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Sun Y, Fan C, Lei D. Association between gut microbiota and postpartum depression: A bidirectional Mendelian randomization study. J Affect Disord 2024; 362:615-622. [PMID: 39029663 DOI: 10.1016/j.jad.2024.07.057] [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: 10/25/2023] [Revised: 07/04/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUNDS Empirical investigations have shown an association between gut microbiota and postpartum depression (PPD); nevertheless, the precise cause-and-effect relationship between these two variables remains ambiguous. This research aimed to examine the possible reciprocal causal relationship between the gut microbiota and PPD. METHODS In this work, we used Mendelian randomization (MR) to analyze the relationship between the gut microbiota (n = 18,340) and PPD (n = 67,205). We obtained the relevant SNPs from publicly accessible genome-wide association studies (GWAS). The SNP estimations were combined by the inverse-variance weighted (IVW) method, including sensitivity analyses such as weighted median, MR Egger, and MR Pleiotropy Residual Sum and Outlier (PRESSO). RESULTS We have identified strong correlations between six bacterial characteristics and the likelihood of developing PPD. Our research revealed that the genus Ruminococcaceae UCG010, the family Veillonellaceae, and the class Clostridia had a beneficial effect on preventing PPD. The class Alphaproteobacteria, genus Slackia, and order NB1n were found to have a significant negative impact on PPD. The sensitivity studies conducted on these bacterial features consistently confirmed these finding. LIMITATIONS It is crucial to acknowledge that our study was conducted just within a European society, which may restrict its applicability to other groups. CONCLUSIONS The findings from our MR investigation indicate a potential causal relationship between certain kinds of gut bacteria and PPD. Additional investigation is required to elucidate the influence of gut microbiota on the advancement of PPD.
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Affiliation(s)
- Yonghao Sun
- Fujian Provincial Key Laboratory of Reproductive Health Research, School of Medicine, Xiamen University, Xiamen, China
| | - Cuifang Fan
- Department of Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430000, China.
| | - Di Lei
- Department of Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430000, China.
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Gallego-Gómez C, Rodríguez-Gutiérrez E, Torres-Costoso A, Martínez-Vizcaíno V, Martínez-Bustelo S, Quezada-Bascuñán CA, Ferri-Morales A. Urinary incontinence increases risk of postpartum depression: systematic review and meta-analysis. Am J Obstet Gynecol 2024; 231:296-307.e11. [PMID: 38437894 DOI: 10.1016/j.ajog.2024.02.307] [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: 11/03/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Postpartum depression is one of the most common complications after childbearing. Urinary incontinence is a frequent symptom during pregnancy and the postnatal period, often being the first time that women experience it. This systematic review and meta-analysis aimed to synthesize the evidence on the association between urinary incontinence and postpartum depression and to assess whether this association becomes weaker at 6 months after childbirth. DATA SOURCES MEDLINE, Embase, Cochrane Library, Web of Science, and PsycINFO were searched from inception to December 26, 2023. STUDY ELIGIBILITY CRITERIA Cross-sectional and cohort studies addressing the association between urinary incontinence and postpartum depression were included. METHODS Pooled odds ratios and their 95% confidence intervals, and 95% prediction intervals were estimated using a DerSimonian and Laird random-effects model for the association between urinary incontinence and postpartum depression. Subgroup analyses were conducted on the basis of time after delivery (<6 or ≥6 months). The risk of bias was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort Studies. RESULTS Eleven published studies were included in the systematic review and meta-analysis. Overall, the odds ratio for the association between urinary incontinence and postpartum depression was 1.45 (95% confidence interval, 1.11-1.79; 95% prediction interval, 0.49-2.40; I2=65.9%; P=.001). For the 7 cohort studies, the odds ratio was 1.63 (95% confidence interval, 1.35-1.91; 95% prediction interval, 1.14-2.13; I2=11.1%; P=.345). For the 4 cross-sectional studies, the odds ratio was 1.05 (95% confidence interval, 1.04-1.05; 95% prediction interval, 1.04-1.06; I2=0.0%; P=.413). According to the time after delivery, the odds ratio estimates for cohort studies with a postpartum period <6 months were 1.44 (95% confidence interval, 1.07-1.81; prediction interval, 0.63-2.25; I2=0.0%; P=.603) and 1.53 (95% confidence interval, 1.16-1.89; prediction interval, 0.41-2.65; I2=50.7%; P=.087) for those with a postpartum period ≥6 months. CONCLUSION This systematic review and meta-analysis suggests that urinary incontinence may be a potential predictor of postpartum depression. Thus, it is important that health care professionals offer support and treatment options to women who experience these conditions.
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Affiliation(s)
- Cristina Gallego-Gómez
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain; Physiotherapy Unit, Health Center of Camarena, Toledo, Spain; Toledo Physiotherapy Research Group (GIFTO), University of Castilla-La Mancha, Toledo, Spain
| | | | - Ana Torres-Costoso
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain; Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Sandra Martínez-Bustelo
- Psychosocial Intervention and Functional Rehabilitation Research Group, Faculty of Physiotherapy, University of A Coruña, A Coruña, Spain
| | | | - Asunción Ferri-Morales
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain; Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain
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Thompson J, Lo DF, Foschini A, Sundaresh S. Exploring perinatal ketamine for postpartum depression following cesarean section: A systematic review. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e70004. [PMID: 39219739 PMCID: PMC11362499 DOI: 10.1002/pcn5.70004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 07/25/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024]
Abstract
The aim of this study was to explore the use of perinatal ketamine to see if it can be used for the reduction of postpartum depression (PPD) following cesarean section (C-section). PubMed, Cochrane, and Web of Science were the primary databases used for this review. Search terms used on January 5, 2024 incorporated "ketamine," "C-section," "postpartum depression," and related synonyms. The criteria for inclusion centered on studies published between January 1, 2008 and January 5, 2024. The final selection of articles was screened based on extraction criteria leaving eight randomized control trials in the final review. The selected data from the studies incorporated sample characteristics, study and population characteristics, and quantitative analyses covering Edinburgh Postpartum Depression Scale (EPDS) scores and depression rates. The Risk of Bias assessment was utilized to gain a deeper understanding of the quality of methodology used by the research studies. The review showed that ketamine can reduce the symptoms of PPD in mothers who have recently undergone C-sections. Some studies showed decreased EPDS scores following the administration of ketamine while two studies also reported no significant differences in PPD following ketamine administration in C-section patients. For example, Ma et al. found that the EPDS score at postpartum day 4 was significantly lower in the ketamine group compared with the control group (p = 0.007) while Yang et al. found that there were no significant differences between the ketamine and control group at 3 days postpartum (p = 0.553). The research from this review suggests that ketamine administration can prevent or decrease the symptoms of PPD, but more research is needed to establish the causal relationship between ketamine dosage and PPD in C-section patients.
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Affiliation(s)
- Jaylyn Thompson
- Department of MedicineRowan‐Virtua School of Osteopathic MedicineStratfordNew JerseyUSA
| | - David F. Lo
- Department of MedicineRowan‐Virtua School of Osteopathic MedicineStratfordNew JerseyUSA
- Department of ResearchAmerican Preventive Screening & Education Association (APSEA)StratfordNew JerseyUSA
- Department of MedicineRutgers, The State University of New JerseyNew BrunswickNew JerseyUSA
- Department of ResearchLumina Institute 501(c)3Cream RidgeNew JerseyUSA
- Department of ResearchFutures Forward Research InstituteToms RiverNew JerseyUSA
| | - Alexis Foschini
- Department of MedicineRowan‐Virtua School of Osteopathic MedicineStratfordNew JerseyUSA
| | - Suvan Sundaresh
- Department of ResearchFutures Forward Research InstituteToms RiverNew JerseyUSA
- Department of ResearchPenn State UniversityState CollegePennsylvaniaUSA
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Alikamali M, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Gharehbaghi MM, Homayouni-Rad A, Fardiazar Z, Shahnazi M. Effect of probiotic administration to breastfeeding mothers with very low birthweight neonates on some neonatal and maternal outcomes: study protocol for a randomised, double-blind, placebo-controlled trial. BMJ Open 2024; 14:e079526. [PMID: 39209790 DOI: 10.1136/bmjopen-2023-079526] [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] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Premature birth and very low birth weight (VLBW) are leading causes of neonatal mortality. Almost all premature infants experience hyperbilirubinaemia. Administering probiotics to breastfeeding mothers may positively affect infant outcomes. This trial aims to investigate whether probiotic supplementation for mothers with VLBW infants affects total serum bilirubin levels and postpartum depression scores (primary outcomes), as well as some other neonatal and maternal outcomes (secondary outcomes). METHODS AND ANALYSIS This is a randomised, double-blind, placebo-controlled superiority trial with two parallel arms. Participants, caregivers and outcome assessors will be blinded. A total of 122 breastfeeding mothers of neonates with a birth weight of 1000-1500 g, along with their infants within 48 hours of birth, will be assigned to either the probiotic or placebo group in a 1:1 ratio through block randomisation, stratified by singleton and twin births. The intervention will involve oral administration of probiotics containing Lactobacillus paracasei 431 and Bifidobacterium lactis BB-12, or an indistinguishable placebo, for 42-45 days. Outcomes will be assessed through daily observations, laboratory assessments and the Edinburgh Postpartum Depression Scale. Adverse events will also be documented. Modified intention-to-treat analyses will be employed for the primary and secondary outcomes, excluding participants lost to follow-up from all postintervention assessments. ETHICS AND DISSEMINATION This study protocol has been approved by the Medical University of Tabriz Ethics Committee (IR.TBZMED.REC.1401.735). Findings will be disseminated through publication in a peer-reviewed journal and presentations at relevant conferences. TRIAL REGISTRATION NUMBER IRCT20100414003706N42.
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Affiliation(s)
- Maryam Alikamali
- Student Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Sakineh Mohammad-Alizadeh-Charandabi
- Faculty of Nursing and Midwifery, Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Mojgan Mirghafourvand
- Faculty of Nursing and Midwifery, Social Determinants of Health Research Center, Department of Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Manizheh Mostafa Gharehbaghi
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran (the Islamic Republic of)
| | - Aziz Homayouni-Rad
- Faculty of Nutrition and Food Science, Department of Food Science and Technology, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Zahra Fardiazar
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran (the Islamic Republic of)
| | - Mahnaz Shahnazi
- Faculty of Nursing and Midwifery, Department of Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
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Zacher Kjeldsen MM, Mægbæk ML, Liu X, Madsen MG, Bliddal M, Egsgaard S, Bang Madsen K, Munk-Olsen T. The HOPE cohort: cohort profile and evaluation of selection bias. Eur J Epidemiol 2024:10.1007/s10654-024-01150-4. [PMID: 39158818 DOI: 10.1007/s10654-024-01150-4] [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: 01/05/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024]
Abstract
The HOPE cohort is a Danish nationwide cohort with ongoing follow-up, holding information on postpartum depression (PPD) symptoms and diagnoses on 170,218 childbirths (142,795 unique mothers). These data have been linked with extensive register data on health and socioeconomic information on the mothers, their partners, parents, and children. This cohort profile aimed to provide an overview of the data collection and content, describe characteristics, and evaluate potential selection bias. PPD screenings, using the Edinburgh Postnatal Depression Scale, were collected from 67 of the 98 Danish municipalities, covering the period January 2015 to December 2021. This data was linked with register data on PPD diagnoses (identified through medication prescriptions and hospital contacts) as well as background information. Cohort characteristics were compared to the source population, defined as all childbirths by women residing in Denmark during the same period (452,207 childbirths). Potential selection bias was evaluated by comparing odds ratios of five well-established associations between the cohort and the source population. The HOPE cohort holds information on 170,218 childbirths (38% of the source population) involving 142,795 unique mothers. The HOPE cohort only differed slightly from the source population on most characteristics examined, but larger differences were observed on specific characteristics with an underrepresentation of the youngest and oldest age groups, women with more than three children or twins/triplets, and women born outside Denmark. Similar associations were identified across the two populations within the five well-established associations. There was no indication of selection bias on the five examined associations, and the HOPE cohort is representative of the source population on important perinatal characteristics.
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Affiliation(s)
- Mette-Marie Zacher Kjeldsen
- NCRR-National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.
- Department of Public Health, Aarhus University, Aarhus, Denmark.
- CIRRAU - Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark.
| | - Merete Lund Mægbæk
- NCRR-National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- CIRRAU - Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Xiaoqin Liu
- NCRR-National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- CIRRAU - Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Malene Galle Madsen
- NCRR-National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Mette Bliddal
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sofie Egsgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Psychiatric Unit, Region of Southern Denmark, Odense, Denmark
| | - Kathrine Bang Madsen
- NCRR-National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- CIRRAU - Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Trine Munk-Olsen
- NCRR-National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Psychiatric Unit, Region of Southern Denmark, Odense, Denmark
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Lu D, Valdimarsdóttir UA, Wei D, Chen Y, Andreassen OA, Fang F, László KD, Bränn E. Perinatal depression and risk of maternal cardiovascular disease: a Swedish nationwide study. Eur Heart J 2024; 45:2865-2875. [PMID: 38889798 PMCID: PMC11328867 DOI: 10.1093/eurheartj/ehae170] [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: 09/01/2023] [Revised: 02/09/2024] [Accepted: 03/06/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND AND AIMS Increasing evidence suggests that some reproductive factors/hazards are associated with a future risk of cardiovascular disease (CVD) in women. While major (non-perinatal) depression has consistently been associated with CVD, the long-term risk of CVD after perinatal depression (PND) is largely unknown. METHODS A nationwide population-based matched cohort study involving 55 539 women diagnosed with PND during 2001-14 in Sweden and 545 567 unaffected women individually matched on age and year of conception/delivery was conducted. All women were followed up to 2020. Perinatal depression and CVD were identified from Swedish national health registers. Using multivariable Cox models, hazard ratios (HR) of any and type-specific CVD according to PND were estimated. RESULTS The mean age at the PND diagnosis was 30.8 [standard deviation (SD) 5.6] years. During the follow-up of up to 20 years (mean 10.4, SD 3.6), 3533 (6.4%) women with PND (expected number 2077) and 20 202 (3.7%) unaffected women developed CVD. Compared with matched unaffected women, women with PND had a 36% higher risk of developing CVD [adjusted HR = 1.36, 95% confidence interval (CI): 1.31-1.42], while compared with their sisters, women with PND had a 20% higher risk of CVD (adjusted HR = 1.20, 95% CI 1.07-1.34). The results were most pronounced in women without a history of psychiatric disorder (P for interaction < .001). The association was observed for all CVD subtypes, with the highest HR in the case of hypertensive disease (HR = 1.50, 95% CI: 1.41-1.60), ischaemic heart disease (HR = 1.37, 95% CI: 1.13-1.65), and heart failure (HR 1.36, 95% CI: 1.06-1.74). CONCLUSIONS Women with PND are at higher risk of CVD in middle adulthood. Reproductive history, including PND, should be considered in CVD risk assessments of women.
