Maternal mental disorders in pregnancy and the puerperium and risks to infant health

Increased depressive-like behaviour of postpartum Flinders sensitive and resistant line rats is reversed by a predictable postpartum stressor

During the peripartum period, women are at an increased risk to develop perinatal distress, presenting as symptoms of depression and/or anxiety. Yet, due to practical and ethical restrictions, our understanding of this condition remains limited. Animal studies that focus on the neuropsychiatric mechanisms associated with the postpartum period, often ignore the genetical predisposition factor. We therefore investigated whether pregnancy could alter the bio-behavioural profile of the Flinders sensitive and resistant line rats, and whether these effects are exacerbated by a postpartum stressor. Postpartum dams were compared to nulliparous controls in behavioural tests, analysing depressive- and anxiety-like behaviours. Next, postpartum dams were subjected to a maternal separation and early weaning (MSEW) regimen, with their behaviour and serotonergic and noradrenergic concentrations compared to rats not separated from their pups. Regardless of strain, pregnancy decreased time spent in the open arms of the elevated plus maze and hippocampal serotonin concentrations. Time spent immobile in the forced swim test was also increased, with a significant effect in the FRL and a strong trend in the FSL rats. MSEW reversed these behaviours in both strains and increased social interaction with a male counterpart in the FSL rats, without influencing hippocampal or cortical serotonin or norepinephrine. Taken together, these results suggest that pregnancy influences postpartum behaviour, in a strain-dependent manner. Contrary to what we expected, MSEW overall decreased depressive- and anxiety-like behaviours, with strain specific differences, indicating that a chronic, predictable stressor may not necessarily adversely affect postpartum behaviour.

Epidemiological profile of perinatal mental disorders at a tertiary hospital in Yaoundé- Cameroon

In developing countries, 15.6% of pregnant women and 19.8% after childbirth experience a mental disorder. In the absence of data on the situation in Cameroon, we carried out a study to determine the prevalence of perinatal mental illness in this hospital and its risk factors among women in perinatal period and the relationship between both at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, a reference mother and child hospital. We conducted a hospital-based, cross sectional, observational study. Data was collected using structured and semi-structured interviews. There were six sub-themes covered: participants' socio-demographic profile, clinical profile, perinatal history, psychopathology aspects with the Mini International Psychiatric Interview, the Edinburgh Postnatal Depression Scale, the State Trait Anxiety Inventory and the perinatal mental illness risk factors. Data entry was done using Microsoft Excel 2010 and transferred to Statistical Package for the Social Sciences version 23.0 for analysis. Among 194 women who participated in the study, the general prevalence for perinatal mental disorders was 53.6% (104/194), 25.8% among pregnant women and 27.8% among postnatal women. Comorbidities were present in 17.5% of our study population. We observed that 45.8% suffered from depression, 17% had a risk of suicide, 10.3% suffered from perinatal anxiety, 3.1% presented with post-traumatic stress disorder, 3.6% acute stress disorder, 7.7% had adjustment disorder. Concerning risk factors, we found a significant link between depression and severe anxiety before delivery (p < 0.05) and the absence of social support (p = 0.005). We found that women with at least four risk factors were 1.6 times more likely to present with a perinatal mental disorder. The prevalence of perinatal mental disorders at this Hospital is very high. This highlights the need for institutional screening and management of perinatal mental disorders, which suggests that we explore the situation in others and other health facilities in Cameroon.

Infancy weight faltering and childhood neurodevelopmental disorders: a general population birth-cohort study

While it is known that intrauterine growth restriction is associated with later mental disorders, it is still unclear whether similar associations exists for postnatal weight faltering, also known as 'failure to thrive' in infancy. This study examined the potential connection between infancy weight faltering and mental disorders diagnosed in childhood focusing specifically on neurodevelopmental disorders. The Copenhagen Child Cohort (CCC2000) was used to explore weight gain in infancy assessed by community health nurses. Data from the Danish national registries were used to quantify ICD-10 mental disorders diagnosed between birth and 12 years of age, as well as potential child and family confounders. Of 4.476 children with sufficient weight data, 339 (7.3%) children were diagnosed with a mental disorder in childhood. Both any (weight gain < -1SD) and severe infancy weight faltering (weight gain < -2SD) were associated with psychomotor delays, while severe infancy weight faltering was also associated with intellectual impairments. Notably, no significant associations were found between weight faltering and autism spectrum disorders or attention deficit hyperactivity disorders. Weight faltering in infancy may be an early marker of neurodevelopmental delays. This possibility should be considered when assessing infants with slow weight gain, to early identification and treatment of co-occurring neurodevelopmental disorders.

