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. 

Two studies in this collection look at the psychological impact of COVID-19 pandemic on pregnant women: one from China and the other from Quebec, Canada.  Not surprisingly, women experienced higher levels of anxiety than women who were assessed before the pandemic.  We will be discussing this article in greater detail next week.  

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


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The feasibility of acupuncture as an adjunct intervention for antenatal depression: a pragmatic randomised controlled trial.

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Ormsby SM, Hannah CA, et al.  J Affect Disord, May 2020.

Fifty-seven pregnant women with depressive symptoms were randomised to acupuncture (n=19) plus treatment as usual (TAU), progressive muscle relaxation (PMR, n=19) plus TAU or only TAU (n=19). At the end of the intervention, there were significantly lower depression scores in the acupuncture group compared to PMR and TAU.  However, there were no differences between the three groups at six months postpartum.

Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study.

Farren J, Jalmbrant M, Falconieri N, Mitchell-Jones N, Bobdiwala S, Al-Memar M, Tapp S, Van Calster B, Wynants L, Timmerman D, Bourne T.  Am J Obstet Gynecol. 2020 Apr;222(4):367.

In this prospective study, women were recruited after early pregnancy loss and were followed prospectively.  A control group of women who had not experienced a pregnancy loss were recruited from the same clinic.  Participants completed the Hospital Anxiety and Depression Scale and Posttraumatic stress Diagnostic Scale, at 1, 3, and 9 months after the loss. Among women who had experienced a loss, 29% met criteria for posttraumatic stress after 1 month and 18% after 9 months.  Moderate/severe anxiety was reported in 24% after 1 month and in 17% after 9 months. Moderate/severe depression was reported in 11% of the women after 1 month and 6% of the women after 9 months.  

The impact of obesity on pregnancy outcomes among women with psychiatric disorders: Results from a prospective pregnancy registry.

Freeman MP, Goez-Mogollon L, Sosinsky AZ, Church TR, McElheny SA, Viguera AC, Cohen LS.  J Psychosom Res. 2019 Aug.  

In a sample of 584 participants (N?=?252 normal-weight; N?=?170 overweight; N?=?162 obese), obesity was not significantly associated with higher risk for birth defects. After adjusting for potential confounders, women with obesity were at higher risk for gestational diabetes (OR:3.23; 95% CI:1.30,7.98), as were women in the overweight BMI category (OR:3.77; 95% CI:1.58,9.00). Among women with obesity, there was a tendency for a higher C-section rate (p?=?0.07) compared to women in the normal-weight BMI category.

Uptrend in distress and psychiatric symptomatology in pregnant women during the COVID-19 pandemic.

Berthelot N, Lemieux R, Garon-Bissonnette J, Drouin-Maziade C, Martel É, Maziade M. Acta Obstet Gynecol Scand. 2020 May 25.

Pregnant women assessed during the COVID-19 pandemic reported more distress and psychiatric symptoms than pregnant women assessed before the pandemic, mainly in the form of depression and anxiety symptoms. 

Perinatal depressive and anxiety symptoms of pregnant women along with COVID-19 outbreak in China.

Wu Y, Zhang C, Liu H, Duan C, Li C, Fan J, Li H, Chen L, Xu H, Li X, Guo Y, Wang Y, Li X, Li J, Zhang T, You Y, Li H, Yang S, Tao X, Xu Y, Lao H, Wen M, Zhou Y, Wang J, Chen Y, Meng D, Zhai J, Ye Y, Zhong Q, Yang X, Zhang D, Zhang J, Wu X, Chen W, Dennis CL, Huang H.  Am J Obstet Gynecol. 2020 May 10. Free Article

A total of 4124 pregnant women from 25 hospitals in 10 provinces across China were screened for depression using the EPDS during their third trimester in  a cross-sectional study between January 1 and February 9, 2020.  In this cohort, 1285 were assessed after January 20, 2020 when the coronavirus epidemic was publicly declared, and 2839 were assessed before this time point.  A clinically significant rise in 288 the prevalence of depressive symptoms was found among pregnant women increasing 289 from 26% before January 20 to 34.2% between February 5 to 9, 2020. A significant 290 increase in anxiety symptoms was also found. 

Prenatal maternal C-reactive protein prospectively predicts child executive functioning at ages 4-6 years.

Morgan JE, Lee SS, Mahrer NE, Guardino CM, Davis EP, Shalowitz MU, Ramey SL, Dunkel Schetter C.  Dev Psychobiol. 2020 May 22.

Higher maternal C- reactive protein (CRP), a biomarker of inflammation, but not maternal hemoglobin A1C (a marker of glucose control) or blood pressure, uniquely predicted poorer child cognitive flexibility, even after controlling for relevant demographic factors, and multiple prenatal/perinatal covariates (i.e. preconception maternal body mass index, maternal depression, maternal age at birth, child birth weight, child birth order, child gestational age, and child birth/neonatal complications).  Third trimester maternal CRP robustly predicted child cognitive flexibility independently of preconception and second trimester CRP

Prevalence of Prenatal Depression Among Pregnant Women and the Importance of Resilience: A Multi-Site Questionnaire-Based Survey in Mainland China.

