatal psychosocial distress and concentrations of immune factors was found, whereas higher psychosocial distress was predictive of higher cortisol concentrations in human milk. Conclusion In the current study we found no evidence for an association between natural variations in maternal distress and immune factor concentrations in milk. It is uncertain if this lack of association would also be observed in studies with larger populations, with less uniform demographic characteristics, or with women with higher (clinical) levels of anxiety, stress and/or depressive symptoms. In contrast, maternal psychosocial distress was positively related to higher milk cortisol concentrations at week 2 post-delivery. Further investigation on maternal psychosocial distress in relation to human milk composition is warranted.
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Affiliation(s)
- Marina Aparicio
- Department of Nutrition and Food Science, Faculty of Veterinary Sciences, Complutense University of Madrid, Madrid, Spain
| | - Pamela D. Browne
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christine Hechler
- Developmental Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Roseriet Beijers
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Developmental Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Juan Miguel Rodríguez
- Department of Nutrition and Food Science, Faculty of Veterinary Sciences, Complutense University of Madrid, Madrid, Spain
| | - Carolina de Weerth
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail: (CdW); (LF)
| | - Leonides Fernández
- Departmental Section of Galenic Pharmacy and Food Technology, Faculty of Veterinary Sciences, Complutense University of Madrid, Madrid, Spain
- * E-mail: (CdW); (LF)
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Lillie M, Gallis JA, Hembling J, Owusu RK, Ali M, Abubakr-Bibilazu S, Aborigo R, Adam H, McEwan E, Awoonor-Williams JK, Baumgartner JN. Prevalence and Correlates of Depression Among Pregnant Women Enrolled in a Maternal and Newborn Health Program in Rural Northern Ghana: a Cross-sectional Survey. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2020; 7:131-140. [PMID: 32509505 PMCID: PMC7252621 DOI: 10.1007/s40609-020-00170-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Women in many sub-Saharan African countries are at elevated risk of depression during pregnancy. However, there are still gaps in the estimates of antenatal depression and associated risk factors in very low-resource settings such as Northern Ghana. This study describes the prevalence of depression among rural pregnant women, participating in a maternal and child health program, in Ghana, and examines associated risk factors for depression. Pregnant women who were registered for group-based maternal and child health community programs were recruited for study participation from 32 communities in two rural districts in Northern Ghana (n = 374). Baseline surveys were conducted and depression was assessed using the Patient Health Questionnaire (PHQ-9). Bivariate and multivariable analyses used a modified Poisson and generalized estimating equations (GEE) model. Of the women in our study population, 19.7% reported symptoms indicative of moderate to severe depression (PHQ-9 score ≥ 10), with 14.1% endorsing suicidal ideation in the last 2 weeks. Bivariate analyses revealed that lower hopefulness, moderate and severe hunger, experiences of emotional, physical, and/or sexual intimate partner violence (IPV), and insufficient social support from female relatives were associated with symptoms indicating moderate to severe depression. In the multivariable analyses, low hopefulness, household hunger, emotional IPV, physical and/or sexual IPV, and insufficient female relative support remained significantly associated with depression. Antenatal depression is associated with unmet basic needs and safety. Perinatal mental health programming must take an ecological perspective and address personal, familial, and community-level factors.
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Affiliation(s)
| | - John A. Gallis
- Duke Department of Biostatistics and Bioinformatics, Durham, NC USA
| | - John Hembling
- Catholic Relief Services Head Quarters, Baltimore, MD USA
| | | | - Mohammed Ali
- Catholic Relief Services Country Office, Tamale, Ghana
| | | | | | - Haliq Adam
- Catholic Relief Services Country Office, Tamale, Ghana
| | - Elena McEwan
- Catholic Relief Services Head Quarters, Baltimore, MD USA
