Happy New Year! Only a week into 2019, there is no shortage of articles to review and discuss.  Over the last week, the article that has received the most press is the one documenting the association between prenatal use of valproic acid and increased risk of ADHD in exposed offspring.  This adds to a long list of deleterious effects stemming from prenatal exposure to valproic acid, including high risk of congenital malformations,  increased risk of autism, and other neurodevelopmental problems.

Over the last few years, we have also seen an increased number of articles which have attempted to measure the impact of prenatal depression and anxiety on children’s behavior.  Kataja and colleagues observe that anxiety an/or depression experienced by the mother early on in the pregnancy may alter how the infant perceives new stimuli and may make children more likely to perceive a given stimulus as threatening.

Ruta Nonacs, MD PhD

Association of Prenatal Exposure to Valproate and Other Antiepileptic Drugs With Risk for Attention-Deficit/Hyperactivity Disorder in Offspring.  Christensen J, Pedersen LH, Sun Y.  JAMA Netw Open 2019.
Prenatal exposure to valproic acid, but not other AEDs, is associated with a small increase in risk of ADHD.

Maternal and paternal trajectories of depressive symptoms predict family risk and children’s emotional and behavioral problems after the birth of a sibling.

Volling BL, Yu T, Gonzalez R, Tengelitsch E, Stevenson MM.  Dev Psychopathol. 2018 Nov 5:1-18.

Families in which both mothers and fathers had high levels of depressive symptoms were more likely to exhibit marital negativity, parenting stress, lower levels of parental efficacy, and internalizing and externalizing problems in the children.

Maternal pre- and postnatal anxiety symptoms and infant attention disengagement from emotional faces.

Kataja EL, Karlsson L, Parsons CE, Pelto J, Pesonen H, Häikiö T, Hyönä J, Nolvi S, Korja R, Karlsson H.  J Affect Disord. 2019 Jan 15;243:280-289.

Maternal prenatal but not postpartum anxiety symptoms were associated with higher threat bias in infants, and the relationship between maternal anxiety symptoms in early pregnancy and higher threat bias in infants remained significant after controlling for maternal postpartum symptoms. Maternal postpartum anxiety symptoms were associated with higher probability of disengagement from faces to distractors, but the effects varied by child sex.

Maternal Depressive Symptoms During the Pre- and Postnatal Periods and Infant Attention to Emotional Faces.

Kataja EL, Karlsson L, Leppänen JM, Pelto J, Häikiö T, Nolvi S, Pesonen H, Parsons CE, Hyönä J, Karlsson H.  Child Dev. 2018 Oct 8.

The overall probability of an infant to visually disengage from faces to distractors was not related to maternal depressive symptoms, but fear bias was heightened in infants whose mothers reported depressive symptoms.

Protective Effects of Pregnancy on Risk of Alcohol Use Disorder.

Edwards AC, Ohlsson H, Svikis DS, Sundquist J, Sundquist K, Kendler KS.  Am J Psychiatry. 2018 Nov 29.

Pregnancy was inversely associated with alcohol use disorder across all analyses (odds ratios, 0.17-0.32). Within individuals, rates of alcohol use disorder were substantially decreased during pregnancy relative to the prepregnancy period (odds ratios, 0.25-0.26), and they remained reduced during postpartum periods (odds ratios, 0.23-0.31).

Related but different: distinguishing postpartum depression and fatigue among women seeking help for unsettled infant behaviours.

Wilson N, Wynter K, Fisher J, Bei B.  BMC Psychiatry. 2018 Sep 25;18(1):309. Free Article

For women attending a clinical service with relatively high fatigue and psychological distress, postpartum depression and fatigue remain separate but related experiences.

A key for perinatal depression early diagnosis: The body dissatisfaction.

Riquin E, Lamas C, Nicolas I, Dugre Lebigre C, Curt F, Cohen H, Legendre G, Corcos M, Godart N.  J Affect Disord. 2018 Nov 5;245:340-347.

