One of the most common symptoms we observe during pregnancy is insomnia.  While we have a large body of data to support the use of many antidepressants, there is considerably less information available on benzodiazepines and sedative-hypnotics.  There is evidence to support the use of cognitive-behavioral therapy for insomnia (CBT-I) in pregnant populations; however,  our clinical experience is that it can be quite difficult to find providers with CBT skills (especially if you want to find a provider who accepts a particular type of insurance).

In a randomized controlled trial, Fleder and colleagues demonstrate that digital version of CBT-I was an effective, safe, acceptable intervention for improving insomnia symptoms during pregnancy.  We are looking forward to seeing the app for that one.

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.

Ruta Nonacs, MD PhD


The Effects of Mindfulness-Based Cognitive Therapy on Depression and Anxiety in Women with Premenstrual Syndrome.Panahi F, Faramarzi M.  Depress Res Treat. Free Article

MBCT intervention is acceptable and potentially beneficial in women with PMS symptoms. Psychotherapy should be considered as a treatment option for mild to moderate PMS in women with depressive symptoms.

Contraception counseling for women with premenstrual dysphoric disorder (PMDD): current perspectives.

Rapkin AJ, Korotkaya Y, Taylor KC.  Open Access J Contracept. 2019 Sep 20;10:27-39.  Free Article

Combined hormonal contraceptive (CHC) pills, specifically the 20 mcg ethinyl estradiol/3mg drospirenone in a 24/4 extended cycle regimen has been shown to significantly improve the emotional and physical symptoms of PMDD.  Other combined monophasic, extended cycle hormonal contraceptive pills with less androgenic progestins may also be helpful, although not well studied.


No articles this week


The association between gestational diabetes mellitus, antipsychotics and severe mental illness in pregnancy: A multicentre study.Galbally M, Frayne J, Watson SJ, Morgan V, Snellen M.  Aust N Z J Obstet Gynaecol. 2019 May 29.

Women with psychotic disorders had a significantly elevated risk for GDM (20.9%) compared with women with non-psychotic severe mental illnesses during pregnancy, and nearly threefold the expected population rate (8.3%). Furthermore, women using specific antipsychotic agents – risperidone (P = 0.016), clozapine (P < 0.001) and higher-dose quetiapine (P = 0.029) – also had a higher risk of developing GDM.

Efficacy of Digital Cognitive Behavioral Therapy for the Treatment of Insomnia Symptoms Among Pregnant Women: A Randomized Clinical Trial.

Felder JN, Epel ES, Neuhaus J, Krystal AD, Prather AA.  JAMA Psychiatry. 2020 Jan 22.

208 pregnant women were randomized to receive digital CBT-I (n?=?105) or standard treatment (n?=?103) for insomnia.

In this trial, digital CBT was an effective, scalable, safe, and acceptable intervention for improving insomnia symptoms during pregnancy.

Changes in psychopathological symptoms during pregnancy and after delivery: A prospective-longitudinal study in women with and without anxiety and depressive disorders prior to pregnancy.

Asselmann E, Kunas SL, Wittchen HU, Martini J.  J Affect Disord. 2019 Nov 23;263:480-490.

Peripartum psychopathological symptoms are higher in women with versus without lifetime anxiety and depressive disorders prior to pregnancy.

The Association Between the Use of Antenatal Care Smartphone Apps in Pregnant Women and Antenatal Depression: Cross-Sectional Study.

Mo Y, Gong W, Wang J, Sheng X, Xu DR.

JMIR Mhealth Uhealth. 2018 Nov 29;6(11).  Free Article

In a study from the Hunan Province, in a group of 1304 pregnant women, 71.31% (930/1304) used antenatal care apps on their smartphone. Higher usage of apps was associated with urban residency, nonmigrant status, first pregnancy, planned pregnancy, and opportunity to communicate with peer pregnant women. The cutoff score of the Edinburgh Postnatal Depression Scale was 10, and 46.11% (601/1304) of the pregnant women had depression. Depression was associated with the availability of disease-screening functions in the apps (odds ratio (OR) 1.78, 95% CI 1.03-3.06) and spending 30 minutes or more using the app (OR 2.05, 95% CI 1.19-3.52). Using apps with social media features was a protective factor for antenatal depression (OR 0.33, 95% CI 0.12-0.89).

Prenatal maternal stress and risk of neurodevelopmental disorders in the offspring: a systematic review and meta-analysis.

Manzari N, Matvienko-Sikar K, Baldoni F, O’Keeffe GW, Khashan AS. Soc Psychiatry Psychiatr Epidemiol. 2019 Nov;54(11):1299-1309.  Review.