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Heller HM, Hoogendoorn AW, Honig A, Broekman BFP, van Straten A. The Effectiveness of a Guided Internet-Based Tool for the Treatment of Depression and Anxiety in Pregnancy (MamaKits Online): Randomized Controlled Trial. J Med Internet Res 2020; 22:e15172. [PMID: 32202505 PMCID: PMC7136839 DOI: 10.2196/15172] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/26/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pregnant women with symptoms of depression or anxiety often do not receive adequate treatment. In view of the high incidence of these symptoms in pregnancy and their impact on pregnancy outcomes, getting treatment is of the utmost importance. A guided internet self-help intervention may help to provide more women with appropriate treatment. OBJECTIVE This study aimed to examine the effectiveness of a guided internet intervention (MamaKits online) for pregnant women with moderate to severe symptoms of anxiety or depression. Assessments took place before randomization (T0), post intervention (T1), at 36 weeks of pregnancy (T2), and 6 weeks postpartum (T3). We also explored effects on perinatal child outcomes 6 weeks postpartum. METHODS This randomized controlled trial included pregnant women (<30 weeks) with depressive symptoms above threshold (ie, Center for Epidemiological Studies Depression scale [CES-D] >16) or anxiety above threshold (ie, Hospital Anxiety and Depression Scale-Anxiety subscale [HADS-A] >8) or both of them. Participants were recruited via general media and flyers in prenatal care waiting rooms or via obstetricians and midwives. After initial assessment, women were randomized to (1) MamaKits online in addition to treatment as usual or (2) treatment as usual (control condition). MamaKits online is a 5-week guided internet intervention based on problem solving treatment. Guidance was was provided by trained students pursuing a Master's in Psychology. Outcomes were based on a Web-based self-report. Women in the control condition were allowed to receive the intervention after the last assessment (6 weeks postpartum). RESULTS Of the 159 included women, 79 were randomized to MamaKits online, 47% (79/37) of whom completed the intervention. Both groups showed a substantial decrease in affective symptoms on the CES-D, HADS-A, and Edinburgh Postnatal Depression Scale over time. In the intervention group, affective symptoms decreased more than that in the control group, but between-group effect sizes were small to medium (Cohen d at T3=0.45, 0.21, and 0.23 for the 3 questionnaires, respectively) and statistically not significant. Negative perinatal child outcomes did not differ between the 2 groups (χ21=0.1; P=.78). Completer analysis revealed no differences in outcome between the treatment completers and the control group. The trial was terminated early for reasons of futility based on the results of an interim analysis, which we performed because of inclusion problems. CONCLUSIONS Our study did show a significant reduction in affective symptoms in both groups, but the differences in reduction of affective symptoms between the intervention and control groups were not significant. There were also no differences in perinatal child outcomes. Future research should examine for which women these interventions might be effective or if changes in the internet intervention might make the intervention more effective. TRIAL REGISTRATION Netherlands Trial Register NL4162; https://tinyurl.com/sdckjek.
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Affiliation(s)
- Hanna M Heller
- Department of Psychiatry, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Adriaan W Hoogendoorn
- Department of Psychiatry, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,GGZ inGeest, Amsterdam, Netherlands
| | - Adriaan Honig
- Department of Psychiatry, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Psychiatry, OLVG Hospital, Amsterdam, Netherlands
| | - Birit F P Broekman
- Department of Psychiatry, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Psychiatry, OLVG Hospital, Amsterdam, Netherlands
| | - Annemieke van Straten
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Payne JL, Osborne LM, Cox O, Kelly J, Meilman S, Jones I, Grenier W, Clark K, Ross E, McGinn R, Wadhwa PD, Entringer S, Dunlop AL, Knight AK, Smith AK, Buss C, Kaminsky ZA. DNA methylation biomarkers prospectively predict both antenatal and postpartum depression. Psychiatry Res 2020; 285:112711. [PMID: 31843207 PMCID: PMC7702696 DOI: 10.1016/j.psychres.2019.112711] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/12/2019] [Accepted: 11/27/2019] [Indexed: 12/19/2022]
Abstract
We sought to replicate and expand upon previous work demonstrating antenatal TTC9B and HP1BP3 gene DNA methylation is prospectively predictive of postpartum depression (PPD) with ~80% accuracy. In a preterm birth study from Emory, Illumina MethylEPIC microarray derived 1st but not 3rd trimester biomarker models predicted 3rd trimester Edinburgh Postnatal Depression Scale (EPDS) scores ≥ 13 with an AUC=0.8 (95% CI: 0.63-0.8). Bisulfite pyrosequencing derived biomarker methylation was generated using bisulfite pyrosequencing across all trimesters in a pregnancy cohort at UC Irvine and in 3rd trimester from an independent Johns Hopkins pregnancy cohort. A support vector machine model incorporating 3rd trimester EPDS scores, TTC9B, and HP1BP3 methylation status predicted 4 week to 6 week postpartum EPDS ≥ 13 from 3rd trimester blood in the UC Irvine cohort (AUC=0.78, 95% CI: 0.64-0.78) and from the Johns Hopkins cohort (AUC=0.84, 95% CI: 0.72-0.97), both independent of previous psychiatric diagnosis. Technical replicate predictions in a subset of the Johns Hopkins cohort exhibited strong cross experiment correlation. This study confirms the PPD prediction model has the potential to be developed into a clinical tool enabling the identification of pregnant women at future risk of PPD who may benefit from clinical intervention.
