Maternal postnatal depression and child growth: a European cohort study

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Association between maternal postpartum depression and children's physical growth in early childhood: a birth cohort study

Background

Untreated maternal postpartum depression (PPD) has consequences for children's physical growth, but no published study has evaluated changes in this effect over time. Here we therefore aimed to evaluate the dynamic effects of PPD on the physical growth of children in a prospective birth cohort.

Methods

Between 2015 and 2019, 960 mother-child pairs in Changsha, China were followed up when the child was aged 1-48 months. Data were obtained through household surveys. The mothers' depressive symptoms were measured using the Edinburgh Postpartum Depression Scale (EPDS) at 1 month postpartum. Linear mixed models were used to examine the changes in the association of PPD and EPDS scores with physical growth in six different age groups of children between 1 and 48 months.

Results

A total of 604 mother-child pairs completed the follow-up, and 3.3% of mothers reported PPD. No associations were found between PPD and weight or height growth at any age. While EPDS scores were associated with weight gain (β = -0.014, 95% CI (-0.025, -0.002), P = 0.024) and height growth (β = -0.044, 95% CI (-0.084, -0.004), P = 0.030) rates at 1-3 months, no associations were found in older children.

Limitations

The number of mothers who reported PPD was relatively small, and the measurement of PPD was not continuously taken.

Conclusions

After adjustments for confounders, no dynamic association was found between PPD and children's weight and height growth. EPDS scores, in contrast, did negatively affect children's weight and height growth at age 1-3 months, but this effect was not long-lasting.

Maternal depressiveness and infant growth outcomes: Findings from the MAASTHI cohort study in India

OBJECTIVE

The study aims to examine the association between depressiveness in mothers on infant obesity and stunting at one year of age.

METHODS

We enrolled 4829 pregnant women, followed them up at public health facilities in Bengaluru for one year after birth. We collected information on women's sociodemographic characteristics, obstetric history, depressive symptoms during pregnancy and delivery within 48 h. We took infant anthropometric measurements at birth and one year. We used chi-square tests, and calculated an unadjusted odds ratio using univariate logistic regression. We used multivariate logistic regression to examine the association between maternal depressiveness, childhood adiposity, and stunting.

RESULTS

We found that the prevalence of depressiveness was 31.8% in mothers who delivered in public health facilities in Bengaluru. Infants born to mothers with depressiveness at birth had 3.9 times higher odds of having larger waist circumference than infants born to mothers with no depressiveness (AOR: 3.96, 95% Confidence Interval: 1.24,12.58) and 1.9 times higher odds of having a larger sum of skinfold thickness (AOR: 1.99, 95% CI: 1.18,3.38). Additionally, we found that infants born to mothers with depressiveness at birth had 1.7 times higher odds of stunting than infants born to mothers with no depressiveness (AOR: 1.72; 95%CI: 1.22,2.43) after adjusting for confounders.

CONCLUSION

Our study highlights a high prevalence of depressiveness among mothers seeking antenatal care at a public hospital is associated with an increased risk of infant adiposity and stunting at one year. Further research is needed to understand the underlying mechanisms and identify effective interventions.

Association of maternal psychological distress with children with overweight/obesity in Ethiopia

BACKGROUND

Poor maternal mental health is a major risk factor for adverse offspring health outcomes, including overweight/obesity status. Maternal mental distress is highly prevalent and associated with parenting practices influencing child weight. To date, there is little information documented in Ethiopia on maternal mental distress and children with overweight/obesity status. This study examined the association between maternal mental distress and children with overweight/obesity among mother-child dyads in Addis Ababa, Ethiopia.

METHODS

An observational population-based cross-sectional study was conducted among mother-child dyads in representative samples in Addis Ababa, Ethiopia. Maternal mental distress was measured using the Self-Reporting Questionnaire (SRQ)-20. Child/adolescent overweight/obesity was defined as more than 1 SD above the median World Health Organization (WHO) growth reference. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

The prevalence of maternal mental distress and children with overweight/obesity was estimated to be 10.1% and 28.8%, respectively. After adjusting for confounders, including maternal education, maternal occupation, average monthly household income, maternal body mass index (BMI) and the number of household members/family size, maternal psychological distress was not associated with offspring overweight/obesity status (adjusted OR [aOR] = 0.54; 95% CI: 0.25, 1.14).

CONCLUSIONS

There is no evidence of an association between maternal psychological distress and children with overweight/obesity. This lack of association might be attributable to our cross-sectional study design. Future epidemiologic studies, particularly those using prospectively collected data, are warranted to examine better the effects of maternal psychological distress on offspring body weight.

A quantitative comparison of two measures of postpartum depression

BACKGROUND

Studies investigating the prevalence and risk factors for postpartum depression (PPD) have used different definitions. Some studies have used a high score on the Edinburgh Postnatal Depression Scale (EPDS) to define PPD, whereas others have used information on antidepressant medication use and/or diagnostic information on treatment for depression at a psychiatric hospital. We wanted to compare results using these two approaches to evaluate to what degree results can be compared. Moreover we wanted to evaluate, whether use of EPDS or PPAT (defined below) leads to identification of different risk factor profiles.

METHODS

We identified women who delivered a child between 1 January 2014 and 31 December 2016 in Copenhagen or in one of the municipalities that were part of the Danish Health Visitors' Child Health Database. The potential risk factors were demographic factors and pregnancy- and obstetrical events. Outcomes of interest were an EPDS score ≥ 13, use of antidepressants (ATC: N06A) and/or a diagnosis of depression (F32) within six months after birth. Use of antidepressants and/or diagnosis of depression will be referred to as postpartum antidepressant treatment (PPAT). Agreement between EPDS ≥ 13 and PPAT was evaluated by the kappa coefficient. Associations between risk factors and the two outcomes (EPDS ≥ 13 and PPAT) were estimated by risk ratios (RR) using log-linear binomial regression. Presence of a systematic difference between RRs based on EPDS ≥ 13 (RR_EPDS≥13) and PPAT (RR_PPAT) was evaluated in a meta-regression approach weighted by inverse-variance and with logarithm of the RRs as outcome.

RESULTS

The estimated PPD prevalence using EPDS ≥ 13 was 3.2% and of PPAT 0.4%. The agreement between the two measures was small (Kappa = 0.08), but their risk factor profile was very similar with no systematic difference between them.

CONCLUSIONS

Using the two different methods of case identification produced different prevalence estimates, but a similar risk factor profile. The differences in estimated prevalence and low agreement suggest that the two measures identify different potential PPD cases and using only one of the methods in defining PPD would underestimate PPD prevalence. The similar risk factor profile suggests that the considered risk factors are involved in the general development of PPD.

Maternal depressed mood and child development over the first five years of life in South Africa

BACKGROUND

While the negative impact of peri-natal depression is well-documented in high-income countries, the long-term effects across the life course in low and middle-income countries is less clear. Children's adjustment over the first five years is examined as a function of patterns of maternal depressed mood.

METHODS

Pregnant women in 24 peri-urban townships (N = 1,238) were randomized to a home-visiting intervention or standard care and reassessed five times, with high retention. There were no intervention effects on children past 18 months. Multilevel regression models examined the impact of depressed mood on child outcomes. Using the Edinburgh Postnatal Depression Scale, four patterns of maternal depressed mood were identified: never (40.6%); antenatal (13.0%); early childhood (26.1%); and recurrent episodes of depressed mood (20.3 %).

