On this week’s list, we have multiple articles on the impact of perinatal mood and anxiety disorders on the pregnancy and on the family.  While we clearly see an increased interest in identifying women with perinatal mood and anxiety disorders, less attention has been devoted to how to deliver care to this vulnerable patient population.  We continue to hear stories of women, even those with financial resources and/or excellent health insurance, who struggle to access care.  

There is one interesting article on the list from researchers in Singapore (Shorey et al, 2019) which uses a technology-based interface to provide peer support to patients and demonstrate that this type of intervention can be used to reduce risk of postpartum depression. While we tend to focus on interventions delivered by highly trained health professionals, like cognitive-behavioral therapy, this study shows us that trained paraprofessionals can also have a significant impact in this population.  

For more detailed descriptions of many of these topics, you can read the CWMH NEWSLETTER which comes out every Thursday.  You can sign up for our newsletter HERE.

 

Ruta Nonacs, MD PhD


PMS AND PMDD

No articles this week

INFERTILITY AND MENTAL HEALTH

No articles this week

PSYCHIATRIC ILLNESS DURING PREGNANCY

The Association between Positive Antenatal Depression Screening and Breastfeeding Initiation and Continuation.

Stark EL, Shim J, Ross CM, Miller ES.  Am J Perinatol. 2019 Sep 3. 

Among the 2,871 women meeting inclusion criteria, 302 (10.5%) were screened positive for antenatal depression. After adjusting for confounders, there were no differences in breastfeeding initiation (adjusted odds ratio [aOR]?=?0.78, 95% confidence interval [CI]: 0.52-1.16), but women with a positive antenatal depression screen were significantly less likely to continue breastfeeding at 6 weeks’ postpartum (aOR= 0.67, 95% CI: 0.48-0.96).

Vitamin D deficiency and depressive symptoms in pregnancy are associated with adverse perinatal outcomes.

Accortt EE, Lamb A, Mirocha J, Hobel CJ.  J Behav Med. 2018 Oct;41(5):680-689. 

A higher rate of adverse outcome was found when women had both prenatal vitamin D deficiency and elevated depressive symptoms (EPDS???10). Sixty percent with both risk factors had an adverse perinatal outcome versus 17% with only one or neither risk factor (relative risk 3.60; 95% CI 1.55-8.38, p?=?0.045), worthy of investigation with larger samples. Together, prenatal vitamin D deficiency and elevated depressive symptoms in pregnancy may increase risk for adverse perinatal outcomes, especially in racial minorities. Obstetric providers should consider routine prenatal depression screening. The impact of vitamin D supplementation to reduce risk for adverse perinatal outcomes should be studied in prospective trials. 

Chronic Medical Conditions and Peripartum Mental Illness: A Systematic Review and Meta-Analysis.

Brown HK, Qazilbash A, Rahim N, Dennis CL, Vigod SN.  Am J Epidemiol. 2018 Sep 1;187(9):2060-2068.

Chronic medical conditions overall were associated with peripartum mental illness overall (adjusted pooled odds ratios (aPOR) = 1.43, 95% confidence interval (CI): 1.25, 1.63). No studies examined risk of bipolar or psychotic disorders. Diabetes (aPOR = 1.34, 95% CI: 1.07, 1.69), hypertension/heart disease (aPOR = 1.60, 95% CI: 1.05, 2.45), migraine (aPOR = 1.75, 95% CI: 1.20, 2.54), and other neurological disorders (aPOR = 1.45, 95% CI: 1.19, 1.77), but not asthma, were each associated with peripartum mental illness. 

Guidelines on treatment of perinatal depression with antidepressants: An international review.

Molenaar NM, Kamperman AM, Boyce P, Bergink V.  Aust N Z J Psychiatry. 2018 Apr;52(4):320-327. Free Article

MEDICATIONS AND PREGNANCY

?-Blocker Use in Pregnancy and the Risk for Congenital Malformations: An International Cohort Study.

Bateman BT, Heide-Jørgensen U, Einarsdóttir K, Engeland A, Furu K, Gissler M, Hernandez-Diaz S, Kieler H, Lahesmaa-Korpinen AM, Mogun H, Nørgaard M, Reutfors J, Selmer R, Huybrechts KF, Zoega H.  Ann Intern Med. 2018 Nov 20;169(10):665-673. 

