Several articles on this week’s list look at adverse childhood experiences or ACEs in the mother and their impact on her offspring. Experiencing adversity in childhood is associated with negative health and mental health sequelae which persist into adulthood. There is now increasing data to indicate that maternal childhood adversity can negatively impact a woman’s children.
Racine and colleagues observe that ACEs increase a woman’s vulnerability to both depression during pregnancy and postpartum depression. A second study observed that maternal ACEs indirectly were associated with children’s externalizing problems via maternal attachment avoidance, attachment anxiety, and depression (Cooke et al, 2019). A direct effect was also observed from maternal ACEs to child externalizing problems.
While we screen for depressive symptoms in pregnancy and the postpartum period, these studies indicate that a consideration of maternal ACEs may help to identify women who are most vulnerable to perinatal depression and subsequent parenting problems.
Ruta Nonacs, MD PhD
PMS AND PMDD
|No articles this week|
INFERTILITY AND MENTAL HEALTH
|Psychological health of women who have conceived using assisted reproductive technology in Taiwan: findings from a longitudinal study.|
Huang MZ, Kao CH, Lin KC, Hwang JL, Puthussery S, Gau ML. BMC Womens Health. 2019 Jul 12;19(1):97. Free Article
Levels of anxiety and depression were highest during the first trimester. After the first trimester, anxiety scores decreased and remained stable through the remainder of pregnancy but increased at two-months postpartum. Depression scores showed a similar pattern, declining in the second and third trimesters and then increasing at two-months postpartum.
PSYCHIATRIC ILLNESS DURING PREGNANCY
|Stress-related sleep reactivity is associated with insomnia, psychopathology and suicidality in pregnant women: preliminary results.|
Palagini L, Cipollone G, Masci I, Novi M, Caruso D, Kalmbach DA, Drake CL. Sleep Med. 2019 Apr;56:145-150.
Pregnant women with high stress-related sleep reactivity, relative to those with low reactivity, reported greater symptoms of insomnia, as well as higher rates of depression (62.0% vs 6.1%, p < 0.001), anxiety (55.1% vs 15.1%, p = 0.030), and suicidality (17.2% vs 3.0%, p = 0.025).
MEDICATIONS AND PREGNANCY
|No articles this week|
POSTPARTUM PSYCHIATRIC ILLNESS
|Perinatal depression: The role of maternal adverse childhood experiences and social support.|
Racine N, Zumwalt K, McDonald S, Tough S, Madigan S. J Affect Disord. 2019 Nov 10.
ACEs predicted depressive symptoms in pregnancy (AOR = =1.26, CI = =1.12-1.43), the postpartum period (AOR = =1.34, CI = =1.17-1.52), and across the perinatal period (AOR = =1.31, CI = =1.12-1.54). Low social support predicted the highest odds of depression.
MEDICATIONS AND BREASTFEEDING
|No articles this week|
PERINATAL SUBSTANCE USE DISORDERS
|Prenatal exposure to tobacco and marijuana and child autonomic regulation and reactivity: An analysis of indirect pathways via maternal psychopathology and parenting.|
Schuetze P, Zhao J, Eiden RD, Shisler S, Huestis MA. Dev Psychobiol. 2019 Nov;61(7):1022-1034.
Participants were 247 dyads (81 PTE, 97 PTME, and 69 nonexposed) who were followed up at 2 (N = 247) and 16 months (N = 238) of child age. Researchers observed an indirect association between prenatal tobacco and marijuana exposure and autonomic functioning during the second year of life, which was mediated by harsh parenting during caregiver-infant interactions.
MATERNAL MENTAL HEALTH AND CHILD OUTCOMES
|Prenatal Developmental Origins of Future Psychopathology: Mechanisms and Pathways.|
Monk C, Lugo-Candelas C, Trumpff C. Annu Rev Clin Psychol. 2019 May 7;15:317-344.
This article reviews several biological systems hypothesized to be mechanisms by which maternal distress affects fetal and child brain and behavior development, as well as the clinical implications of studies of the developmental origins of health and disease that focus on maternal distress.