FINDINGS

Mothers' patterns of depressive symptoms and child outcomes were similar, regardless of intervention. Never depressed mothers were significantly younger, had higher income, less food insecurity, were more likely to have electricity, be living with HIV or have an HIV positive partner, and had fewer problems with alcohol than depressed mothers. Children of mothers who experienced depressed mood weighed less, were more aggressive, and were hospitalized more often than children of never depressed mothers, but were similar in cognitive and social development.

INTERPRETATIONS

Depressed mood, has significant negative impacts on South African children's growth and aggressive behavior. The timing of maternal depressed mood was less important than never having a depressed mood or a recurrent depressed mood.

FUNDING

There were no funding conflicts in executing this trial.

Maternal depressive symptoms are not associated with child anaemia: A cross-sectional population study in Peru, 2015

INTRODUCTION

Approximately, one in three Peruvian children aged 6 to 59 months old have anaemia. Maternal depression, which may be disabling and affect the proper care of children, is associated with chronic malnutrition in their offspring. Therefore, the aim of this study is to evaluate if there is an association between depressive symptoms of mothers with the presence of anaemia in their children.

METHODS

Analytical cross-sectional study of the Peruvian Demographic Health Survey 2015, which is nationally representative. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) using a score of 10 as cut-off. The presence of anaemia was measured using HemoCue® and was considered positive when the haemoglobin was less than 11 g/dl.

RESULTS

Crude and adjusted prevalence ratios (PR and aPR) were calculated with 95% confidence interval (CI), using generalized linear models of the Poisson family. We analysed 6683 mother-child binomials. The prevalence of anaemia in the children and depressive symptoms in women were 28.7% (95% CI: 27.3-30.2) and 6.9% (95% CI: 6.1-7.9), respectively. We found no statistically significant association between these variables in the bivariable analysis or in the different multivariable models (aPR: 1.05, 95% CI: 0.85-1.30). The sample did not have moderate or severe malnutrition.

CONCLUSIONS

There is no statistically significant difference between the prevalence of anaemia in children of mothers with or without depressive symptoms. We recommend continuing research in this field to determine more associate factors to childhood anaemia in order to improve primary prevention interventions. Ideally, conducting longitudinal studies such as prospectives cohorts to determine risk factors should be done.

Association of Antidepressant Continuation in Pregnancy and Infant Birth Weight

PURPOSE

The aim of the study was to evaluate the association of antidepressant continuation in pregnancy with infant birth weight among women using antidepressants before pregnancy.

METHODS

This retrospective cohort study used electronic health data linked with state birth records. We identified singleton live births (2001-2014) to enrolled women with 1 or more antidepressant prescriptions filled 6 months or less before pregnancy, including "continuers" (≥1 antidepressant fills during pregnancy, n = 1775) and "discontinuers" (no fill during pregnancy, n = 1249). We compared birth weight, small or large for gestational age (SGA or LGA), low birth weight (LBW; <2500 g), and macrosomia (>4500 g) between the 2 groups, using inverse probability of treatment weighting to account for pre-pregnancy characteristics, including mental health conditions.

RESULTS

After weighting, infants born to antidepressant continuers weighed 71.9 g less than discontinuers' infants (95% confidence interval [CI], -115.5 to -28.3 g), with a larger difference for female infants (-106.4 g; 95% CI, -164.6 to -48.1) than male infants (-48.5 g; 95% CI, -107.2 to 10.3). For female infants, SGA risk was greater in continuers than discontinuers (relative risk [RR],1.54; 95% CI, 1.02 to 2.32). Low birth weight risk was greater in continuers with 50% or more of days covered (RR, 1.69; 95% CI, 1.11 to 2.58) and exposure in the second trimester (RR, 1.53; 95% CI, 1.02 to 2.29), as compared with discontinuers.

CONCLUSIONS

Depending on infant sex, as well as duration and timing of use, continuation of antidepressant use during pregnancy may be associated with lower infant birth weight, with corresponding increases in LBW and SGA.

Feeding and Growth in Infants With Cleft Lip and/or Palate: Relationships With Maternal Distress

OBJECTIVE

To examine relationships between early feeding and growth and maternal distress in infants with and without cleft lip and/or palate (CL/P).

DESIGN

Cross-sectional.

SETTING

Pediatric academic medical center in the Midwestern United States.

PARTICIPANTS

Mothers of infants 1 to 12 weeks old with CL/P (n = 30) and without CL/P (control group, n = 30) were recruited at craniofacial clinic or pediatrician appointments.

MAIN OUTCOME MEASURE(S)

Maternal responses on the Feeding/Swallowing Impact Survey (FS-IS), Parenting Stress Index, Fourth Edition, Short Form (PSI-4-SF), and Edinburgh Postnatal Depression Scale. Infant feeding history and growth measurements were obtained.

RESULTS

Having an infant with CL/P revealed greater impact on maternal health-related quality of life due to feeding problems (F = 4.83, P = .03). Mothers of infants with CL/P reported average range Total Stress scores on the PSI-4-SF, which were higher than controls (F = 4.12, P = .05). Edinburgh Postnatal Depression Scale scores did not differ between groups. Compared to controls, infants with cleft palate had lower percentiles for weight (t = 4.13, P = .04) and length (t = 2.93, P = .01). Higher FS-IS scores were associated with longer feeding duration (r = 0.32, P = .01) and lower weight (r = -0.31, P = .02) and length (r = -0.32, P = .02).

CONCLUSIONS

Despite receiving early team care and feeding interventions, mothers of infants with CL/P reported higher stress and more challenges with feeding and growth. Future studies should examine targeted psychosocial interventions to improve feeding and growth outcomes in infants with CL/P.

Maternal depression trajectories from 3 months to 11 years postpartum and offspring body composition in early adolescence

OBJECTIVE

To investigate the effect of maternal depressive symptom trajectories, from 3 months to 11 years postpartum, on the offspring's body composition at 11 years of age.

DESIGN

Data from the Pelotas 2004 Birth Cohort, from the perinatal interview and from the 3-, 12-, 24- and 48-month and 6- and 11-year follow-ups.

SETTING

Community-based sample from the city of Pelotas, located in southern Brazil with approximately 350 000 inhabitants. The maternal depression symptom trajectories were identified through a semi-parametric group-based modelling approach, using the Edinburgh Postnatal Depression Scale (EPDS), with data from 3 months to 11 years postpartum.

PARTICIPANTS

A total of 3467 (81·9 % of the total cohort).

RESULTS

Five trajectory groups of EPDS scores were identified ('Low', 'Moderate low', 'Increasing', 'Decreasing' and 'Chronic high'). A total of 170 women (4·9 %) from the sample belonged to the 'Chronic high' group, having scored ≥13 EPDS points at every follow-up. Mean BMI in the 'Low' trajectory group was 0·77 (z-score 1·4), compared with 0·56 (z-score 1·4) in the 'Chronic high' group. Children from mothers in the 'Chronic high' group had lower fat mass (FM) (-1·34 ± 0·64 kg), FM% (-2·02 ± 0·85 percentage points) and FM index (-0·57 ± 0·27 kg/m2), compared with children from mothers in the 'Low' trajectory group. Adjusted analyses showed that sustained or transitory maternal depressive symptoms during childhood had no effect on the offspring's body composition indices at 11 years of age.

