Exercise plays a vital role in achieving and maintaining good health.  Along with numerous other health benefits, recent studies have shown that exercise alleviates symptoms of depression and may be useful in treating mild to moderate major depressive disorder (MDD). A study by Dunn and colleagues (2005) examined the efficacy of exercise as a treatment for depression, along with the dose-response relationship of exercise and reduction in depressive symptoms.
Despite efforts over the last decade to increase awareness regarding the negative effects of alcohol and other drug use during pregnancy, substance abuse among pregnant women continues to be a significant problem in the United States. The 2003 National Household Survey on Drug Use and Health indicated that 9.3% of pregnant women used alcohol and 4.3% percent of pregnant women used illicit drugs. In other countries, the prevalence of substance use and abuse may be even higher. For example, in a recent survey of pregnant women in Ireland, 54% admitted to drinking alcohol during pregnancy.
Given recent discussions within our group and with our colleague, Lewis Holmes, MD, chief of the Genetics and Teratology Unit at Massachusetts General Hospital for Children and director of the North American AED (Antiepileptic Drug) Pregnancy Registry, I wanted to expand upon a previous blog post. In the initial post, I wrote that women who take certain medications, like mood stabilizers or antiepileptic drugs, are advised to take increased doses of folic acid before pregnancy and throughout pregnancy.
A new study reported in Human Reproduction supports what many other studies have found, that untreated depression during pregnancy increases the likelihood of delivering before 37 weeks gestation.
While postpartum depression is common among new mothers, our ability to reliably detect this illness remains poor. Recent studies have indicated that most obstetricians report that they screen for postpartum psychiatric problems at routine follow-up visits but typically do not use standardized instruments to assess for postpartum depression. Unfortunately, studies which have measured the success of routine screening suggest that without the use of standardized screening tools like the Edinburgh Postnatal Depression Scale, many women with postpartum depression are not identified.
This Friday, October 10, is Screening for Mental Health's National Depression Screening Day, an effort to raise awareness for depression and its treatment.
Post-Traumatic Stress Disorder (PTSD) after childbirth is an understudied condition. Traditionally, much of the data have been based on case reports, indicating that PTSD can occur following a range of childbirth and child loss situations, including long or complicated labor, severe pain with labor or delivery, cesarean section, and unanticipated pregnancy outcome, such as child loss, miscarriage or infant birth defects. PTSD related to childbirth is frequently overlooked by physicians; the relative newness of the diagnosis and lack of literature on this topic are factors which may hinder recognition of this disorder.
In 2006, Chambers and colleagues published an article linking SSRI use during late pregnancy to an increased risk of persistent pulmonary hypertension in the newborn (PPHN). Based on the results of this analysis, the authors estimated the risk of PPHN to be about 1% in infants exposed to SSRIs late in pregnancy (after 20 weeks). However, subsequent studies did not demonstrate a significant association between PPHN and SSRI usage. A new study, this one relying upon data from the Swedish Medical Birth Register, has observed an elevated risk of PPHN among SSRI-exposed infants.
Infertility and its treatment have been shown to be a trigger for both depression and anxiety. Women with pre-existing histories of depression and anxiety who have been stable on medication may find themselves with worsening symptoms brought on by the stress involved in the process of infertility treatment. Many women find the process an emotional roller coaster of hopefulness and disappointment.
A recent population-based case-control study published in the American Journal of Obstetrics & Gynecology used Washington State birth certificates linked to hospital discharge data to evaluate the association between hospitalization for a psychiatric illness before delivery and risk of postpartum suicide attempt. The study compared women hospitalized for a postpartum suicide attempt (n = 355) with a group of controls who had not been hospitalized (n = 1420).
