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Ma S, Dou Y, Wang W, Wei A, Lan M, Liu J, Yang L, Yang M. Association between esketamine interventions and postpartum depression and analgesia following cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2024; 6:101241. [PMID: 38262519 DOI: 10.1016/j.ajogmf.2023.101241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE This study aimed to compare the efficacy and safety of the use of esketamine to reduce the risk for postpartum depression and pain after cesarean delivery. DATA SOURCES Literature searches were conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wan fang from inception to August 2023. STUDY ELIGIBILITY CRITERIA The eligibility criteria were all randomized controlled trials of people who underwent a cesarean delivery and who were randomized to receive esketamine interventions irrespective of age or ethnicity. The outcomes that were assessed included the incidence of postpartum depression and the Edinburgh Postnatal Depression Scale score within 7 days and at 28 to 42 days after delivery, the pain score (visual analog scale or numerical rating scale, 0-10), the consumption of opioids, and intraoperative and postoperative adverse events. METHODS The Cochrane collaboration's tool was used for quality appraisal of the included studies. Statistical analysis of the data was performed using Review Manager 5.3 software, and the results were expressed as mean differences with 95% confidence intervals. Assessments were pooled using a random-effects or fixed-effects model. Study heterogeneity was assessed using the standard I2 statistic. RESULTS Among the 11 included randomized controlled trials that used the Edinburgh Postnatal Depression Scale for postpartum depression assessment, patients in esketamine group had a lower risk for postpartum depression within a week of surgery (risk ratio, 0.45; 95% confidence interval, 0.33-0.62). Intraoperative use of esketamine maintained a lower Edinburgh Postnatal Depression Scale score after surgery (mean difference, -1.64; 95% confidence interval, -2.14 to -1.14). Esketamine was associated with a beneficial effect in terms of the other outcomes, including a significant decline in pain score within 48 hours (mean difference, -0.71; 95% confidence interval, -0.89 to 0.52). Esketamine increased the risk for adverse neurologic and mental events during surgery without harming health, and there was no significant difference after delivery when compared with the control group. CONCLUSION Esketamine may reduce the risk for postpartum depression among patients who are undergoing cesarean delivery in the short term. In addition, as an adjunct to reduce analgesia, esketamine also effectively assists in pain management. Because of the lack of more high-quality evidence, we need more compelling evidence to confirm the value of esketamine in improving postpartum recovery.
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Affiliation(s)
- Shijin Ma
- Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Ms Ma, Mr Dou, Ms Wang, Ms Wei, Ms Lan, Ms Liu, Ms Yang, and Dr Yang)
| | - Yuzhe Dou
- Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Ms Ma, Mr Dou, Ms Wang, Ms Wei, Ms Lan, Ms Liu, Ms Yang, and Dr Yang)
| | - Wei Wang
- Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Ms Ma, Mr Dou, Ms Wang, Ms Wei, Ms Lan, Ms Liu, Ms Yang, and Dr Yang)
| | - Ai Wei
- Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Ms Ma, Mr Dou, Ms Wang, Ms Wei, Ms Lan, Ms Liu, Ms Yang, and Dr Yang)
| | - Mengxia Lan
- Chengdu University of Traditional Chinese Medicine, Chengdu, China (Ms Lan)
| | - Jingyu Liu
- Southwest Medical University, Luzhou, China (Ms Liu)
| | - Lina Yang
- Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Ms Ma, Mr Dou, Ms Wang, Ms Wei, Ms Lan, Ms Liu, Ms Yang, and Dr Yang).
| | - Mengchang Yang
- Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China (Ms Ma, Mr Dou, Ms Wang, Ms Wei, Ms Lan, Ms Liu, Ms Yang, and Dr Yang).
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Wang W, Ling B, Chen Q, Xu H, Lv J, Yu W. Effect of pre-administration of esketamine intraoperatively on postpartum depression after cesarean section: A randomized, double-blinded controlled trial. Medicine (Baltimore) 2023; 102:e33086. [PMID: 36862862 PMCID: PMC9981392 DOI: 10.1097/md.0000000000033086] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND To evaluate the effect of pre-administration of esketamine intraoperatively on the occurrence of postpartum depression after cesarean section under combined spinal-epidural anesthesia. METHODS A total of 120 women aged 24 to 36 years undergoing cesarean section by spinal-epidural anesthesia with American Society of Anesthesiologists physical status II were enrolled. According to the intraoperative use of esketamine, all participants were randomly divided into 2 groups: test group (group E) and control group (group C). Esketamine was administered intravenously at a dose of 0.2 mg/kg after the infant was delivered in group E and equal volume of normal saline was given in group C. The incidence of postpartum depression was recorded at 1 week and 6 weeks after the operation. The occurrence of adverse reactions such as postpartum bleeding, nausea and vomiting, drowsiness, and nightmares were also recorded at 48 hours after surgery. RESULTS Compared with group C, the incidence of postpartum depression was significantly lower at 1 week and 6 weeks after surgery in group E (P < .01). There was no significant difference of the adverse effects at 48 hours after the operation between the 2 groups. CONCLUSION Intravenous infusion of 0.2 mg/kg esketamine in women during cesarean section can significantly reduce the incidence of postpartum depression at 1 week and 6 weeks after surgery without increasing related adverse effects.