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Affiliation(s)
- Jennifer L. Payne
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren M. Osborne
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olivia Cox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Kelly
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Samantha Meilman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ilenna Jones
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Winston Grenier
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Clark
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Evelyn Ross
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel McGinn
- The Royal’s Institute of Mental Health Research, University of Ottawa, 1145 Carling Avenue, Rm, 6458 Ottawa, Ontario, Canada
| | - Pathik D. Wadhwa
- Department of Psychiatry & Human Behavior, UC Irvine Genetic Epidemiology Research Institute, University of California, Irvine, CA, USA
| | - Sonja Entringer
- Development, Health and Disease Research Program, University of California, Irvine, CA, USA,Medical Psychology Department, Charité University Medicine Berlin, Berlin, Germany
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
| | - Anna K. Knight
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
| | - Alicia K. Smith
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
| | - Claudia Buss
- Development, Health and Disease Research Program, University of California, Irvine, CA, USA,Medical Psychology Department, Charité University Medicine Berlin, Berlin, Germany
| | - Zachary A. Kaminsky
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA,The Royal’s Institute of Mental Health Research, University of Ottawa, 1145 Carling Avenue, Rm, 6458 Ottawa, Ontario, Canada,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada,Corresponding author at: The Royal Ottawa Mental Health Center, Institute of Mental Health Research, University of Ottawa, 1145 Carling Avenue, Rm 6458, Ottawa Ontario Canada. (Z.A. Kaminsky)
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Kapra O, Rotem R, Gross R. The Association Between Prenatal Exposure to Antidepressants and Autism: Some Research and Public Health Aspects. Front Psychiatry 2020; 11:555740. [PMID: 33329095 PMCID: PMC7719777 DOI: 10.3389/fpsyt.2020.555740] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/08/2020] [Indexed: 01/22/2023] Open
Abstract
Use of antidepressants (ADs) in general, and in pregnant notwithstanding, has been increasing globally in recent decades. Associations with a wide range of adverse perinatal and childhood outcomes following prenatal ADs exposure have been observed in registry-based studies, with Autism Spectrum Disorders (ASD) frequently reported. Studies using animal models, sibling analyses, and negative control approaches, have linked dysfunctional serotonin metabolism with ASD, but did not convincingly tease apart the role of maternal mental health from that of ADs. As work to decipher the nature of the AD-ASD association continues, this review raises some public health concerns pertinent to a hypothetical conclusion that this association is causal, including the need to identify specific gestation periods with higher risk, the importance of precise assessment of the ASD potential prevention that might be attributed to AD discontinuation, and the estimation of risks associated with prenatal exposure to untreated depression.
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Affiliation(s)
- Ori Kapra
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel-Aviv, Israel
| | - Ran Rotem
- School of Public Health, Harvard University, Boston, MA, United States.,Morris Kahn Maccabi Health Data Science Institute, Tel-Aviv, Israel
| | - Raz Gross
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel-Aviv, Israel.,Sheba Medical Center, Ramat Gan, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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38
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Maternal prenatal plasma oxytocin is positively associated with prenatal psychological symptoms, but method of immunoassay extraction may affect results. Biol Psychol 2019; 147:107718. [DOI: 10.1016/j.biopsycho.2019.107718] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/08/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
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Shah MR, Jampa A, Kaur M, Robert CA, Patel RS. Transcranial Magnetic Stimulation for Major Depressive Disorder in Pregnancy: A Literature Review. Cureus 2019; 11:e5431. [PMID: 31632880 PMCID: PMC6797004 DOI: 10.7759/cureus.5431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Major depressive disorder (MDD) is a growing problem among pregnant women as current treatment with antidepressants pose significant risks to the mother and fetus. Transcranial magnetic stimulation (TMS) is a neuromodulation technique that is being increasingly utilized to treat MDD in adults. We conducted a literature search using the keyword “TMS” and cross-referencing it with MDD, depression, major depressive episode, pregnancy, efficacy, safety, and clinical trial. This review explores current studies conducted to evaluate the efficacy and safety of TMS to treat MDD in pregnant females. Low-frequency TMS over the right dorsolateral prefrontal cortex, when given to pregnant women with MDD during the second and third trimester, has shown a significant response in depressive symptom reduction. TMS offers a promising alternative to current treatment options for managing MDD during pregnancy, but with limited research available, its safety and efficacy still need to be studied by conducting multicenter trials and long-term studies.
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Affiliation(s)
| | - Alekhya Jampa
- Obstetrics and Gynecology, KLE University, Jawaharlal Nehru Medical College, Belgaum, IND
| | - Mandeep Kaur
- Psychiatry, American University of Antigua, Hayward, USA
| | - Chris A Robert
- Obstetrics & Gynecology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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40
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Wyatt T, Shreffler KM, Ciciolla L. Neonatal intensive care unit admission and maternal postpartum depression. J Reprod Infant Psychol 2019; 37:267-276. [PMID: 30450956 PMCID: PMC6526079 DOI: 10.1080/02646838.2018.1548756] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 08/11/2018] [Indexed: 10/27/2022]
Abstract
Objective: This study aimed to examine the impact of newborns' Neonatal Intensive Care Unit (NICU) admittance on maternal postpartum depression. Background: Prior research on the parental psychological impacts of a NICU admittance typically includes a hospital sample of parents following birth, so the causality of NICU admittance and maternal depressive symptomatology is unclear. Methods: 127 women across 38 counties in a South Central US state participated in online surveys in their third trimester and approximately six weeks post-birth in 2016. Pre- and post-birth assessments of depression were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). NICU admittance was asked in the post-birth survey. t-Tests and multivariable regression analyses were used to determine predictors of NICU admittance and postnatal depressive symptomatology. Results: Findings indicate that prenatal depression does not differ significantly between mothers by NICU admission status, but NICU admission is a significant predictor of postpartum depressive symptomatology. Conclusions: Having a newborn admitted to the NICU is a risk factor for maternal postpartum depression. These findings have implications for practice; screening mothers in the NICU for depression as a target for intervention has the potential to improve maternal well-being, which in turn should enhance subsequent infant developmental outcomes.
