Perinatal Depression: Challenges and Opportunities

Perinatal Mood and Anxiety Disorders: Evidence-Based Approaches to Screening and Management During Pregnancy and Postpartum

This is a review of the existing literature and guidelines for the screening, management, and follow-up of perinatal mood and anxiety disorders, with a focus on major depressive disorder and generalized anxiety disorder.

Randomized clinical trial protocol of an app-based intervention to prevent postpartum depression

PURPOSE

To develop and evaluate the effectiveness of an asynchronously delivered app, InBloom, for postpartum depression (PPD) prevention relative to an evidence-based synchronously delivered in-person intervention, ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) for depression and return on investment via a prospective randomized controlled trial and quasi-experimental cohort analyses.

BACKGROUND

PPD affects 1 in 7 gestational parents in the US, causing emotional distress, consequences for infant development and child adjustment, disruptions in family relationships, and financial burden. ROSE is an evidence-based intervention administered as four in-person group sessions plus one postpartum booster session. Despite ROSE's demonstrated effectiveness, pragmatic barriers impact disseminating an in-vivo group intervention broadly to people at risk for PPD. If effective, an app may help overcome implementation barriers.

DESIGN

We will develop an app based on the ROSE intervention, recruit 152 pregnant people ≥18 years, 17-32 weeks' gestation, and with risk factors for PPD, and randomize participants either to InBloom or ROSE. Primary outcomes are depression and return on investment (ROI). Hypothesized mechanisms are perceived access, engagement, and satisfaction with the intervention. Control groups include historical control subjects from the largest ROSE trial for depression outcomes and Electronic Health Record (EHR) data on concurrent patients from the same clinics not offered InBloom or ROSE for ROI outcomes.

CONCLUSION

At the end of the trial, we will know if InBloom is a viable alternative to ROSE, allowing further implementation studies of an easy, low-cost distribution app to reduce risk of PPD.

CLINICALTRIALS

govRegistration Identifier:NCT05518162.

Perinatal Mental Health Disorders and Resilience in Patients with Fetal Anomalies

OBJECTIVE

 Pregnant women face heightened vulnerability to mental health disorders (MHDs). There remains a lack of data during the antenatal period, particularly for high-risk subpopulations such as those with fetal anomalies. Understanding the psychological impact of women receiving a fetal anomaly diagnosis is crucial, as it can lead to MHDs. Additionally, maternal stress due to such diagnoses can have adverse effects on short- and long-term health outcomes for both the mother and the child. This study aimed to address the gap in knowledge regarding prenatal MHDs in women with fetal anomalies by characterizing maternal peripartum psychological health and identifying factors related to MHDs.

STUDY DESIGN

 Women diagnosed with fetal anomalies (N = 110) were recruited from a tertiary fetal care center and completed surveys assessing resilience, anxiety, depression, and posttraumatic stress symptoms (PTSs). Demographic characteristics were also collected and analyzed. Multiple regression analyses were conducted to explore associations between demographic variables and mental health outcomes.

RESULTS

 Participants endorsed elevated depressive symptoms (45%), anxiety (43%), and PTSs (39%). Private insurance and relationship status were positively associated, and resilience was negatively associated, with depression and anxiety levels. Maternal perception of diagnostic severity correlated with increased depressive symptoms and PTSs, whereas physician ratings of diagnostic severity did not.

CONCLUSION

 The findings underscore the prevalence of MHD among pregnant women with fetal anomalies and emphasize the importance of assessing maternal perception of severity in predicting mental health outcomes. Identifying risk factors like insurance status and relationship status suggests avenues for targeted screening and intervention. Multidisciplinary collaboration is essential for implementing effective strategies to address peripartum psychopathology related to fetal anomalies and improve overall maternal and fetal health.

KEY POINTS

· Pregnant women with fetal anomalies face poor mental health.. · Resilience is negatively related to poor mental health.. · Perception of severity impacts mental health symptoms..

Factor structure and longitudinal measurement invariance of Edinburgh Postnatal Depression Scale during the whole perinatal period: a multicenter cohort study in China

BACKGROUND

Perinatal depression is common worldwide, which can cause many adverse effects on the physical and mental health of the mother and baby, as well as the whole family. The Edinburgh Postnatal Depression Scale (EPDS) is an efficient and effective instrument for perinatal depression. However, few studies have examined its longitudinal measurement invariance (LMI) during the whole perinatal period, which is particularly important in longitudinal studies, such as exploring developmental trajectories of perinatal depression and evaluating the effects of certain interventions.

METHODS

4139 pregnant women from 24 hospitals in 15 provinces of China were measured using EPDS in the first, second, third trimesters and 6 weeks postpartum. Exploratory factor analysis and confirmatory factor analysis were used to explore the factor structure of EPDS at each time point. Multi-group analyses were performed to examine LMI of EPDS.

RESULTS

A three-factor model was optimal at all time points, showing the clearest factor structure and best model fit: Anhedonia (Items 1-2), Anxiety (Items 3-6), Depression (Items 7-10). Internal reliability of EPDS was good at all time points (e.g., Cronbach's α > 0.80). A series of multi-group analyses further indicated that the EPDS held strict LMI (configural, metric, scalar and strict invariance) during the perinatal period.

CONCLUSION

The findings further confirmed three-factor structure and good reliability of the EPDS when used in Chinese pregnant and postpartum women. The LMI justified comparisons of EPDS scores among different measurement time points.

Case Report of Dysphoric Milk Ejection Reflex

Dysphoric milk ejection reflex (D-MER) is a dysregulation of emotions (dysphoria) that can occur during the milk ejection reflex and during breastfeeding or expressing breast milk. Symptoms of D-MER present suddenly and can include hopelessness, sadness, nervousness, irritability, nausea, dread, palpitations, and a hollow feeling in the stomach. Although D-MER was first reported in 2007, it remains understudied to date and should not be confused with postnatal depression or anxiety disorders. Knowing that they are experiencing symptoms of a named condition is very supportive for women who experience D-MER. It is important that health care professionals who interact with the breastfeeding dyad be aware of D-MER so they can provide supportive care, manage symptoms, and protect the breastfeeding relationship. In this article, we describe the case of a woman who experienced D-MER while she breastfed her newborn.

A systematic review of associations between hormone levels in hair and peripartum depression

Peripartum depression is a global health concern, characterized by mood disturbances inclusive of pregnancy through up to 12-months postpartum. Hormones play a vital role in pregnancy maintenance, fetal development, and labor and delivery and change significantly as a function of pregnancy and childbirth. However, such life sustaining changes may have consequences related to risk for peripartum depression. To date, most studies that have examined hormones in relation to peripartum depression have focused on blood or saliva sampling approaches, though hair analysis offers unique information on trajectories of hormone concentrations over more sustained periods of time (i.e., over months). The aim of this systematic review was to provide a comprehensive review of the association between hair measures of hormones (i.e., cortisol, progesterone, estrogen, and testosterone) and depression during the peripartum period. Forty-one studies were identified for inclusion. A majority of studies reported statistically null associations. Between-person studies varied widely in reported direction and magnitude of hair hormone-depression associations, most likely attributable to a wide range of methodological approaches including timing of assessments and sample size. Studies using within-person approaches observed positive coupling of cortisol concentration and symptoms across time. Most studies focused exclusively on cortisol. We recommend future research consider both stress and reproductive hormones, prioritize within-person change in hormone levels given this is a period of dramatic change, and include contextual (e.g., social support, adverse and benevolent childhood experiences, physical and psychiatric conditions) features that may modify both changes in hormones and the association between hormone levels and depression in the peripartum period.

Effect of postpartum clinical guideline on maternal outcomes in iranian women: a randomized controlled clinical trial

BACKGROUND

The postpartum period is a vital time for women, infants, spouses, parents, caregivers and families. Considering the importance of postpartum care and the necessity of using comprehensive and up-to-date clinical guidelines in Iran, this study was designed to implement a indigenized clinical guideline in Iran on maternal outcomes, including maternal functioning, postpartum depression and postpartum specific anxiety (primary outcomes) as well as infant care, maternal health problems, experiencing violence, feeding method and contraception use (secondary outcomes).

METHODS

This randomized controlled trial was conducted with 272 postpartum women in Taleghani and Alzahra hospitals in Tabriz in 2023. Participants were randomly allocated to intervention and control groups. The intervention group received care and training based on clinical guideline while the control group received routine care and training. Both groups were followed up by telephone at the second and sixth week after delivery. Questionnaires assessing maternal health problems and postpartum depression were completed in the second and sixth weeks and while assessments of maternal functioning, postpartum depression, postpartum specific anxiety, infant care behavior, and experiences of violence were conducted in the sixth week after delivery. ANCOVA, independent-t tests, and Mann-Whitney U tests were used for data analysis.

RESULTS

There was no significant difference between the two groups regarding of socio-demographic characteristics (P < 0.05). Additionally, there were no significant differences in the mean score of maternal functioning, anxiety, depression, infant care behavior or experiences of violence after the intervention between the intervention and control groups based on ANCOVA or Mann-Whitney U tests (P < 0.05). However, the rate of infant formula use was significantly lower in the intervention group (12.9%) compared to the control group (23.4%) (P = 0.027). In terms of contraceptive methods used, 24.3% of the intervention group and 22.2% of the control group reported using reliable contraceptive methods )P = 0.035(. Furthermore, 98.5% of participants in the intervention group expressed satisfaction with the education and recommendations provided, compared to 88.2% in the control group (P = 0.002).

