This week we have several interesting and clinically relevant articles. We have long know that depression during pregnancy is one of the most robust predictors of postpartum depression; Lupattelli and colleagues demonstrate that treatment during pregnancy decreases the risk of postpartum depression. Munk-Olsen and colleagues examine outcomes in infants exposed to lithium, observing a small increase in congenital malformations but no increase in risk of cardiovascular malformations (as seen in the study from Patorno, et al); we will cover this study in greater detail next week.
Ruta Nonacs, MD PhD
Self-reported perinatal depressive symptoms and postnatal symptom severity after treatment with antidepressants in pregnancy: a cross-sectional study across 12 European countries using the Edinburgh Postnatal Depression Scale.
Lupattelli A, Twigg MJ, Zagorodnikova K, Moretti ME, Drozd M, Panchaud A, Rieutord A, Juraski RG, Odalovic M, Kennedy D, Rudolf G, Juch H, Nordeng H. Clin Epidemiol. 2018 Jun 6;10:655-669. Free Article
Among women with psychiatric disorders, those who had been on treatment with antidepressants during pregnancy were less likely to report postnatal depressive symptoms, particularly within the 6-month period after childbirth, compared with the nonmedicated women.
Munk-Olsen T, Liu X, Viktorin A, et al: Maternal and infant outcomes associated with lithium use in pregnancy: an international collaborative meta-analysis of six cohort studies. Lancet Psychiatry 2018.
Lithium exposure was associated with a small overall increase in the risk of congenital malformations but not cardiovascular anomalies.
Galbally, M et al. Designing research that can untangle the effects in pregnancy of pharmacological treatments for mental disorders. Lancet Psychiatry, May 2018.
Grove K, Lewis AJ, Galbally M. Pediatrics. 2018 Jun 21.
24 studies were included in the systematic review, and 18 met inclusion criteria for the meta-analysis. The total pooled results were based on random effects models and revealed a significant association between exposure to antidepressants during pregnancy and overall occurrence of poorer motor outcomes in children (effect size = 0.22; 95% confidence interval = 0.07 to 0.37) with a moderate degree of heterogeneity (I2 = 56.6%). However, the marked methodological variation among studies and the limited control for possible confounds warrants cautious interpretation of these findings.
JAMA Pediatr. 2018 Jun 11.
Fedock GL, Alvarez C. J Womens Health (Larchmt). 2018 May 14.
Predictors of universal postpartum screenings included the following: clinic priority (AOR 3.01; 95% CIs: 2.12-4.28), provider comfort with diagnosing depression (AOR 1.58; 95% CIs: 1.04-2.39), and provider belief of patients unlikely to disclose depression unprompted (AOR 0.40; 95% CIs: 0.24-0.68).
Ystrom E, Hysing M, Torgersen L, Ystrom H, Reichborn-Kjennerud T, Sivertsen B.
J Pediatr Psychol. 2017 Nov 1;42(10):1156-1164.
Gustafsson HC, Sullivan EL, Nousen EK, Sullivan CA, Huang E, Rincon M, Nigg JT, Loftis JM. Brain Behav Immun. 2018 Jun 16.
Maternal pro-inflammatory cytokines during the third trimester (including interleukin-6, tumor necrosis factor-alpha and monocyte chemoattractant protein-1 concentrations as indicators) mediated the effect, such that higher maternal depressive symptoms were associated with higher maternal inflammation, and this mediated the effect on maternal report of infant negative affect (controlling for maternal affect during the infant period).
Cluxton-Keller F, Bruce ML.
PLoS One. 2018 Jun 14;13(6):e0198730. Free Article
Although a limited number of controlled trials on family therapeutic interventions for this population exist, the findings show that these types of interventions are effective in both the prevention and treatment of perinatal depression.
Li S, Zhong W, Peng W, Jiang G. Acupunct Med. 2018 Jun 15.
Acupuncture appears to be effective for postpartum depression with respect to certain outcomes. However, the evidence thus far is inconclusive.
Vargas-Terrones M, Barakat R, Santacruz B, Fernandez-Buhigas I, Mottola MF. Br J Sports Med. 2018 Jun 13.
Schürger N, Klein E, Hapfelmeier A, Kiechle M, Paepke D.
BMC Complement Altern Med. 2018 Jun 15;18(1):187. Free Article
60% declared using CAM in general, 45% specifically in relation to their pregnancy or postpartum. Most commonly used modalities were vitamins (31% of all patients), yoga (24%), and herbal supplements (23%).
Steinberg JR, Laursen TM, Adler NE, Gasse C, Agerbo E, Munk-Olsen T. JAMA Psychiatry. 2018 May 30.
Women who have abortions are more likely to use antidepressants compared with women who do not have abortions. However, findings from this study support the conclusion that increased use of antidepressants is not attributable to having had an abortion but to differences in risk factors for depression.
Galbally M, Frayne J, Watson SJ, Snellen M. J Affect Disord. 2018 Jun 14;238:593-596.
This small study of 26 women using aripiprazole during pregnancy did not demonstrated increased risk of metabolic syndrome.
Spinelli M. Arch Womens Ment Health. 2018 Jun 25.