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Affiliation(s)
- Wei Wang
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
| | - Bin Ling
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
| | - Qian Chen
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
| | - Hua Xu
- Department of Gynaecology and obstetrics, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
| | - Jie Lv
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
- * Correspondence: Jie Lv, Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, No. 168 Gushan Road, CN-Jiangsu, Nanjing 211100, China (e-mail: )
| | - Wanyou Yu
- Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China
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House TS, Alnajjar E, Mulekar M, Spiryda LB. Mommy Meltdown: Understanding Racial Differences Between Black and White Women in Attitudes About Postpartum Depression and Treatment Modalities. JOURNAL OF CLINICAL GYNECOLOGY AND OBSTETRICS 2021; 9:37-42. [PMID: 33732401 PMCID: PMC7962419 DOI: 10.14740/jcgo664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Postpartum depression is a major public health problem, but limited information is available about risk factors and attitudes of minority women about postpartum depression. The objective of this study is to determine attitudes of minority women toward postpartum depression and treatment. Methods: In this prospective study at an academic resident and faculty clinic, 39 women (19 black and 20 white) at the 6-week postpartum visit completed a survey that was developed for this study to assess personal and family attitudes about postpartum depression in addition to the routinely distributed Edinburgh postnatal depression scale. The primary outcome variable was the presence of postpartum depression amongst minority women compared to other races. The secondary outcome looked at descriptors of attitudes about depression and treatment. Data were analyzed with Chi-square test for categorical data and Student’s t-test for continuous data. Results: Black and white participants were comparable in age, distribution of gestational age at birth, delivery type and pregnancy complications. The diagnosis of postpartum depression was not different in either population (two black and three white women; P = 0.667). Black participants were referred less frequently to counseling as treatment (5% vs. 30%; P = 0.052) but both black and white study participants viewed counseling as helpful (84% vs. 80%; P = 0.345). Black participants had a lower frequency of family history of depression (11% vs. 40%; P = 0.052) but both study groups were comfortable discussing the topic with their families, felt that their families were not ashamed of any social stigma about depression, and would be supportive of either counseling or medications as a treatment modality. Conclusions: Postpartum depression was common among our patients regardless of race. Most black and white women were willing to discuss depression with their families and accept treatment. Despite previous evidence to the contrary, black women stated that they were open to counseling as treatment for depression.
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Affiliation(s)
- Talelia S House
- Department of Obstetrics and Gynecology, University of South Alabama College of Medicine, Mobile, AL 36688, USA
| | - Eva Alnajjar
- Department of Obstetrics and Gynecology, University of South Alabama College of Medicine, Mobile, AL 36688, USA
| | - Madhuri Mulekar
- Department of Mathematics and Statistics, University of South Alabama College of Medicine, Mobile, AL 36688, USA
| | - Lisa B Spiryda
- Department of Obstetrics and Gynecology, Phelps Hospital-Northwell, Zucker School of Medicine Hofstra/Northwell, Hempstead, NY, USA
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Edinoff AN, Odisho AS, Lewis K, Kaskas A, Hunt G, Cornett EM, Kaye AD, Kaye A, Morgan J, Barrilleaux PS, Lewis D, Viswanath O, Urits I. Brexanolone, a GABA A Modulator, in the Treatment of Postpartum Depression in Adults: A Comprehensive Review. Front Psychiatry 2021; 12:699740. [PMID: 34594247 PMCID: PMC8477036 DOI: 10.3389/fpsyt.2021.699740] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Postpartum depression (PPD) is one of the three major categories on the spectrum of postpartum psychiatric syndromes. Postpartum psychiatric syndromes are classified as either postpartum blues, postpartum depression, or postpartum psychosis. Postpartum depression is important to recognize clinically because of the effect it can have on the mother-child bond. The neurosteroid allopregnanolone, a progesterone derivative, is important for its role in positively modulating GABAA receptors. GABA-mediated signaling has been previously implicated in major depressive disorder. Allopregnanolone-mediated signaling has been identified as an important therapeutic target. Treatment with an allopregnanolone-analog, brexanolone, has been shown to improve depression scores in trials for the treatment of PPD. Brexanolone is a positive allosteric modulator of GABAA and is the first drug approved by the FDA to treat postpartum depression. Brexanolone enhances the inhibitory effects of GABAA, restores dysfunctional GABAA transmembrane channels, and mimics a naturally produced progesterone metabolite that fluctuates during pregnancy and postpartum. One open-label study and two phase two studies have some significant reduction in HAM-D scores after treatment and that the effect was still there 30 days post-treatment. Per the data reported, intravenous infusion of brexanolone could be efficacious and safe for the treatment of women suffering from postpartum depression.