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Affiliation(s)
- Donghao Lu
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Nobels väg 13, 17177 Stockholm, Sweden
| | - Unnur A Valdimarsdóttir
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Nobels väg 13, 17177 Stockholm, Sweden
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Dang Wei
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Nobels väg 13, 17177 Stockholm, Sweden
| | - Yufeng Chen
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Nobels väg 13, 17177 Stockholm, Sweden
| | - Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Fang Fang
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Nobels väg 13, 17177 Stockholm, Sweden
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Emma Bränn
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Nobels väg 13, 17177 Stockholm, Sweden
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Zhang K, He L, Li Z, Ding R, Han X, Chen B, Cao G, Ye JH, Li T, Fu R. Bridging Neurobiological Insights and Clinical Biomarkers in Postpartum Depression: A Narrative Review. Int J Mol Sci 2024; 25:8835. [PMID: 39201521 PMCID: PMC11354679 DOI: 10.3390/ijms25168835] [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: 07/27/2024] [Revised: 08/10/2024] [Accepted: 08/13/2024] [Indexed: 09/02/2024] Open
Abstract
Postpartum depression (PPD) affects 174 million women worldwide and is characterized by profound sadness, anxiety, irritability, and debilitating fatigue, which disrupt maternal caregiving and the mother-infant relationship. Limited pharmacological interventions are currently available. Our understanding of the neurobiological pathophysiology of PPD remains incomplete, potentially hindering the development of novel treatment strategies. Recent hypotheses suggest that PPD is driven by a complex interplay of hormonal changes, neurotransmitter imbalances, inflammation, genetic factors, psychosocial stressors, and hypothalamic-pituitary-adrenal (HPA) axis dysregulation. This narrative review examines recent clinical studies on PPD within the past 15 years, emphasizing advancements in neuroimaging findings and blood biomarker detection. Additionally, we summarize recent laboratory work using animal models to mimic PPD, focusing on hormone withdrawal, HPA axis dysfunction, and perinatal stress theories. We also revisit neurobiological results from several brain regions associated with negative emotions, such as the amygdala, prefrontal cortex, hippocampus, and striatum. These insights aim to improve our understanding of PPD's neurobiological mechanisms, guiding future research for better early detection, prevention, and personalized treatment strategies for women affected by PPD and their families.
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Affiliation(s)
- Keyi Zhang
- Department of Anatomy, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China; (K.Z.); (L.H.); (Z.L.); (R.D.); (X.H.); (B.C.); (G.C.)
| | - Lingxuan He
- Department of Anatomy, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China; (K.Z.); (L.H.); (Z.L.); (R.D.); (X.H.); (B.C.); (G.C.)
| | - Zhuoen Li
- Department of Anatomy, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China; (K.Z.); (L.H.); (Z.L.); (R.D.); (X.H.); (B.C.); (G.C.)
| | - Ruxuan Ding
- Department of Anatomy, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China; (K.Z.); (L.H.); (Z.L.); (R.D.); (X.H.); (B.C.); (G.C.)
| | - Xiaojiao Han
- Department of Anatomy, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China; (K.Z.); (L.H.); (Z.L.); (R.D.); (X.H.); (B.C.); (G.C.)
| | - Bingqing Chen
- Department of Anatomy, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China; (K.Z.); (L.H.); (Z.L.); (R.D.); (X.H.); (B.C.); (G.C.)
| | - Guoxin Cao
- Department of Anatomy, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China; (K.Z.); (L.H.); (Z.L.); (R.D.); (X.H.); (B.C.); (G.C.)
| | - Jiang-Hong Ye
- Department of Anesthesiology, Pharmacology, Physiology & Neuroscience, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA;
| | - Tian Li
- Department of Gynecology and Obstetrics, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China
| | - Rao Fu
- Department of Anatomy, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China; (K.Z.); (L.H.); (Z.L.); (R.D.); (X.H.); (B.C.); (G.C.)
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Gonda X, Tarazi FI, Dome P. The emergence of antidepressant drugs targeting GABA A receptors: A concise review. Biochem Pharmacol 2024:116481. [PMID: 39147329 DOI: 10.1016/j.bcp.2024.116481] [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: 05/21/2024] [Revised: 08/06/2024] [Accepted: 08/09/2024] [Indexed: 08/17/2024]
Abstract
Depression is among the most common psychiatric illnesses, which imposes a major socioeconomic burden on patients, caregivers, and the public health system. Treatment with classical antidepressants (e.g. tricyclic antidepressants and selective serotonine reuptake inhibitors), which primarily affect monoaminergic systems has several limitations, such as delayed onset of action and moderate efficacy in a relatively large proportion of depressed patients. Furthermore, depression is highly heterogeneus, and its different subtypes, including post-partum depression, involve distinct neurobiology, warranting a differential approach to pharmacotherapy. Given these shortcomings, the need for novel antidepressants that are superior in efficacy and faster in onset of action is fully justified. The development and market introduction of rapid-acting antidepressants has accelerated in recent years. Some of these new antidepressants act through the GABAergic system. In this review, we discuss the discovery, efficacy, and limitations of treatment with classic antidepressants. We provide a detailed discussion of GABAergic neurotransmission, with a special focus on GABAA receptors, and possible explanations for the mood-enhancing effects of GABAergic medications (in particular neurosteroids acting at GABAA receptors), and, ultimately, we present the most promising molecules belonging to this family which are currently used in clinical practice or are in late phases of clinical development.
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Affiliation(s)
- Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.
| | - Frank I Tarazi
- Department of Psychiatry and Neurology, Harvard Medical School and McLean Hospital, Boston, MA, USA
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; Nyiro Gyula National Institute of Psychiatry and Addictology, Budapest, Hungary
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Gallant F, Cooley K, Grigoriadis S, Ebrahimi N. Targeting maternal gut microbiome to improve mental health outcomes-a pilot feasibility trial. Front Psychiatry 2024; 15:1414291. [PMID: 39171074 PMCID: PMC11335611 DOI: 10.3389/fpsyt.2024.1414291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/12/2024] [Indexed: 08/23/2024] Open
Abstract
Background Perinatal depression and anxiety (PDA) is prevalent in new and expectant mothers, affecting millions of women worldwide. Those with a history of mood and anxiety disorders are at the greatest risk of experiencing PDA in a subsequent pregnancy. Current safety concerns with pharmacological treatments have led to a greater need for adjunctive treatment options for PDA. Changes in the composition of the microbiome have been associated with various diseases during pregnancy, and these changes are thought to play some role in perinatal mood disorders. While the relationship between PDA and the microbiome has not been explored, evidence suggests that nutritional interventions with fiber, fish oils, and probiotics may play a favorable role in neuropsychiatric outcomes during and after pregnancy. The primary objective of the present study is to assess the feasibility and acceptability of a combination of nonpharmacological interventions to maintain stability in pregnant women who have a history of depression and/or anxiety. This study will also aim to understand ease of recruitment and protocol adherence in this cohort. Methods This is a single-centered, partially randomized, placebo-controlled, double-blind feasibility trial. One hundred pregnant women with a history of depression and/or anxiety/PDA will be recruited and randomized into one of four arms, which could include the following: receiving a daily dose of both investigational products and dietary counseling on increasing dietary fiber, receiving a daily dose of both investigational drugs only, receiving fish oil investigational product and placebo, and a control arm with no intervention. The study involves six study visits, all of which can be conducted virtually every 3 months from the time of enrollment. At all study visits, information on diet, mental health, physical activity, and sleep quality will be collected. Additionally, all participants will provide a stool sample at each visit. Discussion It is anticipated that pregnant women with a history of depression and anxiety will be particularly interested in partaking in this trial, resulting in favorable recruitment rates. Given the positive findings of omega-3 fatty acids (O3FAs) and probiotic supplements on mental health symptoms in nonpregnant adults, we expect a similar trend in PDA symptoms, with a low likelihood of adverse events. This study will build the foundation for larger powered studies to further contribute evidence for the efficacy of this potential preventative treatment option. Trial registration This trial was registered at ClinicalTrials/gov on October 6, 2023; NCT06074250. Trial Sponsor: The Canadian College of Naturopathic Medicine, 1255 Sheppard Ave E, Toronto, ON M2K 1E2, 416-498-1255.
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Affiliation(s)
- Faith Gallant
- Rehabilitation Nevena Christina Case Management and Occupational Therapy Services (NCCO), Toronto, ON, Canada
| | - Kieran Cooley
- Department of Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine (CCNM), Toronto, ON, Canada
- Department of Human Biology, University of Toronto, Toronto, ON, Canada
- National Center for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - Sophie Grigoriadis
- Women’s Mood and Anxiety Center, Reproductive Transitions, Department of Psychiatry, Sunnybrook Health Sciences, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Neda Ebrahimi
- Department of Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine (CCNM), Toronto, ON, Canada
- Women’s Mood and Anxiety Center, Reproductive Transitions, Department of Psychiatry, Sunnybrook Health Sciences, Toronto, ON, Canada
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10
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Sobol M, Błachnio A, Meisner M, Szyszkowska J, Jankowski KS. Sleep, circadian activity patterns and postpartum depression: A systematic review and meta-analysis of actigraphy studies. J Sleep Res 2024; 33:e14116. [PMID: 38095248 DOI: 10.1111/jsr.14116] [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: 07/28/2023] [Revised: 10/15/2023] [Accepted: 11/14/2023] [Indexed: 01/16/2024]
Abstract
Transition to motherhood is a period full of challenges and demands. In this review, we focused on the associations of sleep and circadian activity patterns during and after pregnancy with postpartum mental health factors. A systematic review and meta-analysis were conducted (PROSPERO reference 316,505). A search for articles was performed using PsycARTICLES, PsycINFO, PubMed, MEDLINE, Scopus, Cochrane, DARE, hand search, and citation tracking. The search was meant to identify peer-reviewed, experimental and observational studies reporting on women over 18 years old that assessed sleep and circadian activity patterns during pregnancy or postpartum using actigraphy, and investigated postpartum mental health factors. Nineteen relevant publications were selected. Postpartum total sleep at night was the indicator that was most closely related to the psychological functioning of women after childbirth. The results of the systematic review indicated that postpartum total sleep at night was related to postpartum fatigue, and the results of the meta-analysis suggested that total sleep at night was most strongly linked with postpartum depression. More studies are needed to estimate the associations of sleep-wake rhythm during pregnancy and in the postpartum period with postpartum mental health factors.
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Affiliation(s)
| | - Agata Błachnio
- Department of Psychology, Catholic University of Lublin, Lublin, Poland
| | - Michał Meisner
- Department of Psychology, University of Warsaw, Warsaw, Poland
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11
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Sharma P, Khera K. A novel tool for risk assessment, screening, diagnosis, assessment, and therapy in postpartum depression. Int J Gynaecol Obstet 2024; 166:617-625. [PMID: 38343269 DOI: 10.1002/ijgo.15421] [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: 10/05/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 07/18/2024]
Abstract
Postpartum depression (PPD), as a common condition occurring in women in the postnatal period, is underdiagnosed, seldom identified, and infrequently treated. Undiagnosed PPD can have negative consequences for overall quality-of-life outcomes in the mother, psychological growth of the infant, and bonding between the infant and its mother. However, early diagnosis and prompt treatment of PPD can lead to an improvement in postpartum maternal health and a healthier relationship between the mother and her infant. Additionally, early identification of risk factors in the prenatal and antenatal period can enable preventive treatment and ensure that the expectant or pregnant woman remains free of disease after giving birth. Therefore, we propose a protocol for the risk assessment, screening, diagnosis, assessment, and therapy of postnatal depression (RASDAT). The RASDAT protocol recommends assessment of risk factors for PPD in the perinatal period as well as early diagnosis and treatment in the early-to-mid postpartum period. It also recognizes, for the first time, insomnia and anxiety as important predictors, comorbidities, and poor prognostic factors in postpartum depression. Further studies are necessary to determine the feasibility and applicability of this novel tool, including costs of availing health facilities, burden on the health system, and knowledge, attitudes, and practices among physicians and clinical pharmacists regarding PPD and its resolution.
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Affiliation(s)
- Prachi Sharma
- Department of Pharmacology, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
| | - Kanav Khera
- Department of Pharmacology, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
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12
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Hukill JF, Blanco MA, ElSeed Peterson EE, Torres CM. Maternal Postpartum Depression Screening and Early Intervention in the Neonatal Intensive Care Unit. Adv Pediatr 2024; 71:55-67. [PMID: 38944489 DOI: 10.1016/j.yapd.2024.01.004] [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: 07/01/2024]
Abstract
Families with infants admitted to the neonatal intensive care unit (NICU) are at a markedly increased risk of developing postpartum depression (PPD) because of the stressors they experience by having an infant in this intensive setting. Routine screening for PPD is not regularly performed for these families because many NICUs do not offer it and well-child visits are missed while the infant is hospitalized. Because the identification and treatment of PPD is often missed in these families, screening needs to be administered in the NICU to ensure improved outcomes.
