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. 

In an article published in the Journal of Affective Disorders, Auger and colleagues looked at risk for cardiovascular disease in women who suffer from severe mood disorders.  Researchers identified a cohort of about one million women who were pregnant between 1989 and 2012 and followed them over time, tracking cardiovascular hospitalizations up to 23 years later.  Compared to women with no psychiatric hospitalization, women who were hospitalized for bipolar disorder or depression before, during, or in the 5 years after delivery were much more likely to be hospitalized for a cardiovascular event during the follow up period.  

Bipolar disorder was associated with 3.0 times the risk of cardiovascular disease (95% CI 1.92-4.73), and depression was associated with 2.3 times the risk (95% CI 1.34-3.99). 

This study was not designed to explain why there is such a strong association between mood disorder and cardiovascular disease in women.  One possible explanation is that suffering from a mood disorder may lead to physiologic changes, such as increased activity of the hypothalamic-pituitary-adrenal (HPA) axis, which may contribute to risk for cardiovascular disease.  Another possible explanation is that similar factors increase risk for both mood disorders and cardiovascular disease, such as chronic inflammation, exposure to chronic stress, or childhood adversity.

This finding might also explain previous studies which have shown worse pregnancy outcomes in women with bipolar disorder and major depression, including increased risk for hypertension and pre-eclampsia.  

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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Suicide ideation among pregnant women: The role of different experiences of childhood abuse.

Zhang X, Sun J, Wang J, Chen Q, Cao D, Wang J, Cao F.  J Affect Disord. 2020 Jan 24;266:182-186. 

Women with any experience of childhood abuse had high risk of suicide ideation (OR = 2.44, 95%CI: 1.31-4.55). 

Mood disorders in pregnant women and future cardiovascular risk.

Auger N, Potter BJ, Healy-Profitós J, He S, Schnitzer ME, Paradis G.  J Affect Disord. 2020 Jan 15;266:128-134.

Incidence of cardiovascular events was higher for bipolar disorder (4.4 per 1,000 person-years) and depression (4.2 per 1,000) than no mental illness (1.8 per 1,000). Compared with no mental disorder, bipolar disorder was associated with 3.0 times the risk of cardiovascular disease (95% CI 1.92-4.73), and depression with 2.3 times the risk (95% CI 1.34-3.99). 

Assessment of anxiety during pregnancy: are existing multiple anxiety scales suitable and comparable in measuring anxiety during pregnancy?

Adhikari K, Patten SB, Williamson T, Patel AB, Premji S, Tough S, Letourneau N, Giesbrecht G, Metcalfe A.  J Psychosom Obstet Gynaecol. 2020 Feb 14:1-7.

Findings indicate that these scales do not measure anxiety as a single dimension and that these scales are incomparable and may conceptualize anxiety differently.


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Preventing postpartum depressive symptoms using an educational video on infant crying: A cluster randomized controlled trial.

Doi S, Fujiwara T, Isumi A, Mitsuda N.  Depress Anxiety. 2020 Feb 14.

In the total group of mothers, the intervention did not significantly reduce risk for PPD; however, among young mothers (<25 years), the analysis showed a 67.0% reduction in postpartum depression (odds ratio: 0.33, 95% CI: 0.15-0.72).

Fair enough? Decreased equity of dyadic coping across the transition to parenthood associated with depression of first-time parents.

Meier F, Milek A, Rauch-Anderegg V, Benz-Fragnière C, Nieuwenboom JW, Schmid H, Halford WK, Bodenmann G.  PLoS One. 2020 Feb 19;15(2):e0227342.  Free Article

Decreases in women’s perceived equity in either direction were associated with more depressive symptoms in women and their male partners. 

Delayed sleep timing and circadian rhythms in pregnancy and transdiagnostic symptoms associated with postpartum depression.

Obeysekare JL, Cohen ZL, Coles ME, Pearlstein TB, Monzon C, Flynn EE, Sharkey KM.  Transl Psychiatry. 2020 Jan 21;10(1):14.

Fifty-one women with a previous, but not active, episode of unipolar or bipolar depression had symptoms evaluated.  Delayed sleep timing in this sample of at-risk women was associated with more symptoms of mania, depression, and OCD in the postpartum period. Sleep timing may be a modifiable risk factor for postpartum depression.