CONCLUSION

Providing clinical guideline-based care was associated with increased breastfeeding rates, greater use of reliable contraception methods, and higher levels of maternal satisfaction. However, it did not have a significant impact on other maternal outcomes.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT) IRCT20120718010324N76 Date of registration 27/1/2023. URL: https://trialsearch.who.int/Trial2.aspx?

TRIALID

IRCT20120718010324N76 DATE OF FIRST REGISTRATION: 27/3/2023.

Associations Between Brominated Flame Retardant Exposure and Depression in Adults: A Cross-Sectional Study

BACKGROUND

Brominated flame retardants (BFRs) are a type of widespread pollutant that can be transmitted through particulate matter, such as dust in the air, and have been associated with various adverse health effects, such as diabetes, metabolic syndrome, and cardiovascular disease. However, there is limited research on the link between exposure to mixtures of BFRs and depression in the general population.

METHODS

To analyze the association between exposure to BFRs and depression in the population, nationally representative data from the National Health and Nutrition Examination Survey (NHANES; 2005-2016) were used. In the final analysis, a total of 8138 adults aged 20 years and older were included. To investigate the potential relationship between BFRs and outcomes, we used binary logistic regression, restricted cubic spline (RCS), quantile-based g computation (QGC), and weighted quantile sum (WQS) regression.

RESULTS

The findings showed that serum BFR concentrations were associated with depressive symptoms over a broad spectrum. Binary logistic regression and RCS analysis showed that certain BFRs, particularly PBB153, were significantly and positively associated with the incidence of depression, even after adjustment for various confounders (p < 0.05). Mixed exposure to BFRs was also found to be associated with depression in the population, with a stronger association in men. The two most influential BFRs, PBB153 and PBDE85, were identified in both mixed exposure models and are potential risk factors of concern.

CONCLUSION

Our study identified new insights into the relationship between BFRs and depression, but sizable population-based cohort studies and toxicology mechanism studies will be needed to establish causality.

The mediating role of rumination in the relationship between negative cognitive styles and depression among pregnant women in Guangzhou, China

Backgrounds

Negative cognitive styles (NCSs) have been identified as risk factor for the onset of depression. However, little empirical evidence is available to support its role in psychological disorders in the perinatal period. Moreover, less is known about the underlying mechanism in the relation between NCSs and depression in pregnant women. The purpose of this study was to examine the mediation effect of rumination on the relationship between NCSs and antenatal depression (AD). Specifically, the mediation effects of two subtypes of rumination were tested.

Methods

A cross-sectional study was conducted from February to May 2023 using anonymous online questionnaire among women in their third trimester of pregnancy in the antenatal care clinic of a tertiary hospital. The Edinburgh Postnatal Depression Scale was used to screen antenatal depression. Attributional Style Questionnaire and Ruminative Responses Scale were employed to assess NCSs and rumination respectively. Correlational analysis of the associations between NCSs, rumination, and AD was conducted. Bootstrap mediation analysis and multiple mediation models were applied to investigate whether rumination, and its brooding and reflection components would mediate the relationship between NCSs and AD.

Results

NCSs had a significant positive effect on depression in pregnant women (c=1.45, SE=0.03, p<0.001, 95%CI: 0.92∼1.70). Rumination mediated the relationship between NCSs and depression in pregnant women (point estimate=0.41, 95%CI: 0.13∼0.79, effect size=0.22, K2 = 0.19). Multiple mediation analysis revealed that brooding, instead of reflection, mediated the relationship between NCSs and depression in pregnant women (point estimate=0.41, 95%CI: 0.15∼0.78).

Conclusion

This study provided novel evidence for the role of rumination, specifically its brooding subtype, in shaping the link between NCSs and depression in pregnant women, highlighting potentially useful targets for interventions aimed at preventing the onset of AD.

Practical resources for effective postpartum parenting (PREPP): a randomized controlled trial of a novel parent-infant dyadic intervention to reduce symptoms of postpartum depression

BACKGROUND

There is little known about the effectiveness of psychological interventions to prevent postpartum depression that focus on the birthing parent and infant dyad. Risk factors for PPD include depression during pregnancy, low parenting self-efficacy, and disrupted parental nocturnal sleep. The brief Practical Resources for Effective Postpartum Parenting (PREPP) intervention is designed for pregnant individuals at-risk for postpartum depression, providing them with 1) caregiving strategies aimed at reducing infant fuss and cry behavior and increasing infant sleep, 2) self-reflection and mindfulness skills and 3) psychoeducation about the postpartum period and infant behavior. The aims are to set more realistic postpartum expectations, enhance parenting confidence and sleep via supporting infant regulatory behavior, improve parental affect regulation and ultimately reduce the risk of postpartum depression.

OBJECTIVE

Assess the effectiveness of PREPP compared to enhanced treatment as usual in reducing symptoms of depression and anxiety and episodes of infant fuss and cry behavior and improving parental and infant sleep in the early postpartum.

STUDY DESIGN

A randomized controlled trial was conducted of 175 pregnant individuals. Inclusion criteria were standard prenatal care for a singleton pregnancy, aged 18 to 45 and at increased risk of PPD as determined by a score of ≥19 on the Predictive Index of Postnatal Depression or ≥7 on the Edinburgh Postnatal Depression Scale. Participants assigned to the PREPP group (n=88) received 3 coaching sessions and 2 phone check-ins. Participants assigned to the enhanced treatment as usual group (n=87) received 3 sessions which included psychoeducation, mood assessments, and clinical referral and follow-up as indicated. Assessments were conducted at 28 to 32 weeks and 34 to 39 weeks gestation, and at 6, 12 and 16 weeks postpartum and included measures of parental depression, anxiety and sleep (Edinburgh Postnatal Depression Scale, Patient Health Questionnaire (PHQ-9), Hamilton Rating Scales of Depression and Anxiety and Pittsburgh Sleep Quality Index) and infant sleep and fuss and cry behavior (Baby Day Diary).

RESULTS

Compared to enhanced treatment as usual, PREPP significantly reduced depressive symptoms at 6, 12 and 16 weeks postpartum with medium to large effect sizes (d=0.7-0.98). Compared to enhanced treatment as usual, participants receiving PREPP reported less of a decline in sleep quality at 6 weeks postpartum (p=0.035) and the effect size was large (d=0.83). Moreover, parents receiving the PREPP intervention reported less infant fussing and crying, with the largest effect for morning crying (p<.001; d=-1.48).

CONCLUSION

The results provide evidence that PREPP, initiated during pregnancy, reduced symptoms of parental depression and infant fuss and cry behavior in the early postpartum, compared to enhanced treatment as usual, in a sample at-risk for postpartum depression.

The construction and validation of the novel nomograms for the risk prediction of prenatal depression: a cross-sectional study

Background

Nomograms are superior to traditional multivariate regression models in the competence of quantifying an individual's personalized risk of having a given condition. To date, no literature has been found to report a quantified risk prediction model for prenatal depression. Therefore, this study was conducted to investigate the prevalence and associated factors of prenatal depression. Moreover, two novel nomograms were constructed for the quantitative risk prediction.

Methods

In this cross-sectional study, the participants were recruited using convenience sampling and administered with the research questionnaires. The prevalence of prenatal depression was calculated with a cutoff point of ≥ 10 in the 8-item Patient Health Questionnaire. Univariate and multivariate binomial logistic regression models were subsequently employed to identify the associated factors of prenatal depression. Two nomograms for the risk prediction were constructed and multiple diagnostic parameters were used to examine their performances.

Results

The prevalence of prenatal depression was 9.5%. Multivariate binomial logistic regression model based on sociodemographic, health-related, and pregnancy-related variables (model I) suggested that unemployment, poor relationship with partners, antecedent history of gynecologic diseases, unplanned pregnancy, an earlier stage of pregnancy, and more severe vomiting symptoms were associated with increased risk of prenatal depression. In the regression model that further included psychosocial indicators (model II), unemployment, antecedent history of gynecologic diseases, unplanned pregnancy, an earlier stage of pregnancy, and a higher total score in the Pregnancy Stress Rating Scale were found to be associated with prenatal depression. The diagnostic parameters suggested that both nomograms for the risk prediction of prenatal depression have satisfactory discriminative and predictive efficiency and clinical utility. The nomogram based on model II tended to have superior performances and a broader estimating range and that based on model I could be advantageous in its ease of use.

Conclusions

The prevalence of prenatal depression was considerably high. Risk factors associated with prenatal depression included unemployment, poor relationship with partners, antecedent history of gynecologic diseases, unplanned pregnancy, an earlier stage of pregnancy, more severe vomiting symptoms, and prenatal stress. The risk prediction model I could be used for fasting screening, while model II could generate more precise risk estimations.

Implementing universal maternal depression screening in Head Start: A convergent mixed methods study

Aims

Implementing maternal depression screening in child-serving programs can help ensure that more mothers receive mental health services. This study examined the implementation of universal maternal depression screening in community-based Head Start programs.

Methods

Quantitative and qualitative data were merged in a convergent mixed method design to assess four domains from the RE-AIM implementation science framework (Reach, Adoption, Implementation, and Maintenance). Qualitative data included interviews with stakeholders and meeting minutes from the implementation period. Quantitative data included intervention outcomes and administrative data.

