The article that has received the most media attention over the last few weeks is at the top of the list.  We will be covering this in greater detail next week. In brief, this is a study where Lugo-Candelas and colleagues used structural and diffusion magnetic resonance imaging (MRI) to examine brain development in children exposed to SSRIs.  Although they did observe some differences between SSRI-exposed and unexposed children, it is difficult to rule out the possibility that other factors may contribute to the differences between the various groups.  Also on the list is a very good article from EURAP which looks at outcomes in children exposed to various antiepileptic drugs. We will also be discussing that article in the near future.

Ruta Nonacs, MD PhD

Associations Between Brain Structure and Connectivity in Infants and Exposure to Selective Serotonin Reuptake Inhibitors During Pregnancy.

Lugo-Candelas C, Cha J, Hong S, Bastidas V, Weissman M, Fifer WP, Myers M, Talati A, Bansal R, Peterson BS, Monk C, Gingrich JA, Posner J.  JAMA Pediatr. 2018 Apr 9.

Using structural and diffusion magnetic resonance imaging (MRI), this study assessed brain development in 98 infants at the mean age of was 3.43 (SD 1.50) weeks. In SSRI-exposed infants, as compared to infants born to healthy controls and mothers with untreated depression, they observed significant gray matter volume expansion in the right amygdala and right insula.  In connectome-level analysis of white matter structural connectivity, the SSRI group showed a significant increase in connectivity between the right amygdala and the right insula with a large effect size.

Comparative risk of major congenital malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry.
Tomson T et al. Lancet Neurol. (2018)

Valproate associated with high rates of congenital malformations, even at low doses.  The anticonvulsants lamotrigine and leviceteram appear to carry the lowest risk in this study from EURAP.

Emilia-Romagna Study on Pregnancy and Exposure to Antiepileptic drugs (ESPEA): a population-based study on prescription patterns, pregnancy outcomes and fetal health.

Mostacci B, Bisulli F, Poluzzi E, Cocchi G, Piccinni C, Curti A, Simonazzi G, Astolfi G, Rizzo N, Zenesini C, D’Alessandro R, Tinuper P; and the ESPEA Study Group.  J Neurol Neurosurg Psychiatry. 2018 Mar 16.

In 611 pregnancies exposed to AEDs, 21% of pregnancies ended in termination vs 12% in the non-exposed women. Rates of spontaneous abortions, stillbirths, neonatal distress and small for gestational age were comparable.

Association between particulate air pollution exposure during pregnancy and postpartum maternal psychological functioning.

Sheffield PE, Speranza R, Chiu YM, Hsu HL, Curtin PC, Renzetti S, Pajak A, Coull B, Schwartz J, Kloog I, Wright RJ.  PLoS One. 2018 Apr 18;13(4):e0195267.  Free Article

In a lower income, ethnically mixed sample of urban US women including 557 mothers who delivered at ?37 weeks gestation, increased exposure to particulate matter with diameter ? 2.5 ?m (PM2.5) in mid-pregnancy was associated with increased depressive and anhedonia symptoms during the postpartum period, particularly in Black women.  These findings are consistent with studies inhuman non-pregnant adults, where increased exposure to ambient particulate matter, nitrogen dioxide, and ozone have been associated with adverse neuropsychological functioning, including anxiety and depressive symptoms.  Possible reasons for this finding include inflammation, accumulation of neurotoxic substances, oxidative stress, and altered gene expression.

Maternal depressive symptoms during and after pregnancy and child developmental milestones.

Tuovinen S, Lahti-Pulkkinen M, Girchenko P, Lipsanen J, Lahti J, Heinonen K, Reynolds RM, Hämäläinen E, Kajantie E, Laivuori H, Pesonen AK, Villa PM, Räikkönen K.  Depress Anxiety. 2018 Apr 18.

A total of 2,231 mothers participating in the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) study completed the Center for Epidemiological Studies Depression Scale biweekly up to 14 times during pregnancy and twice up to 12 months after pregnancy. When their children were between the ages of 1.9 and 5.7 years, the mothers completed the Beck Depression Inventory-II as a measurement of their own depressive symptoms and the Ages and Stages Questionnaire as an assessment of child developmental milestones. Higher mean maternal depressive symptoms and consistently clinically relevant symptomatology during pregnancy predicted lower total developmental milestones, fine and gross motor, communication, problem solving, and personal/social skills scores in children. Although maternal depressive symptoms up to 12 months after pregnancy and in early childhood also predicted lower developmental milestones scores, developmental milestones scores were the lowest in children whose mothers’ depressive symptoms were above the clinical cutoff either only during pregnancy, both during and up to 12 months after pregnancy, or at each three time-points.

Parenting Stress Plays a Mediating Role in the Prediction of Early Child Development from Both Parents’ Perinatal Depressive Symptoms.

Fredriksen E, von Soest T, Smith L, Moe V.  J Abnorm Child Psychol. 2018 Apr 6.

The study used data from 1036 families participating in a community-based study from mid-pregnancy until 18 months postpartum. Depressive symptoms were assessed at seven time points during pregnancy (4 timepoints) and the postpartum period (3 timepoints).  Perinatal depressive symptoms, in either the mother or the father, predicted child social-emotional functioning, specifically externalizing, internalizing, and dysregulation problems, as well as language developmental delay at 18 months. Controlling for postnatal symptoms we found no independent effect of prenatal depressive symptoms on any child outcomes.  Maternal symptoms were more likely to be associated with social-emotional outcomes, whereas paternal symptoms had a greater effect on language outcomes. There was no evidence of stronger associations between depressive symptoms and child outcomes when both parents showed high symptom loads. However, parenting stress mediated most relations between parental depressive symptoms and child outcomes.

