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. 

Over the years, we have seen multiple studies which have demonstrated the impact of maternal depressive symptoms on children’s development and behavior.  It has been more difficult to quantify the impact of exposure to maternal stress and depression during pregnancy; however, we have seen a fair number of recent studies looking at the impact of maternal symptoms on the structure of the brain.  Goodman and colleagues observe that children exposed to depression during pregnancy (but not during the postpartum period) have an asymmetry of the EEG which persists at least up until one year of age.  Lautarescu and colleagues observe that in children born prematurely, antenatal stress is associated with changes in the development of cortical-limbic pathways.  While it is not fully understood what these structural changes signify, it has been postulated that these changes are associated with increased risk for psychopathology later in childhood.  

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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Feasibility, Acceptability, and Preliminary Effects of “Mindful Moms”- a Mindful Physical Activity Intervention for Pregnant Women with Depression.

Kinser PA, Thacker LR, Rider A, Moyer S, Amstadter AB, Mazzeo SE, Bodnar-Deren S, Starkweather A.  Nurs Res. 2020 Oct 17. 

“Mindful Moms” participants experienced decreases in depressive symptoms, perceived stress, anxiety, and ruminations. However, this study did not include a control group.

Prevalence of maternal antenatal and postnatal depression and their association with sociodemographic and socioeconomic factors: A multicentre study in Italy.

Cena L, Mirabella F, Palumbo G, Gigantesco A, Trainini A, Stefana A.

J Affect Disord. 2020 Oct 7;279:217-221. Free Article.

In this study from Italy, high economic status was associated with an approximate fivefold reduction in odds of depression in the antenatal period (ORa: 0.23, 95%CI: 0.10-0.54) and about a sixfold reduction in the postnatal period (ORa: 0.15, 95%CI: 0.05-0.45).

Association between hyperemesis gravidarum and psychological symptoms, psychosocial outcomes and infant bonding: a two-point prospective case-control multicentre survey study in an inner city setting.

Mitchell-Jones N, Lawson K, Bobdiwala S, Farren JA, Tobias A, Bourne T, Bottomley C.  BMJ Open. 2020 Oct 13;10(10):e039715. Free Article.

During pregnancy, 49% of women with hyperemesis gravidarum (HG) had probable depression compared with 6% of controls (OR 14.4 (5.29 to 39.44)). During the postpartum period, 29% of women with HG had probable depression versus 7% of controls (OR 5.2 (1.65 to 17.21)). There was no direct association between HG and infant bonding. 



Selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitors (SNRI) and epidemiological characteristics associated with prenatal diagnosis of congenital heart disease.

Melov SJ, Shetty PS, Pasupathy D, Kirby A, Sholler GF, Winlaw DS, Alahakoon TI. Prenat Diagn. 2020 Oct 17.

In this study from Australia, exposure factors were compared in 70,842 general obstetric patients and 470 obstetric patients with a fetus affected by congenital herat disease (CHD). Multivariate analysis showed independent associations between CHD and use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) in the first trimester (relative risk [RR] 4.14, 95% CI 2.58-6.65), history of anxiety or mood disorder with no SSRI/SNRI in the first trimester (RR 2.26, 95% CI 1.82-2.82), folate and/or pregnancy multivitamin use in the first trimester (RR 0.68, 95% CI 0.54-0.86) and increased risk with maternal age >40 years (RR 2.30, 95% CI 1.57-3.38).

Gestational Exposure to Serotonin Reuptake Inhibitors and Pregnancy Outcome ; Exploring the Role of Bias and Confounders.

Koren G, Ornoy A.  Curr Neuropharmacol. 2020 Oct 15. 

Gabapentin in pregnancy and the risk of adverse neonatal and maternal outcomes: A population-based cohort study nested in the US Medicaid Analytic eXtract dataset.

Patorno E, Hernandez-Diaz S, Huybrechts KF, Desai RJ, Cohen JM, Mogun H, Bateman BT.  PLoS Med. 2020 Sep 1;17(9):e1003322. Free Article.

