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Brown A, Griffin S, Weaver G, Shenker N. Receiving screened donor human milk as part of a community-based lactation support programme reduces parental symptoms of anxiety and depression. MATERNAL & CHILD NUTRITION 2024:e13686. [PMID: 38898718 DOI: 10.1111/mcn.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
Infant feeding decisions and maternal mental health are closely tied. Donor human milk (DHM) protects premature infant health and development and can reduce hospital stays. Recent qualitative research has highlighted that having the option for an infant to receive DHM can also support parental wellbeing through reducing concerns about infant health and supporting feeding preferences. However, no quantitative study has examined this relationship. In this study, anxiety and depression scores were measured before and after receiving DHM using the Hospital Anxiety and Depression Scale for 80 parents (77 mothers, 3 fathers) who had sought DHM from a community-facing milk bank. Reasons for seeking DHM included maternal cancer, maternal and infant health complications, insufficient glandular tissue, and low milk supply. Open-ended questions explored the experience of receiving milk. Milk bank records were used to match details of milk given (volume, duration, exclusivity, lactation support given) with survey responses. Both anxiety and depression scores significantly reduced after receiving milk. Although greater lactation support and longer duration of milk predicted a greater decrease in scores, in a regression analysis, only volume of milk given remained a significant predictor. Almost all parents agreed that being able to access DHM supported their wellbeing predominantly through reducing anxieties around infant health but also through feeding choices being respected and the support given at difficult times. The findings add important considerations to the literature considering when and for whom DHM should be used and the complex interplay between infant feeding and mental health.
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Affiliation(s)
- Amy Brown
- Centre for Lactation, Infant Feeding and Translation (LIFT), Swansea, UK
- Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, UK
| | - Sam Griffin
- The Human Milk Foundation, Victory Road, Berkhamsted, UK
| | - Gillian Weaver
- The Human Milk Foundation, Victory Road, Berkhamsted, UK
| | - Natalie Shenker
- The Human Milk Foundation, Victory Road, Berkhamsted, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Balan I, Boero G, Chéry SL, McFarland MH, Lopez AG, Morrow AL. Neuroactive Steroids, Toll-like Receptors, and Neuroimmune Regulation: Insights into Their Impact on Neuropsychiatric Disorders. Life (Basel) 2024; 14:582. [PMID: 38792602 PMCID: PMC11122352 DOI: 10.3390/life14050582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/18/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
Pregnane neuroactive steroids, notably allopregnanolone and pregnenolone, exhibit efficacy in mitigating inflammatory signals triggered by toll-like receptor (TLR) activation, thus attenuating the production of inflammatory factors. Clinical studies highlight their therapeutic potential, particularly in conditions like postpartum depression (PPD), where the FDA-approved compound brexanolone, an intravenous formulation of allopregnanolone, effectively suppresses TLR-mediated inflammatory pathways, predicting symptom improvement. Additionally, pregnane neurosteroids exhibit trophic and anti-inflammatory properties, stimulating the production of vital trophic proteins and anti-inflammatory factors. Androstane neuroactive steroids, including estrogens and androgens, along with dehydroepiandrosterone (DHEA), display diverse effects on TLR expression and activation. Notably, androstenediol (ADIOL), an androstane neurosteroid, emerges as a potent anti-inflammatory agent, promising for therapeutic interventions. The dysregulation of immune responses via TLR signaling alongside reduced levels of endogenous neurosteroids significantly contributes to symptom severity across various neuropsychiatric disorders. Neuroactive steroids, such as allopregnanolone, demonstrate efficacy in alleviating symptoms of various neuropsychiatric disorders and modulating neuroimmune responses, offering potential intervention avenues. This review emphasizes the significant therapeutic potential of neuroactive steroids in modulating TLR signaling pathways, particularly in addressing inflammatory processes associated with neuropsychiatric disorders. It advances our understanding of the complex interplay between neuroactive steroids and immune responses, paving the way for personalized treatment strategies tailored to individual needs and providing insights for future research aimed at unraveling the intricacies of neuropsychiatric disorders.
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Affiliation(s)
- Irina Balan
- Bowles Center for Alcohol Studies, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (I.B.); (S.L.C.); (M.H.M.); (A.G.L.)
- Department of Psychiatry, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Giorgia Boero
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA;
| | - Samantha Lucenell Chéry
- Bowles Center for Alcohol Studies, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (I.B.); (S.L.C.); (M.H.M.); (A.G.L.)
- Neuroscience Curriculum, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Minna H. McFarland
- Bowles Center for Alcohol Studies, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (I.B.); (S.L.C.); (M.H.M.); (A.G.L.)
- Neuroscience Curriculum, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Alejandro G. Lopez
- Bowles Center for Alcohol Studies, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (I.B.); (S.L.C.); (M.H.M.); (A.G.L.)
- Department of Biochemistry and Biophysics, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - A. Leslie Morrow
- Bowles Center for Alcohol Studies, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (I.B.); (S.L.C.); (M.H.M.); (A.G.L.)
- Department of Psychiatry, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Pharmacology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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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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Esalatmanesh S, Kashani L, Khooshideh M, Moghaddam HS, Ansari S, Akhondzadeh S. Efficacy and safety of celecoxib for treatment of mild to moderate postpartum depression: a randomized, double-blind, placebo-controlled trial. Arch Gynecol Obstet 2024; 309:1429-1439. [PMID: 37097311 DOI: 10.1007/s00404-023-07042-4] [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: 12/13/2022] [Accepted: 04/06/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Evidence has demonstrated the roles of inflammatory processes in pathogenesis of depression. We aim to assess the effects of adjunctive celecoxib with cognitive behavioral therapy (CBT), an anti-inflammatory agent, in treatment of postpartum depression and on levels of Brain-derived neurotrophic factor (BDNF) and inflammatory cytokines. METHODS This was a randomized, double-blind, placebo-controlled trial to investigate the effects of adjunctive celecoxib with CBT on postpartum depression. Fifty outpatient women with postpartum depression, participated in this study. Patients randomly received either a celecoxib capsule twice a day or a placebo capsule twice a day for 6 weeks. Patients were assessed using the Hamilton Depression Rating Scale (HDRS) and the adverse event checklist at baseline and weeks 2, 4, and 6. RESULTS Patients in the celecoxib group showed a greater decline in HDRS scores from baseline to all three study time points compared to the placebo group (p = 0.12 for week 2, p = 0.001 for week 4, p < 0.001 for week 6). Rate of response to treatment was significantly higher in the celecoxib group compared to the placebo group at week 4 (60 vs 24%, p = 0.010) and week 6 (96 vs 44%, p < 0.001). Rate of remission was significantly higher in the celecoxib group compared to the placebo group at week 4 (52 vs 20%, p = 0.018) and week 6 (96 vs 36%, p < 0.001). Levels of most inflammatory markers were significantly lower in the celecoxib group compared to the placebo group at week 6. Levels of BDNF were significantly higher in the celecoxib group compared to the placebo group at week 6 (p < 0.001). CONCLUSIONS Findings suggest adjunctive celecoxib is an effective treatment for the improvement of postpartum depressive symptoms.
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Affiliation(s)
- Sophia Esalatmanesh
- Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Street, Tehran, 13337, Iran
| | - Ladan Kashani
- Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Khooshideh
- Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Sanjari Moghaddam
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Street, Tehran, 13337, Iran
| | - Sahar Ansari
- Psychosomatic Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Street, Tehran, 13337, Iran.
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Blackman A, Ukah UV, Platt RW, Meng X, Shapiro GD, Malhamé I, Ray JG, Lisonkova S, El-Chaâr D, Auger N, Dayan N. Severe Maternal Morbidity and Mental Health Hospitalizations or Emergency Department Visits. JAMA Netw Open 2024; 7:e247983. [PMID: 38652472 PMCID: PMC11040413 DOI: 10.1001/jamanetworkopen.2024.7983] [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: 12/01/2023] [Accepted: 02/25/2024] [Indexed: 04/25/2024] Open
Abstract
Importance Severe maternal morbidity (SMM) can have long-term health consequences for the affected mother. The association between SMM and future maternal mental health conditions has not been well studied. Objective To assess the association between SMM in the first recorded birth and the risk of hospitalization or emergency department (ED) visits for a mental health condition over a 13-year period. Design, Setting, and Participants This population-based retrospective cohort study used data from postpartum individuals aged 18 to 55 years with a first hospital delivery between 2008 and 2021 in 11 provinces and territories in Canada, except Québec. Data were analyzed from January to June 2023. Exposure SMM, defined as a composite of conditions, such as septic shock, severe preeclampsia or eclampsia, severe hemorrhage with intervention, or other complications, occurring after 20 weeks' gestation and up to 42 days after a first delivery. Main Outcomes and Measures The main outcome was a hospitalization or ED visit for a mental health condition, including mood and anxiety disorders, substance use, schizophrenia, and other psychotic disorder, or suicidality or self-harm event, arising at least 43 days after the first birth hospitalization. Cox regression models generated hazard ratios with 95% CIs, adjusted for baseline maternal comorbidities, maternal age at delivery, income quintile, type of residence, hospital type, and delivery year. Results Of 2 026 594 individuals with a first hospital delivery, 1 579 392 individuals (mean [SD] age, 30.0 [5.4] years) had complete ED and hospital records and were included in analyses; among these, 35 825 individuals (2.3%) had SMM. Compared with individuals without SMM, those with SMM were older (mean [SD] age, 29.9 [5.4] years vs 30.7 [6.0] years), were more likely to deliver in a teaching tertiary care hospital (40.8% vs 51.1%), and to have preexisting conditions (eg, ≥2 conditions: 1.2% vs 5.3%), gestational diabetes (8.2% vs 11.7%), stillbirth (0.5% vs 1.6%), preterm birth (7.7% vs 25.0%), or cesarean delivery (31.0% vs 54.3%). After a median (IQR) duration of 2.6 (1.3-6.4) years, 1287 (96.1 per 10 000) individuals with SMM had a mental health hospitalization or ED visit, compared with 41 779 (73.2 per 10 000) individuals without SMM (adjusted hazard ratio, 1.26 [95% CI, 1.19-1.34]). Conclusions and Relevance In this cohort study of postpartum individuals with and without SMM in pregnancy and delivery, there was an increased risk of mental health hospitalizations or ED visits up to 13 years after a delivery complicated by SMM. Enhanced surveillance and provision of postpartum mental health resources may be especially important after SMM.