Mac Giollabhui N, Breen EC, Murphy SK, Maxwell SD, Cohn BA, Krigbaum NY, Cirillo PM, Perez C, Alloy LB, Drabick DAG, Ellman LM. J Psychiatr Res. 2019 Apr;111:96-103.
Elevated maternal inflammation during pregnancy is associated with the emergence of separate psychological phenotypes in the offspring. Elevated IL-8 in the first trimester was associated with significantly higher levels of externalizing symptoms in offspring. Higher IL-1 in the second trimester was associated with higher offspring internalizing symptoms. Further, second trimester IL-1 was associated with increased internalizing symptoms in females only.
Luoma I, Korhonen M, Puura K, Salmelin RK.Psychol Health Med. 2019 Jul;24(6):667-679.
Some 34-38% of the mothers reported loneliness at the different study points. Maternal loneliness showed associations with dissatisfaction with life and the pair relationship, and with the presence of depressive symptoms. The mother’s prenatal loneliness predicted the child’s internalizing problems in adolescence.
Hannigan LJ, Eilertsen EM, Gjerde LC, Reichborn-Kjennerud T, Eley TC, Rijsdijk FV, Ystrom E, McAdams TA. Lancet Psychiatry. 2018 Oct;5(10):808-815.
Prenatal depressive symptoms were found to be associated with early-life psychopathology primarily via intergenerationally shared genetic factors, which explained 41% (95% CI 36-46) of variance in children’s internalising problems and 37% (30-44) of variance in children’s externalising problems.
Priel A, Djalovski A, Zagoory-Sharon O, Feldman R. J Child Psychol Psychiatry. 2019 Jan;60(1):30-42.
Maternal depression continues to play a role in children’s development beyond infancy. The mediating effects of oxytocin and synchronous, mutually regulated interactions underscore the role of plasticity in resilience.
Nawa N, Black MM, Araya R, Richiardi L, Surkan PJ. J Affect Disord. 2019 Oct 1;257:136-142.
Maternal anxiety around childbirth was associated with modest increases in child BMI gain during the child’s second year of life.
MENOPAUSE AND MENTAL HEALTH
|No articles this week|
OTHER TOPICS IN WOMEN’S MENTAL HEALTH
|Adverse Childhood Experiences: Implications for Offspring Telomere Length and Psychopathology.|
Esteves KC, Jones CW, Wade M, Callerame K, Smith AK, Theall KP, Drury SS. Am J Psychiatry. 2019 Sep 6.
Within an individual, telomere length (TL) is an established marker of cellular stress and aging and is associated with both exposure to adverse childhood events (ACE) and psychopathology. Higher maternal ACEs were associated with shorter infant telomere length (TL) across infancy and higher infant externalizing behavioral problems at 18 months. In infants whose mothers reported higher scores on the Adverse Childhood Experience questionnaire, greater telomere attrition predicted higher externalizing problems, even when accounting for maternal postnatal depression and prenatal stress.
Cooke JE, Racine N, Plamondon A, Tough S, Madigan S. Child Abuse Negl. 2019 Jul;93:27-37.
Maternal ACEs indirectly predicted children’s externalizing problems via maternal attachment avoidance, attachment anxiety, and depression. A direct effect was also observed from maternal ACEs to child externalizing problems.
Young CA, Burnett H, Ballinger A, Castro G, Steinberg S, Nau M, Bakken EH, Thomas M, Beck AL. Acad Pediatr. 2019 Nov – Dec;19(8):934-941.
Five major themes emerged: 1) barriers to maternal mental health care, including psychiatric symptoms impairing access, stigma, and fear of Child Protective Services; 2) benefits of embedded care, including convenience, low barrier to entry and trust; 3) motherhood as facilitator to care, with early motherhood described as a time of vulnerability to relapse; 4) focus on parenting, including appreciation for parenting skills and normalization of the mothering experience; 5) treatment modality preferences, including concerns about medications and a preference for psychotherapy.