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. 

We are seeing an increased number of articles looking at the impact of the COVID-19 pandemic on the mental health of pregnant and postpartum women and their families.  Interestingly, the studies show a variety of findings.  Farrell and colleagues observed higher rates of anxiety and depression in an obstetric sample of women from Qatar.  On the other hand, in a study from China (Zhou et al, 2020), pregnant women experienced much lower levels of anxiety, depression, and insomnia than non-pregnant women.   And in a third study carried out in Hanover, New Hampshire, Thayer and colleagues noted that 24% of women had clinically significant depressive symptoms which strongly associated with financial distress.  

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



No articles this week



No articles this week



Association between maternal antenatal depression and neonatal Apgar score: A systematic review and meta-analysis of prospective cohort studies.

Sun YF, Chang Q, Wu QJ, Gao SY, Zang ST, Liu YS, Zhao YH.  J Affect Disord. 2020 Sep 17;278:264-275. 

In a meta-analysis of 12,017 women, antenatal depression increased the risk of a low Apgar score at 5 min (OR= 1.91, 95% CI= 1.23-2.59), but the association between the 5 min Apgar score and antenatal depression was not significant (mean difference= -0.001, 95% CI= -0.07-0.07).

The impact of the COVID-19 pandemic on the perinatal mental health of women.

Farrell T, Reagu S, Mohan S, Elmidany R, Qaddoura F, Ahmed EE, Corbett G, Lindow S, Abuyaqoub SM, Alabdulla MA.  J Perinat Med. 2020 Sep 25

A survey of obstetric patients using the Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS) revealed a high prevalence of anxiety and Depressive symptomatology (34.4 and 39.2% respectively). These rates were not affected by occupation, previous mental health problems or pregnancy complications.

The prevalence of psychiatric symptoms of pregnant and non-pregnant women during the COVID-19 epidemic.

Zhou Y, Shi H, Liu Z, Peng S, Wang R, Qi L, Li Z, Yang J, Ren Y, Song X, Zeng L, Qian W, Zhang X.  Transl Psychiatry. 2020 Sep 19;10(1):319. 

Compared to non-pregnant women, pregnant women were at reduced risk of symptoms of depression (OR = 0.23; 95% CI: 0.12-0.45), anxiety (OR = 0.26; 95% CI: 0.16-0.42), insomnia (OR = 0.19; 95% CI: 0.06-0.58), and PTSD (OR = 0.15; 95% CI: 0.04-0.53) during the COVID-19 epidemic.

Maternal schizophrenia and adverse birth outcomes: what mediates the risk?

Vigod SN, Fung K, Amartey A, Bartsch E, Felemban R, Saunders N, Guttmann A, Chiu M, Barker LC, Kurdyak P, Brown HK.  Soc Psychiatry Psychiatr Epidemiol. 2020 May;55(5):561-570. 

Among infants of women with schizophrenia, risk was higher for prematurity (11.4% vs. 6.9%, aRR 1.64, 95% CI 1.51-1.79), SGA (3.5% vs. 2.5%, aRR 1.40, 95% CI 1.20-1.64), and Apgar score < 8 at 1 (19.0% vs. 12.8%, aRR 1.49, 95% CI 1.40-1.59) and 5 min (5.6% vs. 3.0%, aRR 1.90, 95% CI 1.68-2.16).  The increase in these complications is partly explained by potentially modifiable factors such as smoking and illicit drug use.

 COVID-19-related financial stress associated with higher likelihood of depression among pregnant women living in the United States.

Thayer ZM, Gildner TE.  Am J Hum Biol. 2020 Sep 22:

COVID-19-related financial stress was significantly associated with increased likelihood of a clinically significant depression score, even after adjustment for covariates including participant education and income (adjusted Odds Ratio: 2.23, 95% CI = 1.80, 2.77, P < .001.

Symptoms of Obsessive-Compulsive Disorder during Pregnancy and the Postpartum Period: a Systematic Review and Meta-Analysis.

Starcevic V, Eslick GD, Viswasam K, Berle D.  Psychiatr Q. 2020 May 22. 

Aggressive obsessions were much more common in postpartum OCD than in pregnancy OCD and non-perinatal OCD.  Obsessions about accidental harm to the infant and other infant-focused obsessions, checking compulsions, self-reassurance and seeking reassurance from others were also relatively common in postpartum OCD.

Development and Validation of a Machine Learning Algorithm for Predicting the Risk of Postpartum Depression among Pregnant Women.

Zhang Y, et al.  J Affect Disord, Sept 2020.

Using data drawn from the electronic medical record, information on clinical features related to mental health history, medical comorbidity, obstetric complications, medication prescription orders, and patient demographic characteristics could be used to predict risk for PPD.  The model performances as measured by area under the receiver operating characteristic curve (AUC) are 0.937 (95% CI 0.912 – 0.962) and 0.886 (95% CI 0.879-0.893) in the development and validation datasets, respectively.


No articles this week



Preclinical characterization of zuranolone (SAGE-217), a selective neuroactive steroid GABAA receptor positive allosteric modulator.

Althaus AL, Ackley MA, Belfort GM, Gee SM, Dai J, Nguyen DP, Kazdoba TM, Modgil A, Davies PA, Moss SJ, Salituro FG, Hoffmann E, Hammond RS, Robichaud AJ, Quirk MC, Doherty JJ.  Neuropharmacology. 2020 Sep 22.

Health practitioners’ recognition and management of postpartum obsessive-compulsive thoughts of infant harm.

Mulcahy M, Rees C, Galbally M, Anderson R.  Arch Womens Ment Health. 2020 Oct;23(5):719-726

This study investigated health practitioners’ recognition of, and clinical management strategies for, postpartum obsessive-compulsive symptoms (OCS). Ninety-four perinatal health practitioners completed a survey comprised of a hypothetical case vignette and questions eliciting their responses to a clinical presentation of postpartum infant harming obsessions. Almost 70% of participants did not accurately identify OCS within the case.  The majority of practitioners endorsed at least one contraindicated clinical management strategy likely to aggravate postpartum OCS.


No articles this week



No articles this week



Maternal antenatal stress and mental and behavioral disorders in their children.

Tuovinen S, Lahti-Pulkkinen M, Girchenko P, Heinonen K, Lahti J, Reynolds RM, Hämäläinen E, Villa PM, Kajantie E, Laivuori H, Raikkonen K.  J Affect Disord. 2020 Sep 15;278:57-65. 

Maternal antenatal stress is associated with higher risk of childhood mental and behavioral disorders.

Maternal-fetal bonding among pregnant women at psychosocial risk: The roles of adult attachment style, prenatal parental reflective functioning, and depressive symptoms.

Røhder K, Væver MS, Aarestrup AK, Jacobsen RK, Smith-Nielsen J, Schiøtz ML.

PLoS One. 2020 Sep 17;15(9):PMID: 32941499 Free article.

Parenting Stress During the COVID-19 Outbreak: Socioeconomic and Environmental Risk Factors and Implications for Children Emotion Regulation.

Spinelli M, Lionetti F, Setti A, Fasolo M.  Fam Process. 2020 Sep 28.

Household chaos predicted higher levels of parenting stress, which, in turn, was associated with less effective emotion regulation in children through the mediating role of parental involvement. More stressed parents were less involved in their children’s activities, decreasing children’s effective emotion regulation.


No articles this week



No articles this week



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