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Affiliation(s)
- Asia Blackman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Ugochinyere V. Ukah
- Pregnancy and Child Research Center, HealthPartners Institute, Minneapolis, Minnesota
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | - Robert W. Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Xiangfei Meng
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
- Douglas Research Centre, Montreal, Québec, Canada
| | - Gabriel D. Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Isabelle Malhamé
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | - Joel G. Ray
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darine El-Chaâr
- Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Nathalie Auger
- Institut national de santé publique du Québec, Quebec City, Québec, Canada
| | - Natalie Dayan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
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Patterson R, Balan I, Morrow AL, Meltzer-Brody S. Novel neurosteroid therapeutics for post-partum depression: perspectives on clinical trials, program development, active research, and future directions. Neuropsychopharmacology 2024; 49:67-72. [PMID: 37715106 PMCID: PMC10700474 DOI: 10.1038/s41386-023-01721-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023]
Abstract
This article reviews novel neurosteroid therapeutics for post-partum depression, with a focus on their development, clinical trial data, current practices, and future directions in this exciting field. We discuss the clinical impact of brexanolone and several other neurosteroids, particularly as they relate to the treatment of postpartum depression (PPD) and major depressive disorders outside of the perinatal period. There has been increasing interest in GABA signaling and modulation as it pertains to the development of altered circuity and depressive states. This scientific underpinning served as the rationale for the initial development of brexanolone. We review the clinical trials supporting its Food and Drug Administration (FDA) approval as the first rapidly acting antidepressant specific for PPD, and the subsequent development of a clinical brexanolone program at an academic medical center, highlighting new research and data from that site as well as the challenges with the delivery of this I.V. drug. In addition to the GABA signaling hypothesis, we discuss the new evidence demonstrating that brexanolone inhibits inflammatory signaling post-infusion, suggesting that inflammatory signaling may contribute to the etiology of PPD. Finally, we describe new and future directions in neurosteroid therapeutics, including the development of an oral agent, zuranolone, and the IV and oral formulations of ganaxolone. Ultimately, the hope is that these novel neurosteroid therapeutics will provide fast-acting treatment for these impairing disorders and improve our understanding of the underlying mechanisms of depressive disorders.
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Affiliation(s)
- Riah Patterson
- Department of Psychiatry and Emergency Medicine, MacNider Bldg. Suite 304, CB# 7160, Chapel Hill, NC, 27599-7160, USA.
| | - Irina Balan
- Department of Psychiatry, Bowles Center for Alcohol Studies, 3027 Thurston Bowles Building, CB 7178, Chapel Hill, NC, 27599-7178, USA
| | - A Leslie Morrow
- Department of Psychiatry and Pharmacology, Bowles Center for Alcohol Studies, 3027 Thurston Bowles Building, CB 7178, Chapel Hill, NC, 27599-7178, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, UNC Center for Women's Mood Disorders, MacNider Bldg. Suite 304CB #7160, Chapel Hill, NC, 27599-7160, USA
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Ding X, Liang M, Wang H, Song Q, Guo X, Su W, Li N, Liu H, Ma S, Zhou X, Sun Y. Prenatal stressful life events increase the prevalence of postpartum depression: Evidence from prospective cohort studies. J Psychiatr Res 2023; 160:263-271. [PMID: 36889197 DOI: 10.1016/j.jpsychires.2023.02.036] [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: 03/15/2022] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023]
Abstract
Postpartum depression (PPD) occurs frequently among postpartum women. Stressful life events (SLE) have gradually been recognized as risk factors for PPD. However, research on this topic has produced equivocal results. The purpose of this study was to explore whether women who experienced prenatal SLE had a higher prevalence of PPD. Electronic databases were systematically searched until October 2021. Only prospective cohort studies were included. Pooled prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using random effects models. This meta-analysis included 17 studies involving 9822 individuals. Women who experienced prenatal SLE had a higher prevalence for PPD (PR = 1.82, 95%CI = 1.52-2.17). In subgroup analyses, a 112% and 78% higher prevalence of depressive disorders (PR = 2.12, 95%CI = 1.34-3.38) and depressive symptoms (PR = 1.78, 95%CI = 1.47-2.17) were detected in women who experienced prenatal SLE. The effect of SLE on PPD at postpartum different time points differed: PR = 3.25 (95%CI = 2.01-5.25) for ≤6 weeks, PR = 2.01 (95%CI = 1.53-2.65) for 7-12 weeks, PR = 1.17 (95%CI = 0.49-2.31) for >12 weeks. No obvious publication bias was detected. The findings support that prenatal SLE increase the prevalence of PPD. The effect of SLE on PPD tends to slightly decrease during the postpartum period. Furthermore, these findings highlight the importance of screening for PPD as early as possible, particularly among postpartum women who have experienced SLE.
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Affiliation(s)
- Xiuxiu Ding
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Mingming Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Hao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Qiuxia Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xianwei Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Wanying Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Ning Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Haixia Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Shaodi Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xiaoqin Zhou
- Department of Psychiatry, Chaohu Hospital/Anhui Psychiatric Center, Anhui Medical University, Hefei, 238000, China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China; Chaohu Hospital, Anhui Medical University, Hefei, 238000, China; Centre for Evidence-Based Practice, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
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Balan I, Patterson R, Boero G, Krohn H, O'Buckley TK, Meltzer-Brody S, Morrow AL. Brexanolone therapeutics in post-partum depression involves inhibition of systemic inflammatory pathways. EBioMedicine 2023; 89:104473. [PMID: 36801618 PMCID: PMC9984433 DOI: 10.1016/j.ebiom.2023.104473] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Brexanolone has rapid, long-lasting, and remarkable efficacy in the treatment of post-partum depression (PPD). We test the hypothesis that brexanolone inhibits proinflammatory modulators and macrophage activation in PPD patients, which may promote clinical recovery. METHODS PPD patients (N = 18) provided blood samples before and after brexanolone infusion according to the FDA-approved protocol. Patients were unresponsive to prior treatment before brexanolone therapy. Serum was collected to determine neurosteroid levels and whole blood cell lysates were examined for inflammatory markers and in vitro responses to the inflammatory activators lipopolysaccharide (LPS) and imiquimod (IMQ). FINDINGS Brexanolone infusion altered multiple neuroactive steroid levels (N = 15-18), reduced levels of inflammatory mediators (N = 11) and inhibited their response to inflammatory immune activators (N = 9-11). Specifically, brexanolone infusion reduced whole blood cell tumor necrosis factor-α (TNF-α, p = 0.003), and interleukin-6 (IL-6, p = 0.04) and these effects were correlated with HAM-D score improvement (TNF-α, p = 0.049; IL-6, p = 0.02). Furthermore, brexanolone infusion prevented LPS and IMQ-induced elevation of TNF-α (LPS: p = 0.02; IMQ: p = 0.01), IL-1β (LPS: p = 0.006; IMQ: p = 0.02) and IL-6 (LPS: p = 0.009; IMQ: p = 0.01), indicating inhibition of toll-like receptor (TLR)4 and TLR7 responses. Finally, inhibition of TNF-α, IL-1β and IL-6 responses to both LPS and IMQ were correlated with HAM-D score improvements (p < 0.05). INTERPRETATION Brexanolone actions involve inhibition of inflammatory mediator production and inhibition of inflammatory responses to TLR4 and TLR7 activators. The data suggest that inflammation plays a role in post-partum depression and that inhibition of inflammatory pathways contributes to the therapeutic efficacy of brexanolone. FUNDING The Foundation of Hope, Raleigh, NC and UNC School of Medicine, Chapel Hill.
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Affiliation(s)
- Irina Balan
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, 27599, NC, USA
| | - Riah Patterson
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, 27599, NC, USA
| | - Giorgia Boero
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, 27599, NC, USA
| | - Holly Krohn
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, 27599, NC, USA
| | - Todd K O'Buckley
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, 27599, NC, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, 27599, NC, USA
| | - A Leslie Morrow
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, 27599, NC, USA; Department of Pharmacology, University of North Carolina School of Medicine, Chapel Hill, 27599, NC, USA.
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9
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Baattaiah BA, Alharbi MD, Babteen NM, Al-Maqbool HM, Babgi FA, Albatati AA. The relationship between fatigue, sleep quality, resilience, and the risk of postpartum depression: an emphasis on maternal mental health. BMC Psychol 2023; 11:10. [PMID: 36635743 PMCID: PMC9836926 DOI: 10.1186/s40359-023-01043-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/06/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Several factors can contribute to the development of postpartum depression (PPD) and negatively affect mothers' mental and physical well-being. The objective of this study was to determine the relationship between fatigue, sleep quality, resilience, and the risk of PPD development. METHODS A cross-sectional study was conducted using an online questionnaire distributed to mothers during their postpartum period. The risk of PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS), postpartum fatigue (PPF) was assessed using the Fatigue Severity Scale (FSS), sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and resilience was assessed using the Brief Resilience Scale (BRS). The Pearson correlation coefficient was calculated to determine the relationship between the study variables. Simple and multiple linear regression analyses were performed to explain the contributions of PPF, sleep quality, and resilience as independent predictors of PPD development. RESULTS A total of 1409 postpartum women were included in the analysis, with 75% of the participants reporting a risk of PPD, 61% reporting PPF, 97% reporting having sleep problems, and 36% being in the "low resilience level" category. In terms of correlations, the scores of FSS and the PSQI showed moderate positive relationships with the EPDS scores (r = 0.344 and r = 0.447, respectively, p = .000). The BRS scores were negatively associated with the EPDS scores (r = -0.530, p = 0.000). Fatigue, sleep quality, and resilience were predictors of depressive symptoms (β = 0.127, β = 0.262, and β = -0.393, respectively, R2 = 0.37, p = 0.000). The association remained significant in the regression model after adjusting for mother's age, mother's BMI, child's age, smoking status, full-term pregnancy, having a chronic disease, and taking anti-depressant. CONCLUSIONS Mothers with higher levels of fatigue, poor sleep quality, and low resilience levels were at high risk of developing PPD. Healthcare providers should identify these factors and thus set better rehabilitation goals to improve overall maternal health.
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Affiliation(s)
- Baian A. Baattaiah
- grid.412125.10000 0001 0619 1117Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589 Saudi Arabia
| | - Mutasim D. Alharbi
- grid.412125.10000 0001 0619 1117Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589 Saudi Arabia
| | - Nouf M. Babteen
- grid.412125.10000 0001 0619 1117Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589 Saudi Arabia
| | - Haneen M. Al-Maqbool
- grid.412125.10000 0001 0619 1117Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589 Saudi Arabia
| | - Faten A. Babgi
- grid.412125.10000 0001 0619 1117Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589 Saudi Arabia
| | - Ashar A. Albatati
- grid.412125.10000 0001 0619 1117Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589 Saudi Arabia
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10
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Rathi A, Khapre S, Chavada J, Gupta S, Singla T. Postpartum Depression and Its Biological Biomarkers. Cureus 2022; 14:e31124. [DOI: 10.7759/cureus.31124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/05/2022] [Indexed: 11/08/2022] Open
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11
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Association between breastfeeding and postpartum depression: A meta-analysis. J Affect Disord 2022; 308:512-519. [PMID: 35460745 DOI: 10.1016/j.jad.2022.04.091] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 03/17/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The association of breastfeeding (BF) for postpartum depression (PPD) remains controversial. Currently there are no specific guidelines on the role of BF in the management of PPD. OBJECTIVES To determine the association between BF and PPD. METHODS We searched PubMed, Cochrane Library, and EMBASE up to December 2021 for relevant articles associated between PPD and BF. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with a random-effects model. RESULTS A total of 8 studies with 18,570 participants were included. BF was associated with a 14% lower risk of PPD (OR 0.86, 95% CI 0.77-0.94, I2 = 51.78%). For a single BF episode, BF duration of >1 month was associated a 37% lower risk (OR 0.63, 95% CI 0.47-0.79, I2 = 34.98%, P = 0.19), and BF for <1 month was associated with a 6% lower risk (OR 0.94, 95% CI 0.89-0.99, I2 = 0.00%, P = 0.61). Exclusive breastfeeding (EBF) compared with never breastfeeding (NBF) was associated with a 53% lower risk for PPD (OR 0.47, 95% CI 0.27-0.66, I2 = 0.00%, P = 0.98). And EBF compared with partial breastfeeding (PBF) was associated with an 8% lower risk for PPD (OR 0.92, 95% CI 0.86-0.98, I2 = 13.86%, P = 0.31). The subgroups we studied may be a source of heterogeneity. CONCLUSIONS Our results show an association between PPD and risk for BF. To confirm the conclusion, more studies with large sample sizes are required.