Maternal mental health and infant and young child undernutrition: protocol for a systematic review

INTRODUCTION

Mental health disorder, particularly depression, is one of the leading causes of 'disease related disability' in women that both affects the women but has adverse effect on their children. This can have an impact on mothers' capacity of child care which ultimately increases the risk of infection, malnutrition, impaired growth and behavioural problems in children that might extend to adulthood too. Diminished child growth has an irreversible effect both short and long terms, affecting physical growth, brain development, performance in education, working capacity and increased risks to non-communicable diseases. To date, the reviews conducted are only limited to few countries or maternal depression or certain age group of children. Our aim is to provide a global perspective focusing on all early childhood undernutrition (under 5 years) and to see if the association between maternal mental health and child undernutrition has yielded similar or different result. Furthermore, we intend to explore the risk factors associated with copresence of maternal mental health issues and undernutrition in children.

METHODS AND ANALYSIS

MEDLINE (PubMed), PsycINFO, CINAHL, Cochrane Library, Global Health Library Relevant reports from the WHO, United Nations of Children Education Fund and organisations working in maternal and child health will also be searched. Database of systematic reviews and database of abstracts of reviews of effects will also be searched for relevant literature. Papers published from 1995 to 2020 in English will be included. Title, abstract or both will be screened independently by reviewers. For data analysis and synthesis, we will present all the outcomes mentioned in the studies and a subgroup analysis for age and sex will be conducted. This study aims to conduct a meta-analysis.

ETHICS AND DISSEMINATION

Ethical approval is not required to conduct this review.

PROSPERO REGISTRATION NUMBER

CRD42020189315.

Maternal Mental Disorders and Pediatric Infectious Diseases: A Retrospective Cohort Study

BACKGROUND

Maternal stress and depression are associated with infections in offspring, but there is a paucity of data for other mental disorders.

METHODS

We conducted a retrospective cohort study of 832,290 children born between 2006 and 2016 in hospitals of Quebec, Canada. We identified maternal mental disorders before and during pregnancy, and admissions for otitis media, pneumonia, infectious enteritis and other infections in children before 13 years of age. We used Cox proportional hazards regression to estimate hazard ratios (HRs) with 95% confidence intervals (CI) for the association between maternal mental disorders and the risk of pediatric infectious diseases, adjusted for maternal age, comorbidity, socioeconomic disadvantage, and other confounders.

RESULTS

The incidence of pediatric infection hospitalization was higher for maternal mental disorders compared with no disorder (66.1 vs. 41.1 cases per 1000 person-years). Maternal mental disorders were associated with 1.38 times the risk of otitis media (95% CI: 1.35-1.42), 1.89 times the risk of bronchitis (95% CI: 1.68-2.12), and 1.65 times the risk of infectious enteritis in offspring (95% CI: 1.57-1.74). Stress and anxiety disorders (HR 1.49, 95% CI: 1.46-1.53) and personality disorders (HR 1.55, 95% CI: 1.49-1.61) were more strongly associated with the risk of pediatric infection hospitalization than other maternal mental disorders. Associations were prominent in the first year of life and weakened with age.

CONCLUSIONS

Maternal mental disorders are risk factors for infectious disease hospitalization in offspring. Women with mental disorders may benefit from psychosocial support to reduce the risk of serious infections in their children.

Psycho-educational interventions focused on maternal or infant sleep for pregnant women to prevent the onset of antenatal and postnatal depression: A systematic review

AIMS

This systematic review aimed to evaluate randomized controlled trials (RCTs) to examine the effect of maternal and infant sleep intervention during women's pregnancy for the purpose of preventing perinatal depression.

METHOD

A systematic search (from inception to January 28, 2019) for RCTs using five electronic databases-the Cochrane Controlled Register of Trials (CENTRAL), Embase, PubMed, PsycINFO, and Ichushi Web (Japan Medical Abstracts Society)-was conducted. Twelve investigators independently conducted initial screenings based on title and abstract, and then, two researchers performed full-text reviews one by one. A meta-analysis would be conducted if at least three studies were found. However, only two articles that met inclusion criteria, and narrative data synthesis was conducted for these two articles. The study protocol has been registered at PROSPERO (CRD42019119999).