Results

In terms of reach, 85% of eligible Head Start mothers were screened for depression, and English-speaking mothers were more likely to refuse screening than Spanish-speaking or bilingual mothers. Barriers to screening included lack of availability, stigma, privacy concerns, lack of interest, and lack of trust. In terms of adoption, all sites and staff adopted screening due to organizational mandates. In terms of implementation, there was wide variation in rates of positive screenings across staff completing the screening (ranging from 0% to 46%), and barriers included concerns about staff role and lack of training. In terms of maintenance, screening was not sustained after the study period due to organizational priorities and lack of buy-in from staff.

Conclusion

Universal maternal depression screening has the potential to reach low-income Head Start mothers, but additional efforts should be made to build staff capacity to engage mothers in screening.

Disparities in Screening and Treatment Patterns for Depression and Anxiety During Pregnancy: An Integrative Review

INTRODUCTION

Symptoms of untreated depression and anxiety during pregnancy are associated with serious adverse effects for the pregnant person, birth outcomes, and child development. However, pregnant persons are less likely to be screened and treated compared with nonpregnant people. In this systematic review, we aimed to explore individual, provider, and systems factors that impact screening, identification, and treatment patterns for depression and anxiety during pregnancy.

METHODS

Studies were eligible for inclusion if they were conducted within the United States and published in English between January 2012 and January 2023. Each study included analysis that compared rates of screening, identification, or treatment engagement and explicitly discussed disparities or health equity in marginalized groups. Fifteen articles met full inclusion criteria.

RESULTS

Results demonstrated variation in the screening, identification, and treatment of depression and anxiety during pregnancy among diverse groups of patients. Screening rates ranged from 51.3% in Puerto Rico to 90.7% in Alaska. Among specific clinical populations, rates were as low as 2.0%. Fewer than half of patients were referred to treatment when indicated by screening or diagnoses. Patient characteristics such as age, race, ethnicity, socioeconomic and health factors, mental health history, and obesity were associated with variation in the rates of screening, diagnoses, or treatment engagement. Language factors were the most common factor associated with lower rates of screening and treatment access.

DISCUSSION

Results suggest that many pregnant people are being overlooked and lack appropriate referrals or resources to access treatment. Results are consistent with previous findings that role confusion and lack of time, provider training, and interest contribute to low rates of screening and treatment. Future research must focus on system level factors to address perceived barriers to screening and treating depression and anxiety during pregnancy in a systematic and equitable way.

Prolonged transcranial magnetic stimulation in a pregnant patient with treatment-resistant depression: a case report

INTRODUCTION

Perinatal depression is a serious and highly prevalent medical condition in the USA. Nearly 85% of individuals with perinatal depression go untreated, leading to significant morbidity and mortality. There is an urgent need to develop and advance safe and effective treatments for perinatal depression. Transcranial magnetic stimulation is an established intervention for depression in non-pregnant individuals yet is not well studied in perinatal depression.

CASE PRESENTATION

A 33-year-old pregnant Latina female presented with severe, recurrent, treatment-resistant depression and suicidal ideation. The patient had previously trialed psychotherapy, multiple antidepressants, and mood stabilizers and had achieved remission with lithium prior to pregnancy. Due to pregnancy and fetal safety concerns, the patient discontinued lithium and consequently suffered progressive worsening of perinatal depression. At 24 weeks gestation and after additional failed medication trials, a prolonged course of transcranial magnetic stimulation was initiated. Following 46 transcranial magnetic stimulation treatments over 9 weeks using two protocol types (repetitive transcranial magnetic stimulation and intermittent theta burst stimulation), she achieved near-remission of perinatal depression and resolution of suicidal ideation. There were no identified maternal or fetal adverse events at 6 weeks post-delivery.

CONCLUSION

To our knowledge, this is the first published case of a pregnant individual with perinatal depression who received and tolerated a prolonged transcranial magnetic stimulation course with two distinct protocols (repetitive transcranial magnetic stimulation and intermittent theta burst stimulation) with clinically significant response. Transcranial magnetic stimulation is a well-tolerated and effective intervention that warrants further investigation for use in treatment-resistant perinatal depression.

Profiles and associated factors of prenatal psychological symptoms and their association with health-related quality of life among pregnant women: a cross-sectional study

OBJECTIVES

To cluster prenatal psychological symptoms into different profiles and investigate prenatal psychological symptoms' sociodemographic, health-related and pregnancy-related factors. Furthermore, health-related quality of life was compared across prenatal psychological symptom profiles.

DESIGN

Cross-sectional study.

SETTING

Obstetrics clinics of two university-affiliated, governmental, tertiary hospitals in Xi'an City, Northwestern China.

PARTICIPANTS

Between June and August 2020, 1020 pregnant women who maintained their health assessment appointments at the two research sites participated in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

This study's primary outcome was the creation of latent profiles of prenatal psychological symptoms. These were represented by the coexisting symptoms of three common psychological disorders: depression measured using the eight-item Patient Health Questionnaire, anxiety measured using the Generalised Anxiety Disorder-7 and stress measured using the Pregnancy Stress Rating Scale. Secondary outcomes included potential sociodemographic, health-related and pregnancy-related factors associated with prenatal psychological symptoms, which were measured using a researcher-designed information sheet, and health-related quality of life, measured using the 5-Level EuroQol 5-Dimension questionnaire.

RESULTS

Prenatal psychological symptoms were classified into three latent profiles using latent profile analysis: low (62.9%), moderate (31.3%) and severe (5.8%). Factors associated with the severity of prenatal psychological symptoms included age, relationship with partner, relationship with mother-in-law, history of gynaecological diseases, history of dysmenorrhoea, stage of pregnancy, unplanned pregnancy, severity of vomiting symptoms and abnormal pregnancy indicators. Moreover, an inverse association was identified between the severity of prenatal psychological symptoms and health-related quality of life.

CONCLUSIONS

Considering the high prevalence of prenatal psychological symptoms and their adverse effects on health-related quality of life, the assessment of prenatal psychological symptoms should be integrated into prenatal healthcare and made routine practice. Investigating the relevant associated factors would be beneficial for identifying vulnerable individuals.

Risk factors of the antenatal depression in a sample of Italian pregnant women: a preliminary study

BACKGROUND

Antenatal depression is characterized by low mood, insomnia, disorganised behaviour, irritability, and agitation during the pregnancy. If underestimated, antenatal depression is untreated during the pregnancy. It is associated to higher levels of suicide, higher risk of depression after childbirth, preeclampsia, preterm birth, low birth weight, poor interactions between child and mother and severe obstetric outcomes. New data underlined the importance to prevent the risk of depression during the pregnancy. This study examines the predictive validity of potential risk factors, such as socio-demographic and psychological factors, in developing the antenatal depression.

METHODS

The sample was composed by Italian pregnant women (N = 247, mean age of 33.77, SD = 4.78 years). This sample completed the Edinburg Postnatal Depression Scale (EPDS), the Teate Depression Inventory (TDI) and questionnaires about demographic variables. To study associations among variables examined bivariate correlations were computed. To analyse the role of socio-demographic factors and the psychological dimension to predict the severity of the antenatal depression a logistic regression was performed.

RESULTS

Results showed significantly positive correlations between the EPDS and the TDI, and no associations among the EPDS and all socio-demographic factors. Therefore, only the psychological factors were significant predictive risk factors of antenatal period. Finally, higher score of the depression measured via TDI predicted higher score of the EPDS.

CONCLUSIONS

Our results had implications in clinical field. Indeed, the early diagnosis of depression during the pregnancy can help operators in the gynaecological field to prevent the depression in the post-partum period.

Enhancing Obstetric Healthcare Providers' Knowledge of Black Maternal Mental Health: A Feasibility Study

Despite guidelines for screening and treating perinatal mood and anxiety disorders (PMADs), systemic issues and clinician biases often result in unmet mental health needs in Black women. This study assessed the feasibility and impact of comprehensive PMAD training on obstetric healthcare providers' attitudes, knowledge, and implicit racial biases. We conducted a feasibility study with two cohorts of healthcare providers who received either in-person or virtual training. The training focused on PMADs, implicit bias, and culturally responsive care. Participants completed pre- and post-training assessments measuring attitudes, knowledge, empathy, and implicit racial biases. Both training modalities showed trends towards improved PMAD screening attitudes and empathy, with significant increases in beliefs about treatment efficacy. Implicit bias scores approached significance, showing a shift toward fewer participants with racial preferences. However, there was an unexplained increase in preference for White over Black post training. The training improved healthcare providers' readiness to screen for PMADs and enhanced their understanding of PMADs. However, the persistence of implicit biases highlights the need for ongoing, sustained interventions to address deeply rooted biases. Future research should incorporate continuous learning strategies and link training to healthcare outcomes for minoritized communities.

