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. 

For more detailed descriptions of many of these topics, you can sign up to receive our weekly CWMH NEWSLETTER which comes out every Thursday.  

And don’t forget to visit ESSENTIAL READS – a curated selection of up-to-date and clinically relevant articles in women’s mental health.

Ruta Nonacs, MD PhD


HPA axis activity across the menstrual cycle – a systematic review and meta-analysis of longitudinal studies.

Klusmann H, Schulze L, Engel S, Bücklein E, Daehn D, Lozza-Fiacco S, Geiling A, Meyer C, Andersen E, Knaevelsrud C, Schumacher S.  Front Neuroendocrinol. 2022 May 18;66:100998.

Long J, Wang Y, Liu L, Zhang J. The Prominent Role of the Temporal Lobe in Premenstrual Syndrome and Premenstrual Dysphoric Disorder: Evidence From Multimodal Neuroimaging. Front Psychiatry. 2022 Jun 28; 13:954211.

Recent studies have revealed some novel findings on PMS and PMDD based on brain morphology, function, and metabolism. Additionally, multiple studies have suggested that PMS and PMDD are closely related to brain structural and functional variations in certain core temporal lobe regions, such as the amygdala and hippocampus. 



No articles this week



Associations Between Implementation of the Collaborative Care Model and Disparities in Perinatal Depression Care.

Snowber K, Ciolino JD, Clark CT, Grobman WA, Miller ES.  Obstet Gynecol. 2022 Aug 1;140(2):204-211. 

Implementation of the perinatal collaborative care model is associated with a mitigation of racial disparities in antenatal depression care and may be an equity-promoting intervention for maternal health.

Prevalence of Bipolar Disorder in Perinatal Women: A Systematic Review and Meta-Analysis.

Masters GA, Hugunin J, Xu L, Ulbricht CM, Moore Simas TA, Ko JY, Byatt N.  J Clin Psychiatry. 2022 Jul 13;83(5):21r14045.

In women with no known psychiatric illness preceding the perinatal period, pooled prevalence of BD was 2.6% (95% CI, 1.2%-4.5%) and prevalence of bipolar-spectrum mood episodes (including depressed, hypomanic/manic, mixed) during pregnancy and the postpartum period was 20.1% (95% CI, 16.0%-24.5%). In women with a prior BD diagnosis, 54.9% (95% CI, 39.2%-70.2%) were found to have at least one bipolar-spectrum mood episode occurrence in the perinatal period.

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Perspectives on addressing bipolar disorder in the obstetric setting.

Masters GA, Xu L, Cooper KM, Moore Simas TA, Brenckle L, Mackie TI, Schaefer AJ, Straus J, Byatt N.  Gen Hosp Psychiatry. 2022 Jul-Aug;77:130-140. 

Obsessive-compulsive and related disorder symptoms in the perinatal period: prevalence and associations with postpartum functioning.

Miller ML, Roche AI, Lemon E, O’Hara MW.  Arch Womens Ment Health. 2022 Aug;25(4):771-780.

OCRD symptoms occur during pregnancy and the postpartum period at rates similar or higher than other life periods. Elevated OCRD symptoms are associated with poorer postpartum functioning across domains. 

Body dissatisfaction and disordered eating in the perinatal period: an underrecognized high-risk timeframe and the opportunity to intervene.

Vanderkruik R, Ellison K, Kanamori M, Freeman MP, Cohen LS, Stice E.  Arch Womens Ment Health. 2022 Aug;25(4):739-751. doi: 10.1007/s00737-022-01236-6. Epub 2022 May 6.

Over 50% of the women surveyed in this study were dissatisfied with their body image. Approximately 80% reported that they would have appreciated the opportunity to participate in a program focused on body acceptance or expectations of body changes in pregnancy and postpartum. We identified intervention preferences as well as commonly reported themes regarding experiences of body image and eating concerns in pregnancy and postpartum. Body dissatisfaction and eating concerns are prevalent issues in pregnancy and postpartum women.

Perinatal mental health literacy: knowledge, attitudes, and help-seeking among perinatal women and the public – a systematic review.

Daehn D, Rudolf S, Pawils S, Renneberg B.  BMC Pregnancy Childbirth. 2022 Jul 19;22(1):574. 