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Affiliation(s)
- Tara Wyatt
- a Human Development and Family Science , Oklahoma State University , Tulsa , OK , USA
| | - Karina M Shreffler
- a Human Development and Family Science , Oklahoma State University , Tulsa , OK , USA
| | - Lucia Ciciolla
- b Department of Psychology , Oklahoma State University , Stillwater , OK , USA
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41
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Yun H, Park ES, Choi S, Shin B, Yu J, Yu J, Amarasekara DS, Kim S, Lee N, Choi JS, Choi Y, Rho J. TDAG51 is a crucial regulator of maternal care and depressive-like behavior after parturition. PLoS Genet 2019; 15:e1008214. [PMID: 31251738 PMCID: PMC6599150 DOI: 10.1371/journal.pgen.1008214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 05/27/2019] [Indexed: 12/11/2022] Open
Abstract
Postpartum depression is a severe emotional and mental disorder that involves maternal care defects and psychiatric illness. Postpartum depression is closely associated with a combination of physical changes and physiological stress during pregnancy or after parturition in stress-sensitive women. Although postpartum depression is relatively well known to have deleterious effects on the developing fetus, the influence of genetic risk factors on the development of postpartum depression remains unclear. In this study, we discovered a novel function of T cell death-associated gene 51 (TDAG51/PHLDA1) in the regulation of maternal and depressive-like behavior. After parturition, TDAG51-deficient dams showed impaired maternal behavior in pup retrieving, nursing and nest building tests. In contrast to the normal dams, the TDAG51-deficient dams also exhibited more sensitive depressive-like behaviors after parturition. Furthermore, changes in the expression levels of various maternal and depressive-like behavior-associated genes regulating neuroendocrine factor and monoamine neurotransmitter levels were observed in TDAG51-deficient postpartum brain tissues. These findings indicate that TDAG51 plays a protective role against maternal care defects and depressive-like behavior after parturition. Thus, TDAG51 is a maternal care-associated gene that functions as a crucial regulator of maternal and depressive-like behavior after parturition. Postpartum depression is a severe emotional and mental disease that can affect women typically after parturition. However, the genetic risk factors associated with the development of postpartum depression are still largely unknown. We discovered a novel function of T cell death-associated gene 51 (TDAG51) in the regulation of maternal behavior and postpartum depression. We report that TDAG51 deficiency induces depressive-like and abnormal maternal behavior after parturition. The loss of TDAG51 in postpartum brain tissues induces changes in the expression levels of various maternal and depressive-like behavior-associated genes that regulate the levels of neuroendocrine factors and monoamine neurotransmitters. TDAG51 is a maternal care-associated gene that functions as a crucial regulator of maternal and depressive-like behavior after parturition.
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Affiliation(s)
- Hyeongseok Yun
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | - Eui-Soon Park
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | - Seunga Choi
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | - Bongjin Shin
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | - Jungeun Yu
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | - Jiyeon Yu
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | | | - Sumi Kim
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | - Nari Lee
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
| | - Jong-Soon Choi
- Division of Life Science, Korea Basic Science Institute, Daejeon, Korea
| | - Yongwon Choi
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jaerang Rho
- Department of Microbiology and Molecular Biology, Chungnam National University, Daejeon, Korea
- * E-mail:
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Kołomańska D, Zarawski M, Mazur-Bialy A. Physical Activity and Depressive Disorders in Pregnant Women-A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E212. [PMID: 31130705 PMCID: PMC6572339 DOI: 10.3390/medicina55050212] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/05/2019] [Accepted: 05/21/2019] [Indexed: 12/12/2022]
Abstract
Background and Objectives: Pregnancy is a unique period in the life of every woman. The lifestyle of a pregnant woman has a significant impact on her and her child's health. Regular physical activity is one of the elements that help maintain normal mental and physical well-being. In pregnant women who regularly have moderate physical activity, there is a lower risk of developing obesity and overweight. Physical exercises have an impact on maintaining proper muscular tonus, reduce pain and prepare for the exertion during labour. Based on the available literature, the aim of this study was to present the impact of physical activity on depressive disorders in pregnant women. Materials and Methods: A review of the literature was carried out in the Medline PubMed database. The basic search terms were: "pregnancy" AND "physical activity AND depression". The work included only English-language publications published in the years 2000-2018. Results: A total of 408 references were found. On the basis of an analysis of titles, abstracts and the language of publication (other than English), 354 articles were rejected, and 54 articles were fully read, of which five were rejected due to lack of access to the full version. Finally, 17 references were included in the review. Conclusions: Physical activity, at least once a week, significantly reduces the symptoms of depression in pregnant women and may be an important factor in the prevention of depression in this period.