Unveiling perinatal depression: A dual-network EEG analysis for diagnosis and severity assessment

Perinatal depression (PD), which affects about 10-20 percent of women, often goes unnoticed because related symptoms frequently overlap with those commonly experienced during pregnancy. Moreover, identifying PD currently depends heavily on the use of questionnaires, and objective biological indicators for diagnosis has yet to be identified. This research proposes a safe and non-invasive method for diagnosing PD and aims to delve deeper into its underlying mechanism. Considering the non-invasiveness and clinical convenience of electroencephalogram (EEG) for mothers-to-be and fetuses, we collected the resting-state scalp EEG of pregnant women (with PD/healthy) at the 38th week of gestation. To compensate for the low spatial resolution of scalp EEG, source analysis was first applied to project the scalp EEG to the cortical-space. Afterwards, cortical-space networks and large-scale networks were constructed to investigate the mechanism of PD from two different level. Herein, differences in the two distinct types of networks between PD patients and healthy mothers-to-be were explored, respectively. We found that the PD patients illustrated decreased network connectivity in the cortical-space, while the large-scale networks revealed weaker connections at cerebellar area. Further, related spatial topological features derived from the two different networks were combined to promote the recognition of pregnant women with PD from those healthy ones. Meanwhile, the depression severity at patient level was effectively predicted based on the combined spatial topological features as well. These findings consistently validated that the two kinds of networks indeed played off each other, which thus helped explore the underlying mechanism of PD; and further verified the superiority of the combination strategy, revealing its reliability and potential in diagnosis and depression severity evaluation.

The role of emotion regulation in perinatal depression and anxiety: a systematic review

BACKGROUND

Major depressive disorder and anxiety disorders are highly prevalent and comorbid during the perinatal period. Although research and clinicians agree that emotion regulation (ER) is an important transdiagnostic factor underlying both disorders in the general population, ER during the perinatal period has received less research attention. The aim of this systematic review was to assess the literature regarding the role of ten commonly studied ER strategies in the onset and maintenance of perinatal depression and anxiety in pregnant women and young mothers, using the Process Model of Gross (1998) as a theoretical framework.

METHODS

We searched four electronic databases with variations of the following key words: women; emotion regulation (i.e., behavioral approach, behavioral avoidance, problem solving, support seeking, distraction, rumination, reappraisal, acceptance, expressive suppression, and expressive engagement); perinatal period; and psychopathology. The aim was to identify peer-reviewed, and quantitative studies published between January 1999 and January 2023. Six articles were selected for analysis.

RESULTS

Similar ER strategies emerged as risk and protective factors in perinatal depression and anxiety. Overall, behavioral avoidance, distraction, rumination, and expressive engagement appeared as risk factors, while problem solving, emotional and instrumental support seeking, cognitive reappraisal, and acceptance, emerged as protective factors in the onset and maintenance of perinatal depression and anxiety. These findings align with previous research in perinatal community samples, as well as in non-perinatal clinical samples.

CONCLUSIONS

Our results support the role of ER as a transdiagnostic factor underlying both perinatal depression and anxiety. Clinicians are encouraged to implement ER strategies into the screening, prevention, and treatment of perinatal depression and anxiety. Further research is needed to strengthen these findings and to examine the role of emotion regulation during antenatal depression and anxiety more closely.

"Association between perinatal mood disorders of parents and child health outcomes"

PURPOSE

Perinatal mood disorders affect both parents, impacting their children negatively. Little is known on the association between parental perinatal mood disorders and pediatric outcomes in Japan considering relevant covariates. Our objective was to investigate the association between paternal and maternal perinatal mood disorders and adverse physical and psychological child outcomes by the age of 36 months, adjusting for covariates such as the child's sex, age of parent at child's birth, perinatal mood disorders of the other parent, and perinatal antidepressant use.

METHODS

We identified parents in the JMDC Claims Database in Japan from 2012 to 2020. Perinatal mood disorders were defined using International Classification of Diseases, 10th codes for mood disorders during the perinatal period combined with psychiatric treatment codes. We evaluated the association between parental perinatal mood disorders and pediatric adverse outcomes by the age of 36 months using Cox proportional hazard models adjusted for the covariates.

RESULTS

Of the 116,423 father-mother-child triads, 2.8% of fathers and 2.3% of mothers had perinatal mood disorders. Paternal perinatal mood disorders were not significantly associated with adverse child outcomes. After adjusting for paternal perinatal mood disorders and antidepressant use, maternal perinatal mood disorders were associated with delayed motor development, language development disorders, autism spectrum disorders, and behavioral and emotional disorders (adjusted hazard ratio [95% confidence interval]: 1.65 [1.01-2.69], 2.26 [1.36-3.75], 4.16 [2.64-6.55], and 6.12 [1.35-27.81], respectively).

CONCLUSIONS

Paternal perinatal mood disorders were not associated with adverse child outcomes in this population. Maternal perinatal mood disorders were associated with multiple child outcomes.

Early Life Trauma, Emotion Dysregulation and Hormonal Sensitivity Across Female Reproductive Life Events

PURPOSE OF REVIEW

To explore the relationship between early life trauma, hormonal sensitivity, and psychiatric disorders across female-reproductive life events, with a focus on the neurobiological mechanisms.

RECENT FINDINGS

Childhood trauma significantly increases the risk of subsequent mood disorders during periods of intense hormonal fluctuation such as premenstrual, pregnancy, postpartum, and perimenopause. Neurobiological changes resulting from early trauma influence emotion regulation, which emerges as a key predisposing, exacerbating, and perpetuating factor to hormonal sensitivity and subsequent psychiatric symptoms. We identified altered stress response and allopregnanolone imbalance, bias in cognitive processing of emotions, neuroimage correlates and sleep disturbances as potential underlying neurobiological mechanisms. This review integrates cumulative findings supporting a theoretical framework linking early life trauma to hormonal sensitivity and mood disorders. We propose that some women might be more susceptible to such hormonal fluctuations because of emotion dysregulation following significant early life trauma.

Guideline No. 454: Identification and Treatment of Perinatal Mood and Anxiety Disorders

OBJECTIVE

To help perinatal health care providers identify and assist pregnant and postpartum patients with perinatal mental illness, specifically perinatal mood and anxiety disorders. Areas of focus include risk factors and identification, screening, treatment, and referral.

TARGET POPULATION

All individuals who are pregnant or in the first year postpartum.

OUTCOMES

Open dialogue and evidence-informed care for perinatal mood and anxiety disorders, including competency for identification, screening, treatment, and referral, which will lead to improvements in patient care.

BENEFITS, HARMS, AND COSTS

Pregnant and postpartum individuals with untreated perinatal mental illness, including mood and anxiety disorders, may suffer devastating effects and their family may experience short- and long-term adverse outcomes.

EVIDENCE

A literature search was conducted using Medline (Ovid), PubMed, Embase and the Cochrane library from inception to June 2024. Additional articles were identified from article bibliographies and grey literature published by reputable societies and organizations (see online Appendix A).

VALIDATION METHODS

The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix B (Tables B1 for definitions and B2 for interpretations of strong and weak recommendations).

INTENDED AUDIENCE

All heath care providers who provide preconception counselling and/or care during pregnancy and the postpartum period. The term "perinatal" will be used throughout this guideline to refer to these health care providers.

SOCIAL MEDIA ABSTRACT

New SOGC Guideline! Identify, support, and treat perinatal mood and anxiety disorders. Focused on risk factors, screening, treatment and referrals during pregnancy and the postpartum period. Let's open dialogue and provide evidence-informed care for improved patient outcomes.

SUMMARY STATEMENTS

RECOMMENDATIONS: IDENTIFICATION AND RISKSCREENINGTREATMENT.

Antenatal depression and drug use among deaf and hard-of-hearing birthing parents: results from a U.S. National Survey

PURPOSE

This study aimed to investigate antenatal depression and drug use among deaf and hard-of-hearing (DHH) birthing parents who use American Sign Language (ASL), spoken English, or bilingually both ASL and English.

METHODS

DHH participants in the United States responded to the Survey on Pregnancy Experiences of Deaf and Hard-of-Hearing Women. Respondents self-reported their antenatal depression diagnoses and drug use (i.e., pain relievers, cannabis, or illicit drugs) during their last pregnancy. Poisson regression models were used to estimate prevalence ratios, adjusting for age, race/ethnicity, education, marital status, and parity.

RESULTS

The average age of respondents (n = 587) was 35 years. Respondents were predominantly non-Hispanic white (80%), college educated (60%), and married (74%). Relative to DHH English-speakers, DHH ASL-users had lower prevalence of reporting antenatal depression diagnosis (aPR = 0.40, 95% CI: 0.23 to 0.72). DHH people who reported antenatal depression diagnosis had higher prevalence of reporting antenatal drug use (PR = 2.34, 95% CI: 1.65 to 3.33). There were no significant associations between preferred language and antenatal drug use.

CONCLUSIONS

DHH ASL-users are less likely to report receiving an antenatal depression diagnosis compared to DHH English-speakers. Given well-documented patient-provider communication barriers among DHH ASL-users, it is unclear if the lower prevalence observed in this study is the result of inadequate or inaccessible screening during pregnancy. Future work should consider universal use of linguistically appropriate screening tools for DHH birthing parents in both clinical and research settings.

Metabolic Perturbations Associated with both PFAS Exposure and Perinatal/Antenatal Depression in Pregnant Individuals: A Meet-in-the-Middle Scoping Review

PURPOSE OF REVIEW

Depression during the perinatal or antenatal period affects at least 1 in 10 women worldwide, with long term health implications for the mother and child. Concurrently, there is increasing evidence associating maternal exposure to per- and poly-fluoroalkyl substances (PFAS) to adverse pregnancy outcomes. We reviewed the body of evidence examining both the associations between PFAS exposure and perturbations in the maternal metabolome, and the associations between the maternal metabolome and perinatal/antenatal depression. Through this, we sought to explore existing evidence of the perinatal metabolome as a potential mediation pathway linking PFAS exposure and perinatal/antenatal depression.

