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Wu D, Chen S, Zhong X, Zhang J, Zhao G, Jiang L. Prevalence and factors associated with antenatal depressive symptoms across trimesters: a study of 110,584 pregnant women covered by a mobile app-based screening programme in Shenzhen, China. BMC Pregnancy Childbirth 2024; 24:480. [PMID: 39014317 PMCID: PMC11251361 DOI: 10.1186/s12884-024-06680-z] [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: 03/11/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Antenatal depression is a significant public health issue affecting pregnant women both globally and in China. Using data from a mobile app-based screening programme, this study explored the prevalence and factors associated with antenatal depressive symptoms across different trimesters in Shenzhen. METHODS A retrospective cross-sectional study was conducted on pregnant women who gave birth in any hospital in Shenzhen between July 2021 and May 2022 and underwent depression screening using an official maternal and infant health mobile app at least once during pregnancy. Depressive symptoms were evaluated using the 9-item Patient Health Questionnaire (PHQ-9), with cut-off scores of 5 and 10 for mild and high level of symptoms, respectively. The prevalence for each trimester was determined by calculating the proportion of women scoring 5 or higher. A variety of sociodemographic, obstetric, psychological, and lifestyle factors were assessed for their association with depressive symptoms. Chi-square test and multivariate logistic regression were performed to identify significant predictors. RESULTS A total of 110,584 pregnant women were included in the study, with an overall prevalence of depressive symptoms of 18.0% and a prevalence of high-level symptoms of 4.2%. Depressive symptoms were most prevalent in the first trimester (10.9%) and decreased in the second (6.2%) and third trimesters (6.3%). Only a small proportion (0.4%) of women showed persistent depressive symptoms across all trimesters. Anxiety symptoms in early pregnancy emerged as the most significant predictor of depressive symptoms. Other factors linked to an increased risk throughout pregnancy include lower marital satisfaction, living with parents-in-law, experience of negative life events, as well as drinking before and during pregnancy. Factors associated with a reduced risk throughout pregnancy include multiparity and daily physical activity. CONCLUSIONS This large-scale study provides valuable insights into the prevalence and factors associated with antenatal depressive symptoms in Shenzhen. The findings underscore the need for targeted interventions for high-risk groups and the integration of mental health care into routine antenatal services. Continuous, dynamic monitoring of depressive symptoms for pregnant women and ensuring at-risk women receive comprehensive follow-up and appropriate psychological or psychiatric care are crucial for effectively addressing antenatal depression and improving maternal and infant health outcomes.
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Affiliation(s)
- Dadong Wu
- Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, 518000, Guangdong Province, China
- Shenzhen Key Laboratory of Maternal and Child Health and Diseases, Shenzhen, 518000, Guangdong Province, China
| | - Siqi Chen
- Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, 518000, Guangdong Province, China
| | - Xiaoqi Zhong
- The Second School of Clinical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, Guangdong Province, China
| | - Jiayi Zhang
- School of Health Management, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
| | - Guanglin Zhao
- Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, 518000, Guangdong Province, China
| | - Lei Jiang
- Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, 518000, Guangdong Province, China.
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Galbally M, Watson S, MacMillan K, Sevar K, Howard LM. Intimate partner violence across pregnancy and the postpartum and the relationship to depression and perinatal wellbeing: findings from a pregnancy cohort study. Arch Womens Ment Health 2024:10.1007/s00737-024-01455-z. [PMID: 38459991 DOI: 10.1007/s00737-024-01455-z] [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: 03/30/2023] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE To compare the prevalence of emotional and physical intimate partner violence (IPV) across pregnancy and the first year postpartum in those with and without clinical depression and assess the association between maternal childhood trauma, current stressful life events and depression and IPV over the perinatal period. METHODS Data were obtained from 505 pregnant women from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a cohort study with data collected across pregnancy until 12 months postpartum. Maternal antenatal depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV) with repeat measurement of perinatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). Trauma was measured using the Childhood Trauma Questionnaire, and experiences of physical and emotional intimate partner violence using items in the Stressful Life Events Scale. RESULTS Women experiencing IPV across the perinatal period were significantly more likely to score over 13 on the EPDS (p < .001) at each timepoint in pregnancy and the postpartum and physical IPV was associated with clinical depression. Further, a history of childhood trauma and current additional stressful life events were significantly associated with reporting current IPV in the perinatal period. CONCLUSIONS This study confirmed the risk factors of childhood trauma and current stressful life events for reporting experiences of IPV in the perinatal period. Furthermore, women experiencing IPV reported higher depressive symptoms, providing evidence supporting the value of assessing those women who screen higher on the EPDS for IPV. Together these findings also support trauma informed care across pregnancy and the postpartum.
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Affiliation(s)
- Megan Galbally
- School of Clinical Sciences, Monash University, Clayton, Australia.
- Health Futures Institute, Murdoch University, Perth, Australia.