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12
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Yan M, Bo X, Zhang X, Zhang J, Liao Y, Zhang H, Cheng Y, Guo J, Cheng J. Mangiferin Alleviates Postpartum Depression-Like Behaviors by Inhibiting MAPK Signaling in Microglia. Front Pharmacol 2022; 13:840567. [PMID: 35721155 PMCID: PMC9204178 DOI: 10.3389/fphar.2022.840567] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/03/2022] [Indexed: 12/11/2022] Open
Abstract
Postpartum depression (PPD), a severe mental health disorder, is closely associated with decreased gonadal hormone levels during the postpartum period. Mangiferin (MGF) possesses a wide range of pharmacological activities, including anti-inflammation. Growing evidence has suggested that neuroinflammation is involved in the development of depression. However, the role of MGF in the development of PPD is largely unknown. In the present study, by establishing a hormone-simulated pregnancy PPD mouse model, we found that the administration of MGF significantly alleviated PPD-like behaviors. Mechanistically, MGF treatment inhibited microglial activation and neuroinflammation. Moreover, we found that MGF treatment inhibited mitogen-activated protein kinase (MAPK) signaling in vivo and in vitro. Together, these results highlight an important role of MGF in microglial activation and thus give insights into the potential therapeutic strategy for PPD treatment.
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Affiliation(s)
- Meichen Yan
- Center on Translational Neuroscience, College of Life and Environmental Science, Minzu University of China, Beijing, China
| | - Xuena Bo
- Center on Translational Neuroscience, College of Life and Environmental Science, Minzu University of China, Beijing, China
| | - Xinchao Zhang
- Center on Translational Neuroscience, College of Life and Environmental Science, Minzu University of China, Beijing, China
| | - Jingdan Zhang
- Center on Translational Neuroscience, College of Life and Environmental Science, Minzu University of China, Beijing, China
| | - Yajin Liao
- Center on Translational Neuroscience, College of Life and Environmental Science, Minzu University of China, Beijing, China
| | - Haiyan Zhang
- Key Laboratory of Modern Preparation of TCM, Ministry of Education, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Yong Cheng
- Center on Translational Neuroscience, College of Life and Environmental Science, Minzu University of China, Beijing, China
| | - Junxia Guo
- Beijing Key Laboratory of Bioactive Substances and Functional Foods, Beijing Union University, Beijing, China
| | - Jinbo Cheng
- Center on Translational Neuroscience, College of Life and Environmental Science, Minzu University of China, Beijing, China.,The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
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Brown A, Shenker N. Receiving screened donor human milk for their infant supports parental wellbeing: a mixed-methods study. BMC Pregnancy Childbirth 2022; 22:455. [PMID: 35641919 PMCID: PMC9154035 DOI: 10.1186/s12884-022-04789-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/25/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Access to donor human milk (DHM) has primarily been based on the health and development outcomes of premature infants but there has been little examination of the broader impact of an infant receiving it upon parental mental health. Breastfeeding and mental health are closely tied with women who experience breastfeeding difficulties or are unable to meet their own breastfeeding goals often experiencing feelings of guilt, sadness and anger, alongside an increased risk of postnatal depression. The aim of the current study was to explore how experience of receiving DHM for their baby affected the wellbeing of parents. METHODS UK parents of infants aged 0 - 12 months who had received screened DHM from a milk bank (typically on the neonatal unit or in some cases in the community) completed an online questionnaire exploring their experiences. The questionnaire included Likert scale items examining perceived impact upon infant health, own wellbeing and family functioning alongside open-ended questions exploring perceptions of how receiving DHM affected wellbeing. RESULTS Almost all of the 107 participants (women = 102) agreed that receiving DHM had a positive impact upon infant health and development, their own mental and physical health, and their family's wellbeing. Parents felt relieved that their infant was receiving DHM for health reasons but also due to the experience of being listened to, supported and having their infant feeding decisions facilitated. Receiving DHM helped mothers to process some of their emotions at not being able to breastfeed, in part because knowing their baby was being fed gave them the space to focus on recovery and bonding with their baby. Some parents did experience challenges, feeling guilty at receiving DHM, insecure that another woman was able to feed their baby when they could not, or negative reactions from family. Although the impact of receiving DHM upon breastfeeding was not measured, some women who were working to build their own milk supply noted that it helped motivate them to continue. CONCLUSIONS DHM may play an important role not only in protecting infant health and development but in supporting the mental health and wellbeing of mothers for whom their infant receiving human milk is important.
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Affiliation(s)
- A. Brown
- grid.4827.90000 0001 0658 8800School of Health and Social Care, Swansea University, Singleton Park, Swansea, UK ,grid.4827.90000 0001 0658 8800Centre for Lactation, Infant Feeding and Translation, Swansea University, Swansea, UK
| | - N. Shenker
- grid.7445.20000 0001 2113 8111Department of Surgery and Cancer, Imperial College London, London, UK
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Ouedraogo MO, Benova L, Smekens T, Sinke GG, Hailu A, Wanyonyi HB, Tolani M, Zumbe C, Abejirinde IOO. Prevalence of and factors associated with lactational mastitis in eastern and southern Africa: an exploratory analysis of community-based household surveys. Int Breastfeed J 2022; 17:24. [PMID: 35346272 PMCID: PMC8962073 DOI: 10.1186/s13006-022-00464-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/07/2022] [Indexed: 11/11/2022] Open
Abstract
Background Lactational mastitis is an extremely painful and distressing inflammation of the breast, which can seriously disrupt breastfeeding. Most of the evidence on the frequency of this condition and its risk factors is from high-income countries. Thus, there is a crucial need for more information on lactational mastitis and its associated factors in Sub-Saharan Africa (SSA). Methods We used data from representative, community-based cross-sectional household surveys conducted in 2020 with 3,315 women from four countries (Ethiopia, Kenya, Malawi, and Tanzania) who reported ever-breastfeeding their last child born in the two years before the survey. Our measure of lactational mastitis was self-reported and defined using a combination of breast symptoms (breast redness and swelling) and flu-like symptoms (fever and chills) experienced during the breastfeeding period. We first estimated country-specific and pooled prevalence of self-reported lactational mastitis and examined mastitis-related breastfeeding discontinuation. Additionally, we examined factors associated with reporting mastitis in the pooled sample using bivariate and multivariable logistic regression accounting for clustering at the country level and post-stratification weights. Results The prevalence of self-reported lactational mastitis ranged from 3.1% in Ethiopia to 12.0% in Kenya. Close to 17.0% of women who experienced mastitis stopped breastfeeding because of mastitis. The adjusted odds of self-reported lactational mastitis were approximately two-fold higher among women who completed at least some primary school compared to women who had no formal education. Study participants who delivered by caesarean section had 1.46 times higher odds of reporting lactational mastitis than women with a vaginal birth. Despite wide confidence intervals, our models also indicate that young women (15 – 24 years) and women who practiced prelacteal feeding had higher odds of experiencing lactational mastitis than older women (25 + years) and women who did not give prelacteal feed to their newborns. Conclusions The prevalence of lactational mastitis in four countries of SSA might be somewhat lower than estimates reported from other settings. Further studies should explore the risk and protective factors for lactational mastitis in SSA contexts and address its negative consequences on breastfeeding. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00464-x.
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Elkashif MML. Prevalence of Postpartum Depression, Associated Factors, Social Support, and Professional Assistance: A Cross-Sectional Study in Port Said, Egypt. INTERNATIONAL JOURNAL OF CHILDBIRTH 2022. [DOI: 10.1891/ijc-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTIONPostpartum depression is a mental illness that affects post-childbirth mothers. It is associated with psychological and social risk factors such as negative childhood experiences and pregnancy and childbirth problems. Postpartum depression has not been a focus of concern in Egypt. Therefore, this study aimed to identify the prevalence of postpartum depression, its associated factors, social support, and professional assistance in Port Said, Egypt.METHODOLOGYA random sampling strategy was used to select 540 women ten weeks postpartum. Data were collected using a questionnaire during an interview to identify potential risk factors for postpartum depression. The modified Arabic version of the Edinburgh Postpartum Depression Scale was used to assess symptoms of postpartum depression which is a multidimensional measure of social communication. Statistical analysis was completed using SPSS 25.0. software.RESULTSIt was found that 24.4% of women were at risk for postpartum depression. Social support from family and friends was significantly associated with mitigation of postpartum depression.CONCLUSIONThis study affirmed postpartum depression was a common health problem among 540 women who gave birth in Port Said, Egypt. Early detection and efficient screening methods to detect postpartum depression should be applied, especially in areas with a high risk for this condition. Early detection may prevent complications for mothers, babies, and families.
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Sawyer KM. The role of inflammation in the pathogenesis of perinatal depression and offspring outcomes. Brain Behav Immun Health 2021; 18:100390. [PMID: 34877551 PMCID: PMC8633814 DOI: 10.1016/j.bbih.2021.100390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 12/13/2022] Open
Abstract
The role of inflammation in the pathogenesis of depression is becoming increasingly apparent, but its role in perinatal depression is less well-studied. Pregnancy and the postpartum are characterised by distinct and changing inflammatory profiles throughout, which makes the study of depression-related alterations in this period complex. This review presents literature discussing a role for the immune system in both antenatal and postnatal depression. Furthermore, literature investigating the role of the maternal immune system on breast milk composition and offspring immunological and behavioural outcomes is discussed, before concluding with suggestions for future work as this developing field grows.
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Affiliation(s)
- Kristi M Sawyer
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
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17
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Hsiao BSJ, Sibeko L. Breastfeeding Is Inversely Associated with Allostatic Load in Postpartum Women: Cross-Sectional Data from Nationally Representative US Women. J Nutr 2021; 151:3801-3810. [PMID: 34515317 DOI: 10.1093/jn/nxab302] [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: 06/17/2021] [Revised: 07/30/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The postpartum period is a critical transition period when exposures to protective factors such as breastfeeding can have long-lasting health impact. Studies have suggested downregulating effects of breastfeeding on stress biomarkers such as cortisol but have not explored the way breastfeeding interacts with allostatic load, a multisystem indicator of chronic stress. OBJECTIVE We aimed to examine the association between breastfeeding and maternal allostatic load among women within 2 y postpartum using nationally representative data. METHODS A cross-sectional analysis of 10 waves of data from the NHANES (1999-2018) was conducted in a sample of 1302 women aged ≥18 y who provided information on breastfeeding through the reproductive health questionnaire. Clinical and empirical allostatic load scores (range: 0-10; higher numbers associated with increased risk) were derived for each participant based on 10 biomarkers reflecting metabolic, cardiovascular, and immune health. Multiple linear regression tested associations between breastfeeding and allostatic load, adjusting for maternal age, race and ethnicity, education, poverty level, and survey wave. RESULTS Breastfeeding had a significant inverse association with allostatic load in unadjusted and adjusted models. Controlling for age, race and ethnicity, education, poverty level, and survey wave, breastfeeding women had a 0.36-point lower clinical allostatic load score than nonbreastfeeding women (β = -0.36, SE = 0.11; 95% CI: -0.59, -0.14; P = 0.002) and a 0.44-point lower empirical allostatic load score (β = -0.44, SE = 0.15; 95% CI: -0.74, -0.14; P = 0.005). CONCLUSIONS Our study suggests that breastfeeding is protective of maternal stress and provides a more comprehensive picture of breastfeeding's influence on multiple body systems, exemplifying physiological benefits beyond effects on single biomarkers. However, limitations of cross-sectional data and non-classification of breastfeeding duration, mode, and intensity should be considered when interpreting these findings, and further research to address the role of breastfeeding and allostatic load is needed.
