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.
On Wednesdays, we will continue to offer virtual rounds for perinatal psychiatry providers.
Back by popular demand, the CWMH is pleased to announce a second course offering of ‘Psychiatric Disorders in Women’ with the MGH Psychiatry Academy. The course will run this Summer, and is available to all healthcare providers with an interest in reproductive psychiatry. Please find more information and registration here.
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
|The uterine-chemokine-brain axis: menstrual cycle-associated symptoms (MCAS) are in part mediated by CCL2, CCL5, CCL11, CXCL8 and CXCL10.|
Roomruangwong C, et al. J Affect Disord 269, 15 May 2020, 85-93.
Chemokines produced by the uterus may link the uterus with brain functions via a putative uterine-chemokine-brain axis.
Dubol M, Neill Epperson C, Lanzenberger R, Sundström-Poromaa I, Comasco E. Front Neuroendocrinol. 2020 Apr 5:
Greater cerebellar grey matter volume and metabolism were observed in patients with PMDD, along with altered serotonergic and GABAergic neurotransmission. Differential corticolimbic activation in response to emotional stimuli distinguishes the PMDD brain, namely enhanced amygdalar and diminished fronto-cortical function.
INFERTILITY AND MENTAL HEALTH
|No articles this week.|
PSYCHIATRIC ILLNESS DURING PREGNANCY
|Financial Toll of Untreated Perinatal Mood and Anxiety Disorders Among 2017 Births in the United States.|
Luca DL, Margiotta C, Staatz C, Garlow E, Christensen A, Zivin K. Am J Public Health. 2020 Apr 16:e1-e9.
We estimated PMADs to cost $14 billion for the 2017 birth cohort from conception to 5 years postpartum. The average cost per affected mother-child dyad was about $31?800. Mothers incurred 65% of the costs; children incurred 35%. The largest costs were attributable to reduced economic productivity among affected mothers, more preterm births, and increases in other maternal health expenditures.
Slavin V, Creedy DK, Gamble J. BMC Pregnancy Childbirth. 2020 Apr 14;20(1):211. Free Article
Recommended method of case-identification (PHQ-2 ? 3) missed an unacceptable number of women at-risk of depression.
Dowse E, Chan S, Ebert L, Wynne O, Thomas S, Jones D, Fealy S, Evans TJ, Oldmeadow C. Matern Child Health J. 2020 Apr 17.
Babies born to women self-reporting anxiety were more likely to have birth complications, be admitted to the nursery, had lower Apgar scores and longer hospital stays. Babies born to women self-identifying as experiencing a level of depression were more likely to have a lower birth weight, shorter gestational age, and, lower Apgar score. These babies were more likely to be admitted to the nursery with an increased length of stay.
MEDICATIONS AND PREGNANCY
|Antipsychotic drug use in pregnancy: A multinational study from ten countries.|
Reutfors J, Cesta CE, Cohen JM, Bateman BT, Brauer R, Einarsdóttir K, Engeland A, Furu K, Gissler M, Havard A, Hernandez-Diaz S, Huybrechts KF, Karlstad Ø, Leinonen MK, Li J, Man KKC, Pazzagli L, Schaffer A, Schink T, Wang Z, Yu Y, Zoega H, Bröms G. Schizophr Res. 2020 Apr 12.
This study included 8,394,343 pregnancies. Typical antipsychotic use was highest in the UK (4.4%) whereas atypical antipsychotic use was highest in the US Medicaid population (1.5%). Atypical antipsychotic use increased over time in most populations, reaching 2% in Australia (2012) and US Medicaid (2013). In most countries, prochlorperazine (typically used for nausea and vomiting) was the most commonly used typical antipsychotic and quetiapine the most commonly used atypical antipsychotic. Use of antipsychotics decreased across the trimesters of pregnancy in all populations except Finland. Antipsychotic use was elevated among smokers and those with parity ? 4 in the Nordic countries.
POSTPARTUM PSYCHIATRIC ILLNESS
Addressing maternal depression in home visiting: Findings from the home visiting collaborative improvement and innovation network
D Tandon, M Mackrain, L Beeber, et al. PLOS One, 2020.
Garthus-Niegel S, Karl M, Schaber R, et al. Research Square; 2020.
Employed women were questioned about their work during pregnancy and mental health 8 weeks after delivery. Work-privacy conflict, low reward at work, and precarious working conditions significantly predicted symptoms of PPD, even after controlling for lifetime depression, anxiety, education, parity, and age.
Lim G, LaSorda KR, Farrell LM et al. BMC Pregnancy Childbirth 20, 240 (2020).
Pain at all perinatal time points—prenatal, labor, and postpartum—appear to be independently linked to depression scores at 6 weeks postpartum.
