What’s worse? Exposure to antidepressant medication? Or exposure to untreated maternal depression?  In the first paper on the list, Mitchell and colleagues analyze data from 11 studies, finding that there were few differences between these two groups.  Another study (Cook et al, 2018) looks at the effects of maternal PTSD on birth outcomes. Kingston and colleagues, following mothers with postpartum depression observe that persistent depressive symptoms in the mother are associated with hyperactivity/inattention, physical aggression and separation anxiety symptoms in the child.

Ruta Nonacs, MD PhD

Comparative effects of antidepressant medications and untreated major depression on pregnancy outcomes: a systematic review.

Mitchell J, Goodman J.  Arch Womens Ment Health. 2018 Apr 11.

Eleven prospective observational and case-control studies were selected for final inclusion. Risk of low birth weight and related outcomes do not differ between antidepressant-treated pregnant women and untreated depressed women. Average gestational lengths tend to be slightly shorter with antidepressant use but it is unclear whether these differences are clinically meaningful or extend to preterm delivery. Very limited research on spontaneous abortion did not allow conclusions to be drawn regarding that outcome.

Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review.

Cook N, Ayers S, Horsch A.  J Affect Disord. 2018 Jan 1;225:18-31.

Maternal postpartum PTSD is associated with low birth weight and lower rates of breastfeeding. Evidence for an association between maternal PTSD and preterm birth, fetal growth, head circumference, mother-infant interaction, the mother-infant relationship or child development is contradictory. Associations between maternal PTSD and infant salivary cortisol levels, and eating/sleeping difficulties are based on single studies, so require replication.

Trajectories of maternal depressive symptoms during pregnancy and the first 12 months postpartum and child externalizing and internalizing behavior at three years.

Kingston D, Kehler H, Austin MP, Mughal MK, Wajid A, Vermeyden L, Benzies K, Brown S, Stuart S, Giallo R.  PLoS One. 2018 Apr 13;13(4):e0195365.  Free Article

1983 participants were followed and four distinct trajectories of maternal depressive symptoms were observed: low level (64.7%); early postpartum (10.9%); subclinical (18.8%); and persistent high (5.6%).  The proportion of children with elevated behavior symptoms was highest for children whose mothers had persistent high depressive symptoms, followed by mothers with moderate symptoms (early postpartum and subclinical trajectories) and lowest for minimal symptoms. After accounting for demographic, child and psychosocial factors, the relationships between depression trajectories and child hyperactivity/inattention, physical aggression (subclinical trajectory only) and separation anxiety symptoms remained significant.

Thyroid peroxidase antibodies during early gestation and the subsequent risk of first-onset postpartum depression: A prospective cohort study.

Wesseloo R, Kamperman AM, Bergink V, Pop VJM.  J Affect Disord. 2018 Jan 1;225:399-403.

Women with an increased TPO-ab titer during early gestation are at increased risk for self-reported first-onset depression at four months postpartum (adjusted OR 3.8; 95% CI 1.3-11.6), but not at other postpartum time points. The longitudinal pattern of self-reported postpartum depression in the TPO-ab positive group was similar to the typical course of postpartum TPO-ab titers changes. This suggests overlap in the etiology of first-onset postpartum depression and autoimmune thyroid dysfunction.

Physical activity in pregnancy and postpartum depressive symptoms in a multiethnic cohort.
Shakeela N, Richardsen KR, Martinsen EW, et al. J of Affective Disorders (2018).

In a group of 643 pregnant women, physical activity was recorded at gestational week 28 using a fitness tracking armband.  Women performing ?150 minutes per week of moderate to vigorous physical activity in bouts > 10 min had substantially lower risk of postpartum depression, compared to those who did not accumulate any physical activity of at least moderate intensity.  Brisk and slow walking were the most frequently reported modes of physical activity in our sample. However, this was not a randomized trial so we cannot conclude that exercise decreases risk.

Opioid Detoxification During Pregnancy: A Systematic Review.

Terplan M, Laird HJ, Hand DJ, Wright TE, Premkumar A, Martin CE, Meyer MC, Jones HE, Krans EE.  Obstet Gynecol. 2018 May;131(5):803-814.

Although the belief that opioid detoxification during pregnancy raises risk for pregnancy loss seems unfounded, risk for relapse to illicit substance use is considerable

The Comprehensive Addiction and Recovery Act: Opioid Use Disorder and Midwifery Practice.

Murphy J, Goodman D, Johnson MC, Terplan M.  Obstet Gynecol. 2018 Mar;131(3):542-544.

Certified nurse-midwives and certified midwives, who care for a significant proportion of pregnant and postpartum women and attend a significant proportion of births in the United States, were not included in the Comprehensive Addiction and Recovery Act legislation which was designed to increase access to treatment with special emphasis on services for pregnant women and follow-up for infants affected by prenatal substance exposure.