- Monash Health, Clayton, VIC, Australia.
| | - Stuart Watson
- School of Clinical Sciences, Monash University, Clayton, Australia
- Health Futures Institute, Murdoch University, Perth, Australia
| | - Kelli MacMillan
- School of Clinical Sciences, Monash University, Clayton, Australia
- Health Futures Institute, Murdoch University, Perth, Australia
| | - Katherine Sevar
- School of Clinical Sciences, Monash University, Clayton, Australia
| | - Louise M Howard
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
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Sucu ST, Karaman E, Kose C, Sucu S, Keskin HL. Is postpartum depression related to total weight gain during pregnancy and maternal anemia? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20230908. [PMID: 38451577 PMCID: PMC10913786 DOI: 10.1590/1806-9282.20230908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVE This study aimed to investigate the effects of weight gain and maternal anemia on postpartum depression. METHODS This is a prospective, single-center, case-control study. We recorded the demographic characteristics, blood ferritin level, and weight gain during the pregnancy. This study was planned between April 2023 and June 2023 in the Obstetrics and Gynecology Clinic of Ankara Etlik City Hospital. A total of 109 patients were enrolled in the study. Patients were assessed with the Edinburgh Postpartum Depression Scale. Weight gain, nutritional education, educational level, mode of delivery, and pregnancy history were asked in person. Ferritin levels at the onset of labor were determined to detect anemia. Twin births, births due to fetal anomalies or intrauterine stillbirths, patients with systemic infections, and patients diagnosed with a psychiatric disorder in the past 6 months whose records were not accessible were excluded from the study. RESULTS Pregnancy weight gain and percentage of pregnancy weight gain were higher. Serum ferritin levels and nutritional education during pregnancy were lower in the postpartum depression group (p<0.001). These parameters with statistical significance were identified as risk factors in the regression analysis for postpartum depression (p<0.05). In receiver operating characteristics analysis, >15 kg for weight gain, >28.8 for percentage of weight gain in pregnancy, and <19 ng/dL for serum ferritin level were identified as cutoff values (p<0.001). CONCLUSION Nutritional education and vitamin supplementation should be recommended to pregnant women during routine examinations.
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Affiliation(s)
- Serap Topkara Sucu
- Ankara Etlik City Hospital, Department of Gynecology and Obstetrics – Ankara, Turkey
| | - Elif Karaman
- Ankara Etlik City Hospital, Department of Psychology – Ankara, Turkey
| | - Caner Kose
- Ankara Etlik City Hospital, Department of Gynecology and Obstetrics – Ankara, Turkey
| | - Sadun Sucu
- Ankara Etlik City Hospital, Department of Perinatology – Ankara, Turkey
| | - Hüseyin Levent Keskin
- Ankara Etlik City Hospital, Department of Gynecology and Obstetrics – Ankara, Turkey
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Jacobs B, Testa A. Functional Disabilities and Food Insufficiency During Pregnancy: Results from the Pregnancy Risk Assessment Monitoring System. J Womens Health (Larchmt) 2024; 33:178-186. [PMID: 37843931 DOI: 10.1089/jwh.2023.0237] [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] [Indexed: 10/18/2023] Open
Abstract
Background: Disability is a well-documented risk factor for food insecurity. However, prior literature has overlooked the possible connection between disability and food insecurity during the antenatal period. This study extends previous research by examining the relationship between those with any functional disabilities and food insufficiency during pregnancy among a sample of mothers. Methods: Data are from the Pregnancy Risk Assessment Monitoring System, 2019-2020 (N = 9084). The relationship between the number of self-reported functional disabilities and food insufficiency is examined using modified multivariable Poisson regression. Results: After adjusting for control variables, the results reveal that those with any functional disability have a significantly higher risk of food insufficiency during pregnancy (risk ratio [RR] = 1.464, 95% confidence interval [CI] = 1.201-1.785). Findings reveal that all types of functional disability are associated with a higher risk of food insufficiency, including difficulty seeing, difficulty hearing, difficulty walking, difficulty remembering, difficulty with self-care, and difficulty communicating. Finally, the findings revealed that respondents with two functional disabilities (RR = 1.473, 95% CI = 1.153-1.882) and three or more functional disabilities (RR = 1.974, 95% CI = 1.534-2.541) are significantly more likely to report food insufficiency compared with respondents with no disabilities. Conclusions: There is a significant positive association between reporting functional disabilities and food insufficiency. Expanding current public health programs, educating health care professionals, and implementing effective screening guidelines directed at pregnant women with disabilities may reduce the prevalence of food insufficiency and promote greater health equity.
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Affiliation(s)
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Ďuríčeková B, Škodová Z, Bašková M. Risk factors associated with postpartum depression and PTSD after birth in a sample of Slovak women. Heliyon 2024; 10:e23560. [PMID: 38173480 PMCID: PMC10761800 DOI: 10.1016/j.heliyon.2023.e23560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Background Pregnancy, childbirth and the postpartum period represent a unique experience in a woman's life that significantly changes their life. Methods The aim of the study is to analyse risk factors of postpartum depression and posttraumatic stress disorder symptoms after birth in a sample of women in Slovakia. Data from the INTERSECT project were collected, including 437 postpartum women (mean age 30.5 ± 4.8). Posttraumatic stress disorder was (PTSD) measured through the City BiTS questionnaire, postpartum depression (PPD) symptoms were detected using the Edinburgh Postnatal Depression Scale (EPDS) and birth satisfaction was measured by the Birth Satisfaction Scale- Revised (BSS-R). Results An increased risk for the development of PPD (the EPDS score >12.5) was found in 11.4 % of respondents, PTSD after birth was identified among 2.8 % of respondents. In the linear regression models, birth satisfaction (95%CI: 0,56; -0,19), subjective perception of birth (95%CI: 0,82; 1,63), previous trauma (95%CI: 0,27; 3,74), respect during birth (95%CI: 5,08; -0,45), and health complications of both mother (95%CI: 0,12; 2,81) and child (95%CI: 1,53; 1,84) were found significantly associated with the posttraumatic stress symptoms after birth (total explained variance 37 %). Subjective perception of birth as traumatic (95%CI: 0,82; 1,63), previous trauma in the anamnesis (95%CI: 0,27; 3,74) and respect during birth (95%CI: 5,08; -0,45) were significantly associated with the depression symptoms (total explained variance 15 %). Conclusion Subjective perception of birth, birth satisfaction, previous trauma in anamnesis as well as lack of respect during birth were found as crucial risk factors for both PPD and postpartum PTSD.