RECENT FINDINGS

There are few studies examining the metabolomics of PFAS exposure-specifically in pregnant women-and the metabolomics of perinatal/antenatal depression, let alone studies examining both simultaneously. Of the studies reviewed (N = 11), the majority were cross sectional, based outside of the US, and conducted on largely homogenous populations. Our review identified 23 metabolic pathways in the perinatal metabolome common to both PFAS exposure and perinatal/antenatal depression. Future studies may consider findings from our review to conduct literature-derived hypothesis testing focusing on fatty acid metabolism, alanine metabolism, glutamate metabolism, and tyrosine metabolism when exploring the biochemical mechanisms conferring the risk of perinatal/antenatal depression due to PFAS exposure. We recommend that researchers also utilize heterogenous populations, longitudinal study designs, and mediation approaches to elucidate key pathways linking PFAS exposures to perinatal/antenatal depression.

Screening for perinatal depression and stress: a prospective cohort study

PURPOSE

There is currently a heightened need for perinatal medical services to timely recognize and accurately meet the psychological needs of pregnant women. Psychological disturbances a mother experiences during pregnancy, such as depression and anxiety, can be later associated with inadequate maternal capacity for antenatal care for herself and the baby, and may lead to subsequent mental health problems later in the mother's life. Routine prenatal assessment could significantly benefit from being proactively enriched with early prevention mental health screening tools to assess, appropriately manage vulnerable populations, and subsequently implement preventive actions.

METHODS

178 pregnant women, under routine prenatal medical assessment, were measured regarding depressive symptomatology and stress, through the use of two validated psychometric tools (the Edinburgh Postnatal Depression Scale (EPDS) and the Perceived Stress Scale (PSS-14)).

RESULTS

Heightened perceived stress and depressive symptomatology levels were associated with younger maternal age, an obstetrical record of more than one births and a history of abortion. Results additionally showed a connection between the requirement for a psychiatric referral-based on the levels of symptomatology recorded through the psychometric assessment and a clinical interview-and currently running the earlier stages (weeks) of pregnancy.

CONCLUSION

Our revised proposed prenatal screening protocol for depression and stress suggests an amplified follow-up assessment including all pregnant women scoring high in both depression and in perceived stress, regardless of previous history of prenatal depression or of suicidality, to detect earlier or less manifest expressions of distress during pregnancy, in vulnerable perinatal populations.

Prevalence and risk factors of perinatal depression among mothers and fathers in Pakistan: a systematic review and meta-analysis

Background

Perinatal mental health issues affect approximately 10% of women in high-income countries and 30% in low- or middle-income countries. This review aims to determine the prevalence of perinatal depression among mothers and fathers in Pakistan and identify associated risk factors.

Methods

We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We included quantitative studies on the prevalence or incidence of maternal and paternal perinatal depression, including antenatal or postnatal depression in Pakistan, with or without associated risk factors. We performed an electronic search, dual-title/abstract and full-text screening, and data extraction. Analysis was conducted on Revman and JBI SUMARI software. The quality of the included studies was assessed with the NHLBI tool. This review updated a previously published review that included 43 studies, with the last search date of 31st May 2019, now extended to literature published up to June 30, 2023.

Results

Consistent with the previous review, our analysis of 61 studies indicated a pooled prevalence of 37% (95% confidence interval (CI): 30.6-43.6) for maternal antenatal depression. Postnatal depression at different time points, revealed rates of 34.2% (95% CI: 22.7-46.7), 40.9% (95% CI: 0-97.4), and 43.1% (95% CI: 24.4-62.9) at 3, 6 and 12 months, respectively. Paternal postnatal depression was observed at 40.5% (95% CI: 14.9-69) based on two studies. Risk factors for maternal perinatal depression include multiparity, contraceptive failure, inadequate antenatal care, pregnancy-induced hypertension, previous psychiatric illness, passive smoking, drug abuse, low socio-economic status, marital problems, family hardships, recent bereavement, housing difficulties, food insecurity, husband's illiteracy, his unemployment, and being blamed for child disability.

Conclusion

The findings reveal a high prevalence of perinatal depression among mothers with very limited evidence of fathers residing in Pakistan, emphasising the need for prospective studies addressing mental health challenges.

Registration

This review is registered on PROSPERO (CRD42023442581).

Pregnancy-induced metabolic reprogramming and regenerative responses to pro-aging stresses

Pregnancy is associated with physiological adaptations that affect virtually all organs, enabling the mother to support the growing fetus and placenta while withstanding the demands of pregnancy. As a result, mammalian pregnancy is a unique state that exerts paradoxical effects on maternal health. On one hand, the metabolic stress induced by pregnancy can accelerate aging and functional decline in organs. On the other hand, pregnancy activates metabolic programming and tissue regenerative responses that can reverse age-related impairments. In this sense, the oocyte-to-blastocyst transition is not the only physiological reprogramming event in the mammalian body, as pregnancy-induced regeneration could constitute a second physiological reprogramming event. Here, we review findings on how pregnancy dualistically leads to aging and rejuvenation in the maternal body.

Childhood maltreatment exposure is differentially associated with transdiagnostic perinatal depression symptoms

History of childhood maltreatment (CM) is common and robustly associated with prenatal and postpartum (perinatal) depression. Given perinatal depression symptom heterogeneity, a transdiagnostic approach to measurement could enhance understanding of patterns between CM and perinatal depression.

METHODS

In two independently collected samples of women receiving care at perinatal psychiatry clinics (n = 523 and n = 134), we categorized longitudinal symptoms of perinatal depression, anxiety, stress, and sleep into transdiagnostic factors derived from the Research Domain Criteria and depression literatures. We split the perinatal period into four time points. We conducted a latent profile analysis of transdiagnostic factors in each period. We then used self-reported history of CM (total exposure and subtypes of abuse and neglect) to predict class membership.

RESULTS

A three-class solution best fit our data. In relation to positive adaptive functioning, one class had relatively more positive symptoms (high adaptive), one class had average values (middle adaptive), and one class had fewer adaptive symptoms (low adaptive). More total CM and specific subtypes associated with threat/abuse increased an individual's likelihood of being in the Low Adaptive class in both samples (ORs: 0.90-0.97, p < .05).

LIMITATIONS

Generalizability of our results was curtailed by 1) limited racial/ethnic diversity and 2) missing data.

CONCLUSIONS

Our results support taking a person-centered approach to characterize the relationship between perinatal depression and childhood maltreatment. Given evidence that increased exposure to childhood maltreatment is associated with worse overall symptoms, providers should consider incorporating preventative, transdiagnostic interventions for perinatal distress in individuals with a history of childhood maltreatment.

Effect of different physical activity interventions on perinatal depression: a systematic review and network meta-analysis

BACKGROUND

Perinatal depression can have profound impacts on both families and society. Exercise therapy is gradually becoming a widely used adjunct treatment for perinatal depression. Some studies have already focused on the relationship between physical activity and perinatal depression (PND). However, there is currently a lack of systematic and comprehensive evidence to address the crucial question of making optimal choices among different forms of physical activity. This study aims to compare and rank different physical activity intervention strategies and identify the most effective one for perinatal depression.

METHODS

Four databases, namely PubMed, Cochrane Library, Embase, and Web of Science, were searched for randomized controlled trials assessing the impact of physical activity interventions on perinatal depression. The search covered the period from the inception of the databases until May 2024. Two researchers independently conducted literature screening, data extraction, and quality assessment. Network meta-analysis was performed using Stata 15.1.

RESULTS

A total of 48 studies were included in the analysis. The results indicate that relaxation therapy has the most effective outcome in reducing perinatal depression (SUCRA = 99.4%). Following that is mind-body exercise (SUCRA = 80.6%). Traditional aerobics and aquatic sports were also effective interventions (SUCRA = 70.9% and 67.1%, respectively).

CONCLUSION

Our study suggests that integrated mental and physical (MAP) training such as relaxation therapy and mind-body exercise show better performance in reducing perinatal depression. Additionally, while exercise has proven to be effective, the challenge lies in finding ways to encourage people to maintain a consistent exercise routine.

TRIAL REGISTRATION

This study has been registered on PROSPERO (CRD 42,023,469,537).

Antenatal and postpartum depression in women who conceived after infertility treatment: a longitudinal study

BACKGROUND

Although the association between a history of infertility treatment and perinatal depression has been investigated, most research has been cross-sectional and has not used diagnostic assessment tools.

AIMS

This study investigates longitudinally the association between a history of infertility treatment and perinatal depression using WHO-Composite International Diagnostic Interview 3.0 (WHO-CIDI 3.0) and the Edinburgh Postnatal Depression Scale (EPDS).

METHODS

This study used data (N = 2,435) from the control group of a randomised controlled trial on a sample of pregnant women. Survival analysis was used to examine the influence of infertility treatment on perinatal depressive disorder evaluated by WHO-CIDI 3.0. The EPDS scores at four time points (T1 [baseline]: 18 ± 2 weeks gestation, T2: 32 weeks gestation, T3: 1 week postpartum, T4: 3 months postpartum) were analysed using generalised mixed model analysis.