RESULT

A total of 13 654 studies were initially searched. After removing duplicates, 10 547 studies were screened, and finally, two studies met the inclusion criteria. In both studies, the intervention was a one-time face-to-face session during pregnancy to deliver the behavioral knowledge and skills for optimizing sleep hygiene for both infant and mother. Effectiveness of the intervention in improving maternal mood was not significant in one study. In the other, there was a significant difference in maternal mood between the intervention and control group. No mood comparison was made between baseline and postintervention.

CONCLUSION

This study found limited evidence to support the effectiveness of sleep intervention for all pregnant women, which means "universal intervention," to protect maternal mental health. Further well-designed RCTs are needed to confirm these findings.

Associations of postpartum mother-infant bonding with maternal childhood maltreatment and postpartum mental health: a cross-sectional study

BACKGROUND

After delivery, some women experience impairment of their mother-infant bonding (MIB), which can lead to long-term disturbances of the mother-child relationship and the child's social-emotional development. Little is known about the association between early maternal bonding problems and mothers' own adverse childhood experiences, even though the hypothesis of the intergenerational transmission of caregiving indicates continuity in parenting quality across generations. Therefore, the current study aimed at examining the relationship between maternal childhood maltreatment and postpartum MIB, controlling for the role of postpartum mental health.

METHODS

From February 2014 to March 2015, 725 women completed self-report measures 2 months postpartum. Maternal childhood maltreatment was assessed with the Childhood Trauma Questionnaire, postpartum depression with the Revised Beck Depression Inventory, postpartum anxiety with the Symptom Checklist-90-Revised, and postpartum MIB with the abridged version of the Postpartum Bonding Questionnaire. Data were analysed using a hierarchical regression analysis.

RESULTS

Almost 46% of the included women reported at least one type of childhood maltreatment with emotional neglect being most prevalent. 13% displayed at least mild postpartum depressive symptomatology and 20% scored above the 75th percentile for postpartum anxiety. In the final regression model, which explained 29% of variance, higher severity of maternal emotional neglect in childhood, higher levels of postpartum depression and higher education were significantly related to more postpartum MIB impairment. In contrast, higher severity of maternal physical neglect was significantly associated with less postpartum MIB impairment.

CONCLUSIONS

This study is the first to explore the relationship between diverse types of maternal childhood maltreatment and postpartum MIB, adjusting for postpartum mental health. Maternal experiences of emotional neglect and postpartum depressive symptoms could serve as indicators to identify and support mothers with heightened risk for bonding problems, but results need to be validated in longitudinal studies.

Sintomas depressivos maternos no puerpério imediato: fatores associados

Resumo Objetivo Investigar a prevalência e fatores de risco para sintomas depressivos maternos no puerpério imediato. Métodos Estudo transversal, realizado com 1099 puérperas. A presença de sintomas depressivos maternos foi obtida com a escala de Depressão Pós-natal de Edimburgo, aplicada no segundo dia após o parto, adotando-se como ponto de corte escore ≥10. Os dados foram coletados em Botucatu-SP, no período de janeiro a junho de 2012. Fatores associados aos sintomas depressivos foram inicialmente investigados por regressão logística múltipla e aqueles associados em nível de p<0,20 foram incluídos em modelo de regressão final, considerando-se nível crítico de significância p<0,05, com intervalo de confiança de 95%. Este estudo foi aprovado por Comitê de Ética em Pesquisa e atendeu às recomendações para pesquisas com seres humanos. Resultados A prevalência de sintomas depressivos foi de 6,7%. Uso de medicação antidepressiva na gestação, violência sofrida na gestação e cesariana associaram-se a sintomas depressivos no puerpério imediato em duas, quatro e duas vezes, respectivamente. Conclusão Especial atenção deve ser dada às mulheres usuárias de medicação antidepressiva, àquelas que sofreram violência na gestação e às que evoluíram para cesariana, visto que esses eventos foram identificados como fatores de risco de sintomas depressivos.

