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Costello LA, Ziegler K, McCormack L, Akbaryan A, Vargas JC, Harris WS, Jackson KH, Barber M, Morales S, Elliott AJ, Hockett C, Shuffrey LC. Pre-pregnancy overweight or obesity moderates the association between prenatal maternal depressive symptoms and infant cord blood omega-3 levels. BMC Pregnancy Childbirth 2024; 24:535. [PMID: 39143534 PMCID: PMC11323614 DOI: 10.1186/s12884-024-06732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 08/01/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Empirical evidence has demonstrated associations between pre-pregnancy obesity and perinatal maternal depressive symptoms. Omega-3 is an essential fatty acid derived from dietary sources that is critical for fetal brain development. Pre-pregnancy obesity is associated with higher omega-3 intake, but a weaker association between dietary intake and respective maternal and cord blood omega-3 levels. Further, lower intake of omega-3 during pregnancy has been linked to higher depressive symptoms. Yet, prior studies have not examined the interactive effects of pre-pregnancy overweight or obesity (OWOB) and prenatal maternal mental health symptoms on infant cord blood omega-3 levels. METHODS Participants included 394 maternal-infant dyads from the NIH Environmental influences on Child Health Outcomes (ECHO) - Safe Passage Study in South Dakota. A pre-pregnancy body mass index (BMI) > 25 was used to dichotomize participants as OWOB (54%) vs. non-OWOB (46%). Prenatal maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) and prenatal maternal anxiety symptoms were measured using the State-Trait Anxiety Inventory (STAI). We implemented linear regression models to examine the interaction term between pre-pregnancy BMI category and prenatal maternal mental health symptoms on cord blood omega-3 levels. Secondary analyses were stratified by pre-pregnancy BMI category. RESULTS We observed a significant interaction between pre-pregnancy BMI category and prenatal maternal depressive symptoms with cord blood omega-3 (F(4,379) = 6.21, p < .0001, adj. R2 = 0.05). Stratified models revealed an association between prenatal maternal depressive symptoms with lower cord blood omega-3 levels only among individuals with pre-pregnancy OWOB (β = -0.06, 95% CI = -0.11, -0.02; F (2,208) = 4.00, p < .05, adj R2 = 0.03). No associations were observed among non-OWOB participants. CONCLUSIONS Findings suggest maternal-placental transfer of omega-3 may represent one pathway by which maternal metabolic and mental health impacts infant development.
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Affiliation(s)
- Lauren A Costello
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA.
| | - Katherine Ziegler
- Avera Research Institute, Sioux Falls, SD, 57108, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, 57108, USA
- Department of Internal Medicine, University of South Dakota School of Medicine, Sioux Falls, SD, 57108, USA
| | - Lacey McCormack
- Avera Research Institute, Sioux Falls, SD, 57108, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, 57108, USA
| | - Anahid Akbaryan
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - Julianna Collazo Vargas
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - William S Harris
- Department of Internal Medicine, University of South Dakota School of Medicine, Sioux Falls, SD, 57108, USA
- Fatty Acid Research Institute, Sioux Falls, SD, 57106, USA
| | - Kristina H Jackson
- Fatty Acid Research Institute, Sioux Falls, SD, 57106, USA
- OmegaQuant Analytics, LLC, Sioux Falls, SD, 57106, USA
| | - Maria Barber
- Avera Research Institute, Sioux Falls, SD, 57108, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, 57108, USA
| | - Santiago Morales
- Department of Psychology, University of Southern California, Los Angeles, CA, 90007, USA
| | - Amy J Elliott
- Avera Research Institute, Sioux Falls, SD, 57108, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, 57108, USA
| | - Christine Hockett
- Avera Research Institute, Sioux Falls, SD, 57108, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, 57108, USA
| | - Lauren C Shuffrey
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
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Platt IS, Pendl-Robinson EL, Dehus E, O'Neil SS, Vohra D, Kenny M, Pentenrieder L, Zivin K. Societal costs of untreated perinatal mood and anxiety disorders in Vermont. Arch Womens Ment Health 2024; 27:585-594. [PMID: 38321244 DOI: 10.1007/s00737-024-01429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/19/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE To estimate the societal costs of untreated perinatal mood and anxiety disorders (PMADs) in Vermont for the 2018-2020 average annual birth cohort from conception through five years postpartum. METHODS We developed a cost analysis model to calculate the excess cases of outcomes attributed to PMADs in the state of Vermont. Then, we modeled the associated costs of each outcome incurred by birthing parents and their children, projected five years for birthing parents who do not achieve remission by the end of the first year postpartum. RESULTS We estimated that the total societal cost of untreated PMADs in Vermont could reach $48 million for an annual birth cohort from conception to five years postpartum, amounting to $35,910 in excess societal costs per birthing parent with an untreated PMAD and their child. CONCLUSION Our model provides evidence of the high costs of untreated PMADs for birthing parents and their children in Vermont. Our estimates for Vermont are slightly higher but comparable to national estimates, which are $35,500 per birthing parent-child pair, adjusted to 2021 US dollars. Investing in perinatal mental health prevention and treatment could improve health outcomes and reduce economic burden of PMADs on individuals, families, employers, and the state.
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Affiliation(s)
- Isabel S Platt
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA.
| | | | - Eric Dehus
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA
| | - Sasigant So O'Neil
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA
| | - Divya Vohra
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA
| | - Michael Kenny
- Vermont Department of Health, 108 Cherry Street, Burlington, VT, 05402, USA
| | - Laura Pentenrieder
- Vermont Department of Health, 108 Cherry Street, Burlington, VT, 05402, USA
| | - Kara Zivin
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA
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Asante HA, Boyetey ST, Essaw E, Nyame CA, Mante B, Dziwornu L, Okyere P. Prevalence and factors associated with antepartum depression among adolescent women in the assin north district of Ghana: a cross-sectional study. BMC Womens Health 2024; 24:276. [PMID: 38711102 DOI: 10.1186/s12905-024-03111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/23/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Globally, depression is a leading cause of disease-related disability among women. In low-and-middle-income countries (LMICs), the prevalence rate of antepartum depression is estimated to range between 15% and 57% and even higher in adolescent antepartum women. Although a number of studies have shown that depression is common in adolescent pregnancies and has a prevalence rate between 28% and 67% among adolescent mothers, there currently exists no literature on depression among adolescent pregnant women in Ghana. The study aimed to determine the prevalence of antepartum depression and identify the factors associated with it among pregnant adolescent women. METHODS A quantitative cross-sectional study design was adopted by randomly recruiting 220 adolescent pregnant women visiting antenatal clinics in five selected health facilities in five communities in the Assin North District of Ghana. Data were collected using the Edinburgh Postnatal Depression Scale (EPDS). Data analysis was performed using Stata version 14. Both descriptive and inferential analyses were performed. A chi-square analysis was conducted to identify the association between independent and dependent variables. A multivariate logistic regression analysis was carried out to identify the independent variables that were significantly associated with the dependent variable. In all analyses, p-values ≤ 0.05 were deemed statistically significant at a 95% confidence interval. RESULTS The results indicated prevalence of depression was 38.6% using the EPDS cut-off ≥ 13. Respondents who were cohabiting were less likely to experiencing antepartum depression compared to those who were single (AOR = 0.36, 95% CI: 0.20-0.64, p = 0.001). Also, Respondents who had completed Junior High School had a lower likelihood of experiencing antepartum depression compared to those who had no formal education (AOR = 0.19, 95% CI: 0.05-0.76, p = 0.019). Respondents who perceived pregnancy-related items to be costly had higher odds of experiencing antepartum depression (AOR = 2.05, 95% CI: 1.02-4.12, p = 0.042). Lastly, adolescent pregnant women who reported that pregnancy-related items are costly were likely to experience antepartum depression compared to those who did not report such costs (AOR = 2.12, 95% CI: 1.20-3.75, p < 0.001). CONCLUSION The results of this study highlight the importance of a multi-pronged strategy for combating antepartum depression in adolescents and improving the overall health and well-being of pregnant adolescents. Considering that adolescence is a transitional period occasioned by several bio-psycho-social challenges, setting up systems to ensure that young girls are motivated and supported to stay in school will enhance their economic prospects and improve their standards of life while providing psycho-social support will benefit their health and general well-being.