Shaber R, Karl M, et al. J Affect Disord, April 2020.
Education was not significantly associated with PPD symptoms. Job burden was a significant risk factor for postpartum depressive (PPD) symptoms, whereas job satisfaction was a significant protective factor for PPD symptoms.
Halal CS, Bassani DG, Santos IS, Tovo-Rodrigues L, Del-Ponte B, Silveira MF, Bertoldi AD, Barros FC, Nunes ML. J Sleep Res. 2020 Apr 14.
Although mothers in the depressed group were more likely to report more night wakings, objective data from actigraphy did not replicate this finding. Dysfunctional cognition, maternal behavioural factors and sleep impairment associated with perinatal depression may affect the mother’s impression of her infant’s sleep.
Levinson M, Parvez B, Aboudi D, Shah S. J Matern Fetal Neonatal Med. 2020 Apr 21:1-9.
In mothers with a child admitted to the NICU, the incidence of positive PPD screening was 19% (25/135). Positive PPD screening was associated with exclusive breastfeeding (67% vs, 35%, p?<?.05) and maternal age <35?years (32% vs. 12%, p?<?.05). Mean PPD screening scores were higher in infants with intraventricular hemorrhage and necrotizing enterocolitis.
MEDICATIONS AND BREASTFEEDING
|No articles this week|
PERINATAL SUBSTANCE USE
|Opioid use disorder among pregnant women in the 2000-2014 North Carolina state inpatient database.|
Alemu BT, Beydoun HA, Olayinka O, Young B. J Addict Dis. 2020 Apr 14:1-9. A Opioid use disorder prevalence: 3.14 cases per 1,000 discharge. Maternal opioid use was associated with an increased odds of early onset delivery, threatened preterm labor, premature rupture of membranes, postpartum depression, stillbirth and poor fetal growth. Women who used opioids during pregnancy had prolonged hospital stays (>5?days) and were 2 times as likely to have more than 4 procedures performed during hospitalization. Compared to other racial groups, non-Hispanic whites had a notably higher prevalence of opioid use disorders (5.8/1,000 pregnancy-related discharges).
MATERNAL MENTAL HEALTH AND CHILD OUTCOMES
|Here’s looking at you, kid? Maternal depression and adolescent attention to self- or other-directed emotional faces.|
Seidman SB, et al. J Affect Disord, April 2010.
Mother-daughter dyads (N?=?56) were recruited based on presence or absence of maternal depression history and absence of depression in the daughters. Familial depression risk is associated with altered responsivity of adolescent girls to face-orientation Children of depressed mothers exhibited a pattern of vigilance-avoidance.
Romero G, Huth-Bocks A, Puro-Gallagher E, Riggs J. J Reprod Infant Psychol. 2020 Apr 22:1-15.
This study revealed significant, negative associations between prenatal (but not postpartum) psychiatric symptoms and positive perceptions of infant emotions. Results also revealed significant indirect effects of prenatal depressive and PTSD symptoms on negative parenting via perceptions of infant emotion.
Porto JA, Bick J, Perdue KL, Richards JE, Nunes ML, Nelson CA. Infant Behav Dev. 2020 Apr 16;
Infants of mothers reporting higher negative affect had greater oxyhemoglobin (oxyHb) activation across all emotions over the left inferior frontal gyrus, a region implicated in emotional communication. Follow-up analyses indicated that associations were driven by maternal depression, but not anxiety symptoms.
MENOPAUSE AND MENTAL HEALTH
|Gabapentin for the treatment of hot flushes in menopause: a meta-analysis.|
Yoon SH, Lee JY, Lee C, Lee H, Kim SN. Menopause. 2020 Apr;27(4):485-493
Gabapentin effective for the treatment VMS in postmenopausal women with contraindications to hormonal therapy.
Fraser GL, Lederman S, Waldbaum A, Kroll R, Santoro N, Lee M, Skillern L, Ramael S. Menopause. 2020; 27(4):382-392.
Fezolinetant reduced moderate/severe VMS frequency by -1.9 to -3.5/day at week 4 and -1.8 to -2.6/day at week 12 (all P?<?0.05 vs placebo). Response (50% reduction) relative to placebo was achieved by 81.4% to 94.7% versus 58.5% of participants at end of treatment (all doses P?<?0.05). Treatment-emergent adverse events were largely mild/moderate; no serious treatment-related treatment-emergent adverse events occurred.
OTHER TOPICS IN WOMEN’S MENTAL HEALTH
|Mobile Health for Perinatal Depression and Anxiety: Scoping Review.|
Hussain-Shamsy N, Shah A, Vigod SN, Zaheer J, Seto E. J Med Internet Res. 2020 Apr 13;22(4):e17011. Free Article