While we are becoming more attentive to screening for depressive symptoms during pregnancy and the postpartum period, we may not always ask about a history of trauma, especially when a woman has had what most would consider an “uncomplicated” pregnancy. A recent study, however, indicates that a history of trauma may be a risk factor for depression during pregnancy.
Many studies have demonstrated an increased risk for depression among the children of mothers with depression. Exactly how this vulnerability to depression is transmitted to the child is not precisely understood. Genetic factors clearly play an important role, but there are other important factors which contribute to the intergenerational transmission of depression. For example, many studies have shown that postpartum depression may contribute to parenting styles which increase a child’s likelihood of developing depression later on. While the child appears to be particularly sensitive to the effects of maternal depression during the first year of life, it appears that older children are also affected by maternal depression and are more likely to suffer from depression and other psychiatric symptoms than children with non-depressed mothers.
In an excellent and thoughtful review article, Kristina Deligiannidis and Marlene Freeman (from the MGH Center for Women’s Mental Health) summarize data on the efficacy of complementary and alternative medicine therapies for the treatment of perinatal depression. This is one of the most thorough reviews on CAM and provides thoughtful, evidence-based recommendations regarding the use of these treatments for women with perinatal depression. It is definitely worth tracking down a copy of this review, but if you can’t find it, here is a summary.
This is a very nice article published by the College of Psychiatric and Neurologic Pharmacists discussing the limitations of the current FDA pregnancy category labeling system.
Iodine is essential for thyroid hormone synthesis. We have known for a long time that severe iodine deficiency during pregnancy may affect the cognitive development of the unborn child. According to a recent Lancet study, even children born to women with mild-to-moderate iodine deficiency during pregnancy are at increased risk for lower IQ and reading ability (assessed at age 9). The most severe effects were observed among children born to women with severe deficiency (<50 mcg/g iodine:creatinine ratio).
The omega-3 fatty acids, including eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA), have a broad range of health benefits and may be beneficial for the treatment of mood disorders. Because during pregnancy omega-3 fatty acids are diverted to the developing fetus, some women may develop a deficiency of omega-3 fatty acids during pregnancy. Previous studies have shown that pregnant women with lower levels of DHA may be more vulnerable to depressive symptoms. Several small studies have attempted to use omega-3 fatty acids to treat perinatal depression but have yielded inconsistent findings.
The Edinburgh Postnatal Depression Scale (EPDS) was designed to screen women for postnatal depression. Cox and Holden (2003) state that the EPDS was not designed to measure anxiety. However, recent emphasis on the importance of recognizing symptoms of perinatal anxiety disorders, coupled with findings in research, have led to the suggestion that the EPDS may be used as a multidimensional tool to screen for anxiety disorders in addition to depression during the perinatal period (Matthey et al, 2012).
A significant number of women experience anxiety symptoms during pregnancy, with about 8.5% of women meeting criteria for generalized anxiety disorder. Other anxiety disorders are less common. The estimated prevalence of panic disorder during pregnancy is 1-2%. The estimated prevalence of obsessive-compulsive disorder is 0.2-1.2%. While we use certain tools, including the Edinburgh Postnatal Depression Scale (EPDS) to screen for depression during pregnancy, what are the best tools for indentifying women with clinically significant anxiety symptoms?
The CDC recently analyzed data from the 2011 Behavioral Risk Factor Surveillance System (BRFSS) to determine the prevalence, frequency, and intensity of binge drinking among adult women. Data from the 2011 national Youth Risk Behavior Survey (YRBS) was used to assess current alcohol use and binge drinking among high school girls.
In studies of pregnant women with unipolar depression, it has been shown that untreated psychiatric illness in the mother may have a negative impact on pregnancy outcomes, influencing the length of gestation and birthweight. There is far less data on pregnancy outcomes in women with bipolar disorder. A recent Swedish study analyzes pregnancy outcomes in treated and untreated women with bipolar disorder and attempts to distinguish between the effects of medication versus the effects of untreated psychiatric illness in the mother.