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Affiliation(s)
- Bi-Sek J Hsiao
- Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Lindiwe Sibeko
- Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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18
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Morniroli D, Consales A, Colombo L, Bezze EN, Zanotta L, Plevani L, Fumagalli M, Mosca F, Giannì ML. Exploring the Impact of Restricted Partners' Visiting Policies on Non-Infected Mothers' Mental Health and Breastfeeding Rates during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126347. [PMID: 34208247 PMCID: PMC8296174 DOI: 10.3390/ijerph18126347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
Changes in perinatal care occurring during the coronavirus disease 2019 (COVID-19) pandemic may negatively affect mothers' mental health and breastfeeding. This study, performed between April and May 2020, aimed to investigate the effect of restricted partners' visiting policies on non-infected mother's anxiety symptoms, the perceived postpartum support, and the breastfeeding outcomes at discharge. A cross-sectional study was conducted in a neonatal tertiary referral center in northern Italy during Italy's lockdown. We enrolled mothers with a negative nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), adequate oral and written comprehension of the Italian language, and absence of underlying maternal or neonatal clinical conditions. Maternal anxiety levels were assessed through the State-Trait Anxiety Inventory-Form Y (STAI-Y). Maternal perception of staff's support was evaluated by the Nurse Parent Support Tool (NPST). A STATE-A (concurrent emotional state after a specific situation) score ≥ 40 was considered indicative of clinically significant symptoms of anxiety. A total of 109 mothers completed the study. Mean STATE-A score was ≥40 in 42% of mothers, and median NPST score was 4.23. Mothers separated from their partner had a mean STATE-A score ≥ 40 in a higher percentage of cases than those who were not (51% vs. 30%, p = 0.03) and a lower perception of caregiver support. A NPST score ≤4.23, partner 's absence during the hospital stay and primiparity were independently associated with a STATE-A score ≥ 40. Breastfeeding rates at discharge were not influenced by maternal anxiety levels and partner's restricted policies. Instead, they were influenced by mode of delivery, a well-known risk factor, and pre-pandemic intention to breastfeed. Our study demonstrates the positive impact of a partner's presence on maternal mental health and perception of caregiver support.
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Affiliation(s)
- Daniela Morniroli
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
| | - Alessandra Consales
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-025503-2907
| | - Lorenzo Colombo
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
| | - Elena Nicoletta Bezze
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
| | - Lidia Zanotta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
| | - Laura Plevani
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
| | - Monica Fumagalli
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Maria Lorella Giannì
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy; (D.M.); (L.C.); (E.N.B.); (L.Z.); (L.P.); (M.F.); (F.M.); (M.L.G.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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Kiełbasa A, Gadzała-Kopciuch R, Buszewski B. Cytokines-Biogenesis and Their Role in Human Breast Milk and Determination. Int J Mol Sci 2021; 22:6238. [PMID: 34207900 PMCID: PMC8229712 DOI: 10.3390/ijms22126238] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 12/13/2022] Open
Abstract
Cytokines play a huge role in many biological processes. Their production, release and interactions are subject to a very complex mechanism. Cytokines are produced by all types of cells, they function very differently and they are characterized by synergism in action, antagonism, and aggregation activity, opposing action of one cytokine, overlapping activity, induction of another cytokine, inhibition of cytokine synthesis at the mRNA level as well as autoregulation-stimulation or inhibition of own production. The predominance of pro-inflammatory cytokines leads to a systemic inflammatory response, and anti-inflammatory-to an anti-inflammatory response. They regulate the organism's immune response and protect it against sudden disturbances in homeostasis. The synthesis and activity of cytokines are influenced by the central nervous system through the endocrine system (pituitary gland, adrenal glands).
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Affiliation(s)
- Anna Kiełbasa
- Department of Environmental Chemistry and Bioanalysis, Faculty of Chemistry, Nicolaus Copernicus University in Toruń, ul. Gagarina 7, 87-100 Toruń, Poland; (A.K.); (B.B.)
| | - Renata Gadzała-Kopciuch
- Department of Environmental Chemistry and Bioanalysis, Faculty of Chemistry, Nicolaus Copernicus University in Toruń, ul. Gagarina 7, 87-100 Toruń, Poland; (A.K.); (B.B.)
- Interdisciplinary Centre of Modern Technologies, Group for Separation and Bioanalytical Methods (Bio-Sep) Nicolaus Copernicus University in Toruń, ul. Wileńska 4, 87-100 Toruń, Poland
| | - Bogusław Buszewski
- Department of Environmental Chemistry and Bioanalysis, Faculty of Chemistry, Nicolaus Copernicus University in Toruń, ul. Gagarina 7, 87-100 Toruń, Poland; (A.K.); (B.B.)
- Interdisciplinary Centre of Modern Technologies, Group for Separation and Bioanalytical Methods (Bio-Sep) Nicolaus Copernicus University in Toruń, ul. Wileńska 4, 87-100 Toruń, Poland
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Vassilopoulou E, Feketea G, Koumbi L, Mesiari C, Berghea EC, Konstantinou GN. Breastfeeding and COVID-19: From Nutrition to Immunity. Front Immunol 2021; 12:661806. [PMID: 33897707 PMCID: PMC8058436 DOI: 10.3389/fimmu.2021.661806] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/10/2021] [Indexed: 12/15/2022] Open
Abstract
Breastfeeding not only provides the optimum source of nutrients for the neonate and its first strong shield against infection but also lays the foundation for somatic and psychological bonding between the mother and child. During the current COVID-19 pandemic, although the guidelines of the relevant international and national agencies recommend breastfeeding by SARS-CoV-2-infected mothers, considerable insecurity persists in daily clinical practice regarding the safety of the infants and the perceived advantages and disadvantages of discontinuation of breastfeeding. This is a systematic review of the currently available information regarding the transmissibility of SARS-CoV-2 through or while breastfeeding and the protection against infection that breast milk might provide. The accumulated body of knowledge regarding the role of breast milk in the development of the neonatal immune system and protection against infection by other respiratory viruses is discussed, with a focus on the anti-inflammatory role of the antibodies, microbes, and viruses provided to the infant in breast milk and its relevance to the case of SARS-CoV-2.
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Affiliation(s)
- Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Gavriela Feketea
- PhD School, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Pediatrics, Pediatric Allergy Outpatient Clinic, “Karamandaneio”, Children Hospital, Patras, Greece
| | - Lemonica Koumbi
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Christina Mesiari
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Elena Camelia Berghea
- Department of Pediatrics, Allergology and Clinical Immunology Outpatient Clinic, Clinical Hospital of Emergency for Children MS Curie, Bucharest, Romania
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - George N. Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
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21
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Butler MS, Young SL, Tuthill EL. Perinatal depressive symptoms and breastfeeding behaviors: A systematic literature review and biosocial research agenda. J Affect Disord 2021; 283:441-471. [PMID: 33272686 PMCID: PMC7954873 DOI: 10.1016/j.jad.2020.11.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/08/2020] [Accepted: 11/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Breastfeeding is recommended to improve maternal and infant health globally. Depression has been posited to negatively impact breastfeeding, although potential causal and bidirectional pathways between these two phenomena have not been sufficiently characterized. We therefore conducted a systematic review to critically evaluate available evidence on the relationship between perinatal depressive symptoms and breastfeeding behaviors; to identify knowledge gaps and propose a biosocial research agenda to advance our understanding of this topic. METHODS A systematic search strategy was applied across seven databases. Data were extracted and aggregated using the matrix method to provide a narrative synthesis of findings. RESULTS Thirty-eight studies from 20 countries spanning 1988 through 2018 fit the inclusion criteria. In general, methods across studies were heterogeneous. Fourteen different tools were used to measure perinatal depressive symptoms. Nearly half the studies did not provide breastfeeding definitions. No studies from low-income countries met inclusion criteria. More than half (63%) of studies demonstrated a negative association between depressive symptoms across the perinatal period and less exclusive breastfeeding and/or shorter breastfeeding durations. LIMITATIONS Heterogeneity in study design, definitions, assessment tools, and measurement time points limited the comparability of study findings. Causality cannot be assessed. CONCLUSIONS Available evidence suggests perinatal depressive symptoms negatively associated with breastfeeding exclusivity and duration, which can lead to suboptimal infant nutrition and detrimental impacts on maternal mental and physical health. To better understand this relationship, we propose including consistent operationalization and assessment of depression and breastfeeding globally and concurrent repeated measures of key biological and social factors.
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Affiliation(s)
| | - Sera L Young
- Department of Anthropology, Northwestern University; Institute for Policy Research, Northwestern University
| | - Emily L Tuthill
- Department of Community Health Systems, University of California, San Francisco
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22
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Women's Mental Health as a Factor Associated with Exclusive Breastfeeding and Breastfeeding Duration: Data from a Longitudinal Study in Greece. CHILDREN-BASEL 2021; 8:children8020150. [PMID: 33671169 PMCID: PMC7922988 DOI: 10.3390/children8020150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 12/29/2022]
Abstract
Background: This study investigated the relationship between exclusive breastfeeding and breastfeeding duration, and maternal psychological well-being in the perinatal period. Methods: A longitudinal study involving a retrospective follow-up of a group of 1080 women from pregnancy to the 1st year postpartum, who gave birth during the 5-year period between January 2014 and January 2019 in Athens, Greece, was designed. Women’s history and two psychometric tools—the Edinburg Postpartum Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9) administered at 5-time points—were used for data collection. Logistic regression analysis and a series of multiple analysis of variance (MANOVA) tests were performed. Results: The chance for exclusive breastfeeding (giving only breast milk) appeared to decrease (a) with an increase of the scores for psychometric tools antenatally (PHQ-9, p = 0.030) or at the 6th week postpartum (EPDS, p < 0.001 and PHQ-9, p < 0.001), (b) with an increase in the number of psychotherapeutic sessions needed antenatally (p = 0.030), and (c) when the initiation of psychotherapy was necessary postpartum (p = 0.002). Additionally, a shorter duration of any breastfeeding (with or without formula or other types of food/drink) seems to be associated with (a) the occurrence of pathological mental health symptoms (p = 0.029), (b) increased PHQ-9 scores antenatally (p = 0.018), (c) increased EPDS scores at the 6th week (p = 0.004) and the 12th month postpartum (p = 0.031), (d) the initiation of psychotherapy postpartum (p = 0.040), and e) the need for more than 13 psychotherapeutic sessions (p = 0.020). Conclusions: This study demonstrates a negative relationship between exclusive breastfeeding and breastfeeding duration, and poor maternal mental health in the perinatal period.