Based on the findings of this review, there is a need for educational campaigns and interventions to improve perinatal MHL in perinatal women and the public as a whole.

 Experiences with use of technology and telehealth among women with perinatal depression.

Parameswaran UD, Pentecost R, Williams M, Smid M, Latendresse G.  BMC Pregnancy Childbirth. 2022 Jul 18;22(1):571. 

This study provides growing evidence informed by perinatal women of positive experiences with engagement in a videoconference intervention for PD. Telehealth may be a reasonable and acceptable platform to increase access and retention for mental health services in childbearing women. 

Web-based treatment for depression in pregnancy: a feasibility study of Mum2BMoodBooster.

Gemmill AW, Oliva JL, Ericksen J, Holt C, Holt CJ, Milgrom J.   BMC Psychiatry. 2022 Jul 16;22(1):476.

In this feasibility trial, depression scores on both the PHQ-9 and the DASS-21, showed significant reductions representing large effects, with average symptom scores reduced by > 50%, and maintained in the ‘minimal or no depression’ range at 3 month follow-up. 



Neurobehavioral follow-up of children exposed to selective serotonin reuptake inhibitors in utero.

Cohen LS, Rhodes SM, Claypoole LD, Góez-Mogollón L, Sosinsky AZ, Moustafa D, Noe OB, McElheny SA, Cheng LJ, Bick JR, Freeman MP, Nelson CA.  Ann Clin Psychiatry. 2022 Aug;34(3):197-206. 

No associations were found between maternal use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy and atypical neurodevelopment of children. 

Pregnancy outcomes after first-trimester exposure to buspirone: prospective longitudinal outcomes from the MGH National Pregnancy Registry for Psychiatric Medications.

Freeman MP, Szpunar MJ, Kobylski LA, Harmon H, Viguera AC, Cohen LS.  Arch Womens Ment Health. 2022 Jul 16. 

Among this sample of 72 infants with prenatal exposure to buspirone, there were no malformations present.

The Pursuit to Recognize Bipolar Disorder in Pregnant and Postpartum Women.

Freeman MP, Goldberg JF.  J Clin Psychiatry. 2022 Jul 13;83(5):22ed14399.



The Effects of Breastfeeding on Maternal Mental Health: A Systematic Review.

Yuen M, Hall OJ, Masters GA, Nephew BC, Carr C, Leung K, Griffen A, McIntyre L, Byatt N, Moore Simas TA.  J Womens Health (Larchmt). 2022 Jun;31(6):787-807.

Interpersonal therapy versus antidepressant medication for treatment of postpartum depression and anxiety among women with HIV in Zambia: a randomized feasibility trial.

Spelke MB, Paul R, Blette BS, Meltzer-Brody S, Schiller CE, Ncheka JM, Kasaro MP, Price JT, Stringer JSA, Stringer EM.  J Int AIDS Soc. 2022 Jul;25(7):e25959. 

Impact of coronavirus 2019 pandemic on post-traumatic stress disorder symptoms among pregnant women in Jordan.

Bataineh MF, Mohamad MN, Al Dhaheri AS, Rawashdeh M, Al-Nawaiseh AM, Asali FF, Hashim M, Jarrar A, Abu Jamous DO, Stojanovska L, Daour RA, Saleh ST, Osaili TM, Cheikh Ismail L.  Womens Health (Lond). 2022 Jan-Dec;18:17455057221112935. 

IPT and antidepressant treatment both improved measures of depression severity; however, a full-scale trial is required to determine whether treatment of PPD and anxiety improves maternal-infant HIV outcomes.



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Impact of menstrual cycle events on bipolar disorder course: a narrative review of current evidence.

Aragno E, Fagiolini A, Cuomo A, Paschetta E, Maina G, Rosso G.  Arch Womens Ment Health. 2022 Apr;25(2):257-266.

This review observes that a subset of women with bipolar disorder are vulnerable to the impact of menstrual cycle events. Menarche seems to be associated with age at onset of bipolar illness especially in case of bipolar disorder type I and the specific age at menarche may predict some clinical features of the disorder. Menstrual cycle likely affects the course of bipolar disorder but the pattern of mood variability is not clear. Menopause appears to be not only a period of vulnerability to mood alteration, especially depressive episodes, and impairment of quality of life, but also a potential trigger of bipolar illness onset.