CONCLUSION

Children raised by chronically depressed mothers have body composition indices at 11 years of age that are similar to those of children whose mothers have never been depressed.

Postpartum stress and infant outcome: A review of current literature

Postpartum stress has been shown to have an association with infant growth, nutrition, bonding, temperament and ultimately childhood mental wellbeing. When persistent, recurring or chronic, it can negatively impact infant outcome, including the subscales of mental wellbeing such as growth, development, feeding, attachment and sleep. This study aims to define the physical and functional effect of postpartum stress on measures of infant mental wellbeing. A systematic review of English language articles published between 1995 and 2019 on PubMed, Medline and Psych base databases was carried out. Search terms used included postpartum, stress, infant, growth, development, nutrition, attachment and sleep. Both qualitative and quantitative studies were reviewed with eligibility criteria. Inclusion criteria of human studies, mothers diagnosed with depressive and anxiety symptoms postpartum with infant correlates were used. All animal studies and studies with women already on medication were excluded. A total of 74 articles were reviewed and summarized into postpartum stress associations with infant growth, development, nutrition, sleep and maternal fetal attachment. Postpartum stress is negatively associated with poor developmental trajectories and linear growth deficits, causing stunting in growth; poor language and cognitive development; poor gross and fine motor movement, and infant sleep. An inverse relationship exists with breast feeding and postpartum depression. More importantly, breastfeeding efficacy is important for sustaining positive infant feeding outcome. Increased maternal age during postpartum depression has been linked, as a contributing factor, to decreased maternal fetal attachment/bonding. A ripple effect exists from the association between postpartum stress and poor infant sleep. There is strong evidence that correlates PPS to infant outcome, mediated through many external factors. More research needs to be conducted to delineate and potentially mitigate the impact of modifiable factors. Not all articles in the literature were reviewed.

Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes

Introduction:

The postpartum period represents the time of risk for the emergence of maternal postpartum depression. There are no systematic reviews of the overall maternal outcomes of maternal postpartum depression. The aim of this study was to evaluate both the infant and the maternal consequences of untreated maternal postpartum depression.

Methods:

We searched for studies published between 1 January 2005 and 17 August 2016, using the following databases: MEDLINE via Ovid, PsycINFO, and the Cochrane Pregnancy and Childbirth Group trials registry.

Results:

A total of 122 studies (out of 3712 references retrieved from bibliographic databases) were included in this systematic review. The results of the studies were synthetized into three categories: (a) the maternal consequences of postpartum depression, including physical health, psychological health, relationship, and risky behaviors; (b) the infant consequences of postpartum depression, including anthropometry, physical health, sleep, and motor, cognitive, language, emotional, social, and behavioral development; and (c) mother–child interactions, including bonding, breastfeeding, and the maternal role.

Discussion:

The results suggest that postpartum depression creates an environment that is not conducive to the personal development of mothers or the optimal development of a child. It therefore seems important to detect and treat depression during the postnatal period as early as possible to avoid harmful consequences.

Pre- and post-natal maternal anxiety and early childhood weight gain

BACKGROUND

While maternal depression has been linked to impaired child growth, the relationship between anxiety and child weight gain is unknown. The study objective was to investigate maternal pre- and post-natal anxiety in relation to child weight gain.

METHODS

Data included 1168 children in the Avon Longitudinal Study of Parents and Children. Child height and weight were measured at the median ages of 25 and 31 months postnatally and used to calculate body mass index (BMI). Maternal anxiety was measured with the Crown-Crisp Experiential Index at 18 and 32 gestational weeks, and two and 21 months postpartum. Mothers scoring in the top 15% at one or more of the four time points were considered to have anxiety. Maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale-7 (EPDS-7) at these same time points. Maternal depression was defined as EPDS-7 scores of >10. We used Generalized Estimating Equations to assess whether child BMI trajectories varied by the presence of maternal anxiety. Parallel analyses were conducted for maternal depression.

RESULTS

Among children of mothers who had anxiety at least at one timepoint, the BMI changes associated with a three-month increase in child age increased by 0.06 (95% CI:0.004-0.12) compared to BMI changes in children of mothers without anxiety. Maternal depressive symptoms were not associated with child BMI trajectories.

LIMITATIONS

Maternal anxiety and depressive symptoms were based on maternal self-report.

CONCLUSION

Maternal anxiety around childbirth was associated with modest increases in child BMI gain during the child's second year of life.

Review of the prevalence of postnatal depression across cultures

The purpose of this review was to examine articles related to recent epidemiological evidence of the prevalence of maternal postnatal depression (PND) across different countries and cultures and to identify specific epidemiological studies that have been carried out exclusively in Malaysia on the prevalence of maternal PND. The review was undertaken in two stages, an initial review and an updated review. At both stages systematic literature searches of online databases were performed to identify articles on the prevalence of maternal PND. A total of 124 articles concerning research conducted in more than 50 countries were included in the final analysis. There were wide variations in the screening instruments and diagnostic tools used although the Edinburgh Postnatal Depression Scale (EPDS) was the most common instrument applied to identify PND. The prevalence of maternal PND ranged from 4.0% to 63.9%, with Japan and America recording the lowest and highest rates, respectively. Within continents, a wide variation in reported prevalence was also found. The reported rates of maternal PND in Malaysia were much higher than that previously documented with a range of 6.8–27.3%. This review indicated that the widely cited prevalence of maternal PND of 10–15% underestimates rates of PND worldwide. The reasons for this variability may not be fully explained by review methods. Future studies should evaluate the nature of women's PND experiences across cultures to explain these wide variations.

Intimate Partner Violence, Depression, and Child Growth and Development

BACKGROUND

Evidence on the relationship between maternal depression and exposure to intimate partner violence (IPV) with child physical growth and development is equivocal. Our aim in the current study is to examine these relationships among women and their children in Tanzania.

METHODS

The Bayley Scales of Infant Development and anthropometric measures were used to assess children 18 to 36 months of age (n = 1031). Maternal exposure to IPV and depression were assessed using the Tanzania Demographic and Health Survey questionnaire and the Patient Health Questionnaire-9, respectively. We used linear regression models to calculate standardized mean differences (SMDs) for developmental outcomes and generalized linear models to estimate the associations with nutritional status.

RESULTS

Mild depressive symptoms in mothers (Patient Health Questionnaire-9 ≥5) and exposure to physical and sexual IPV were associated with lower SMDs for motor skills (-0.14 [P = .023] and -0.23 [P < .01], respectively), expressive communication (-0.13 [P = .187] and -0.23 [P < .01], respectively), receptive communication (-0.19 [P < .009] and -0.16 [P = .03], respectively), and cognitive development (-0.08 [P = .245] and -0.12 [P = .07], respectively). Exposure to physical and sexual IPV was associated with higher risk for stunting (relative risk = 1.6; P < .001).

CONCLUSIONS

This study reveals that maternal depressive symptoms and IPV are associated with adverse child nutritional and developmental outcomes. Further research is needed to develop programs to address IPV and depression among women and enhance the growth and development of their children.

