A study of the risk of mental retardation among children of pregnant women who have attempted suicide by means of a drug overdose

Early environmental risk factors for neurodevelopmental disorders - a systematic review of twin and sibling studies

While neurodevelopmental disorders (NDDs) are highly heritable, several environmental risk factors have also been suggested. However, the role of familial confounding is unclear. To shed more light on this, we reviewed the evidence from twin and sibling studies. A systematic review was performed on case control and cohort studies including a twin or sibling within-pair comparison of neurodevelopmental outcomes, with environmental exposures until the sixth birthday. From 7,315 screened abstracts, 140 eligible articles were identified. After adjustment for familial confounding advanced paternal age, low birth weight, birth defects, and perinatal hypoxia and respiratory stress were associated with autism spectrum disorder (ASD), and low birth weight, gestational age and family income were associated with attention-deficit/hyperactivity disorder (ADHD), categorically and dimensionally. Several previously suspected factors, including pregnancy-related factors, were deemed due to familial confounding. Most studies were conducted in North America and Scandinavia, pointing to a global research bias. Moreover, most studies focused on ASD and ADHD. This genetically informed review showed evidence for a range of environmental factors of potential casual significance in NDDs, but also points to a critical need of more genetically informed studies of good quality in the quest of the environmental causes of NDDs.

Predictors and outcomes of suicidal ideation during peripartum period

INTRODUCTION

Suicide belongs to the leading causes of maternal perinatal mortality and suicidal ideation is one of the strongest predictors for suicide attempt and completion and thus represents an opportunity for early intervention prior to self and infant harm. This post-hoc analysis aims to investigate predictors of peripartum suicidality (PS) and potential maternal and infant outcomes of PS.

METHODS

In the prospective-longitudinal Maternal Anxiety in Relation to Infant Development (MARI) study, n = 306 women were repeatedly examined from early pregnancy until 16 months postpartum using interviews (Composite International Diagnostic Interview for Women) and questionnaires (Edinburgh Postnatal Depression Scale, Brief Symptom Inventory) to obtain sociodemographic, gynecological and offspring characteristics as well as information about PS (thoughts of death/self-harm, suicide plans, suicide attempt).

RESULTS

PS was indicated by n = 15 women. A stepwise multivariate logistic regression revealed a history of suicide attempt (OR = 17.84, 95%CI: 4.61-69.05), living together with the partner (OR = 0.14, 95%CI: 0.03-0.63), and social support (OR = 0.35, 95%CI: 0.13-0.91) as significant predictors for PS (model fit: AUC = 0.7926). As compared to women with no PS, infants of women with PS presented lower scores in neuropsychological development (p = 0.020).

LIMITATIONS

This post-hoc analysis was conducted with the aim of generating hypotheses for future research. The small number of women who indicated PS limits the statistical power.

CONCLUSION

PS is an important perinatal complication that requires clinical attention. Larger prospective studies are warranted to verify the findings. This will lead to improved preventive and therapeutic approaches and a better understanding of the motives behind maternal suicide and infanticide.

Suicidal ideation in pregnancy: an epidemiologic review

Suicidal behaviors are the leading causes of injury and death worldwide, and are leading causes of maternal deaths in some countries. One of the strongest risk factors, suicidal ideation, is considered a harbinger and distal predictor of later suicide attempt and completion, and also presents an opportunity for interventions prior to physical self-harm. The purpose of this systematic epidemiologic review is to synthesize available research on antepartum suicidal ideation. Original publications were identified through searches of the electronic databases using the search terms pregnancy, pregnant women, suicidal ideation, and pregnan* and suicid* as root searches. We also reviewed references of published articles. We identified a total of 2626 articles through the electronic database search. After irrelevant and redundant articles were excluded, 57 articles were selected. The selected articles were original articles that focused on pregnancy and suicidal ideation. Of the 57 included articles, 20 reported prevalence, 26 reported risk factors, 21 reported consequences of antepartum suicidal ideation, and 5 reported on screening measures. Available evidence indicates that pregnant women are more likely than the general population to endorse suicidal ideation. Additionally, a number of risk factors for antepartum suicidal ideation were identified including intimate partner violence, <12-year education, and major depressive disorder. There is a need for enhanced screening for antepartum suicidal ideation. The few screening instruments that exist are limited as they were primarily developed to measure antepartum and postpartum depression. Given a substantial proportion of women with suicidal ideation that does not meet clinical thresholds of depression and given the stress-diathesis model that shows susceptibility to suicidal behavior independent of depressive disorders, innovative approaches to improve screening and detection of antepartum suicidal ideation are urgently needed.

The long-term psychiatric and medical prognosis of perinatal mental illness

The perinatal period provides an important window into a woman's long-term health. Perinatal mental illness is a common condition conferring potential serious long-term psychiatric and medical consequences for the mother and family. It is known that childbirth acts as a powerful trigger for depressive episodes in some women, and that women with histories of a mood disorder are particularly vulnerable. Some evidence links perinatal mental illness with obstetrical complications and reduced lactation initiation and duration. Therefore, perinatal mental illness may be a marker for long-term risk, and may contribute directly to subsequent cardiometabolic disease through both neuroendocrine mechanisms and the effects of mental illness on health behaviours. In clinical practice, these associations underscore the importance of screening and treating women with perinatal mental illness to ensure best possible long-term outcomes. Early screening and treatment may both mitigate the primary disease process and reduce the risk of comorbid medical conditions.