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Affiliation(s)
- Jessica F Hukill
- Department of Pediatrics, University of South Florida, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA.
| | - Michelle A Blanco
- Division of General Academic Pediatrics, Department of Pediatrics, University of South Florida, 17 Davis Boulevard Suite #100, Tampa, FL 33606, USA
| | - Erica E ElSeed Peterson
- Division of Neonatology, Department of Pediatrics, University of South Florida, 5 Tampa General Circle, 4th Floor Suite 450, Tampa, FL 33606, USA
| | - Chelsea M Torres
- Division of General Academic Pediatrics, Department of Pediatrics, University of South Florida, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA
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13
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Sajjad A, Shah S, Abbas G, Aslam A, Randhawa F, Khurram H, Assiri A. Treatment gap and barriers to access mental healthcare among women with postpartum depression symptoms in Pakistan. PeerJ 2024; 12:e17711. [PMID: 39035151 PMCID: PMC11260416 DOI: 10.7717/peerj.17711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
Background and Objectives Postpartum depression (PPD) is prevalent among women after childbirth, but accessing mental healthcare for PPD is challenging. This study aimed to assess the treatment gap and barriers to mental healthcare access for women with PPD symptoms living in Punjab, Pakistan. Methods A multicenter cross-sectional study was conducted in five populous cities of Punjab from January to June 2023 by administering the questionnaire to the women using stratified random sampling. A total of 3,220 women in first 6 months postpartum were screened using the Edinburgh Postnatal Depression Scale. Of them, 1,503 women scored thirteen or above, indicating potential depressive disorder. Interviews were conducted to explore help-seeking behavior and barriers to accessing mental healthcare. Descriptive statistics along with nonparametric tests (e.g., Kruskal-Wallis, Mann-Whitney U) were used and group differences were examined. Scatter plot matrices with fitted lines were used to explore associations between variables. Classification and regression tree methods were used to classify the importance and contribution of different variables for the intensity of PPD. Results Only 2% of women (n = 33) with high PPD symptoms sought mental healthcare, and merely 5% of women (n = 75) had been in contact with a health service since the onset of their symptoms. 92.80% of women with PPD symptoms did not seek any medical attention. The majority of women, 1,215 (81%), perceived the need for mental health treatment; however, 91.23% of them did not seek treatment from healthcare services. Women who recently gave birth to a female child had higher mean depression scores compared to those who gave birth to a male child. Age, education, and birth location of newborn were significantly associated (p < 0.005) with mean barrier scores, mean social support scores, mean depression scores and treatment gap. The results of classification and regression decision tree model showed that instrumental barrier scores are the most important in predicting mean PPD scores. Conclusion Women with PPD symptoms encountered considerable treatment gap and barriers to access mental health care. Integration of mental health services into obstetric care as well as PPD screening in public and private hospitals of Punjab, Pakistan is critically needed to overcome the treatment gap and barriers.
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Affiliation(s)
- Aqsa Sajjad
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Faisalabad, Pakistan
| | - Shahid Shah
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Faisalabad, Pakistan
| | - Ghulam Abbas
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Faisalabad, Pakistan
| | - Ayesha Aslam
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
| | - Fawad Randhawa
- Department of Endocrinology, King Edward Medical University, Lahore, Pakistan
| | - Haris Khurram
- Department of Mathematics and Computer Science, Faculty of Science and Technology Prince of Songkla University, Pattani Campus, Thailand
- Department of Science and Humanities, National University of Computer and Emerging Science, Chiniot-Faisalabad Campus, Chiniot, Pakistan
| | - Abdullah Assiri
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
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14
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Ma B, Tao X, Qi Y, Cao H, Cao Q, Zhou Z, Wang S. Effects of perioperative application of esketamine on postpartum depression in cesarean section: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e38821. [PMID: 38968456 PMCID: PMC11224862 DOI: 10.1097/md.0000000000038821] [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: 03/04/2024] [Accepted: 06/13/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND To evaluate the effect of perioperative esketamine administration on postpartum depression in pregnant women undergoing cesarean section. METHODS Data sources was PubMed, Embase, Web of Science, and Cochrane Library from inception to February 1, 2024. Randomized controlled trials in pregnant women undergoing cesarean section were selected and compared to the use of esketamine in the perioperative period. The primary outcome measure was the incidence of postpartum maternal depression. Preferred reporting items for systematic reviews and meta-analyses were used. Data pooled by random-effects models are presented as risk ratios (RR) (95% confidence intervals, 95% CI) or mean differences (95% CI). This review was registered in PROSPERO (ID: CRD42023431197). RESULTS We included 8 studies with a total of 1655 participants. The quality of the studies was rated high or unclear. Seven studies involving 1485 participants reported the incidence of postpartum depression. Compared with pregnant women undergoing cesarean section without the use of esketamine, those using esketamine in the perioperative period showed a 48% decreased risk of developing postpartum depression (RR: 0.52, 95% CI: 0.35-0.79) and a 1.43-point reduction in EPDS (Edinburgh Postnatal Depression Scale) (mean difference: -1.43, 95% CI: -2.32 to -0.54). For immediate intraoperative adverse reactions, the application of esketamine caused maternal nausea and vomiting (RR: 2.16, 95% CI: 1.22-3.81), dizziness (RR: 6.11, 95% CI: 1.49-24.98), and hallucinations (RR: 6.83, 95% CI: 1.57-29.68) compared to no esketamine use. CONCLUSIONS Perioperative use of esketamine in pregnant women undergoing cesarean section may reduce postpartum depression and increase intraoperative adverse reactions, but has no significant effect on postoperative adverse reactions.
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Affiliation(s)
- Baoyu Ma
- Department of Anesthesiology and Perioperative Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Medical Group), Qingdao, China
| | - Xinyi Tao
- Department of Anesthesiology and Perioperative Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Medical Group), Qingdao, China
| | - Yanyu Qi
- Department of Anesthesiology and Perioperative Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Medical Group), Qingdao, China
| | - Hong Cao
- Department of Anesthesiology and Perioperative Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Medical Group), Qingdao, China
| | - Qianqian Cao
- Department of Anesthesiology and Perioperative Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Medical Group), Qingdao, China
| | - Zhixia Zhou
- Country Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, China
| | - Shoushi Wang
- Department of Anesthesiology and Perioperative Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Medical Group), Qingdao, China
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15
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Raja A, Ahmed S, Basit Ali Siddiqui M, Lamiya Mir S, Kumar R, Ahmed M, Raja S, Bin Amin S, Alim Ur Rahman H, Deepak F, Asghar MS. Evaluating the safety and efficacy of zuranolone in the management of major depressive disorder and postpartum depression, with or without concurrent insomnia: a rigorous systematic review and meta-analysis. Front Psychiatry 2024; 15:1425295. [PMID: 39035602 PMCID: PMC11257908 DOI: 10.3389/fpsyt.2024.1425295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/10/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Major depressive disorder (MDD), postpartum depression (PPD), and insomnia are neuropsychological conditions in which zuranolone is used to improve symptoms and prognosis of the disorder. This meta-analysis aimed to determine the efficacy of zuranolone in comparison to other drugs used for treating these conditions. Methods This meta-analysis included patients aged between 18 and 75 years who were diagnosed with major depressive disorder and postpartum depression with or without insomnia and were administered zuranolone for treatment. Only randomized controlled trials (RCTs) were included, and animal studies were excluded. The databases used were PubMed, Scopus, Cochrane, and Clinicaltrials.gov, with MeSH terms and relevant keywords for (Zuranolone) and (Depression). The Cochrane risk of bias tool was used for quality assessment. Results The meta-analysis included eight RCTs that analyzed data from 2031 patients. The meta-analysis revealed statistically significant changes in the Hamilton Depression Rating Scale (HAM-D), Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), and treatment-emergent adverse effects (TEAE) scores in the PPD subgroup. HAM-D and TEAEs scores were also significant in the MDD subgroup, but the changes in the MADRS, HAM-A, and Bech-6 scores were insignificant. Serious adverse events were insignificant in all subgroups. Conclusion Meta-analysis found a significant improvement in depressive symptoms with zuranolone treatment, especially on day 15. This suggests that zuranolone is a promising therapeutic option for patients with MDD and PPD with or without insomnia. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=459554, identifier CRD42023459554.
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Affiliation(s)
- Adarsh Raja
- Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Saboor Ahmed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Syeda Lamiya Mir
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Rakesh Kumar
- Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Muhammad Ahmed
- Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Sandesh Raja
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Shafin Bin Amin
- Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Hafsah Alim Ur Rahman
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Fnu Deepak
- Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Muhammad Sohaib Asghar
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
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Lonstein JS, Meinhardt TA, Pavlidi P, Kokras N, Dalla C, Charlier TD, Pawluski JL. Maternal probiotic Lactocaseibacillus rhamnosus HN001 treatment alters postpartum anxiety, cortical monoamines, and the gut microbiome. Psychoneuroendocrinology 2024; 165:107033. [PMID: 38569396 DOI: 10.1016/j.psyneuen.2024.107033] [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: 10/19/2023] [Revised: 02/02/2024] [Accepted: 03/17/2024] [Indexed: 04/05/2024]
Abstract
Peripartum mood and anxiety disorders (PMADs) affect 15-20% of peripartum women and are well known to disrupt infant caregiving. A recent study in humans reported that anxiety and depressive symptoms were alleviated by peripartum treatment with the probiotic, Lactocaseibacillus rhamnosus HN001. The current study determined the effects of chronic Lactocaseibacillus rhamnosus HN001 (HN001) treatment on postpartum affective and caregiving behaviors in a laboratory rodent model. Female rats were given probiotic overnight in their drinking water, or untreated water, from the first day of pregnancy through postpartum day 10. To determine whether the HN001 effects were influenced by a background of stress, half the females underwent chronic variable pregnancy stress and the other half remained undisturbed. The results revealed that, even without pregnancy stress, HN001 reduced postpartum anxiety-related behavior, increased variability in behavioral fragmentation when dams interacted with pups, increased time away from pups, and decreased prefrontal cortex norepinephrine (NE), dopamine (DA) and serotonin (5-HT). Probiotic plus stress consistently reduced the latency to float in the forced swim test, increased DA and 5-HT turnovers in the prefrontal cortex, increased hippocampal NE, and reduced hypothalamic DA. Fecal microbe alpha and beta diversities were lower postpartum than prepartum, which was prevented by the probiotic treatment and/or stress. Across the entire sample lower postpartum anxiety behavior was associated with lower fecal Bacteroides dorei. This study reveals novel information about how L. rhamnosus HN001 influences postpartum behavior and microbiota-gut-brain physiology in female laboratory rats, with implications for probiotic supplement use by pregnant and postpartum women.
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Affiliation(s)
- Joseph S Lonstein
- Behavioral Neuroscience Program, Department of Psychology, Michigan State University, East Lansing, MI 48824, USA.
| | - Taryn A Meinhardt
- Behavioral Neuroscience Program, Department of Psychology, Michigan State University, East Lansing, MI 48824, USA
| | - Pavlina Pavlidi
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Goudi 11527, Greece
| | - Nikos Kokras
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Goudi 11527, Greece; First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Greece
| | - Christina Dalla
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Greece
| | - Thierry D Charlier
- Universite de Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Rennes F-35000, France
| | - Jodi L Pawluski
- Universite de Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Rennes F-35000, France
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17
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Subbiah GK, Reijneveld SA, Hartman CA, van der Zee-van den Berg AI, Boere-Boonekamp MM, Almansa J, de Kroon MLA. Impact of trajectories of maternal postpartum depression on infants' socioemotional development. Pediatr Res 2024; 96:519-524. [PMID: 37337109 DOI: 10.1038/s41390-023-02697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/27/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND We assessed (a) the effects of postpartum depression (PPD) trajectories until 6 months postpartum on infants' socioemotional development (SED) at age 12 months, and (b) the mediating role of maternal self-efficacy (MSE), and the additional effect of postpartum anxiety at age 12 months. METHODS We used data from POST-UP trial (n = 1843). PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 1, 3, and 6 months. Infants' SED was assessed at 12 months using the Ages and Stages Questionnaire-Social-Emotional (ASQ-SE). Structural equations were applied to estimate the effect of PPD trajectories on infants' SED and mediation by MSE. The additional effects of postpartum anxiety were assessed with conditional regression. RESULTS Higher levels of PPD over time were associated with a lower SED (coefficient for log-EPDS 3.5, 95% confidence interval 2.8; 4.2, e.g., an increase in the EPDS score from 9 to 13 worsens the ASQ-SE by 1.3 points). About half of this relationship was mediated by MSE. Postpartum anxiety had an independent adverse effect on SED. CONCLUSIONS PPD and postpartum anxiety have a negative impact on infants' SED. MSE as a mediator may be a potential target for preventive interventions to alleviate the negative effects of maternal psychopathology on infants' SED. IMPACT The trajectories of postpartum depression (PPD) from 1 month to 6 months were negatively related to infants' socioemotional development (SED) at age 12 months, underlining the importance of repeated assessment of PPD. Maternal self-efficacy (MSE) mediated the association between PPD and SED, implying MSE could be a potential target for preventive interventions. An additional independent negative effect of postpartum anxiety was identified, implying the assessment of postpartum anxiety also has a surplus value to identify mothers at risk.
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Affiliation(s)
- Gireesh Kumar Subbiah
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands.
