Every week we review the most recent publications in women’s mental health, covering topics related to premenstrual symptoms, perinatal mood and anxiety disorders, use of medications in pregnant and breastfeeding women, perinatal substance use, and menopausal mental health. 

For more detailed descriptions of many of these topics, you can sign up to receive our weekly CWMH NEWSLETTER which comes out every Thursday.  

And don’t forget to visit ESSENTIAL READS – a curated selection of up-to-date and clinically relevant articles in women’s mental health.

Ruta Nonacs, MD PhD

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PMS AND PMDD

Premenstrual Mood Symptoms in the Perimenopause.

Sander B, Gordon JL. Curr Psychiatry Rep. 2021 Oct 6;23(11):73.

A subset of women with menstrually related mood disordersmay exhibit an increased mood sensitivity to the ovarian hormone withdrawal that accompanies the late menopause transition and early postmenopausal phase. Though additional research is needed to clarify the trajectory of premenstrual dysphoria in the menopause transition, there is reason to believe that health care providers should be vigilant for a potential worsening of symptoms in perimenopause for women with past or current premenstrual dysphoric disorder.

Pilot Data on the Feasibility And Clinical Outcomes of a Nomegestrol Acetate Oral Contraceptive Pill in Women With Premenstrual Dysphoric Disorder.

Robertson E, Thew C, Thomas N, Karimi L, Kulkarni J. Front Endocrinol (Lausanne). 2021 Sep 24;12:704488. Free article.

35 (74.5%) women reported a subjective positive mood response to nomegestrol acetate/17-beta estradiol, 31 (63.3%) adhered to the medication, and only 10 (20.4%) women reported side effects as the main reason for discontinuing nomegestrol acetate/17-beta estradiol. There were statistically significant reductions (p<0.05) in the overall DASS-21 scores from before women commenced nomegestrol acetate/17-beta estradiol and after commencement of treatment.


INFERTILITY AND MENTAL HEALTH

No articles this week


PSYCHIATRIC ILLNESS DURING PREGNANCY

The Association between Positive Antenatal Depression Screening and Breastfeeding Initiation and Continuation.

Stark EL, Shim J, Ross CM, Miller ES. Am J Perinatol. 2021 Jan;38(2):171-175.

After adjusting for confounders, there were no differences in breastfeeding initiation in women with or without depressive symptoms during pregnancy; however, women with a positive antenatal depression screen were significantly less likely to continue breastfeeding at 6 weeks’ postpartum (aOR= 0.67, 95% CI: 0.48-0.96).

Effectiveness of nurses and midwives-led psychological interventions on reducing depression symptoms in the perinatal period: A systematic review and meta-analysis.

Wang TH, Pai LW, Tzeng YL, Yeh TP, Teng YK. Nurs Open. 2021 Sep;8(5):2117-2130. Free article.

Twelve studies were included in the analysis. Psychological interventions provided by nurses and midwives had a significant effect on reducing perinatal depressive symptoms (RR: 0.72, 95% CI [0.64-0.82]). Among the approaches of psychological intervention, supportive counselling was the most effective (RR: 0.58, 95% CI [0.42-0.80]). The best intensity of intervention was six to eight sessions (RR: 0.66, 95% CI [0.55-0.79]).


MEDICATIONS AND PREGNANCY

Gestational and Neurodevelopmental Outcomes Associated With Antipsychotic Drug Exposure During Pregnancy.

Andrade C. J Clin Psychiatry. 2021 Oct 12;82(5):21f14265.

Gestational exposure to antipsychotics was associated with a small but significantly increased risk of preterm birth; there was no significant increase in the risk of small for gestational age, ADHD, or ASD. When pregnancies with gestational vs (only) pregestational (pre-pregnancy) exposure to antipsychotics were compared, and when exposed vs unexposed siblings were compared, gestational antipsychotic exposure was not associated with a significantly increased risk of any of these adverse outcomes.


POSTPARTUM PSYCHIATRIC ILLNESS

Postpartum Depression and Psychosis and Subsequent Severe Mental Illnesses in Mothers and Neurodevelopmental Disorders in Children: A Nationwide Study.

Chen MH, Pan TL, Bai YM, Huang KL, Tsai SJ, Su TP, Chen TJ, Hsu JW. J Clin Psychiatry. 2021 Jul 27;82(4):20m13735.

Women experiencing postpartum depression or postpartum psychosis were more likely to have a diagnosis of schizophrenia, bipolar disorder, and major depressive disorder in mothers, with hazard ratios (HRs) ranging between 8.80 (95% CI, 7.95-9.74) and 63.96 (95% CI, 50.39-81.18). Children exposed to maternal postpartum depression or psychosis were more likely to develop ADHD. Only postpartum depression was related to an increased likelihood of offspring ASD.

Effectiveness of Telehealth Interventions for Women With Postpartum Depression: Systematic Review and Meta-analysis.

Zhao L, Chen J, Lan L, Deng N, Liao Y, Yue L, Chen I, Wen SW, Xie RH.

JMIR Mhealth Uhealth. 2021 Oct 7;9(10):e32544. Free article.