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Affiliation(s)
- Barbora Ďuríčeková
- Comenius University, Jessenius Faculty of Medicine, Department of Midwifery, Martin, Slovakia
| | - Zuzana Škodová
- Comenius University, Jessenius Faculty of Medicine, Department of Midwifery, Martin, Slovakia
| | - Martina Bašková
- Comenius University, Jessenius Faculty of Medicine, Department of Midwifery, Martin, Slovakia
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Xiao J, Xiong R, Wen Y, Liu L, Peng Y, Xiao C, Yin C, Liu W, Tao Y, Jiang F, Li M, Luo W, Chen Y. Antenatal depression is associated with perceived stress, family relations, educational and professional status among women in South of China: a multicenter cross-sectional survey. Front Psychiatry 2023; 14:1191152. [PMID: 37333907 PMCID: PMC10272520 DOI: 10.3389/fpsyt.2023.1191152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Background Antenatal depression is a commonly seen mental health concern for women. This study introduced a multicenter cross-sectional survey with a large sample to provide new insights into pregnant women's depression, its socio-demographic and obstetric characteristics correlates, and its perceived stress among Chinese pregnant women. Methods This study conducted an observational survey according to the STROBE checklist. The multicenter cross-sectional survey was performed from August 2020 to January 2021 by distributing paper questionnaires among pregnant women from five tertiary hospitals in South China. The questionnaire included socio-demographic and obstetrics information, the Edinburgh Postnatal Depression Scale, and the 10-item Perceived Stress Scale. For the analyses, the Chi-square test and Multivariate logistic regression were utilized. Results Among 2014 pregnant women in their second/third trimester, the prevalence of antenatal depression was 36.3%. 34.4% of pregnant women reported AD in their second trimester of pregnancy, and 36.9% suffered from AD in third trimester of pregnancy. A multivariate logistic regression model indicated that unemployed women, lower levels of education, poor marital relationships, poor parents-in-law relationships, concerns about contracting COVID-19, and higher perceived stress could aggravate antenatal depression among participants (p<0.05). Conclusion There is a high proportion of antenatal depression among pregnant women in South China, so integrating depression screening into antenatal care services is worthwhile. Maternal and child health care providers need to evaluate pregnancy-related risk factors (perceived stress), socio-demographic factors (educational and professional status), and interpersonal risk factors (marital relations and relationship with Parents-in-law). In future research, the study also emphasized the importance of providing action and practical support to reduce the experience of antenatal depression among disadvantaged sub-groups of pregnant women.
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Affiliation(s)
- Julan Xiao
- Department of Thoracic Surgery, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
- Shenzhen Clinical Research Centre for Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
| | - Ribo Xiong
- The Seventh Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Yi Wen
- Department of Thoracic Surgery, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
- Shenzhen Clinical Research Centre for Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
| | - Lili Liu
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Yueming Peng
- Shenzhen Clinical Research Centre for Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- Department of Nursing, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Chaoqun Xiao
- Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Caixin Yin
- Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China
| | - Wenting Liu
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Yanling Tao
- Longgang Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Fengju Jiang
- Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China
| | - Min Li
- Boai Affiliated Hospital of Southern Medical University, Zhongshan, Guangdong, China
| | - Weixiang Luo
- Shenzhen Clinical Research Centre for Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- Department of Nursing, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Yu Chen
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
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Phipps JE, Whipps MDM, D'Souza I, LaSalle JM, Simmons LA. Pregnant in a Pandemic: Mental Wellbeing and Associated Healthy Behaviors Among Pregnant People in California During COVID-19. Matern Child Health J 2023:10.1007/s10995-023-03657-w. [PMID: 37029891 PMCID: PMC10083068 DOI: 10.1007/s10995-023-03657-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Pregnancy is a time of increased vulnerability to mental health disorders. Additionally, the COVID-19 pandemic has increased the incidence of depression and anxiety. Thus, we aimed to assess mental health and associated healthy behaviors of pregnant people in California during the pandemic in order to contextualize prenatal well-being during the first pandemic of the twenty-first century. METHODS We conducted an online cross-sectional study of 433 pregnant people from June 6 through July 29, 2020. We explored 3 hypotheses: (1) mental health would be worse during the pandemic than in general pregnant samples to date; (2) first-time pregnant people would have worse mental health; and (3) healthy behaviors would be positively related to mental health. RESULTS Many of our participants (22%) reported clinically significant depressive symptoms and 31% reported clinically significant anxiety symptoms. Multiparous pregnant people were more likely to express worries about their own health and wellbeing and the process of childbirth than were primiparous pregnant people. Additionally, as pregnancy advanced, sleep and nutrition worsened, while physical activity increased. Lastly, anxious-depressive symptomology was significantly predictive of participant sleep behaviors, nutrition, and physical activity during the past week. DISCUSSION Pregnant people had worse mental health during the pandemic, and this was associated with worse health-promoting behaviors. Given that the COVID-19 pandemic and associated risks are likely to persist due to low vaccination rates and the emergence of variants with high infection rates, care that promotes mental and physical well-being for the pregnant population should be a public health priority.