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Affiliation(s)
- Hannah Amoquandoh Asante
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Shadrach Tetteh Boyetey
- Department of Health Policy, Management and Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ebenezer Essaw
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Christopher Amoah Nyame
- Department of Occupational and Environmental Health and Safety, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bertha Mante
- Department of Real Estate and Land Management, University for Development Studies, Tamale, Ghana
| | - Louisa Dziwornu
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Paul Okyere
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Wohrer F, Ngo H, DiDomenico J, Ma X, Roberts MH, Bakhireva LN. Potentially modifiable risk and protective factors affecting mental and emotional wellness in pregnancy. Front Hum Neurosci 2024; 18:1323297. [PMID: 38445095 PMCID: PMC10912531 DOI: 10.3389/fnhum.2024.1323297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Impaired mental and emotional wellness often co-occurs with prenatal substance use, and both affect infant socio-emotional, cognitive, language, motor, and adaptive behavioral outcomes. Guided by the modified biopsychosocial framework, this study examined the role of common substance exposures during pregnancy (i.e., alcohol and cannabis), socio-cultural factors (social support during pregnancy, adverse childhood experiences), and reproductive health factors on maternal mental health (MMH). Methods Data were obtained from a prospective cohort study-Ethanol, Neurodevelopment, Infant, and Child Health (ENRICH-2), and included 202 pregnant persons. Alcohol and cannabis exposures were assessed through repeated prospective interviews and a comprehensive battery of drug and ethanol biomarkers. MMH outcomes were evaluated during the third trimester through the Perceived Stress Scale, Edinburgh Depression Scale, Generalized Anxiety Disorders-7, and Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders. Univariate and multivariable linear regression models evaluated significant predictors of MMH. Results Results of multivariable analysis indicate that both maternal adverse childhood experiences and alcohol exposure, even at low-to-moderate levels, during pregnancy were associated with poorer scores for most MMH measures, while higher level of social support and Spanish as the primary language at home (as a proxy of enculturation) had protective effects (all p's < 0.05). Conclusion These findings highlight the importance of assessing substance use, including periconceptional alcohol exposure, and mental health in pregnant persons as closely related risk factors which cannot be addressed in isolation. Our findings also emphasize a strong protective effect of socio-cultural factors on maternal mental and emotional wellbeing-a strong precursor to maternal-infant bonding and infant neurodevelopment.
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Affiliation(s)
- Fiona Wohrer
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Helen Ngo
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Jared DiDomenico
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Xingya Ma
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Melissa H. Roberts
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Ludmila N. Bakhireva
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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Gorman-Sandler E, Wood G, Cloude N, Frambes N, Brennen H, Robertson B, Hollis F. Mitochondrial might: powering the peripartum for risk and resilience. Front Behav Neurosci 2023; 17:1286811. [PMID: 38187925 PMCID: PMC10767224 DOI: 10.3389/fnbeh.2023.1286811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/01/2023] [Indexed: 01/09/2024] Open
Abstract
The peripartum period, characterized by dynamic hormonal shifts and physiological adaptations, has been recognized as a potentially vulnerable period for the development of mood disorders such as postpartum depression (PPD). Stress is a well-established risk factor for developing PPD and is known to modulate mitochondrial function. While primarily known for their role in energy production, mitochondria also influence processes such as stress regulation, steroid hormone synthesis, glucocorticoid response, GABA metabolism, and immune modulation - all of which are crucial for healthy pregnancy and relevant to PPD pathology. While mitochondrial function has been implicated in other psychiatric illnesses, its role in peripartum stress and mental health remains largely unexplored, especially in relation to the brain. In this review, we first provide an overview of mitochondrial involvement in processes implicated in peripartum mood disorders, underscoring their potential role in mediating pathology. We then discuss clinical and preclinical studies of mitochondria in the context of peripartum stress and mental health, emphasizing the need for better understanding of this relationship. Finally, we propose mitochondria as biological mediators of resilience to peripartum mood disorders.
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Affiliation(s)
- Erin Gorman-Sandler
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
- Columbia VA Healthcare System, Columbia, SC, United States
| | - Gabrielle Wood
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Nazharee Cloude
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Noelle Frambes
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Hannah Brennen
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Breanna Robertson
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Fiona Hollis
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, United States
- Columbia VA Healthcare System, Columbia, SC, United States
- USC Institute for Cardiovascular Disease Research, Columbia, SC, United States
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Bourdeau AI, Harley KG, Nguyen AM. Association between maternity care practitioner type and postpartum depression screening. Birth 2023; 50:923-934. [PMID: 37435935 DOI: 10.1111/birt.12735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/27/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Postpartum depression (PPD) is increasingly common in the United States and poses a significant threat to maternal and neonatal health. Universal screening for postpartum depression is recommended by numerous organizations, including the American College of Obstetricians and Gynecologists, but is not achieved in practice. METHODS A cross-sectional, weighted, state-representative study of California residents who gave birth in 2016 using the Listening to Mothers in California 2018 data set. Primary exposure was type of maternity care professional providing care during pregnancy, and the primary outcome was PPD screening. The secondary exposure was self-reported depression or anxiety during pregnancy, and the secondary outcome was attending a postpartum office visit. Bivariate analyses were conducted using Rao-Scott chi-square tests, and multivariate analyses were conducted using logistic regression. RESULTS Compared to participants cared for by obstetricians, participants cared for by midwives had 2.6 times the odds of reporting being screened for PPD after controlling for covariates (95% CI = 1.5, 4.4). Receiving care from any other practitioner type compared with an obstetrician was not associated with a different rate of postpartum depression screening. Reporting depression or anxiety during pregnancy was associated with 0.7 times the odds (95% CI = 0.5, 1.0) of returning for postpartum care after controlling for covariates. CONCLUSIONS Being cared for by a midwife during pregnancy increases the likelihood of being screened for postpartum depression. In addition, even perfectly implemented universal screening will miss a vulnerable sector of the population that is at high risk for postpartum depression and is less likely to return for postpartum care.
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Affiliation(s)
- Althea I Bourdeau
- School of Public Health, University of California, Berkeley, California, USA
| | - Kim G Harley
- School of Public Health, University of California, Berkeley, California, USA
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Sulley S, Adzrago D, Mamudu L, Odame EA, Atandoh PH, Tagoe I, Ruggieri D, Kahle L, Williams F. Assessment of prenatal depression among U.S. pregnant women without access to paid sick leave and regular place of care: National Health Interview Survey of U.S.-born and non-U.S.-born. Prev Med Rep 2023; 35:102322. [PMID: 37554349 PMCID: PMC10404555 DOI: 10.1016/j.pmedr.2023.102322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
Prenatal depression is one of the most common risks during pregnancy. This study examined the prevalence and likelihood of prenatal depression association with sociodemographic factors, paid sick leave, and place of care among U.S. pregnant women. We conducted bivariate Chi-square tests to assess the statistical difference and multivariable logistic regression models to assess the association of prenatal depression using the National Health Interview Survey, cross-sectional data from 2010 to 2019 of pregnant women aged 18-44 years (N = 957). The prevalence of prenatal depression was 40.6%, 28.5%, and 27.2% among White, Black, and other racial pregnant women, respectively. Pregnant women with no regular/routine place of care had a prenatal depression prevalence rate of 58.1%, and those without access to paid sick leave had 46.9%. Also, pregnant women without access to paid sick leave were found to have an increased likelihood of reporting prenatal depression ([adjusted odds ratio] AOR = 2.50, 95% CI = 1.72-3.64), as well as those without a regular place of care (AOR = 2.43, 95% CI = 1.32-4.47). The findings identify factors that need to be addressed to minimize depression among U.S. pregnant women and establish the need for tailored interventions to address prenatal depression.