RESULTS

The risk of experiencing a major depressive episode evaluated by WHO-CIDI 3.0 did not significantly differ between women conceiving through infertility treatment and those conceiving spontaneously (adjusted hazard ratio = 1.64, p = 0.109). The longitudinal analysis demonstrated that EPDS scores significantly increased at T3 and T4 among women conceiving through infertility treatment compared with those conceiving spontaneously (adjusted estimates of fixed effect from T1 to T3: 1.17, p < 0.01; from T1 to T4: 0.71, p = 0.022).

CONCLUSION

Women conceiving through infertility treatment were not found to have a higher risk of diagnosable perinatal depressive disorder than those conceiving naturally. However, a history of infertility treatment can marginally increase sub-clinical postpartum depressive symptoms.

Economic evaluation of Be a Mom, a web-based intervention to prevent postpartum depression in high-risk women alongside a randomized controlled trial

BACKGROUND

Postpartum depression (PPD) poses significant challenges, affecting both mothers and children, with substantial societal and economic implications. Internet-based cognitive behavioral therapy interventions (iCBT) offer promise in addressing PPD, but their economic impact remains unexplored. This study aimed to evaluate the cost-utility of Be a Mom, a self-guided iCBT intervention, compared with a waiting-list control among postpartum women at high risk of PPD.

METHODS

This economic evaluation was conducted alongside a 14-month randomized controlled trial adopting a societal perspective. Participants were randomized to Be a Mom (n = 542) or a waitlisted control group (n = 511). Self-report data on healthcare utilization, productivity losses, and quality-adjusted life years (QALYs) were collected at baseline, post-intervention, and 4 and 12 months post-intervention. Incremental cost-effectiveness ratios (ICERs) were calculated, and cost-effectiveness acceptability curves were generated using nonparametric bootstrapping. Sensitivity analyses were conducted to assess result robustness.

RESULTS

Over 14 months, Be a Mom generated a QALY gain of 0.0184 (0.0022, 0.0346), and cost savings of EUR 34.06 (-176.16, 108.04) compared to the control group. At a willingness to pay of EUR 20,000, Be a Mom had a 97.6 % probability of cost-effectiveness.

LIMITATIONS

Results have limitations due to self-selected sample, potential recall bias in self-reporting, missing data, limited follow-up, and the use of a waiting-list control group.

CONCLUSIONS

This study addresses a critical gap by providing evidence on the cost-utility of an iCBT intervention tailored for PPD prevention. Further research is essential to identify scalable and cost-effective interventions for reducing the burden of PPD.

A sum of its parts: A systematic review evaluating biopsychosocial and behavioral determinants of perinatal depression

INTRODUCTION

Depression is one of the most common yet underdiagnosed perinatal complications and our understanding of its pathophysiology remains limited. Though perinatal depression is considered to have a multifactorial etiology, integrative approaches to investigation are minimal. This review takes an integrative approach to systematically evaluate determinants (e.g., biological, behavioral, environmental, social) and interactions among determinants of perinatal depression and the quality of methods applied.

METHODS

Four databases (i.e., PubMed, CINAHL, APA PsycInfo, Web of Science) were systematically searched to identify studies examining determinants of perinatal depression in adult perinatal persons (≥ 18 years). Articles were excluded if the outcomes were not focused on perinatal persons and depression or depression symptoms, depression was examined in a specific subpopulation evidenced to have psychological consequences due to situational stressors (e.g., fetal/infant loss, neonatal intensive care unit admission), or was considered grey literature. The Critical Appraisal Skills Programme and AXIS tools were used to guide and standardize quality appraisal assessments and determine the level of risk of bias.

RESULTS

Of the 454 articles identified, 25 articles were included for final review. A total of 14 categories of determinants were investigated: biological (5), behavioral (4), social and environmental (5). Though only 32% of studies simultaneously considered determinants under more than one domain, a pattern of interactions with the tryptophan pathway emerged. Concerns for risk of bias were noted or were unclear for three types of bias: 13 (52%) selection bias, 3 (12%) recall bias, and 24 (96%) measurement bias.

CONCLUSIONS

Future research is needed to explore interactions among determinants and the tryptophan pathway; to strengthen the methods applied to this area of inquiry; and to generate evidence for best practices in reporting, selecting, and applying methods for measuring determinants and perinatal depression.

A Network Analysis of Perinatal Depression, Anxiety, and Temperaments in Women in the First, Second, and Third Trimesters of Pregnancy

Background/Objectives: Although depression and anxiety are found to be affected by temperaments, little research has studied these relationships in pregnancy. The present study explored the associations among perinatal depression (PD), anxiety dimensions (state, trait, and generalized anxiety disorder (GAD)), and temperaments between women in the three trimesters of pregnancy through a network analysis approach. Moreover, differences in the severity of PD and anxiety between women in the three trimesters were evaluated. Methods: Women in first (N = 31), second (N = 184), and third (N = 54) trimesters of pregnancy were recruited in the present cross-sectional study. The network analysis included PD, anxiety dimensions, and temperaments. Three network models were estimated, and ANOVAs evaluated the differences in the severity of PD and anxiety, including trimesters as a between-subject factor. Results: PD and GAD were the nodes most strongly connected across the three groups. Cyclothymic, depressive, and anxious temperaments were most frequently associated with PD and GAD. Hyperthymic temperament was in the periphery of the three networks. Lastly, women in the first trimester had the highest severity of PD and GAD. Conclusions: PD and GAD showed the strongest associations. Anxiety dimensions had positive associations with PD and GAD, suggesting their role as possible risk factors. Temperaments were differently associated within the network between the three groups. Clinical interventions during pregnancy should target the central variables, considering their direct and indirect relationships.

A machine learning model to predict the risk of perinatal depression: Psychosocial and sleep-related factors in the Life-ON study cohort

Perinatal depression (PND) is a common complication of pregnancy associated with serious health consequences for both mothers and their babies. Identifying risk factors for PND is key to early detect women at increased risk of developing this condition. We applied a machine learning (ML) approach to data from a multicenter cohort study on sleep and mood changes during the perinatal period ("Life-ON") to derive models for PND risk prediction in a cross-validation setting. A wide range of sociodemographic variables, blood-based biomarkers, sleep, medical, and psychological data collected from 439 pregnant women, as well as polysomnographic parameters recorded from 353 women, were considered for model building. These covariates were correlated with the risk of future depression, as assessed by regularly administering the Edinburgh Postnatal Depression Scale across the perinatal period. The ML model indicated the mood status of pregnant women in the first trimester, previous depressive episodes and marital status, as the most important predictors of PND. Sleep quality, insomnia symptoms, age, previous miscarriages, and stressful life events also added to the model performance. Besides other predictors, sleep changes during early pregnancy should therefore assessed to identify women at higher risk of PND and support them with appropriate therapeutic strategies.

For Whom and for How Long Does the "Be a Mom" Intervention Work? A Secondary Analysis of Data From a Randomized Controlled Trial Exploring the Mid-Term Efficacy and Moderators of Treatment Response

This study explored clinical and sociodemographic moderators of treatment response to "Be a Mom", an internet-based cognitive behavioral therapy (iCBT) intervention, from baseline to postintervention, in women at high risk for postpartum depression (PPD). The study also assessed the stability of women's treatment gains from baseline to 4-months postintervention (follow-up). This open-label randomized controlled trial (RCT) involved a sample of 1,053 postpartum Portuguese women identified as being at high risk for PPD (i.e., having a score of 5.5 or higher on the Postpartum Depression Predictors Inventory-Revised); participants were allocated to "Be a Mom" intervention group or a waiting-list control group, and completed self-report measures at baseline, postintervention, and a 4-month follow-up (554 women completed follow-up assessments). Depressive and anxiety symptoms were measured using the Edinburgh Postnatal Depression Scale and the anxiety subscale of the Hospital Anxiety and Depression Scale, and flourishing/positive mental health was assessed with the Mental Health Continuum. Regression models and linear mixed models were used to examine moderators of treatment and the mid-term efficacy of the "Be a Mom" intervention, respectively. The results revealed that treatment completion, higher depression scores at baseline, and higher income levels were linked to greater symptom reduction and positive mental health enhancement. Moreover, the efficacy of the "Be a Mom" intervention was supported at the 4-month follow-up. The "Be a Mom" intervention appears to be an effective iCBT tool for reducing psychological distress and enhancing positive mental health in women at risk for PPD, with therapeutic improvements maintained over a 4-month period.

Effect of eHealth interventions on perinatal depression: A meta-analysis

BACKGROUND

Perinatal depression (PND) is a common mental health problem, and eHealth interventions may provide a strategy for alleviating PND.

AIM

This meta-analysis aimed to determine the effect of eHealth interventions on PND.

METHODS

Six databases were searched to retrieve published randomized controlled trials (RCTs) on the effect of eHealth interventions on PND. A meta-analysis was performed on the data of these studies using a random effects model.

RESULTS

A total of 21 RCTs were included in the meta-analysis, which revealed that eHealth interventions significantly reduced antenatal depression (WMD = -1.64, 95 % CI [-2.92, -0.35], P = .013), postpartum depression (SMD = -0.41, 95 % CI [-0.52, -0.29], P < .001), anxiety (SMD = -0.39, 95 % CI [-0.51, -0.28], P < .001), stress (WMD = -2.93, 95 % CI [-4.58, -1.27], P = .001), and improved self-efficacy (SMD = 0.42, 95 % CI [0.21, 0.63], P < .001) compared with the control group. However, eHealth interventions did not significantly improve social support (SMD = 0.27, 95 % CI [-0.01, 0.56], P = .058). For antenatal depression, significant subgroup differences were observed in the digital platform and material presentation format. In addition, for postpartum depression, significant subgroup differences were found in the type of therapy.

