This week, there are two very interesting articles on the importance of folic acid supplementation during pregnancy.  Not only does folic acid reduce the risk of neural tube defects, it may affect other aspects of brain development associated and may reduce the risk of psychosis and possibly other neuropsychiatric disorders in children.  In another study, Kronenfeld looked at developmental outcomes in children exposed to antidepressants in breast milk.

Ruta Nonacs, MD PhD

Association of Prenatal Exposure to Population-Wide Folic Acid Fortification With Altered Cerebral Cortex Maturation in Youths.

Eryilmaz H, Dowling KF, Huntington FC, Rodriguez-Thompson A, Soare TW, Beard LM, Lee H, Blossom JC, Gollub RL, Susser E, Gur RC, Calkins ME, Gur RE, Satterthwaite TD, Roffman JL.  JAMA Psychiatry. 2018 Jul 3.

Epidemiologic data on severe mental illness suggest that prenatal folate exposure may impact postnatal brain development and subsequent vulnerability to certain types of mental illness. This study suggests that gestational exposure to folic acid in fortified grain products was associated with altered cortical development and, in turn, with reduction in the risk of psychosis in adolescence.

Neuroprotective Effects of Prenatal Folic Acid Supplementation: Why Timing Matters.

Roffman JL.  JAMA Psychiatry. 2018 Jul 1;75(7):747-748.

Chronic use of psychotropic medications in breastfeeding women: Is it safe?

Kronenfeld N, Ziv Baran T, Berlin M, Karra N, Dinavitser N, Cohen R, Wiener Y, Schwartzberg E, Bercovitch M.  PLoS One. 2018 May 21;13(5):e0197196. 29782546 Free Article

This prospective study included 280 infants whose mothers contacted the Drug Consultation Center (DCC) at Assaf Harofeh Medical Center seeking information regarding the chronic use of psychotropic medications during lactation.  At follow-up, no significant differences between infants in the two groups were observed with regard to height, weight, head circumference and weight-length ratio percentile. Children in both groups were, according to their parents, within the normal developmental range for all milestones, according to the Denver Developmental Scale.

A systematic review of interventions for healthcare professionals to improve screening and referral for perinatal mood and anxiety disorders.

Long MM, Cramer RJ, Jenkins J, Bennington L, Paulson JF.  Arch Womens Ment Health. 2018 Jul 2. Review.

The most common intervention type was educational, with others including changes in electronic medical records and standardized patients for training. Interventions demonstrated moderate positive impacts on screening completion rates, referral rates for PMAD, and patient-provider communication. Studies suggested positive receptivity to screening protocols by mothers and providers.

Antidepressants and recurrence of depression in the postpartum period.

Pope CJ, Sharma V, Sommerdyk C, Mazmanian D.  Arch Womens Ment Health. 2018 Jun 26.

The findings of this study align with research which suggests that the postpartum period is a particularly vulnerable time for recurrence of depression. Moreover, our results suggest that this remains the case regardless of antidepressant treatment.

Psychotherapeutic Treatments for Depression During Pregnancy.

Genovez M, Vanderkruik R, Lemon E, Dimidjian S.  Clin Obstet Gynecol. 2018 Jun 30.

GABAA dysregulation as an explanatory model for late-onset postpartum depression associated with weaning and resumption of menstruation.

Burke CS, Susser LC, Hermann AD.  Arch Womens Ment Health. 2018 Jul 3. doi: 10.1007/s00737-018-0871-9. Review.

The authors hypothesize that the resumption of menstruation may modify GABAA receptors such that allopregnanolone  may contribute to rather than ameliorate depressive symptoms in vulnerable individuals.

Postpartum depression and social support in a racially and ethnically diverse population of women.

Pao C, Guintivano J, Santos H, Meltzer-Brody S.  Arch Womens Ment Health. 2018 Jul 3.

Higher levels of social support had a strong protective association against PPD (MOS total score OR, 0.23; 95% CI, 0.19–0.27; p?=?6.92E-90;  PPD symptom severity is significantly and negatively correlated with the degree of social support.

Risk factors of new onset anxiety and anxiety exacerbation in the perinatal period: A systematic review and meta-analysis.

Furtado M, Chow CHT, Owais S, Frey BN, Van Lieshout RJ.  J Affect Disord. 2018 Jun 18;238:626-635. Review.

The impact of maternal prenatal and postnatal anxiety on children’s emotional problems: a systematic review.

Rees S, Channon S, Waters CS.  Eur Child Adolesc Psychiatry. 2018 Jun 15.

Overall, both maternal prenatal and postnatal anxiety have a small adverse effect on child emotional outcomes. However, the evidence appears stronger for the negative impact of prenatal anxiety.

Involvement of prolactin in newborn infant irritability following maternal perinatal anxiety symptoms.

Zhang H, Shao S, Su Q, Yao D, Sun H, Ding D, Dang S, Wang S, Zhu Z, Li H.  J Affect Disord. 2018 Jun 21;238:526-533.

Scores of irritability in the newborns of mothers with anxiety were higher than those in the contol group.  Lower serum prolactin and serotonin and higher serum cortisol were found in the newborns of mothers with anxiety compared to the control group both at postpartum days 2 and 15 (p?<?0.05). The level of serum PRL in newborn infants were significantly and negatively correlated to the scores of irritability.

The Welch Emotional Connection Screen (WECS): Validation of a brief mother-infant relational health screen.

Hane AA, LaCoursiere JN, Mitsuyama M, Wieman S, Ludwig RJ, Kwon KY, Browne J, Austin J, Myers M, Welch MG.  Acta Paediatr. 2018 Jun 30.

The Welch Emotional Connection Screen (WECS), a new instrument, assesses mother-infant Emotional Connection in clinical settings.


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