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Affiliation(s)
- Saanie Sulley
- National Healthy Start Association, Washington, DC, USA
| | - David Adzrago
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Lohuwa Mamudu
- Department of Public Health, California State University, Fullerton, CA, USA
| | - Emmanuel A. Odame
- Department of Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul H. Atandoh
- Department of Statistics, Western Michigan University, Kalamazoo, MI, USA
| | - Ishmael Tagoe
- Division of Health Services, College of Nursing and Advanced Health Professions, The Chicago School of Professional Psychology, Chicago, IL, USA
| | - David Ruggieri
- Information Management Services, Inc., Calverton, MD, USA
| | - Lisa Kahle
- Information Management Services, Inc., Calverton, MD, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Werler MM, Kerr SM, Ailes EC, Reefhuis J, Gilboa SM, Browne ML, Kelley KE, Hernandez-Diaz S, Smith-Webb RS, Garcia MH, Mitchell AA. Patterns of Prescription Medication Use during the First Trimester of Pregnancy in the United States, 1997-2018. Clin Pharmacol Ther 2023; 114:836-844. [PMID: 37356083 PMCID: PMC10949220 DOI: 10.1002/cpt.2981] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/16/2023] [Indexed: 06/27/2023]
Abstract
The objective of this analysis was to describe patterns of prescription medication use during pregnancy, including secular trends, with consideration of indication, and distributions of use within demographic subgroups. We conducted a descriptive secondary analysis using data from 9,755 women whose infants served as controls in two large United States case-control studies from 1997-2011 and 2014-2018. After excluding vitamin, herbal, mineral, vaccine, i.v. fluid, and topical products and over-the-counter medications, the proportion of women that reported taking at least one prescription medication in the first trimester increased over the study years, from 37% to 50% of women. The corresponding proportions increased with increasing maternal age and years of education, were highest for non-Hispanic White women (47%) and lowest for Hispanic women (24%). The most common indication for first trimester use of a medication was infection (12-15%). Increases were observed across the years for medications used for indications related to nausea/vomiting, depression/anxiety, infertility, thyroid disease, diabetes, and epilepsy. The largest relative increase in use among women was observed for medications to treat nausea/vomiting, which increased from 3.8% in the earliest years of the study (1997-2001) to 14.8% in 2014-2018, driven in large part by ondansetron use. Prescription medication use in the first trimester of pregnancy is common and increasing. Many medical conditions require treatments among pregnant women, often involving pharmacotherapy, which necessitates consideration of the risk and safety profiles for both mother and fetus.
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Affiliation(s)
- Martha M. Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Stephen M. Kerr
- Slone Epidemiology Center at Boston University School of Medicine, Boston, Massachusetts, USA
| | - Elizabeth C. Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne M. Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marilyn L. Browne
- Birth Defects Registry, New York State Department of Health; Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Katherine E. Kelley
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Rashida S. Smith-Webb
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michelle Huezo Garcia
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Allen A. Mitchell
- Slone Epidemiology Center at Boston University School of Medicine, Boston, Massachusetts, USA
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Ouyang L, Cox S, Xu L, Robbins CL, Ko JY. Mental health and substance use disorders at delivery hospitalization and readmissions after delivery discharge. Drug Alcohol Depend 2023; 247:109864. [PMID: 37062248 PMCID: PMC10352865 DOI: 10.1016/j.drugalcdep.2023.109864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/20/2023] [Accepted: 04/01/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND The objective was to assess mental health and substance use disorders (MSUD) at delivery hospitalization and readmissions after delivery discharge. METHODS This is a population-based retrospective cohort study of persons who had a delivery hospitalization during January to September in the 2019 Nationwide Readmissions Database. We calculated 90-day readmission rates for MSUD and non-MSUD, overall and stratified by MSUD status at delivery. We used multivariable logistic regressions to assess the associations of MSUD type, patient, clinical, and hospital factors at delivery with 90-day MSUD readmissions. RESULTS An estimated 11.8% of the 2,697,605 weighted delivery hospitalizations recorded MSUD diagnoses. The 90-day MSUD and non-MSUD readmission rates were 0.41% and 2.9% among delivery discharges with MSUD diagnoses, compared to 0.047% and 1.9% among delivery discharges without MSUD diagnoses. In multivariable analysis, schizophrenia, bipolar disorder, stimulant-related disorders, depressive disorders, trauma- and stressor-related disorders, alcohol-related disorders, miscellaneous mental and behavioral disorders, and other specified substance-related disorders were significantly associated with increased odds of MSUD readmissions. Three or more co-occurring MSUDs (vs one MSUD), Medicare or Medicaid (vs private) as the primary expected payer, lowest (vs highest) quartile of median household income at residence zip code level, decreasing age, and longer length of stay at delivery were significantly associated with increased odds of MSUD readmissions. CONCLUSION Compared to persons without MSUD at delivery, those with MSUD had higher MSUD and non-MSUD 90-day readmission rates. Strategies to address MSUD readmissions can include improved postpartum MSUD follow-up management, expanded Medicaid postpartum coverage, and addressing social determinants of health.
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Affiliation(s)
- Lijing Ouyang
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Likang Xu
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cheryl L Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jean Y Ko
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Rinne GR, Mahrer NE, Guardino CM, Shalowitz MU, Ramey SL, Dunkel Schetter C. Childhood family stress modifies the association between perinatal stressful life events and depressive symptoms. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2023; 37:432-442. [PMID: 36996242 PMCID: PMC10238650 DOI: 10.1037/fam0001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The childhood family environment can influence long-term well-being in part by modifying how individuals' respond to and cope with stress across the life span. Theoretical models propose that childhood stress will either exacerbate (stress sensitization) or attenuate (steeling effect) the effects of adult stress on mental health. This study tests whether childhood family stress modifies the association between stressful life events and depressive symptoms in pregnancy and consecutive postpartum periods. A sample of 127 women reported on depressive symptoms after one birth, during a subsequent pregnancy, and postpartum following that birth. Childhood family stress was assessed with the Risky Families Questionnaire. Stressful life events were measured at all three timepoints to capture the number of life events during both pregnancies and between pregnancies. Associations between stressful life events and depressive symptoms varied as a function of childhood family stress. At the between-persons level, more stressful life events were associated with greater depressive symptoms among women who reported infrequent exposure to childhood family stress in this sample, but not among women who reported more frequent exposure to childhood family stress. Results provide novel evidence that moderate exposure to childhood family stress may attenuate the association between stressful life events and depressive symptoms in the perinatal period, consistent with a steeling effect. That is, some degree of childhood family stress may promote resilience to perinatal stress. Findings underscore the utility of examining the interaction of risk factors across the life span in predicting perinatal mental health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Gabrielle R. Rinne
- Department of Psychology, University of California, Los Angeles. Los Angeles, CA
| | | | | | | | - Sharon L. Ramey
- Fralin Biomedical Research Institute, Department of Psychology, Department of Psychiatry, Virginia Polytechnic Institute and State University. Blacksburg, VA
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11
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Ayala NK, Schlichting L, Lewkowitz AK, Kole-White MB, Gjelsvik A, Monteiro K, Amanullah S. The Association of Antenatal Depression and Cesarean Delivery among First-Time Parturients: A Population-Based Study. Am J Perinatol 2023; 40:356-362. [PMID: 36228650 PMCID: PMC9970759 DOI: 10.1055/a-1960-2919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Antenatal depression (AD) has been considered a risk factor for cesarean delivery (CD); however, the supporting data are inconsistent. We used a large, nationally representative dataset to evaluate whether there is an association between AD and CD among women delivering for the first time. STUDY DESIGN We utilized the 2016 to 2019 Multistate Pregnancy Risk Assessment Monitoring System (PRAMS) from the Centers for Disease Control. First-time parturients who reported depression in the 3 months prior to or at any point during their recent pregnancy were compared with those who did not. The mode of delivery was obtained through the birth certificate. Maternal demographics, pregnancy characteristics, and delivery characteristics were compared by the report of AD using bivariable analyses. Population-weighted multivariable regression was performed, adjusting for maternal age, race/ethnicity, insurance, pregnancy complications, preterm birth, and body mass index (BMI). RESULTS Of the 61,605 people who met the inclusion criteria, 18.3% (n = 11,896) reported AD and 29.8% (n = 19,892) underwent CD. Parturients with AD were younger, more likely to be non-Hispanic white, publicly insured, use tobacco in pregnancy, deliver earlier, have lower levels of education, higher BMIs, and more medical comorbidities (hypertension and diabetes). After adjustment for these differences, there was no difference in risk of CD between those with AD compared with those without (adjusted odds ratio: 1.04; 95% confidence interval: 0.97-1.13). CONCLUSION In a large, population-weighted, nationally representative sample of first-time parturients, there was no association between AD and CD. KEY POINTS · Antenatal depression is increasingly common and has multiple known morbidities.. · Prior data on antenatal depression and cesarean delivery are mixed.. · We found no association between depression and cesarean delivery..