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Affiliation(s)
- Jennifer E Phipps
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA.
| | - Mackenzie D M Whipps
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Indira D'Souza
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Janine M LaSalle
- Department of Medical Microbiology and Immunology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Leigh Ann Simmons
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA
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Lasheras G, Farré-Sender B, Osma J, Martínez-Borba V, Mestre-Bach G. Mother-infant bonding screening in a sample of postpartum women: comparison between online vs offline format. J Reprod Infant Psychol 2022; 40:500-515. [PMID: 33950755 DOI: 10.1080/02646838.2021.1921716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS We aim to study the the reliability and factorial structure of the Postpartum Bonding Questionnaire (PBQ)administered through two different formats, offline (paper-and-pencil) and online. We also compared clinical, obstetrical, reproductive, and psychopathological variables related to poor mother infant bonding (MIB). METHODS A cross-sectional study was conducted on 1,269 mothers. The offline group included 812 women who attended a 40-day postpartum clinical appointment. The online group consisted of 457 women recruited during admission for delivery who volunteered to carry out the online protocol 40 days postpartum. All the participants individually completed the PBQ, the Edinburg Postnatal Depression Scale (EPDS) and other clinical and sociodemographic variables. RESULTS The 4-factor solution proposed in the PBQ and its Spanish validation showed good model fit for both samples. Online participants reported higher levels of stress, depressive symptoms, and poor bonding, specifically on PBQ scores and the Rejection and Anger subscales. No differences were found in both samples regarding the type of statistical associations between PBQ and sociodemographic, reproductive, obstetric and psychological outcomes. CONCLUSION Online assessment may be an appropriate option for detecting possible alterations in MIB due to the reduction of desirability bias, the increased perception of anonymity, and being a more cost-effective method.
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Affiliation(s)
- Gracia Lasheras
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain
| | - Borja Farré-Sender
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain
| | - Jorge Osma
- Department of Psychology and Sociology, Universidad De Zaragoza. Instituto De Investigación Sanitaria De Aragón, Zaragoza, Spain
| | - Verónica Martínez-Borba
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I. Instituto De Investigación Sanitaria De Aragón, Zaragoza, Spain
| | - Gemma Mestre-Bach
- Facultad de Ciencias de la Salud, Universidad Internacional De La Rioja, La Rioja, Spain
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Lin J, Zhou Y, Gu W. The synergistic effects of short inter-pregnancy interval and micronutrients deficiency on third-trimester depression. Front Nutr 2022; 9:949481. [PMID: 36245527 PMCID: PMC9554465 DOI: 10.3389/fnut.2022.949481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To explore the effect of inter-pregnancy interval (IPI) and micronutrients on depression in the third trimester of pregnancy. Materials and methods A total of 5,951 eligible pregnant women were included in this single-center retrospective cohort study. Variables with potential effects on third-trimester depression were collected. These variables included: maternal factors [age, pregnancy interval, body mass index (BMI), BMI change, gravidity, native place, education, smoking, and alcohol consumption], previous delivery outcomes [preterm birth, preeclampsia, intrahepatic cholestasis of pregnancy (ICP), gestational diabetes mellitus (GDM), fetal growth restriction (FGR), and delivery mode], and micronutrients in early pregnancy (folic acid, 25-hydroxy vitamin D, vitamin B12, calcium, and ferritin). Univariate and multivariate analyses were used to screen the factors affecting the occurrence of depression. Based on these factors, the nomogram model was established. At the same time, the interaction between IPI and micronutrients was verified. Results The incidence of depression in the third trimester of pregnancy was 4.3%. Univariate and multivariate analysis showed that there were five independent risk factors for third-trimester depression: gravidity, previous cesarean section delivery, folic acid, and vitamin D levels in early pregnancy and IPI. According to the multivariate logistic regression analysis, the prediction model and nomogram were established. The prediction cut-offs of the corresponding factors were calculated according to the Youden index. Finally, the synergistic effect of short IPI and micronutrient deficiency was verified. Conclusion There is a synergistic effect between short IPI and micronutrient deficiency in early pregnancy, which can aggravate the occurrence of depression in late pregnancy.