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Affiliation(s)
- Daria Kołomańska
- Department of Ergonomics and Exercise Physiology, Faculty of Health Science, Jagiellonian University Medical College, Grzegorzecka 20, 31-531 Krakow, Poland.
| | - Marcin Zarawski
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Rydygier Hospital, Złotej Jesieni 1, 31-826 Krakow, Poland.
| | - Agnieszka Mazur-Bialy
- Department of Ergonomics and Exercise Physiology, Faculty of Health Science, Jagiellonian University Medical College, Grzegorzecka 20, 31-531 Krakow, Poland.
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Lin PY, Chiu TH, Ho M, Pei-Chen Chang J, Hui-Chih Chang C, Su KP. Major depressive episodes during pregnancy and after childbirth: A prospective longitudinal study in Taiwan. J Formos Med Assoc 2019; 118:1551-1559. [PMID: 30928189 DOI: 10.1016/j.jfma.2019.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/31/2018] [Accepted: 03/07/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Major depressive episodes (MDEs) are common during pregnancy and postpartum periods, and the consequences can be severe to mother and offspring. Few studies have investigated the clinical factors associated with the onset and remission of perinatal depression in different time points. METHODS A cohort of 234 pregnant women was recruited and assessed with structured Mini-International Neuropsychiatric Interview (MINI) for diagnoses of MDEs. The severity of mood status was measured with Taiwanese version of the Edinburgh Postnatal Depression Scale (EPDS-T) and the second edition of Beck Depression Inventory (BDI-II) at 16 weeks' gestation, 28 weeks' gestation and 4 weeks postpartum. Statistical analysis was conducted by independent t-tests, chi-squared, and Fisher's exact tests. RESULTS Thirty-one pregnant women (13.2%) developed MDEs; 11 (4.7%) at the 16th week, 8 (3.4%) at the 28th week of gestation, and 12 (5.1%) at the 4th week of postpartum. Among the 19 women with prenatal MDEs, 9 (47%) experienced remission by the end of pregnancy, and 10 sustained, resulting in the cumulative prevalence of 9.4% (22 out of 234) for postpartum MDEs. Women with lower levels of education, family history of psychiatric disorders, lack of postpartum recuperation, and family-bond stress were more likely to experience MDEs. More preterm birth and lower birth weights were reported in postpartum-onset than pregnancy-onset MDEs. Psychiatric interventions were associated with a higher percentage of remission of MDE during the perinatal period. CONCLUSION The findings of this study provide clinical implications for early detection and intervention of MDEs throughout the pregnancy.
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Affiliation(s)
- Pan-Yen Lin
- College of Medicine, China Medical University, Taichung, Taiwan; Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Department of Psychiatry, Wei Gong Memorial Hospital, Miao-Li, Taiwan
| | - Tsan-Hung Chiu
- Department of Obstetrics, China Medical University Hospital, Taichung, Taiwan
| | - Ming Ho
- Department of Obstetrics, China Medical University Hospital, Taichung, Taiwan
| | - Jane Pei-Chen Chang
- College of Medicine, China Medical University, Taichung, Taiwan; Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
| | - Cherry Hui-Chih Chang
- Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Pin Su
- College of Medicine, China Medical University, Taichung, Taiwan; Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.
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Al-Hashimi FJG, Kareem Alalaf S, Al Tawil NG. Screening for depression during pregnancy using the Kurdish version of the Edinburgh Postnatal Depression Scale in Erbil city. Health Care Women Int 2019; 41:240-254. [PMID: 30865576 DOI: 10.1080/07399332.2019.1571592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We aimed to determine any difference in the prevalence rate of depression during the three trimesters of pregnancy and its association with certain obstetric risk factors. In total, 1000 pregnant women attending primary health centers in the city of Erbil, Kurdistan, Iraq were assessed for depression using the Edinburgh Postnatal Depression Scale. Women in the first and second trimesters had a significantly higher probability of depression than those in the third trimester. Screening early in pregnancy and following pregnant women in each trimester may help to identify those who are susceptible to depression and enable appropriate intervention.
