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. 

The most exciting thing we have this week is not an article but something new we will be offering to perinatal psychiatry providers — virtual rounds!!  

Our colleagues are invited to join us for rounds on Wednesdays from 2-3 PM EST, beginning on April 1st.  Health care professionals can register HERE for this interactive rounds format where we will review cases which you submit in advance using the Zoom platform. We will discuss cases presented in advance and also cases or questions submitted with the Zoom “chat” function during the virtual rounds.  We hope you will join us for rounds at the Ammon-Pinizzotto Center for Women’s Mental Health at Mass General this coming Wednesday, April 1.

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 Effectiveness of a Guided Internet-Based Tool for the Treatment of Depression and Anxiety in Pregnancy (MamaKits Online): Randomized Controlled Trial.

Heller HM, et al.  J Med Internet Res 2020;22(3):e15172.

Of the 159 included women, 79 were randomized to MamaKits online, 47% (79/37) of whom completed the intervention. Both groups showed a substantial decrease in affective symptoms on the CES-D, HADS-A, and Edinburgh Postnatal Depression Scale over time. In the intervention group, affective symptoms decreased more than that in the control group, but between-group effect sizes were small to medium and statistically not significant. 


Association of stress-related sleep disturbance with psychiatric symptoms among pregnant women.

Sanchez SE, Friedman LE, Rondon MB, Drake CL, Williams MA, Gelaye B.  Sleep Med. 2020 Feb 17;70:27-32. 

In this cohort of pregnant women, 24.9% had antepartum depression, 32.2% had generalized anxiety disorder, 30.9% had PTSD, and 27.6% were assessed as having a high risk of psychosis.  Stress-related sleep disturbance was reported by 33.2% of women. After adjusting for confounders, women with stress-related sleep disturbances were more likely to experience antepartum depression (OR = 2.74; 95%CI: 2.22-3.38), generalized anxiety disorder (OR = 2.48; 95%CI: 2.04-3.02), PTSD (OR = 2.36; 95%CI: 1.93-2.88), and high risk for psychosis (OR = 2.07; 95%CI: 1.69-2.54) as compared to women without stress-related sleep disturbances.


The association between symptoms of depression during pregnancy and low birth weight: a prospective study.

Li X, Gao R, Dai X, Liu H, Zhang J, Liu X, Si D, Deng T, Xia W.  BMC Pregnancy Childbirth. 2020 Mar 6;20(1):147. Free Article

Of the 1377 subjects, the prevalence of antenatal depression was 19.1%. After adjustment for maternal age, education, parity, pre-pregnancy body mass index (BMI), residential area, fetal gender, an EPDS score???12 (versus. <?12) was associated with an twofold increased risk for low birth weight (odds ratio: 2.05, 95% CI: 1.12-4.64), but not for preterm birth, large for gestational age, small for gestational age or macrosomia.


Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy.

Kalmbach DA, Roth T, Cheng P, Ong JC, Rosenbaum E, Drake CL.  Sleep Health. 2020 Mar 4.

Ruminating in bed at night is strongly associated with insomnia and depression during pregnancy, whereas mindfulness may potentially protect against these stress-related perinatal complications


Prenatal stress: Effects on fetal and child brain development.

Lautarescu A, Craig MC, Glover V.  Int Rev Neurobiol. 2020;150:17-40.

 

MEDICATIONS AND PREGNANCY

Antidepressant prescriptions, discontinuation, depression and perinatal outcomes, including breastfeeding: A population cohort analysis.

Jordan S, Davies GI, Thayer DS, Tucker D, Humphreys I.  PLoS One. 2019 Nov 18;14(11):e0225133. Free Article

Antidepressants, particularly high dose SSRIs, increased the prevalence of SGA <3rd centile, whereas depression, particularly if medicated, affected duration of gestation.


Patterns of prenatal antidepressant exposure and risk of preeclampsia and postpartum haemorrhage.

Palmsten K, Chambers CD, Wells A, Bandoli G.  Paediatr Perinat Epidemiol. 2020 Mar 24. 

While this study indicates that women with sustained antidepressant exposure during pregnancy, especially at higher doses, were at increased risk for preeclampsia and postpartum hemorrhage, but we cannot rule out the possibility that underlying depression and anxiety may contribute to the increased risk.  

 

POSTPARTUM PSYCHIATRIC ILLNESS

Thoughts of self-harm and associated risk factors among postpartum women in Canada.

Palladino E, et al.  J Affect Disord, March 2020.

Approximately 1/10 women reported experiencing thoughts of self-harm postpartum.  37% of women with thoughts of self-harm reported “fair” or “poor” mental health.   54% of women with thoughts of self-harm had moderate levels of symptoms of PPD. 37% of women with thoughts of self-harm had symptoms of GAD.  Low mental health, symptoms of PPD and GAD were associated with thoughts of self-harm.  


Long-Term Outcomes of Postpartum Psychosis: A Systematic Review and Meta-Analysis.

Gilden J, Kamperman AM, Munk-Olsen T, Hoogendijk WJG, Kushner SA, Bergink V.  J Clin Psychiatry. 2020 Mar 10;81(2). 

In this meta-analysis, more than 40% of women were classified as having “isolated postpartum psychosis,” which could be considered a distinct diagnostic category with a more favorable prognosis. The remaining women had severe non-puerperal psychiatric episodes occurring during longitudinal follow-up.

 

MEDICATIONS AND BREASTFEEDING

No articles this week

 

PERINATAL SUBSTANCE USE

Impact of timing of methadone initiation on perinatal outcomes following delivery among pregnant women on methadone maintenance therapy in Ontario.

Guan Q, Sproule BA, Vigod SN, Cadarette SM, Greaves S, Martins D, Gomes T.  Addiction. 2019 Feb;114(2):268-277. 

Among 1842 women on methadone maintenance treatment (MMT) during pregnancy, 87.6% (n = 1614) initiated MMT before conception. Almost a quarter of their infants (22.2%; n = 408) were born small for gestational age, 17.5% (n = 323) were preterm and 5.9% (n = 109) were born with a congenital anomaly. The odds of primary outcomes occurring did not differ based on timing of methadone initiation; however, infants of mothers who initiated methadone during pregnancy had up to a fourfold increase in the odds of social services removal at the hospital [adjusted odds ratio (aOR) range = 3.70-4.19] compared with those whose mothers were stabilized on MMT prior to conception.

MATERNAL MENTAL HEALTH AND CHILD OUTCOMES

No articles this week

 

MENOPAUSE AND MENTAL HEALTH

No articles this week

 

OTHER TOPICS IN WOMEN’S MENTAL HEALTH

Progesterone levels predict reductions in behavioral avoidance following cognitive restructuring in women with spider phobia.

Li SH, et al.  J Affect Disord, March 2020.

The effectiveness of cognitive therapy for anxiety disorders in women may differ depending on endogenous levels of progesterone, and raise the possibility that progesterone could be a useful pharmacological adjunct to cognitive therapy.


Risk of bipolar disorder in patients with endometriosis: A nationwide population-based cohort study.

Chen S-F, et al.  J Affect Disord, March 2020.

Endometriosis patients had an increased risk of developing bipolar disorder compared to controls without endometriosis, after adjusting for age and different treatment options (1.04 versus 0.56 per 1,000 person-years, HR: 2.34).  There was no significant difference in risk between women receiving different hormonal or surgical treatments, suggesting a limited impact of treatment on risk of developing bipolar disorder.