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Affiliation(s)
- Nina K. Ayala
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
- Address for correspondence Nina K. Ayala, MD Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island101 Dudley Street, Providence, RI 02905
| | - Lauren Schlichting
- Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
| | - Adam K. Lewkowitz
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Martha B. Kole-White
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Annie Gjelsvik
- Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Siraj Amanullah
- Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Health Services, Policy and Practice, Brown School of Public Health, Providence, Rhode Island
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12
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Mental health as a family experience: Relationship of paternal characteristics with maternal perinatal depressive symptoms in a matched sample. Arch Womens Ment Health 2023; 26:135-139. [PMID: 35982295 DOI: 10.1007/s00737-022-01254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/03/2022] [Indexed: 11/02/2022]
Abstract
The present study investigates the relationship between perinatal maternal depressive symptoms and paternal factors using linked maternal-paternal survey data. From October 2018 to July 2019, among a representative sample and 2-6 months following the birth of an infant, mothers and fathers completed surveys and reported depressive symptoms. Results from the linked dyadic data (n = 243) show the prevalence of maternal depressive symptoms, both overall (16%) and by marital status and paternal health care involvement. Viewing mental health as a family experience may further understanding of postpartum maternal mental illness.
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13
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Gumusoglu SB, Santillan MK. SSRI use in pregnancy: Moving towards collaborative, evidence-based decision-making. Pregnancy Hypertens 2022; 30:146-147. [PMID: 36219941 PMCID: PMC10158533 DOI: 10.1016/j.preghy.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/01/2022] [Indexed: 11/07/2022]
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14
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Effect of transcutaneous auricular vagus nerve stimulation on major depressive disorder with peripartum onset: A multicenter, open-label, controlled proof-of-concept clinical trial (DELOS-1). J Affect Disord 2022; 316:34-41. [PMID: 35932937 DOI: 10.1016/j.jad.2022.07.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/23/2022] [Accepted: 07/30/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Postpartum depression has a high prevalence in the United States (~13 %) and often goes undertreated/untreated. We conducted a multicenter, open-label, proof-of-concept trial to assess the Nēsos wearable, non-invasive, transcutaneous auricular vagus nerve stimulation (taVNS) system for the treatment of major depressive disorder with peripartum onset (PPD). METHODS Women (n = 25), ages 18 to 45, within 9 months postpartum, and diagnosed with PPD were enrolled at 3 sites. The study included 6 weeks open-label therapy and 2 weeks observation. Efficacy outcomes included change from baseline (CFB) in Hamilton Rating Scale for Depression (HAMD17) total scores, HAM-D17 response and remission, and patient and clinician global impression of change (PGIC, CGIC) scores. Analysis included descriptive statistics and mixed-effects models for repeated measures. RESULTS The most common AEs (≥5 %) were discomfort (n = 5), headache (n = 3), and dizziness (n = 2); all resolved without intervention. No serious AEs or deaths occurred. Baseline mean HAM-D17 score was 18.4. Week 6 least squares (LS) mean CFB in HAM-D17 score was -9.7; 74 % achieved response and 61 % achieved remission. At week 6, at least some improvement was reported by 21 of 22 (95 %) clinicians on CGIC and 22 of 23 (96 %) participants on PGIC. LIMITATIONS This was a single-arm, open-label study, and enrollment was limited to participants with mild-to-moderate peripartum depression. CONCLUSION Results from this proof-of-concept study suggest that the Nēsos taVNS system is well tolerated and may be an effective non-invasive, non-pharmacological treatment for major depressive disorder with peripartum onset. Further evaluation in larger sham-controlled studies is needed. CLINICALTRIALS govNCT03972995.
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15
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Diagnosis and Management of Perinatal Depression. Nurs Womens Health 2022; 26:318-330. [PMID: 35714763 DOI: 10.1016/j.nwh.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 04/27/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022]
Abstract
Perinatal depression is a mood disorder that may occur during pregnancy or within a year after childbirth. It can be disabling for the birthing parent and cause attachment and developmental problems for the infant. A host of risk factors, including genetics, reproductive history, and life experiences, are associated with perinatal depression. With validated screening tools, health care providers can assess individuals, initiate treatment, and/or refer as appropriate. Successful treatment, which may include modalities such as cognitive behavioral therapy and/or pharmacologic therapies, helps individuals maintain a sense of control, develop self-confidence, take control of their thinking, and learn coping skills. Integrative therapies and lifestyle changes have some success but may not be adequate for many individuals. Patients may benefit from providers learning and initiating cognitive behavioral therapy techniques while awaiting therapy.
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16
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Hung KH, Tsao SL, Yang SF, Wang BY, Huang JY, Li WT, Yeh LT, Lin CH, Chen YY, Yeh CB. Association of General Anesthesia and Neuraxial Anesthesia in Caesarean Section with Maternal Postpartum Depression: A Retrospective Nationwide Population-Based Cohort Study. J Pers Med 2022; 12:jpm12060970. [PMID: 35743754 PMCID: PMC9224722 DOI: 10.3390/jpm12060970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2023] Open
Abstract
Although cesarean section (CS) has become a common method of child delivery in recent decades, the choice between general anesthesia (GA) and neuraxial anesthesia (NA) for CS must be carefully considered. Depending on the type of anesthesia used in CS, a major outcome observed is the occurrence of postpartum depression (PPD). This study investigated the association between PPD risk and the anesthesia method used in CS by using data from three linked nationwide databases in Taiwan, namely, the National Health Insurance Research Database, the National Birth Reporting Database, and the National Death Index Database. After propensity score matching by baseline depressive disorders, maternal demographics, status at delivery, infant’s health, maternal diseases during pregnancy, and age of partner, we included women who had natural births (n = 15,706), cesarean sections with GA (n = 15,706), and cesarean sections with NA (n = 15,706). A conditional logistic regression was used to estimate the odds ratios and 95% confidence intervals (CIs) of PPDs, including depression, sleep disorder, and medication with hypnotics or antidepressants, under anesthesia during CS. The prevalence rates of combined PPDs were 26.66%, 43.87%, and 36.30% in natural births, CS with GA, and CS with NA, respectively. In particular, the proportions of postpartum use of hypnotic drugs or antidepressants were 21.70%, 39.77%, and 31.84%, which were significantly different. The aORs (95% CIs) were 2.15 (2.05–2.25) for the included depressive disorders, 1.10 (1.00–1.21) for depression, 1.03 (0.96–1.11) for sleep disorder, and 2.38 (2.27–2.50) for medication with hypnotics or antidepressants in CS with GA compared with natural births. Women who underwent CS with GA had a significantly higher risk of depressive disorders and a higher need for antidepressants for sleep problems than those who underwent CS with NA. The risks of PPD were significantly associated with the anesthesia method, especially GA. Our results can assist physicians in carefully considering the appropriate anesthesia method for CS delivery, particularly with regard to postpartum drug abuse and drug safety.
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Affiliation(s)
- Kuo-Hsun Hung
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (K.-H.H.); (S.-F.Y.); (B.-Y.W.); (J.-Y.H.); (L.-T.Y.)
| | - Shao-Lun Tsao
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan 320, Taiwan; (S.-L.T.); (W.-T.L.)