The Effects of Enriched Environmental Intervention on the Parturition Outcome and Filial Health of Pregnant Mice With Chronic Pain

Chronic pain (CP) adversely impacts people's health. However, the influence of CP on pregnant women and their fetuses remains unclear. Few reasonable interventions have been offered to these women. This study aimed to examine the effects of enriched environmental intervention (EEI) on the delivery outcome and offspring health of pregnant mice with CP. Forty pregnant mice were equally and randomly divided into four groups (control, sham, CP, and CP + EEI). Monoarthritis was induced by subcutaneous injection of the complete Freund's adjuvant (100 μg/100 μl) into the left hind paw of mice on Day 0 of gestation. Sham mice received 100 µl of sterile phosphate-buffered saline subcutaneously. General health status and delivery outcomes of pregnant mice and general physical status, growth, and development of offspring were observed and compared between groups. CP mice exhibited less weight gain, higher rate of premature delivery, smaller litter size, lower live birth rate, lower filial birth weight, shorter filial tail length, and lower filial rates of achieving righting reflex and crawling compared to mice in the control/sham/CP + EEI groups. There were no significant differences between mice in the CP + EEI group and those in the control and sham groups. CP during pregnancy led to serious adverse impacts on both the mother and fetus mice in this study, and EEI was an effective treatment for these effects.

Characteristics of drug use among pregnant women in the United States: Opioid and non-opioid illegal drug use

BACKGROUND

The opioid epidemic in the US is affecting pregnant women and their offspring, with rising numbers of maternal and neonatal treatment episodes. The aim of this study was to characterize pregnant drug users in order to inform intervention strategies based on sociodemographic, mental health, and substance use characteristics.

METHODS

Data on pregnant women aged 18-44 reporting past-year, nonmedical opioid use or use of non-opioid illegal drugs (other than marijuana) were analyzed from the National Survey on Drug Use and Health (2005-2014). Women (N = 818) were categorized into 3 groups: 1) use of opioids only (n = 281), 2) opioid-polydrug users (n = 241), and 3) other (non-opioid) illegal drug users (n = 296). Characteristics between the 3 groups of women were compared using bivariable analyses.

RESULTS

Most women were non-Hispanic White (67.6%), had a high school diploma or less education (61.0%), a household income <$20,000/year (72.2%), and health insurance coverage (84.3%). No significant differences between the three groups were found regarding sociodemographic characteristics. Past-30-day marijuana use was less prevalent among opioid-only users (10.9%) compared to opioid-polydrug users (43.6%) and other pregnant illegal drug users (27.6%) (P < 0.001) and past-year drug/alcohol treatment was less prevalent among opioid-only users (6.3%) compared to opioid-polydrug users (20.3%) and other illegal drug users (8.3%) (P = 0.002). Opioid-only users also reported lower prevalence of past-year depression (P < 0.001) and anxiety (P = 0.039).

CONCLUSIONS

Pregnant drug-using women were often of low socioeconomic status, with mental health and substance use patterns suggesting the need for targeted mental health/substance use screening and interventions before and during pregnancy, particularly for opioid-polydrug users.

Clinical, Cognitive, and Neuroimaging Evidence of a Neurodevelopmental Continuum in Offspring of Probands With Schizophrenia and Bipolar Disorder

BACKGROUND

Studies in child and adolescent offspring of patients with schizophrenia or bipolar disorders may help understand the influence of neurodevelopmental factors on the premorbid phenotype of these disorders.

AIMS

To assess whether a combination of neurodevelopmental factors discriminates between young offspring of patients with schizophrenia (SzO) or bipolar disorder (BpO) and community controls (CcO). To assess the association between these factors and rates of psychiatric diagnoses in high risk (HR) youth.

METHODS

One hundred thirty-three HR offspring (47 SzO and 86 BpO) and 84 CcO, aged 6-17, underwent cross-sectional clinical, neurocognitive, and structural neuroimaging assessment. Information on perinatal events and early childhood development was also obtained. General linear mixed models were performed to assess group discrimination and association with lifetime axis I psychiatric disorders.

RESULTS

Multivariate analyses revealed that greater neurological soft signs (NSS), less total grey matter volume (GMV) and a higher frequency of obstetric complications discriminated HR offspring from CcO. When comparing each group individually, greater NSS and a higher frequency of obstetric complications discriminated SzO from CcO, and BpO from CcO, while lower intelligence also discriminated SzO from CcO and from BpO. Within HR offspring, lower intelligence and less total GMV were associated with lifetime incidence of psychiatric disorders.

CONCLUSIONS

Both SzO and BpO showed evidence of neurodevelopmental insult, although this may have a greater impact in SzO. Lower intelligence and less total GMV hold potential as biomarkers of risk for psychiatric disorders in HR youth.