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Affiliation(s)
| | - Shahla Kareem Alalaf
- Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq
| | - Namir G Al Tawil
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq
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Ayano G, Tesfaw G, Shumet S. Prevalence and determinants of antenatal depression in Ethiopia: A systematic review and meta-analysis. PLoS One 2019; 14:e0211764. [PMID: 30779765 PMCID: PMC6380851 DOI: 10.1371/journal.pone.0211764] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/21/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Maternal depression is the most prevalent psychiatric disorder during pregnancy, can alter fetal development and have a lasting impact on the offspring's neurological and behavioral development. However, no review has been conducted to report the consolidated magnitude of antenatal depression (AND) in Ethiopia. Therefore, this review aimed to systematically summarize the existing evidence on the epidemiology of AND in Ethiopia. METHODS Using PRISMA guideline, we systematically reviewed and meta-analyzed studies that examined the prevalence and associated factors of AND from three electronic databases (PubMed, EMBASE, and SCOPUS). We used predefined inclusion criteria to screen identified studies. A qualitative and quantitative analysis was employed. Heterogeneity across the studies was evaluated using Q and the I² test. Publication bias was assessed by funnel plot and Egger's regression test. RESULTS In this review, a total of 193 studies were initially identified and evaluated. Of these, five eligible articles were included in the final analysis. In our meta-analysis, the pooled prevalence of AND in Ethiopia was 21.28% (95% CI; 15.96-27.78). The prevalence of AND was highest in the third trimester of pregnancy at 32.10% and it was 19.13% in the first trimester and 18.86% in the second trimester of pregnancy. The prevalence of AND was 26.48% and 18.28% as measured by Beck depression inventory (BDI) and the Edinburgh Postnatal Depression Scale (EPDS), respectively. Moreover, the prevalence of AND was 15.50% for the studies conducted in the community setting and it was 25.77% for the studies conducted in the institution-based setting. In our qualitative synthesis, we found that those pregnant women who had a history of stillbirth, complications during pregnancy, previous history of depression, no ANC follow-up, irregular ANC follow-up, not satisfied by ANC follow-up, and monthly income <1500 Ethiopian birr were linked with a greater risk of developing ANC. We also found that those women who experienced partner violence during pregnancy, food insecurity, medium and low social support, and those who were unmarried, age group 20-29, house wives and farmers were associated with a higher risk of developing ANC. CONCLUSION AND RECOMMENDATIONS Our meta-analysis found that the pooled prevalence of AND in Ethiopia was 21.28%. The prevalence of AND was high in the third trimester of pregnancy as compared to the first and second trimesters of pregnancy. The prevalence of AND was high in studies conducted using BDI than EPDS. Studies on the magnitude of AND as well as the possible determinants in each trimester of pregnancy with representative sample size are recommended. Screening of depression in a pregnant woman in perinatal setting might be considered backed by integration of family planning and mental health services. The use of validated and a standard instrument to assess AND is warranted. SYSTEMATIC REVIEW REGISTRATION The protocol for this systematic review and meta-analysis was registered at PROSPERO (record ID=CRD42017076521, 06 December 2017).
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Affiliation(s)
- Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
- * E-mail:
| | - Getachew Tesfaw
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
- Department of Psychiatry, University of Gondar, Gondar, Ethiopia
| | - Shegaye Shumet
- Department of Psychiatry, University of Gondar, Gondar, Ethiopia
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Hippman C, Balneaves LG. Women's decision making about antidepressant use during pregnancy: A narrative review. Depress Anxiety 2018; 35:1158-1167. [PMID: 30099817 DOI: 10.1002/da.22821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/27/2018] [Accepted: 07/11/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Depression is common, particularly among women of childbearing age, and can have far-reaching negative consequences if untreated. Efficacious treatments are available, but little is known about how women make depression treatment decisions during pregnancy. The purpose of this narrative review is to interpretively synthesize literature on women's decision making (DM) regarding antidepressant use during pregnancy. METHODS The databases PubMed, CINAHL, and PsycINFO were searched between May 2015 and August 2017 for peer-reviewed, English-language papers using terms such as "depression," "pregnancy," and "DM." The literature matrix abstraction method was used to systematically abstract data from full articles that met criteria for inclusion. RESULTS Of the articles abstracted (N = 10), half did not cite a DM theory on which the work was based. Key aspects of DM for this population were need for information and decision support, desire for active participation in DM, reflection on beliefs and values, evaluation of treatment option sequelae, and societal expectations. Treatment DM for depression during pregnancy is particularly impacted by the stigma associated with depression and societal expectations of pregnant women related to medication use during pregnancy. These findings, however, were based on studies of predominantly Caucasian and well-educated women. CONCLUSIONS Women require a nonjudgmental environment, in which shared DM feels safe, to foster positive DM experiences and outcomes. Future research is needed to define how to best support women to make depression treatment decisions in pregnancy, with particular attention to DM in the second and third trimesters of pregnancy.