Nine RCTs with a total of 1958 women with PPD were included. The EPDS and anxiety scores were significantly lower in the telehealth group compared with the control group. Significant subgroup differences were found in depressive symptoms according to the severity of PPD, telehealth technology, specific therapy, and follow-up time.


Predictors of Early Postpartum Maternal Functioning Among Women Veterans.

Goger P, Szpunar MJ, Baca SA, Gartstein MA, Lang AJ. Matern Child Health J. 2021 Oct 9.

Pregnancy-related anxiety was a more robust predictor of postpartum depression (PPD) than depression during pregnancy. PPD, in turn, was significantly associated with bonding and parenting stress, such that more depressed mothers were more likely to experience greater bonding difficulties, increased rejections and pathological anger towards their infants, greater anxiety towards their infants, and more parenting stress.

Effects of an evidence-based nursing intervention on prevention of anxiety and depression in the postpartum period.

Meng J, Du J, Diao X, Zou Y. Stress Health. 2021 Oct 11.

Six weeks of evidence-based nursing intervention significantly reduced the incidence of postpartum depression. The application of the evidence-based nursing also improved the patients’ satisfaction degree and effectively alleviated their anxiety according to both the intention-to-treat and per protocol analyses. E

Postpartum Psychiatric Admissions in the United States.

Wen T, Fein AW, Wright JD, Mack WJ, Attenello FJ, D’Alton ME, Friedman AM. Am J Perinatol. 2021 Jan;38(2):115-121.

Of 15.7 million deliveries from 2010 to 2014, 11,497 women (0.07%) were readmitted for a primary psychiatric diagnosis within 60 days postpartum. In the adjusted model, women with psychiatric diagnoses at delivery were 9.7 times more likely to be hospitalized compared with those without psychiatric comorbidity. Women at highest risk for psychiatric admission were those with Medicare and Medicaid, in lower income quartiles, and of younger age.


Socioeconomic and racial/ethnic disparities in postpartum consultation for mental health concerns among US mothers.

Dagher RK, Pérez-Stable EJ, James RS. Arch Womens Ment Health. 2021 Oct;24(5):781-791.

Latinas had lower odds of seeking mental health consultations than Whites (OR 0.39). Mothers who were employed prenatally full-time or part-time had lower odds of seeking consultations than non-employed mothers (OR 0.62; OR 0.52). Mothers with household incomes of $50,000-$74,999 had higher odds of seeking consultations than those with incomes less than $25,000 (OR 2.20).


MEDICATIONS AND BREASTFEEDING

No articles this week


PERINATAL SUBSTANCE USE

Pregnant and Parenting Women’s Experiences with Substance Use Disorder.

Wright ME, Temples HS, Shores E, Chafe O, Lannamann R, Lautenschlager C. MCN Am J Matern Child Nurs. 2021 Sep-Oct 01;46(5):271-276.

Positive social support co-occurring with recovery efforts appears to facilitate recovery, highlighting the need for strengthened social support structures.

Outcomes of mothers and newborns to prenatal exposure to kratom: a systematic review.

Wright ME, Ginsberg C, Parkison AM, Dubose M, Sherbondy M, Shores E. J Perinatol. 2021 Jun;41(6):1236-1243. Free article.

Kratom is a legal, widely available substance that contains opioid agonist alkaloids. Due to the marketing of kratom as an opioid alternative for treatment of pain, anxiety, depression, or to reduce opioid withdrawal symptoms, the use of kratom has increased among persons in the USA including pregnant women. The literature includes six case reports of prenatal kratom exposure. Maternal and infant withdrawal from kratom exposure was described in each case, resulting in pharmacologic treatment for both mothers and infants.


MATERNAL MENTAL HEALTH AND CHILD OUTCOMES

Maternal stress and depression are associated with respiratory phenotypes in urban children.

Ramratnam SK, Lockhart A, Visness CM, Calatroni A, Jackson DJ, Gergen PJ, Bacharier LB, O’Connor GT, Sandel MT, Kattan M, Wood RA, Gern JE; Inner-City Asthma Consortium. J Allergy Clin Immunol. 2021 Jul;148(1):120-127.

Among high-risk, urban children, maternal stress and depression in early life were positively associated with respiratory illnesses and a moderate-wheeze-low-atopy phenotype. These results suggest that treating stress and depression in expectant and new mothers could reduce viral respiratory illnesses and recurrent wheeze during the preschool years and some forms of childhood asthma.


MENOPAUSE AND MENTAL HEALTH

No articles this week


OTHER TOPICS IN WOMEN’S MENTAL HEALTH

Perinatal Loss: The Impact on Maternal Mental Health.

Davoudian T, Gibbins K, Cirino NH. Obstet Gynecol Surv. 2021 Apr;76(4):223.

Grief is an expected, normal response to perinatal loss. Psychological morbidities, including major depressive disorder, generalized anxiety disorder, and posttraumatic stress disorder, are also associated with perinatal loss. Risk factors for these conditions include history of a psychiatric illness, childlessness, unknown cause of perinatal loss, limited social support, and marital/relationship discord. Careful interviewing and brief screening measures can help identify patients who may suffer from depressive or anxiety disorders following reproductive loss.

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