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 this week discuss peripartum post-traumatic stress disorder.  While OB-GYNs have become more comfortable with the diagnosis and management of postpartum depression, Canfield and colleagues argue that few obstetric providers are aware of PTSD in the context of child-bearing and call for greater attention to this topic.  Dekel et al present data on how childbirth stressors, including obstetric complications and peritraumatic distress in birth, increase the likelihood of developing comorbid childbirth-related PTSD and postpartum depression.

And in a more theoretical article, Witteveen and colleagues discuss how endogenous and exogenous oxytocin may modulate vulnerability to peripartum PTSD.

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



Short report: cognitive behavioral therapy – a primary mode for premenstrual syndrome management: systematic literature review.

Kancheva Landolt N, Ivanov K.  Psychol Health Med. 2020 Aug 26:1-12.

All 32 identified studies found a significant reduction in PMS to complete remission with nonpharmacological interventions. 



Is in vitro fertilization (IVF) associated with perinatal affective disorders?

Capuzzi E, Caldiroli A, Ciscato V, Zanvit FG, Bollati V, Barkin JL, Clerici M, Buoli M.  J Affect Disord. 2020 Aug 13;277:271-278.

Summarizing the findings of ten studies, this group found inconsistencies; however, it does not appear that IVF is associated with increased risk for depression or anxiety.



Effect of supervised group exercise on psychological well-being among pregnant women with or at high risk of depression (the EWE Study): a randomized controlled trial.

Broberg L, Tabor A, Rosthøj S, Backhausen M, Frokjaer VG, Damm P, Hegaard HK. Acta Obstet Gynecol Scand. 2020 Aug 30.

Supervised group exercise did not improve psychological well-being for women with or at high risk of depression at 29-34 weeks of gestation; however, at 8 weeks postpartum, the intervention group reported significantly higher psychological well-being than the control group.

Effects of psychological stress on adverse pregnancy outcomes and non-pharmacologic approaches for reduction: an expert review.

Traylor CS, Johnson J, Kimmel MC, Manuck TA.  Am J Obstet Gynecol MFM. 2020 Sep 24:100229.

Mindfulness meditation and biofeedback have shown effectiveness in improving one’s mental health, such as depressive symptoms and anxiety. Exercise, including yoga, may improve both depressive symptoms and birth outcomes. Expressive writing has successfully been applied postpartum and in response to pregnancy challenges. 

Effectiveness of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal: a cluster randomised trial in Pakistan.

Maselko J, Sikander S, Turner EL, Bates LM, Ahmad I, Atif N, Baranov V, Bhalotra S, Bibi A, Bibi T, Bilal S, Biroli P, Chung E, Gallis JA, Hagaman A, Jamil A, LeMasters K, O’Donnell K, Scherer E, Sharif M, Waqas A, Zaidi A, Zulfiqar S, Rahman A.  Lancet Psychiatry. 2020 Sep;7(9):775-787.

Effectiveness of an intervention for perinatal depression: challenges in task shifting to peer volunteers.

Herba CM, Tariq M.  Lancet Psychiatry. 2020 Sep;7(9):725-726.

Effectiveness of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal: a cluster randomised trial in Pakistan.

Maselko J, Sikander S, Turner EL, Bates LM, Ahmad I, Atif N, Baranov V, Bhalotra S, Bibi A, Bibi T, Bilal S, Biroli P, Chung E, Gallis JA, Hagaman A, Jamil A, LeMasters K, O’Donnell K, Scherer E, Sharif M, Waqas A, Zaidi A, Zulfiqar S, Rahman A.  Lancet Psychiatry. 2020 Sep;7(9):775-787.

Reduced symptom severity and high remission rates were seen across both the intervention and enhanced usual care groups, possibly masking any effects of the intervention.

The role of clock genes in perinatal depression: the light in the darkness.

Buoli M, Grassi S, Iodice S, Carnevali GS, Esposito CM, Tarantini L, Barkin JL, Bollati V.  Acta Psychiatr Scand. 2019 Oct;140(4):382-384.