- Department of Anesthesiology, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (K.-H.H.); (S.-F.Y.); (B.-Y.W.); (J.-Y.H.); (L.-T.Y.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Bo-Yuan Wang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (K.-H.H.); (S.-F.Y.); (B.-Y.W.); (J.-Y.H.); (L.-T.Y.)
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (K.-H.H.); (S.-F.Y.); (B.-Y.W.); (J.-Y.H.); (L.-T.Y.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Wen-Tyng Li
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan 320, Taiwan; (S.-L.T.); (W.-T.L.)
| | - Liang-Tsai Yeh
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (K.-H.H.); (S.-F.Y.); (B.-Y.W.); (J.-Y.H.); (L.-T.Y.)
- Department of Anesthesiology, Changhua Christian Hospital, Changhua 500, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Cheng-Hung Lin
- Department of Information Technology, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
- Department of Medical Informatics, Chung Shan Medical University, Taichung 402, Taiwan
| | - Yin-Yang Chen
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Department of Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (Y.-Y.C.); (C.-B.Y.)
| | - Chao-Bin Yeh
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (K.-H.H.); (S.-F.Y.); (B.-Y.W.); (J.-Y.H.); (L.-T.Y.)
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (Y.-Y.C.); (C.-B.Y.)
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17
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Pollack LM, Chen J, Cox S, Luo F, Robbins CL, Tevendale HD, Li R, Ko JY. Healthcare Utilization and Costs Associated With Perinatal Depression Among Medicaid Enrollees. Am J Prev Med 2022; 62:e333-e341. [PMID: 35227542 PMCID: PMC9247863 DOI: 10.1016/j.amepre.2021.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/17/2021] [Accepted: 12/01/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Differences in healthcare utilization and medical expenditures associated with perinatal depression are estimated. METHODS Using the MarketScan Multi-State Medicaid Database, the analytic cohort included individuals aged 15-44 years who had an inpatient live birth delivery hospitalization between January 1, 2017 and December 31, 2018. Multivariable negative binomial regression models were used to estimate the differences in utilization associated with perinatal depression, and multivariable generalized linear models were used to estimate the differences in expenditures associated with perinatal depression. Analyses were conducted in 2021. RESULTS The cohort included 330,593 individuals. Nearly 17% had perinatal depression. Compared with individuals without perinatal depression individuals with perinatal depression had a larger number of inpatient admissions (0.19, 95% CI=0.18, 0.20), total inpatient days (0.95, 95% CI=0.92, 0.97), outpatient visits (14.02, 95% CI=13.81, 14.22), emergency department visits (1.70, 95% CI=1.66, 1.74), and weeks of drug therapy covered by a prescription (28.70, 95% CI=28.12, 29.28) and larger total expenditures ($5,078, 95% CI=$4,816, $5,340). Non-Hispanic Black individuals had larger differences in utilization and expenditures for inpatient services and outpatient visits but smaller differences in utilization for pharmaceutical services associated with perinatal depression than non-Hispanic White individuals. Hispanic individuals had larger differences in utilization for outpatient visits but smaller differences in utilization for pharmaceutical services associated with perinatal depression than non-Hispanic White individuals. CONCLUSIONS Individuals with perinatal depression had more healthcare utilization and medical expenditures than individuals without perinatal depression, and differences varied by race/ethnicity. The findings highlight the need to ensure comprehensive and equitable mental health care to address perinatal depression.
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Affiliation(s)
- Lisa M Pollack
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Jiajia Chen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Feijun Luo
- Division of Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cheryl L Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heather D Tevendale
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rui Li
- Division of Research, Office of Epidemiology and Research, Health Resources & Services Administration, Maternal & Child Health, Rockville, Maryland
| | - Jean Y Ko
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Commissioned Corps, U.S. Public Health Service, HHS, Rockville, Maryland
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18
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Logue TC, Wen T, Monk C, Guglielminotti J, Huang Y, Wright JD, D'Alton ME, Friedman AM. Trends in and complications associated with mental health condition diagnoses during delivery hospitalizations. Am J Obstet Gynecol 2022; 226:405.e1-405.e16. [PMID: 34563500 DOI: 10.1016/j.ajog.2021.09.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mental health conditions during delivery hospitalizations are not well characterized. OBJECTIVE This study aimed to characterize the prevalence of maternal mental health condition diagnoses and associated risk during delivery hospitalizations in the United States. STUDY DESIGN The 2000 to 2018 National Inpatient Sample was used for this repeated cross-sectional analysis. Delivery hospitalizations of women aged 15 to 54 years with and without mental health condition diagnoses, including depressive disorder, anxiety disorder, bipolar spectrum disorder, and schizophrenia spectrum disorder, were identified. Temporal trends in mental health condition diagnoses during delivery hospitalizations were determined using the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change with 95% confidence intervals. The trends in chronic conditions associated with mental health condition diagnoses, including asthma, pregestational diabetes mellitus, chronic hypertension, obesity, and substance use, were analyzed. The association between mental health conditions and the following adverse outcomes was determined: (1) severe maternal morbidity, (2) preeclampsia or gestational hypertension, (3) preterm delivery, (4) postpartum hemorrhage, (5) cesarean delivery, and (6) maternal mortality. Regression models for each outcome were performed with unadjusted and adjusted risk ratios as measures of effects. RESULTS Of 73,109,791 delivery hospitalizations, 2,316,963 (3.2%) had ≥1 associated mental health condition diagnosis. The proportion of delivery hospitalizations with a mental health condition increased from 0.6% in 2000 to 7.3% in 2018 (average annual percent change, 11.4%; 95% confidence interval, 10.3%-12.6%). Among deliveries in women with a mental health condition diagnosis, chronic health conditions, including asthma, pregestational diabetes mellitus, chronic hypertension, obesity, and substance use, increased from 14.9% in 2000 to 38.5% in 2018. Deliveries to women with a mental health condition diagnosis were associated with severe maternal morbidity (risk ratio, 1.88; 95% confidence interval, 1.86-1.90), preeclampsia and gestational hypertension (risk ratio, 1.59; 95% confidence interval, 1.58-1.60), preterm delivery (risk ratio, 1.35; 95% confidence interval, 1.35-1.36), postpartum hemorrhage (risk ratio, 1.37; 95% confidence interval, 1.36-1.38), cesarean delivery (risk ratio, 1.20; 95% confidence interval, 1.20-1.20), and maternal death (risk ratio, 1.31; 95% confidence interval, 1.12-1.56). The increased risk was retained in adjusted models. CONCLUSION The proportion of delivery hospitalizations with mental health condition diagnoses increased significantly throughout the study period. Mental health condition diagnoses were associated with other underlying chronic health conditions and a modestly increased risk of a range of adverse outcomes. The findings suggested that mental health conditions are an important risk factor in adverse maternal outcomes.
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Affiliation(s)
- Teresa C Logue
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Timothy Wen
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; New York State Psychiatric Institute, New York, NY
| | - Jean Guglielminotti
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY.
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Abstract
The National Institutes of Health (NIH) Office of Research on Women's Health (ORWH) was established in 1990. With the completion of the office's 30th anniversary year, we look back and recount some of the key events and overall zeitgeist that led to ORWH's formation, and how it became the focal point at the nation's primary biomedical research agency for coordinating research on science to improve the health of women. We discuss ORWH's mission and signature programs and the bold vision that drives the NIH-wide strategic, interdisciplinary, and collaborative approach to research on women's health and efforts to promote women in biomedical careers. Also discussed are several of the many scientific advances in research on the health of women, policy innovations and their effects, and career advancements made by women in medicine and related scientific fields. We also highlight key challenges for the health of women, the need to continue pushing for equity in biomedical research careers, and NIH's approach to addressing these problems to ensure progress for the next 30 years and beyond.