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Affiliation(s)
- Catriona Hippman
- Translational Psychiatric Genetics Group, BC Mental Health & Addictions Research Institute, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Lynda G Balneaves
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
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Czarzasta K, Makowska-Zubrycka M, Kasarello K, Skital VM, Tyszkowska K, Matusik K, Jesion A, Wojciechowska M, Segiet A, Wrzesien R, Biały M, Krzascik P, Wisłowska-Stanek A, Sajdel-Sulkowska EM. A rat model to study maternal depression during pregnancy and postpartum periods, its comorbidity with cardiovascular diseases and neurodevelopmental impact in the offspring. Physiol Behav 2018; 199:258-264. [PMID: 30465806 DOI: 10.1016/j.physbeh.2018.11.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 11/14/2018] [Accepted: 11/17/2018] [Indexed: 12/24/2022]
Abstract
This study aimed to develop an animal model of human depression during pregnancy and lactation to examine the effect of maternal, perinatal depression on offspring development. Maternal depression during pregnancy affects up to 20% of women and is a risk factor for both the developmental and long-term health issues. It is often comorbid with the cardiovascular disease (CVD) that affects the uteroplacental circulation and impacts offspring development. More than half of the expecting mothers with depression use antidepressants that cross the placenta and may interfere with the neurodevelopmental programming. Thus, depressed pregnant mothers face a difficult choice whether "to use or not to use" antidepressant therapy, since both untreated depression and antenatal antidepressant exposure present increased risks of neurodevelopmental pathologies. The ongoing clinical debate presents inconclusive data, while the existing animal models of maternal depression do not include early gestational periods, and, do not monitor depressive-like behavior nor address the cardiovascular abnormalities. The presented model includes pregestational depressive behavior extending into pregnancy and lactation, periods that have not been previously examined. Rat dams exposed to pre-gestational chronic mild stress (CMS) developed a sustained decrease in self-grooming behavior, correlated with hormonal, behavioral, and cardiac changes persisting through the postpartum period. Preliminary data indicate neurodevelopmental delays, behavioral and cardiac abnormalities, and altered levels of both the brain and the heart markers in the offspring of stressed dams. Furthermore, the preliminary data predict that maternal pregnancy during the perinatal period is likely to impact the neurodevelopmental process in a sex-dependent manner. Thus the presented here model (PG-LAC CMS) fulfills both the face and the construct validity criteria for maternal stress-induced depression during pregnancy and postpartum that may facilitate further studies of the relative risks of untreated vs. antidepressant-treated maternal depression during pregnancy to the mother and her offspring.
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Affiliation(s)
- Katarzyna Czarzasta
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Poland
| | - Monika Makowska-Zubrycka
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Poland
| | - Kaja Kasarello
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Poland
| | - Veronica M Skital
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Poland
| | - Karolina Tyszkowska
- Central Laboratory of Experimental Animals, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Matusik
- Central Laboratory of Experimental Animals, Medical University of Warsaw, Warsaw, Poland
| | - Anika Jesion
- Central Laboratory of Experimental Animals, Medical University of Warsaw, Warsaw, Poland
| | - Malgorzata Wojciechowska
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Poland
| | - Agnieszka Segiet
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Poland
| | - Robert Wrzesien
- Central Laboratory of Experimental Animals, Medical University of Warsaw, Warsaw, Poland
| | - Michal Biały
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Poland
| | - Pawel Krzascik
- Department of Experimental and Clinical Pharmacology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warszawa, Poland
| | - Aleksandra Wisłowska-Stanek
- Department of Experimental and Clinical Pharmacology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warszawa, Poland
| | - Elzbieta M Sajdel-Sulkowska
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Poland; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Gajaria A, Ravindran AV. Interventions for perinatal depression in low and middle-income countries: A systematic review. Asian J Psychiatr 2018; 37:112-120. [PMID: 30173015 DOI: 10.1016/j.ajp.2018.08.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/11/2018] [Accepted: 08/16/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perinatal depression has been associated with infant low birth weight and with multiple health indicators affecting childhood morbidity and mortality. The condition is twice as prevalent in low and middle-income countries (LMICs) compared to high-income countries but poorly studied. AIM To conduct a review of published literature on interventions for perinatal depression in LMICs. METHODS A search of the literature was performed for articles published up to October 2017. The key inclusion criteria were peer-reviewed studies focusing on interventions for perinatal depression during pregnancy and/or up to one-year postpartum. RESULTS 1088 citations were retrieved, of which 18 studies with representation from countries in Africa, Asia, North America (Mexico) and South America were included. The majority of interventions were conducted in lower-income settings. Most were psychosocial in nature and often provided by lay health workers and in the community. Interventions integrated as part of general health programs and employing psychotherapeutic approaches were more effective and were also preferred. Only one study incorporated the use of psychiatric medications. CONCLUSION Despite the limited publications, there is reasonable evidence for the benefit of psychological interventions in perinatal depression in LMICs. More research is needed to verify and extend these results and, in particular, to evaluate the benefit of adjunctive medications when treating moderate to severe depression and whether interventions can increase social supports.
