This week includes several good reviews.  The first one is a review of postpartum anxiety. Thomson and Sharma review the treatment of bipolar disorder during pregnancy.  And there is also a review of IPT for the treatment of perinatal depression.

Ruta Nonacs, MD PhD

Postnatal anxiety prevalence, predictors and effects on development: A narrative review. 

Field T.  Infant Behav Dev. 2018 Mar 12;51:24-32.

The demographic risk factors for postnatal anxiety include being a young mother, having more education and being employed. Childbirth risk factors include being primiparous in one sample and multiparous in another, caesarean delivery, fear of the birth and of death during delivery, lack of control during labor, low self-confidence for the delivery and the delivery staff, and premature delivery. Social support problems include the lack of family support, marital/family conflict, and social health issues. Psychiatric history risk factors include prenatal depression and anxiety.  Only six postnatal anxiety intervention studies could be found including paternal education, music therapy during labor, mothers massaging their infants, cognitive behavior therapy and administering oxytocin.

Weighing the Risks: the Management of Bipolar Disorder During Pregnancy.

Thomson M, Sharma V.  Curr Psychiatry Rep. 2018 Mar 17;20(3):20. Review.

A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women.

Sockol LE.  J Affect Disord. 2018 May;232:316-328.

IPT is an effective preventive intervention for perinatal depression and an effective treatment for perinatal depression and anxiety

How obstetric settings can help address gaps in psychiatric care for pregnant and postpartum women with bipolar disorder.

Byatt N, Cox L, Moore Simas TA, Kini N, Biebel K, Sankaran P, Swartz HA, Weinreb L.  Arch Womens Ment Health. 2018 Mar 13.

Structured, in-depth interviews were conducted with 25 pregnant and postpartum women recruited from obstetric practices who scored ??10 on the Edinburgh Postnatal Depression Scale and met DSM-IV criteria for bipolar disorder using the Mini International Neuropsychiatric Interview. Most participants (n?=?19, 79.17%) did not have a clinical diagnosis of bipolar disorder documented in their medical records nor had received referral for treatment during pregnancy (n?=?15, 60%). Of participants receiving pharmacotherapy (n?=?14, 58.33%), most were treated with an antidepressant alone (n?=?10, 71.42%). Most medication was prescribed by an obstetric (n?=?4, 28.57%) or primary care provider (n?=?7, 50%).

Prevalence of Depression Among Women of Reproductive Age in the United States.

Guo N, Robakis T, Miller C, Butwick A.  Obstet Gynecol. 2018 Mar 8.

The overall prevalences of major and minor depression were 4.8% (95% CI 4.0-5.7%) and 4.3% (95% CI 3.5-5.2%), respectively. The prevalences of antidepressant use among women with major depression and minor depression were 32.4% (95% CI 25.3-40.4%) and 20.0% (95% CI 12.9-29.7%), respectively.

Is the effect of postpartum depression on mother-infant bonding universal?

Badr LK.  Infant Behav Dev. 2018 Mar 10;51:15-23.

Impaired bonding was associated with older age, history of depression and low social support, which explained 39% of the variance.

A Systematic Review of Integrated Care Interventions Addressing Perinatal Depression Care in Ambulatory Obstetric Care Settings.

Moore Simas TA, Flynn MP, Kroll-Desrosiers AR, Carvalho SM, Levin LL, Biebel K, Byatt N.  Clin Obstet Gynecol. 2018 Mar 16.

Despite limitations among the available studies including marked heterogeneity, there is evidence supporting feasibility, effectiveness, and acceptability.

Predictors of treatment retention in postpartum women prescribed buprenorphine during pregnancy.

O’Connor AB, Uhler B, O’Brien LM, Knuppel K.  J Subst Abuse Treat. 2018 Mar;86:26-29.

At 12 months postpartum, women were more likely to remain in medication treatment if they entered treatment early in pregnancy (at the time of conception or prior to 13 weeks gestation). Being prescribed an antidepressant medication during the third trimester was also associated with enhanced treatment retention at six months postpartum (p=0.005). The use of illicit drugs (including opioids, cocaine and benzodiazepines) during the third trimester of pregnancy was negatively correlated with treatment retention at 6 and 12 months postpartum.

Acupuncture at BL67 for mild postpartum depression: a prospective case series.

Tian CB.  Acupunct Med. 2018 Mar 14.

Acupuncture therapy at BL67 may alleviate symptoms of mild PPD, however controlled clinical investigations are required to confirm its efficacy and effectiveness for this condition.

The levonorgestrel-releasing intrauterine device potentiates stress reactivity.

Aleknaviciute J, Tulen JHM, De Rijke YB, Bouwkamp CG, van der Kroeg M, Timmermans M, Wester VL, Bergink V, Hoogendijk WJG, Tiemeier H, van Rossum EFC, Kooiman CG, Kushner SA.  Psychoneuroendocrinology. 2017 Jun;80:39-45.

Women using the levonorgestrel-releasing intrauterine device ( LNG-IUD) had an exaggerated salivary cortisol response.

State-trait anxiety levels during pregnancy and foetal parameters following intervention with music therapy.

Garcia-Gonzalez J, Ventura-Miranda MI, Requena-Mullor M, Parron-Carreño T, Alarcon-Rodriguez R.  J Affect Disord. 2018 May;232:17-22.

After the infant non-stress test (NST), the women from the music therapy group showed significantly lower scores in state anxiety (OR = 0.87; p < 0.001) as well as trait anxiety (p < 0.001) than the control group. Furthermore, the pregnant women from the music group presented lower levels of state-trait anxiety than the control group in relation to the variables of birth process, and higher birth weight and chest circumference in the newborn (OR = 3.5 and OR = 0.81, respectively; p < 0.05).

Anxiety and depressive symptoms in women and men from early pregnancy to 30 months postpartum.

Canário C, Figueiredo B.  J Reprod Infant Psychol. 2017 Nov;35(5):431-449.

Anxiety and depression symptoms decreased from the first trimester to 3 months postpartum and increased from 3 to 30 months postpartum, returning to the baseline levels in the overall sample. The symptoms were positively correlated within-dyad; in a given time point when a partner reported more symptoms, the other reported more symptoms as well. Changes in anxiety and depression symptoms over time were different according to gender and parity, especially from 3 to 30 months postpartum. Primiparous women revealed low stable symptoms, whereas multiparous women revealed the steepest symptoms increase (in comparison to primiparous men and women and multiparous men).

The relationship between hyperemesis gravidarum and maternal psychiatric well-being during and after pregnancy: controlled study.

Senturk MB, Y?ld?z G, Y?ld?z P, Yorguner N, Çakmak Y.  J Matern Fetal Neonatal Med. 2017 Jun;30(11):1314-1319.

Mental health is negatively affected by HG at pregnancy, and in this case, psychiatric symptoms may continue even after discontinuation HG.

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