Effect of maternal postpartum depression on offspring's growth

BACKGROUND

Previous studies have linked maternal depression to different child offspring's growth outcomes. However, its effect has not been well established. The aim of this review was to evaluate the available evidence on the effect of maternal postpartum depression on offspring weight and height growth outcomes.

METHODS

A systematic review of longitudinal studies that evaluated the effect of maternal depression on child's growth outcomes was conducted in PubMed, LILACs, Web of Science, Science Direct and PsyInfo databases, using maternal postpartum depression related keywords, according to each database searching tool.

RESULTS

A total of 9608 articles were screened and 20 met the final inclusion criteria. The child's first-year growth was the most affected by the exposure to maternal depression. Children of depressed mothers had a higher chance of being underweight and stunted in the first year of life. Maternal depression was also associated with child's linear growth impairment after the first year.

LIMITATIONS

As a literature review, a publication bias could not be ruled out. The diversity of the published data made it unfeasible for a pooled effect to be estimated.

CONCLUSIONS

Considering the results observed on child's first year of life growth, physicians should engage in assessing maternal depression, as it is a treatable and manageable disease, thus avoiding unnecessary harm on child's physical development.

Factors Associated With Maternal Depression in the Maldives: A Prospective Cohort Study

The aim of the study was to document perinatal depression in mothers in the Maldives and associated factors. A cohort of 458 mothers was recruited at the 2 major hospitals in Malé, the Maldives, and followed from 36 weeks of pregnancy to 3 months after birth. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure maternal depression. Maternal sociodemographic factors and infant’s health were also recorded. The prevalence of depressive symptoms (EPDS score ≥13) at 36 weeks of pregnancy and at 1 and 3 months postpartum were 24%, 27%, and 12%, respectively. Having experienced stressful life events is an established risk factor for maternal depression across these time points. Having depressive symptoms during the postpartum period is significantly associated with presence of antenatal depressive symptoms. Future studies may look into effectiveness of strategies that cope with stressors in the management of maternal depression.

Risks of using SSRI / SNRI antidepressants during pregnancy and lactation

At present, affective disorders are among the most commonly diagnosed mental diseases. In pregnancy, they can occur as pre-delivery depression, recurrent depressive disorder or postnatal depression. The estimated prevalence of depressive disorders in pregnancy is approximately 9–16%, with some statistics reporting up to 20%. Approximately 2–3% of pregnant women take antidepressants during pregnancy, and the number of mothers treated increases by birth to 5–7%. Treatment of depression during pregnancy and breastfeeding is a controversial issue, as antidepressants can negatively affect the developing fetus. According to epidemiological studies, the effects of treated depression in pregnancy are related to premature birth, decreased body weight of the child, intrauterine growth retardation, neonatal adaptive syndrome, and persistent pulmonary hypertension. However, untreated depression can adversely affect maternal health and increase the risk of preeclampsia and eclampsia, as well as of subsequent postnatal depression, which can lead to disruption of the mother-child relationship. Based on the above mentioned facts, the basic question arises as to whether or not to treat depression during pregnancy and lactation.

Health professionals' perspective on the promotion of e-mental health apps in the context of maternal depression

OBJECTIVE

Our study focuses on exploring (1) the intention of health professionals to use and recommend e-mental health applications, (2) how this intention of health professionals might be influenced, (3) which group of health professionals might be most accessible to promote e-mental health applications for maternal depression, and (4) for which tasks they rate them to be most useful.

MATERIALS AND METHODS

Based on a questionnaire informed by the theory of planned behavior, we collected 131 responses of U.S., Spanish, and Swiss health professionals in the field of pregnancy and maternal care (including psychologists, psychiatrists, midwives, and doctors) by means of an online survey. We analyzed the gathered data applying a structured equation model.

RESULTS

Our study reveals that health professionals would in general intend to recommend and use e-mental health applications. However, their attitude towards e-mental health applications varies regarding the respective use cases and also differs among health professions.

CONCLUSION

We offer three alternative propositions for private or public organizations, associations, or any other entity whose purpose is service to the community for introducing e-mental health applications into practice.

Association between maternal depressive symptoms with child malnutrition or child excess weight

Abstract Objectives: to verify associations between maternal depressive symptoms with child malnutrition or child excess weight. Methods: prospective study with data from the BRISA prenatal cohort in São Luís, Brazil, obtained from the 22nd to the 25th week of gestation (in 2009 and 2010) and, later, when children were aged 12 to 32 months (in 2010 and 2012). Maternal depressive symptoms were identified using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Edinburgh Postnatal Depression Scale (EPDS). For the excess weight evaluation, BMI z-score for age > +2 was used. For measuring child malnutrition, height z-score for age < -2 was used. The confounding factors were identified using a directed acyclic graph in DAGitty software. Results: we did not find associations between maternal depressive symptoms with child malnutrition or child excess weight. The prevalence of maternal depressive symptoms was 27.6% during gestation and 19.8% in the second or third year of the child's life. The malnutrition rate was 6% and the excess weight rate was 10.9%. Conclusions: no associations between maternal depressive symptoms in prenatal or in the second or third year of the child's life and child malnutrition or excess weight were detected.

Maternal depression and child development: Evidence from São Paulo's Western Region Cohort Study

Introduction:

While a growing body of evidence has investigated the relationship between maternal mental health and child development, evidence on children's early life outcomes remains mixed. We analyze the empirical relationship between maternal depression and children's development at age one using data from the São Paulo Western Region Cohort project.

Method:

Seven hundred and ninety-eight (798) mother-child dyads living in the Butantã-Jaguaré' region of São Paulo were assessed through a home visit between January and March 2015. Maternal mental health was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Mothers were classified as "possibly depressed" if their EPDS score was between 10 and 13 and as "likely depressed" if their EPDS score was > 13. The child outcomes analyzed were height, weight, and overall development as assessed by the Ages and Stages Questionnaire (ASQ). Height and weight were age-normalized using WHO growth standards. Stunting was defined as height-for-age z-score (HAZ) < -2. Obesity was defined as body mass index z-score (BMIZ) > 2. Adjusted and unadjusted linear regression models were used to assess the associations between Edinburgh scores and child outcomes.

Results:

No association was found between maternal depression variables and children's height, weight, stunting, and obesity. Positive associations were found between possible depression and ASQ (delta = 0.33; 95CI 0.11-0.54; p-value<0.01); no associations were found between likely depression and any of the outcomes analyzed.

Conclusion:

The results from this study suggest that symptoms of maternal depression are not associated with delays in child development in the study setting analyzed. Further research will be needed to understand this lack of association: while it is possible that caregivers' mental health did not affect caregiving behavior, it is possible that the effect of maternal depression can vary according to timing, persistence, and intensity. It is also possible that the EPDS instrument may fail to identify mothers with clinical depression, or that children with depressed mothers get increased support from other family members or public early childhood focused programs.

