Most women with depression experience considerable difficulty in making decisions about whether or not to use antidepressant medications during pregnancy. These decisions are very complex, and women must consider their own illness history and personal preferences in the context of available data regarding the reproductive safety of antidepressants.   Simone Vigod and colleagues present preliminary data online patient decision aid (PDA) for the use of antidepressants during pregnancy.

On this list are also several articles looking at PTSD related to childbirth.  While we focus on postpartum depression and anxiety, PTSD symptoms are relatively common among women who have had traumatic childbirth experiences.  These recent articles give us more detailed information on the symptoms of postpartum PTSD and consider how these symptoms may affect maternal bonding and attachment.  

And if you would like to read more about neuroactive steroids and how they may play a role in the neurobiology of major depression and postpartum depression, there is an interesting review from James Maguire.


Ruta Nonacs, MD PhD

A patient decision aid for antidepressant use in pregnancy: Pilot randomized controlled trial.

Vigod SN, Hussain-Shamsy N, Stewart DE, Grigoriadis S, Metcalfe K, Oberlander TF, Schram C, Taylor VH, Dennis CL.  J Affect Disord. 2019 Mar 18;251:91-99.

Evaluation of an online patient decision aid (PDA) for antidepressant use in pregnancy with national recruitment is feasible. Pilot results suggest that the tool is acceptable and reduces decisional conflict more than clinical care alone in a non-specialist setting. Evaluation of the PDA’s impact on longer-term maternal and child clinical outcomes is a key next step.

Is childbirth-induced PTSD associated with low maternal attachment?

Dekel S, Thiel F, Dishy G, Ashenfarb AL.  Arch Womens Ment Health. 2019 Feb;22(1):119-122.

Attachment problems were more common in women who experienced childbirth-related PTSD, compared to women who had non-childbirth PTSD and to postpartum women without PTSD.Childbirth-induced posttraumatic stress may interfere with the formation of maternal attachment, warranting screening of at-risk women.

Examining Symptom Clusters of Childbirth-Related Posttraumatic Stress Disorder.

Thiel F, Ein-Dor T, Dishy G, King A, Dekel S.  Prim Care Companion CNS Disord. 2018 Sep 27;20(5). Free Article

Childbirth-related peritraumatic stress was strongly and positively associated with postpartum PTSD symptom severity. Cluster modeling revealed four distinctive symptom groups: reliving (some reexperiencing symptoms), specifically nightmares and flashbacks; avoidance coupled with unwanted memories (other reexperiencing symptoms); negative cognitions and mood; and hyperarousal reactivity.

Neuroactive Steroids and GABAergic Involvement in the Neuroendocrine Dysfunction Associated With Major Depressive Disorder and Postpartum Depression.

Maguire J. Front Cell Neurosci. 2019 Mar 8;13:83. Free Article

Mental Disorders and Suicide Attempts in the Pregnancy and Postpartum Periods Compared with Non-Pregnancy: A Population-Based Study.

Mota NP, Chartier M, Ekuma O, Nie Y, Hensel JM, MacWilliam L, McDougall C, Vigod S, Bolton JM.  Can J Psychiatry. 2019 Mar 20

Within the perinatal cohort, pregnancy was associated with a lower rate of diagnosed mood or anxiety disorder, substance use disorder, and suicide attempt relative to pre-pregnancy (aRR range, 0.22-0.82). Pregnancy also had lower rates of all outcomes compared with the postpartum period (aRR, 0.44-0.87). Postpartum had a higher rate of psychotic disorder compared with pre-pregnancy (aRR, 1.61; 95% CI, 1.17-2.21), but a lower rate of mood or anxiety disorder and suicide attempt. Compared with non-perinatal women, pregnancy was associated with lower rates of all outcomes (aRR range, 0.25-0.87).

Depressive symptoms during pregnancy and postpartum in women and use of antidepressant treatment – a longitudinal cohort study.

Sunnqvist C, Sjöström K, Finnbogadóttir H.  Int J Womens Health. 2019 Feb 7;11:109-117. Free Article

In this prospective study from Iceland, depressive symptoms (EPDS scores ?13) were detected in 10.1% of the women during the whole pregnancy, of those 6.2% had depressive symptoms already in early pregnancy and 10.0 % during the postpartum period. Women with EPDS scores ?13 and non-exposure to domestic violence were more often non-medicated (P<0.001). None of the women with EPDS scores ?13 with exposures to domestic violence had received any antidepressant medication.

Obstetric and perinatal health outcomes related to schizophrenia: A national register-based follow-up study among Finnish women born between 1965 and 1980 and their offspring.

Simoila L, Isometsä E, Gissler M, Suvisaari J, Halmesmäki E, Lindberg N.  Eur Psychiatry. 2018 Aug;52:68-75.

Women with schizophrenia had a 1.4-fold increased risk of induction of labor, delivery by cesarean section, and delivery by elective cesarean section. Regarding offspring, the risk of premature birth and the risk of low Apgar score at 1?min (<7) were 1.6-fold, of resuscitation 2.5-fold, and of neonatal monitoring 2.1-fold higher.