33% of the women who were dissatisfied with their body image suffered from perinatal depression vs. 11.3% of the women who were not dissatisfied (p?<?0.0001). The risk of perinatal depression was 4 times higher in women dissatisfied with their body image (p?<?0.001) if unintended pregnancy and age are taken into account and is 3 times significantly higher in women with higher levels of eating disorder symptoms (p?<?0.001) if unintended pregnancy and age are taken into account.

A Novel, Synthetic, Neuroactive Steroid Is Effective at Decreasing Depression-Like Behaviors and Improving Maternal Care in Preclinical Models of Postpartum Depression.

Melón L, Hammond R, Lewis M, Maguire J.  Front Endocrinol (Lausanne). 2018 Nov 23;9:703.   Free Article

In a mouse model of postpartum depression, SAGE-516, which is a novel, synthetic allopregnanolone analog similar to brexanolone, reduced depressive=like symptoms and improved maternal care.  The researchers hypothesize that SAGE-516 may work by preventing the stress-induced increases in corticosterone that occur during the postpartum period in this animal model.

Depression, depressive symptoms and treatments in women who have recently given birth: UK cohort study.

Petersen I, Peltola T, Kaski S, Walters KR, Hardoon S.

BMJ Open. 2018 Oct 24;8(10): Free Article

In this study from the UK, of 206?517 women, 23?623 (11%) had a record of depressive diagnosis or symptoms in the year after delivery and more than one in eight women received antidepressant treatment. 6848 (3%) of women were referred for non-pharmacological treatment.  Recording and treatment peaked 6-8 weeks after delivery. A third of the women had at least one record suggestive of depression at any time point prior to delivery and of these one in four received SSRI treatment in the year after delivery.Younger women were most likely to have records of depression and depressive symptoms. (Relative risk for postnatal depression: age 15-19: 1.92 (1.76 to 2.10), age 20-24: 1.49 (1.39 to 1.59) versus age 30-34). The risk of depression, postnatal depression and depressive symptoms increased with increasing social deprivation.

Access to Maternal Mental Health Services: Trends in State Legislation.

Nguyen MHT, Duderstadt KG.  J Pediatr Health Care. 2018 Nov – Dec;32(6):644-647.

Physical activity during pregnancy and postpartum depression: Systematic review and meta-analysis.

Nakamura A, van der Waerden J, Melchior M, Bolze C, El-Khoury F, Pryor L.  J Affect Disord. 2018 Dec 12;246:29-41.

Physical activity (PA) during pregnancy appears to reduce the risk of PPD symptoms; however, there was considerable heterogeneity among the studies with regard to how PA was assessed and how PPD symptoms were identified.

Opening windows of opportunities: Evidence for interventions to prevent or treat depression in pregnant women being associated with changes in offspring’s developmental trajectories of psychopathology risk.

Goodman SH, Cullum KA, Dimidjian S, River LM, Kim CY.  Dev Psychopathol. 2018 Aug;30(3):1179-1196.

Based on 25 studies, the authors found support for interventions designed to change maternal prenatal mood being associated with changes in offspring functioning, but with a very small effect size.

Psychotherapeutic Treatments for Depression During Pregnancy.

Genovez M, Vanderkruik R, Lemon E, Dimidjian S.

Clin Obstet Gynecol. 2018 Sep;61(3):562-572.

Treatments reviewed include interpersonal therapy, cognitive-behavioral therapy, behavioral activation, and mindfulness-based cognitive therapy.

Role of sleep deprivation in the causation of postpartum obsessive-compulsive disorder.

Sharma V.  Med Hypotheses. 2019 Jan;122:58-61.

Clusters of premenstrual symptoms in women with PMDD: Appearance, stability and association with impairment.

Kaiser G, Janda C, Kleinstäuber M, Weise C.  J Psychosom Res. 2018 Dec;115:38-43.

Clusters of PMDD symptoms appear to be stable across multiple menstrual cycles (except of pain and eating behavior).  Somatic dysphoria was the cluster most strongly associated with impairment. As the risk of impairment differs between symptom clusters, individual treatment options should be considered and further investigated in research and treatment.

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