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
| | - Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | | | - Magda M Boere-Boonekamp
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
| | - Josué Almansa
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
| | - Marlou L A de Kroon
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ, Groningen, the Netherlands
- Department of Public Health and Primary Care, Environment and Health, KU Leuven, Kapucijnenvoer 35, P.O. Box 7001, 3000, Leuven, Belgium
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18
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Si S, Zhao G, Song G, Liu J. Assisted reproductive technologies and postpartum depressive symptoms: A meta-analysis. J Affect Disord 2024; 356:300-306. [PMID: 38583599 DOI: 10.1016/j.jad.2024.03.168] [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: 03/07/2023] [Revised: 03/08/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Assisted reproductive technologies (ARTs) have become the main treatment for infertility. ART treatment can be a stressful life event for infertile females. Whether there is an association between ARTs and postpartum depressive symptoms (PDS) has not been established. METHODS PubMed, MEDLINE, EMBASE, PsycINFO, and CNKI were searched. The pooled outcome was the difference in incidence of PDS within 1 year postpartum between ARTs and the spontaneous pregnancy group. RESULTS A total of 12 cohort studies, which were conducted in eight developed countries and two developing countries, were involved. In total, 106,338 pregnant women, including 4990 infertile females with ARTs treatment and 101,348 women with spontaneous pregnancy, were enrolled in our final analysis. ARTs women had a lower incidence of PDS compared to the spontaneous pregnancy group according to a random effect model (OR = 0.83, 95 % CI: 0.71-0.97, p = 0.022, I2 = 62.0 %). Subgroup analyses indicated that studies on late PDS (follow-up: 3-12 months postpartum) were more heterogeneous than those on early PDS (follow-up: <3 months postpartum) (I2 = 24.3 % vs. I2 = 0 %, interaction p-value < 0.001). There was a strong relationship between ARTs and late PDS (OR = 0.65, 95 % CI: 0.55-0.77, p < 0.001). Therefore, the possible source of heterogeneity was the postpartum evaluation time, which was confirmed by post-hoc meta-regression. LIMITATIONS Some underlying confounders, such as previous psychiatric illness, the limited availability of ARTs, and ethnic disparities, cannot be ignored and may have biased interpretation of the results. CONCLUSION The available data suggested that ARTs were associated with lower incidence of PDS, especially when follow-up lasted over 3 months. However, these findings should be interpreted with caution. Better-designed trials are needed to confirm this association.
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Affiliation(s)
- Si Si
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, China
| | - Ge Zhao
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Liu
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, China.
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19
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Barnes KN, Vogl CM, Nelson LA. Zuranolone: The First FDA-Approved Oral Treatment Option for Postpartum Depression. Ann Pharmacother 2024; 58:728-734. [PMID: 37876133 DOI: 10.1177/10600280231204953] [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: 10/26/2023] Open
Abstract
OBJECTIVE The objective of this study was to review the characteristics, efficacy, and safety of zuranolone in the management of postpartum depression (PPD). DATA SOURCES Literature was identified using PubMed (1966-August 2023) and EMBASE (1973-August 2023) and clinicaltrials.gov. Search terms included zuranolone, SAGE-217, and PPD with further limitation of those published in English. STUDY SELECTION AND DATA EXTRACTION Articles selected for inclusion included trials evaluating zuranolone for the treatment of PPD. DATA SYNTHESIS Zuranolone was evaluated for the treatment of moderate to severe PPD in 2 phase III trials. Both studies resulted in statistically significant improvement in depressive symptoms at day 15 (P = 0.003 and P < 0.001). Sustained differences in remission rates favoring zuranolone were found in both studies at day 45 compared with placebo (P = 0.01 and P < 0.05). Zuranolone was well tolerated, with somnolence, dizziness, headache, and sedation reported as the most common side effects. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON TO EXISTING DRUGS Zuranolone is only the second medication approved by the Food and Drug Administration (FDA) for PPD and offers an advantage over brexanolone in that it can administered orally in the outpatient setting. The rapid onset of effect of zuranolone is advantageous to traditional antidepressant therapy which can be weeks to months; however, limited information is available on safety during lactation. CONCLUSIONS The recent FDA approval of oral zuranolone for PPD offers a second rapid-acting treatment for PPD, extending the opportunity for treatment to patients in the outpatient setting.
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Affiliation(s)
- Kylie N Barnes
- Division of Pharmacy Practice and Administration, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Claire M Vogl
- School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Leigh Anne Nelson
- Division of Pharmacy Practice and Administration, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
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20
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Cardaci V, Carminati M, Tondello M, Pecorino B, Serretti A, Zanardi R. Understanding and treating postpartum depression: a narrative review. Int Clin Psychopharmacol 2024:00004850-990000000-00143. [PMID: 38941162 DOI: 10.1097/yic.0000000000000560] [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] [Indexed: 06/30/2024]
Abstract
Postpartum depression (PPD) is an increasingly prevalent but still poorly characterized disorder. Causal and modulating factors include hormones fluctuations, such as estrogen, progesterone, and allopregnolone, pathways imbalances, such as oxytocin and kynurenine, chronobiological factors, and brain imaging alterations. Treatment may differ from the traditional major depression management, while selective serotonin reuptake inhibitors such as sertraline are commonly used and suggested by guidelines, neurosteroids such as brexanolone and the more convenient zuranolone have been recently approved. Newer neurosteroids such as ganaxolone, valaxanolone, and lysaxanolone are currently under development, but also esketamine and psychedelics are promising potential treatments. Other somatic treatments including brain stimulation techniques and light therapy also showed benefit. PPD is therefore increasingly understood as, at least partially, independent from major depressive disorder. Specific and individualized treatments including pharmacological and non-pharmacological therapies are progressively being introduced in the routine clinical practice.
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Affiliation(s)
- Vincenzo Cardaci
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan
| | - Matteo Carminati
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan
| | - Mattia Tondello
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan
| | - Basilio Pecorino
- Department of Medicine and Surgery, Kore University of Enna, Enna
| | | | - Raffaella Zanardi
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan
- Department of Psychiatry, Mood Disorder Unit, IRCCS San Raffaele Hospital, Milan, Italy
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21
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Baattaiah BA, Alharbi MD, Aldhahi MI, Khan F. Factors associated with postpartum fatigue: an exploration of the moderating role of resilience. Front Public Health 2024; 12:1394380. [PMID: 38947349 PMCID: PMC11211369 DOI: 10.3389/fpubh.2024.1394380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024] Open
Abstract
Background Postpartum fatigue (PPF) can impair the physical and mental well-being of women. The aims of this study were to assess the associations between fatigue and maternal health-related variables, specifically, sleep quality, depression symptoms, and resilience, and to explore the moderating role of resilience in the relationships between sleep quality, depression symptoms, and fatigue. Methods This cross-sectional study used data collected from mothers during the postpartum period via an online platform. PPF was assessed using the Fatigue Severity Scale, whereas sleep quality and depression symptoms were assessed using the Pittsburgh Sleep Quality Index and Edinburgh Postnatal Depression Scale, respectively. The Brief Resilience Scale was used to assess resilience. Simple and multiple binary logistic regression analyses were performed to examine the association of each independent variable with PPF and to determine the most significant predictors of PFF. The data were analyzed using SPSS, and structural equation modeling was performed using AMOS 23. A moderation analysis was performed to explore the moderating role of resilience using the Hayes PROCESS macro. Results A total of 1,443 postpartum mothers were included in the analysis. The simple binary logistic regression analysis showed that having chronic disease (odds: 1.52; p = 0.02), mother's age (odds: 0.97; p = 0.03), mother's body mass index (BMI; odds: 1.03; p = 0.01), depression symptoms (odds: 1.09; p ≤ 0.0001), sleep quality (odds: 1.17; p ≤ 0.0001), and resilience (odds: 0.42; p ≤ 0.0001) all contributed to fatigue during postpartum. Multivariate logistic regression showed that the mother's BMI, sleep quality, depression symptoms, and resilience were significant predictors of PPF. Moderation analyses showed that resilience was not a significant moderator between the main effects of sleep quality and fatigue (interaction effect: β = 0.01, p = 0.31, 95% CI: -0.01 to 0.04) or between the main effects of depression symptoms and fatigue during postpartum (interaction effect: β = 0.01, p = 0.82, 95% CI: -0.01 to 0.02). Conclusion Given the deleterious effects of PPF on maternal health outcomes, factors associated with PPF should be assessed regularly. In addition to mothers' BMI, sleep quality, and depression symptoms, resilience could also be a crucial factor in predicting fatigue severity during this critical time for mothers even though it was not a significant moderator among this sample.
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Affiliation(s)
- Baian A. Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mutasim D. Alharbi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Monira I. Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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22
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Lubis PN, Saputra M, Rabbani MW. A systematic review of the benefits of breastfeeding against postpartum depression in low-middle-income countries. J Ment Health 2024:1-13. [PMID: 38869015 DOI: 10.1080/09638237.2024.2361232] [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: 02/16/2023] [Accepted: 03/16/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND The positive impact of breastfeeding against postpartum depression has been increasingly reported. However, no studies have systematically and critically examined current evidence on breastfeeding practices' influences on postpartum depression in LMICs. AIM To review the influence of breastfeeding on postpartum depression in LMICs. METHODS We searched original research in English published over the last ten years (2012 - 2022) within 8 databases: EBSCOhost, EMBASE, Pubmed, Sage Journals, Science Direct, APA PsycArticles, Taylor & Francis, Google Scholar, and citation tracking. The risk of bias assessment used The Newcastle Ottawa Scale and The Modified Jadad Scale. We followed the PRISMA statement after the protocol had been registered on the PROSPERO. The review included 21 of 11015 articles. RESULTS Of 21 articles, 16 examined breastfeeding practices, 2 each investigated breastfeeding self-efficacy and breastfeeding education, and 1 each assessed breastfeeding attitude and breastfeeding support. 3 randomized control trials and 5 cohorts revealed that breastfeeding decreased the EPDS scores. However, 4 cross-sectional studies indicated that breastfeeding is nonsignificantly associated with postpartum depression. CONCLUSION This review indicated that breastfeeding may alleviate or prevent postpartum depression. Our findings indicated that integrating breastfeeding-related programs and policies into postpartum depression prevention may benefit public health. REGISTRATION PROSPERO (CRD42022315143).
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Affiliation(s)
| | - Maman Saputra
- Tulodo Organizations and Universitas Terbuka, Indonesia
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23
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Nashwan AJ, Rehan ST, Imran L, Abbas SG, Khan SF. Exploring the clinical potentials of zuranolone in managing postpartum depression: A new therapeutic horizon. Prog Neuropsychopharmacol Biol Psychiatry 2024; 132:110983. [PMID: 38412941 DOI: 10.1016/j.pnpbp.2024.110983] [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: 10/20/2023] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
Postpartum depression (PPD) poses a major threat to maternal mental health and wellbeing while also adversely affecting the mother's relationship with her baby, leading to significant repercussions that may hinder the growth and cognitive development of the child. For decades, antidepressants have been the mainstay of treating PPD; however, recent evidence suggests that antidepressants are not as effective as they are believed to be and there is a dire need to explore new treatment options. In 2023, a breakthrough in treating PPD emerged with the recent FDA approval of zuranolone, a gamma-aminobutyric acid (GABAA) receptor selective positive allosteric modulator. The implementation of zuranolone in treating PPD can prove to be revolutionary, considering it is the first oral medication available for PPD. Our review aims to discuss the various clinical trials that have been conducted to validate the efficacy of zuranolone in mitigating the symptoms of PPD, hence, leading to better outcomes for mothers.
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Affiliation(s)
- Abdulqadir J Nashwan
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar; Hamad Medical Corporation, Doha 3050, Qatar.
| | | | - Laiba Imran
- Dow University of Health Sciences, Karachi 74200, Pakistan
| | | | - Sara Fahim Khan
- Institute of Professional Psychology, Bahria University, Karachi 75260, Pakistan
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24
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Winslow M, White E, Rose SJ, Salzer E, Nemec EC. The efficacy of zuranolone versus placebo in postpartum depression and major depressive disorder: a systematic review and meta-analysis. Int J Clin Pharm 2024; 46:590-601. [PMID: 38489051 DOI: 10.1007/s11096-024-01714-0] [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: 12/21/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Zuranolone, an oral version of allopregnanolone and neurosteroid, is a novel drug for the treatment of major depressive disorder (MDD) and postpartum depression (PPD). AIM The purpose of this systematic review and meta-analysis was to assess the efficacy of zuranolone in the treatment of MDD and PPD. METHOD A systematic search was conducted using EBSCOhost to simultaneously search Academic Search Premier, APA PsycArticles, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL Ultimate, and MEDLINE with Full Text. Two independent reviewers screened the articles and completed a full-text review using Covidence. The quality of each study was assessed using the Cochrane Risk of Bias tool for randomized trials (RoB 2). A meta-analysis was then conducted using Review Manager (RevMan v5.4) software. RESULTS The initial search yielded 127 results, with 6 articles fitting our inclusion and exclusion criteria. All 6 studies, comprising 1707 participants, had an overall low risk of bias. There was a significant decrease in HAM-D scores for MDD at 15 days versus placebo (MD - 2.40, 95% CI - 3.07 to - 1.63; p < .001). When pooling data for PDD, there was an overall significant decrease in HAM-D scores at 15 days versus placebo (MD - 4.06, 95% CI - 4.25 to - 3.87; p < .001). CONCLUSION The results suggest that zuranolone can improve symptoms of PPD at 15 days; however, results were not clinically significant for MDD. Future research is needed to evaluate the long-term efficacy of zuranolone in PPD and the treatment efficacy in MDD.
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Affiliation(s)
- Mackenzie Winslow
- Master of Physician Assistant Studies, Sacred Heart University, 5151 Park Ave, Fairfield, CT, 06825, USA
| | - Emily White
- Master of Physician Assistant Studies, Sacred Heart University, 5151 Park Ave, Fairfield, CT, 06825, USA
| | - Suzanne J Rose
- Master of Physician Assistant Studies, Sacred Heart University, 5151 Park Ave, Fairfield, CT, 06825, USA
- Department of Research and Discovery, Stamford Health, Stamford, CT, USA
| | - Elijah Salzer
- College of Health Professions, PACE University, New York, NY, USA
| | - Eric C Nemec
- Master of Physician Assistant Studies, Sacred Heart University, 5151 Park Ave, Fairfield, CT, 06825, USA.
