Perinatal mood and anxiety disorders are relatively common; however, it has been difficult to conduct randomized clinical trials (RCTs) in this population.  This week, we have a couple of RCTs including women with postpartum depression. The first study, from Michael O’Hara and colleagues, compares interpersonal therapy (IPT) to treatment with sertraline or placebo.  The next study (from Boyd and colleagues) is exciting because it uses an innovative approach to reach and deliver treatment to women with PPD. This study explored the use of a parenting intervention delivered using a social media platform; this intervention not only decreased depressive symptoms, it was associated with much higher levels of participation than traditionally delivered psychotherapeutic treatments.  

Ruta Nonacs, MD PhD


A placebo controlled treatment trial of sertraline and interpersonal psychotherapy for postpartum depression.

O’Hara MW, Pearlstein T, Stuart S, Long JD, Mills JA, Zlotnick C.  J Affect Disord. 2019 Feb 15;245:524-532.

162 women with PPD were randomly assigned to IPT, sertraline-clinical management (CM), or pill placebo-CM. CM included infant-focused psychoeducation. There was improvement for all postpartum women in all conditions.

Pilot RCT of a social media parenting intervention for postpartum mothers with depression symptoms.

Boyd RC, Price J, Mogul M, Yates T, Guevara JP.  J Reprod Infant Psychol. 2018 Dec 17:1-12

The social media group had significantly improved parenting competence and decreased depression severity when compared to the in-person group. Attendance in the social media group was high (83%), but extremely poor in the in-person group (3%).

A systematic review and meta-analysis of the effects of antenatal anxiety on postpartum outcomes.

Grigoriadis S, Graves L, Peer M, Mamisashvili L, Tomlinson G, Vigod SN, Dennis CL, Steiner M, Brown C, Cheung A, Dawson H, Rector NA, Guenette M, Richter M.  Arch Womens Ment Health. 2018 Dec 6.

Antenatal anxiety was significantly associated with postpartum depression (PPD) measured within 6 months postpartum (pooled odds ratio [OR]?=?2.64, 95% CI 2.02-3.46; 8 studies) and at 6-10 months postpartum (4.42, 1.45-13.49; 3 studies). Maternal anxiety was also associated with reduced odds of breastfeeding (0.63, 0.53-0.74; 5 studies).

Pre-pregnancy body mass index and the risk of antenatal depression and anxiety.

Holton S, Fisher J, Nguyen H, Brown WJ, Tran T.  Women Birth. 2019 Feb 4.

Higher pre-pregnancy BMI and certain sociodemographic characteristics including not having a paid job were significantly related to higher antenatal depression and anxiety scores.

Delusional Pregnancy Presenting to the Massachusetts General Hospital National Pregnancy Registry for Atypical Antipsychotics.

Sosinsky AZ, Freeman MP, Savella GM, Cheng LJ, Viguera AC, Cohen LS.  J Clin Psychopharmacol. 2017 Aug;37(4):472-474.

Perinatal SSRI medications and offspring hippocampal plasticity: interaction with maternal stress and sex.

Pawluski JL, Gemmel M.  Hormones (Athens). 2018 Mar;17(1):15-24. Free Article

Perinatal exposure to SSRIs can have a long-term effect on plasticity in the hippocampus of offspring; however, we do not fully understand the clinical  implications of these changes.

Epigenetic variation at the SLC6A4 gene promoter in mother-child pairs with major depressive disorder.

Mendonça MS, Mangiavacchi PM, De Sousa PF, Crippa JAS, Mendes AV, Loureiro SR, Martín-Santos R, Quirino CR, Kanashiro MM, Rios AFL.  J Affect Disord. 2019 Feb 15;245:716-723.

Despite the high frequency of S allele of 5-HTTLPR (67.5%) in this cohort, there were not statistically significant differences between individuals carrying at least one S allele between the depressed and healthy control subjects, or among the mother-child pair groups with different patterns of occurrence of depression. In the group where the mother and child were both diagnosed with depression, there was a statistically significant decrease of the 5mC level at the SLC6A4 promoter region.

Dynamic DNA methylation changes in the maternal oxytocin gene locus (OXT) during pregnancy predict postpartum maternal intrusiveness.

Toepfer P, O’Donnell KJ, Entringer S, Garg E, Heim CM, Lin DTS, MacIsaac JL, Kobor MS, Meaney MJ, Provençal N, Binder EB, Wadhwa PD, Buss C.  Psychoneuroendocrinology. 2019 Jan 14;103:156-162.

OXT promoter DNAm changes significantly throughout gestation in peripheral blood and that these changes are associated with variability in maternal behavior, providing a novel potential biomarker predicting postpartum maternal behavior.

Plasma and cerebrospinal fluid inflammatory cytokines in perinatal depression.

Miller ES, Sakowicz A, Roy A, Yang A, Sullivan JT, Grobman WA, Wisner KL.  Am J Obstet Gynecol. 2018 Dec 14.

Higher concentrations of cytokines in the cerebrospinal fluid were associated with perinatal depression. These cerebrospinal fluid cytokines were not strongly correlated with plasma cytokines, and accordingly, plasma cytokines were not significantly associated with perinatal depression.  This suggests that central neuroinflammation, as opposed to peripheral inflammation, may represent a mechanistic pathway that contributes to perinatal depression.

Validity of the WHIPLASHED as a tool to identify bipolar disorder in women.

Mahmoud DR, Yang A, Ciolino JD, Fisher SD, Sit D, Pinheiro E, Pendergrast T, O’Shea K, Wisner KL, Clark CT.  J Affect Disord. 2018 Dec 17;246:69-73.

Women were diagnosed with unipolar (n?=?54) and bipolar (n?=?28) depression.  WHIPLASHED had strong predictive ability (AUC?=?0.877) in differentiating bipolar from unipolar depression. A cutoff score of ?5 generated 96% sensitivity and 52% specificity, while raising the threshold to 6 generated 89% sensitivity and 76% specificity for a bipolar disorder diagnosis.

An educational intervention for NICU staff decreased maternal postpartum depression.

Ahlqvist-Björkroth S, Axelin A, Korja R, Lehtonen L.  Pediatr Res. 2019 Jan 23.

A total of 10.3% of the mothers in the pre-intervention cohort and 2.1% in the post-intervention cohort exceeded the threshold for depression.

Like mother, like child? Maternal determinants of children’s early social-emotional development.

Behrendt HF, Scharke W, Herpertz-Dahlmann B, Konrad K, Firk C.  Infant Ment Health J. 2019 Feb 7.

Mothers’ sensitivity predicted fewer social-emotional and behavioral problems and that stronger bonding predicted fewer problems and more social-emotional competencies. Emotion regulation difficulties were significantly associated with maternal depressive symptoms; yet, when accounting for shared variances, both factors differentially predicted less positive child outcomes such that more difficulties indirectly, through poorer bonding, predicted greater delay in competencies, and more symptoms indirectly, through less sensitivity, predicted more problems.

Advice for Health Care Professionals and Users: An Evaluation of Websites for Perinatal Anxiety.

Moore D, Harrison V.  JMIR Ment Health. 2018 Dec 20;5(4):e11464.  Free Article

Information was often incomplete and focused on symptoms rather than risk factors or impact of untreated perinatal anxiety. Websites often had information on treatment (46/50, 92%), but much less on screening (19/50, 38%). Most sites provided at least some resources to support mothers (49/50, 98%), but active, guided support was infrequent (25/50, 50%). Website quality was extremely variable and mostly difficult to read (42/50, 84%).

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