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23
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Gómez L, Verd S, de-la-Banda G, Cardo E, Servera M, Filgueira A, Ponce-Taylor J, Mulet M. Perinatal psychological interventions to promote breastfeeding: a narrative review. Int Breastfeed J 2021; 16:8. [PMID: 33407656 PMCID: PMC7789781 DOI: 10.1186/s13006-020-00348-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Emotional distress in mothers inhibits the let-down reflex, thus affecting breastfeeding self-efficacy. A breastfeeding mother may have to cope with both physical discomfort and psychological distress. However, literature on initiatives to improve breastfeeding rates has focused mainly on providing community-based peer support, or social policies. The aim of this review is to assess evidence on the effectiveness of a broad range of psychological interventions to facilitate breastfeeding for mothers facing difficulties around the time of delivery. Methods The review of the literature is derived from a search on Cochrane Library, PubMed, EBSCOhost, and PsycINFO for papers published since 1980. The approach was to explore quantitative and qualitative parameters. Quantitative parameters included breastfeeding initiation, duration, and composition. Qualitative parameters recorded the evaluation of maternal perceptions on breastfeeding success. The high heterogeneity of the studies led to a narrative review; 20 selected papers that report on breastfeeding outcomes and psychological programs met the inclusion criteria. Results The evidence on breastfeeding support through psychotherapy is heterogeneous and scant. Out of the included studies, 11 were randomized controlled trials, two were non-randomised trials, and two used a quasi-experimental design. None of the studies reported an increase in adverse breastfeeding outcomes. Three studies failed to report an association between psychological procedures and improved breastfeeding outcomes. A literature review showed that 17 (85%) analyses support stress-releasing techniques to facilitate breastfeeding. Conclusions This review suggests that relaxation interventions carefully tailored to address perinatal emotional distress may lead to important health benefits, including improvement in breastfeeding outcomes. There is also some indication that psychotherapy support while breastfeeding may have more impact than routine counselling. Conversely, this review did not find an association between self-hypnosis and breastfeeding outcomes. Data from this study can be used in designing prevention programs and future research with appropriate theoretical underpinning.
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Affiliation(s)
- Lidia Gómez
- Department of Child Psychiatry, Son Espases Hospital, Valldemossa road, 07120, Palma de Mallorca, Spain.,Baleares Medical Research Council (IdISBa), Valldemossa road, 07120, Palma de Mallorca, Spain
| | - Sergio Verd
- Baleares Medical Research Council (IdISBa), Valldemossa road, 07120, Palma de Mallorca, Spain. .,Pediatric Unit, La Vileta Surgery, Department of Primary Care, Matamusinos street, 07013, Palma de Mallorca, Spain.
| | - Gloria de-la-Banda
- Department of Psychology, Baleares Islands University, Valldemossa road, 07122, Palma de Mallorca, Spain
| | - Esther Cardo
- Pediatric Unit, La Vileta Surgery, Department of Primary Care, Matamusinos street, 07013, Palma de Mallorca, Spain.,Department of Paediatrics, Hospital Son Llatzer, Manacor road, 07128, Palma de Mallorca, Spain
| | - Mateu Servera
- Department of Psychology, Baleares Islands University, Valldemossa road, 07122, Palma de Mallorca, Spain
| | - Ana Filgueira
- Department of Paediatrics, Hospital Son Llatzer, Manacor road, 07128, Palma de Mallorca, Spain
| | - Jaume Ponce-Taylor
- Accidents & Emergency Unit, Department of Primary Care, Illes Balears street., 07014, Palma de Mallorca, Spain
| | - Margarita Mulet
- Mental Health Unit, Department of Primary Care, Simo Tort street, 07500, Mallorca, Manacor, Spain
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24
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Brown A, Shenker N. Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support. MATERNAL & CHILD NUTRITION 2021; 17:e13088. [PMID: 32969184 PMCID: PMC7537017 DOI: 10.1111/mcn.13088] [Citation(s) in RCA: 164] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic and subsequent lockdown and social distancing led to changes to breastfeeding support available to women in the United Kingdom. Face-to-face professional support was reduced, and face-to-face peer support was cancelled. Anecdotal media accounts highlighted practices separating some mothers and babies in hospitals, alongside inaccurate stories of the safety of breastfeeding circulating. Meanwhile, new families were confined to their homes, separated from families and support networks. Given that we know breastfeeding is best supported by practices that keep mother and baby together, high-quality professional and peer-to-peer support, and positive maternal well-being, it is important to understand the impact of the pandemic upon the ability to breastfeed. To explore this, we conducted an online survey with 1219 breastfeeding mothers in the United Kingdom with a baby 0-12 months old to understand the impact of the pandemic upon breastfeeding duration, experiences and support. The results highlighted two very different experiences: 41.8% of mothers felt that breastfeeding was protected due to lockdown, but 27.0% of mothers struggled to get support and had numerous barriers stemming from lockdown with some stopped breastfeeding before they were ready. Mothers with a lower education, with more challenging living circumstances and from Black and minority ethnic backgrounds were more likely to find the impact of lockdown challenging and stop breastfeeding. The findings are vital in understanding how we now support those women who may be grieving their loss of breastfeeding and are affected by their negative experiences and how we can learn from those with a positive experience to make sure all breastfeeding women are better supported if similar future events arise.
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Affiliation(s)
- Amy Brown
- Department of Public Health, Policy and Social SciencesSwansea UniversitySwanseaUK
- Centre for Lactation, Infant Feeding and TranslationSwansea UniversitySwanseaUK
| | - Natalie Shenker
- Department of Surgery and CancerImperial College LondonLondonUK
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25
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Yu Y, Liang HF, Chen J, Li ZB, Han YS, Chen JX, Li JC. Postpartum Depression: Current Status and Possible Identification Using Biomarkers. Front Psychiatry 2021; 12:620371. [PMID: 34211407 PMCID: PMC8240635 DOI: 10.3389/fpsyt.2021.620371] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/19/2021] [Indexed: 12/25/2022] Open
Abstract
Postpartum depression (PPD) is a serious health issue that can affect about 15% of the female population within after giving birth. It often conveys significant negative consequences to the offsprings. The symptoms and risk factors are somewhat similar to those found in non-postpartum depression. The main difference resides in the fact that PPD is triggered by postpartum specific factors, including especially biological changes in the hormone levels. Patients are usually diagnosed using a questionnaire onsite or in a clinic. Treatment of PPD often involves psychotherapy and antidepressant medications. In recent years, there have been more researches on the identification of biological markers for PPD. In this review, we will focus on the current research status of PPD, with an emphasis on the recent progress made on the identification of PPD biomarkers.
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Affiliation(s)
- Yi Yu
- Central Laboratory, Yangjiang People's Hospital, Yangjiang, China.,Center for Analyses and Measurements, College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Hong-Feng Liang
- Central Laboratory, Yangjiang People's Hospital, Yangjiang, China
| | - Jing Chen
- Central Laboratory, Yangjiang People's Hospital, Yangjiang, China.,Institute of Cell Biology, Zhejiang University, Hangzhou, China
| | - Zhi-Bin Li
- Central Laboratory, Yangjiang People's Hospital, Yangjiang, China.,Institute of Cell Biology, Zhejiang University, Hangzhou, China
| | - Yu-Shuai Han
- Central Laboratory, Yangjiang People's Hospital, Yangjiang, China.,Institute of Cell Biology, Zhejiang University, Hangzhou, China
| | - Jia-Xi Chen
- Central Laboratory, Yangjiang People's Hospital, Yangjiang, China.,Institute of Cell Biology, Zhejiang University, Hangzhou, China
| | - Ji-Cheng Li
- Central Laboratory, Yangjiang People's Hospital, Yangjiang, China.,Institute of Cell Biology, Zhejiang University, Hangzhou, China
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26
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Cárdenas EF, Kujawa A, Humphreys KL. Neurobiological changes during the peripartum period: implications for health and behavior. Soc Cogn Affect Neurosci 2020; 15:1097-1110. [PMID: 31820795 PMCID: PMC7657461 DOI: 10.1093/scan/nsz091] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/01/2019] [Accepted: 10/14/2019] [Indexed: 01/22/2023] Open
Abstract
Pregnancy and the transition to parenthood is an important period marked by dramatic neurobiological and psychosocial changes that may have implications for the health of women and offspring. Although human and non-human animal research suggests that the brain undergoes alterations during the peripartum period, these changes are poorly understood. Here, we review existing research, particularly human neuroimaging and psychophysiological research, to examine changes in brain structure and function during the peripartum period and discuss potential implications for the health of women and offspring. First, we discuss the potential causes of these changes across pregnancy, including physiological and psychosocial factors. Next, we discuss the evidence for structural and functional changes in the brain during pregnancy and into the postpartum period, noting the need for research conducted prospectively across human pregnancy. Finally, we propose potential models of individual differences in peripartum neurobiological changes (i.e. hypo-response, typical response, hyper-response) and emphasize the need to consider trajectories of change in addition to pre-existing factors that may predict maternal adjustment to parenthood. We suggest that the consideration of individual differences in neurobiological trajectories across pregnancy may contribute to a better understanding of risk for negative health and behavior outcomes for women and offspring.
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Affiliation(s)
- Emilia F Cárdenas
- Department of Psychology and Human Development, Vanderbilt University, 37203, Nashville, USA
| | - Autumn Kujawa
- Department of Psychology and Human Development, Vanderbilt University, 37203, Nashville, USA
| | - Kathryn L Humphreys
- Department of Psychology and Human Development, Vanderbilt University, 37203, Nashville, USA
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27
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Mustafa OM, Daoud YJ. Breastfeeding and Maternal Age-Related Cataract in the U.S. Population. Ophthalmic Epidemiol 2020; 28:244-249. [PMID: 32883149 DOI: 10.1080/09286586.2020.1817505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE An estimated 38 million and 50 million individuals will have cataract in the U.S. alone by 2030 and 2050, respectively. Breastfeeding is known to improve a number of health outcomes in both breastfed children and breastfeeding mothers. However, little is known about the relationship between breastfeeding and cataract, the leading cause of blindness worldwide, in breastfeeding mothers. This study was conducted to investigate the relationship between breastfeeding and maternal cataract extraction history in a nationally representative sample of the U.S. population. METHODS A 10-year multistage, probability-sampling survey data was used to identify parous women aged ≥50 years who provided breastfeeding history and cataract extraction history (n = 4897). Breastfeeding history was considered positive if a participant reported breastfeeding at least one child for ≥1 month. The main outcome was cataract extraction history. Estimates are presented in odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS Approximately half of the studied women breastfed at least one child ≥1 month, and about 18% reported cataract extraction history. Participants with a positive breastfeeding history were less likely to have a positive cataract extraction history in both age-adjusted (OR = 0.814, 95%CI = 0.670-0.989) and multivariable logistic regression (OR = 0.794, 95%CI = 0.639-0.988). Higher number of breastfed children was also associated with a lower risk of cataract extraction history (OR = 0.934, 95%CI = 0.883-0.988). CONCLUSIONS The findings suggest that breastfeeding may be associated with a decrease in the likelihood of age-related cataract extraction in parous women from the U.S. population.
