This week there are two very interesting articles which look at the impact of parental exposure to adverse childhood experiences may affect a child developmental outcomes. Colker and colleagues note that about 20% of women with histories of psychiatric illness experience suicidal ideation during the postpartum period.
Ruta Nonacs, MD PhD
Folger AT, Eismann EA, Stephenson NB, Shapiro RA, Macaluso M, Brownrigg ME, Gillespie RJ. Pediatrics. 2018 Mar 21.
Maternal and paternal exposure to adverse childhood experiences (ACEs) maybe associated with negative offspring development at 24 months of age in a suburban pediatric primary care population. For each additional maternal ACE, there was an 18% increase in the risk for a suspected developmental delay (relative risk: 1.18, 95% confidence interval: 1.08-1.29). A similar trend was observed for paternal ACEs (relative risk: 1.34, 95% confidence interval: 1.07-1.67). Three or more maternal ACEs (versus <3 ACEs) was associated with a significantly increased risk for a suspected developmental delay that affected multiple domains.
Racine N, Plamondon A, Madigan S, McDonald S, Tough S. Pediatrics. 2018 Mar 20.
Psychosocial risks in pregnancy, but not in early infancy, contribute to the transmission of vulnerability from maternal ACEs to child development outcomes in infancy via maternal behavior. Maternal health risk in pregnancy indirectly confers risk from maternal ACEs to child development outcomes at 12 months of age through infant health risk. Maternal health and psychosocial well-being in pregnancy may be key targets for intervention.
Coker JL, Tripathi SP, Knight BT, Pennell PB, Magann EF, Newport DJ, Stowe ZN. Arch Womens Ment Health. 2017 Oct;20(5):687-694.
Pregnant women (n=842) with neuropsychiatric illness were enrolled prior to 20 weeks of gestation. Up to 22.3% of postpartum women admitted SI on rating scales, despite the majority (79%) receiving active pharmacological treatment for psychiatric illness. Postpartum women admitting self-harm/SI were more likely to meet criteria for current major depressive episode (MDE), less than college education, an unplanned pregnancy, a history of past suicide attempt, and a higher score on the Childhood Trauma Questionnaire. In women with a history of neuropsychiatric illness, over 20% admitted SI during the postpartum period despite ongoing psychiatric treatment.
Guintivano J, Manuck T, Meltzer-Brody S. Clin Obstet Gynecol. 2018 Mar 28.
Current best predictors are clinical assessments for psychiatric history and adverse life events, highlighting the need for increased depression screening across the perinatal period.
Mughal MK, Giallo R, Arnold P, Benzies K, Kehler H, Bright K, Kingston D. J Affect Disord. 2018 Mar 9;234:318-326.
Data were analyzed from 1983 mother-child dyads who participated in the three year follow-up of the All Our Families (AOF) study. Multivariate analysis showed mothers assigned to the high anxiety symptoms class had an increased risk (adjusted OR 2.80, 95% CI 2.80 (1.42 ? 5.51), p?=?0.003) of having a child with developmental delays at 3 years.
Buglione-Corbett R, Deligiannidis KM, Leung K, Zhang N, Lee M, Rosal MC, Moore Simas TA. Arch Womens Ment Health. 2018 Mar 30.
In a study including 63 participants, elevated serum TNF-? was associated with lower EPDS total score (? =?-?0.90, p?=?0.046) after adjusting for demographics and medication use. In contrast, IL-6, CRP, and IL-1? did not demonstrate statistically significant associations with depressive symptoms by the EPDS in either crude or adjusted models. Study findings showed no association or an inverse (TNF-?) association between inflammatory markers and perinatal depressive symptoms.
Swanson LM, Burgess HJ, Zollars J, Todd Arnedt J. Arch Womens Ment Health. 2018 Mar 30.
Light therapy was beneficial; however this study included only six participants.
Effects of oral versus transdermal menopausal hormone treatments on self-reported sleep domains and their association with vasomotor symptoms in recently menopausal women enrolled in the Kronos Early Estrogen Prevention Study (KEEPS).
Cintron D, Lahr BD, Bailey KR, Santoro N, Lloyd R, Manson JE, Neal-Perry G, Pal L, Taylor HS, Wharton W, Naftolin F, Harman SM, Miller VM. Menopause. 2018 Feb;25(2):145-153. Free Article
Levey EJ, Zhong QY, Rondon MB, Sanchez S, Li J, Williams MA, Gelaye B. Arch Womens Ment Health. 2018 Mar 20.
Abramowitz A, Miller ES, Wisner KL. Arch Womens Ment Health. 2017 Jun;20(3):363-372.
Heller HM, Ravelli ACJ, Bruning AHL, de Groot CJM, Scheele F, van Pampus MG, Honig A. BMC Pregnancy Childbirth. 2017 Jun 2;17(1):166. Free Article
In a matched cohort observational study, postpartum haemorrhage occurred in 9.7% of the women using serotonergic medication. In the matched controls PP hemorrhage occurred in 6.6% of the women. The adjusted odds ratio (aOR) before matching was 1.6 (95% CI 1.2-2.1) and after matching 1.5 (95% CI 1.1-2.1). Among the women using other psychopharmacological medications, the incidence of postpartum haemorrhage before matching was 12.0% versus 6.1% (p?=?0.08) with OR 2.1 (95% CI 0.9-4.9), and after matching 12.1% versus 4.4% (p?=?0.03) with aOR of 3.3 (95% CI 1.1-9.8).
Holt C, Milgrom J, Gemmill AW. Arch Womens Ment Health. 2017 Dec;20(6):791-801.
When comparing women who experienced emotional distress with those who did not, odds of seeking help were 4.0 times higher for the motivational intervention condition than Routine Care (p = .004).
Choi KW, Houts R, Arseneault L, Pariante C, Sikkema KJ, Moffitt TE. Dev Psychopathol. 2018 Mar 22:1-14.
Mothers who had been maltreated as children, especially those who had experienced emotional or sexual abuse, were at increased risk for postpartum depression. In turn, postpartum depression predicted children’s exposure to maltreatment, followed by emotional and behavioral problems. Indirect effects from maternal childhood maltreatment to child outcomes were robust across child sex and supported significant mediation through postpartum depression; however, this appeared to be carried by mothers’ depression beyond the postpartum period.
Sacchi C, De Carli P, Vieno A, Piallini G, Zoia S, Simonelli A. Early Hum Dev. 2018 Mar 23;119:56-61.
Infants with high negative emotionality seem to be more susceptible to the effect of maternal depression. Specifically, high maternal depression tends to foster the negative effect of infant’s negativity on motor development across time, albeit not significantly. Finally, the absence of maternal depression significantly buffers negative temperament in infants.