Marijuana use during and after pregnancy and association of prenatal use on birth outcomes: A population-based study.

Ko JY, Tong VT, Bombard JM, Hayes DK, Davy J, Perham-Hester KA.  Drug Alcohol Depend. 2018 Mar 29;187:72-78.

Respectively, 4.2% (95% CI: 3.8-4.7) and 6.8% (95% CI: 6.0-7.7) of women reported using marijuana during and after pregnancy. After adjustment, no differences in gestational age or birthweight were observed. Postpartum users were more likely to smoke cigarettes (48.7% vs. 20.3%), experience postpartum depressive symptoms (14.0% vs. 9.0%), and breastfeed for <8 weeks (34.9% vs. 18.1%).

Antidepressants for preventing postnatal depression.

Molyneaux E, Telesia LA, Henshaw C, Boath E, Bradley E, Howard LM..  Cochrane Database Syst Rev. 2018 Apr 18

Only two randomized controlled  trials including a total of 81 participants have assessed the effectiveness for the prevention of postpartum depression.   According to this analysis, it is not possible to draw any clear conclusions about the effectiveness of antidepressants for the prevention of depression in this setting.

Changing antiepilepsy drug-prescribing trends in women with epilepsy in the UK and Ireland and the impact on major congenital malformations.

Kinney MO, Morrow J, Patterson CC, Campbell E, Russell A, Smithson HW, Parsons L, Morrison PJ, Bromley R, Liggan B, Delanty N, Irwin B, Hunt SJ, Craig JJ.  J Neurol Neurosurg Psychiatry. 2018 Apr 16.

Despite significant changes in the prescribing habits (less valproic acid, more lamotrigine and levicitram) in this cohort over 20 years, statistically significant change in the rate of major malformations was not observed. This work should be replicated on a larger scale.

Chronic Medical Conditions and Perinatal Mental Illness: A Systematic Review and Meta-Analysis.

Brown HK, Qazilbash A, Rahim N, Dennis CL, Vigod SN.  Am J Epidemiol. 2018 Apr 7.

Chronic medical illness overall was associated with perinatal mental illness overall (aPOR = 1.43, 95% CI: 1.25, 1.63). Chronic medical illness overall was associated with antenatal (aPOR = 1.41, 95% CI: 1.10, 1.81) and postnatal mental illness separately (aPOR = 1.44, 95% CI: 1.13, 1.85) and with perinatal depression (aPOR = 1.45, 95% CI: 1.25, 1.67) and anxiety separately (aPOR = 1.63, 95% CI: 1.35, 1.95).  Diabetes (aPOR = 1.34, 95% CI: 1.07, 1.69), hypertension/heart disease (aPOR = 1.60, 95% CI: 1.05, 2.45), migraine (aPOR = 1.75, 95% CI: 1.20, 2.54), and other neurological disorders (aPOR = 1.45, 95% CI: 1.19, 1.77), but not asthma, were each associated with perinatal mental illness.

Association between postpartum physical symptoms and mood.

Schaffir J, Kunkler A, Lynch CD, Benedict J, Soma L, Doering A.  J Psychosom Res. 2018 Apr;107:33-37.

Women screening positive for depression had significantly greater physical symptoms as measured by the total Postpartum Symptom Inventory (PSI) scores than women who did not screen positive (20.2 vs 12.2, p?<?0.001). After adjustment for history of depression and age, the odds of screening positive for depression were 3.6 times higher in women with PSI scores over 10 compared to women with lower scores [95% CI: (1.1, 11.4); p?=?0.03].

Association between intrapartum epidural use and maternal postpartum depression presenting for medical care: a population-based, matched cohort study.

Wu J, et al.  Int J Obstetric Anaesthesia (2018).

A total of 40,303 women who received an intrapartum epidural were matched to an equal number of women who did not receive an intrapartum epidural. Overall rate of new onset depression presenting to the healthcare system was 0.88% within 12 months postpartum.  Intrapartum epidural use was not associated with maternal postpartum depression presenting to the healthcare system in term nulliparous women who had a vaginal delivery. However, the rate of PPD is so low in this study that it is likely that many women with PPD were not assessed using this methodology.  

Vitamin D deficiency and depressive symptoms in pregnancy are associated with adverse perinatal outcomes.

Accortt EE, Lamb A, Mirocha J, Hobel CJ.  J Behav Med. 2018 Apr 18.

A higher rate of adverse outcome was found when women had both prenatal vitamin D deficiency and elevated depressive symptoms (EPDS???10). Sixty percent with both risk factors had an adverse perinatal outcome versus 17% with only one or neither risk factor (relative risk 3.60; 95% CI 1.55–8.38, p?=?0.045).


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