At the top of the list is our most recent review on the reproductive safety of psychotropic medications.  Molenaar and colleagues look at the incidence of perinatal depression in women with pregravid histories of major depression, noting that the women at greatest risk are those with early onset of psychiatric illness and those with psychiatric comorbidity.

While many studies have demonstrated that perinatal depression may be associated with worse developmental outcomes in infants and young children.  There are several studies this week which have assessed the long term impact of perinatal depression. Faleschini and colleagues note that more severe depressive symptoms during pregnancy are associated with poorer scores on the BRIEF Behavior Regulation Index in school age children.  Maternal depression was associated with worse executive functioning was observed in children participating in a Head Start program (Baker 2018). Maternal depression was also associated with less secure attachment in preadolescent children (Pratt et al, 2019).

 

Ruta Nonacs, MD PhD

Safety of Psychotropic Medications During Pregnancy.

Raffi ER, Nonacs R, Cohen LS.  Clin Perinatol. 2019 Jun;46(2):215-234.

 

Recurrence of depression in the perinatal period: Clinical features and associated vulnerability markers in an observational cohort.

Molenaar NM, Brouwer ME, Kamperman AM, Burger H, Williams AD, Hoogendijk WJG, Bockting CLH, Lambregtse-van den Berg MP.  PLoS One. 2019 Feb 22.  Free Article

Among 85 pregnant women with a history of depression who maintained treatment with antidepressants, 8 women (9.4%) experienced a recurrence of depression; two during pregnancy and six in the first 12 weeks postpartum. All women with recurrence of depression had first onset of depression during childhood or adolescence and had at least 2 psychiatric co-morbidities.

 

Associations of Prenatal and Postnatal Maternal Depressive Symptoms with Offspring Cognition and Behavior in Mid-Childhood: A Prospective Cohort Study.

Faleschini S, Rifas-Shiman SL, Tiemeier H, Oken E, Hivert MF.

Int J Environ Res Public Health. 2019 Mar 20;16(6). Free Article

In this study of 125 mother-child pairs, high maternal depressive symptoms during pregnancy were associated with poorer scores on the BRIEF Behavior Regulation Index and some SDQ scales based on reports from teachers and mothers. High prenatal maternal depressive symptoms were associated with poorer behavioral development. Postpartum symptoms did not show strong associations with outcomes after adjusting for symptoms during the prenatal period.

 

MATERNAL DEPRESSION AND THE DEVELOPMENT OF EXECUTIVE FUNCTION AND BEHAVIOR PROBLEMS IN HEAD START: INDIRECT EFFECTS THROUGH PARENTING.

Baker CE.  Infant Ment Health J. 2018 Mar;39(2):134-144.

Preliminary analyses revealed that 36% of the mothers of Head Start children (N=3,349) had clinically significant levels of depressive symptoms. Furthermore, a path analysis with demographic controls showed that mother-reported warmth (and not mother-child reading) mediated the association between maternal depression, children’s executive functioning, and behavior problems.

 

Exposure to early and persistent maternal depression impairs the neural basis of attachment in preadolescence.

Pratt M, Zeev-Wolf M, Goldstein A, Feldman R.  Prog Neuropsychopharmacol Biol Psychiatry. 2019 Mar 12;93:21-30.

Maternal depression impacted child’s brain response in two ways. First, maternal depression significantly increased the prevalence of child affective disorder and such children showed no neural differentiation between attachment and non-attachment stimuli. Second, maternal depression decreased maternal sensitivity, affect synchrony, and child oxytocin across early childhood and these were longitudinally associated with aberrant neural response to attachment-specific and social-general cues in preadolescence.

 

Water Contaminant Levels Interact with Parenting Environment to Predict Development of Depressive Symptoms in Adolescents.

Manczak EM, Miller JG, Gotlib IH.  Dev Sci. 2019 Apr 22:e12838.

Drinking water contaminants interact with negative family environments (parental psychological control) to predict changes in depressive symptoms in 110 adolescents-a developmental period when symptoms often first emerge. This effect was not present in adolescents in non-controlling families. Importantly, these associations were not accounted for by family- or community-level socioeconomic resources, demographic features, or by the adolescents’ stress exposure.

 

Parental depression moderates the relationships of cortisol and testosterone with children’s symptoms.

Black SR, Goldstein BL, Klein DN.  J Affect Disord. 2019 Mar 18;251:42-51.

Having two parents with a history of depression moderated the associations of reduced total daily cortisol output with higher externalizing scores, as well as the association of reduced testosterone with higher internalizing scores. A maternal history of depression, on the other hand, moderated the relationship between higher cortisol awakening response and higher internalizing scores. Furthermore, lower daily cortisol output was associated with higher internalizing scores among girls, but not boys, with two parents with a history depression.

 

Prenatal maternal antidepressants, anxiety, and depression and offspring DNA methylation: epigenome-wide associations at birth and persistence into early childhood.

Cardenas A, Faleschini S, Cortes Hidalgo A, Rifas-Shiman SL, Baccarelli AA, DeMeo DL, Litonjua AA, Neumann A, Felix JF, Jaddoe VWV, El Marroun H, Tiemeier H, Oken E, Hivert MF, Burris HH.

Clin Epigenetics. 2019 Mar 29;11(1):56.  Free Article

In Project Viva, 2.9% (14/479) pregnant women were prescribed antidepressants, 9.0% (40/445) experienced high pregnancy-related anxiety, and 8.2% (33/402) reported symptoms consistent with depression. Newborns exposed to antidepressants in pregnancy had 7.2% lower DNA methylation at cg22159528 located in the gene body of ZNF575, and this association was replicated in the Generation R Study.  In Project Viva, the association persisted in early but not mid-childhood. The ZNF575 gene is involved in transcriptional regulation but specific functions are largely unknown. While 13 CpG sites were associated with high maternal prenatal anxiety and three with prenatal maternal depression in Project Viva, these associations were not observed in the Generation R Study.

Prenatal exposure to tobacco and marijuana and child autonomic regulation and reactivity: An analysis of indirect pathways via maternal psychopathology and parenting.

Schuetze P, Zhao J, Eiden RD, Shisler S, Huestis MA.  Dev Psychobiol. 2019 Mar 13.

Researchers observed an indirect association between prenatal tobacco and marijuana exposure and autonomic functioning during the second year of life, which was mediated by harsh parenting during caregiver-infant interactions.

Hypertensive Disorders of Pregnancy and Symptoms of Depression and Anxiety as Related to Gestational Age at Birth: Findings from the All Our Families Study.

Horsley KJ, Tomfohr-Madsen LM, Ditto B, Tough SC.  Psychosom Med. 2019 Apr 12.

Of 2763 women who had a singleton pregnancy and live birth, 247 (9%) were diagnosed with HDP. Women with HDP had significantly shorter gestational length relative to those without the diagnosis (M=37.87 vs. M=38.99 weeks of gestation).  Depressive symptoms and state anxiety during pregnancy may add to the increased risk for shortened gestation associated with hypertension.

The Relationship between Gestational Weight Gain and Postpartum Depression in Normal and Overweight Pregnant Women.

Dayan F, Javadifar N, Tadayon M, Malehi AS, Komeili Sani H.  J Pregnancy. 2018 Oct 21. Free Article

In healthy pregnant women with first trimester body mass index (BMI) between 18.5 and 30, 32.2% of mothers scored above 12 on the EPDS. The only variable associated with depression was third trimester weight gain (OR 1.17).

Course of a major postpartum depressive episode: A prospective 2 years naturalistic follow-up study.

Torres A, Gelabert E, Roca A, Navarro P, Plaza A, Subirà S, Martin-Santos R, Ascaso C, Garcia-Esteve L.  J Affect Disord. 2019 Feb 15

The probability of recovering was 30.2% at 6 months of follow-up, 66.3% at 12 months of follow-up, and 90.3%  at 24 months of follow-up. Mothers with financial difficulties, onset of depressive episode prIor to birth, and those with prior treated depressive episodes took longer in achieving full remission.

Effectiveness of mindfulness-based cognitive therapy for comorbid depression and anxiety in pregnancy: a randomized controlled trial.

Zemestani M, Fazeli Nikoo Z.  Arch Womens Ment Health. 2019 Apr 13.

Intent to treat analyses provided preliminary evidence that MBCT can be effective in reducing depressive and anxiety symptoms and in enhancing the use of adaptive emotion regulation strategies and psychological well-being. Improvements in outcomes were maintained 1 month.