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Affiliation(s)
- Regine Douthard
- Office of Research on Women's Health, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Janine Austin Clayton
- Office of Research on Women's Health, National Institutes of Health, Bethesda, Maryland, USA
- Address correspondence to: Janine Austin Clayton, MD, FARVO, Office of Research on Women's Health, National Institutes of Health, 6707 Democracy Blvd., Suite #400, Bethesda, MD 20892, USA
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20
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Saxton DL, Archer NP. The Effect of Postpartum Depressive Symptoms (PDS) on Maternal Health Practices After Childbirth, Texas Pregnancy Risk Assessment Monitoring System, 2012-2015. Matern Child Health J 2022; 26:537-544. [PMID: 35001175 DOI: 10.1007/s10995-021-03304-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study examined the contribution of postpartum depressive symptoms (PDS) on select maternal health practices among Texas women, using 2012-2015 survey data from the Pregnancy Risk Assessment Monitoring System. METHODS Multiple logistic regression was used to assess the effect of PDS on postpartum checkups, postpartum dental visits, and use of postpartum birth control. Covariates included maternal age, race/ethnicity, marital status, education, and depression before birth. RESULTS Data from 4679 respondents were used in analyses, and the prevalence of women reporting PDS was 13.8 percent. Women without PDS were more likely to attend a postpartum checkup (adjusted OR = 1.5; 95% CI 1.1-2.1) or have a postpartum dental visit (adjusted OR = 1.4, 95% CI 1.0-1.8) than women with PDS. There was insufficient evidence to conclude any association between PDS and use of postpartum birth control. CONCLUSIONS These findings highlight adverse effects of PDS on maternal health practices not previously studied. Results stress the importance of healthcare professionals monitoring the moods and actions of women of childbearing age to provide early interventions for women experiencing PDS, and of emphasizing positive maternal health practices after childbirth.
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Affiliation(s)
- Debra L Saxton
- Maternal & Child Health Epidemiology Unit, Division for Community Health Improvement, Texas Department of State Health Services, PO Box 149347, Austin, TX, 78714, USA
| | - Natalie P Archer
- Environmental Epidemiology & Disease Registries Section, Texas Department of State Health Services, PO Box 14934, MC 1964, Austin, TX, 78714, USA.
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21
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Trost SL, Beauregard JL, Smoots AN, Ko JY, Haight SC, Moore Simas TA, Byatt N, Madni SA, Goodman D. Preventing Pregnancy-Related Mental Health Deaths: Insights From 14 US Maternal Mortality Review Committees, 2008-17. Health Aff (Millwood) 2021; 40:1551-1559. [PMID: 34606354 PMCID: PMC11135281 DOI: 10.1377/hlthaff.2021.00615] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Each year approximately 700 people die in the United States from pregnancy-related complications. We describe the characteristics of pregnancy-related deaths due to mental health conditions, including substance use disorders, and identify opportunities for prevention based on recommendations from fourteen state Maternal Mortality Review Committees (MMRCs) from the period 2008-17. Among 421 pregnancy-related deaths with an MMRC-determined underlying cause of death, 11 percent were due to mental health conditions. Pregnancy-related mental health deaths were more likely than deaths from other causes to be determined by an MMRC to be preventable (100 percent versus 64 percent), to occur among non-Hispanic White people (86 percent versus 45 percent), and to occur 43-365 days postpartum (63 percent versus 18 percent). Sixty-three percent of pregnancy-related mental health deaths were by suicide. Nearly three-quarters of people with a pregnancy-related mental health cause of death had a history of depression, and more than two-thirds had past or current substance use. MMRC recommendations can be used to prioritize interventions and can inform strategies to enable screening, care coordination, and continuation of care throughout pregnancy and the year postpartum.
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Affiliation(s)
- Susanna L Trost
- Susanna L. Trost is an Oak Ridge Institute for Science and Education Fellow in the Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia
| | - Jennifer L Beauregard
- Jennifer L. Beauregard is an epidemiologist in the Division of Reproductive Health, CDC, and a lieutenant in the US Public Health Service, in Rockville, Maryland
| | - Ashley N Smoots
- Ashley N. Smoots is an epidemiologist in the Division of Reproductive Health, CDC
| | - Jean Y Ko
- Jean Y. Ko is the lead for the Maternal Health and Chronic Disease Team, Division of Reproductive Health, CDC, and a commander in the US Public Health Service
| | - Sarah C Haight
- Sarah C. Haight is a graduate research assistant in the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, in Chapel Hill, North Carolina. She was an epidemiologist in the Division of Reproductive Health, CDC, at the time of writing
| | - Tiffany A Moore Simas
- Tiffany A. Moore Simas is the chair of the Department of Obstetrics and Gynecology and medical director of the Lifeline for Moms Program, University of Massachusetts Medical School/UMass Memorial Health, in Worcester, Massachusetts
| | - Nancy Byatt
- Nancy Byatt is the executive director of the Lifeline for Families Center and Lifeline for Moms Program, Department of Psychiatry, University of Massachusetts Medical School/UMass Memorial Health Care
| | - Sabrina A Madni
- Sabrina A. Madni is a statistician with BeVera Solutions in the National Center for Immunization and Respiratory Diseases, CDC. She was an Oak Ridge Institute for Science and Education Fellow in the Division of Reproductive Health, CDC, at the time of writing
| | - David Goodman
- David Goodman is the lead for the Maternal Mortality Prevention Team, Division of Reproductive Health, CDC
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22
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Wenzel ES, Pinna G, Eisenlohr-Moul T, Bernabe BP, Tallon RR, Nagelli U, Davis J, Maki PM. Neuroactive steroids and depression in early pregnancy. Psychoneuroendocrinology 2021; 134:105424. [PMID: 34607173 PMCID: PMC8943472 DOI: 10.1016/j.psyneuen.2021.105424] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/30/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
Progesterone (P4) can be metabolized to two general classes of neuroactive steroids (NAS) -those like allopregnanolone (ALLO) and pregnanolone (PA) which are positive allosteric modulators of the Gamma Aminobutyric Acid type A (GABAA) receptor and those like isoallopregnanolone (ISOALLO) and epipregnanolone (EPI) which are negative allosteric modulators of the GABAA receptor. While exogenous administration of ALLO is effective in treating postpartum depression, knowledge gaps remain in the dynamic interplay of NAS across the perinatal period. In particular little is known about ALLO and PA in relation to depression earlier in pregnancy, and the role of ISOALLO and EPI in relation to depression at any point in the perinatal period. In a prospective, nested case/control study in low-income women of color, we compared the metabolism of P4 to four NAS (i.e., ratios ALLO:P4, PA:P4, ISOALLO:P4, EPI:P4) in pregnant women with depression at either or both of the first and second trimesters (cases) and women without depression at either time point (controls). Fifty women (36% depressed, 56% Black, 28% Latina) completed depression screening using a computerized adaptive test of mental health (CAT-MH™) and provided blood serum samples in both trimesters. In longitudinal mixed effects models of both trimesters, PND cases showed higher ratios of ALLO:P4 (p = .002) and PA:P4 (p = .03) compared to controls. In regression models of only first trimester data, there was no significant difference in NAS ratios between cases and controls (p > .05). Conversely, in models of the second trimester, ratios of PA:P4 (p = .002) and ISOALLO:P4 (p = .01) were significantly higher in cases compared to controls, and ratios of ALLO:P4 (p = .08) and EPI:P4 (p = .1) also trended higher in cases. The most severe cases, those with depression at both trimesters, showed an increase in ALLO:P4 (p = .06) and EPI:P4 (p < .001) ratios from the first to the second trimester, whereas controls showed a decrease in these ratios. Secondary analyses confirmed higher levels of ALLO (p = .04) and PA (p = .07) overall in cases compared to controls, along with higher levels of PA (p = .005) and ISOALLO (p = .02) in the second trimester alone. This work suggests a dynamic relationship between NAS and PND; whereas low ALLO levels have been previously associated with postpartum depression, earlier in pregnancy a higher metabolism of P4 to ALLO (and higher ALLO levels) is associated with depression. Some women may show a hormone-sensitive depressive response to acute increases in NAS metabolism in early pregnancy.