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Affiliation(s)
- Osama M Mustafa
- Cornea, Cataract, and Refractive Surgery Division, Wilmer Eye Institute, The Johns Hopkins University, Baltimore, MD, USA
| | - Yassine J Daoud
- Cornea, Cataract, and Refractive Surgery Division, Wilmer Eye Institute, The Johns Hopkins University, Baltimore, MD, USA
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28
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Barth C, de Lange AMG. Towards an understanding of women's brain aging: the immunology of pregnancy and menopause. Front Neuroendocrinol 2020; 58:100850. [PMID: 32504632 DOI: 10.1016/j.yfrne.2020.100850] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/23/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Abstract
Women are at significantly greater risk of developing Alzheimer's disease and show higher prevalence of autoimmune conditions relative to men. Women's brain health is historically understudied, and little is therefore known about the mechanisms underlying epidemiological sex differences in neurodegenerative diseases, and how female-specific factors may influence women's brain health across the lifespan. In this review, we summarize recent studies on the immunology of pregnancy and menopause, emphasizing that these major immunoendocrine transition phases may play a critical part in women's brain aging trajectories.
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Affiliation(s)
- Claudia Barth
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Ann-Marie G de Lange
- Department of Psychology, University of Oslo, Oslo, Norway; Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
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29
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Morrow AL, Boero G, Porcu P. A Rationale for Allopregnanolone Treatment of Alcohol Use Disorders: Basic and Clinical Studies. Alcohol Clin Exp Res 2020; 44:320-339. [PMID: 31782169 PMCID: PMC7018555 DOI: 10.1111/acer.14253] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022]
Abstract
For many years, research from around the world has suggested that the neuroactive steroid (3α,5α)-3-hydroxypregnan-20-one (allopregnanolone or 3α,5α-THP) may have therapeutic potential for treatment of various symptoms of alcohol use disorders (AUDs). In this critical review, we systematically address all the evidence that supports such a suggestion, delineate the etiologies of AUDs that are addressed by treatment with allopregnanolone or its precursor pregnenolone, and the rationale for treatment of various components of the disease based on basic science and clinical evidence. This review presents a theoretical framework for understanding how endogenous steroids that regulate the effects of stress, alcohol, and the innate immune system could play a key role in both the prevention and the treatment of AUDs. We further discuss cautions and limitations of allopregnanolone or pregnenolone therapy with suggestions regarding the management of risk and the potential for helping millions who suffer from AUDs.
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Affiliation(s)
- A. Leslie Morrow
- Department of Psychiatry, Department of Pharmacology, Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC 27599
| | - Giorgia Boero
- Department of Psychiatry, Department of Pharmacology, Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC 27599
| | - Patrizia Porcu
- Neuroscience Institute, National Research Council of Italy (CNR), Cagliari, Italy
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30
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Boero G, Porcu P, Morrow AL. Pleiotropic actions of allopregnanolone underlie therapeutic benefits in stress-related disease. Neurobiol Stress 2019; 12:100203. [PMID: 31879693 PMCID: PMC6920111 DOI: 10.1016/j.ynstr.2019.100203] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/15/2019] [Accepted: 11/21/2019] [Indexed: 01/20/2023] Open
Abstract
For several years, research from around the world has suggested that the neuroactive steroid (3α,5α)-3-hydroxypregnan-20-one (allopregnanolone) may have therapeutic potential for treatment of various stress-related diseases including post-traumatic stress disorder (PTSD), depression, alcohol use disorders (AUDs), as well as neurological and psychiatric conditions that are worsened in the presence of stress, such as multiple sclerosis, schizophrenia, and seizure disorders. In this review, we make the argument that the pleiotropic actions of allopregnanolone account for its ability to promote recovery in such a wide variety of illnesses. Likewise, the allopregnanolone precursors, pregnenolone and progesterone, share many actions of allopregnanolone. Of course, pregnenolone and progesterone lack direct effects on GABAA receptors, but these compounds are converted to allopregnanolone in vivo. This review presents a theoretical framework for understanding how endogenous neurosteroids that regulate 1) γ-aminobutyric acid (GABA)A receptors, 2) corticotropin releasing factor (CRF) and 3) pro-inflammatory signaling in the innate immune system and brain could play a key role in both the prevention and treatment of stress-related disease. We further discuss cautions and limitations of allopregnanolone or precursor therapy as well as the need for more clinical studies.
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Affiliation(s)
- Giorgia Boero
- Department of Psychiatry, Department of Pharmacology, Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, 27599, USA
| | - Patrizia Porcu
- Neuroscience Institute, National Research Council of Italy (CNR), Cagliari, Italy
| | - A Leslie Morrow
- Department of Psychiatry, Department of Pharmacology, Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, 27599, USA
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31
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Pittet F, Van Caenegem N, Hicks-Nelson AR, Santos HP, Bradburn S, Murgatroyd C, Nephew BC. Maternal social environment affects offspring cognition through behavioural and immune pathways in rats. J Neuroendocrinol 2019; 31:e12711. [PMID: 30887654 DOI: 10.1111/jne.12711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/14/2019] [Accepted: 03/14/2019] [Indexed: 12/11/2022]
Abstract
The social environment of lactation is a key etiological factor for the occurrence of postpartum disorders affecting women and their children. Postpartum depression and anxiety disorders are highly prevalent in new mothers and negatively affect offspring's cognitive development through mechanisms which are still unclear. Here, using a rat model, we manipulated the maternal social environment during lactation and explored the pathways through which social isolation (vs. the opportunity for limited social interaction with another lactating female, from 1 day before parturition to postpartum day 16) and chronic social conflict (daily exposure to a male intruder from postpartum day 2 to day 16) affect offspring learning and memory, measured at 40 to 60 days of age. We specifically explored the consequences of these social treatments on two main hypothesized mediators likely to affect offspring neurophysiological development: the quality of maternal care and maternal inflammation factors (brain-derived neurotrophic factor, granulocyte-macrophage colony-stimulating factor, intercellular adhesion molecule 1, tissue inhibitor of metalloproteinases 1 and vascular endothelial growth factor) likely to influence offspring development through lactation. Maternal rats which had the opportunity to interact with another lactating female spent more time with their pups which, in turn, displayed improved working and reference memory. Social stress affected maternal plasma levels of cytokines that were associated with cognitive deficits in their offspring. However, females subjected to social stress were protected from these stress-induced immune changes and associated offspring cognitive impairment by increased social affiliation. These results underscore the effects of social interaction for new mothers and their offspring and can be used to inform the development of clinical preventative measures and interventions.
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Affiliation(s)
- Florent Pittet
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts
- Neuroscience and Behavior Unit, California National Primate Research Center, University of California, Davis, California
- School for Human Evolution and Social Change, Arizona State University, Tempe, Arizona
| | - Nicolas Van Caenegem
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts
| | - Alexandria R Hicks-Nelson
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts
- Department of comparative Medicine, Stanford University School of Medicine, Stanford, California
| | - Hudson P Santos
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Steven Bradburn
- Bioscience Research Centre, Manchester Metropolitan University, Manchester, UK
| | | | - Benjamin C Nephew
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, Massachusetts
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
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32
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Peripartum depression and infant care, sleep and growth. Sci Rep 2019; 9:10186. [PMID: 31308415 PMCID: PMC6629993 DOI: 10.1038/s41598-019-46563-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 06/26/2019] [Indexed: 11/30/2022] Open
Abstract
Peripartum depression is a common, serious complication in mothers. To assess the influence of infant care, sleep and growth on the risk of peripartum depression, 1,271 mothers of healthy one-month-old infants completed comprehensive questionnaires including the Edinburgh Postnatal Depression Scale. Relationships between high depression scores and variables related to infants’ care, sleep and growth were assessed adjusting for other variables. High depression scores were found in 233 mothers, which were associated with variables related to infants’ care (poor satisfaction with infant care support, p < 0.001; mothers’ passive response to night-time fussing, p = 0.001), sleep (dim bedroom lighting, p < 0.05; short sleep duration, p < 0.05) and growth (poor weight gain, p < 0.05), as well as maternal variables (primiparas, p < 0.001; poor income satisfaction, p < 0.001; poor sleep satisfaction, p < 0.001; daytime sleepiness, p = 0.001). Considering the observed association between high depression scores and infants’ care, sleep and growth, a multidisciplinary approach accounting for infant care would be required to prevent peripartum depression.
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33
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Webber E, Benedict J. Postpartum depression: A multi-disciplinary approach to screening, management and breastfeeding support. Arch Psychiatr Nurs 2019; 33:284-289. [PMID: 31227081 DOI: 10.1016/j.apnu.2019.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/13/2018] [Accepted: 01/24/2019] [Indexed: 01/16/2023]
Abstract
Postpartum depression (PPD) is a common condition affecting 11%-20% of all postpartum women. Depression can have significant consequences for both mother and infant. There are many risk factors associated with PPD, all of which contribute to an inflammatory response in the mother. An inverse relationship exists between PPD and breastfeeding; women with PPD are less likely to have a positive breastfeeding experience which can lead to early weaning, while long-term exclusive breastfeeding is associated with decreased rates of PPD. A multi-disciplinary approach to managing PPD, including strong breastfeeding support, will lead to improved mental health outcomes for women and their children.
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Affiliation(s)
- Elaine Webber
- University of Detroit Mercy, 4001 W McNichols Rd, Detroit, MI 48221, United States.
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34
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Abdollahpour S, Bolbolhaghighi N, Khosravi A. Effect of the Sacred Hour on Postnatal Depression in Traumatic Childbirth: a Randomized Controlled Trial. J Caring Sci 2019; 8:69-74. [PMID: 31249815 PMCID: PMC6589481 DOI: 10.15171/jcs.2019.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/25/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction: the implementation of the baby’s nine instinctive stages as a sacred hour after birth is very effective in starting breastfeeding. About half of newly delivered mothers have reported a traumatic childbirth experience often associated with mental health problems. The present study aimed to examine the effect of the sacred hour on the depression in traumatic childbirths. Methods: In this clinical trial, 84 mothers who had experienced a traumatic childbirth were randomly allocated into the intervention (n = 42) and control (n = 42) groups. The intervention group received sacred hour (baby’s nine instinctive responses), but the control group received only the routine care. Postnatal depression was evaluated as primary outcome at 2 week, 4-6 week and 3 month intervals after the delivery. The data were analyzed using t test, chi-square test and the repeated measures analysis of variance. Results: The results showed that the marginal total mean (SD: standard deviation) scores of depression in the intervention and control groups were 7.5 (2.6) and 9.6 (2.6); therefore, the mean difference (95% CI) between the groups (-2.1, (-3.2,-0.95)) was significant. Conclusion: The implementation of the sacred hour is recommended as a preventive approach to reduce the postnatal depression in women with a traumatic childbirth experience.
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Affiliation(s)
- Sedigheh Abdollahpour
- Department of Midwifery, Faculty of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Nahid Bolbolhaghighi
- Department of Midwifery, Faculty of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ahmad Khosravi
- Department of Epidemiology, Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
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Hollen R, Smith AG, Smith-Gagen J. Breastmilk Pumping for the Mental Health of the NICU Mother. CLINICAL LACTATION 2019. [DOI: 10.1891/2158-0782.10.2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ObjectiveWhile much is known about breastfeeding and postpartum depression, little is known about breast milk pumping's impact on postpartum depression among mothers with infants in the neonatal intensive care unit (NICU).MethodsThirty-two mothers of infants admitted to a Level III NICU between February and July 2017 were screened for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS). They were also surveyed for current breastmilk pumping activities and demographic factors. Multivariable logistic regression was used to assess the associations between postpartum depression and breast milk pumping, adjusting for confounding variables.ResultsAfter controlling for confounding variables, mothers who did not pump breast milk (relative to mothers who did) were 11 times more likely to have lower EPDS depression scores indicative of probable postpartum depression (OR = 11.7, p-value .05).ConclusionsOur results suggest a significant reduction in probable postpartum depression among NICU mothers who express breastmilk.