CONCLUSIONS

The meta-analysis results suggest that eHealth interventions can relieve depression, anxiety, and stress symptoms and improve self-efficacy in perinatal women. However, these interventions did not improve social support. Additional high-quality studies on eHealth interventions in PND are needed to validate these results.

Increasing Social Support for Women via Humanizing Postpartum Depression

Women experiencing postpartum depression (PPD) often face the debilitating symptoms of depression as well as the stigmatization associated with having a mental health crisis during motherhood. Accordingly, there have been numerous calls for theoretical-based approaches to reduce the stigma and promote social support for women with PPD. Guided by stigma research, anthropomorphism literature, and attribution theory, this research explored the effect of PPD anthropomorphism (i.e., imbuing humanlike intentions and characteristics to PPD) on perceived controllability, sympathy, anger toward PPD, and willingness to provide social support (WPSS). Results of three studies revealed that humanizing PPD led to decreased perceived controllability attributed to women with PPD, resulting in increased sympathy, more anger toward PPD, and consequently, greater WPSS. This research contributes to the extant health communication literature, particularly in the realm of mental health stigma, by addressing how humanizing risk-bearing entities affects individuals' mental health related perceptions and decisions.

Exploring prenatal depression and postpartum depression: Findings from a prospective cohort study at University Hospital Obstetrics in Damascus

The perinatal period is crucial for both mother and newborn, and mental health, including prenatal and postpartum depression (PPD), is a significant aspect. Screening for these disorders allows for early treatment and helps prevent risks to both mother and child. This prospective cohort study was carried out at University Hospital Obstetrics in Damascus City. The first phase was during the third trimester of pregnancy and the second phase involved a follow-up assessment after 6 weeks of delivery. The Arabic-validated version of the Edinburgh Postnatal Depression Scale questionnaire (EPDS) was used. A cutoff of 13 or higher was used to determine the presence of probable depression in both assessments. Of 347 pregnant women, 38.6% had prenatal depression (PND). 295 patients have achieved the second assessment, of which 30.2% had PPD. Furthermore, 42.6% who had PND developed PPD on follow-up. Binary logistic regression indicated that PND was predicted by non-Syrian nationality, paternal absence, poor financial status, number of previous pregnancies, and a history of depression independent of pregnancy. PPD was predicted by a history of PPD, and work status. Findings underscore potential value of early screening for depressive symptoms as a predictive measure. It is recommended that women with a history of depression receive heightened attention and care, irrespective of the timing of their depressive episodes.

Antenatal depressive symptoms and adverse birth outcomes in healthy start participants: The modifying role of utilization of mental health services

OBJECTIVE

We examined the association between antenatal depressive symptoms and adverse birth outcomes in Midland Healthy Start (MHS) participants and determined whether receiving mental health services reduced the odds of adverse outcomes among those with elevated antenatal depressive symptoms.

METHOD

Data from a retrospective cohort of participants (N = 1,733) served by the MHS in South Carolina (2010-2019) were linked with their birth certificates. A score of ≥16 on the Center for Epidemiologic Studies Depression Scale was defined as elevated antenatal depressive symptoms. Services provided by MHS were categorized into: (1) receiving mental health services, (2) receiving other services, and (3) not receiving any services. Adverse birth outcomes included preterm birth, low birth weight, and small for gestational age.

RESULTS

Around 31 % had elevated antenatal depressive symptoms. The prevalences of preterm birth, low birthweight, and small for gestational age were 9.5 %, 9.1 %, and 14.6 %, respectively. No significant associations were observed between elevated depressive symptoms and adverse outcomes. Among women with elevated antenatal depressive symptoms, the odds for small for gestational age were lower in those who received mental health services (AOR 0.33, 95 % CI 0.15-0.72) or other services (AOR 0.34, 95 % CI 0.16-0.74) compared to those who did not receive any services. The odds for low birth weight (AOR 0.34, 95 % CI 0.13-0.93) were also lower in those who received mental health services.

CONCLUSIONS

Receiving screening and referral services for antenatal depression reduced the risks of having small for gestational age or low birth weight babies among MHS participants.

Improving Maternal Health Care Quality and Outcomes: Evaluation of a Pregnancy Medical Home

Current maternal care recommendations in the United States focus on monitoring fetal development, management of pregnancy complications, and screening for behavioral health concerns. Often missing from these recommendations is support for patients experiencing socioeconomic or behavioral health challenges during pregnancy. A Pregnancy Medical Home (PMH) is a multidisciplinary maternal health care team with nurse navigators serving as patient advocates to improve the quality of care a patient receives and health outcomes for both mother and infant. Using bivariate comparisons between PMH patients and reference groups, as well as interviews with project team members and PMH graduates, this evaluation assessed the impact of a PMH at an academic medical university on patient care and birth outcomes. This PMH increased depression screenings during pregnancy and increased referrals to behavioral health care. This evaluation did not find improvements in maternal or infant birth outcomes. Interviews found notable successes and areas for program enhancement.

Differences between rural and urban residence in the detection and treatment of perinatal mood and anxiety disorders

BACKGROUND

Perinatal mood and anxiety disorders are common, serious complications of pregnancy. Disparities exist by race and income in the prevalence and treatment of these conditions, and overall treatment rates remain low. Outside of pregnancy, a small body of literature suggests that rural residency may contribute to higher rates of depression for those who identify as women. However, among more diverse populations, evidence suggests urban residency may be associated with higher rates of depression among women of color. It is not known whether these trends hold for mood and anxiety disorders during pregnancy and postpartum.

OBJECTIVE

We examined differences in the detection and treatment of perinatal mood and anxiety disorders by rural and urban residents and assessed if the observed differences varied by maternal race or ethnicity.

STUDY DESIGN

We conducted a cross-sectional study using linked Medicaid claims and birth certificate records from Oregon and South Carolina from 2016 to 2020. We identified perinatal mood and anxiety disorder diagnoses during the perinatal period (pregnancy and within 60 days postpartum) using International Classification of Disease 10th edition codes and enumerated receipt of pharmacotherapy and psychotherapy treatment using Medicaid claims. We used logistic regression models controlling for relevant clinical and sociodemographic characteristics to estimate associations between rural residence and mood disorder detection and treatment.

RESULTS

Among the 185,809 births in our sample, 27% of births (n=50,820) were to people who lived in rural areas and 73% (n=134,989) to those in urban areas. The prevalence of any perinatal mood and anxiety disorders diagnosis was higher for urban residents (19.5%) than for rural residents (18.0%; P<.001). Overall treatment rates were low among people with a perinatal mood and anxiety disorder (42% [n=14,789]). In our adjusted models, those living in urban areas had higher odds of a perinatal mood and anxiety disorder diagnosis (adjusted odds ratio, 1.059 [95% confidence interval, 1.059-1.059], P<.001). We found a significant interaction between maternal race and rurality (P<.001). When we stratified by race, we found that among those who identified as Black, the odds of a perinatal mood and anxiety disorder diagnosis were increased for urban residents (odds ratio, 1.188 [95% confidence interval, 1.188-1.188]), whereas among those who identified as White, there were no such increased odds (odds ratio, 1.027 [95% confidence interval, 0.843-1.252]).

CONCLUSION

We saw small but meaningful differences between rural and urban residents in perinatal mood and anxiety disorder diagnosis rates. We detected an interaction between race and rural vs urban maternal residence that impacted the observed differences. By elucidating the intersection between race and other sociodemographic factors, we hope more targeted and meaningful investments can be made in the communities most in need.

The Impact of Social Determinants of Maternal Mental Health in Marginalized Mothers

Background: A deeper understanding of the key determinants of maternal mental health is important for improving care for women, especially women who are at an economic disadvantage. Objectives: To explore the associations of select social determinants: access, social support, and stress, with the onset of antepartum depression in low-income mothers. Participants: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, population-based surveillance system with selected data from 2016 to 2019, establishing a randomly selected sample of women with a recent live birth at most 4 months postdelivery, between 1,300 and 3,400 women per state (n ∼ 162,558). Methods: In this cross-sectional study, the phase 8 PRAMS was adapted to measure social support, access, stress, and their relationships with the onset of antepartum depression in low-income mothers. To assess low-income marginalization, a threshold was established based on income levels within 130% of the federal poverty level; antepartum (n ∼ 41,289). Results: The defined access, social support, and stress factors showed a statistically significant association with the onset of antepartum depression among low-income mothers. Of women in this sample, 22.6% indicated antepartum depression (p < 0.001; R2 = 0.066). Negative social support indicators were associated with an increased likelihood of antepartum depression; 3.71 increased odds of depression for abuse during pregnancy, and 0.79 decreased odds with positive acknowledgment of paternity. Access indicator terms showed an association with the decreased likelihood of antepartum depression through breastfeeding information support (Info from Baby Doc, odds ratio [OR] = 0.86), prenatal care utilization (12+ visits, OR = 0.82), and specific insurance type (insurance by job, OR = 0.82). All instances of stressful life events showed an increased likelihood of depression during pregnancy (for majority of stressful life events: OR >1.12). Conclusions: Economically marginalized mothers face unmet social and health care needs leading to poorer outcomes during pregnancy. These findings provide additional support for improved policy and public health efforts, such as assessment, education, and interventions, to decrease prevalence and improve treatment for antepartum depression among marginalized mothers.