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Affiliation(s)
- Elizabeth S Wenzel
- University of Illinois at Chicago, Department of Psychiatry, 912 S Wood St, Chicago, IL 60612, USA; University of Illinois at Chicago, Department of Psychology, 1007 W Harrison St, Chicago, IL 60607, USA
| | - Graziano Pinna
- University of Illinois at Chicago, Department of Psychiatry, 912 S Wood St, Chicago, IL 60612, USA
| | - Tory Eisenlohr-Moul
- University of Illinois at Chicago, Department of Psychiatry, 912 S Wood St, Chicago, IL 60612, USA
| | - Beatriz Penalver Bernabe
- University of Illinois at Chicago, Department of Biomedical Engineering, 820 S Wood St, Chicago, IL, 60612, USA
| | - Raquel Romay Tallon
- University of Illinois at Chicago, Department of Psychiatry, 912 S Wood St, Chicago, IL 60612, USA
| | - Unnathi Nagelli
- University of Illinois at Chicago, Department of Psychiatry, 912 S Wood St, Chicago, IL 60612, USA
| | - John Davis
- University of Illinois at Chicago, Department of Psychiatry, 912 S Wood St, Chicago, IL 60612, USA
| | - Pauline M Maki
- University of Illinois at Chicago, Department of Psychiatry, 912 S Wood St, Chicago, IL 60612, USA; University of Illinois at Chicago, Department of Psychology, 1007 W Harrison St, Chicago, IL 60607, USA; University of Illinois at Chicago, Department of Obstetrics and Gynecology, 820 S Wood St, Chicago, IL 60612, USA.
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23
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Barger MK. Current Resources for Evidence-Based Practice, July/August 2021. J Midwifery Womens Health 2021; 66:540-547. [PMID: 34338411 DOI: 10.1111/jmwh.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
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24
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Truong C, Juhl A, Hwang SS. Risk factors for postpartum depressive symptoms among mothers of Colorado-born preterm infants. J Perinatol 2021; 41:2028-2037. [PMID: 34035446 DOI: 10.1038/s41372-021-01088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/08/2021] [Accepted: 04/29/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Identify risk factors of postpartum depressive symptoms (PDS) among preterm infants' mothers. STUDY DESIGN Retrospective cross-sectional analysis of Colorado's Pregnancy Risk Assessment Monitoring System from 2012 to 2018 included weighted n = 33,633 mothers of preterm infants. Multivariate regression models calculated adjusted risk factors of PDS. RESULTS PDS risk factors include history of maternal depression (adjusted risk ratio [aRR] 1.98, 95% confidence interval [CI] 1.28-3.05), early preterm birth <34wga (aRR 1.48, 95% CI 1.05-2.08), no prenatal care (aRR 3.19, 95% CI 1.52-6.71), non-Hispanic other (Asian/Pacific Islander, American Indian/Alaskan, or mixed) race/ethnicity (aRR 1.76, 95% CI 1.10-2.82), and pre-pregnancy public insurance (aRR 2.34, 95% CI 1.46-3.76). CONCLUSION PDS risk factors among Colorado mothers of preterm infants slightly differ from identified risk factors among mothers of term infants. These findings can improve PDS screening and diagnosis so effective therapies and support can be offered during and after NICU hospitalization.
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Affiliation(s)
- Connie Truong
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Ashley Juhl
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Sunah S Hwang
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.,Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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25
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Vuong HE, Coley EJL, Kazantsev M, Cooke ME, Rendon TK, Paramo J, Hsiao EY. Interactions between maternal fluoxetine exposure, the maternal gut microbiome and fetal neurodevelopment in mice. Behav Brain Res 2021; 410:113353. [PMID: 33979656 DOI: 10.1016/j.bbr.2021.113353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/26/2021] [Accepted: 05/07/2021] [Indexed: 01/16/2023]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are the most widely used treatment by women experiencing depression during pregnancy. However, the effects of maternal SSRI use on early offspring development remain poorly understood. Recent studies suggest that SSRIs can modify the gut microbiota and interact directly with particular gut bacteria, raising the question of whether the gut microbiome impacts host responses to SSRIs. In this study, we investigate effects of prenatal SSRI exposure on fetal neurodevelopment and further evaluate potential modulatory influences of the maternal gut microbiome. We demonstrate that maternal treatment with the SSRI fluoxetine induces widespread alterations in the fetal brain transcriptome during midgestation, including increases in the expression of genes relevant to synaptic organization and neuronal signaling and decreases in the expression of genes related to DNA replication and mitosis. Notably, maternal fluoxetine treatment from E7.5 to E14.5 has no overt effects on the composition of the maternal gut microbiota. However, maternal pretreatment with antibiotics to deplete the gut microbiome substantially modifies transcriptional responses of the fetal brain to maternal fluoxetine treatment. In particular, maternal fluoxetine treatment elevates localized expression of the opioid binding protein/cell adhesion molecule like gene Opcml in the fetal thalamus and lateral ganglionic eminence, which is prevented by maternal antibiotic treatment. Together, these findings reveal that maternal fluoxetine treatment alters gene expression in the fetal brain through pathways that are impacted, at least in part, by the presence of the maternal gut microbiota.
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Affiliation(s)
- Helen E Vuong
- Department of Integrative Biology & Physiology, University of California Los Angeles, Los Angeles, CA, 90095, USA.
| | - Elena J L Coley
- Department of Integrative Biology & Physiology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Maria Kazantsev
- Department of Integrative Biology & Physiology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Michaela E Cooke
- Department of Integrative Biology & Physiology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Tomiko K Rendon
- Department of Integrative Biology & Physiology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Jorge Paramo
- Department of Integrative Biology & Physiology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Elaine Y Hsiao
- Department of Integrative Biology & Physiology, University of California Los Angeles, Los Angeles, CA, 90095, USA
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26
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Chen HY, Blackwell SC, Yang LJS, Mendez-Figueroa H, Chauhan SP. Neonatal brachial plexus palsy: associated birth injury outcomes, hospital length of stay and costs. J Matern Fetal Neonatal Med 2021; 35:5736-5744. [PMID: 33632043 DOI: 10.1080/14767058.2021.1892066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the birth injury outcomes and hospital length of stay and costs among newborns delivered at 34-42 weeks with neonatal brachial plexus palsy (NBPP) versus those without. STUDY DESIGN We conducted a retrospective, cross-sectional study using data from the National Inpatient Sample to identify all newborns hospitalizations that occurred in the U.S. between 2016 and 2017. We included non-anomalous single liveborn delivered in-hospital at 34-42 weeks. The newborns with NBPP were identified by International Classification of Diseases, 10th Revision, Clinical Modification codes. Birth injury outcomes, and hospital length of stay and hospital costs were examined. A multivariable Poisson regression model with robust error variance was used to examine the association between NBPP and birth injury outcomes. A multivariable generalized linear regression model was used to examine the association between NBPP and hospital length of stay and hospital costs. RESULTS Of 7,019,722 non-anomalous single liveborn delivered at 34-42 weeks in the U.S. from 2016 to 2017, the rate of NBPP (n = 6695) was 0.95 per 1000 newborn hospitalizations. After multivariable regression adjustment, compared to newborns without NBPP, the risk of the composite birth injury outcome was 2.91 (95% CI 2.61-3.25) times higher in those with NBPP. Similar results of an increased risk among newborns with NBPP were observed in all individual birth injury outcomes. Compared to newborns without NBPP, after adjustment, the hospital length of stay was 1.48 (95% IC 1.38-1.59) times higher and the hospital costs were 2.21 (95% CI 1.97-2.48) times higher in those with NBPP. CONCLUSIONS Among newborns delivered at 34-42 weeks, the risk of associated birth injuries, hospital length of stay and costs, were significantly higher in newborns with NBPP than those without.