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25
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Tzitiridou-Chatzopoulou M, Orovou E, Zournatzidou G. Digital Training for Nurses and Midwives to Improve Treatment for Women with Postpartum Depression and Protect Neonates: A Dynamic Bibliometric Review Analysis. Healthcare (Basel) 2024; 12:1015. [PMID: 38786425 PMCID: PMC11120917 DOI: 10.3390/healthcare12101015] [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: 02/15/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
The high prevalence of postpartum depression makes it necessary for midwives and nurses to implement prenatal interventions for expectant mothers. The current study aims to investigate and highlight the importance of the digital training of nurses in order to help women mitigate the symptoms of postpartum depression and protect infants. To approach this, we conducted a bibliometric analysis to address the study's main objective. Articles were retrieved from the Scopus database for the timeframe 2000-2023. Data analysis was conducted using the statistical programming language R (version R-4.4.) and the bibliometric software VOSviewer (version 1.6.20) and Biblioshiny (version 4.1.4), focused on year, journal, and country. For this investigation, we selected a total of 31 MeSH keywords and sub-headings that exhibited significant frequencies. We consistently used six significant clusters of MeSH keywords. We obtained a total of 585 articles from the Scopus database that were major contributors to the field of PPD, as evidenced by their extensive publication of research articles and their influential role in the domain. The studies included a thorough analysis of depression research, the use of scales for diagnosing and screening PPD, psychological studies related to PPD, and the exploration of causes, mechanisms, outcomes, and genetic factors. Our study's results demonstrate a steady and significant increase in the availability of information on PPD. Importantly, the novelty of the current study lies in highlighting the need for a transition in the ways in which nurses and midwives are trained to mitigate postpartum disease by integrating emerging technologies into their practices. The knowledge provided here has the potential to serve as a foundation for future advancements in obstetric psychology, both presently and in the future.
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Affiliation(s)
- Maria Tzitiridou-Chatzopoulou
- Midwifery Department, School of Healthcare Sciences, University of Western Macedonia, Koila, 50100 Kozani, Greece; (M.T.-C.); (E.O.)
| | - Eirini Orovou
- Midwifery Department, School of Healthcare Sciences, University of Western Macedonia, Koila, 50100 Kozani, Greece; (M.T.-C.); (E.O.)
| | - Georgia Zournatzidou
- Department of Accounting and Finance, Hellenic Mediterranean University, 71410 Heraklion, Greece
- Department of Business Administration, University of Western Macedonia, 50100 Kozani, Greece
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26
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Hitt EM. Zuranolone: A Narrative Review of a New Oral Treatment for Postpartum Depression. Clin Ther 2024; 46:433-438. [PMID: 38697873 DOI: 10.1016/j.clinthera.2024.04.001] [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: 10/12/2023] [Revised: 03/05/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE Postpartum depression is a prevalent and overlooked mental disorder. Pathophysiology is thought to originate from a combination of biological and social factors, including hormones, and genetics. The consequences of untreated postpartum depression can be severe and negatively impact maternal and infant health. Zuranolone was approved as an oral agent in August 2023 for the treatment of postpartum depression in adults. The purpose of this article is evaluating the clinical aspects of zuranolone, including safety and efficacy pertaining to the drug and the clinical data that led to its approval. METHODS A literature search was conducted using PubMed, Web of Science, and EMBASE with the terms postpartum depression, postpartum depression management, and zuranolone to locate relevant data for this narrative review. The prescribing information of zuranolone and clinicaltrials.gov were also utilized. FINDINGS Two Phase III trials (Study 1-NCT04442503 and Study 2-NCT02978326) led to the approval of zuranolone by the Food and Drug Administration (FDA) based on clinically meaningful improvement in depressive symptoms. The trials met their primary endpoint, a change from baseline in HAM-D total score at day 15 (Study 1; 95% CI -6.3 to -1.7, P = 0.001: Study 2; 95% CI (-6.9 to -1.5, P = 0.003). IMPLICATIONS Zuranolone, an oral and rapidly acting antidepressant, represents a promising new oral treatment option for individuals with postpartum depression.
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Affiliation(s)
- Emily M Hitt
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, WA.
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27
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Haile ZT, Karim S, Murton K, Patibandla S, Haider MR. Association between history of hookah use and symptoms of postpartum depression: A population-based study. Int J Gynaecol Obstet 2024; 165:746-755. [PMID: 38063019 DOI: 10.1002/ijgo.15285] [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: 07/12/2023] [Revised: 10/19/2023] [Accepted: 11/20/2023] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Although several biologic, psychosocial, and behavioral factors have been linked to postpartum depressive symptoms, studies examining the association between non-cigarette tobacco products and symptoms of postpartum depression are currently lacking. This study examined the association between hookah use and postpartum depressive symptoms. METHODS A cross-sectional study was conducted using data from the US Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System 2016-2020. Self-reported data on hookah use in the last 2 years and maternal mental health were captured using a structured questionnaire. Descriptive and inferential statistics were performed. RESULTS The final study sample consisted of 106 894 participants. Approximately 8.2% of the participants reported postpartum depressive symptoms and 4.1% reported hookah use in the past 2 years. Compared with those without postpartum depressive symptoms, participants with postpartum depressive symptoms were more likely to be hookah users (5.5% vs 4.0%, P < 0.001). After adjustment for confounders, the odds of having postpartum depressive symptoms were significantly higher among participants who used a hookah in the past 2 years compared with non-users; adjusted odds ratio (95% confidence interval) 1.20 (1.03-1.40); P = 0.022. CONCLUSION In a large, population-based sample of US women, hookah use in the past 2 years significantly increased the odds of having postpartum depressive symptoms, independent of potential confounders. This finding underscores the need for healthcare providers to communicate effectively about the health risks of hookah use.
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Affiliation(s)
- Zelalem T Haile
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio, USA
| | - Sabrina Karim
- Institute for Families in Society, College of Social Work, University of South Carolina, Columbia, South Carolina, USA
| | - Kasey Murton
- Ohio University Heritage College of Osteopathic Medicine, Cleveland, Ohio, USA
| | - Sravya Patibandla
- Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio, USA
| | - Mohammad Rifat Haider
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
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28
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Wang S, Zhao Y, Yang Z, Liu Y, Xu R, Tu R, Liu S, Zou X, Zhang L, Hao J, Gao P. 919 granules improve postpartum depression through the regulation of abnormal peripheral blood IL-1β. Biomed Pharmacother 2024; 174:116623. [PMID: 38643545 DOI: 10.1016/j.biopha.2024.116623] [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: 02/06/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 04/23/2024] Open
Abstract
Postpartum depression (PPD) has a significant impact on the physical and mental health of mothers, potentially leading to symptoms such as low mood, fatigue, and decreased appetite. It may also affect the healthy growth of the infant. The onset of PPD is closely related to abnormalities in inflammation and the immune system. PPD patients exhibit abnormalities in the proportion of peripheral blood immune cells, along with an increase in pro-inflammatory cytokines. Excessive pro-inflammatory cytokines in peripheral blood can disrupt the blood-brain barrier (BBB) by activating astrocytes and reducing transendothelial electrical resistance (TEER), allowing peripheral immune cells or cytokines to enter the brain and trigger inflammation, ultimately leading to the onset of depression. In addition, PPD lacks safe and effective treatment medications. In this study, we collected peripheral blood from both healthy postpartum women and those with PPD, conducted single cell RNA sequencing (scRNA-seq), and used an in-house analytical tool scSTAR to reveal that PPD patients exhibit elevated proportions of peripheral blood cDC2 and Proliferation B cells, which are significantly correlated with IL-1β. Additionally, animal experiments were designed to validate that 919 granules can improve PPD by modulating the levels of peripheral blood IL-1β, providing a potential therapeutic mechanism for PPD treatment.
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Affiliation(s)
- Shusheng Wang
- Department of Traditional Chinese Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Yan Zhao
- Department of Laboratory Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Zhicheng Yang
- Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Yujun Liu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Ru Xu
- Department of Traditional Chinese Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Ruoxin Tu
- Department of Traditional Chinese Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Songping Liu
- Department of Obstetrics and Gynecology, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Xin Zou
- Institute of Clinical Science, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lan Zhang
- Department of Traditional Chinese Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China.
| | - Jie Hao
- Institute of Clinical Science, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Pengfei Gao
- Department of Traditional Chinese Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China.
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29
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Niwa M, Lockhart S, Wood DJ, Yang K, Francis-Oliveira J, Kin K, Ahmed A, Wand GS, Kano SI, Payne JL, Sawa A. Prolonged HPA axis dysregulation in postpartum depression associated with adverse early life experiences: A cross-species translational study. NATURE. MENTAL HEALTH 2024; 2:593-604. [PMID: 38736646 PMCID: PMC11087073 DOI: 10.1038/s44220-024-00217-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/21/2024] [Indexed: 05/14/2024]
Abstract
Childhood and adolescent stress increase the risk of postpartum depression (PPD), often providing an increased probability of treatment refractoriness. Nevertheless, the mechanisms linking childhood/adolescent stress to PPD remain unclear. Our study investigated the longitudinal effects of adolescent stress on the hypothalamic-pituitary-adrenal (HPA) axis and postpartum behaviors in mice and humans. Adolescent social isolation prolonged glucocorticoid elevation, leading to long-lasting postpartum behavioral changes in female mice. These changes were unresponsive to current PPD treatments but improved with post-delivery glucocorticoid receptor antagonist treatment. Childhood/adolescent stress significantly impacted HPA axis dysregulation and PPD in human females. Repurposing glucocorticoid receptor antagonists for some cases of treatment-resistant PPD may be considered.
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Affiliation(s)
- Minae Niwa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Department of Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham School of Engineering, Birmingham, AL, USA
| | - Sedona Lockhart
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel J. Wood
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kun Yang
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jose Francis-Oliveira
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Kyohei Kin
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Adeel Ahmed
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Gary S. Wand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shin-ichi Kano
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Department of Neurobiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Jennifer L. Payne
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlotte, VA, USA
| | - Akira Sawa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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30
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Guard M, Labonte AK, Mendoza M, Myers MJ, Duncan M, Drysdale AT, Mukherji E, Rahman T, Tandon M, Kelly JC, Cooke E, Rogers CE, Lenze S, Sylvester CM. Brexanolone Treatment in a Real-World Patient Population: A Case Series and Pilot Feasibility Study of Precision Neuroimaging. J Clin Psychopharmacol 2024; 44:240-249. [PMID: 38551454 PMCID: PMC11177577 DOI: 10.1097/jcp.0000000000001859] [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] [Indexed: 04/13/2024]
Abstract
PURPOSE/BACKGROUND Brexanolone is approved for postpartum depression (PPD) by the United States Food and Drug Administration. Brexanolone has outperformed placebo in clinical trials, but less is known about the efficacy in real-world patients with complex social and medical histories. Furthermore, the impact of brexanolone on large-scale brain systems such as changes in functional connectivity (FC) is unknown. METHODS/PROCEDURES We tracked changes in depressive symptoms across a diverse group of patients who received brexanolone at a large medical center. Edinburgh Postnatal Depression Scale (EPDS) scores were collected through chart review for 17 patients immediately prior to infusion through approximately 1 year postinfusion. In 2 participants, we performed precision functional neuroimaging (pfMRI), including before and after treatment in 1 patient. pfMRI collects many hours of data in individuals for precision medicine applications and was performed to assess the feasibility of investigating changes in FC with brexanolone. FINDINGS/RESULTS The mean EPDS score immediately postinfusion was significantly lower than the mean preinfusion score (mean change [95% CI]: 10.76 [7.11-14.40], t (15) = 6.29, P < 0.0001). The mean EPDS score stayed significantly lower at 1 week (mean difference [95% CI]: 9.50 [5.23-13.76], t (11) = 4.90, P = 0.0005) and 3 months (mean difference [95% CI]: 9.99 [4.71-15.27], t (6) = 4.63, P = 0.0036) postinfusion. Widespread changes in FC followed infusion, which correlated with EPDS scores. IMPLICATIONS/CONCLUSIONS Brexanolone is a successful treatment for PPD in the clinical setting. In conjunction with routine clinical care, brexanolone was linked to a reduction in symptoms lasting at least 3 months. pfMRI is feasible in postpartum patients receiving brexanolone and has the potential to elucidate individual-specific mechanisms of action.
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Affiliation(s)
- Meg Guard
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
- New York State Psychiatric Institute and the Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Alyssa K. Labonte
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Molly Mendoza
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael J. Myers
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Maida Duncan
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Andrew T. Drysdale
- New York State Psychiatric Institute and the Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Emily Mukherji
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Tahir Rahman
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Mini Tandon
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Jeannie C. Kelly
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, USA
| | - Emily Cooke
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Cynthia E. Rogers
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA
| | - Shannon Lenze
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Chad M. Sylvester
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
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Chen G, Zhang Y, Li R, Jin L, Hao K, Rong J, Duan H, Du Y, Yao L, Xiang D, Liu Z. Environmental enrichment attenuates depressive-like behavior in maternal rats by inhibiting neuroinflammation and apoptosis and promoting neuroplasticity. Neurobiol Stress 2024; 30:100624. [PMID: 38524250 PMCID: PMC10958482 DOI: 10.1016/j.ynstr.2024.100624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/25/2024] [Accepted: 03/10/2024] [Indexed: 03/26/2024] Open
Abstract
Gestational stress can exacerbate postpartum depression (PPD), for which treatment options remain limited. Environmental enrichment (EE) may be a therapeutic intervention for neuropsychiatric disorders, including depression, but the specific mechanisms by which EE might impact PPD remain unknown. Here we examined the behavioral, molecular, and cellular impact of EE in a stable PPD model in rats developed through maternal separation (MS). Maternal rats subjected to MS developed depression-like behavior and cognitive dysfunction together with evidence of significant neuroinflammation including microglia activation, neuronal apoptosis, and impaired synaptic plasticity. Expanding the duration of EE to throughout pregnancy and lactation, we observed an EE-associated reversal of MS-induced depressive phenotypes, inhibition of neuroinflammation and neuronal apoptosis, and improvement in synaptic plasticity in maternal rats. Thus, EE effectively alleviates neuroinflammation, neuronal apoptosis, damage to synaptic plasticity, and consequent depression-like behavior in mother rats experiencing MS-induced PPD, paving the way for new preventive and therapeutic strategies for PPD.