Severity of anxiety moderates the association between neural circuits and maternal behaviors in the postpartum period.

Guo C, Moses-Kolko E, Phillips M, Swain JE, Hipwell AE.  Cogn Affect Behav Neurosci. 2018 Apr 4.

Positive and negative caregiving behaviors during filmed face-to-face mother-infant interactions were assessed.  The higher a mother’s anxiety, the stronger the association between positive caregiving (i.e., maternal warmth and involvement) and amygdala-right posterior superior temporal sulcus (amygdala-RpSTS) functional connectivity.  These findings suggest that functional connectivity between the amygdala and a social perception region (RpSTS) plays a particularly important role for anxious mothers in facilitating their positive parenting. These findings extend our understanding of the specific neural circuits that support positive maternal caregiving in the context of maternal anxiety, and they may help inform the future design of personalized and effective interventions.

Latent trajectory groups of perinatal depressive and anxiety symptoms from pregnancy to early postpartum and their antenatal risk factors.

Ahmed A, Feng C, Bowen A, Muhajarine N.  Arch Womens Ment Health. 2018 Apr 13.

Women (n?=?615) from the Feelings in Pregnancy and Motherhood (FIP) longitudinal study were followed from early pregnancy to early postpartum.  Four latent trajectory groups of perinatal depressive symptoms were observed: “low-stable” (49.6%), “moderate-stable” (42.3%), “postpartum” (3.6%), and “antepartum” (4.6%). Significant risk factors associated with these trajectory group memberships were past depression, stress level, ethnicity, the mother’s age, and relationship satisfaction. Three latent trajectory groups of perinatal anxiety symptoms were identified: “very low-stable” (8.9%); “low-stable” (60.7%); and “moderate-stable” (30.4%). Significant risk factors associated with these trajectories were past depression, stress level, and income level.

Effectiveness of self-help psychological interventions for treating and preventing postpartum depression: a meta-analysis.

Lin PZ, Xue JM, Yang B, Li M, Cao FL.  Arch Womens Ment Health. 2018 Apr 4.

In treatment trials, depression scores decreased, and self-help interventions were significantly more effective, relative to control conditions, in promoting recovery from postpartum depression. Effectiveness in preventing depression did not differ significantly between self-help interventions and control conditions.

Feasibility and Acceptability of a Web-Based Treatment with Telephone Support for Postpartum Women With Anxiety: Randomized Controlled Trial.

Ashford MT, Olander EK, Rowe H, Fisher JR, Ayers S.  JMIR Ment Health. 2018 Apr 20;5(2):e19.

Feasibility was assessed for an internet-based treatment for postpartum anxiety (iWaWa), consisting of 9 modules with optional weekly telephone support. Postpartum (<12 months) women with mild-to-severe anxiety were recruited via social media during an 8-week period, and 89 women were randomized to the iWaWa treatment (8 weeks) or a wait-list control group.   Women were predominantly Caucasian, well-educated, married, on maternity leave, first-time mothers and reported moderate levels of anxiety. Dropout rates were high, especially in the treatment group (treatment: 82%, 38/46; wait-list control: 51%, 22/43). Despite interest in iWaWa, the results suggest that both the study and iWaWa were not feasible in the current format.

Psychosocial and health-related risk factors for depressive symptom trajectories among midlife women over 15 years: Study of Women’s Health Across the Nation (SWAN).

Bromberger JT, Schott LL, Avis NE, Crawford SL, Harlow SD, Joffe H, Kravitz HM, Matthews KA.  Psychol Med. 2018 Apr 6:1-10.

Five symptom trajectories were compared (50% very low; 29% low; 5% increasing; 11% decreasing; 5% high). Relative to whites, blacks were less likely to be in the increasing trajectory and more likely to be in the decreasing symptom trajectory and Hispanics were more likely to have a high symptom trajectory than an increasing trajectory. A rise in sleep problems was associated with higher odds of having an increasing trajectory and a rise in social support was associated with lower odds. Women with low role functioning for 50% or more visits had three times the odds of being in the increasing symptom group.

Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis.

van Driel C, Stuursma AS, Schroevers MJ, Mourits M, de Bock GH.  BJOG. 2018 Mar 15. Review.

Improvement of postpartum depression and psychosis after electroconvulsive therapy: A population-based study with a matched comparison group.

Rundgren S, Brus O, Båve U, Landén M, Lundberg J, Nordanskog P, Nordenskjöld A.  J Affect Disord. 2018 Apr 9;235:258-264.

In this study from Sweden, 185 women with postpartum depression and/or psychosis received ECT within 6 months of delivery.  Compared to a matched comparison group of 185 women with depression and/or psychosis (not within the postpartum period), more women with postpartum illness responded to ECT (87.0%) than comparison group subjects (73.5%).

Consequences of Antepartum Depression.

Schaffir J.  Clin Obstet Gynecol. 2018 Apr 13. Review.

The association of serum C-reactive protein with the occurrence and course of postpartum depression.

Miller ES, Hoxha D, Pinheiro E, Grobman WA, Wisner KL.  Arch Womens Ment Health. 2018 Apr 13.

C-reactive protein has been positively correlated with depressive symptomatology in non-pregnant, non-postpartum adults.  Of the 35 women with PPD included, neither baseline log CRP nor exit log CRP was significantly associated with severity of depressive symptoms. Baseline CRP was not associated with response or remission. In this sample of women with PPD, CRP was not associated with depressive symptoms nor response to treatment.

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