A Prospective Study of Social Needs Associated with Mental Health among Postpartum Patients Living in Underserved Communities

OBJECTIVE

Given the rising rates of maternal morbidity and mortality in the United States and the contribution of mental illness, especially among individuals living in underresourced communities, the objective was to evaluate the prevalence of unmet health-related social needs and their impact on perinatal mental health outcomes.

STUDY DESIGN

This was a prospective observational study of postpartum patients residing within regions with increased rates of poor perinatal outcomes and sociodemographic disparities. Patients were enrolled in a multidisciplinary public health initiative "extending Maternal Care After Pregnancy (eMCAP)" between October 1, 2020 and October 31, 2021. Unmet health-related social needs were assessed at delivery. Symptoms of postpartum depression and anxiety were evaluated at 1 month postpartum utilizing the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD7) screening tools, respectively. Mean EPDS and GAD7 scores and odds of screening positive (scoring ≥ 10) were compared among individuals with and without unmet health-related social needs with p < 0.05 considered significant.

RESULTS

Of participants enrolled in eMCAP, 603 completed at least one EPDS or GAD7 at 1 month. Most had at least one social need, most commonly dependence on social programs for food (n = 413/603; 68%). Individuals lacking transportation to medical (odds ratio [OR]: 4.0, 95% confidence interval [CI]: 1.2-13.32) and nonmedical appointments (OR: 4.17, 95% CI: 1.08-16.03) had significantly higher odds of screening positive on EPDS while participants lacking transportation to medical appointments (OR: 2.73, 95% CI: 0.97-7.70) had significantly higher odds of screening positive on GAD7.

CONCLUSION

Among postpartum individuals in underserved communities, social needs correlate with higher depression and anxiety screening scores. This highlights the need to address social needs to improve maternal mental health.

KEY POINTS

· Social needs are prevalent among underserved patients.. · Needs can be assessed in a structured or freeform manner.. · Unmet needs correlate with poor mental health outcomes.. · Similar needs correlate with depression and anxiety..

The relationship between maternal-infant bonding and postpartum depression/anxiety: moderating effect of childhood psychological abuse and validation of the Mother-to-Infant Bonding scale (MIBS-8) in Arabic

BACKGROUND

The emotional bond that a mother senses to her infant is essential to their social, emotional, and cognitive development. Understanding the level of mother-infant bonding plays an imperative role in the excellence of care. However, in Lebanon, there is a paucity of information about mother-infant bonding in the postpartum period. Given that Lebanese pregnant women constitute an important part of the population to look at, the objectives of the study were to (1) validate the Arabic version of the mother-infant bonding scale and (2) the relation between mother-infant bond and postpartum depression/anxiety; (3) the moderating effect of child abuse in the association between mother-infant bond and postpartum depression/anxiety.

METHODS

This cross-sectional study was conducted from September 2022 until June 2023, enrolling 438 women 4-6 weeks after delivery (mean age: 31.23 ± 5.24 years). To examine the factor structure of the mother-infant bond scale, we used an Exploratory-Confirmatory (EFA-CFA) strategy. To check if the model was adequate, several fit indices were calculated: the normed model chi-square (χ2/df), the Steiger-Lind root mean square error of approximation (RMSEA), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI).

RESULTS

EFA was conducted on the first subsample. Three items were removed. The five items remaining loaded on one factor, which explained 73.03% of the common variance (ω = .91 / α = .90). After adding a correlation between residuals for items 2-7 and 5-8, fit indices of the CFA results were acceptable: χ2/df = 6.97/3 = 2.32, RMSEA = .068 (90% CI .001, .135), SRMR = .017, CFI = .996, TLI = .988. The interaction maternal-infant bonding by child psychological abuse was significantly associated with depression and anxiety respectively. At low, moderate and high levels of child psychological abuse, higher maternal-infant bonding scores (greater difficulty in bonding) were significantly associated with higher depression and higher anxiety respectively.

CONCLUSION

This study provides, for the first time, a specific Arabic scale to assess mother-infant bonding reliably and validly. Furthermore, our study has suggested the existence of factors that have additive effects in potentiating the risk for depression and anxiety among Lebanese postpartum women, namely a history of psychological child abuse. Therefore, laborious awareness programs and healthcare services need to be implemented in order to prevent maternal mental health disorders from being unrecognized and left untreated.

Perinatal Mood And Anxiety Disorders Rose Among Privately Insured People, 2008-20

Nationwide, perinatal mood and anxiety disorder (PMAD) diagnoses among privately insured people increased by 93.3 percent from 2008 to 2020, growing faster in 2015-20 than in 2008-14. Most states and demographic subgroups experienced increases, suggesting worsening morbidity in maternal mental health nationwide. PMAD-associated suicidality and psychotherapy rates also increased nationwide from 2008 to 2020. Relative to 2008-14, psychotherapy rates continued to rise in 2015-20, whereas suicidality rates declined.

Perinatal Mental Disorders: The ‘Non Liquet’ Facet of Mental Health Legislative Instruments in India

Due to the impetus provided by the Millennium Development Goals and the Sustainable Development Goals, maternal health has become the subject matter of various legislative instruments worldwide. However, perinatal mental disorders have remained an underestimated public health issue in many countries. High prevalence rates of such perinatal disorders in India have been reported by various evidence-based studies. This makes it imperative to analyse the provisions of the mental healthcare legislative instruments that have been brought into force in India. This article aims to evaluate and analyse coverage of perinatal mental disorders under the provisions of the legislative instruments, especially statutes, providing for mental health in India. Websites of the Government of India, various Indian Ministries and other government agencies were visited to obtain relevant documents regarding the mental health policy and legislation. None of the mental health legislative instruments in India underscore perinatal mental disorders as a public health concern, whereby failing to identify the unique characteristics of perinatal mental disorders. They consequently do not provide for nationwide detection and treatment measures. There is an immediate and pertinent need to highlight perinatal mental disorders through legislative instruments. The National Mental Health Policy, 2014 provides for comprehensive healthcare services; however, it excludes measures for perinatal mental health services. The Mental Healthcare Act, 2017 should be amended to explicitly include women during the perinatal period, along with originally provided mental health services for children and elderly individuals.

Experiential avoidance as a mediator of risk factors for higher order internalizing psychopathology in the perinatal period

OBJECTIVES

Perinatal psychopathology can be damaging. This study examined the strength of the associations between risk factors and all perinatal mood and anxiety disorder symptoms while assessing the mediating effect of experiential avoidance.

METHOD

Participants (N = 246) completed assessments during pregnancy (28-32 weeks) and the postpartum (6-8 weeks). Structural equation modeling (SEM) was used to examine associations between risk factors and latent factors: distress (composed of depression, generalized anxiety, irritability, and panic symptoms); fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive); and bipolar (mania and obsessive-compulsive).

RESULTS

During pregnancy, past psychiatric history, anxiety sensitivity, maladaptive coping, and age were significant risk factors. In the postpartum, negative maternal attitudes and past psychiatric history were only risk factors for symptoms that composed distress. Experiential avoidance mediated the relation between maladaptive coping and symptoms that composed fear.

CONCLUSION

It is important to assess for psychological risk factors starting in pregnancy. This study identified critical risk factors that are associated with the underlying commonality among perinatal mood and anxiety symptoms. Some of the risk factors as well as the mediator are malleable (negative maternal attitudes, experiential avoidance), creating new possibilities for prevention and treatment of perinatal mood and anxiety disorder symptoms.

Risk Factors of Perinatal Negative Mood and Its Influence on Prognosis: A Retrospective Cohort Study

Background

Maternal anxiety or depression in the perinatal period has a high prevalence. The negative emotion during the puerpera is unfavorable to the process of childbirth and also affects the recovery and the quality of life in postpartum patients significantly. The present study aimed to elucidate the risk factors of negative emotion in perinatal women and its influence on prognosis to provide a reference for improving maternal prognosis.

Methods

Initially, 350 expectant mothers were randomly enrolled in the present study between August 2021 and August 2022. Among these, after applying the established inclusion and exclusion criteria, 314 patients were eventually selected. The independent risk factors of negative emotion and poor prognosis were analyzed through binary logistics regression and multiple linear regression. Follow-up was conducted via telephone, email, and a follow-up visit one month after discharge.

Results

Among the included patients, 18 (5.7%) had prenatal anxiety, 16 (5.1%) had prenatal depression, 31 (9.9%) had postnatal anxiety, and 28 (8.9%) had postnatal depression. Perinatal negative emotional risk factors include age, marital relationship, regular prenatal examination, E2 level, 5-HT level before and after delivery, family monthly income, neonatal health, breastfeeding time, intrapartum hemorrhage, constipation and other complications. The development of postpartum negative emotions is a risk factor for maternal prognosis.

Conclusion

The results showed that the risk factors of perinatal depression and anxiety were complex. In order to improve the quality of life of pregnant women, maintain their long-term emotional stability, and promote their postpartum recovery, it may be considered to promote the use of screening tools to identify women at risk of anxiety and depression before and after delivery, and timely psychological counseling for patients with high risk factors to promote their mental health.