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Affiliation(s)
- Amber N Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | - Amira S Odisho
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | - Kendall Lewis
- Louisiana State University Shreveport School of Medicine, Shreveport, LA, United States
| | - Amir Kaskas
- Louisiana State University Shreveport School of Medicine, Shreveport, LA, United States
| | - Grace Hunt
- Louisiana State University Shreveport School of Medicine, Shreveport, LA, United States
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, United States
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, United States
| | - Adam Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, United States
| | - John Morgan
- Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, Shreveport, LA, United States
| | - P Scott Barrilleaux
- Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, Shreveport, LA, United States
| | - David Lewis
- Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, Shreveport, LA, United States
| | - Omar Viswanath
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, United States.,University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, United States.,Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, United States
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, United States.,Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA, United States
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Sun J, Zhu Y, Li Y, Li N, Liu T, Su X, Dai Z, Zhang Y, Pan L, Jiang W, Zhu W. Maternal postpartum feeding anxiety was associated with infant feeding practices: results from the mother-infant cohort study of China. BMC Pregnancy Childbirth 2020; 20:780. [PMID: 33317471 PMCID: PMC7737271 DOI: 10.1186/s12884-020-03483-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 12/08/2020] [Indexed: 11/20/2022] Open
Abstract
Background Maternal feeding anxiety (FA) was prevalent during puerperium and might affect infant feeding practices. This study was aimed to investigate the FA status in Chinese postpartum women and its relationship with infant feeding practices (FPs). Methods Participants were from the Mother-Infant Cohort Study of China, in which the dietary and feeding practices, physical and psychiatric health for both mothers and infants were followed up from childbirth to next 2 years. In this study the maternal feeding anxiety (FA) status at 0–3 months postpartum was assessed by Li’s Self-rating Feeding Anxiety Scale (SFAS). Infant feeding practices (FPs) at 0–3 months, including breastfeeding-related behaviors, responsive feeding and infant food refusal were investigated by self-designed questionnaire. Results In total 456 mothers the average feeding anxiety scores (FAS) was 41.02 ± 8.02 (mean ± SD), and maternal FA prevalence were 61.4% (FAS>38) with severe FA being 8.6% (FAS>52) at 0–3 months postpartum. The FAS was related with infant FPs, and lower maternal FAS was significantly related with infant colostrum feeding (40.86 ± 8.02 vs 44.74 ± 11.33, P < 0.05), but higher FAS was related with bottle feeding (41.95 ± 8.28 vs 39.69 ± 7.92, P < 0.05). The mothers with severe feeding anxiety (FAS > 53) were more likely to feed infants with bottle (ORs, 95%CI: 2.41, 1.11 ~ 5.19). There were not significant association between FAS and exclusive breastfeeding and responsive feeding practices (P > 0.05). The higher FAS was associated with infant food refusal behaviors, the maternal scores whose infant “never”, “rarely”, “sometimes” and “often” spat out food when feeding were 39.86 ± 8.02, 41.47 ± 8.18, 41.36 ± 7.44 and 42.14 ± 12.03 increasingly (P > 0.05), and the FA prevalence was significantly different among groups (P < 0.05). The infants whose mother was identified as feeding anxiety were more likely to refuse opening the mouth when feeding (P < 0.05). Multivariate analysis indicated maternal FAS was positively related to infant bottle feeding (βi = 2.487, P < 0.05) and outdoor sunshine exposure practice (βi = 1.787, P < 0.05), and negatively related to household income level (βi = − 0.118, P < 0.05). Conclusions Maternal postpartum feeding anxiety was associated with some infant feeding practices, including bottle feeding and infant food refusal behaviors. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03483-w.