Effectiveness of Structured Education in Reduction of Postpartum Depression Scores: A Quasi-Experimental Study

The aim of this study was to evaluate effectiveness of structured education in reduction of postpartum depression scores among women. This was a quasi-experimental study with a pre-post tests and a control group. Non-random sampling was used and the study included a total of 103 Turkish women, 52 of whom were in the intervention group and 51 were in the control group. The women in the intervention group were offered structured education for postpartum depression and given structured education material. Effectiveness of the education given was evaluated by comparing scores for Edinburg Postpartum Depression Scale obtained before and after delivery between the intervention and the control groups. Before education, median score (8.0±4.8) for Edinburg Postpartum Depression Scale of the intervention group were significantly higher the than the control group (6.0±6.0, p=0.010), but the groups were statistically similar in terms of having depression (intervention: 17.3%, control: 11.8%, p=0.425). After education, the median score for Edinburg Postpartum Depression Scale and the ratio of the women having depression in the intervention group were significantly lower than in the control group (respectively intervention: 4.0±3.0, control: 10.0±4.0, p=0.000; intervention: 7.7%, control: 25.5%, p=0.015). Besides, the median score (8.0±4.8) of the intervention group before education were significantly higher than the score (4.0±3.0) obtained after education (p=0.000), while the median score (6.0±6.0) of the control group before education were lower than the score (10.0±4.0) obtained after education (p=0.000). This study revealed that structured education offered to women by nurses was effective in reducing the postpartum depression scores and the numbers of women having depression.

Differentiating between Transient and Enduring distress on the Edinburgh Depression Scale within screening contexts

BACKGROUND

Research has shown that women screened as being 'possibly depressed' on the Edinburgh Depression Scale consist of two distinct duration types: those with Transient distress, and those with Enduring distress. This paper reports on the exploration of antenatal data to ascertain if information from the initial EDS screening can help determine which women may have Transient, and which Enduring, distress after just a few weeks.

METHODS

Data from three antenatal studies were explored, where the EDS had been given twice within a psychosocial screening setting. Repeat testing of the EDS, together with a diagnostic interview, was conducted 2-5 weeks later.

RESULTS

Women with Enduring distress (those scoring high on both occasions) were significantly more likely to meet criteria for a depressive disorder than those with Transient distress. They also scored significantly and clinically meaningfully higher on their initial EDS, though no cut-off score was optimal in discriminating between the two duration categories. Differentiation could also not be made from the endorsement of the self-harm question, but was best when women were asked to predict how they would be feeling, and why.

LIMITATIONS

The data come from three studies just with English-speaking women with slightly different methodologies, producing information on a fairly small number of women with Transient (n=12-29) and Enduring (n=14-25) distress. In addition the EDS re-test interval of between 2 and 5 weeks was quite wide.

CONCLUSIONS

Clinical implications are that women who score high initially on the EDS are most likely to continue to score high (have Enduring distress) if they themselves think this will be the case, or if they only give wishful thinking as the reason as to why they think they will feel better. Research studies should also therefore analyse their data taking into account this duration category.

Maternal Depressive Symptoms and Attained Size Among Children in the First 2 Years of Life

OBJECTIVE

To evaluate the relation of maternal depressive symptoms with attained size and whether it is stronger for young children in low-income families.

METHODS

Secondary analysis was performed of longitudinal data from enrollment and parents surveys from the Healthy Steps for Young Children National Evaluation among 4745 children who made at least one visit to a Healthy Steps site. Length and weight data from medical records were converted to z scores and percentiles for length for age and weight for length at 6, 12, and 24 months using 2000 Centers for Disease Control and Prevention growth standards. Analyses evaluated the relation of maternal depressive symptoms at 2 to 4 months using a modified 14-item Center for Epidemiologic Depression Scale with attained size and child, maternal, and family characteristics. Regression models estimated the relation of symptoms with z scores and logistic regression the relation for short stature (below 10th percentile for length for age), adjusted for covariates.

RESULTS

Maternal depressive symptoms were associated with z scores for length for age at 6, 12, and 24 months and short stature at 6 and 24 months for children in low/middle-income families. The z scores at 24 months remained significantly lower for children in low/middle-income families whose mothers reported depressive symptoms, after adjustment for covariates. The odds of short stature were significantly increased at 6 months in the total sample and among low/middle-income families for children whose mothers reported symptoms. Other measures of attained size were not associated with depressive symptoms.

CONCLUSIONS

The link between maternal symptoms and young children's risk of short stature reinforces recommendations for increased screening for postpartum depressive symptoms and for clinicians to review growth charts with parents for impaired/unfavorable patterns.

Treatment of nausea in pregnancy: a cross-sectional multinational web-based study of pregnant women and new mothers

BACKGROUND

The factors related to the treatment of nausea during pregnancy have not yet been investigated in several countries simultaneously. The present study aimed to describe differences in self-reported nausea during pregnancy and the patterns of use for both conventional and herbal medicines across countries. The factors related to nausea and its treatment and the relationships between different self-reported co-morbidities and nausea were also investigated.

METHODS

This cross-sectional study used data collected by a web-based questionnaire distributed between October 2011 and February 2012 in several countries within five regions: Western, Northern, and Eastern Europe, North America, and Australia. Women who were pregnant or had a child less than one year old were eligible to participate.

RESULTS

A total of 9113 women were included in the study, whereof 6701 (73.5%) had experienced nausea during pregnancy. Among respondents with nausea, conventional medicines were used by 1201 (17.9%) women and herbal medicines by 556 (8.3%) women. The extent of self-reported nausea and its treatment varied by country. Education, working status, and folic acid use were significantly associated with the use of conventional medicines against nausea. Respondents who had nausea also had a high burden of co-morbidity.

CONCLUSION

The prevalence of nausea was high across all participating countries but its treatment varied, possibly due to cultural differences and differences in attitudes towards medicines. A high degree of co-morbidity was found among respondents with nausea.

Patterns and factors associated with low adherence to psychotropic medications during pregnancy--a cross-sectional, multinational web-based study

BACKGROUND

No previous studies have explored how closely women follow their psychotropic drug regimens during pregnancy. This study aimed to explore patterns of and factors associated with low adherence to psychotropic medication during pregnancy.

METHODS

Multinational web-based study was performed in 18 countries in Europe, North America, and Australia. Uniform data collection was ensured via an electronic questionnaire. Pregnant women were eligible to participate. Adherence was measured via the 8-item Morisky Medication Adherence Scale (MMAS-8). The Beliefs about Prescribed Medicines Questionnaire (BMQ-specific), the Edinburgh Postnatal Depression Scale (EPDS), and a numeric rating scale were utilized to measure women's beliefs, depressive symptoms, and antidepressant risk perception, respectively. Participants reporting use of psychotropic medication during pregnancy (n = 160) were included in the analysis.

RESULTS

On the basis of the MMAS-8, 78 of 160 women (48.8%, 95% CI: 41.1-56.4%) demonstrated low adherence during pregnancy. The rates of low adherence were 51.3% for medication for anxiety, 47.2% for depression, and 42.9% for other psychiatric disorders. Smoking during pregnancy, elevated antidepressant risk perception (risk≥6), and depressive symptoms were associated with a significant 3.9-, 2.3-, and 2.5-fold increased likelihood of low medication adherence, respectively. Women on psychotropic polytherapy were less likely to demonstrate low adherence. The belief that the benefit of pharmacotherapy outweighed the risks positively correlated (r = .282) with higher medication adherence.