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Affiliation(s)
- Guopeng Chen
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yuhui Zhang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Ruiling Li
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Liuyin Jin
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Keke Hao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jingtong Rong
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Hao Duan
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yiwei Du
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Lihua Yao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Dan Xiang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
- Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, 430071, China
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Graziottin A, Di Simone N, Guarano A. Postpartum care: Clinical considerations for improving genital and sexual health. Eur J Obstet Gynecol Reprod Biol 2024; 296:250-257. [PMID: 38484617 DOI: 10.1016/j.ejogrb.2024.02.037] [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: 11/08/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 04/19/2024]
Abstract
The postpartum period encompasses the biological and psychoaffective transition to motherhood. However, it remains a most neglected phase in a woman's life. Furthermore, the transition to parenthood is a critical and potentially disrupting factor in a couple's relationship, which can be complicated by undiagnosed biological and psychosexual difficulties. Lack of recognition of the many biological and medical factors that can affect women's health and sexuality in the postpartum period is a common and persistent clinical omission worldwide. Communication difficulties exist between healthcare professionals and women and there are wording biases in describing female genitalia. This can further contribute to the diagnostic lack of attention and timely diagnosis and treatment of even very bothersome symptoms. Early diagnosis and treatment of common postpartum conditions is vital and quality care for new mothers should include psychological and emotional support, lactation assistance, early diagnosis and treatment of genital and sexual pain symptoms, pelvic floor rehabilitation and sexual health guidance. The inclusion of correct genital hygiene practices is a critical element of postpartum gynaecological counselling and can help improve overall genital and sexual health. In this review, we summarise the variability in global professional guidelines for postpartum care, identify common health problems faced by postpartum women and discuss appropriate postpartum care. We pay specific attention to prominent biological or medical factors that can impact the emotional and psychosexual wellbeing of women and couples. The aetiology, diagnosis and treatment of sexual dysfunction, in particular sexual pain disorders, is therefore discussed with a pragmatic approach. Finally, the role of intimate hygiene care is discussed with special attention given to cleanser ingredients with solid scientific evidence to help clinicians adopt a more tailored approach with their clinical recommendations.
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Affiliation(s)
- Alessandra Graziottin
- Centre of Gynaecology and Medical Sexology, Department of Obstetrics and Gynaecology, San Raffaele Resnati Hospital, 20122 Milan, Italy; Department of Obstetrics and Gynaecology, University of Verona, 37129 Verona, Italy; Specialty School, Endocrinology and Metabolic Diseases Department, Federico II University, 80131 Naples, Italy; Alessandra Graziottin Foundation for the Cure and Care of Pain in Women, NPO, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Alice Guarano
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy.
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Dimcea DAM, Petca RC, Dumitrașcu MC, Șandru F, Mehedințu C, Petca A. Postpartum Depression: Etiology, Treatment, and Consequences for Maternal Care. Diagnostics (Basel) 2024; 14:865. [PMID: 38732283 PMCID: PMC11083152 DOI: 10.3390/diagnostics14090865] [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: 01/28/2024] [Revised: 03/18/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Postpartum depression (PPD) is a disabling condition that has recently shown an increase in prevalence, becoming an essential public health problem. This study is a qualitative review summarizing the most frequent risk factors associated with PPD, evaluating molecular aspects of PPD and current approaches to detect and prevent PPD. The most prevalent risk factors were detected in the areas of economic and social factors, obstetrical history, lifestyle, and history of mental illness. Research on the genetic basis for PPD has taken place in recent years to identify the genes responsible for establishing targeted therapeutic methods and understanding its pathogenesis. The most frequently studied candidate gene was the serotonin transporter gene (SERT) associated with PPD. Among biological studies, antidepressants and psychological interventions provided the most evidence of successful intervention. The obstetrician can serve an essential role in screening for and treating PPD. Postpartum women with risk factors should be screened using the Edinburgh Postnatal Depression Scale (EPDS), but, at the moment, there are no prevention programs in Europe. In conclusion, data from this review increase concerns among this vulnerable population and can be used to design a screening tool for high-risk pregnant women and create a prevention program.
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Affiliation(s)
- Daiana Anne-Marie Dimcea
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.-M.D.); (M.C.D.); (C.M.); (A.P.)
| | - Răzvan-Cosmin Petca
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 050659 Bucharest, Romania
| | - Mihai Cristian Dumitrașcu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.-M.D.); (M.C.D.); (C.M.); (A.P.)
- Department of Obstetrics and Gynecology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Florica Șandru
- Department of Dermatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Dermatology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Claudia Mehedințu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.-M.D.); (M.C.D.); (C.M.); (A.P.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.A.-M.D.); (M.C.D.); (C.M.); (A.P.)
- Department of Obstetrics and Gynecology, Elias University Emergency Hospital, 011461 Bucharest, Romania
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Wang X, Zhang L, Lin X, Nian S, Wang X, Lu Y. Prevalence and risk factors of postpartum depressive symptoms at 42 days among 2462 women in China. J Affect Disord 2024; 350:706-712. [PMID: 38244787 DOI: 10.1016/j.jad.2024.01.135] [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: 04/25/2023] [Revised: 01/07/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Postpartum depression is a common and serious mental health problem that is affecting an increasing percentage of the world's population. We aimed to evaluate the prevalence of postpartum depressive symptoms in Beijing, China, during the COVID-19 pandemic and identify several potential risk factors. METHODS This was a cross-sectional observational study conducted at Peking University First Hospital from 2020 to 2021. Women who delivered and had postpartum reviews at 42 days after delivery were invited to complete the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS) under the guidance of trained nurses. A score of ≥10 was used as the threshold of postpartum depression. t-tests, chi-square tests or Mann-Whitney U tests were applied. A multivariate logistic regression analysis was conducted to assess the risk factors for postpartum depressive symptoms. RESULTS A total of 2462 mothers were included in this study, 20.2 % of whom were considered to have postpartum depressive symptoms. Multivariate logistic regression analysis showed that formula feeding (OR = 2.219, 95 % CI: 1.300-3.786, P = 0.013), preterm birth (OR = 1.619, 95 % CI: 1.108-2.367, P = 0.013), cervical insufficiency (OR 3.022, 95 % CI: 1.200-7.615, P = 0.019) and history of depression (OR = 6.519, 95 % CI: 1.537-27.659, P = 0.011) were associated with a high prevalence of postpartum depressive symptoms. CONCLUSION There is a high prevalence of postpartum depressive symptoms in developed regions of China during the COVID-19 pandemic. More attention should be given to mothers with risk factors for PPD, and follow-up care is needed.
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Affiliation(s)
- Xiaoxiao Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Lei Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Xiufeng Lin
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Songwen Nian
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Xiaoqing Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Ye Lu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
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Ren P, Wang JY, Chen HL, Wang Y, Cui LY, Duan JY, Guo WZ, Zhao YQ, Li YF. Activation of σ-1 receptor mitigates estrogen withdrawal-induced anxiety/depressive-like behavior in mice via restoration of GABA/glutamate signaling and neuroplasticity in the hippocampus. J Pharmacol Sci 2024; 154:236-245. [PMID: 38485341 DOI: 10.1016/j.jphs.2024.02.003] [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: 10/25/2023] [Revised: 01/28/2024] [Accepted: 02/02/2024] [Indexed: 03/19/2024] Open
Abstract
Postpartum depression (PPD) is a significant contributor to maternal morbidity and mortality. The Sigma-1 (σ-1) receptor has received increasing attention in recent years because of its ability to link different signaling systems and exert its function in the brain through chaperone actions, especially in neuropsychiatric disorders. YL-0919, a novel σ-1 receptor agonist developed by our institute, has shown antidepressive and anxiolytic effects in a variety of animal models, but effects on PPD have not been revealed. In the present study, excitatory/inhibitory signaling in the hippocampus was reflected by GABA and glutamate and their associated excitatory-inhibitory receptor proteins, the HPA axis hormones in the hippocampus were assessed by ELISA. Finally, immunofluorescence for markers of newborn neuron were undertaken in the dentate gyri, along with dendritic spine staining and dendritic arborization tracing. YL-0919 rapidly improves anxiety and depressive-like behavior in PPD-like mice within one week, along with normalizing the excitation/inhibition signaling as well as the HPA axis activity. YL-0919 rescued the decrease in hippocampal dendritic complexity and spine density induced by estrogen withdrawal. The study results suggest that YL-0919 elicits a therapeutic effect on PPD-like mice; therefore, the σ-1 receptor may be a novel promising target for PPD treatment in the future.
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Affiliation(s)
- Peng Ren
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Jing-Ya Wang
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Hong-Lei Chen
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yue Wang
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing, China
| | - Lin-Yu Cui
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing, China
| | - Jing-Yao Duan
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing, China
| | - Wen-Zhi Guo
- Department of Anesthesiology, 7th Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Yong-Qi Zhao
- Beijing Institute of Basic Medical Sciences, Beijing, China.
| | - Yun-Feng Li
- Beijing Institute of Basic Medical Sciences, Beijing, China; Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing, China.
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36
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Esposito G, Cantarutti A, Lupattelli A, Franchi M, Corrao G, Parazzini F. Does preterm birth increase the initiation of antidepressant use during the postpartum? A population-based investigation. Front Pharmacol 2024; 15:1325381. [PMID: 38601467 PMCID: PMC11004433 DOI: 10.3389/fphar.2024.1325381] [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: 10/21/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Background Preterm birth may affect maternal mental health. We explored the relationship between preterm birth and the risk of initiating antidepressant use during the year after birth. Methods We conducted a population-based investigation using regional healthcare utilization databases. The exposure considered was preterm birth. The outcome was having at least one prescription for antidepressant medications during the year after birth. We used a log-binomial regression model including terms for maternal age at birth, nationality, educational level, parity, modality of conception, modality of delivery, use of other psychotropic drugs, and diabetes to estimate relative risk (RR) and 95% confidence intervals (CI) for the association between preterm birth and the initiation of antidepressant use. In addition, the absolute risk differences (ARD) were also computed according to the timing of birth. Results The cohort included 727,701 deliveries between 2010 and 2020 in Lombardy, Northern Italy. Out of these, 6,522 (0.9%) women had at least one prescription for antidepressant drugs during the year after birth. Preterm births were related to a 38% increased risk of initiation of antidepressant use during the year after birth (adjusted RR = 1.38; 95% CI: 1.25-1.52) for moderate to late preterm and to 83% (adjusted RR = 1.83; 95% CI: 1.46-2.28) for extremely and very preterm. Excluding women with only one antidepressant prescription, the association was consistent (adjusted RR = 1.41, 95%CI: 1.23-1.61 for moderate to late preterm and adjusted RR = 1.81, 95% CI: 1.31-2.49 for extremely and very preterm). Also, excluding women who used other psychotropics, the association remained consistent (adjusted RR = 1.39, 95%CI: 1.26-1.54 and adjusted RR = 1.91, 95% CI: 1.53-2.38, respectively for moderate to late and extremely and very preterm). Conclusion Women who delivered preterm may have an excess risk of initiation of antidepressant consumption during the first year after birth.
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Affiliation(s)
- Giovanna Esposito
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anna Cantarutti
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, University of Oslo, Oslo, Norway
| | - Matteo Franchi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Liu Y, Wang Z, Li D, Lv B. Bilirubin and postpartum depression: an observational and Mendelian randomization study. Front Psychiatry 2024; 15:1277415. [PMID: 38525255 PMCID: PMC10957769 DOI: 10.3389/fpsyt.2024.1277415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024] Open
Abstract
Background Postpartum depression (PPD) is one of the most common complications of delivery and is usually disregarded. Several risk factors of PPD have been identified, but its pathogenesis has not been completely understood. Serum bilirubin has been found to be a predictor of depression, whose relationship with PPD has not been investigated. Methods Observational research was performed followed by a two-sample Mendelian randomization (MR) analysis. From 2017 to 2020, the clinical data of pregnant women were retrospectively extracted. Logistic regression and random forest algorithm were employed to assess the risk factors of PPD, including the serum levels of total bilirubin and direct bilirubin. To further explore their potential causality, univariable and multivariable Mendelian randomization (MVMR) were conducted. Sensitivity analyses for MR were performed to test the robustness of causal inference. Results A total of 1,810 patients were included in the PPD cohort, of which 631 (34.87%) were diagnosed with PPD. Compared with the control group, PPD patients had a significantly lower level of total bilirubin (9.2 μmol/L, IQR 7.7, 11.0 in PPD; 9.7 μmol/L, IQR 8.0, 12.0 in control, P < 0.001) and direct bilirubin (2.0 μmol/L, IQR 1.6, 2.6 in PPD; 2.2 μmol/L, IQR 1.7, 2.9 in control, P < 0.003). The prediction model identified eight independent predictive factors of PPD, in which elevated total bilirubin served as a protective factor (OR = 0.94, 95% CI 0.90-0.99, P = 0.024). In the MR analyses, genetically predicted total bilirubin was associated with decreased risk of PPD (IVW: OR = 0.86, 95% CI 0.76-0.97, P = 0.006), which remained consistent after adjusting educational attainment, income, and gestational diabetes mellitus. Conversely, there is a lack of solid evidence to support the causal relationship between PPD and bilirubin. Conclusion Our results suggested that decreased total bilirubin was associated with the incidence of PPD. Future studies are warranted to investigate its potential mechanisms and illuminate the pathogenesis of PPD.
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Affiliation(s)
- Yi Liu
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhihao Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Duo Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Lv
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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Bränn E, Chen Y, Song H, László KD, D'Onofrio BM, Hysaj E, Almqvist C, Larsson H, Lichtenstein P, Valdimarsdottir UA, Lu D. Bidirectional association between autoimmune disease and perinatal depression: a nationwide study with sibling comparison. Mol Psychiatry 2024; 29:602-610. [PMID: 38191927 PMCID: PMC11153129 DOI: 10.1038/s41380-023-02351-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024]
Abstract
Although major depression, characterized by a pro-inflammatory profile, genetically overlap with autoimmune disease (AD) and the perinatal period involve immune system adaptations and AD symptom alterations, the bidirectional link between perinatal depression (PND) and AD is largely unexplored. Hence, the objective of this study was to investigate the bidirectional association between PND and AD. Using nationwide Swedish population and health registers, we conducted a nested case-control study and a matched cohort study. From 1,347,901 pregnancies during 2001-2013, we included 55,299 incident PND, their unaffected full sisters, and 10 unaffected matched women per PND case. We identified 41 subtypes of AD diagnoses recorded in the registers and compared PND with unaffected population-matched women and full sisters, using multivariable regressions. Women with an AD had a 30% higher risk of subsequent PND (95% CI 1.2-1.5) and women exposed to PND had a 30% higher risk of a subsequent AD (95% CI 1.3-1.4). Comparable associations were found when comparing exposed women with their unaffected sisters (nested case-control OR: 1.3, 95% CI 1.2-1.5, matched cohort HR: 1.3, 95% CI 1.1-1.6), and when studying antepartum and postpartum depression. The bidirectional association was more pronounced among women without psychiatric comorbidities (nested case-control OR: 1.5, 95% CI 1.4-1.6, matched cohort HR: 1.4, 95% CI 1.4-1.5) and strongest for multiple sclerosis (nested case-control OR: 2.0, 95% CI 1.6-2.3, matched cohort HR: 1.8, 95% CI 1.0-3.1). These findings demonstrate a bidirectional association between AD and PND independent of psychiatric comorbidities, suggesting possibly shared biological mechanisms. If future translational science confirms the underlying mechanisms, healthcare providers need to be aware of the increased risk of PND among women with ADs and vice versa.
