This week brings some interesting reviews on the use of ECT during pregnancy (Thyen et al) and the impact of maternal PTSD on child outcomes (Cook et al).  Also worth reading are two articles — one from Byatt and colleagues, the other from Cook et al — which look at the factors which either facilitate or impede help-seeking and access to care in women with perinatal mood and anxiety disorders.

Electroconvulsive Therapy During Pregnancy.

Thyen A, Narang P, Sarai S, Tegin G, Lippmann S.  Prim Care Companion CNS Disord. 2017 Jul 13;19(4).   Free Article

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

Cook N, Ayers S, Horsch A.  J Affect Disord. 2017 Jul 27;225:18-31.

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 mixed.

Improving help-seeking for postnatal depression and anxiety: a cluster randomised controlled trial of motivational interviewing.

Holt C, Milgrom J, Gemmill AW.  Arch Womens Ment Health. 2017 Aug 3.

Three risk factors for postpartum depression modulated help-seeking: antenatal anxiety (OR = 2.8), depression history (OR = 2.5) and self-esteem (OR = 0.7). Common barriers to seeking help were thinking that one would or should be able to manage without help (endorsed by 11.1%).

Access to Pharmacotherapy Amongst Women with Bipolar Disorder during Pregnancy: a Preliminary Study.

Byatt N, Cox L, Moore Simas TA, Biebel K, Sankaran P, Swartz HA, Weinreb L.  Psychiatr Q. 2017 Jul 11.

Women with bipolar disorder  identified barriers to seeking treatment,  including the perception that psychiatric providers lack training and experience in the treatment of psychiatric illness during pregnancy, are reluctant to treat bipolar disorder among pregnant women, and believe that pharmacotherapy is not needed for psychiatric illness during pregnancy. Facilitators included participants’ perception that providers’ acknowledge risks associated with untreated or undertreated psychiatric illness during pregnancy and provide psycho-education about the risks, benefits and alternatives to pharmacotherapy.

The presence of anxiety, depression and stress in women and their partners during pregnancies following perinatal loss: A meta-analysis.

Hunter A, Tussis L, MacBeth A.  J Affect Disord. 2017 Jul 11;223:153-164.

These findings confirm elevated anxiety and depression levels during pregnancies following perinatal loss. Further research on predictors of distress in women and their partners is required.

High paternal testosterone may protect against postpartum depressive symptoms in fathers, but confer risk to mothers and children.

Saxbe DE, Schetter CD, Simon CD, Adam EK, Shalowitz MU.  Horm Behav. 2017 Jul 27.

Higher levels of testosterone in fathers may protect against paternal depression, it resulted in higher levels  of partner aggression which contributed to maternal distress and suboptimal family outcomes.

Phenotypical characteristics of postpartum psychosis: A clinical cohort study.

Kamperman AM, Veldman-Hoek MJ, Wesseloo R, Robertson Blackmore E, Bergink V.  Bipolar Disord. 2017 Jul 12.

The most prevalent symptoms of PP were irritability (73%), abnormal thought content (72%), and anxiety (71%). Suicidal and infanticidal ideation was present in 19% and 8% of patients, respectively. Delusions and hallucinations often had a negative content. Latent class analysis revealed three symptom profiles, a manic (34%), depressive (41%) and atypical (25%) profile, respectively.

Prenatal developmental origins of behavior and mental health: the influence of maternal stress in pregnancy.

van den Bergh BRH, van den Heuvel MI, Lahti M, Braeken M, de Rooij SR, Entringer S, Hoyer D, Roseboom T, Räikkönen K, King S, Schwab M.  Neurosci Biobehav Rev. 2017 Jul 27.

This looks like a good review.  Effects of maternal stress on offspring neurodevelopment, cognitive development, negative affectivity, difficult temperament and psychiatric disorders are shown in numerous epidemiological and case-control studies. Offspring of both sexes are susceptible to prenatal stress but effects differ. There is not any specific vulnerable period of gestation; prenatal stress effects vary for different gestational ages possibly depending on the developmental stage of specific brain areas and circuits, stress system and immune system.

Risk of postpartum psychosis after IVF treatment: a nationwide case-control study.

Vikström J, Josefsson A, Hammar M, Bladh M, Sydsjö G.  Hum Reprod. 2017 Jan;32(1):139-146.

There were no differences in PPP prevalence between the IVF group and the control group who conceived naturally.

Psychopharmacological drug utilization patterns in pregnant women with bipolar disorder – A nationwide register-based study.

Broeks SC, Thisted Horsdal H, Glejsted Ingstrup K, Gasse C.  J Affect Disord. 2017 Mar 1;210:158-165.

In a group of 336 Danish women with bipolar disorder, the proportion of women redeeming prescriptions for any psychotropic drug decreased during pregnancy, from 54.8% in the 3 months preconception to 36.6% in the third trimester. Lithium dosing increased significantly during pregnancy. A total of 35 (41.2%) of the women on psychotropic monotherapy and 37 (50.0%) of the women on psychotropic polypharmacy used an antidepressant without concomitant use of a mood-stabilizer at some point during pregnancy.

A Systematized Review of Atypical Antipsychotics in Pregnant Women: Balancing Between Risks of Untreated Illness and Risks of Drug-Related Adverse Effects.

Tosato S, Albert U, Tomassi S, Iasevoli F, Carmassi C, Ferrari S, Nanni MG, Nivoli A, Volpe U, Atti AR, Fiorillo A.  J Clin Psychiatry. 2017 May;78(5):e477-e489.

Abrupt discontinuation of treatment-exposed mothers with bipolar disorder or schizophrenia led to a high risk of relapses during pregnancy. Untreated bipolar disorder and schizophrenia may be considered independent risk factors for congenital malformations, while second generation antipsychotics were not associated with increased risk of malformations.


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