CONCLUSIONS

Approximately one of two pregnant women using psychotropic medication demonstrated low adherence in pregnancy. Life-style factors, risk perception, depressive symptoms, and individual beliefs are important factors related to adherence to psychotropic medication in pregnancy.

The relationship between maternal depression and smoking cessation during pregnancy--a cross-sectional study of pregnant women from 15 European countries

Epidemiologic studies have reported an association between depression and continuing smoking during pregnancy. However, differences in study design and methodology challenge study comparability. The purpose of this study was to examine the relationship between maternal depression and continuing smoking among pregnant European women while adjusting for maternal characteristics. This multinational, web-based study evaluated pregnant women in 15 European countries recruited from October 2011 to February 2012. Data on depression status, smoking habits, maternal socio-demographic characteristics, and life-style factors were collected via an anonymous online questionnaire. Associations were estimated with logistic regression. Of 4,295 women included, 1,481 (34.5 %) reported smoking before pregnancy, and 391 (26.4 %) continued smoking during pregnancy whereof 127 (32.5 %) were depressed. The association between depression and continuing smoking during pregnancy were uniform across the European countries (OR 2.02, 95 % CI 1.50-2.71), with about twice the prevalence of continuing smoking among the depressed. There was a strong relationship between continuing smoking in pregnancy and low education level (OR 4.46, 95 % CI 2.72-7.32), which coincided with risky pregnancy behavior such as failure to attend pregnancy/birth preparation courses (OR 1.80, 95 % CI 1.19-2.72) and follow recommended use of folic acid (OR 1.81, 95 % CI 1.23-2.65). Women who perceived the risk for the fetus of continued smoking during pregnancy as higher were the least likely to continue smoking during pregnancy (OR 0.72, 95 % CI 0.68-0.77). This underlines the clustering of risk in some pregnant women, and the results should guide antenatal care of depressed women struggling to quit smoking during pregnancy.

Does maternal psychopathology increase the risk of pre-schooler obesity? A systematic review

The preschool years may be a critical period for child obesity onset; however, literature examining obesity risk factors to date has largely focused on school-aged children. Several links have been made between maternal depression and childhood obesity risks; however, other types of maternal psychopathology have been widely neglected. The aim of the present review was to systematically identify articles that examined relationships between maternal psychopathology variables, including depressive and anxiety symptoms, self-esteem and body dissatisfaction, and risks for pre-schooler obesity, including weight outcomes, physical activity and sedentary behaviour levels, and nutrition/diet variables. Twenty articles meeting review criteria were identified. Results showed positive associations between maternal depressive symptoms and increased risks for pre-schooler obesity in the majority of studies. Results were inconsistent depending on the time at which depression was measured (i.e., antenatal, postnatal, in isolation or longitudinally). Anxiety and body dissatisfaction were only measured in single studies; however, both were linked to pre-schooler obesity risks; self-esteem was not measured by any studies. We concluded that maternal depressive symptoms are important to consider when assessing risks for obesity in preschool-aged children; however, more research is needed examining the impact of other facets of maternal psychopathology on obesity risk in pre-schoolers.

A longitudinal analysis of maternal depressive symptoms and children's food consumption and weight outcomes

OBJECTIVE

Maternal depressive symptoms negatively impact mothers' parenting practices and children's development, but the evidence linking these symptoms to children's obesity is mixed.

DESIGN

We use a large sample to examine contemporaneous and lagged associations between maternal depressive symptoms and children's BMI, obesity and food consumption, controlling for background characteristics.

SETTING

Data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a longitudinal study of children from infancy through kindergarten in the USA, were collected at four waves from 2001 to 2007, when children were 9 months, 2 years, 4 years and 5½years of age, through surveys, child assessments and observations.

SUBJECTS

A sub-sample of children from the ECLS-B is used (n 6500).

RESULTS

Between 17 % and 19 % of mothers reported experiencing depressive symptoms; 17 % to 20 % of children were obese. Maternal depressive symptoms were associated with a small decrease in the likelihood her child was obese (0·8 percentage points) and with lower consumption of healthy foods. The duration of maternal depressive symptoms was associated with higher BMI (0·02 sd) among children whose parents lacked college degrees.

CONCLUSIONS

Results indicate that mothers' depressive symptoms have small associations with children's food consumption and obesity. Among children whose parents lack college degrees, persistent maternal depressive symptoms are associated with slightly higher child BMI. Findings highlight the need to control for depression in analyses of children's weight. Interventions that consider maternal depression early may be useful in promoting healthy weight outcomes and eating habits among children.

Early maternal depressive symptoms and child growth trajectories: a longitudinal analysis of a nationally representative US birth cohort

BACKGROUND

Maternal depressive symptoms are negatively associated with early child growth in developing countries; however, few studies have examined this relation in developed countries or used a longitudinal design with data past the second year of the child's life. We investigated if and when early maternal depressive symptoms affect average growth in young children up to age 6 in a nationally representative sample of US children.

METHODS

Using data from 6,550 singleton births from the Early Childhood Longitudinal Study -- Birth Cohort (ECLS-B), we fit growth trajectory models with random effects to examine the relation between maternal depressive symptoms at 9 months based on the twelve-item version of the Center for Epidemiologic Studies Depression Scale (CES-D) and child height and body mass index (BMI) to age 6 years.

RESULTS

Mothers with moderate/severe depressive symptoms at 9 months postpartum had children with shorter stature at this same point in time [average 0.26 cm shorter; 95% CI: 5 cm, 48 cm] than mothers without depressive symptoms; children whose mothers reported postpartum depressive symptoms remained significantly shorter throughout the child's first 6 years.

CONCLUSIONS

Results suggest that the first year postpartum is a critical window for addressing maternal depressive symptoms in order to optimize child growth. Future studies should investigate the role of caregiving and feeding practices as potential mechanisms linking maternal depressive symptoms and child growth trajectories.

Association between maternal depressive symptoms in the early post-natal period and responsiveness in feeding at child age 2 years

Maternal depression is a known risk factor for poor outcomes for children. Pathways to these poor outcomes relate to reduced maternal responsiveness or sensitivity to the child. Impaired responsiveness potentially impacts the feeding relationship and thus may be a risk factor for inappropriate feeding practices. The aim of this study was to examine the longitudinal relationships between self-reported maternal post-natal depressive symptoms at child age 4 months and feeding practices at child age 2 years in a community sample. Participants were Australian first-time mothers allocated to the control group of the NOURISH randomized controlled trial when infants were 4 months old. Complete data from 211 mothers (of 346 allocated) followed up when their children were 2 years of age (51% girls) were available for analysis. The relationship between Edinburgh Postnatal Depression Scale (EPDS) score (child age 4 months) and child feeding practices (child age 2 years) was tested using hierarchical linear regression analysis adjusted for maternal and child characteristics. Higher EPDS score was associated with less responsive feeding practices at child age 2 years: greater pressure [β = 0.18, 95% confidence interval (CI): 0.04-0.32, P = 0.01], restriction (β = 0.14, 95% CI: 0.001-0.28, P = 0.05), instrumental (β = 0.14, 95% CI: 0.005-0.27, P = 0.04) and emotional (β = 0.15, 95% CI: 0.01-0.29, P = 0.03) feeding practices (ΔR(2) values: 0.02-0.03, P < 0.05). This study provides evidence for the proposed link between maternal post-natal depressive symptoms and lower responsiveness in child feeding. These findings suggest that the provision of support to mothers experiencing some levels of depressive symptomatology in the early post-natal period may improve responsiveness in the child feeding relationship.