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Park S, Choi NK. Breastfeeding reduces risk of depression later in life in the postmenopausal period: A Korean population-based study. J Affect Disord 2019; 248:13-17. [PMID: 30708102 DOI: 10.1016/j.jad.2018.12.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/30/2018] [Accepted: 12/24/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The relationship between breastfeeding and maternal depression in later life has not yet been investigated. We examined whether the number of breastfed infants or the period of breastfeeding influenced maternal depression in postmenopausal women. METHODS We analyzed 1,372 parous postmenopausal women aged ≥ 50 years who had participated in the Korea National Health and Nutrition Examination Survey 2014. Depression was diagnosed using the Patient Health Questionnaire 9, with scores of 10 or higher indicating depression. Logistic regression analyses were performed to examine the relationships between breastfeeding and postmenopausal depression. RESULTS Women with a moderate (2-3) or high (4-12) number of breastfed infants had 65% [odds ratio (OR) = 0.35, 95% confidence interval (CI) = 0.19-0.65] and 77% (OR = 0.23, 95% CI = 0.10-0.55) decreased risks of depression, respectively, compared to those with low numbers of infants (0-1). Women who breastfed their infants for long periods (47-432 months) had 67% (OR = 0.33, 95% CI = 0.16-0.68) decreased risk of depression, compared to those who breastfed for short periods (0-23 months). The risk of depression decreased by 29% (OR = 0.71, 95% CI = 0.58-0.87) for each additional infant breastfed and by 9% (OR = 0.91, 95% CI = 0.82- < 1.00) for each additional year of breastfeeding. The population-attributable fraction of depression associated with < 2 infants breastfed was 17.3% (95% CI = 14.2-20.3%), while the fraction associated with a period of breastfeeding < 24 months was not significant. CONCLUSIONS Women with more breastfed infants or longer period of breastfeeding are at decreased risk of depression in the postmenopausal period.
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Affiliation(s)
- Sangshin Park
- Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea
| | - Nam-Kyong Choi
- Department of Health Convergence, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic of Korea.
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Thompson AL, Houck KM, Jahnke JR. Pathways linking caesarean delivery to early health in a dual burden context: Immune development and the gut microbiome in infants and children from Galápagos, Ecuador. Am J Hum Biol 2019; 31:e23219. [PMID: 30693586 PMCID: PMC6661198 DOI: 10.1002/ajhb.23219] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/29/2018] [Accepted: 12/28/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Global increases in caesarean deliveries are exposing more infants to perinatal environments that are evolutionarily novel and potentially increasing their risks for inflammatory conditions. Yet, the pathways linking caesareans to later health outcomes are not well understood, particularly in dual burden contexts. We test two of the hypothesized pathways, altered immune function and gut microbiota, which may link delivery mode to later health outcomes and test whether these associations persist when controlling for postnatal nutritional and pathogenic exposures. METHODS Data come from infants, aged 0 to 2 (n = 41), and young children, aged 2 to 11 (n = 135), from the Galápagos, Ecuador. Differences in morbidity, C-reactive protein (CRP), and gut microbiota by delivery type were tested using linear and logistic regression models adjusted for nutritional and pathogenic exposures and infant age. RESULTS Over half of infants and over 40% of children were delivered by caesarean. Morbidity and CRP did not differ between infants or children born by caesarean or vaginally. Microbial taxa abundance differed by delivery mode. Infants born by caesarean had a higher abundance of Firmicutes and a lower relative abundance of Bacteroidales. Children born by caesarean had a higher abundance of Proteobacteria and Enterobacteriales. These differences remained after adjustment for environmental exposure. CONCLUSIONS Caesarean delivery is associated with differences in gut microbiota across childhood even in this dual burden context. Our results highlight the importance of examining caesarean delivery across diverse contexts to better understand the impact of perinatal interventions on short- and longer-term health outcomes.
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Affiliation(s)
- Amanda L. Thompson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kelly M Houck
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Johanna R. Jahnke
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Pajewska-Szmyt M, Sinkiewicz-Darol E, Gadzała-Kopciuch R. The impact of environmental pollution on the quality of mother's milk. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:7405-7427. [PMID: 30687894 PMCID: PMC6447517 DOI: 10.1007/s11356-019-04141-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/02/2019] [Indexed: 05/18/2023]
Abstract
Breastfeeding is a gold standard of neonate nutrition because human milk contains a lot of essential compounds crucial for proper development of a child. However, milk is also a biofluid which can contain environmental pollution, which can have effects on immune system and consequently on the various body organs. Polychlorinated biphenyls are organic pollutants which have been detected in human milk. They have lipophilic properties, so they can penetrate to fatty milk and ultimately to neonate digestive track. Another problem of interest is the presence in milk of heavy metals-arsenic, lead, cadmium, and mercury-as these compounds can lead to disorders in production of cytokines, which are important immunomodulators. The toxicants cause stimulation or suppression of this compounds. This can lead to health problems in children as allergy, disorders in the endocrine system, end even neurodevelopment delay and disorder. Consequently, correlations between pollutants and bioactive components in milk should be investigated. This article provides an overview of environmental pollutants found in human milk as well as of the consequences of cytokine disorder correlated with presence of heavy metals. Graphical abstract.
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Affiliation(s)
- Martyna Pajewska-Szmyt
- Department of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus Copernicus University in Toruń, 7 Gagarin St, 87-100, Toruń, Poland
- Interdisciplinary Centre for Modern Technologies, Nicolaus Copernicus University, 4 Wileńska St, PL-87100, Toruń, Poland
| | - Elena Sinkiewicz-Darol
- Ludwik Rydygier Provincial Polyclinic Hospital in Toruń, Human Milk Bank, Św. Józefa 53-59, 87-100, Toruń, Poland
- Human Milk Bank Foundation, 128J Podkowy St, 04-937, Warsaw, Poland
| | - Renata Gadzała-Kopciuch
- Department of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus Copernicus University in Toruń, 7 Gagarin St, 87-100, Toruń, Poland.
- Interdisciplinary Centre for Modern Technologies, Nicolaus Copernicus University, 4 Wileńska St, PL-87100, Toruń, Poland.
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McCloskey RJ, Karandikar S. Peer-to-Peer Human Milk Sharing: Recipient Mothers' Motivations, Stress, and Postpartum Mental Health. Breastfeed Med 2019; 14:88-97. [PMID: 30668133 DOI: 10.1089/bfm.2018.0182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Some mothers who cannot breastfeed-partially or completely-choose to feed their infants human milk donated from a peer. Few studies have examined mothers' experiences with using donor milk; none has examined whether or not mothers' stress and mental health are associated with using donor milk from a peer. METHODS Researchers conducted semistructured individual interviews with mothers from the United States and Canada (N = 20) to answer the following questions: (a) what are recipient mothers' motivations for participation in peer-to-peer breast milk sharing and (b) what is the relationship between receiving donated milk and mothers' stress and mental health postpartum? Transcripts were coded using an inductive approach and principles of grounded theory were used to analyze data. RESULTS Data were organized under two themes: (a) motivations for using milk from a peer and (b) milk-sharing and stress-related experiences. Motivations included health benefits, medical need, and preference for human milk over formula. Factors inducing stress were as follows: logistical stressors of securing donor milk and fear of running out of milk. Factors reducing stress were as follows: donor milk provided relief and comfort and its use reduced mothers' self-reported symptoms of postpartum depression and anxiety. CONCLUSIONS Mothers participated in peer-to-peer breast milk sharing primarily because of health benefits for children. However, participation also had important psychological benefits for some mothers. Additional research and open discourse are needed to support mothers who choose to use milk from a peer and to promote safety of this practice.
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Male infants and birth complications are associated with increased incidence of postnatal depression. Soc Sci Med 2019; 220:56-64. [DOI: 10.1016/j.socscimed.2018.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/18/2018] [Accepted: 10/14/2018] [Indexed: 12/13/2022]
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Payne JL, Maguire J. Pathophysiological mechanisms implicated in postpartum depression. Front Neuroendocrinol 2019; 52:165-180. [PMID: 30552910 PMCID: PMC6370514 DOI: 10.1016/j.yfrne.2018.12.001] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/13/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023]
Abstract
This review aims to summarize the diverse proposed pathophysiological mechanisms contributing to postpartum depression, highlighting both clinical and basic science research findings. The risk factors for developing postpartum depression are discussed, which may provide insight into potential neurobiological underpinnings. The evidence supporting a role for neuroendocrine changes, neuroinflammation, neurotransmitter alterations, circuit dysfunction, and the involvement of genetics and epigenetics in the pathophysiology of postpartum depression are discussed. This review integrates clinical and preclinical findings and highlights the diversity in the patient population, in which numerous pathophysiological changes may contribute to this disorder. Finally, we attempt to integrate these findings to understand how diverse neurobiological changes may contribute to a common pathological phenotype. This review is meant to serve as a comprehensive resource reviewing the proposed pathophysiological mechanisms underlying postpartum depression.
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Affiliation(s)
- Jennifer L Payne
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Jamie Maguire
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA 02111, USA.
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Agostini A, Lushington K, Dorrian J. The relationships between bullying, sleep, and health in a large adolescent sample. Sleep Biol Rhythms 2018. [DOI: 10.1007/s41105-018-0197-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Aparicio VA, Ocón O, Diaz-Castro J, Acosta-Manzano P, Coll-Risco I, Borges-Cósic M, Romero-Gallardo L, Moreno-Fernández J, Ochoa-Herrera JJ. Influence of a Concurrent Exercise Training Program During Pregnancy on Colostrum and Mature Human Milk Inflammatory Markers: Findings From the GESTAFIT Project. J Hum Lact 2018; 34:789-798. [PMID: 29601268 DOI: 10.1177/0890334418759261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although exercise reduces systemic inflammation, information regarding its influence on human milk is scarce or inexistent. Research Aim: The aim of this study was to investigate the influence of an exercise intervention during pregnancy on colostrum and mature human milk inflammatory markers. METHODS The authors conducted a pseudorandomized controlled trial. The exercise group followed a concurrent aerobic and strength training, three 60-minutes sessions per week, from the 17th gestational week until delivery. For the specific aims of this study, only women able to produce enough milk were included for data analyses, resulting in 24 exercise and 23 control women. Colostrum and mature human milk proinflammatory and anti-inflammatory cytokines (fractalkine, interleukin [IL]-1β, IL-6, IL-8, IL-10, interferon [IFN]-γ, and tumor necrosis factor [TNF]-α) were measured using Luminex xMAP technology. RESULTS The mothers who followed the exercise program had 36% lower IL-8 and 27% lower TNF-α concentrations in their colostrum than those in the control group ( p < .05 and p < .01, respectively). The colostrum from mothers who followed the exercise program also presented borderline significant 22% lower IL-6 ( p < .100). The mature milk from mothers who followed the exercise program had 30% greater fractalkine ( p = .05) and borderline significant 20% higher IL-10 ( p = .100). The exercise intervention did not affect IFN-γ concentrations. CONCLUSIONS This concurrent exercise program promoted a less proinflammatory profile in human milk, especially in colostrum. Moreover, it might increase mature human milk fractalkine, which could induce a greater neurodevelopment and neuroprotection in the newborn. This trial was registered at ClinicalTrials.gov (NCT02582567) on October 20, 2015.