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Affiliation(s)
- Emma Bränn
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Yufeng Chen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Huan Song
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Elgeta Hysaj
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A Valdimarsdottir
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Donghao Lu
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Cho H, Kim J, Kim S, Jeong HI, Kwon M, Kim HM, Shim JS, Kim K, Baek J, Kyung Y, Choi SJ, Oh SY, Bae J, Won HH, Kim J, Ahn K. Postpartum Maternal Anxiety Affects the Development of Food Allergy Through Dietary and Gut Microbial Diversity During Early Infancy. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2024; 16:154-167. [PMID: 38528383 DOI: 10.4168/aair.2024.16.2.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/29/2023] [Accepted: 12/25/2023] [Indexed: 03/27/2024]
Abstract
PURPOSE We aimed to investigate the mediating factors between maternal anxiety and the development of food allergy (FA) in children until 2 years from birth. METHODS In this longitudinal cohort of 122 mother-child dyads from pregnancy to 24 months of age, we regularly surveyed maternal psychological states, infant feeding data, and allergic symptoms and collected stool samples at 6 months of age for microbiome analysis. Considering the temporal order of data collection, we investigated serial mediating effects and indirect effects among maternal anxiety, dietary diversity (DD), gut microbial diversity, and FA using structural equation modeling. RESULTS Among the 122 infants, 15 (12.3%) were diagnosed with FA. Increased maternal anxiety between 3 and 6 months after delivery was associated with a lower DD score. Infants with low DD at 4 months showed low gut microbial richness, which was associated with FA development. When the infants were grouped into 4 subtypes, using consensus clustering of 13 gut bacteria significantly associated with maternal anxiety and DD, Prevotella, Eubacterium, Clostridiales and Lachnospiraceae were more abundant in the group with lower FA occurrence. CONCLUSIONS Postpartum maternal anxiety, mediated by reduced DD and gut microbial diversity, may be a risk factor for the development of FA in infants during the first 2 years of life.
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Affiliation(s)
- Hyunbin Cho
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Jiwon Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sukyung Kim
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong, Korea
| | - Hye-In Jeong
- Department of Pediatrics, Eulji University Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Mijeong Kwon
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Mi Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Sun Shim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Jihyun Baek
- Department of Psychology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yechan Kyung
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaewoong Bae
- R&D Institute, BioEleven Co., Ltd., Seoul, Korea
| | - Hong-Hee Won
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Samsung Genome Institute, Samsung Medical Center, Seoul, Korea.
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea.
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea
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Lu L, Shen Y. Postpartum pain and the risk of postpartum depression: A meta-analysis of observational studies. J Obstet Gynaecol Res 2024; 50:358-365. [PMID: 38105372 DOI: 10.1111/jog.15850] [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: 07/16/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE This meta-analysis of observational studies aimed to derive a more precise estimation of the relationship between postpartum pain and postpartum depression (PPD). METHODS A systematic literature search was completed in the following databases from inception to September 26, 2022: PubMed, Embase, and Web of Science. Quality evaluation of each study was achieved through Newcastle-Ottawa scale (NOS) assessment. Heterogeneity across studies was evaluated by Cochran's Q test and I2 test. Pooled estimates of odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were analyzed using fixed-effects model or random-effects model, according to heterogeneity. Subgroup analysis, sensitivity analysis, and Egger's test were also performed. RESULTS From the identified 1884 articles, a total of 8 studies involving 3973 participants were included in the final meta-analysis. Seven of the 8 studies were evaluated as high-quality, with NOS scores ≥7. A significant heterogeneity was observed (I2 = 66.5%, p = 0.004) among eight studies. Therefore, the performed random-effect model suggested a significant association between postpartum pain and PPD risk (OR 1.29, 95% CI 1.10-1.52, p = 0.002). However, the subgroup analyses did not define the source of heterogeneity. Moreover, the sensitivity analysis showed the stability of the pooled results, but the significant publication bias was identified (p = 0.009). The trim and fill method was performed and resulted in an OR of 1.14 (95% CI 0.95-1.37, p = 0.162). CONCLUSIONS This meta-analysis found a potential association between postpartum pain and PPD. Further researches are needed to provide more robust evidences.
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Affiliation(s)
- Limei Lu
- Delivery Room, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang, China
| | - Ya Shen
- Nursing Department, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang, China
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Wang Y, Gu J, Zhang F, Xu X. Path analysis of influencing factors for maternal antenatal depression in the third trimester. Sci Rep 2024; 14:4742. [PMID: 38413698 PMCID: PMC10899182 DOI: 10.1038/s41598-024-55355-4] [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: 11/13/2023] [Accepted: 02/22/2024] [Indexed: 02/29/2024] Open
Abstract
Maternal antenatal depression (AD) is a nonpsychotic depressive episode during pregnancy that can harm both the pregnant woman and the fetus. This study aimed to investigate the intrinsic interrelationships between AD and its influencing factors by constructing a path model. This survey-based cross-sectional study included 1071 pregnant women who underwent pregnancy examinations in three hospitals in Nantong City, China, between February and June 2023. General information and information regarding maternal AD, pregnancy stress, prenatal anxiety, social support, marital satisfaction, sleep quality, and resilience were collected. Multiple linear regression analysis using SPSS 25.0 was employed to determine the factors influencing pregnancy depression, and Amos25.0 was used to construct a structural equation model. AD incidence was 19.4% (208/1071). The independent risk factors affecting AD in pregnant women have been integrated into the established path analysis model. The model demonstrated a good fit (χ2/DF = 1.238, comparative fit index = 0.999, goodness-of-fit index = 0.998, normed fit index = 0.996, adjusted goodness-of-fit index = 0.990, incremental fit index = 0.999, and root mean square error of approximation = 0.015). While prenatal anxiety (0.230) and hyperthyroidism (0.048) only had direct effects on AD, mental resilience was the biggest factor affecting AD, followed by pregnancy stress, marital satisfaction, prenatal anxiety, sleep quality, social support, and hyperthyroidism. Improved mental resilience, social support, sleep quality, and marital satisfaction; reduced pregnancy stress and prenatal anxiety; and effective hyperthyroidism treatment might reduce AD. This study underscored the significance of delivering actionable strategies and tangible assistance to pregnant women to reduce AD.
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Affiliation(s)
- Yanchi Wang
- Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), Nantong, Jiangsu, China
- Medical School of Nantong University, Nantong, Jiangsu, China
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China
| | - Jian Gu
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Feng Zhang
- Medical School of Nantong University, Nantong, Jiangsu, China.
- Medical School (School of Nursing), Nantong University, Nantong, 226001, Jiangsu, China.
| | - Xujuan Xu
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China.
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Akintunde TY, Chen S, Isangha SO, Di Q. Adverse childhood experiences, emotional distress and dissatisfaction with motherhood among first-time mothers: Mediations and child differences. Glob Ment Health (Camb) 2024; 11:e18. [PMID: 38414725 PMCID: PMC10897492 DOI: 10.1017/gmh.2024.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/27/2023] [Accepted: 01/28/2024] [Indexed: 02/29/2024] Open
Abstract
Despite the challenges associated with motherhood, studies have not consistently identified factors contributing to first-time mothers' dissatisfaction with motherhood in resource-limited regions. To fill this research gap, this study investigates how adverse childhood experiences (ACEs) result in first-time mothers' dissatisfaction with motherhood through emotional distress in Nigeria. Results from the partial least square structural equation model suggests that ACEs are associated with dissatisfaction with motherhood ( = 0.092; p < 0.01) and emotional distress ( = 0.367; p < 0.001). There is also a significant association between emotional distress and dissatisfaction with motherhood ( = 0.728; p < 0.001). Indirect path from first-time mothers' ACEs to dissatisfaction with motherhood through emotional distress shows significance ( = 0.267; 95% CI (0.213, 0.323); p < 0.001). In addition, the indirect path from first-time mothers' ACEs to dissatisfaction with motherhood through child emotional closeness showed significant dampening effects ( = 0.044; 95% CI (0.025, 0.066); p < 0.001). No serial impact of emotional distress and child emotional closeness was found in the study. The findings based on child gender indicated that only among first-time mothers of female children are ACEs predictors of dissatisfaction with motherhood. Trauma-informed interventions should be introduced in primary care settings to screen for ACEs and emotional dysfunctions among first-time mothers.
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Affiliation(s)
- Tosin Yinka Akintunde
- Department of Sociology, School of Public Administration, Hohai University, Nanjing, China
| | - Shaojun Chen
- Department of Sociology, School of Public Administration, Hohai University, Nanjing, China
| | - Stanley Oloji Isangha
- Department of Social and Behavioral Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Qi Di
- Department of Sociology, School of Public Administration, Hohai University, Nanjing, China
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Zhang M, Xie W, Li J, Zheng J, Zhou Y. Postmarketing safety profile of brexanolone: a pharmacovigilance analysis based on FDA Adverse Event Reporting System (FAERS). Arch Womens Ment Health 2024; 27:35-44. [PMID: 37831172 DOI: 10.1007/s00737-023-01378-1] [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: 06/25/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Brexanolone (Zulresso®) that was approved for the USA in March 2019 is indicated for the treatment of postpartum depression (PPD), but information on adverse drug reactions (ADRs) associated with its use is limited. The main aim of this study was to explore the postmarketing safety profile of brexanolone. METHODS In our case/non-case pharmacovigilance study based on the FDA Adverse Event Reporting System (FAERS), the reporting odds ratio and information component with 95% confidence intervals were estimated as measures of disproportionate reporting. Primary disproportionality analyses were performed by comparing brexanolone with all other drugs or selective serotonin reuptake inhibitors (SSRIs). Sensitivity analyses were performed on a subset of perinatal depression. RESULTS We identified 267 cases using brexanolone. Brexanolone was reported as a primary or secondary suspect drug in most cases (n = 260, 97.38%). Of the total brexanolone cases, positive dechallenge and discontinuation accounted for 12.36% (n = 33) and 26.22% (n = 70), respectively. Serious outcomes were reported in 11.61% (n = 31) patients. Compared to all the other drugs or SSRIs within the same time window, the reporting risks of brexanolone were mainly from psychiatric and nervous systems. Sensitivity analyses indicated that these significant disproportionalities were mostly retained. CONCLUSION Our pharmacovigilance analysis showed a high reporting frequency of psychiatric and nervous system ADRs associated with the use of brexanolone. In additional prospective research, these signals urgently need to be clarified.
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Affiliation(s)
- Meilian Zhang
- Department of Ultrasound, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wenhuo Xie
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Jianbin Li
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Jiaping Zheng
- Department of Rehabilitation Medicine, School of Health, Fujian Medical University, Fuzhou, China.
| | - Yu Zhou
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fujian Medical University, Fuzhou, China.
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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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Wang W, Ling B, Zhao H, He J, Xu H, Lv J, Wang Q. Effect of esketamine on postpartum depression after labor analgesia and potential mechanisms: a randomized, double-blinded controlled trial. BMC Anesthesiol 2024; 24:4. [PMID: 38166663 PMCID: PMC10759400 DOI: 10.1186/s12871-023-02377-6] [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: 04/24/2023] [Accepted: 12/10/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To evaluate the effect of esketamine combined with ropivacaine hydrochloride on the occurrence of postpartum depression (PPD) after labor analgesia under epidural analgesia pump and explore the possible mechanisms. METHODS A total of 120 women aged 24 to 36 years old who underwent labor analgesia by epidural analgesia pump, with American Society of Anesthesiologists (ASA) physical status II were enrolled. According to the formula of epidural analgesia pump, all participants were randomly divided into two groups: esketamine group (Group E) and control group (Group C). Epidural anaesthesia were operated in all women between L2 and L3 after cervical dilation up to 2 ~ 3 cm. After successful puncture, the epidural catheter was placed 3.5 cm toward the head and 1% lidocaine was injected for 3 ml. The epidural analgesia pump was connected. Esketamine (0.2 mg/kg) combined with 0.75% ropivacaine hydrochloride (20 ml) were diluted by normal saline up to 100 ml in Group E, when only the equal dose of ropivacaine hydrochloride was used in Group C. The visual analogue scale (VAS) before analgesia (T1), 5 (T2), 10 (T3) and 20 (T4) minutes after analgesia were measured. The duration of the first and second stage of labor, the Apgar score of fetus at delivery, postpartum hemorrhage, consumption of esketamine and ropivacaine were recorded. The incidence of PPD was recorded at 1 week and 6 weeks after delivering. The occurrence of side effects such as nausea and vomiting, dizziness, and nightmares were also recorded for 48 h after delivering. The levels of leptin, norepinephrine(NE), and epinephrine(E) in the peripheral venous blood were measured before labor analgesia and at 24 h, 1 week, and 6 weeks after delivering. RESULTS Compared with Group C, the VAS score at T2, T3 and T4 were significantly lower in Group E (P < 0.01). Compared with Group C, the incidence of PPD was significantly lower at 1 week and 6 weeks after delivering in Group E (P < 0.01). Compared with Group C, the levels of leptin were significantly higher at 24 h and 1 week after delivering in Group E (P < 0.01), while NE and E (P < 0.01) were lower at the same time (P < 0.01). There were no significant difference of the duration of the first and second stage of labor, the Apgar score of fetus at delivery, postpartum hemorrhage, consumption of ropivacaine and the side effects for 48 h after delivering between the two groups. CONCLUSION Esketamine combined with ropivacaine hydrochloride used in labor analgesia can significantly reduce the incidence of postpartum depression after delivering without increasing related side effects, which may be related to the regulation of leptin, norepinephrine, and epinephrine in the serum. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry on 30/05/2022 (CTRI registration number-ChiCTR2200060387). URL of registry: https://www.chictr.org.cn/bin/home .
