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. 

This week, Huybrechts and colleagues publish on the reproductive safety of duloxetine (Cymbalta).  We will cover this in greater detail next week.  

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

PMS AND PMDD

No articles this week

INFERTILITY AND MENTAL HEALTH

No articles this week

PSYCHIATRIC ILLNESS DURING PREGNANCY

The role of glucocorticoid and mineralocorticoid receptor DNA methylation in antenatal depression and infant stress regulation.

Galbally M, Watson SJ, van IJzendoorn M, Saffery R, Ryan J, de Kloet ER, Oberlander TF, Lappas M, Lewis AJ.  Psychoneuroendocrinology. 2020 Feb 8;115:104611.

Two genes involved in stress response regulation, the glucocorticoid and mineralocorticoid receptors (NR3C1 and NR3C2) have been a focus in understanding stressful exposures and mental health outcomes.  These findings show a relationship between antenatal depression, NR3C2 DNA methylation and infant cortisol response providing support for a specific fetal programming pathway.


Utilization of Health Care Among Perinatal Women in the United States: The Role of Depression.

Masters GA, Li N, Lapane KL, Liu SH, Person SD, Byatt N.  J Womens Health (Larchmt). 2020 Feb 20

Among perinatal U.S. women, 7.3% had depressive symptoms. Relative to those without these symptoms, women experiencing depressive symptoms were younger, more impoverished, and uninsured (p?<?0.05). Women with depressive symptoms, compared with those without them, had twice the odds of being without routine medical care (21.6% vs. 12.5%, adjusted odds ratio [aOR]: 2.1, 95% confidence interval [CI]: 1.1 to 4.1) and of using urgent care more frequently (26.5% vs. 15.1%, aOR: 1.9, 95% CI: 1.0 to 3.9). Depressive symptoms combined with lack of insurance generally increased the odds of not having routine care (RERI: 8.4, 95% CI: -0.5 to 17.3) and more frequent use of urgent care (RERI: 7.1, 95% CI: -2.7 to 17.0).


Transcranial direct current stimulation (tDCS) for depression in pregnancy: A pilot randomized controlled trial.

Vigod SN, Murphy KE, Dennis CL, Oberlander TF, Ray JG, Daskalakis ZJ, Blumberger DM.  Brain Stimul. 2019 Nov – Dec;12(6):1475-1483.

At 4 weeks postpartum, 75.0% of tDCS women were remitted versus 12.5% of women receiving sham-control (p?=?0.04).


Disordered sleep is related to delusional ideation and depression during the perinatal period.

Solomonova E, MacKinnon AL, Gold I, Robins S, Wunderlich S, Feeley N, Hayton B, Libman E, Zelkowitz P.  Sleep Health. 2020 Feb 6.

Sleep disturbances in early pregnancy directly predicted symptoms of depression in late pregnancy and had an indirect effect on postpartum depression through DI in late pregnancy.


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 was significantly associated with both concurrent and postpartum anxiety.  Women with mid-pregnancy insomnia had significantly higher levels of perinatal anxiety and postpartum OCD symptoms than participants with normal mid-pregnancy sleep. OCD symptoms affected more women after delivery than before (6.4% vs. 3.8% p = 0.034).

MEDICATIONS AND PREGNANCY

Maternal and fetal outcomes following exposure to duloxetine in pregnancy: cohort study.

Huybrechts KF, Bateman BT, Pawar A, Bessette LG, Mogun H, Levin R, Li H, Motsko S, Scantamburlo Fernandes MF, Upadhyaya HP, Hernandez-Diaz S.  BMJ. 2020 Feb 19.   Free Article

On the basis of the evidence available to date, duloxetine is unlikely to be a major teratogen but may be associated with an increased risk of postpartum hemorrhage and a small increased risk of cardiac malformations. 


Decision-making about antidepressant medication use in pregnancy: a comparison between women making the decision in the preconception period versus in pregnancy.

Barker LC, Dennis CL, Hussain-Shamsy N, Stewart DE, Grigoriadis S, Metcalfe K, Oberlander TF, Schram C, Taylor VH, Vigod SN.  BMC Psychiatry. 2020 Feb 7;20(1):54. Free Article

POSTPARTUM PSYCHIATRIC ILLNESS

The role of kynurenine pathway and kynurenic aminotransferase alleles in postpartum depression following cesarean section in Chinese women.

