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. 

Several articles in this collection address the challenges researchers face when attempting to study the long-term impact of prenatal antidepressant exposure on neurodevelopmental outcomes in children.  Nearly a decade ago, we saw the first reports suggesting a link between prenatal SSRI exposure and risk of autism spectrum disorders in children.  Since that time we have seen multiple studies which have not supported this association, yet it is difficult to let this one rest and, despite multiple meta-analyses supporting the safety of SSRIs, some clinicians still have lingering doubts regarding the use of antidepressants in this setting.  

Vega and colleagues conduct a meta-analysis of the association between prenatal antidepressant exposure and autism risk, examining the utility of different comparison groups to eliminate surveillance bias.  They concluded that using a discordant-sibling design — where outcomes are measured in two siblings, one with prenatal exposure and the other without —  can help to eliminate confounding by genetic and family-specific environmental factors and can thus be used to address the surveillance bias in pharmacovigilance reports derived from national registries and other large databases.

Underscoring the contribution of genetic contributions from the father, a study from Cohen and colleagues observed that fathers who took antidepressants were more likely to have a child with anxiety symptoms than fathers who were not taking antidepressants.  

And finally, a paper from Huybrechts and colleagues lays out guidelines for analyzing data from large databases such that we can learn to improve the analyses of these databases and minimize biases that may threaten the validity and generalizability of the data emerging from such studies.

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

Suicide Attempts Among Pregnant and Postpartum Women in Japan: A Nationwide Retrospective Cohort Study.

Shigemi D, Ishimaru M, Matsui H, Fushimi K, Yasunaga H.  J Clin Psychiatry. 2020 May 5;81(3).

Among the 3,286 eligible patients (3,026 pregnant women and 260 postpartum women), 22 pregnant women and 16 postpartum women had attempted suicide. The prevalence of suicide attempts was significantly higher among postpartum women (6.2%) than among pregnant women (0.7%; P < .001). Postpartum patients were more likely to be aged 30 years or older and to have depression.


Detection of depressive-anxiety symptomatology and associated risk factors among pregnant women in a low-income neighborhood.

Gomà M, Martínez M, Blancafort X, Muniente G, Antón S, Lara S, Arias-Pujol E, Llairó A, Nanzer N.  J Psychosom Obstet Gynaecol. 2020 May 12:1-7. 

In a low-income neighborhood in Barcelona, Spain, nearly half (48%) of pregnant women presented an at-risk degree of anxiety-depressive symptomatology, double that found in the general population.


Perinatal depression screening practices in a large health system: identifying current state and assessing opportunities to provide more equitable care.

Sidebottom A, Vacquier M, LaRusso E, Erickson D, Hardeman R.  Arch Womens Ment Health. 2020 May 5. 

The sample included 7548 women who received prenatal care at 35 clinics and delivered at 10 hospitals. The postpartum sample included 7059 women who returned within 3 months for a postpartum visit. Of those, 65.1% were screened for depression during pregnancy, and 64.4% were screened postpartum. Clinic site was the strongest predictor of screening, accounting for 23-30% of the variability in screening prevalence. Several disparities were identified for postpartum screening. After adjusting for clinic, women who were African American, Asian, and otherwise non-white (Native American, multi-racial) were less likely to be screened postpartum than white women (AORs: 0.81, 0.64, and 0.44, respectively). Women insured by Medicaid/Medicare, a proxy for low-income, were less likely to be screened postpartum than women who were privately insured (AOR 0.78). 


Maternal antenatal mood and child development: an exploratory study of treatment effects on child outcomes up to 5 years.

Milgrom J, Holt CJ, Bleker LS, Holt C, Ross J, Ericksen J, Glover V, O’Donnell KJ, de Rooij SR, Gemmill AW.  J Dev Orig Health Dis. 2019 Apr;10(2):221-231.

In this very small study, treatment of depression during pregnancy showed significant benefits for children’s development at age 2, but not at age 5.

 

MEDICATIONS AND PREGNANCY

Impact of pregnancy on antidepressant treatment course: a population-based comparative cohort study in France.

Bénard-Laribière A, Pambrun E, Sutter-Dallay AL, Gautier S, Hurault-Delarue C, Damase-Michel C, Lacroix I, Pariente A.  Arch Womens Ment Health. 2020 May 12. 

Pregnant women were more likely to experience treatment modification, and especially to stop receiving it, compared with nonpregnant women (adjusted hazard ratio (aHR) 1.58; 95%CI, 1.51-1.62). Pregnant women who discontinued treatment had a 41% decreased incidence of antidepressant resumption compared with nonpregnant women (aHR 0.59; 95%CI, 0.56-0.62). 


Implementation of Advanced Methods for Reproductive Pharmacovigilance in Autism: A Meta-Analysis of the Effects of Prenatal Antidepressant Exposure.

Vega ML, Newport GC, Bozhdaraj D, Saltz SB, Nemeroff CB, Newport DJ.  Am J Psychiatry. 2020 May 7.

In this meta-analysis, neither psychiatric control nor discordant-sibling designs supported an association between prenatal antidepressant exposure and autism. Discordant-sibling designs effectively addressed surveillance bias in pharmacovigilance reports derived from national registries and other large databases.


Paternal antidepressant use as a negative control for maternal use: assessing familial confounding on gestational length and anxiety traits in offspring.