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Affiliation(s)
- Jing Lin
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Ye Zhou
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Wei Gu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
- *Correspondence: Wei Gu,
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Hildingsson I, Rubertsson C. The role of women's emotional profiles in birth outcome and birth experience. J Psychosom Obstet Gynaecol 2022; 43:298-306. [PMID: 33586598 DOI: 10.1080/0167482x.2021.1885026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The aim was to investigate birth outcome and birth experience in relation to women's emotional health. An additional aim was to explore the relationship between emotional health, continuity with a known midwife, and the birth experience. METHODS A prospective longitudinal cohort study of 243 women enrolled in a continuity of care project in a rural area in Sweden. Profiles were constructed from instruments measuring depressive symptoms, worries, fear of birth, and sense of coherence. Antenatal and birth records and questionnaires were used to collect data. RESULT Women were categorized into two cluster profiles: "emotionally healthy" vs. "emotionally unhealthy". Women in the "emotionally unhealthy" cluster had a less positive birth experience (p = 0.006). The total score of the Childbirth Experience Questionnaire was highest in women who had had a known midwife assisting at birth. Babies born to women in the "emotionally unhealthy" cluster were more likely to have a severe neonatal diagnosis. CONCLUSION There were few differences in birth outcome between the clusters, while there were explicit differences in the childbirth experience. Having a known midwife is important to warrant women a more positive childbirth experience. Screening with validated instruments during antenatal care could be a first step to further investigate women's emotional well-being and provide targeted psychosocial support.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
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Jiang L, Wu D, Chen S, Zhao G, Wang Y, Duan W, Liu H. Towards Universal Screening for Postpartum Depression in China: Lessons Learned from a Comprehensive Prevention Programme in Shenzhen. Matern Child Health J 2022; 26:2109-2117. [PMID: 35947274 DOI: 10.1007/s10995-022-03482-7] [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: 05/24/2021] [Revised: 05/09/2022] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE This study was conducted to assess the real-world efficacy of a universal programme for the prevention of postpartum depression (PPD) in Shenzhen. Given the lack of evidence on routine PPD screening and intervention in China, it sought to provide insights for programme planning and implementation, particularly in relation to achievement of the targets set by the first national guidelines for PPD prevention and treatment. METHODS Using routine health information system data, the PPD screening, referral and intervention rates for 2015-2019 were calculated and compared to the programmes targets. Trends of variables were tested by using trend χ2. RESULTS The programme screened 137,761 to 178,857 women for PPD every year with the coverage among all postpartum women increased steadily from 71.1% to 82. 5% (χ2 = 10145.251, p < 0.001). The PPD-positive rate maintained between 4.06% and 4.89%. However, although referral messages were given to an increased percentage of PPD-positive women (χ2 = 1090.908, p < 0.001), the intervention rate (i.e., referral uptake) were far lower than the programme target of 80%. CONCLUSIONS This study demonstrated high efficacy of Shenzhen's comprehensive PPD prevention programme initiated in 2013. The resultant rise in the screening rate among all postpartum women, together with a high referral rate of those screened positive, have contributed to the city's relatively low PPD prevalence. PPD screening and intervention should be included as part of basic public health services to ensure universal coverage and specific strategies should be adopted to ensure referral uptake.
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Affiliation(s)
- Lei Jiang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 2004, Hongli Road, 518000, Shenzhen, Guangdong Province, China
| | - Dadong Wu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 2004, Hongli Road, 518000, Shenzhen, Guangdong Province, China.
| | - Siqi Chen
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 2004, Hongli Road, 518000, Shenzhen, Guangdong Province, China
| | - Guanglin Zhao
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 2004, Hongli Road, 518000, Shenzhen, Guangdong Province, China
| | - Yueyun Wang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 2004, Hongli Road, 518000, Shenzhen, Guangdong Province, China
| | - Weidong Duan
- Shenzhen Kangning Psychiatric Hospital, No. 1080, Cuizhu Road, 518000, Shenzhen, Guangdong Province, China
| | - Honglei Liu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 2004, Hongli Road, 518000, Shenzhen, Guangdong Province, China
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Wu D, Jiang L, Zhao G. Additional evidence on prevalence and predictors of postpartum depression in China: A study of 300,000 puerperal women covered by a community-based routine screening programme. J Affect Disord 2022; 307:264-270. [PMID: 35405436 DOI: 10.1016/j.jad.2022.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/22/2022] [Accepted: 04/03/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Previous studies on the prevalence and predictors of postpartum depression (PPD) in China were mostly hospital-based with relatively small study samples. Basing on a routine screening programme, this study assessed the prevalence and factors associated with PPD at community level. METHODS A cross-sectional study was conducted with all the women who delivered in a hospital and were screened for depression during routine postpartum home visits in Shenzhen between 2015 August and 2017 April. The Edinburgh Postnatal Depression Scale was used as the screening tool with a cut-off score of 10. Predictors of PPD were determined by Chi-square test and stepwise logistic regression. RESULTS Approximately 300,000 puerperal women were included in the study with a PPD prevalence of 4.3%. Prenatal anxiety and depression were associated with 4.55 and 3.80 times of PPD risk, respectively. Stressful life events, family history of mental illness, poor economic status, low Apgar scores and birth defects of the infants, bottle and mixed feeding, as well as living with parents-in-low after childbirth were related to moderate risk. Higher gravidity and parity, larger gestation age, prenatal education, and living with the women's own parents were associated with lower risk. LIMITATIONS The large sample size might have suggested statistically significant differences which were not practical. CONCLUSIONS The prevalence of PPD at community level is significantly lower than the rates detected within hospitals. Prenatal anxiety and depression are the most important predictors of PPD. Integrating depression screening into routine postpartum home visits facilitates achievement of universal coverage.
