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. 

In a meta-analysis published in the Journal of Clinical Psychiatry, Rommel and colleagues assessed long-term outcomes in children prenatally exposed to antidepressants.  The initial analysis suggested statistically significant associations between prenatal antidepressant exposure and a range of physical, neurodevelopmental, and psychiatric outcomes. However, when controlling for confounders, 5 studies investigating physical outcomes (asthma, cancer, body mass index, epilepsy) found no association except conflicting outcomes for BMI.

Reassuringly 18 studies examining neurodevelopmental outcomes (cognition, behavior, IQ, motor development, speech, language, and scholastic outcomes) found no consistent associations with antidepressant exposure after taking confounders into account.  We will be reviewing this study in greater detail later this week.

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

Ruta Nonacs, MD PhD

PMS AND PMDD

No articles this week

INFERTILITY AND MENTAL HEALTH

No articles this week

PSYCHIATRIC ILLNESS DURING PREGNANCY

The Chronicity and Timing of Prenatal and Antenatal Maternal Depression and Anxiety on Child Outcomes at Age 5.

Hentges RF, Graham SA, Fearon P, Tough S, Madigan S. Depress Anxiety. 2020 May 17.

In a prospective study of 1992 pregnant women, depression and anxiety were assessed.  Child outcomes were assessed at age 5. Effect sizes were small for brief incidents of depression/anxiety and increased for intermittent and chronic problems (i.e., measured at three or more timepoints) compared with mothers who had never experienced clinical-level anxiety or depression. 


Comparison of major depression diagnostic classification probability using the SCID, CIDI, and MINI diagnostic interviews among women in pregnancy or postpartum: An individual participant data meta-analysis.

Levis B, McMillan D, Sun Y, He C, et al.  nt J Methods Psychiatr Res. 2019 Dec;28(4):e1803.  Among fully structured interviews, the MINI (15 studies, 2,532 participants, 342 major depression cases) identified depression more often than the CIDI (3 studies, 2,948 participants, 194 major depression cases; adjusted odds ratio [aOR] = 3.72).


The biological underpinnings of perinatal depressive symptoms: a multi-systems approach.

Nazzari S, Fearon P, Rice F, et al.  J Affect Disord, May 2020.

Higher depressive symptoms during pregnancy were found to be associated with higher IL-6 levels, lower morning cortisol levels and a flatter cortisol diurnal slope during pregnancy.


Regional cerebral activity abnormality in pregnant women with antenatal depression.

Cheng B, Wang X, Zhou Y, et al.  J Affect Disord, May 2020.

In women with antenatal depression, aberrant regional functional activities were observed, mainly located within the prefrontal-limbic circuit concerning multiple neural system abnormalities.


Antenatal psychological intervention for universal prevention of antenatal and postnatal depression: A systematic review and meta-analysis.

Yasuma N, Narita Z, Sasaki N, Obikane E, Sekiya J, Inagawa T, Nakajima A, Yamada Y, Yamazaki R, Matsunaga A, Saito T, Watanabe K, Imamura K, Kawakami N, Nishi D.  J Affect Disord. 2020 May.

The meta-analysis showed a significant effect of antenatal psychological intervention on both antenatal and postnatal depression with moderate to high levels of heterogeneity. For subgroup analysis, a significant effect of a CB based approach on antenatal depression was found in an antenatal period, while non-significant results were shown on postnatal depression.


Effects of the COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: a preliminary study.

F Duranku?, E Aksu. J of Maternal-Fetal & Neonatal Medicine, 2020.

MEDICATIONS AND PREGNANCY

Long-Term Effects of Intrauterine Exposure to Antidepressants on Physical, Neurodevelopmental, and Psychiatric Outcomes: A Systematic Review.

Rommel AS, Bergink V, Liu X, Munk-Olsen T, Molenaar NM.  J Clin Psychiatry. 2020 May 12;81(3):19r12965.

The identified studies demonstrated statistically significant associations between prenatal antidepressant exposure and a range of physical, neurodevelopmental, and psychiatric outcomes. However, when controlling for confounders, 5 studies investigating physical outcomes (asthma, cancer, body mass index [BMI], epilepsy) found no association except conflicting outcomes for BMI. Eighteen studies examining neurodevelopmental outcomes (cognition, behavior, IQ, motor development, speech, language, and scholastic outcomes) found no consistent associations with antidepressant exposure after taking confounders into account. Eleven studies investigated psychiatric outcomes. After adjusting for confounders, prenatal antidepressant exposure was associated with affective disorders but not with childhood psychiatric outcomes (eg, autism spectrum disorders, attention-deficit/hyperactivity disorder).


Challenges in Determining Outcomes of Prenatal Exposure to Antidepressants.

Nonacs RM, Cohen LS.  J Clin Psychiatry. 2020 May 12.  Free article. 


Socieconomic status and psychotropic medicine use during pregnancy: a population-based study in British Columbia, Canada.

Hanley GE, Park M, Oberlander TF.  Arch Womens Ment Health. 2020 May 15. 

Women at the low end of the income distribution were significantly more likely to have a diagnosis of any mental health condition, except anxiety, during the perinatal period, when compared to women of the highest socioeconomic status.  Women in the lowest income quintile were less likely to fill a prescription for a psychotropic medicine after controlling for covariates and diagnoses of mental health conditions. However, they were more likely to fill a prescription for an antipsychotic and were more likely to fill psychotropic medicines from three or more different drug categories during pregnancy.

POSTPARTUM PSYCHIATRIC ILLNESS

Trajectories of maternal depressive symptoms from the antenatal period to 24-months postnatal follow-up: findings from the 2015 Pelotas birth cohort.

Jacques N, Mesenburg MA, Matijasevich A, Domingues MR, Bertoldi AD, Stein A, Silveira MF.  BMC Psychiatry. 2020 May 14;20(1):233. Free Article

A total of 3040 women were included in the present analysis. Five distinct maternal depressive symptom trajectories were identified, with 23.4% of the mothers presenting persistent depressive symptoms and 3.9% showing chronic high depressive symptoms throughout the study period. The probability of having persistent depressive symptoms increased among mothers with greater socioeconomic vulnerability.

MEDICATIONS AND BREASTFEEDING

No articles this week

PERINATAL SUBSTANCE USE

No articles this week

MATERNAL MENTAL HEALTH AND CHILD OUTCOMES

Mismatched Prenatal and Postnatal Maternal Depressive Symptoms and Child Behaviours: A Sex-Dependent Role for NR3C1 DNA Methylation in the Wirral Child Health and Development Study.

Hill J, Pickles A, Wright N, Quinn JP, Murgatroyd C, Sharp H.  Cells. 2019 Aug 21;8(9). Free Article


Prenatal maternal personality as an early predictor of vulnerable parenting style.

Hazell Raine K, Cockshaw W, Boyce P, Thorpe K.  Arch Womens Ment Health. 2019 Dec;22(6):799-807.

The interpersonal sensitivity subscales were significantly associated with prenatal depression symptoms but more consistently and robustly predicted postpartum mother-infant interaction quality. The inclusion of personality measures may strengthen prenatal mental health assessment to identify vulnerability to suboptimal mother-infant relationship quality.

MENOPAUSE AND MENTAL HEALTH

No articles this week

OTHER TOPICS IN WOMEN’S MENTAL HEALTH

No articles this week