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Affiliation(s)
- Jing Sun
- Department of Nutrition and Food Hygiene, Peking University School of Public Health; National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Yimin Zhu
- Shijingshan District Center for Diseases Prevention and Control, Beijing, 100043, China
| | - Yongjin Li
- Shunyi District Center for Diseases Prevention and Control, Beijing, 101300, China
| | - Niuniu Li
- Department of Nutrition and Food Hygiene, Peking University School of Public Health; National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Tan Liu
- Department of Nutrition and Food Hygiene, Peking University School of Public Health; National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Xiao Su
- Department of Nutrition and Food Hygiene, Peking University School of Public Health; National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China
| | - Zhiyong Dai
- Peking-Ausnutria Maternal and Infant Nutrition Research Center, Beijing, 100191, China
| | - Yanchun Zhang
- Peking-Ausnutria Maternal and Infant Nutrition Research Center, Beijing, 100191, China
| | - Lina Pan
- Peking-Ausnutria Maternal and Infant Nutrition Research Center, Beijing, 100191, China
| | - Wei Jiang
- Peking-Ausnutria Maternal and Infant Nutrition Research Center, Beijing, 100191, China
| | - Wenli Zhu
- Department of Nutrition and Food Hygiene, Peking University School of Public Health; National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China.
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Mood D, Szarkowski A, Brice PJ, Wiley S. Relational Factors in Pragmatic Skill Development: Deaf and Hard of Hearing Infants and Toddlers. Pediatrics 2020; 146:S246-S261. [PMID: 33139438 PMCID: PMC11215649 DOI: 10.1542/peds.2020-0242d] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 11/24/2022] Open
Abstract
In this article, we review relational factors in early childhood believed to contribute in unique ways to pragmatic skill development in deaf and hard of hearing (DHH) infants and toddlers. These factors include attending to infant interactions with caregivers and others, supporting development of theory of mind through play and use of mental state language (ie, describing one's own or others' thoughts, feelings, and beliefs), and providing accessible opportunities for social interaction. On the basis of a review of the literature and clinical experience, we offer prescriptive strategies for supporting DHH children's development in these areas. To improve outcomes for DHH children, medical care providers and allied health professionals have a responsibility to support the development of young DHH children's pragmatic abilities by understanding these variables, coaching caregivers regarding their importance, and facilitating referrals for support when necessary.
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Affiliation(s)
- Deborah Mood
- Section of Developmental Pediatrics, Department of Pediatrics, University of Colorado, Aurora, Colorado;
- Contributed equally as co-first authors
| | - Amy Szarkowski
- Children's Center for Communication/Beverly School for the Deaf, Beverly, Massachusetts
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Contributed equally as co-first authors
| | | | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Cincinatti Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
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Guo YJ, Shan YM, Wang ZJ, Shen ZF. Efficacy of transcranial magnetic stimulation and fluoxetine in the treatment of postpartum depression: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20170. [PMID: 32481286 PMCID: PMC7249935 DOI: 10.1097/md.0000000000020170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Numerous studies have reported that transcranial magnetic stimulation (TMS) and fluoxetine is used in the treatment of postpartum depression (PPD). Currently, no study has systematically investigated the efficacy and safety of TMS and fluoxetine for the treatment of patients with PPD. Thus, this study will assess the efficacy and safety of TMS and fluoxetine for treating PPD. METHODS Relevant studies involving TMS and fluoxetine for the treatment of patients with PPD will be comprehensively searched from the electronic databases from inception to the February 1, 2020: Cochrane Library, EMBASE, MEDILINE, CINAHL, AMED, WANGFANG, VIP, and CNKI databases. No language and publication time restrictions will be applied. RevMan 5.3 software will be utilized for data pooling, data analysis, and risk of bias evaluation. If necessary, we will also assess reporting bias using funnel plot and Egger test. RESULTS This study will comprehensively summarize the existing evidence to assess the efficacy and safety of TMS and fluoxetine for treating PPD. CONCLUSION The findings of this study may help to establish a better approach to treat PPD using TMS and fluoxetine. DISSEMINATION AND ETHICS This study will be disseminated through a peer-reviewed journal. This study does not need ethical approval as no primary patient data will be used. SYSTEMATIC REVIEW REGISTRATION INPLASY202040017.
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Affiliation(s)
| | - Yong-Ming Shan
- School of Mathematics and Information Engineering, Jiaxing University, Jiaxing, China
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