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Affiliation(s)
- Wei Wang
- Department of Anesthesiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 169 Hushan Road, Nanjing, 211100, China
| | - Bin Ling
- Department of Anesthesiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 169 Hushan Road, Nanjing, 211100, China
| | - Haibo Zhao
- Department of Anesthesiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 169 Hushan Road, Nanjing, 211100, China
| | - Jing He
- Department of Anesthesiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 169 Hushan Road, Nanjing, 211100, China
| | - Hua Xu
- Department of Gynaecology and obstetrics, The Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, 211100, China
| | - Jie Lv
- Department of Anesthesiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 169 Hushan Road, Nanjing, 211100, China
| | - Qi Wang
- Department of Anesthesiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 169 Hushan Road, Nanjing, 211100, China.
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Helle C, Hillesund ER, Øverby NC. Maternal mental health is associated with children's frequency of family meals at 12 and 24 months of age. MATERNAL & CHILD NUTRITION 2024; 20:e13552. [PMID: 37596722 PMCID: PMC10750025 DOI: 10.1111/mcn.13552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/03/2023] [Accepted: 07/20/2023] [Indexed: 08/20/2023]
Abstract
Diet during the child's first years is important for growth and development. In toddlerhood, higher diet quality is reported among children eating meals together with family. Although previous literature has documented several associations between maternal mental health and early child feeding practices, less is known about the relationship between maternal mental health and child frequency of shared family meals. This study explores associations between maternal symptoms of anxiety and depression, measured by The Hopkins Symptoms Checklist (SCL-8), and toddler participation in family meals. We used cross-sectional data from the Norwegian study Early Food for Future Health, in which participants responded to questionnaires at child age 12 (n = 455) and 24 months (n = 295). Logistic regression was used to explore associations between maternal mental health and child having regular (≥5 per week) or irregular (<5 per week) family meals (breakfast and dinner), adjusting for relevant child and maternal confounding variables. Children of mothers with higher scores of anxiety and depression had higher odds of Irregular family meals at both timepoints; (OR: 2.067, p = 0.015) and (OR: 2.444, p = 0.023). This is one of few studies exploring associations between maternal mental health and child frequency of shared family meals in early childhood, a period where the foundation for life-long health is shaped. Given the high prevalence of mental ailments and disorders, these findings are important and may inform future public health interventions. Further exploration of this relation is needed, including longitudinal research to test predictive associations and qualitative studies to increase insight and understanding.
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Affiliation(s)
- Christine Helle
- Department of Nutrition and Public Health, Faculty of Health and Sport SciencesUniversity of AgderKristiansandNorway
| | - Elisabet R. Hillesund
- Department of Nutrition and Public Health, Faculty of Health and Sport SciencesUniversity of AgderKristiansandNorway
| | - Nina Cecilie Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sport SciencesUniversity of AgderKristiansandNorway
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Liseth O, Weng J, Schenone M, Moore K, Betcher H, Branda M, Rivera-Chiauzzi E, Larish A. The impact of fetal surgical procedures on perinatal anxiety and depression. Am J Obstet Gynecol MFM 2024; 6:101244. [PMID: 38061550 DOI: 10.1016/j.ajogmf.2023.101244] [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: 09/09/2023] [Revised: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Perinatal mental illness presents a significant health burden to both patients and families. Many factors are hypothesized to increase the incidence of perinatal depression and anxiety in the fetal surgical population, including uncertain fetal prognosis and inherent risks of surgery and preterm delivery. OBJECTIVE This study aimed to determine the incidence and disease course of postpartum depression and anxiety in the fetal surgery population. STUDY DESIGN A retrospective medical record review study was conducted of fetal surgery patients delivering between November 2016 and November 2021 at an academic level IV perinatal healthcare center. Demographics and surgical, obstetrical, and psychiatric diagnoses were abstracted. Standard descriptive analyses were performed. RESULTS Eligible patients were identified (N=119). Fetal surgery was performed at a mean gestational age of 22.8 weeks (standard deviation, 4.11). Laser ablation of placental anastomoses (n=51) and in utero myelomeningocele repair (n=22) were the most common procedures. Of 119 patients, 34 (28.6%) were diagnosed with preexisting depression or anxiety, with 19 (55.9%) and 17 (50.0%) on baseline medication for depression or anxiety, respectively, before surgery. Of 85 patients, 23 (27.1%) without a history of anxiety or depression had new identification of one or both after delivery. Of note, 2 patients experienced suicidal ideation after delivery. Of the 119 patients, 8 (6.7%) and 12 (10.1%) initiated a new psychiatric medication during or after pregnancy, respectively, and 19 (16.0%) received a therapy referral. Among patients with baseline anxiety or depression, 20 of 34 patients (58.8%) experienced an exacerbation after delivery, 9 of 34 patients (26.5%) were referred for therapy, 9 of 34 patients (26.5%) were changing dose or medication for anxiety, and 11 of 34 patients (32.4%) were changing dose or medication for depression. Of the 119 patients, 24 (20.2%) experienced new or worsening depression or anxiety after the standard 6-week postpartum visit. CONCLUSION Among patients undergoing fetal surgery, a high incidence of postpartum depression and anxiety was identified, with most patients with prepregnancy anxiety or depression experiencing exacerbation after delivery. The timeframe to clinical presentation with depression or anxiety symptoms may be delayed beyond the traditional 6-week postpartum period and into the first postpartum year. This observation could be attributed to de novo postpartum exacerbation or a lack of standardized treatment approaches earlier in the disease course or antepartum period. Understanding effective longitudinal supportive interventions is an essential next step.
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Affiliation(s)
- Olivia Liseth
- Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (Mses Liseth and Weng)
| | - Jessica Weng
- Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (Mses Liseth and Weng)
| | - Mauro Schenone
- Departments of Obstetrics and Gynecology (Drs Schenone, Rivera-Chiauzzi, and Larish)
| | | | | | - Megan Branda
- and Biostatistics (Ms Branda), Mayo Clinic, Rochester, MN
| | - Enid Rivera-Chiauzzi
- Departments of Obstetrics and Gynecology (Drs Schenone, Rivera-Chiauzzi, and Larish)
| | - Alyssa Larish
- Departments of Obstetrics and Gynecology (Drs Schenone, Rivera-Chiauzzi, and Larish).
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Konjevod M, Gredicak M, Vuic B, Tudor L, Nikolac Perkovic M, Milos T, Svob Strac D, Pivac N, Nedic Erjavec G. Overview of metabolomic aspects in postpartum depression. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110836. [PMID: 37541332 DOI: 10.1016/j.pnpbp.2023.110836] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023]
Abstract
Along with the typical biochemical alterations that occur during pregnancy, certain metabolic changes might be associated with the development of several psychiatric disorders, including postpartum depression (PPD), which is the most common type of psychiatric disorder during pregnancy or first postpartum year, and it develops in about 15% of women. Metabolomics is a rapidly developing discipline that deals with the metabolites as the final products of all genetically controlled biochemical pathways, highly influenced by external and internal changes. The aim of this paper was to review the published studies whose results suggest or deny a possible association between the fine regulation of the metabolome and PPD, enabling conclusions about whether metabolomics could be a useful tool in defining the biochemical pathways directly involved in the etiology, diagnosis and course of PPD. Beside numerous hormonal changes, a lot of different metabolic pathways have been discovered to be affected in women with PPD or associated with its development, including alterations in the energy metabolism, tryptophan and amino acid metabolism, steroid metabolism, purine cycle, as well as neurotransmitter metabolism. Additionally, metabolomics helped in defining the association between PPD and the exposure to various endocrine disrupting metabolites during pregnancy. Finally, metabolome reflects different PPD therapies and exposure of fetus or breastfed infants to pharmacotherapy prescribed to a mother suffering from PPD. This review can help in creating the picture about metabolomics' broad application in PPD studies, but it also implies that its potential is still not completely used.
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Affiliation(s)
| | - Martin Gredicak
- General Hospital Zabok and Hospital for the Croatian Veterans, Bracak 8, p.p. 36, 49210 Zabok, Croatia
| | - Barbara Vuic
- Rudjer Boskovic Institute, Bijenicka 54, 10000 Zagreb, Croatia.
| | - Lucija Tudor
- Rudjer Boskovic Institute, Bijenicka 54, 10000 Zagreb, Croatia.
| | | | - Tina Milos
- Rudjer Boskovic Institute, Bijenicka 54, 10000 Zagreb, Croatia.
| | | | - Nela Pivac
- Rudjer Boskovic Institute, Bijenicka 54, 10000 Zagreb, Croatia; University of Applied Sciences Hrvatsko Zagorje Krapina, Setaliste hrvatskog narodnog preporoda 6, 49000 Krapina, Croatia.
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Shi Q, Wang J, Zhao D, Gu LY. Effect of cognitive behavior therapy training and psychological nursing on the midwifery process in the delivery room. World J Psychiatry 2023; 13:1053-1060. [PMID: 38186726 PMCID: PMC10768494 DOI: 10.5498/wjp.v13.i12.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/18/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The severe physical and psychological impact of pain on the physical and mental health of women during labor leads to increased risks and complications during childbirth, presenting a major public health concern. Some studies have shown that cognitive behavioral therapy (CBT) has a positive effect on maternal psychology during delivery, reducing stress and shortening labor time. Thus, CBT training for mothers and delivery room staff may be beneficial in minimizing complications and adverse effects during natural birth. AIM To investigate the clinical effects of CBT training and psychological care during delivery, and their therapeutic effects on women in labor. METHODS This study used a retrospective analysis and included 140 mothers admitted to the maternity ward between January 2021 and January 2023. The study subjects were randomized into two groups: control (n = 70) and observation (n = 70). Routine care, CBT training, and psychological care were provided to mothers in both groups. Psychological status scores, delivery time, and satisfaction with care pre- and post-delivery were compared, and the incidence of complications after receiving care was analyzed between the two groups. RESULTS Although the psychological state of both groups improved significantly in the late stages of labor, the psychological state scores of the mothers in the observation group were significantly lower than those of the mothers in the control group (P < 0.05). The duration of labor and incidence of complications in the observation group were significantly lower than those in the control group (P < 0.05). The mothers in the observation group were significantly more satisfied with nursing care during the course of labor than those in the control group (P < 0.05). CONCLUSION CBT training and psychological care for mothers in the midwifery process can effectively improve anxiety and depression, shorten labor duration, reduce postnatal complications, and improve nursing satisfaction and nurse-patient relationships. Its clinical application is effective and has popularization value, providing a new way to protect maternal mental health.
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Affiliation(s)
- Qin Shi
- Department of Gynaecology and Obstetrics, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215125, Jiangsu Province, China
| | - Jie Wang
- Department of Gynaecology and Obstetrics, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215125, Jiangsu Province, China
| | - Dan Zhao
- Department of Gynaecology and Obstetrics, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215125, Jiangsu Province, China
| | - Ling-Yan Gu
- Department of Gynaecology and Obstetrics, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215125, Jiangsu Province, China
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Marecki R, Kałuska J, Kolanek A, Hakało D, Waszkiewicz N. Zuranolone - synthetic neurosteroid in treatment of mental disorders: narrative review. Front Psychiatry 2023; 14:1298359. [PMID: 38116383 PMCID: PMC10729607 DOI: 10.3389/fpsyt.2023.1298359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023] Open
Abstract
With each passing year, the number of people suffering from mental disorders grows at a disturbing speed. Neuroactive steroids are a new promising group of drugs with the potential for use in many diseases like postpartum depression, postnatal psychosis, major depression, insomnia, bipolar disorder, and Parkinson's tremor, due to their ability to modulate the activity of GABAA receptor. Neurosteroids are progesterone metabolites that are synthesized from cholesterol or steroid hormones in various brain regions. They regulate neuronal development, regeneration, and neurotransmission. They are implicated in mood disorders, anxiety disorders, schizophrenia, PTSD, and impulsive aggression. Neurosteroids have been studied for their potential to prevent or treat neurodegenerative diseases such as Alzheimer's disease and HIV-associated dementia. They can promote neurogenesis, neuronal survival, myelination, and memory function. They can also affect the growth and sensitivity of hormone-dependent brain tumors such as gliomas. Zuranolone, a newly registered neurosteroid drug has shown huge flexibility in both clinical and ambulatory treatment thanks to its pharmacokinetic traits, especially the possibility for oral administration, unlike its predecessor Brexanolone. Zuranolone is a synthetic positive allosteric modulator of the GABAA receptor that can be taken orally. The review aims to summarize the current knowledge on zuranolone as a novel neurosteroid drug for various mental disorders, especially for postpartum mental disorders for which this drug was meant originally. It covers studies indexed in the PubMed, Scopus, and Web of Science databases published since 2017. Keywords used in the search, as well as inclusion and exclusion criteria, are given in the aims and methodology section. The review explains the evidence for the role of neurosteroids, especially allopregnanolone, in the pathophysiology and treatment of postpartum depression. It discusses the mechanisms of neurosteroid action, the changes in neurosteroid levels during pregnancy and postpartum, and the clinical trials of brexanolone and zuranolone, two synthetic analogs of allopregnanolone, for postpartum depression. It provides an overview of the biosynthesis and metabolism of neurosteroids in the central and peripheral nervous system. Furthermore, it explains the different sources and pathways of neurosteroid production and the factors that influence their synthesis and regulation, such as stress, hormones, drugs, and genetic variations. The review also explores the potential relevance of neurosteroids for other psychiatric disorders, such as major depression, bipolar disorder, post-traumatic stress disorder (PTSD), schizophrenia, and premenstrual dysphoric disorder. Finally, it highlights the associations between neurosteroid levels and symptom severity and the effects of neurosteroid modulation on mood, cognition, and neuroplasticity.
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