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Affiliation(s)
- Dadong Wu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Lei Jiang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China.
| | - Guanglin Zhao
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
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13
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Pawils S, Kochen E, Weinbrenner N, Loew V, Döring K, Daehn D, Martens C, Kaczmarek P, Renneberg B. [Postpartum depression-who cares? Approaches to care via midwifery, gynaecology, paediatrics and general practice]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:658-667. [PMID: 35554610 PMCID: PMC9132831 DOI: 10.1007/s00103-022-03545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postpartum depression (PPD) is one of the most common mental illnesses in the postpartum period. If left untreated, it can have serious consequences for the mother-child relationship and the development of the child. In order to prevent possible negative effects, early diagnosis of affected mothers and professional care are essential. AIM OF THE STUDY This article explores the sense of responsibility of the four primary care providers in the postpartum period-midwives, gynaecologists, general practitioners and paediatricians-and examines how they deal with the disease as well as the barriers and possibilities for optimisation in care. MATERIALS AND METHODS The primary care providers of postpartum women in Germany were interviewed in four independent studies. Quantitative questionnaires were used to interview midwives, gynaecologists and general practitioners, and a qualitative telephone survey was conducted with representatives of the German Association of Paediatricians and Adolescents (BVKJ). A systematic comparative analysis was carried out. RESULTS AND DISCUSSION Midwives and gynaecologists showed a significantly higher sense of responsibility for the recognition and treatment of PPD than general practitioners and paediatricians. Closer interdisciplinary cooperation and thus a wider range of referral and therapy options were named by all four professional groups as a central prerequisite for improving the care situation in Germany. A uniform regulation of financial remuneration is also an important aspect for all providers.
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Affiliation(s)
- Silke Pawils
- Zentrum für Medizinische Psychologie, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - Eileen Kochen
- Zentrum für Medizinische Psychologie, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Nora Weinbrenner
- Zentrum für Medizinische Psychologie, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Viola Loew
- Zentrum für Medizinische Psychologie, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Kornelia Döring
- Zentrum für Medizinische Psychologie, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Daria Daehn
- Fachbereich Erziehungswissenschaften und Psychologie, Klinische Psychologie und Psychotherapie, Freie Universität Berlin, Berlin, Deutschland
| | - Claudia Martens
- Zentrum für Medizinische Psychologie, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Philip Kaczmarek
- Zentrum für Medizinische Psychologie, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Babette Renneberg
- Fachbereich Erziehungswissenschaften und Psychologie, Klinische Psychologie und Psychotherapie, Freie Universität Berlin, Berlin, Deutschland
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PAMUK G, GÜÇLÜ YA. Prevalence and accompanying factors for postpartum depression symptoms. FAMILY PRACTICE AND PALLIATIVE CARE 2022. [DOI: 10.22391/fppc.1024922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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Oliveira TA, Luzetti GGCM, Rosalém MMA, Mariani Neto C. Screening of Perinatal Depression Using the Edinburgh Postpartum Depression Scale. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:452-457. [PMID: 35253138 PMCID: PMC9948039 DOI: 10.1055/s-0042-1743095] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To detect depression during pregnancy and in the immediate postpartum period using the Edinburgh postpartum depression scale (EPDS). METHODS Cross sectional study of 315 women, aged between 14 and 44 years, who received perinatal care at the Leonor Mendes de Barros Hospital, in São Paulo, between July 1st, 2019 and October 30th, 2020. The cutoff point suggesting depression was ≥ 12. RESULTS The screening indicated 62 (19.7%) patients experiencing depression. Low family income, multiparity, fewer prenatal appointments, antecedents of emotional disorders, dissatisfaction with the pregnancy, poor relationship with the partner, and psychological aggression were all risk factors associated with depression in pregnancy or in the immediate postpartum period. Antecedents of depression and psychology aggression during pregnancy were significant variables for predicting perinatal depression in the multivariate analysis. CONCLUSION There is a significant association between the occurrence of perinatal depression and the aforementioned psychosocial factors. Screening patients with the EPDS during perinatal and postpartum care could facilitate establishing a line of care to improve the wellbeing of mother and infant.
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Affiliation(s)
- Tenilson Amaral Oliveira
- Hospital Maternidade Leonor Mendes de Barros, São Paulo, SP, Brazil.,Universidade Cidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brazil
| | | | - Márcia Maria Auxiliadora Rosalém
- Hospital Maternidade Leonor Mendes de Barros, São Paulo, SP, Brazil.,Universidade Cidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brazil
| | - Corintio Mariani Neto
- Hospital Maternidade Leonor Mendes de Barros, São Paulo, SP, Brazil.,Universidade Cidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brazil
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Implementing an Inpatient Postpartum Depression Screening, Education and Referral Program: A Quality Improvement Initiative. Am J Obstet Gynecol MFM 2022; 4:100581. [PMID: 35123115 DOI: 10.1016/j.ajogmf.2022.100581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/11/2022] [Accepted: 01/28/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Perinatal mood and anxiety disorders (PMADs) are common and can interfere with pregnancy, delivery and the postpartum period. Best practice includes symptom screening, patient education and appropriate referrals, however, many hospitals struggle to identify and support PMAD patients. Therefore, the Cedars-Sinai Postpartum Depression Screening, Education and Referral Program was initiated. METHODS Using the Standards for QUality Improvement Reporting Excellence (SQUIRE 2.0) guidelines, we report outcomes (N=19,564 deliveries) from four interventions; (1) nurse champion training; (2) Use of the 9-item PHQ-9 in postpartum unit; (3) a series of brief in-service trainings; and (4) a 10 minute video training. We collected data including nurse feedback, screening rates, screen positive rates and social work consultation rates. RESULTS The four interventions improved (1) nurse champion screening comfort and PMAD knowledge; (2) PHQ-9 screening rates from 10% to 99% and screen positive rates from 0.04% to 2.9%; and (3) increased rates of social work consultation from 1.7% to 8.4%. CONCLUSIONS Quality improvement results from the first three years of the program suggest that four interventions improved screening rate, screen positive rate and social work consultation rate. Future work will focus on method of screening, patients at highest risk of PMADs and ongoing nurse training.