A transdiagnostic approach to conceptualizing depression across the perinatal period in a high-risk sample.

Cochran AL, Pingeton BC, Goodman SH, Laurent H, Rathouz PJ, Newport DJ, Stowe ZN.

J Abnorm Psychol. 2020 Aug 27.



No articles this week



Detection and Prevention of Postpartum Posttraumatic Stress Disorder: A Call to Action.

Canfield D, Silver RM.  Obstet Gynecol. 2020 Oct 8.

The oxytocinergic system in PTSD following traumatic childbirth: endogenous and exogenous oxytocin in the peripartum period.

Witteveen AB, Stramrood CAI, Henrichs J, Flanagan JC, van Pampus MG, Olff M.  Arch Womens Ment Health. 2020 Jun;23(3):317-329. 

Observational and experimental studies into the role of the endogenous and exogenous oxytocinergic system in postpartum PTSD are needed and should explore individual and situational circumstances, including level of acute distress, intrapartum exogenous OT exposure, or history of childhood trauma.

Interactive Effects of Infant Gestational Age and Infant Fussiness on the Risk of Maternal Depressive Symptoms in a Nationally Representative Sample.

Quist M, Kaciroti N, Poehlmann-Tynan J, Weeks HM, Asta K, Singh P, Shah PE.  Acad Pediatr. 2019 Nov-Dec;19(8):917-924.

Mothers of mid to late preterm and full-term infants with fussiness had increased odds of moderate-severe depressive symptoms, and mothers of very preterm infants with fussiness had increased risk of mild symptoms.

Maternal Obesity and Perinatal Depression: An Updated Literature Review.

Pavlik LB, Rosculet K.  Cureus. 2020 Sep 30;12(9):e10736. 

Of the seven articles, five demonstrated an association between some level of maternal obesity and increased risk of perinatal depressive symptoms. The two remaining articles did initially find an association, but it was no longer significant after adjusting for or mediating the analysis with covariates.

Beyond postpartum depression: posttraumatic stress-depressive response following childbirth.

Dekel S, Ein-Dor T, Dishy GA, Mayopoulos PA.  Arch Womens Ment Health. 2020 Aug;23(4):557-564.

Childbirth stressors, including obstetric complications and peritraumatic distress in birth, predicted the likelihood of developing comorbid childbirth-related PTSD and postpartum depression, but not depression alone.

Precarious working conditions and psychosocial work stress act as a risk factor for symptoms of postpartum depression during maternity leave: results from a longitudinal cohort study.

Karl M, Schaber R, Kress V, Kopp M, Martini J, Weidner K, Garthus-Niegel S.  BMC Public Health. 2020 Oct 6;20(1):1505. Free article.

Psychosocial work stress and precarious working conditions have important implications for maternal peripartum mental health. They might act as prospective risk factors for PPD during the period of maternal leave.

A meta-synthesis of women’s experiences of online forums for maternal mental illness and stigma.

Moore D, Drey N, Ayers S.  Arch Womens Ment Health. 2020 Aug;23(4):507-515.

The synthesis identified four key themes: (1) a safe place to talk; (2) virtual support; (3) stigma and identity; and (4) repair of the mother identity. Stigma maybe reduced by forum discourse that reconceptualizes what is to be a “good mother” and separates stigma and maternal identity.

A model of risk for perinatal posttraumatic stress symptoms.

Grekin R, O’Hara MW, Brock RL.  Arch Womens Ment Health. 2020 Sep 30.

This study emphasizes the importance of fear of childbirth and subjective and objective birthing experiences in predicting postpartum psychopathology.

The impact of childhood trauma on psychological interventions for depression during pregnancy and postpartum: a systematic review.

Reuveni I, Lauria M, Monk C, Werner E.  Arch Womens Ment Health. 2020 Oct 10.  Review.