Using the Medicaid Analytic eXtract (MAX) dataset, researchers identified 4,642 pregnancies exposed during the first trimester of pregnancy (mean age = 28 years; 69% white).  The reference group consisted of 1,744,447 unexposed pregnancies (24 years; 40% white). The adjusted RR for major malformations was 1.07 (95% CI 0.94-1.21, p = 0.33) and for cardiac defects 1.12 (0.89-1.40, p = 0.35).  When looking at women who received ?2 gabapentin dispensings, the RR for cardiac defects increased slightly to 1.40 (1.03-1.90, p = 0.03). 


Effects of prenatal mindfulness-based childbirth education on child-bearers’ trajectories of distress: a randomized control trial.

Sbrilli MD, Duncan LG, Laurent HK.  BMC Pregnancy Childbirth. 2020 Oct 15;20(1):623.  Free Article.

This study provides preliminary evidence for durable perinatal mental health benefits following a brief mindfulness-based childbirth preparation program and suggests further investigation of these effects in larger samples is warranted.

5HTTLPR polymorphism and postpartum depression risk: A meta-analysis.

Li J, Chen Y, Xiang Q, Xiang J, Tang Y, Tang L.  Medicine (Baltimore). 2020 Sep 25;99(39). Free Article.

This meta-analysis of six studies with 519 cases and 737 controls suggests that certain 5-HTTLPR polymorphisms may be associated with a decreased risk for PPD.



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Cost-effectiveness of electronic- and clinician-delivered screening, brief intervention and referral to treatment for women in reproductive health centers.

Olmstead TA, Yonkers KA, Ondersma SJ, Forray A, Gilstad-Hayden K, Martino S.  Addiction. 2019 Sep;114(9):1659-1669.

Electronically delivered-SBIRT could be a cost-effective approach, from both health-care provider and patient perspectives, for use in reproductive health centers to help women reduce substance misuse.



Consistency of EEG asymmetry patterns in infants of depressed mothers.

Goodman SH, Liu R, Lusby CM, Park JS, Bell MA, Newport DJ, Stowe ZN.

Dev Psychobiol. 2020 Oct 16.

Mothers’ prenatal depression symptom levels (not postpartum or concurrent) were associated with infants having consistent right, rather than left, frontal EEG asymmetry at 12 months of age, even after controlling for infants’ observed affect. 

Maternal Prenatal Stress Is Associated With Altered Uncinate Fasciculus Microstructure in Premature Neonates.

Lautarescu A, Pecheva D, Nosarti C, Nihouarn J, Zhang H, Victor S, Craig M, Edwards AD, Counsell SJ.  Biol Psychiatry. 2020 Mar 15;87(6):559-569. PMID: 31604519 Free Article.

Maternal prenatal stress exposure IS associated with altered development of specific frontolimbic pathways in preterm neonates.



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Preterm Birth Is Associated With Depression From Childhood to Early Adulthood.

Upadhyaya S, Sourander A, Luntamo T, Matinolli HM, Chudal R, Hinkka-Yli-Salomäki S, Filatova S, Cheslack-Postava K, Sucksdorff M, Gissler M, Brown AS, Lehtonen L.  J Am Acad Child Adolesc Psychiatry. 2020 Oct 14:

Increased risk of depression was found in children born ? 25 weeks (1.89, 1.08-3.31), at 26 weeks (2.62, 1.49-4.61), at 27 weeks (1.93, 1.05-3.53) and ? 42 weeks (1.11, 1.05-1.19). In girls, extremely preterm birth was associated with depression diagnosed at 5 to 12 years (2.70, 1.83-3.98) and 13 to 18 years (2.97, 1.84-4.78). In boys, post-term birth (?42 weeks) was associated with depression diagnosed at 19 to 25 years (1.28, 1.07-1.54).

High progesterone levels facilitate women’s social information processing by optimizing attention allocation.

Wang J, Chen A.  Psychoneuroendocrinology. 2020 Sep 24.