No articles this week



Towards a new understanding of pregnancy denial: the misunderstood dissociative disorder.

Barnes DL.  Arch Womens Ment Health. 2022 Feb; 25(1):51-59. 

This review concludes that dissociation is a consistently seen symptom in pervasive pregnancy denial.  The experience of a dissociative episode while giving birth can unintentionally result in neonaticide. Dissociation, in addition to other commonly seen symptoms across cases, suggests specific diagnostic criteria that lend themselves to inclusion in the Diagnostic and Statistical Manual of Mental Disorders.



Antidepressant use during pregnancy and risk of adverse neonatal outcomes: A comprehensive investigation of previously identified associations.

Rommel AS, Momen NC, Molenaar NM, Agerbo E, Bergink V, Munk-Olsen T, Liu X.  Acta Psychiatr Scand. 2022 Jun;145(6):544-556. 

Prenatal antidepressant exposure was associated with small decreases in gestational age and birthweight, as well as higher risk for moderate-to-late preterm birth, moderately low birthweight, neonatal admission and postnatal adaptation syndrome. No differences in risk were found for PPHN, or congenital malformations. The causality of the observed associations cannot be established due to the potential for unmeasured residual confounding linked to the underlying disease.

In utero exposure to antipsychotic medication and psychiatric outcomes in the offspring.

Momen NC, Robakis T, Liu X, Reichenberg A, Bergink V, Munk-Olsen T.  Neuropsychopharmacology. 2022 Feb;47(3):759-766. 

The study does not provide evidence of increased risk of psychiatric disorders among children of women who continue antipsychotic treatment during pregnancy. 



Antenatal screening timeline and cutoff scores of the Edinburgh Postnatal Depression Scale for predicting postpartum depressive symptoms in healthy women: a prospective cohort study.

Tanuma-Takahashi A, Tanemoto T, Nagata C, Yokomizo R, Konishi A, Takehara K, Ishikawa T, Yanaihara N, Samura O, Okamoto A.  BMC Pregnancy Childbirth. 2022 Jun 28;22(1):527. 

An EPDS score of 5 or greater at the second trimester may predict postpartum depressive symptoms.

Antidepressant discontinuation before or during pregnancy and risk of psychiatric emergency in Denmark: A population-based propensity score-matched cohort study.

Liu X, Molenaar N, Agerbo E, Momen NC, Rommel AS, Lupattelli A, Bergink V, Munk-Olsen T.

PLoS Med. 2022 Jan 31;19(1):e1003895.

In this study, discontinuing antidepressant medication during pregnancy (but not before) is associated with an apparent increased risk of psychiatric emergency compared to continuing treatment throughout pregnancy.

Cognitive processing of emotional information during menstrual phases in women with and without postpartum depression: differential sensitivity to changes in gonadal steroids.

Bloch M, Helpman L, Gilboa-Schechtman E, Fried-Zaig I.  Arch Womens Ment Health. 2022 May 9. 

Women with hPPD demonstrate a differential bias in cognitive processing of emotional information that is menstrual phase dependent, and did not correspond to similar difference in mood symptoms. These biases may reflect sensitivity to gonadal steroid fluctuations that are associated with PPD.

Interpersonal therapy versus antidepressant medication for treatment of postpartum depression and anxiety among women with HIV in Zambia: a randomized feasibility trial.

Spelke MB, Paul R, Blette BS, Meltzer-Brody S, Schiller CE, Ncheka JM, Kasaro MP, Price JT, Stringer JSA, Stringer EM.  J Int AIDS Soc. 2022 Jul;25(7):e25959.

IPT and antidepressant medication both improved measures of depression severity; however, a full-scale trial is required to determine whether treatment of PPD and anxiety improves maternal-infant HIV outcomes.



Monitoring of lamotrigine concentrations in mothers, colostrum, and breastfed newborns during the early postpartum period.

Kacirova I, Grundmann M, Brozmanova H.  Biomed Pharmacother. 2022 Jul;151:113167. 