Cohen JM, Wood ME, Hernández-Díaz S, Ystrom E, Nordeng H.

Int J Epidemiol. 2019 Oct 1;48(5):1665-1672. Free Article

Antidepressants were used by 1.1% (n?=?755) of fathers. Paternal antidepressant use was not associated with gestational age at birth whereas it was positively associated with a child anxiety symptom Z-score and high anxiety symptoms (odds ratio 1.33, 95% CI 0.90, 1.97) in unadjusted analyses. While this association was attenuated when controlling for maternal and paternal history of depression and other measured factors, the findings of this study suggest familial confounding could explain the association between maternal use of antidepressants and anxiety traits in the offspring.


Use of real-world evidence from healthcare utilization data to evaluate drug safety during pregnancy.

Huybrechts KF, Bateman BT, Hernández-Díaz S.  Pharmacoepidemiol Drug Saf. 2019 Jul;28(7):906-922.

The approaches presented provide guidance regarding the important methodological considerations that need to be attended to in order to generate valid, minimally biased risk when using large healthcare utilization databases for drug safety surveillance in pregnancy.

 

POSTPARTUM PSYCHIATRIC ILLNESS

The association between labor epidural analgesia and postpartum depression: a systematic review and meta-analysis.

Almeida M, Kosman KA, Kendall MC, De Oliveira GS.  BMC Womens Health. 2020 May 11;20(1):99.   Free Article

Of the 148 studies available, 9 studies with 4442 patients were included in the analysis. The use of labor analgesia on positive depression screen compared to control revealed no significant effect, OR (95% CI) of 1.02 (0.62 to 1.66, P?=?0.94).  Based on current literature, the use of epidural analgesia for pain relief during labor doesn’t appear to affect the likelihood of postpartum depression. 


Maternal depressive symptoms during and after pregnancy are associated with poorer sleep quantity and quality and sleep disorders in 3.5-year-old offspring.

Toffol E, Lahti-Pulkkinen M, Lahti J, Lipsanen J, Heinonen K, Pesonen AK, Hämäläinen E, Kajantie E, Laivuori H, Villa PM, Räikkönen K.  Sleep Med. 2019 Apr;56:201-210. 

Children of mothers with clinically significant symptomatology throughout pregnancy had shorter mother-rated sleep duration, longer sleep latency, higher odds for waking up two or more times during the night and for total and several specific sleep disorders. 


Is There an Association Between Diet, Physical Activity and Depressive Symptoms in the Perinatal Period? An Analysis of the UPBEAT Cohort of Obese Pregnant Women.

  Wilson CA, Seed P, Flynn A, Howard LM, Molyneaux E, Sigurdardottir J, Poston L.  Matern Child Health J. 2020 Apr 30. 

Increased glycaemic load was associated with small increases in levels of depressive symptoms across the perinatal period. There was no evidence for an association between reduced physical activity and increased saturated fat intake and increased levels of depressive symptoms.


Machine Learning Models for the Prediction of Postpartum Depression: Application and Comparison Based on a Cohort Study.

Zhang W, Liu H, Silenzio VMB, Qiu P, Gong W.  JMIR Med Inform. 2020 Apr 30;8(4):e15516. Free Article

The study compared four different machine learning models using data during pregnancy to predict PPD and explored which factors in the model were the most important for the prediction of PPD.


The experiences of mothers with preterm infants within the first-year post discharge from NICU: social support, attachment and level of depressive symptoms.

Leahy-Warren P, Coleman C, Bradley R, Mulcahy H.  BMC Pregnancy Childbirth. 2020 Apr 29;20(1):260. Free Article

In women with premature infants admitted to the NICU, the prevalence of postpartum depression was 37.9% (95% CI: 29.8 to 46.4%). History of depression, older age (30-35), and lower levels of social supports were associated with more severe depressive symptoms.  


Altered Spontaneous Neural Activity in Peripartum Depression: A Resting-State Functional Magnetic Resonance Imaging Study.

Che K, Mao N, Li Y, Liu M, Ma H, Bai W, Xu X, Dong J, Li Y, Shi Y, Xie H. Front Psychol. 2020 Apr 8;11:656. Free Article

In women with postpartum depression, spontaneous neural activity was significantly increased mainly in the left middle frontal gyrus, left precuneus, left inferior parietal lobule, and left dorsolateral prefrontal cortex (DLPFC) and decreased mainly in the bilateral precentral gyrus and right inferior occipital gyrus compared to non-depressed healthy controls.

MEDICATIONS AND BREASTFEEDING

No articles this week

 

PERINATAL SUBSTANCE USE

No articles this week

 

MATERNAL MENTAL HEALTH AND CHILD OUTCOMES

Maternal perinatal depressive symptoms and offspring psychotic experiences at 18 years of age: a longitudinal study.

Srinivasan R, Pearson RM, Johnson S, Lewis G, Lewis G.  Lancet Psychiatry. 2020 May;7(5):431-440. Free Article

Maternal antenatal depressive symptoms were associated with offspring psychotic experiences at 18 years of age, with an unadjusted odds ratio (OR) of 1·38 (95% CI 1·18-1·61, p=0·0001) and after adjustment for confounders, an OR of 1·26 (1·06-1·49, p=0·0074).

 

MENOPAUSE AND MENTAL HEALTH

No articles this week

 

OTHER TOPICS IN WOMEN’S MENTAL HEALTH

No articles this week