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Chai Y, Li Q, Wang Y, Tao E, Asakawa T. The Value of HPA Axis Hormones as Biomarkers for Screening and Early Diagnosis of Postpartum Depression: Updated Information About Methodology. Front Endocrinol (Lausanne) 2022; 13:916611. [PMID: 35903273 PMCID: PMC9315198 DOI: 10.3389/fendo.2022.916611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/25/2022] [Indexed: 12/30/2022] Open
Abstract
Because of the high prevalence of postpartum depression (PPD) and the suffering involved, early diagnosis is urgent; however, current screening tools and diagnosis are inadequate. In addition to conventional methods such as the Edinburgh Postnatal Depression Scale and clinical interviews, several hormones in the hypothalamic-pituitary-adrenal (HPA) axis, such as corticotrophin-releasing hormone, adrenocorticotropic hormone, and cortisol, have been considered because of their critical roles in stress regulation in the mothers. The study designs are complicated, however, and so the effectiveness of these hormones as biomarkers for PPD is still controversial. Such inconsistency may have resulted from the variation in methodology between studies. The methodology problems in the investigation of PPD and HPA axis hormones have not been reported extensively. We therefore sought to summarize the methodological problems of studies published in the past decade, including the strengths and weaknesses of the examinations and the technological difficulties involved. Our findings suggest that (a) suitable samples and appropriate detection methods would reduce heterogeneity among trials; (b) the cutoff value of the scale test should be carefully selected for determining the performance of biomarker tests; (c) evaluation methods and criteria should be chosen with consideration of the tools feasible for use in local hospitals and population; and (d) the cost of diagnosis should be reduced. We hope that these findings provide insight for future investigations of HPA axis hormones as biomarkers for screening and early diagnosis of PPD.
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Affiliation(s)
- Yujuan Chai
- Department of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Qihang Li
- Department of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Yang Wang
- Greater Bay Area International Institute for Innovation, Shenzhen University, Shenzhen, China
| | - Enxiang Tao
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Tetsuya Asakawa
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
- Institute of Neurology, The Third People’s Hospital of Shenzhen, Shenzhen, China
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- *Correspondence: Tetsuya Asakawa, ; orcid.org/0000-0002-2300-3509
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Lozano AFQ, Moura MS, Tavares BM, Kempinas WDG. Exposure of pregnant rats to stress and/or sertraline: Side effects on maternal health and neurobehavioral development of male offspring. Life Sci 2021; 285:119960. [PMID: 34536495 DOI: 10.1016/j.lfs.2021.119960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022]
Abstract
AIMS Sertraline (SE) is one of the most prescribed medications for treating gestational depression, anxiety and stress. However, little is known about its effects on nervous-system development in offspring. Therefore, this study investigated the somatic, reflex and neurobehavioral development of rats exposed to SE during pregnancy, associated or not with stress. MAIN METHODS Pregnant Wistar rats were assigned to the following groups (n = 10-8 rats/group): CO - control animals administered filtered water by gavage; SE - animals administered 20 mg/kg SE by gavage; ST - animals subjected to restraining stress and administered filtered water; ST/SE - animals subjected to restraining stress and administered 20 mg/kg SE. The treatment was administered between gestational days (GD) 13 to 20. Somatic and reflex developments were investigated in the male offspring from postnatal day (PND) 1 to 21. The elevated plus maze was performed on PND 25 and 80. The open field and light/dark box test were performed on PND 90 and 100, respectively. KEY FINDINGS Body weight reduction and vaginal bleeding were observed in pregnant rats exposed to SE. The male offspring of the SE group showed delay in incisor eruption, fur development and negative geotaxis. In addition, the SE group was less exploratory (anxious personality) compared to the CO and ST groups. SIGNIFICANCE The results obtained in the present study demonstrate that sertraline not only impairs maternal health, but also, associated or not with stress, can compromise the somatic, reflex and neurobehavioral development of male rats.
