This week another study highlights the importance of prenatal vitamins in reducing the risk of autism spectrum disorders (ASD).  This study from Schmidt and colleagues focused on high-risk families. In these families, one child had already been diagnosed with ASD.  The risk of having a child with ASD in subsequent children was cut in half in women who took prenatal vitamins during the first month of pregnancy.  Prenatal vitamins must be used early in the course of pregnancy. Most of the women in the study used prenatal vitamins during pregnancy, but the reduction in ASD risk was observed only in the women who took prenatal vitamins during the first month of pregnancy.  Although the authors did not conclude that folic acid was responsible for the finings in this study, this study is consistent with other studies looking at the impact of folic acid supplementation on risk for ASD.  


Ruta Nonacs, MD PhD

Association of Maternal Prenatal Vitamin Use With Risk for Autism Spectrum Disorder Recurrence in Young Siblings.

Schmidt RJ, Iosif AM, Guerrero Angel E, Ozonoff S.  JAMA Psychiatry. 2019 Feb 27.

In high-risk families, where one child has been diagnosed with an autism spectrum disorder (ASD), maternal use of prenatal vitamins during the first month of pregnancy was associated with a reduction in risk of ASD recurrence in younger siblings.

Maternal Self-Harm Deaths: An Unrecognized and Preventable Outcome.

Mangla K, Hoffman MC, Trumpff C, O’Grady S, Monk C.  Am J Obstet Gynecol. 2019 Mar 5.

This review identifies barriers to reporting and ascertainment of maternal suicide and overdose deaths, summarizes available geographic-specific data, addresses potential social and psychological biases that have led to neglect of the topic of maternal self-harm deaths, and suggests recommendations that incorporate the “whole woman” in prenatal care and thus prevention of this devastating outcome.

Course, risk factors, and adverse outcomes of disordered eating in pregnancy.

Chan CY, Lee AM, Koh YW, Lam SK, Lee CP, Leung KY, Tang CSK.  Int J Eat Disord. 2019 Mar 1.

Higher levels of disordered eating in pregnancy were significantly associated with higher levels of disordered eating at 6 weeks and 6?months postpartum, greater anxiety and depressive symptoms, lower 1-min Apgar scores, and abnormal birth weight.

Postpartum depression and social support in a racially and ethnically diverse population of women.

Pao C, Guintivano J, Santos H, Meltzer-Brody S.  Arch Womens Ment Health. 2019 Feb;22(1):105-114.

Higher levels of social support had a strong protective association against PPD (OR, 0.23; 95% CI, 0.19-0.27), and the effects of social support did not differ when accounting for race/ethnicity. Additionally, PPD symptom severity is significantly and negatively correlated with the degree of social support.

A prospective study of postnatal depressive symptoms and associated risk factors in first-time fathers.

Da Costa D, Danieli C, Abrahamowicz M, Dasgupta K, Sewitch M, Lowensteyn I, Zelkowitz P.  J Affect Disord. 2019 Feb 11;249:371-377.

The prevalence of depressive symptoms in fathers was 13.76% at 2 months and 13.60% at 6 months postpartum. Men who were depressed during their partner’s pregnancy were 7 times more likely to be depressed at 2 months postpartum. Older age, poor sleep quality at study entry, worse couple adjustment, having a partner experiencing antenatal depressive symptoms and elevated parental stress were associated with depressive symptoms at 2 months postpartum. Poor sleep quality, financial stress and a decline in couple adjustment were independently associated to depressive symptoms at 6 months postpartum.

The international postpartum depression: action towards causes and treatment (PACT) consortium.

Guintivano J, Putnam KT, Sullivan PF, Meltzer-Brody S.  Int Rev Psychiatry. 2019 Feb 27:1-8.

This international consortium includes 19 institutions and has recruited 17,912 participants and 11,344 participants have been identified using the PPD ACT mobile app, of which 8,432 are PPD cases.

PPD ACT: an app-based genetic study of postpartum depression.