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Affiliation(s)
- Han-Yang Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sean C Blackwell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lynda J-S Yang
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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27
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Dagher RK, Bruckheim HE, Colpe LJ, Edwards E, White DB. Perinatal Depression: Challenges and Opportunities. J Womens Health (Larchmt) 2021; 30:154-159. [PMID: 33156730 PMCID: PMC7891219 DOI: 10.1089/jwh.2020.8862] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Perinatal depression (PND) is a major depressive episode during pregnancy or within 4 weeks after childbirth up to a year. Risk factors for PND include stressful life events, history of depression, poor social support, unplanned and unwanted pregnancies, poor relationship quality, current or previous abuse, and low socioeconomic status. This mental disorder has been shown to have negative effects on mothers' quality of life and their intimate relationships, birth outcomes, and breastfeeding likelihood, as well as long-term effects on children's cognitive and emotional development. To date, no nationally representative study has examined whether there are socioeconomic and/or racial/ethnic differences in PND. This study discusses the prevalence and risk factors for PND, as well as its health consequences for mothers and children, the reasons for its underreporting and undertreatment, the evidence for different screening instruments and different treatment options, and the existing supportive policies to address this disorder in the United States. We conclude with outlining next steps in addressing the gaps in the literature on PND.
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Affiliation(s)
- Rada K. Dagher
- Division of Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Lisa J. Colpe
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Emmeline Edwards
- Division of Extramural Research, National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Della B. White
- Division of Extramural Research, National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland, USA
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28
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McFarland MJ, McFarland CAS, Hill TD, D'Oria R. Postpartum Depressive Symptoms during the Beginning of the COVID-19 Pandemic: An Examination of Population Birth Data from Central New Jersey. Matern Child Health J 2021; 25:353-359. [PMID: 33492587 PMCID: PMC7829096 DOI: 10.1007/s10995-020-03116-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 11/21/2022]
Abstract
Objectives To examine the mental health of women in the perinatal period prior to and during the COVID-19 pandemic. Methods We use provisional vital statistics data for births occurring in the central region of New Jersey. The Edinburgh Postnatal Depression Scale is employed to assess depressive symptoms. Our focal analysis uses linear regression models to test whether giving birth during the pandemic is associated with elevated depressive symptoms. All analyses are performed using time-matched (September 2019-April 2020; n = 18,531) and month-matched (January 2019-April 2019 and January 2020- April 2020; n = 18,346) samples. Results Women who gave birth in March and not in April reported higher levels of depressive symptoms than those who gave birth prior to the pandemic in our time-matched (b = 0.09) and month-matched (b = 0.09) samples. The magnitude of this association is approximately one-third the magnitude of the association between preterm birth and depressive symptoms. Conclusion These findings suggest that researchers and practitioners should pay special attention to signs of postpartum depression and women’s adaptive coping responses in the early stages of pandemics. Supplementary Information
The online version contains supplementary material available at
10.1007/s10995-020-03116-w.
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Affiliation(s)
- Michael J McFarland
- Department of Sociology and Center for Demography and Population Health, Florida State University, 113 Collegiate Loop, P.O. Box 3062270, Tallahassee, FL, 32306-2270, USA.
| | | | - Terrence D Hill
- Department of Sociology, University of Texas, San Antonio, USA
| | - Robyn D'Oria
- Central Jersey Family Health Consortium, North Brunswick Township, USA
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29
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Hayes DK, Robbins CL, Ko JY. Trends in Selected Chronic Conditions and Related Risk Factors Among Women of Reproductive Age: Behavioral Risk Factor Surveillance System, 2011-2017. J Womens Health (Larchmt) 2020; 29:1576-1585. [PMID: 32456604 PMCID: PMC8039859 DOI: 10.1089/jwh.2019.8275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction: Chronic diseases in the United States are the leading drivers of disability, death, and health care costs. In women of reproductive age (WRA), chronic disease and related risk factors can also affect fertility and reproductive health outcomes. This analysis of trends from 2011 to 2017 adds additional indicators and updates an analysis covering 2001-2009. Methods: Data from the 2011-2017 Behavioral Risk Factor Surveillance System were analyzed for 265,544 WRA (18-44 years). To assess trends in 12 chronic conditions and related risk factors, we calculated annual prevalence estimates and adjusted prevalence ratios (APRs) with predicted marginals accounting for age, race, Hispanic ethnicity, education, and health care coverage. Results: From 2011 to 2017, prevalence decreased for current smoking (20.7%-15.9%; p < 0.001), gestational diabetes (3.1%-2.7%; p = 0.003), and high cholesterol (19.0%-16.7%; p < 0.001); prevalence increased for depression (20.4%-24.9%; p < 0.001) and obesity (24.6%-27.6%; p < 0.001). After adjustment, in 2017 WRA were more likely to report asthma (APR = 1.06; 95% confidence interval [CI] = 1.01-1.11), physical inactivity (APR = 1.08; 95% CI = 1.04-1.12), obesity (APR = 1.15; 95% CI = 1.11-1.19), and depression (APR = 1.29; 95% CI = 1.25-1.34) compared with 2011. They were less likely to report high cholesterol (APR = 0.89; 95% CI = 0.85-0.94) in 2015 compared with 2011, and current smoking (APR = 0.86; 95% CI = 0.82-0.89) and gestational diabetes (APR = 0.84; 95% CI = 0.75-0.94) in 2017 compared with 2011. Conclusions: Some chronic conditions and related risk factors improved, whereas others worsened over time. Research clarifying reasons for these trends may support the development of targeted interventions to promote improvements, potentially preventing adverse reproductive outcomes and promoting long-term health.
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Affiliation(s)
- Donald K Hayes
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
| | - Cheryl L Robbins
- Division of Reproductive Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
| | - Jean Y Ko
- Division of Reproductive Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
- United States Public Health Service, Commissioned Corps, Rockville, Maryland, USA
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30
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Guglielminotti J, Li G. Exposure to General Anesthesia for Cesarean Delivery and Odds of Severe Postpartum Depression Requiring Hospitalization. Anesth Analg 2020; 131:1421-1429. [PMID: 33079866 PMCID: PMC9912141 DOI: 10.1213/ane.0000000000004663] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Previous research suggests that, compared with regional anesthesia, general anesthesia is associated with increased odds of postoperative depressive disorders. No study has specifically evaluated the possible protective effect of neuraxial anesthesia for cesarean delivery on maternal mental health compared with general anesthesia. This exploratory study was designed to test the hypothesis that general anesthesia for cesarean delivery is associated with increased odds of severe postpartum depression (PPD) requiring hospitalization compared with neuraxial anesthesia. METHODS This retrospective cohort study included cesarean delivery cases performed in New York State hospitals between January 2006 and December 2013. Exclusion criteria were as follows: (1) having >1 cesarean delivery during the study period; (2) residing outside of New York State; (3) having a general anesthetic for other surgery or delivery in the previous year or in the year after the index case. The primary outcome was the occurrence of PPD, and the secondary outcomes were: (1) the composite of suicidal ideation or self-inflicted injury (ie, suicidality); (2) anxiety disorders; and (3) posttraumatic stress disorders (PTSD). Primary and secondary outcomes were identified during the delivery hospitalization and up to 1 year after delivery. Adjusted odds ratios (aORs) and 95% confidence interval (CI) of adverse psychiatric outcomes associated with general anesthesia were estimated using propensity score matching. RESULTS Of the 428,204 cesarean delivery cases included, 34,356 had general anesthesia (8.0%). Severe PPD requiring hospitalization was recorded in 1158 women (2.7/1000; 95% CI, 2.5-2.9); of them, 60% were identified during readmission, with a median of 164 days after discharge. Relative to neuraxial anesthesia, general anesthesia in cesarean delivery was associated with a 54% increased odds of PPD (aOR, 1.54; 95% CI, 1.21-1.95) and a 91% increased odds of suicidal ideation or self-inflicted injury (aOR, 1.91; 95% CI, 1.12-3.25). There was insufficient evidence in these data that general anesthesia was associated with anxiety disorders (aOR, 1.37; 95% CI, 0.97-1.95) or PTSD (aOR, 1.50; 95% CI, 0.50-4.47). CONCLUSIONS General anesthesia for cesarean delivery is associated with increased odds of severe PPD requiring hospitalization, suicidal ideation, and self-inflicted injury. If confirmed, these preliminary findings underscore the need to avoid the use of general anesthesia for cesarean delivery whenever possible, and to provide mental health screening, counseling, and other follow-up services to obstetric patients exposed to general anesthesia.
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Affiliation(s)
- Jean Guglielminotti
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY 10032, USA
| | - Guohua Li
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
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