Maternal depression and childhood obesity: a systematic review

OBJECTIVE

Maternal depression is prevalent and has been associated with parenting practices that influence child weight. In this systematic review we aimed to examine the prospective association between maternal depression and child overweight.

METHODS

We searched four databases (PsycINFO, PubMed, Embase, and Academic Search Premier) to identify studies for inclusion. We included studies with a prospective design with at least one year follow-up, measuring maternal depression at any stage after childbirth, and examining child overweight or obesity status, body mass index z-score or percentile, or adiposity. Two authors extracted data independently and findings were qualitatively synthesized.

RESULTS

We identified nine prospective studies for inclusion. Results were examined separately for episodic depression (depression at a single measurement occasion) and chronic depression (depression on multiple measurement occasions). Mixed results were observed for the relationship between episodic depression and indicators of child adiposity. Chronic depression, but not episodic depression, was associated with greater risk for child overweight.

CONCLUSIONS

While chronic depression may be associated with child overweight, further research is needed. Research is also needed to determine whether maternal depression influences child weight outcomes in adolescence and to investigate elements of the family ecology that may moderate the effect of maternal depression on child overweight.

Effects of prenatal stress on pregnancy and human development: mechanisms and pathways

A growing body of research shows that prenatal stress can have significant effects on pregnancy, maternal health and human development across the lifespan. These effects may occur directly through the influence of prenatal stress-related physiological changes on the developing fetus, or indirectly through the effects of prenatal stress on maternal health and pregnancy outcome which, in turn, affect infant health and development. Animal and human studies suggest that activation of the maternal stress response and resulting changes in endocrine and inflammatory activity play a role in the aetiology of these effects. Ongoing research is focusing on clarifying these mechanisms, understanding the role of racial and cultural factors in these effects, and examining the epigenetic and transgenerational influences of prenatal stress.

Does fetal exposure to SSRIs or maternal depression impact infant growth?

OBJECTIVE

The aim of this study was to compare the growth of infants born to women with antenatal major depressive disorder, either untreated or treated with selective serotonin reuptake inhibitor (SSRI) antidepressants, and infants born to a nondepressed, nonmedicated comparison group across the first year of life.

METHOD

In this prospective observational study, pregnant women were evaluated at weeks 20, 30, and 36 of gestation, and mother and infant pairs were assessed at 2, 12, 26, and 52 weeks postpartum. Three nonoverlapping groups of women were defined according to their pregnancy exposures: 1) no SSRI and no depression (N=97), 2) SSRI (N=46), and 3) major depression without SSRI (N=31). Maternal demographic and clinical characteristics and newborn outcomes were compared across exposure groups. Infant weight, length, and head circumference were measured by a physician or physician's assistant who was blind to depression and SSRI exposure status at each postpartum time point.

RESULTS

Both adjusted and unadjusted analyses revealed neither antenatal major depression nor SSRI exposure was significantly associated with infant weight, length, or head circumference relative to nonexposure to either. In addition, the interaction of group and prepregnancy body mass index was also evaluated, and no significant synergistic effect was identified. Similarly, no differential effect of group over time was observed for weight, length, or head circumference.

CONCLUSIONS

In utero exposure to major depression or SSRI antidepressants did not affect infant growth with respect to weight, length, or head circumference from birth through 12 months of age.

Repeat testing on the Edinburgh Depression Scale and the HADS-A in pregnancy: differentiating between transient and enduring distress

BACKGROUND

The Edinburgh Depression Scale (EDS/EPDS) is routinely used in many clinical services to screen for probable distress in antenatal and postnatal women. Typically a single administration of this scale results in a referral to a specialist mental health service if the woman scores above the service's cut-off score on the measure - that is, scores 'high'. A few postnatal studies have shown, however, that many women when re-tested just a few weeks later no longer score 'high'. This study explored this phenomenon in a sample of pregnant women, using both the EDS and an anxiety self-report measure (Hospital Anxiety and Depression Scale - Anxiety subscale: HADS-A).

METHOD

164 English-speaking pregnant women attending a local public hospital's antenatal clinic for their first appointment participated. At this appointment they completed the EDS and the HADS-A, and predicted how they might be feeling in about two-week time. Approximately two weeks later they were interviewed by phone and again completed the EDS and the HADS-A, and answered questions about possible mood changes.

RESULTS

Regardless of which of several cut-off scores on the EDS or HADS-A was used to define 'high' scorers, approximately 50% (±6%) of women scoring high at their first appointment on either measure no longer scored 'high' two weeks later. Common reasons given for their mood improvement included reduced morning sickness, reassuring results from routine tests (e.g., ultrasounds), fear of miscarriage subsiding, and a sense of reassurance following their hospital visit. Many of the women were accurate in predicting at their first appointment that they would be feeling better within a few weeks.

LIMITATIONS

The administration procedure for completion of the measures on the two occasions was different. Women initially completed the measures by hand, and on the second occasion over the phone.

CONCLUSION

Half the women screened as having emotional distress - that is, scoring 'high' on self-report mood measures (i.e., EDS and HADS-A) - during their first hospital visit in pregnancy are likely to have transient distress for predictable reasons. Referring women to specialist mental health services based upon just one administration of these measures will therefore result in a large number of unnecessary referrals, thus possibly overstretching the resources available. We therefore believe that when women score high on a self-report mood measure, enquiring as to why this is the case, and about whether the woman expects to feel differently in a few weeks time, together with a second administration of the measures in a few weeks is a better practice, unless there are good clinical reasons to do otherwise. In addition, studies reporting prevalence rates of perinatal distress should not simply use a one-off administration of a self-report mood scale to state the probable rate of disorders or distress.

Impact of maternal depressive symptoms on growth of preschool- and school-aged children

OBJECTIVE

The aim of our study was to examine whether maternal depressive symptoms at 9 months postpartum adversely affect growth in preschool- and school-aged children.

METHODS

We used data from the US nationally representative Early Childhood Longitudinal Study, Birth Cohort. We fit multivariable logistic regression models to study maternal depressive symptoms at 9 months postpartum (using the Center for Epidemiologic Studies Depression Scale) in relation to child growth outcomes, ≤ 10% height-for-age, ≤ 10% weight-for-height, and ≤ 10% weight-for-age at 4 and 5 years.

RESULTS

At 9 months, 24% of mothers reported mild depressive symptoms and 17% moderate/severe symptoms. After adjustment for household, maternal, and child factors, children of mothers with moderate to severe levels of depressive symptoms at 9 months' postpartum had a 40% increased odds of being ≤ 10% in height-for-age at age 4 (odds ratio = 1.40, 95% confidence interval: 1.04-1.89) and 48% increased odds of being ≤ 10% in height-for-age at age 5 (odds ratio = 1.48, 95% confidence interval: 1.03-2.13) compared with children of women with few or no depressive symptoms. There was no statistically significant association between maternal depressive symptoms and children being ≤ 1 0% in weight-for-height and weight-for-age at 4 or 5 years.