Quan C, Wang S, Duan K, Ma J, Yu H, Yang M, Hu N, Long G, Zeng G, Huang Z.  Brain Behav. 2020 Feb 26.
Kynurenic aminotransferase (KAT) is an important kynurenine pathway enzyme, catalyzing kynurenine (KYN) into kynurenic acid (KYNA). These data support a role for alterations in the kynurenine pathway in the pathogenesis of postpartum depressive symptoms.  


Exposure to General Anesthesia for Cesarean Delivery and Odds of Severe Postpartum Depression Requiring Hospitalization.

Guglielminotti J, Li G.  Anesth Analg. 2020 Jan 29.

Of the 428,204 cesarean delivery cases included, 34,356 had general anesthesia (8.0%). Relative to neuraxial anesthesia, general anesthesia in cesarean delivery was associated with a 54% increased odds of PPD (aOR, 1.54; 95% CI, 1.21-1.95) and a 91% increased odds of suicidal ideation or self-inflicted injury (aOR, 1.91; 95% CI, 1.12-3.25).


Telephone-based nurse-delivered interpersonal psychotherapy for postpartum depression: nationwide randomised controlled trial.

Dennis CL, Grigoriadis S, Zupancic J, Kiss A, Ravitz P.  Br J Psychiatry. 2020 Feb 7:1-8.

At 12 weeks, 10.6% of women in the IPT group (11/104) and 35% in the control group (35/100) remained depressed (OR = 0.22, 95% CI 0.10-0.46), with the IPT group 4.5 times less likely to be clinically depressed (SCID); 21.2% in the IPT group and 51% in the control group had an Edinburgh Postnatal Depression Scale (EPDS) score >12 (OR = 0.26, 95% CI 0.14-0.48) at 12 weeks.


A closer look at the nosological status of the highs (hypomanic symptoms) in the postpartum period.

Sharma V, Singh P, Baczynski C, Khan M.  Arch Womens Ment Health. 2020 Feb 7. 

Studies from several countries have reported occurrence of hypomanic symptoms immediately after childbirth; this review discussed the relationship of these hypomanic symptoms with mood disorders. 


Assessing Mothers’ Postpartum Depression From Their Infants’ Cry Vocalizations.

Gabrieli G, Bornstein MH, Manian N, Esposito G.  Behav Sci (Basel). 2020 Feb 6;10(2). Free Article

Previous studies have highlighted the presence of significant differences in the acoustical properties of the vocalizations of infants of depressed and healthy mothers, suggesting that the mothers’ behavior can induce changes in infants’ vocalizations.  Acoustical features of the baby’s crying can be successfully used to distinguished postpartum depressed from non-depressed mothers with high accuracy (89.5%).

MEDICATIONS AND BREASTFEEDING

No articles this week

PERINATAL SUBSTANCE USE

Concurrent prenatal drinking and smoking increases risk for SIDS: Safe Passage Study report.

Elliott AJ, Kinney HC, Haynes RL, et al.  EClinicalMedicine 2020 Feb 1; 19:10247.  

Infants exposed to both alcohol and cigarettes during pregnancy beyond the first trimester have a substantially higher risk for SIDS compared to those unexposed, exposed to alcohol or cigarettes alone, or when mother reported quitting early in pregnancy.

MATERNAL MENTAL HEALTH AND CHILD OUTCOMES

Parent-Child Interaction Therapy with Toddlers: A Community-based Randomized Controlled Trial with Children Aged 14-24 Months.

Kohlhoff J, Morgan S, Briggs N, Egan R, Niec L.  J Clin Child Adolesc Psychol. 2020 Feb 20:1-16.

Mother-child dyads who received the intervention showed significantly better parenting skills (increases in positive parenting skills and decreases in negative parenting skills), emotional availability (increases in parental sensitivity and parental non-intrusiveness), child behavior (decreases in externalizing and internalizing behaviors) and parental perceptions of child difficulty.

MENOPAUSE AND MENTAL HEALTH

No articles this week

OTHER TOPICS IN WOMEN’S MENTAL HEALTH

No articles this week