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Affiliation(s)
- Ana Flávia Quiarato Lozano
- Graduate Program in General and Applied Biology, São Paulo State University (UNESP), Institute of Biosciences, Botucatu, SP, Brazil; Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil.
| | - Mayara Silva Moura
- Graduate Program in General and Applied Biology, São Paulo State University (UNESP), Institute of Biosciences, Botucatu, SP, Brazil; Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Bruna Marques Tavares
- Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Wilma De Grava Kempinas
- Laboratory of Reproductive and Developmental Biology and Toxicology, Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil
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Worldwide prevalence of suicide attempt in pregnant and postpartum women: a meta-analysis of observational studies. Soc Psychiatry Psychiatr Epidemiol 2021; 56:711-720. [PMID: 33191455 DOI: 10.1007/s00127-020-01975-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 10/24/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Past suicide attempts (SA) are a major contributor to suicide. The prevalence of SA in pregnant and postpartum women varied significantly across studies. Therefore, this meta-analysis was conducted to examine the prevalence of SA and its mediating factors in this population. METHODS Relevant articles published in PubMed, EMBASE, Web of Science, PsycINFO, Medline complete, Chinese National Knowledge Infrastructure database (CNKI), Chinese Wanfang and Chongqing VIP database were systematically searched from inception to March 28, 2019. Titles, abstracts and full texts were reviewed independently by three researchers. Studies were included if they reported data on SA prevalence or provided relevant data that enabled the calculation of SA prevalence. Data were extracted by two researchers and checked by one senior researcher. The random-effects model was used to analyze data by the CMA 2.0 and Stata 12.0, with the high degree of statistical heterogeneity present. The primary outcomes were prevalence of SA with 95% CI during pregnancy and during the first-year postpartum. RESULTS Fourteen studies covering 6,406,245 pregnant and postpartum women were included. The pooled prevalence of SA was 680 per 100,000 (95% confidence interval 0.10-4.69%) during pregnancy and 210 per 100,000 (95% confidence interval 0.01-3.21%) during the first-year postpartum. Data source was significantly associated with prevalence of SA in the subgroup analysis (pregnancy, p < 0.001; the first-year postpartum, p = 0.013). CONCLUSION The prevalence of SA is not high in pregnant and postpartum women. Due to the potential loss of life and negative impact of SA on health outcomes, however, careful screening and effective preventive measures should be implemented for this population.
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Wang L, Kroenke K, Stump TE, Monahan PO. Screening for perinatal depression with the Patient Health Questionnaire depression scale (PHQ-9): A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 68:74-82. [PMID: 33360526 PMCID: PMC9112666 DOI: 10.1016/j.genhosppsych.2020.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/13/2020] [Accepted: 12/13/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Perinatal depression (PND) is a prevalent and disabling problem both during pregnancy and the postpartum period. The legacy screening measure has been the Edinburgh Postnatal Depression Scale (EPDS). This systematic review examines the validity of the PHQ-9 as a screener for PND. METHODS The following databases were searched from January 2001 (when the PHQ-9 was first published) through June 2020: MEDLINE, Embase, and PsychInfo. Studies that compared the PHQ-9 to a criterion standard psychiatric interview were used to determine the operating characteristics of sensitivity, specificity and area under the curve (AUC). Studies comparing the PHQ-9 to the EPDS and other depression scales evaluated convergent validity. RESULTS A total of 35 articles were eligible for criterion (n = 10) or convergent (n = 25) validity. Meta-analysis of the 7 criterion validity studies using the standard PHQ-9 cut point ≥10 showed a pooled sensitivity, specificity and AUC of 0.84, 0.81 and 0.89, respectively. Operating characteristics of the PHQ-9 and EPDS were nearly identical in head-to-head comparison studies. The median correlation between the PHQ-9 and EPDS was 0.59, and categorical agreement was moderate. CONCLUSIONS The PHQ-9 appears to be a viable option for perinatal depression screening with operating characteristics similar to the legacy EPDS.
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Affiliation(s)
- Larry Wang
- Indiana University, School of Medicine, Indianapolis, IN, United States.
| | - Kurt Kroenke
- Indiana University, School of Medicine, Indianapolis, IN, United States; Regenstrief Institute Inc, Indianapolis, IN, United States.
| | - Timothy E. Stump
- Department of Biostatistics, Indiana University Fairbanks School of Public Health and School of Medicine, Indianapolis, IN, USA
| | - Patrick O. Monahan
- Department of Biostatistics, Indiana University Fairbanks School of Public Health and School of Medicine, Indianapolis, IN, USA
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Abstract
Telemedicine is an important modality of care delivery in the twenty-first century and has many applications for the obstetric population. Existing research has shown the clinical efficacy and improved patient satisfaction of many telemedicine platforms in obstetrics. Telemedicine has the potential to reduce racial and geographic disparities in pregnancy care, but more research is necessary to inform best practices. Developing cost-effective telemedicine programs and establishing health care policy that standardizes insurance reimbursement are some of the most important steps toward scaling up telemedicine offerings for obstetric patients in the United States.
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Affiliation(s)
- Adina R Kern-Goldberger
- Department of Obstetrics & Gynecology, Maternal Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2nd Floor Silverstein Building, Philadelphia, PA 19146, USA
| | - Sindhu K Srinivas
- Department of Obstetrics & Gynecology, Maternal Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2nd Floor Silverstein Building, Philadelphia, PA 19146, USA.
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22
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Kroenke K. Two Birds with One Stone: Joint Screening for Perinatal Depression and Anxiety. J Womens Health (Larchmt) 2020; 30:455-456. [PMID: 32721235 DOI: 10.1089/jwh.2020.8643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Kurt Kroenke
- Indiana University School of Medicine and Regenstrief Institute, Indianapolis, Indiana, USA
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