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. 

Over the last few years, there have been several articles suggesting that more aggressive pain management at the time of labor and delivery and during the postpartum period may decrease risk for postpartum depression.  A new study from Deng and colleagues suggests that women who use epidural analgesia during a spontaneous vaginal delivery are 60% less likely to experience postpartum depression.  This is a significant reduction in risk; however, the study will need to be replicated in other populations.  

Several articles on the treatment of ADHD during pregnancy.  The first is from Allison Baker at the Center for Women’s Mental Health — the first study to prospectively follow women with ADHD during pregnancy.  While we typically suggest that women with mild ADHD disconune stimulants during pregnancy, this study suggests that this practice may increase risk for depression and worse quality of life in women with ADHD.  You can read more HERE.  

The other article is a review of the use of ADHD medications, including stimulants, in pregnant and breastfeeding women.  

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



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The Course of ADHD during Pregnancy.

Baker AS, Wales R, Noe O, Gaccione P, Freeman MP, Cohen LS.  J Atten Disord. 2020 Dec 11.  

While ADHD symptoms remained stable across pregnancy, women who discontinued stimulant medication during pregnancy reported increased depressive symptoms and lower quality of life.  Read more about this study HERE.

The role of neonatal vitamin D in the association of prenatal depression with toddlers ADHD symptoms: A birth cohort study.

Ma SS, Zhu DM, Yin WJ, Hao JH, Huang K, Tao FB, Tao RX, Zhu P.  J Affect Disord. 2020 Dec 13;281:390-396. 

Toddlers of mothers with higher depression scores during pregnancy were at increased risk for ADHD (20.1% vs 11.1%, P = 0.003; adjusted RR=1.75, 95% CI: 1.10-2.81). Among toddlers with neonatal vitamin D deficiency (VDD), ADHD risk was significantly increased with maternal depression (adjusted RR=3.74, 95% CI: 1.49-9.41), but this association was not found in toddlers with adequate vitamin D during pregnancy.



The effects of drugs used for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) on pregnancy outcome and breastfeeding: a critical review.

Ornoy A, Koren G.  Curr Neuropharmacol. 2020 Nov 27.

The data on the effects of stimulants (methylphenidate and amphetamines) in pregnancy are generally reassuring.

The relationship between oxytocin blood concentrations and antidepressants over pregnancy and the postpartum.

Galbally M, Watson SJ, Keelan JA, Spigset O, Lewis A.  Prog Neuropsychopharmacol Biol Psychiatry. 2020 Dec 17:

Concurrent oxytocin blood concentrations were not associated with perinatal antidepressant use. However, oxytocin blood concentrations increased more steeply in those on antidepressants across the perinatal period compared to untreated control women. 



Adding perinatal anxiety screening to depression screening: is it worth it?

Lieb K, Reinstein S, Xie X, Bernstein PS, Karkowsky CE.  Am J Obstet Gynecol MFM. 2020 May;2(2):100099.

 Screening for perinatal anxiety may increase referral rates to mental health professionals who can then diagnose and treat women who experience mood and anxiety disorders. Anxiety screening may be particularly useful in populations with a history of mental health diagnoses or substance abuse.

Pregnancy associated epigenetic markers of inflammation predict depression and anxiety symptoms in response to discrimination.

Sluiter F, Incollingo Rodriguez AC, Nephew BC, Cali R, Murgatroyd C, Santos HP Jr.

Neurobiol Stress. 2020 Nov 21.  Free article.

The impact of pre-pregnancy BMI on maternal depressive and anxiety symptoms during pregnancy and the postpartum period: A systematic review and meta-analysis.

Dachew BA, Ayano G, Betts K, Alati R.  J Affect Disord. 2020 Dec 10;281:321-330. 

Pre-pregnancy obesity was associated with a 33% increased risk of antenatal depressive symptoms (pooled OR = 1.33 [95% CI; 1.20-1.48]).

Neuraxial labor analgesia is associated with a reduced risk of postpartum depression: A multicenter prospective cohort study with propensity score matching.

Deng CM, Ding T, Li S, Lei B, Xu MJ, Wang L, Xu SC, Yang HX, Sun XY, Li XY, Ma D, Wang DX.

J Affect Disord. 2020 Dec 8;281:342-350.

After adjustment for confounding factors, epidural (neuroaxial) analgesia was associated with decreased odds of postpartum depression (odds ratio [OR] 0.40, 95% CI 0.21-0.77, P=0.006).



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Prenatal opioid exposure – Increasing evidence of harm.

Mactier H, Hamilton R.  Early Hum Dev. 2020 Nov;150:105188. Review.

Cannabis Use in Pregnant and Breastfeeding Women: Behavioral and Neurobiological Consequences.

Navarrete F, García-Gutiérrez MS, Gasparyan A, Austrich-Olivares A, Femenía T, Manzanares J.  Front Psychiatry. 2020 Nov 2;11:586447. Free article.

Among pregnant women aged 15-44, last month cannabis use prevalence was over 4.9%, rising to 8.5% in the 18-25-year-old age range. Pre- and postnatal exposure to cannabis may be associated with critical alterations in the newborn infants that are prolonged throughout childhood and adolescence.

Guideline No. 405: Screening and Counselling for Alcohol Consumption During Pregnancy.

Graves L, Carson G, Poole N, Patel T, Bigalky J, Green CR, Cook JL.  J Obstet Gynaecol Can. 2020 Sep;42(9):1158-1173.

Implementation of the recommendations in these guidelines using validated screening tools and brief intervention approaches may increase obstetrical care provider recognition of alcohol consumption and problematic alcohol use among women of child-bearing age and those who are pregnant. 



Cord Serum Cytokines at Birth and Children’s Anxiety-Depression Trajectories From 3 to 8 Years: The EDEN Mother-Child Cohort.

Galera C, Barbosa S, Collet O, Khalfallah O, Aouizerate B, Sutter-Dalley AL, Koehl M, Capuron L, Van der Waerden J, Melchior M, Côté S, Heude B, Glaichenhaus N, Davidovic L; EDEN Mother–Child Cohort Study Group.  Biol Psychiatry. 2020 Oct 24.

Immune dysregulation at the time of birth was associated with worse outcomes in children.  

Fear of childbirth during pregnancy: associations with observed mother-infant interactions and perceived bonding.

Challacombe FL, Nath S, Trevillion K, Pawlby S, Howard LM.  Arch Womens Ment Health. 2020 Dec 17.

Fear of childbirth makes a distinct contribution to perceived postpartum bonding difficulties but observed mother-infant interaction quality was not affected. 



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