Results suggest that IPT-based interventions are beneficial for women with childhood trauma. The evidence regarding CBT-based interventions is less conclusive.

The Koukopoulos mixed depression rating scale (KMDRS) and the assessment of mixed symptoms during the perinatal period.

Koukopoulos AE, De Chiara L, Simonetti A, Kotzalidis GD, Janiri D, Manfredi G, Angeletti G, Sani G.  J Affect Disord. 2020 Sep 1.

The KMDRS is fit for investigating MxD in perinatal women with a MDE.

Development and validation of a machine learning algorithm for predicting the risk of postpartum depression among pregnant women.

Zhang Y, Wang S, Hermann A, Joly R, Pathak J.  J Affect Disord. 2020 Sep 30;279:1-8.

Electronic health records and machine learning offer the ability to identify women at risk for PPD early in their pregnancy.

Maternal and Infant Performance on the Face-to-Face Still-Face Task following Maternal Cognitive Behavioral Therapy for Postpartum Depression.

Ntow KO, Krzeczkowski JE, Amani B, Savoy CD, Schmidt LA, Van Lieshout RJ.  J Affect Disord. 2020 Sep 29;278:583-591.

Three months after group CBT for PPD, infants‘ withdrawn behavior appears to normalize to levels seen in the infants of healthy controls.

The role of interpersonal emotional regulation on maternal mental health.

Coo S, García MI, Prieto F, Medina F.  J Reprod Infant Psychol. 2020 Oct 3:1-19.

Strategies including modulating the emotional response, situation modification, attentional deployment and cognitive change, modified the association between poor regulation strategies and anxiety symptoms.

Association between neonatal homecare for preterm infants and incidence of severe postpartum depression in mothers.

Andersen KSH, Holm KG, Nordentoft M, Hjorthøj C.  J Affect Disord. 2020 Sep 28;278:453-459. 

Researchers observed an association between the implementation of neonatal homecare and a 23 % reduced incidence rate of severe postpartum depression among mothers of preterm infants.

Unintended pregnancy and postpartum depression: A meta-analysis of cohort and case-control studies.

Qiu X, Zhang S, Sun X, Li H, Wang D.  J Psychosom Res. 2020 Nov;138:110259. 

Women who get pregnant unintendedly compared with those who are intending to be pregnant were at a significantly higher risk of developing PPD (odds ratio [OR] = 1.53; 95% confidence interval [CI]: 1.35-1.74; P < 0.00001).



No articles this week



No articles this week



Intimate partner violence, maternal depression, and pathways to children’s language ability at 10 years.

Conway LJ, Cook F, Cahir P, Mensah F, Reilly S, Brown S, Gartland D, Giallo R.  J Fam Psychol. 2020 Oct 8.

maternal depressive symptoms at 4 years postpartum may be an important mechanism by which exposure to IPV and maternal depressive symptoms in the child’s 1st year is associated with poorer language at age 10.

Maternal Depression in Early Childhood and Developmental Vulnerability at School Entry.

Wall-Wieler E, Roos LL, Gotlib IH.  Pediatrics. 2020 Sep;146(3):e20200794.

Children exposed to maternal depression before age 5 had a 17% higher risk of having at least 1 developmental vulnerability at school entry than did children not exposed to maternal depression before age 5.

Maternal prenatal stress and postnatal depressive symptoms: discrepancy between mother and teacher reports of toddler psychological problems.

Wesselhoeft R, Davidsen K, Sibbersen C, Kyhl H, Talati A, Andersen MS, Bilenberg N.  Soc Psychiatry Psychiatr Epidemiol. 2020 Sep 29. 

Prenatal maternal stress was a significant predictor of both mother and teacher reported toddler emotional and behavioral problems, although effect sizes were small. Postnatal depressive symptoms were associated with increased maternal (but not teacher) reporting of toddler problems. Mothers reported more toddler psychological problems than teachers, and the mother-teacher discrepancy was positively correlated to maternal postnatal depressive symptoms.



No articles this week



No articles this week



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