Mass General Hospital

Harvard Medical School

Weekly Roundup for June 16, 2017: Recent Publications in Women’s Mental Health

This roundup has some really interesting and clinically relevant  articles.  The first one, from Palomo and colleagues, evaluates risk for cardiovascular malformations in children prenatally exposed to lithium.  Yang and colleagues look at neonatal discontinuation symptoms in children exposed to SNRIs and SSRIs and conclude that they are more related to prematurity than to exposure to antidepressants.  Analyzing data from Danish Medical Register, researchers note that first onset of depression or anxiety during the postpartum period may be a marker for bipolarity (Liu, et al).

Ruta Nonacs, MD PhD


Lithium Use in Pregnancy and the Risk of Cardiac Malformations.

Patorno E, Huybrechts KF, Bateman BT, Cohen JM, Desai RJ, Mogun H, Cohen LS, Hernandez-Diaz S.  N Engl J Med. 2017 Jun 8;376(23):2245-2254.

Cardiac malformations were present in 16 of the 663 infants exposed to lithium (2.41%), 15,251 of the 1,322,955 nonexposed infants (1.15%), and 27 of the 1945 infants exposed to lamotrigine (1.39%). The risk ratio was 1.11 for a daily dose of 600 mg or less, 1.60 for 601 to 900 mg, and 3.22 for more than 900 mg.


Neonatal Discontinuation Syndrome in Serotonergic Antidepressant-Exposed Neonates.

Yang A, Ciolino JD, Pinheiro E, Rasmussen-Torvik LJ, Sit DKY, Wisner KL.  J Clin Psychiatry. 2017 May;78(5):605-611.

The presence of neonatal signs at 2-4 weeks was more closely associated with prematurity than with prenatal exposure to SRI or mood disorder exposure.


Depression and Anxiety in the Postpartum Period and Risk of Bipolar Disorder: A Danish Nationwide Register-Based Cohort Study.

Liu X, Agerbo E, Li J, Meltzer-Brody S, Bergink V, Munk-Olsen T.  J Clin Psychiatry. 2017 May;78(5):e469-e476.   Free Article

First-onset nonpsychotic postpartum affective disorder can be a marker of underlying bipolarity. Women who fill an antidepressant prescription following childbirth should be asked about hypomanic or manic symptoms and monitored long term. Clinically, when antidepressant monotherapy is ineffective or the individual woman experiences persistent and concerning symptoms, health professionals should consider a possible bipolar spectrum disorder.


Pregnancy-related anxiety and depressive symptoms are associated with visuospatial working memory errors during pregnancy.

Kataja EL, Karlsson L, Huizink AC, Tolvanen M, Parsons C, Nolvi S, Karlsson H.

J Affect Disord. 2017 Aug 15;218:66-74.

Maternal depressive symptoms and pregnancy-related anxiety symptoms were both associated with decrements in visuospatial working memory/executive functioning.


Maternal psychological distress and child decision-making.

Flouri E, Ioakeimidi S, Midouhas E, Ploubidis GB.  J Affect Disord. 2017 Aug 15;218:35-40.Free Article

Young daughters of chronically distressed mothers tend to be particularly reckless decision-makers.


Mild Depressive Symptoms During the Third Trimester of Pregnancy Are Associated with Disruptions in Daily Rhythms but Not Subjective Sleep Quality.

Simpson W, Frey BN, Steiner M.  J Womens Health (Larchmt). 2016 Jun;25(6):594-8.

Strong correlation between daily rhythm disruptions and prenatal depressive symptoms during the third trimester.


Postpartum depression in adolescent mothers.

Dinwiddie KJ, Schillerstrom TL, Schillerstrom JE.  J Psychosom Obstet Gynaecol. 2017 Jun 2:1-8.


Anticipatory guidance to prevent infant sleep problems within a randomised controlled trial: infant, maternal and partner outcomes at 6 months of age.

Galland BC, Sayers RM, Cameron SL, Gray AR, Heath AM, Lawrence JA, Newlands A, Taylor BJ, Taylor RW.  BMJ Open. 2017 Jun 2;7(5):e014908. PMID:  Free Article

A strategy delivering infant sleep education antenatally and at 3?weeks postpartum was not effective in preventing the development of parent-reported infant sleep problems.


Increased postpartum haemorrhage, the possible relation with serotonergic and other psychopharmacological drugs: a matched cohort study.

Heller HM, Ravelli ACJ, Bruning AHL, de Groot CJM, Scheele F, van Pampus MG, Honig A.

BMC Pregnancy Childbirth. 2017 Jun 2;17(1):166.   Free Article

pregnant women using serotonergic medication have an increased risk of postpartum haemorrhage, but this high risk is also seen in pregnant women using other psychopharmacological medications.


Predictors of Recovery from Depression and Anxiety in Women: A Longitudinal Study from Childbirth to 6 Years.

Shankar R, Badker R, Brain U, Oberlander TF, