The year has certainly been a busy one for reproductive psychiatry.  The weekly roundup will be on vacation next week, but we have plenty of interesting articles to ponder in January.  Stay tuned.

This week there were several important articles looking at bipolar disorder during pregnancy and the postpartum period.  Preliminary research from Nancy Byatt and her colleagues at MCPAP for Moms observe that in the community, obstetric providers are managing the pharmacotherapy of a large proportion of pregnant women with bipolar disorder.  While this is certainly better than receiving no care, this study underlines the importance of bolstering support for these providers so that they are able to (1) better identify women with bipolar disorder, (2) avoid inappropriate prescribing (i.e.,  using antidepressants instead of mood stabilizers) in women with undiagnosed bipolar disorder, and (3) recognize when women should be referred for specialized psychiatric treatment.

Addressing the management of women with bipolar disorder from a slightly different angle, Sharma and colleagues approach pregnancy and childbirth as a time of opportunity. We are now screening for depression in obstetric settings during or after pregnancy; however, we do not typically screen for bipolar disorder.  Because bipolar disorder carries the highest risk for postpartum psychiatric hospitalization compared to other psychiatric disorder,  early identification of at-risk women is crucial.  

For more detailed descriptions of many of these topics, you can read the CWMH NEWSLETTER which comes out every Thursday.  You can sign up for our newsletter HERE.

Wishing everybody a happy holiday!!

Ruta Nonacs, MD PhD



No articles this week


Prenatal attachment in pregnancy following assisted reproductive technology: a literature review.

Ranjbar F, Warmelink JC, Gharacheh M.  J Reprod Infant Psychol. 2019 Dec 18:1-23. 

In most couples who conceived following ART, the level of prenatal attachment was either similar to or higher than in couples who conceive without ART.


Chronic Pain Prevalence and Exposures during Pregnancy.

Ray-Griffith SL, Morrison B, Stowe ZN.  Pain Res Manag. 2019 Aug 8.  Free Article

Of the 156 pregnant women, chronic pain conditions were reported by 44 (28.2%). The most common chronic pain complaints included neck and/or back pain (34.1%) and headaches (31.8%). 

The association between subjective maternal stress during pregnancy and offspring clinically diagnosed psychiatric disorders.

Brannigan R, Cannon M, Tanskanen A, Huttunen MO, Leacy FP, Clarke MC.  Acta Psychiatr Scand. 2019 Apr;139(4):304-310. 

Individuals whose mothers reported stress during pregnancy had significantly greater odds of developing a psychiatric disorder (OR = 1.41, 95% CI = 1.10-1.81) particularly a mood disorder (OR = 1.67, 95% CI = 1.10-2.54).

Is the association between maternal stress during pregnancy and the child’s depression partly causal, and what should we do about it?

Glover V.  Acta Psychiatr Scand. 2019 Apr;139(4):301-303.

Commentary on the article above from Brannigan and colleagues.

Association of antepartum depression, generalized anxiety, and posttraumatic stress disorder with infant birth weight and gestational age at delivery.

Gelaye B, Sanchez SE, Andrade A, Gómez O, Coker AL, Dole N, Rondon MB, Williams MA.  J Affect Disord. 2020 Feb 1;262:310-316.

Generalized anxiety disorder during pregnancy appeared to increase odds of delivering a low-birth-weight or small-for-gestational-age infant, while PTSD was associated with increased odds of delivering preterm. 



Safety of Psychotropic Medications During Pregnancy.

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

The international prevalence of antidepressant use before, during, and after pregnancy: A systematic review and meta-analysis of timing, type of prescriptions and geographical variability.

Molenaar NM, Bais B, Lambregtse-van den Berg MP, Mulder CL, Howell EA, Fox NS, Rommel AS, Bergink V, Kamperman AM.  J Affect Disord. 2019 Dec 9;264:82-89. 

In a total of 14,072,251 pregnancies, selective serotonin reuptake inhibitors (SSRIs) were the most commonly used antidepressants during pregnancy, with an international prevalence estimate of 3.0% (95%CI 2.3;3.7). While Europe and Australasia had pooled prevalence estimates of 1.6% and 1.3% respectively, Northern America had a prevalence estimate of 5.5% (Q-value = 126.19; df = 2; p-value<0.01). Highest SSRI prevalence rates were found for sertraline (1.10%), followed by citalopram and fluoxetine (0.77% and 0.76% respectively) (Q-value = 121.25; df = 5; p-value<0.01). Qualitative analysis indicated an increase in antidepressant use over subsequent calendar years.

Access to Pharmacotherapy Amongst Women with Bipolar Disorder during Pregnancy: a Preliminary Study.

Byatt N, Cox L, Moore Simas TA, Biebel K, Sankaran P, Swartz HA, Weinreb L.

Psychiatr Q. 2018 Mar;89(1):183-190. doi: 10.1007/s11126-017-9525-8. Free Article

Participants identified barriers included perception that psychiatric providers lack training and experience in the treatment of psychiatric illness during pregnancy, are reluctant to treat bipolar disorder among pregnant women, and believe that pharmacotherapy is not needed for psychiatric illness during pregnancy. Facilitators included participants’ perception that providers’ acknowledge risks associated with untreated or undertreated psychiatric illness during pregnancy and provide psycho-education about the risks, benefits and alternatives to pharmacotherapy.

How obstetric settings can help address gaps in psychiatric care for pregnant and postpartum women with bipolar disorder.

Byatt N, Cox L, Moore Simas TA, Kini N, Biebel K, Sankaran P, Swartz HA, Weinreb L.  Arch Womens Ment Health. 2018 Oct;21(5):543-551.

In this small observational study, it was observed that obstetric providers provide the bulk of medical care for women with bipolar disorder and need supports in place to (1) better recognize bipolar disorder, (2) avoid inappropriate prescribing practices for women with undiagnosed bipolar disorder, and (3) ensure women are referred to specialized treatment when needed.



Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics.

Stewart DE, Vigod SN.  Annu Rev Med. 2019 Jan 27;70:183-196.

Childbirth and prevention of bipolar disorder: an opportunity for change.

Sharma V, Bergink V, Berk M, Chandra PS, Munk-Olsen T, Viguera AC, Yatham LN.  Lancet Psychiatry. 2019 Sep;6(9):786-792. 

The authors describe the clinical characteristics of women at risk of developing bipolar disorder after childbirth, before discussing opportunities for prevention and early intervention and outlining challenges in the assessment and management of women at risk of transitioning to bipolar disorder after childbirth. Existing evidence, although scarce, supports a clinical staging model by which at-risk women are managed with a variety of behavioural and pharmacological interventions aimed at preventing bipolar disorder. 

Postpartum psychosis in bipolar disorder: no evidence of association with personality traits, cognitive style or affective temperaments.

Perry A, Gordon-Smith K, Webb I, Fone E, Di Florio A, Craddock N, Jones I, Jones L.  BMC Psychiatry. 2019 Dec 12;19(1):395. Free Article

Personality traits, cognitive styles and affective temperaments previously shown to be associated with bipolar disorder in general were not specifically associated with the occurrence of postpartum psychosis. 

Psychosocial factors associated with trajectories of maternal psychological distress over a 10-year period from the first year postpartum: An Australian population-based study.

Wajid A, Kingston D, Bright KS, Kashif Mughal M, Charrois EM, Giallo R.  J Affect Disord. 2019 Nov 30;263:31-38.

Researchers identified five distinct trajectories of maternal psychological distress symptoms over time. Predictors of trajectories with elevated symptoms reflected a pattern of social and economic disadvantage and psychosocial stress. The strongest predictors of elevated mental health symptoms were a history of depression [OR: 7.57(4.73-12.11)] and 3 or more stressful life events in the past year [OR: 3.38(2.02-5.65)].

Inhibition of expression of glucocorticoids receptors may contribute to postpartum depression.

Wang J, Yun Q, Ma SF, Song HR, Guo MN, Zhang WN.  Biochem Biophys Res Commun. 2019 Dec 11.

In a rat model of PPD, reduced expression of gonadotropin receptors was  was observed in the hippocampus. 

The role of personality dimensions, depressive symptoms and other psychosocial variables in predicting postpartum suicidal ideation: a cohort study.

Gelabert E, Gutierrez-Zotes A, Navines R, Labad J, et al.   Arch Womens Ment Health. 2019 Dec 4

Seven percent of mothers reported suicidal ideation during the first 8 months postpartum. Sixty-two percent of women with suicidal ideation had a major depressive episode at 8 weeks, and 70% at 32 weeks postpartum.



No articles this week


Fetal assessment in buprenorphine-maintained women using fetal magnetoencephalography: a pilot study.

Escalona-Vargas D, Coker JL, Ray-Griffith S, Siegel ER, Lowery CL, Stowe ZN, Eswaran H.  Addiction. 2018 Oct;113(10):1895-1904.

This pilot study showed that a novel biomagnetic technique allows simultaneous quantification of cardiac and brain activities of a group of buprenorphine-exposed and non-exposed fetuses in the third trimester.


Associations between maternal depressive symptoms and risk for offspring early-life psychopathology: the role of genetic and non-genetic mechanisms.

Gjerde LC, Eilertsen EM, Hannigan LJ, Eley T, Røysamb E, Reichborn-Kjennerud T, Rijsdijk FV, McAdams TA, Ystrom E.  Psychol Med. 2019 Dec 9:1-9. 

Associations between maternal symptoms of depression and offspring emotional problems were predominantly explained by passive genetic transmission at 1.5 and 3 years postpartum. However, at age 5, associations were more due to direct environmental exposure. 



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