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Affiliation(s)
- Virginia A Aparicio
- 1 Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Olga Ocón
- 2 Department and UGC of Gynaecology and Obstetrics, Virgen de las Nieves University Hospital, Granada, Spain
| | - Javier Diaz-Castro
- 1 Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Pedro Acosta-Manzano
- 3 Department of Physical Education and Sport, University of Granada, Granada, Spain
| | - Irene Coll-Risco
- 1 Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Milkana Borges-Cósic
- 3 Department of Physical Education and Sport, University of Granada, Granada, Spain
| | | | - Jorge Moreno-Fernández
- 1 Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Julio J Ochoa-Herrera
- 1 Department of Physiology, Faculty of Pharmacy, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
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Glynn LM, Howland MA, Fox M. Maternal programming: Application of a developmental psychopathology perspective. Dev Psychopathol 2018; 30:905-919. [PMID: 30068423 PMCID: PMC6274636 DOI: 10.1017/s0954579418000524] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The fetal phase of life has long been recognized as a sensitive period of development. Here we posit that pregnancy represents a simultaneous sensitive period for the adult female with broad and persisting consequences for her health and development, including risk for psychopathology. In this review, we examine the transition to motherhood through the lens of developmental psychopathology. Specifically, we summarize the typical and atypical changes in brain and behavior that characterize the perinatal period. We highlight how the exceptional neuroplasticity exhibited by women during this life phase may account for increased vulnerability for psychopathology. Further, we discuss several modes of signaling that are available to the fetus to affect maternal phenotypes (hormones, motor activity, and gene transfer) and also illustrate how evolutionary perspectives can help explain how and why fetal functions may contribute to maternal psychopathology. The developmental psychopathology perspective has spurred advances in understanding risk and resilience for mental health in many domains. As such, it is surprising that this major epoch in the female life span has yet to benefit fully from similar applications.
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Affiliation(s)
| | | | - Molly Fox
- University of California,Los Angeles
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Heo SH, Noh YG. Impact of Parenting Stress and Husband's Support on Breastfeeding Adaptation among Breastfeeding Mothers. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2017; 23:233-242. [PMID: 37684902 DOI: 10.4069/kjwhn.2017.23.4.233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/11/2017] [Accepted: 10/31/2017] [Indexed: 09/10/2023] Open
Abstract
PURPOSE This study investigated the relationships among parenting stress, husband's support, and breastfeeding adaptation in mothers. METHODS A correlational survey design was utilized in this study. Data were collected from 181 breastfeeding mothers with infants under 12 months of age. Participants were recruited from the outpatient clinic, a child photo studio, or from the kid's cafe from July 22 to September 13, 2016. Instruments for collecting data included Childcare Stress Inventory (CSI), Husband's Support scale, and the Breastfeeding Adaptation scale. Data were analyzed using SPSS 21.0 by frequency, descriptive statistics, t-test, one-way ANOVA, Pearson's correlation coefficient and multiple regression. RESULTS Of the 181 subjects, 54.7% responded they only breastfed with 75.7% who received breastfeeding education. Seventy-two percent of mothers made a decision to breastfeed by themselves. The mean score was 2.39±0.53 for parenting stress, 3.07±0.43 for husband's support, and 3.85±0.49 for breastfeeding adaptation. Factors influencing breastfeeding adaptation were identified as lower parenting stress (β=-.54), greater husband's support (β=.31), breastfeeding (β=.31), and older age of baby (β=.14), with 56.0% that explained variance. CONCLUSION This study reports that parenting stress has negative effect on breastfeeding adaptation, while husband's support has positive effect. Results may be useful in developing new strategies for enhancing breastfeeding adaptation.
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Coker JL, Tripathi SP, Knight BT, Pennell PB, Magann EF, Newport DJ, Stowe ZN. Rating scale item assessment of self-harm in postpartum women: a cross-sectional analysis. Arch Womens Ment Health 2017; 20:687-694. [PMID: 28664216 PMCID: PMC10906960 DOI: 10.1007/s00737-017-0749-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
We examined the utility of screening instruments to identify risk factors for suicidal ideation (SI) in a population of women with neuropsychiatric illnesses at high risk for postpartum depression. Pregnant women with neuropsychiatric illness enrolled prior to 20 weeks of gestation. Follow-up visits at 4-8-week intervals through 13 weeks postpartum included assessment of depressive symptoms with both clinician and self-rated scales. A total of 842 women were included in the study. Up to 22.3% of postpartum women admitted SI on rating scales, despite the majority (79%) receiving active pharmacological treatment for psychiatric illness. Postpartum women admitting self-harm/SI were more likely to meet criteria for current major depressive episode (MDE), less than college education, an unplanned pregnancy, a history of past suicide attempt, and a higher score on the Childhood Trauma Questionnaire. In women with a history of neuropsychiatric illness, over 20% admitted SI during the postpartum period despite ongoing psychiatric treatment. Patient-rated depression scales are more sensitive screening tools than a clinician-rated depression scale for +SI in the postpartum period.
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Affiliation(s)
- Jessica L Coker
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA.
| | - Shanti P Tripathi
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA
| | - Bettina T Knight
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA
| | - Page B Pennell
- Division of Epilepsy, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA
- Department of Maternal-Fetal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205, USA
| | - D Jeffrey Newport
- Women's Reproductive Mental Health, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1446, Miami, FL, 33136, USA
| | - Zachary N Stowe
- Women's Mental Health Program, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, No. 843, Little Rock, AR, 72205-7199, USA
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Pittet F, Babb JA, Carini L, Nephew BC. Chronic social instability in adult female rats alters social behavior, maternal aggression and offspring development. Dev Psychobiol 2017; 59:291-302. [PMID: 28138966 DOI: 10.1002/dev.21491] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 11/14/2016] [Indexed: 12/30/2022]
Abstract
We investigated the consequences of chronic social instability (CSI) during adulthood on social and maternal behavior in females and social behavior of their offspring in a rat model. CSI consisted of changing the social partners of adult females every 2-3 days for 28 days, 2 weeks prior to mating. Females exposed to CSI behaved less aggressively and more pro-socially towards unfamiliar female intruders. Maternal care was not affected by CSI in a standard testing environment, but maternal behavior of CSI females was less disrupted by a male intruder. CSI females were quicker to attack prey and did not differ from control females in their saccharin consumption indicating, respectively, no stress-induced sensory-motor or reward system impairments. Offspring of CSI females exhibited slower growth and expressed more anxiety in social encounters. This study demonstrates continued adult vulnerability to social challenges with an impact specific to social situations for mothers and offspring.
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Affiliation(s)
- Florent Pittet
- Department of Biomedical Sciences, Tufts University: Cummings School of Veterinary Medicine, North Grafton, Massachusetts
| | - Jessica A Babb
- Department of Biomedical Sciences, Tufts University: Cummings School of Veterinary Medicine, North Grafton, Massachusetts.,Department of Anesthesiology, Perioperative Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lindsay Carini
- Department of Biomedical Sciences, Tufts University: Cummings School of Veterinary Medicine, North Grafton, Massachusetts
| | - Benjamin C Nephew
- Department of Biomedical Sciences, Tufts University: Cummings School of Veterinary Medicine, North Grafton, Massachusetts
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Wood NK, Sanders EA. Mothers With Perceived Insufficient Milk: Preliminary Evidence of Home Interventions to Boost Mother–Infant Interactions. West J Nurs Res 2017; 40:1184-1202. [DOI: 10.1177/0193945916687552] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Perceived insufficient milk (PIM) is the primary reason for breastfeeding discontinuation globally. This study evaluated the short-term impact of mother–infant interactions through home interventions designed to overcome PIM as a result of the infant’s behavior, delivered to 14 dyads of breastfeeding mothers and their full-term singleton infants. A single group, three-occasion prepost design was used. Mother–infant interactions were measured by the Nursing Child Assessment Feeding Scale (NCAFS) at 6, 13, and 27 days postpartum. There were significantly increased mother–infant interactions during intervention. Specifically, significant growth over the intervention occurred for mother’s sensitivity to cues, cognitive growth fostering, infant’s clarity of cues, and responsiveness to caregiver. The NCAFS total score was also significantly improved. Although modifications are required, the three home intervention sessions showed promise in improving mother–infant interactions during breastfeeding. Further investigation using a randomized experimental design is warranted.
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Ghaedrahmati M, Kazemi A, Kheirabadi G, Ebrahimi A, Bahrami M. Postpartum depression risk factors: A narrative review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2017; 6:60. [PMID: 28852652 PMCID: PMC5561681 DOI: 10.4103/jehp.jehp_9_16] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 01/16/2017] [Indexed: 05/03/2023]
Abstract
Postpartum depression is a debilitating mental disorder with a high prevalence. The aim of this study was review of the related studies. In this narrative review, we report studies that investigated risk factors of postpartum depression by searching the database, Scopus, PubMed, ScienceDirect, Uptodate, Proquest in the period 2000-2015 published articles about the factors associated with postpartum depression were assessed in Farsi and English. The search strategy included a combination of keywords include postpartum depression and risk factors or obstetrical history, social factors, or biological factors. Literature review showed that risk factors for postpartum depression in the area of economic and social factors, obstetrical history, and biological factors, lifestyle and history of mental illness detected. Data from this study can use for designing a screening tools for high-risk pregnant women and for designing a prevention programs.
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Affiliation(s)
- Maryam Ghaedrahmati
- Reproductive Health Department Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Kazemi
- Women's Health Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
- Address for correspondence: Dr. Ashraf Kazemi, Women's Health Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Gholamreza Kheirabadi
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amrollah Ebrahimi
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masood Bahrami
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Snyder-Drummond R, Bingham H, Lang JM. Massachusetts Parents’ Experiences With Insurance Coverage for Lactation Consultant Services. CLINICAL LACTATION 2017. [DOI: 10.1891/2158-0782.8.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Women’s Preventive Services component of the Affordable Care Act (ACA) requires coverage of “lactation supplies and services” with no out-of-pocket cost to the patient. However, as IBCLCs providing in-home lactation consults, we found that during the first year of the ACA mandate, clients often described disappointment with coverage for home visits and for breastfeeding support in general. To have a more specific picture of women’s experiences, our association conducted an online survey of families in Massachusetts who sought insurance coverage for IBCLC care outside of the hospital since the ACA provisions came into effect. The goal was to identify the barriers that families who need these services commonly dealt with. Barriers reported by survey respondents included confusing and inconsistent information provided by insurance companies about coverage, lack of coverage for the time and place they sought IBCLC services, lack of coverage for IBCLCs at all, and restriction to a network that did not include IBCLC providers. These findings suggest that many women are not yet receiving the benefits of insurance coverage for lactation support and point to specific changes that insurance providers should make to provide adequate coverage as mandated under the ACA.
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