Chronic psychosocial stress during pregnancy affects maternal behavior and neuroendocrine function and modulates hypothalamic CRH and nuclear steroid receptor expression.

Zoubovsky SP, Hoseus S, Tumukuntala S, Schulkin JO, Williams MT, Vorhees CV, Muglia LJ.  Transl Psychiatry. 2020 Jan 16;10(1):6

Psychosocial stress during pregnancy induces changes in neuroendocrine function and maternal behavior in the early postpartum period.

Maternal postpartum depression is a risk factor for infant emotional variability at 4 months.

Vaever MS, Pedersen IE, Smith-Nielsen J, Tharner A.  Infant Ment Health J. 2020 Feb 14.

Postnatal trajectories of maternal depressive symptoms: Postpartum antecedents and differences in toddler adjustment.

Choe DE, McDonough SC, Sameroff AJ, Lawrence AC.  Infant Ment Health J. 2020 Feb 14. d

Mid-pregnancy insomnia is associated with concurrent and postpartum maternal anxiety and obsessive-compulsive symptoms: A prospective cohort study.

Osnes RS, Eberhard-Gran M, Follestad T, Kallestad H, Morken G, Roaldset JO.  J Affect Disord. 2020 Jan 27;266:319-326. Free Article

Mid-pregnancy insomnia is a marker for concurrent anxiety and predictor of postpartum anxiety. 

Repetitive transcranial magnetic stimulation for the treatment of postpartum depression.

Cox EQ, Killenberg S, Frische R, McClure R, Hill M, Jenson J, Pearson B, Meltzer-Brody SE.  J Affect Disord. 2020 Mar 1;264:193-200.

rTMS was safe and well tolerated among participants with evidence of sustained improvements in depression and anxiety scores.

Treatment resistant depression in women with peripartum depression.

Cepeda MS, Kern DM, Nicholson S.  BMC Pregnancy Childbirth. 2019 Sep 2;19(1):323. Free Article

TRD occurs in approximately 5% of women with peripartum depression. The risk of TRD is higher in pregnant women with a history of depression. Women who went on to develop TRD had more psychiatric comorbidities and painful conditions than women who did not.


Pharmacotherapy for Depression and Bipolar Disorder during Lactation: A Framework to Aid Decision Making.

Sprague J, Wisner KL, Bogan D. Seminars in Perinatology, January 2020.  


Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine: A Nonrandomized Controlled Trial.

Guille C, Simpson AN, Douglas E, Boyars L, Cristaldi K, McElligott J, Johnson D, Brady K.  JAMA Netw Open. 2020 Jan 3;3(1):e1920177.  Free Article

In this nonrandomized controlled trial, virtually integrated OUD care in obstetric practices produced similar maternal and newborn outcomes compared with in-person care.

Association of Depression, Anxiety, and Trauma With Cannabis Use During Pregnancy.

Young-Wolff KC, Sarovar V, Tucker LY, Goler NC, Alexeeff SE, Ridout KK, Avalos LA.  JAMA Netw Open. 2020 Feb 5;3(2):e1921333. Free Article

Women who used cannabis during pregnancy weremore likely than those who did not use cannabis to have an anxiety disorder (8.3% vs 4.7%), depressive disorder (10.6% vs 4.3%), anxiety disorder and depressive disorder (8.4% vs 3.1%), depression symptoms (mild 32.2% vs 24.5%; moderate 13.3% vs 7.0%; and moderately severe to severe, 8.3% vs 3.3%, trauma diagnosis (8.3% vs 2.0%), and self-reported intimate partner violence (4.4% vs 1.8%).


Maternal depression and the emotional availability of mothers at six months postpartum: Findings from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) pregnancy cohort.

MacMillan KK, Lewis AJ, Watson SJ, Galbally M.  J Affect Disord. 2020 Jan 21;266:678-685. 

Maternal depression during pregnancy might have a smaller effect on maternal emotional availability than some existing research implies, with that effect most evident in early pregnancy. 

Antenatal interpersonal sensitivity as an early predictor of vulnerable mother-infant relationship quality.

Raine KH, Boyce P, Thorpe K.  Clin Child Psychol Psychiatry. 2019 Oct;24(4):860-875.

In this study of 73 women, researchers found no significant statistical association between antenatal interpersonal sensitivity and depressive symptoms with postpartum quality of mother-infant relationship.


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