Maternal use of ?-blockers in the first trimester is not associated with a large increase in the risk for overall malformations or cardiac malformations, independent of measured confounders.

POSTPARTUM PSYCHIATRIC ILLNESS

Amygdala and affective responses to infant pictures; comparing depressed and non-depressed mothers and non-mothers.

Dudin A, Wonch KE, Davis AD, Steiner M, Fleming AS, Hall GB.  J Neuroendocrinol. 2019 Sep 5:e12790.

Women with PPD show an enhanced amygdala response to affectively positive infant pictures, but not to affectively positive pictures of scenery. Women with depression outside of the postpartum period show no change in amygdala responsiveness to either stimulus categories. 

 

Maternal perinatal mental health: Associations with bonding, mindfulness, and self-criticism at 18 months’ postpartum.

Brassel A, Townsend ML, Pickard JA, Grenyer BFS.  Infant Ment Health J. 2019 Sep 5.

Maternal depression and self-criticism significantly increased from pregnancy to postpartum. Maternal anxiety, self-criticism, and facets of mindfulness during pregnancy were also associated with mother-infant bonding at 18 months. 

 

Four maternal characteristics determine the 12-month course of chronic severe postpartum depressive symptoms.

Fisher SD, Sit DK, Yang A, Ciolino JD, Gollan JK, Wisner KL.  Depress Anxiety. 2019 Apr;36(4):375-383. 

Analyses resulted in identification of three distinct trajectories of depressive symptoms: (1) gradual remission (50.4%), (2) partial improvement (41.8%), and (3) chronic severe (7.8%). Key predictive characteristics of the chronic severe versus gradual remission and partial improvement trajectories included parity, education, and baseline global functioning and depression severity. 

 

Poor Postpartum Sleep Quality Predicts Subsequent Postpartum Depressive Symptoms in a High-Risk Sample.

McEvoy KM, Rayapati D, Washington Cole KO, Erdly C, Payne JL, Osborne LM.  J Clin Sleep Med. 2019 Aug 12.

Poor sleep quality in the early postpartum period independently predicts development of later PPD.

 

Brexanolone (Zulresso): Finally, an FDA-Approved Treatment for Postpartum Depression.

Powell JG, Garland S, Preston K, Piszczatoski C.  Ann Pharmacother. 2019 Sep 3.

 

Interpersonal trauma and suicide attempts in low-income depressed mothers in home visiting.

Ammerman RT, Scheiber FA, Peugh JL, Messer EP, Van Ginkel JB, Putnam FW.  Child Abuse Negl. 2019 Aug 29;97:104126.

History of suicide attempts is associated with childhood trauma history and later psychosocial impairments in low income, depressed mothers in home visiting.

 

Treatment resistant depression in women with peripartum depression.

Cepeda MS, Kern DM, Nicholson S.  BMC Pregnancy Childbirth. 2019 Sep 2;19(1):323. doi: 10.1186/s12884-019-2462-9.Free Article

TRD occurs in approximately 5% of women with peripartum depression. The risk of TRD is higher in pregnant women with a history of depression. Women who went on to develop TRD had more psychiatric comorbidities and painful conditions than women who did not.

 

Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 1): Randomized Controlled Trial.

Shorey S, Chee CYI, Ng ED, Lau Y, Dennis CL, Chan YH.  J Med Internet Res. 2019 Aug 29;21(8):e12410. Free Article

In this randomized controlled trial, women received a 4-week-long intervention including weekly follow-up with a peer volunteer through phone calls or text messages. The intervention group received peer support in addition to the standard care offered by the hospital. The control group only received standard postpartum care. The technology-based intervention was found to be effective in reducing the risk of postpartum depression among new mothers and showed a generally positive trend in reducing postpartum anxiety and loneliness and increasing perceived social support. 

MEDICATIONS AND BREASTFEEDING

No articles this week

PERINATAL SUBSTANCE USE DISORDERS

No articles this week

MATERNAL MENTAL HEALTH AND CHILD OUTCOMES

No articles this week

MENOPAUSE AND MENTAL HEALTH

No articles this week

OTHER TOPICS IN WOMEN’S MENTAL HEALTH

No articles this week