Zhang L, Yang X, Zhao J, Zhang W, Cui C, Yang F, Ma R, Jia Y.  Front Psychiatry. 2020 May 6;11:374. Free Article

The prevalence of prenatal depression (CES-D ? 16) among Chinese pregnant women was 28.4%.  Prenatal depression was  associated with worries about appearance (odds ratio [OR] 1.666, 95% confidence interval [CI] 1.043-2.661) and perceived stress (OR 1.156, 95% CI 1.104-1.211) and negatively associated with monthly income, relationship with mother (OR 0.287, 95% CI 0.103-0.796), and resilience (OR 0.935, 95% CI 0.918-0.953).

Positive screening rates for bipolar disorder in pregnant and postpartum women and associated risk factors.

Masters GA, Brenckle L, Sankaran P, Person SD, Allison J, Moore Simas TA, Ko JY, Robbins CL, Marsh W, Byatt N.  Gen Hosp Psychiatry. 2019 Nov – Dec;61:53-59.

Women were recruited during pregnancy and followed through three months postpartum from 14 obstetric clinics in Massachusetts. The Mood Disorder Questionnaire (MDQ) was used to screen for bipolar disorder; out of 574 participating women, 18.8% screened positive for bipolar disorder.  Less than half of those with positive bipolar screens (42.0%) and 61.3% with pre-existing bipolar reported receiving psychiatric care during the follow up period.

Association of Antenatal Depression with Clinical Subtypes of Preterm Birth.

Venkatesh KK, Ferguson KK, Smith NA, Cantonwine DE, McElrath TF.  Am J Perinatol. 2019 May;36(6):567-573.

Women with an SPTB (spontaneous labor, preterm premature rupture of membranes, placental abruption, and cervical shortening) were three times more likely to have antenatal depression compared with women without an SPTB (adjusted odds ratio [AOR]: 2.81; 95% confidence interval [CI]: 1.40-5.63).

Psychometric aspects of the Tilburg Pregnancy Distress Scale: data from the HAPPY study.

Boekhorst MGBM, Beerthuizen A, Van Son M, Bergink V, Pop VJM.  Arch Womens Ment Health. 2020 Apr;23(2):215-219.


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Peritraumatic dissociation in childbirth-evoked posttraumatic stress and postpartum mental health.

Thiel F, Dekel S.  Arch Womens Ment Health. 2020 Apr;23(2):189-197. 

Women who had assisted vaginal deliveries or unscheduled Cesareans reported higher peritraumatic dissociation levels than those who had regular vaginal deliveries or scheduled Cesareans. Peritraumatic dissociation predicted postpartum PTSD above and beyond premorbid and other childbirth-related factors.

A pilot study of a group-based perinatal depression intervention on reducing depressive symptoms and improving maternal-fetal attachment and maternal sensitivity.

Alhusen JL, Hayat MJ, Borg L. Arch Womens Ment Health. 2020 May 15. 

60 pregnant women with moderate to severe depressive symptomatology were randomized to a 6-week intervention or usual care group.  At 12 weeks postpartum, participants randomized to the intervention group had an 8.32-point decrease from baseline on the Edinburgh Postnatal Depression Scale (EPDS) as compared to a 4.59-point decrease among participants randomized to usual care.

Effect of Dialectical Behavioral Therapy on the Postpartum Depression, Perceived Stress and Mental Coping Strategies in Traumatic Childbirth: A Randomized Controlled Trial.

Dialectical behavioral therapy can have substantial effects on reducing postpartum depression, reducing perceived stress levels, and increasing the ability to deal with stress in traumatic childbirth.

A brief sleep focused psychoeducation program for sleep-related outcomes in new mothers: A randomised controlled trial.

Kempler L, Sharpe LA, Marshall NS, Bartlett DJ.  Sleep. 2020 May 26.

Prenatal sleep psychoeducation did not produce a sustained effect on maternal sleep throughout the postpartum period. There was little evidence of benefits on depressive symptoms.


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Maternal emotions during the pre/postnatal periods and children’s sleep behaviors: The mediating role of children’s behavior.

Liu J, Ji X, Wang G, Li Y, Leung PW, Pinto-Martin J.  J Affect Disord. 2020 Apr 24;273:138-145.

Maternal depressive emotions during pre- and postnatal periods were associated with an increase in children’s sleep problems (assessed at mean age = 5.74 ± 0.48 years), while increased happiness during pregnancy was associated with a decrease in children’s sleep problems. Children’s behavioral problems significantly mediated these relationships.


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