Prenatal stress was significantly associated with an increased risk of both ASD (pooled OR 1.64 [95% CI 1.15-2.34]; I2 = 90%; 15 articles) and ADHD (pooled OR 1.72 [95% CI 1.27-2.34]; I2 = 85%; 12 articles).

Suicide Ideation among Pregnant Women: The Role of Different Experiences of Childhood Abuse.

Sun XZJ, et al. J Affect Disord 2020 January.

After adjustment for depression, pregnant women with a history of childhood physical abuse had an increased risk of suicidal ideation (OR?=?3.63, 95%CI: 1.32–10.03). Pregnant women with both a history of childhood abuse and depression had an even greater risk of suicidal ideation compared to those with neither risk factor (OR?=?17.78, 95%CI 7.20-43.92).


No articles this week


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 Disorder 2020 January.

Maternal depression might have a smaller effect on maternal emotional availability than some existing research implies.

Past Psychiatric Conditions as Risk Factors for Postpartum Depression: A Nationwide Cohort Study.

Johansen SL, Stenhaug BA, Robakis TK, Williams KE, Cullen MR.  J Clin Psychiatry. 2020 Jan 21;81(1). Free Article

Among 336,522 pregnancies, 9.4% of women were diagnosed with postpartum depression (n = 31,610). Five percent of women with no depression history developed postpartum depression, compared to 65% of women with depression prior to and during pregnancy.

Aberrant resting-state interhemispheric functional connectivity in patients with postpartum depression.

Zhang S, Wang W, Wang G, Li B, Chai L, Guo J, Gao X.  Behav Brain Res. 2020 Jan 16;382:112483.

This study provided evidences of aberrant interhemispheric connectivity within brain regions involved in the maternal care network in PPD, and may contribute to the further understanding of the neural mechanism underlying PPD.

Postpartum stress and infant outcome: A review of current literature.

Oyetunji A, Chandra P.  Psychiatry Res. 2020 Jan 9;284:112769.

Postpartum stress is associated with poor developmental trajectories and linear growth deficits, causing stunting in growth; poor language and cognitive development; poor gross and fine motor movement, and infant sleep problems. An inverse relationship exists with breastfeeding and postpartum depression. More importantly, breastfeeding efficacy is important for sustaining positive infant feeding outcomes.


Risk-Benefit assessment of infant exposure to lithium through breast milk: a systematic review of the literature.Newmark RL, Bogen DL, Wisner KL, Isaac M, Ciolino JD, Clark CT.  Int Rev Psychiatry. 2019 May;31(3):295-304.

Data are limited on the safety of lithium continuation while breastfeeding.


Self-Reported Alcohol, Tobacco, and Marijuana Use in Pregnant Women with Depressive Symptomatology.Hyer J, Ulrickson C, Yerelian E, Metz TD, Allshouse AA, Hoffman MC.  Am J Perinatol. 2019 Jun 25.

Women with depressive symptomatology were more likely to report: any alcohol use (odds ratio [OR]: 1.4, 95% CI: 1.1-1.8),?>?1 drink per week (OR: 1.3, 95% CI: 1.0-1.8), and >1 drink per day (OR: 2.2, 95% CI: 1.5-3.4). Women with depressive symptomatology were also more likely to report use of marijuana (OR: 1.8, 95% CI: 1.2-2.6) and cigarettes (OR: 1.4, 95% CI: 1.1-1.7).

Low-moderate prenatal alcohol exposure and offspring attention-deficit hyperactivity disorder (ADHD): systematic review and meta-analysis.

San Martin Porter M, Maravilla JC, Betts KS, Alati R.  Arch Gynecol Obstet. 2019 Aug;300(2):269-277.

This study found no increased risk of ADHD symptoms in offspring born to mothers who drank alcohol up to 70 g/week.


No articles this week


Bipolar Disorder in the Menopausal Transition.Truong D, Marsh W.  Curr Psychiatry Rep. 2019 Nov 25;21(12):130.

While there are few studies within the last 5 years on bipolar women undergoing the menopausal transition, new evidence suggest that mood symptoms in women worsen with progression through the menopausal transition.


Prenatal folate, homocysteine and vitamin B12 levels and child brain volumes, cognitive development and psychological functioning: the Generation R Study.Ars CL, Nijs IM, Marroun HE, Muetzel R, Schmidt M, Steenweg-de Graaff J, van der Lugt A, Jaddoe VW, Hofman A, Steegers EA, Verhulst FC, Tiemeier H, White T.  Br J Nutr. 2019 Sep;122(s1):S1-S9.

Low prenatal folate levels were associated with a smaller total brain volume and predicted poorer performance on the language and visuo-spatial domains.

Intergenerational Transmission of Depression.

Goodman SH.  Annu Rev Clin Psychol. 2020 Jan 21.

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