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Affiliation(s)
- Amy Gajaria
- University of Toronto, Department of Psychiatry, Canada; Division of Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Arun V Ravindran
- University of Toronto, Department of Psychiatry, Canada; Campbell Family Mental Health Research Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Shorey S, Chee CYI, Ng ED, Chan YH, Tam WWS, Chong YS. Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. J Psychiatr Res 2018; 104:235-248. [PMID: 30114665 DOI: 10.1016/j.jpsychires.2018.08.001] [Citation(s) in RCA: 475] [Impact Index Per Article: 79.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 01/17/2023]
Abstract
This review aims to examine the prevalence and incidence of postpartum depression among healthy mothers without prior history of depression including postpartum depression and who gave birth to healthy full-term infants. A systematic search of ClinicalTrials.gov, CINAHL, EMBASE, PsycINFO, and PubMed was performed for English articles from the inception of the database to November 2017, as well as a manual search of the reference lists of the included articles, and an expert panel was consulted. Across 15,895 articles, 58 articles (N = 37,294 women) were included in the review. The incidence of postpartum depression was 12% [95% CI 0.04-0.20] while the overall prevalence of depression was 17% [95% CI 0.15-0.20] among healthy mothers without a prior history of depression. Prevalence was similar regardless of the type of diagnostic tool used; however, there were statistical differences in the prevalence between different geographical regions, with the Middle-East having the highest prevalence (26%, 95% CI 0.13-0.39) and Europe having the lowest (8%, 95% CI 0.05-0.11). There was no statistical difference in prevalence between different screening time points, but an increasing prevalence was observed beyond six months postpartum. Intervention studies often neglect healthy mothers. This review reports a similar prevalence rate of postpartum depression among mothers without history of depression when compared to mothers with history of depression. Thus, future studies should place equal emphasis on this neglected group of mothers so that targeted interventions and follow-ups can be introduced at appropriate time points.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
| | - Cornelia Yin Ing Chee
- Department of Psychological Medicine, 5 Lower Kent Ridge Road, National University Hospital, 119074, Singapore
| | - Esperanza Debby Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, Block MD 1, 12 Science Drive 2, National University of Singapore, 117549, Singapore
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Yap Seng Chong
- Women's Centre, 5 Lower Kent Ridge Road, National University Hospital, 119074, Singapore
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Rackers HS, Thomas S, Williamson K, Posey R, Kimmel MC. Emerging literature in the Microbiota-Brain Axis and Perinatal Mood and Anxiety Disorders. Psychoneuroendocrinology 2018; 95:86-96. [PMID: 29807325 PMCID: PMC6348074 DOI: 10.1016/j.psyneuen.2018.05.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 12/15/2022]
Abstract
Perinatal Mood and Anxiety Disorders (PMAD) are common and can cause significant morbidity and mortality for mother and child. A healthy perinatal period requires significant adaptations; however, systems can become imbalanced resulting in depressive and anxiety symptoms. The interface between the microbiome, the immune system, and the stress system may be a model for understanding mechanisms underlying PMAD. Emerging literature from general populations regarding immune, hormone, and HPA axis changes in relation to the microbiome combined with literature on immune, gonadotropin, and stress systems in the perinatal period provides a background. We systematically investigated literature in the developing field of the microbiome in relation to PMAD. Our inclusion criteria were 1) reporting measure of maternal mood, stress, or anxious or depressed behavior; 2) in the perinatal period, defined as pregnancy through one year postpartum; and 3) reporting measure of maternal microbiome including manipulations of the microbiome through prebiotics, probiotics, or interventions with microbial byproducts. The review identified research studying associations between stress and maternal microbiome; dietary impacts on microbial composition, mood, and stress; and the relationship between the microbiome and the immune system through immunoregulatory mechanisms. Important themes identified include: the importance of studying the maternal microbiome and measures of stress, anxiety, and depression and that multi-hit models will be needed as research strives to determine the effects of multiple mechanisms working in concert.
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Affiliation(s)
- Hannah S Rackers
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 304 MacNider Hall, CB #7160, Chapel Hill, NC, 27599-7160, United States.
| | - Stephanie Thomas
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 245 Rosenau Hall, CB # 7461, Chapel Hill, NC, 27599-7461, United States.
| | - Kelsey Williamson
- University of North Carolina at Chapel Hill School School of Medicine, Chapel Hill, NC, 27599, United States.
| | - Rachael Posey
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, United States.
| | - Mary C Kimmel
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 304 MacNider Hall, CB #7160, Chapel Hill, NC, 27599-7160, United States.
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