CONCLUSIONS

Maternal depressive symptoms during infancy may affect physical growth in early childhood. Prevention, early detection, and treatment of maternal depressive symptoms during the first year postpartum may prevent childhood height-for-age ≤ 10th percentile among preschool- and school-aged children.

Maternal depression and child BMI: longitudinal findings from a US sample

OBJECTIVE

To examine the association between maternal depression and child body mass index (BMI) from Kindergarten (K) to fifth grade.

METHODS

Analysis of four waves of data from the Early Childhood Longitudinal Study - Kindergarten spanning K to fifth grade. Maternal depressive symptoms (MDSs) were measured by a brief version of the Center for Epidemiological Studies Depression scale. Data were analyzed using multiple regression analyses, adjusting for key covariates and potential confounders. The analytic sample was restricted to children of normal birth weight.

RESULTS

The relationship between MDS and child BMI varies by child gender and age. Among girls, severe MDS at K was related to lower BMI at third grade (but not later at fifth grade) and to an increase in BMI from K to third and K to fifth grades. Among boys, severe MDS at K was related to higher boys' BMI at fifth grade. When severe MDS occurred at third grade, it was related to higher BMI at fifth grade among girls whereas no statistically significant relationship was found for boys. Low levels of physical activity in comparison to peers at fifth grade and more screen time on weekends at third grade are likely mediators of the relationship between MDS and child BMI among girls, while among boys the relationship appears to be mediated by unhealthy eating habits.

CONCLUSIONS

Our findings, indicating developmental and gender differences in the relationship between maternal depression and child BMI, if confirmed, suggest that interventions addressing maternal depression may have concomitant impact on childhood obesity.

Maternal mental health and its association with infant growth at 6 months in ethnic groups: results from the Born-in-Bradford birth cohort study

Objective

To identify factors associated with infant growth up to 6 months, with a particular focus on maternal distress, and to explore the effect of ethnicity on any relation between maternal distress and infant growth.

Methods

Cohort study recruiting White and Pakistani women in the United Kingdom (UK). Infant growth was measured at birth and 6 months. Standard assessment of mental health (GHQ-28) was undertaken in pregnancy (26–28 weeks gestation) and 6 months postpartum. Modelling included social deprivation, ethnicity, and other known influences on infant growth such as maternal smoking and alcohol consumption.

Results

Maternal distress improved markedly from pregnancy to 6 months postpartum. At both times Pakistani women had more somatic and depression symptoms than White women. Depression in pregnancy (GHQ subscale D) was associated with lower infant growth at 6 months. Self-reported social dysfunction in pregnancy (GHQ subscale C) was associated with lower gestational age.. Pakistani women reported higher GHQ scores during pregnancy associated with smaller infants at birth. They lived in areas of higher social deprivation, reported less alcohol consumption and smoking postnatally, all independent influences on growth at 6 months.

Conclusions

Maternal mental health in pregnancy is an independent influence on infant growth up to 6 months and is associated with ethnicity which was itself associated with deprivation in our sample. There is a complex relationship between symptoms of maternal distress, ethnicity, deprivation, health behaviours, and early infant growth. Measures should include both emotional and somatic symptoms and interventions to reduce risks of poor early growth need to include psychological and social components.

Bereavement in early life and later childhood overweight

OBJECTIVE

The rise in the occurrence of childhood obesity during the last decades in many populations indicates an important role of environmental exposures, which may operate very early in life. We aimed to examine the association between bereavement during the first 6 years of life, as a stress indicator, and subsequent risk of overweight in school-aged children.

METHODS

We followed 46,401 singletons born in Denmark who underwent annual health examinations at 7-13 years of age in school of Copenhagen. A total of 492 children experienced bereavement by death of a parent during the first 6 years of life. We compared BMI levels, changes in BMI, and the prevalence of overweight at 7-13 years of age between bereaved and non-bereaved children.

RESULTS

Between bereaved children and non-bereaved children, there were no differences in average BMI levels at any age or changes in BMI at 7-13 years of age. Bereavement during the first 6 years of life was not associated with an increased risk of overweight at 7-13 years of age.

CONCLUSION

This study did not support that stress induced by bereavement during the first 6 years of life has significant influence on overweight in later childhood.

Antidepressant drugs and breastfeeding: a review of the literature

The use of antidepressants in breastfeeding mothers is controversial: Manufacters often routinely discourage breastfeeding for the nursing mother despite the well-known positive impact that breastfeeding carries on the health of the nursing infant and on his or her family and society. We conducted a systematic review of drugs commonly used in the treatment of postpartum depression. For every single drug two sets of data were provided: (1) selected pharmacokinetic characteristics such as half-life, milk-to-plasma ratio, protein binding, and oral bioavailability and (2) information about lactational risk, according to some authoritative sources of the literature: Drugs in Pregnancy and Lactation edited by Briggs et al. (Lippincott Williams, Philadelphia, 2008), Medications and Mothers' Milk by Hale (Hale Publishing, Amarillo, TX, 2010), and the LactMed database of TOXNET ( www.pubmed.gov ; accessed June 2010). Notwithstanding a certain variability of advice, we found that (1) knowledge of pharmacokinetic characteristics are scarcely useful to assess safety and (2) the majority of antidepressants are not usually contraindicated: (a) Selective serotinin reuptake inhibitors and nortryptiline have a better safety profile during lactation, (b) fluoxetine must be used carefully, (c) the tricyclic doxepine and the atypical nefazodone should better be avoided, and (d) lithium, usually considered as contraindicated, has been recently rehabilitated.

Chronic maternal depression is associated with reduced weight gain in latino infants from birth to 2 years of age

BACKGROUND

Latino children are at increased risk for mirconutrient deficiencies and problems of overweight and obesity. Exposures in pregnancy and early postpartum may impact future growth trajectories.

OBJECTIVES

To evaluate the relationship between prenatal and postnatal maternal depressive symptoms experienced in pregnancy and infant growth from birth to 2 years of age in a cohort of Latino infants.

METHODS

We recruited pregnant Latina mothers at two San Francisco hospitals and followed their healthy infants to 24 months of age. At 6, 12 and 24 months of age, infants were weighed and measured. Maternal depressive symptoms were assessed prenatally and at 4-6 weeks postpartum. Women who had high depressive symptoms at both time periods were defined as having chronic depression. Logistic mixed models were applied to compare growth curves and risk for overweight and underweight based on exposure to maternal depression.

RESULTS

We followed 181 infants to 24 months. At 12 and 24 months, respectively, 27.4% and 40.5% were overweight, and 5.6% and 2.2% were underweight. Exposure to chronic maternal depression was associated with underweight (OR = 12.12, 95%CI 1.86-78.78) and with reduced weight gain in the first 2 years of life (Coef = -0.48, 95% CI -0.94-0.01) compared with unexposed infants or infants exposed to episodic depression (depression at one time point). Exposure to chronic depression was also associated with reduced risk for overweight in the first 2 years of life (OR 0.28, 95%CI 0.03-0.92).

CONCLUSIONS

Exposure to chronic maternal depression in the pre- and postnatal period was associated with reduced weight gain in the first two years of life and greater risk for failure to thrive, in comparison with unexposed infants or those exposed episodically. The infants of mothers with chronic depression may need additional nutritional monitoring and intervention.