Guintivano J, Krohn H, Lewis C, Byrne EM, Henders AK, Ploner A, Kirk K, Martin NG, Milgrom J, Wray NR, Sullivan PF, Meltzer-Brody S.  Transl Psychiatry. 2018 Nov 29;8(1):260.  Free Article

A mobile iOS app (PPD ACT) will be used to recruit, consent, screen, and enable DNA collection from women with a lifetime history of PPD to sufficiently power genome-wide association studies.

Rehospitalization of Postpartum Depression and Psychosis After Electroconvulsive Therapy: A Population-Based Study With a Matched Control Group.

Rönnqvist I, Brus O, Hammar Å, Landén M, Lundberg J, Nordanskog P, Nordenskjöld A.  J ECT. 2019 Feb 20.

After treatment with ECT, women with postpartum depression or psychosis (n=180) were compared to a matched group of women with non-postpartum psychiatric illness with respect to relapse rates.  The proportions of patients who suffered relapse after 6 months, 1 year, and 2 years were 28%, 31%, and 40% for the postpartum group and 39%, 50%, and 55% for the non-postpartum group. Treatment with benzodiazepines, several previous psychiatric admissions, and the absence of improvement after ECT were associated with relapse.

Management of perinatal depression with non-drug interventions.

Johansen SL, Robakis TK, Williams KE, Rasgon NL.  BMJ. 2019 Feb 25;364:l322.

Randomized controlled trial of telephone-based cognitive-behavioral therapy on parenting self-efficacy and satisfaction.

Ngai FW, Wong PW, Chung KF, Leung KY, Tarrant M.  Transl Behav Med. 2019 Feb 25.

Telephone-based CBT produced significantly greater improvement in parenting self-efficacy and satisfaction than standard care.

The Relationship Between Perinatal Mental Health and Stress: a Review of the Microbiome.

Redpath N, Rackers HS, Kimmel MC.  Curr Psychiatry Rep. 2019 Mar 2;21(3):18.

Bidirectional communication between the nervous system and the microbiota is an important factor to alter host homeostasis and development of PMAD. Future research in the relationship between the psychoneuroimmune system, the gut microbiota, and PMAD has the potential to be integrated in clinical practice to improve screening, diagnosis, and treatment.

“What if I get ill?” perinatal concerns and preparations in primi- and multiparous women with bipolar disorder.

Anke TMS, Slinning K, Skjelstad DV.  Int J Bipolar Disord. 2019 Mar 3;7(1):7.

Mood instability during pregnancy and postpartum: a systematic review.

Li H, Bowen A, Bowen R, Balbuena L, Feng C, Bally J, Muhajarine N.  Arch Womens Ment Health. 2019 Mar 4.

Mood instability is a prominent feature in perinatal women with and without depression, mood lability during the early postpartum predicts psychopathology up to 14 months postpartum, and maternal emotion dysregulation, rather than maternal psychopathology, increases the risk of heightened facial affect synchrony in mother-infant interactions.

Risk factors for impaired maternal bonding when infants are 3?months old: a longitudinal population based study from Japan.

Nakano M, Upadhyaya S, Chudal R, Skokauskas N, Luntamo T, Sourander A, Kaneko H.  BMC Psychiatry. 2019 Mar 8;19(1):87.  Free Article

Mother’s  negative feelings about pregnancy (OR?=?2.16, 95% CI?=?1.02-4.56) and postpartum depression at 1 month after delivery (OR?=?7.85, 95% CI?=?3.44-17.90) were associated with higher levels of impaired maternal bonding one month after delivery.

A longitudinal study of neurotrophic, oxidative, and inflammatory markers in first-onset depression in midlife women.

Pasquali MA, Harlow BL, Soares CN, Otto MW, Cohen LS, Minuzzi L, Gelain DP, Moreira JCF, Frey BN.  Eur Arch Psychiatry Clin Neurosci. 2018 Dec;268(8):771-781.

The development of MDD in midlife women may be associated with a systemic cascade of pro-oxidative and pro-inflammatory events including increased HSP70, 3-nitrotyrosine, protein carbonyl, and lipid peroxidation and decreased BDNF.

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