Exposure to lamotrigine in breastfed newborns is lower than exposure during pregnancy. However, lamotrigine concentrations in both maternal serum and milk increase significantly after delivery.



No articles this week



The long-term impact of elevated C-reactive protein levels during pregnancy on brain morphology in late childhood.

Suleri A, Blok E, Durkut M, Rommel AS, Witte L, Jaddoe V, Bergink V, White T.  Brain Behav Immun. 2022 Jul;103:63-72.

This study found a direct association between continuous maternal immune activation (MIA) and lower cerebellar volume. In girls, we demonstrated a negative indirect association between continuous MIA and total brain volume, through the mediator gestational age at birth. 



Efficacy of cognitive therapy and behavior therapy for menopausal symptoms: a systematic review and meta-analysis.

Ye M, Shou M, Zhang J, Hu B, Liu C, Bi C, Lv T, Luo F, Zhang Z, Liang S, Feng H, Qian C, Cao S, Liu Z.  Psychol Med. 2022 Feb;52(3):433-445.  

CTBT is an effective psychological treatment for menopausal symptoms, with predominantly small to moderate effects. The efficacy is sustained long-term, although it declines somewhat over time. The efficacy was stronger for natural menopause symptoms, such as vasomotor symptoms, than for treatment-induced menopause symptoms. 



SARS-CoV-2 during pregnancy and associated outcomes: Results from an ongoing prospective cohort.

Molenaar NM, Rommel AS, de Witte L, Dolan SM, Lieb W, Ibroci E, Ohrn S, Lynch J, Capuano C, Stadlbauer D, Krammer F, Zapata LB, Brody RI, Pop VJ, Jessel RH, Sperling RS, Afzal O, Gigase F, Missall R, Janevic T, Stone J, Howell EA, Bergink V.  Paediatr Perinat Epidemiol. 2022 Jul;36(4):466-475. 

Seropositivity for SARS-CoV-2 without RT-PCR positivity at delivery (suggesting that infection occurred earlier during pregnancy) was not associated with selected adverse maternal or neonatal outcomes among live births in a cohort sample from New York City.

The influence of structural racism, pandemic stress, and SARS-CoV-2 infection during pregnancy with adverse birth outcomes.

Janevic T, Lieb W, Ibroci E, Lynch J, Lieber M, Molenaar NM, Rommel AS, de Witte L, Ohrn S, Carreño JM, Krammer F, Zapata LB, Snead MC, Brody RI, Jessel RH, Sestito S, Adler A, Afzal O, Gigase F, Missall R, Carrión D, Stone J, Bergink V, Dolan SM, Howell EA; Krammer Serology Core Study Group.  Am J Obstet Gynecol MFM. 2022 Jul;4(4):100649.

Neighborhood measures of structural racism were associated with both increased risk of SARS-CoV-2 infection and higher rates of preterm birth, but these associations were independent and did not have a synergistic effect. 

The sexual and reproductive health of women with mental illness: a primary care registry study.

Hope H, Pierce M, Johnstone ED, Myers J, Abel KM.  Arch Womens Ment Health. 2022 Jun;25(3):585-593. 

Compared to women without mental illness, women with mental illness were more likely to experience recurrent miscarriage (adjOR = 1.50, 95%CI 1.41 to 1.60), termination (adjOR = 1.48, 95%CI 1.45 to 1.50), gynaecological diseases (adjHR = 1.39, 95%CI 1.37 to 1.40), sexually transmitted infections (adjHR = 1.47, 95%CI 1.43 to 1.51), reproductive cancers (adjHR = 1.10, 95%CI 1.02 to 1.19), contraception (adjHR = 1.28 95%CI 1.26 to 1.29) and emergency contraception (adjHR = 2.30, 95%CI 2.26 to 2.34).

Shared genetic basis between reproductive behaviors and anxiety-related disorders.Ohi K, Kuramitsu A, Fujikane D, Takai K, Sugiyama S, Shioiri T.  Mol Psychiatry. 2022 Jun 24.

This study suggests that those who have earlier sexual debut and childbirth are prone to risk for anxiety disorders and vice versa, while those who have later sexual debut and childbirth are genetically prone to risk for OCD. 

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