Mass General Hospital

Harvard Medical School

Weekly Roundup for February 9, 2018: Recent Publications in Women’s Mental Health

The article that grabbed my attention is the one at the top of the list, from May and colleagues, which suggests that fetal alcohol spectrum disorders (FASD) are probably more common than we had previously estimated.  Using a conservative method of estimation, the prevalence of FASD among first-graders in 4 US communities ranged from 1.1% to 5.0%.  And that article led me to other studies looking at the use of other substances — tobacco, alcohol, cannabis, and opiates — during pregnancy. These studies all document relatively high rates of substance use in pregnant women.  While these articles were fairly grim, there was one study (from Lowe and colleagues) suggesting that high maternal responsiveness may help to mitigate the deleterious effects of prenatal substance abuse.

Ruta Nonacs, MD PhD


Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities.

May PA, Chambers CD, Kalberg WO, et al.  JAMA. 2018 Feb 6;319(5):474-482.

In this study the estimated prevalence of fetal alcohol spectrum disorders among first-graders in 4 US communities ranged from 1.1% to 5.0%, which is around five times higher than observed in previous studies.  


Implications of Higher Than Expected Prevalence of Fetal Alcohol Spectrum Disorders.

Lange S, Rehm J, Popova S.

JAMA. 2018 Feb 6;319(5):448-449.


Prenatal Alcohol Exposure in Relation to Autism Spectrum Disorder: Findings from the Study to Explore Early Development (SEED).

Singer AB, Aylsworth AS, Cordero C, Croen LA, DiGuiseppi C, Fallin MD, Herring AH, Hooper SR, Pretzel RE, Schieve LA, Windham GC, Daniels JL.  Paediatr Perinat Epidemiol. 2017 Nov;31(6):573-582.

These results do not support an adverse association between low-level alcohol exposure and autism spectrum disorders, although these findings were based on retrospective self-reported alcohol use. The most concerning finding is that 20% of women reported using alcohol during pregnancy.


Drinking and smoking patterns during pregnancy: Development of group-based trajectories in the Safe Passage Study.

Dukes K, Tripp T, Willinger M, et al. Alcohol. 2017 Aug;62:49-60.

Group modeling is used to describe smoking and drinking patterns. Future analyses will examine outcomes.


Smoking during pregnancy in the United States, 2005-2014: The role of depression.

Goodwin RD, Cheslack-Postava K, Nelson DB, Smith PH, Wall MM, Hasin DS, Nomura Y, Galea S.  Drug Alcohol Depend. 2017 Oct 1;179:159-166.

Smoking is more common among pregnant women with, compared to without, major depression (32.5% vs. 13.0%; (adjusted OR=2.50)).  Looking at data between 2005 and 2014, the prevalence of women smoking during pregnancy has increased significantly among women with major depression (35.9% to 38.4%) but showed a decreasing trend among women without major depression (12.5% to 9.1%).


Marijuana use during pregnancy: A comparison of trends and correlates among married and unmarried pregnant women.

Oh S, Salas-Wright CP, Vaughn MG, DiNitto DM. Drug Alcohol Depend. 2017 Dec 1;181:229-233.

From 2005-2014, marijuana use prevalence among unmarried pregnant women increased from 5.4% to 10.0% while the prevalence among married pregnant women remained stable (mostly under 1.5%)


The effect of prenatal substance use and maternal contingent responsiveness on infant affect.

Lowe J, Qeadan F, Leeman L, Shrestha S, Stephen JM, Bakhireva LN.  Early Hum Dev. 2017 Dec;115:51-59.

Higher maternal responsiveness was a much stronger predictor of infant behavior than prenatal exposures, suggesting that future interventions should  focus on specific parenting strategies.


Opioid Use During Pregnancy Observations of Opioid Use and Secular Trend from 2006 to 2014 at HealthPartners Medical Group.

Elliott TE, Frail CK, Pawloski PA, Thomas AJ, Werner AM, Rossom RC.  Clin J Pain. 2018 Feb 5.

Among 11,565 deliveries in 9690 unique women, 862 (7.5%) deliveries were associated with significant opioid use. Significant opioid use was associated with single marital status, Caesarean section, Medicaid coverage, tobacco use, depression, anxiety, bipolar disorder, substance use disorder, non-opioid analgesic use, and referral to physical therapy, psychotherapy, or pain specialists.


Distinguishing postpartum and antepartum depressive trajectories in a large population-based cohort: the impact of exposure to adversity and offspring gender.

Denckla CA, Mancini AD, Consedine NS, Milanovic SM, Basu A, Seedat S, Spies G, Henderson DC, Bonanno GA, Koenen KC.  Psychol Med. 2017 Sep 11:1-11.

Researchers use latent growth mixture modeling in a large, population-based cohort (N = 12 121) to investigate temporal patterns of depressive symptoms. Four distinct trajectories emerged, including resilient (74.3%), improving (9.2%), emergent (4.0%), and chronic (11.5%).


A longitudinal study of women’s depression symptom profiles during and after the postpartum phase.

Fox M, Sandman CA, Davis EP, Glynn LM.  Depress Anxiety. 2018 Feb 2.

Looking at different symptoms of perinatal depression, researchers noted that the Worry factor, comprising anxiety and guilt, was significantly more pronounced during the postpartum timepoint, and the Emotional/Circadian/Energetic Dysregulation factor, which contained sadness and anhedonia, was significantly less pronounced during the postpartum period.


Postpartum depression and vitamin D: A systematic review.

Amini S, Jafarirad S, Amani R.  Crit Rev Food Sci Nutr. 2018 Feb 2:1-7.

Five studies thus far have assessed the relationship between levels of vitamin D and PPD. Findings from cohort studies suggest that vitamin-D deficiency is related to the incidence of PPD.


PRogram In Support of Moms (PRISM): Development and Beta Testing.

Byatt N, Pbert L, Hosein S, Swartz HA, Weinreb L, Allison J, Ziedonis D.  Psychiatr Serv. 2016 Aug 1;67(8):824-6.  Free Article

A multidisciplinary work group of perinatal and behavioral health professionals was convened to design, refine, and beta-test PRISM in an obstetric practice. This program includes provider training and a toolkit, screening procedures, implementation assistance, and access to immediate psychiatric consultation. Beta testing with 50 patients over two months demonstrated feasibility and suggested that PRISM may improve provider screening rates and self-efficacy to address depression.


Making the Legal and Ethical Case for Universal Screening for Postpartum Mood and Anxiety Disorders in Pediatric Primary Care.

Gilbert AL, Balio C, Bauer NS.  Curr Probl Pediatr Adolesc Health Care. 2017 Oct;47(10):267-277.


It Is Time for Routine Screening for Perinatal Mood and Anxiety Disorders in Obstetrics and Gynecology Settings.

Accortt EE, Wong MS.  Obstet Gynecol Surv. 2017 Sep;72(9):553-568.


Screening for Depression in Pregnancy and the Postpartum Period.

Learman LA.  Clin Obstet Gynecol. 2018 Jan 31.


Effects of Oral vs Transdermal Estrogen Therapy on Sexual Function in Early Postmenopause: Ancillary Study of the Kronos Early Estrogen Prevention Study (KEEPS).

Taylor HS, Tal A, Pal L, Li F, et al. JAMA Intern Med. 2017 Oct 1; 177(10):1471-1479.  Free Article

Treatment with transdermal, but not oral, estradiol modestly improved sexual function in early postmenopausal women.

 

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