Psychotropic medication use and intimate partner violence at 4 years postpartum: Results from an Australian pregnancy cohort study.

Woolhouse H, Gartland D, Papadopoullos S, Mensah F, Hegarty K, Giallo R, Brown S.  J Affect Disord. 2019 Mar 18;251:71-77.

In this prospective cohort study of 1507 first-time mothers recruited in early pregnancy (mean gestation 15 weeks) in Melbourne Australia, researchers observed that at our years postpartum, almost one in eight mothers (13.9%) were taking psychotropic medication. The prevalence of psychotropic medication use was higher in women experiencing concurrent IPV compared to women not experiencing IPV (25% vs 11%, Odds Ratio?=?2.68). Women experiencing IPV were significantly more likely to be taking psychotropic medication, even after adjusting for sociodemographic factors and depressive symptoms (Adj OR?=?1.86). Only 5% of women reporting IPV at four years postpartum had discussed this with a general practitioner.

Toward a framework for best practices and research guidelines for perinatal depression research.

Kimmel MC, Bauer A, Meltzer-Brody S.  J Neurosci Res. 2019 Mar 28.

The dynamic course of peripartum depression across pregnancy and childbirth.

Dekel S, Ein-Dor T, Ruohomäki A, Lampi J, Voutilainen S, Tuomainen TP, Heinonen S, Kumpulainen K, Pekkanen J, Keski-Nisula L, Pasanen M, Lehto SM.  J Psychiatr Res. 2019 Mar 15;113:72-78.

824 women were assessed at three time points: first trimester (T1), third trimester (T2), and again at eight weeks (T3) postpartum. Researchers observed four discrete PPD symptom trajectory classes including chronic PPD (1.1%), delayed (10.2%), recovered (7.2%), and resilient (81.5%). Delivery complications were associated with chronic PPD but also with the recovered PPD trajectory class. History of mental health disorders was associated with chronic PPD and the delayed PPD class.

Association of Maternal First-Trimester Ondansetron Use With Cardiac Malformations and Oral Clefts in Offspring.

Huybrechts KF, Hernández-Díaz S, Straub L, Gray KJ, Zhu Y, Patorno E, Desai RJ, Mogun H, Bateman BT.  JAMA. 2018 Dec 18;320(23):2429-2437.

Ondansetron (Zofiran) is commonly used to treat nausea and vomiting during pregnancy.  Among offspring of mothers enrolled in Medicaid, first-trimester exposure to ondansetron was not associated with cardiac malformations or congenital malformations overall.

School-age social behavior and pragmatic language ability in children with prenatal serotonin reuptake inhibitor exposure.

Smearman EL, Hendrix CL, Winiarski DA, Johnson KC, Smith AK, Ousley OY, Stowe ZN, Newport DJ, Brennan PA.  Dev Psychopathol. 2019 Feb 7:1-10.

Researchers prospectively followed a cohort of mother-child dyads from pregnancy through early elementary school (N = 178), and obtained maternal and alternate-caregiver ratings of behaviors related to ASD (N = 137), as well as direct, gold-standard assessments of child ASD symptoms and pragmatic language among dyads who experienced prenatal depression and either took SRIs or were medication free during pregnancy (N = 44).

Perinatal selective serotonin reuptake inhibitor medication (SSRI) effects on social behaviors, neurodevelopment and the epigenome.

Gemmel M, Bögi E, Ragan C, Hazlett M, Dubovicky M, van den Hove DL, Oberlander TF, Charlier TD, Pawluski JL.  Neurosci Biobehav Rev. 2018 Feb;85:102-116. Review.

A key for perinatal depression early diagnosis: The body dissatisfaction.

Riquin E, Lamas C, Nicolas I, Dugre Lebigre C, Curt F, Cohen H, Legendre G, Corcos M, Godart N.  J Affect Disord. 2019 Feb 15;245:340-347.

During pregnancy, 33% of the women who were unsatisfied with their body image suffered from perinatal depression vs. 11.3% of the women who were not (p?<?0.0001).

The maternal reward system in postpartum depression.

Post C, Leuner B.  Arch Womens Ment Health. 2018 Dec 15.

This review focuses on the mesolimbic dopamine system, particularly the ventral tegmental area-nucleus accumbens pathway which has been implicated in the regulation of critical functions disrupted in PPD including mood, motivation, and mothering.

Mellow Babies and Mellow Toddlers: Effects on maternal mental health of a group-based parenting intervention for at-risk families with young children.

Levi D, Ibrahim R, Malcolm R, MacBeth A.  J Affect Disord. 2019 Mar 1;246:820-827.

Mellow Parenting (MP) is a suite of parenting interventions targeting at-risk families with complex needs, including those with very young children.   Participation in this program was associated with improvements in maternal mental health, parenting confidence, and a component of child psychosocial behaviour, but not overall child difficulties or daily parenting stress. Mothers with a partner experienced larger benefits in mental health and parenting confidence compared to single mothers. Younger mothers, and those with a history of mental health problems, attended more intervention sessions.

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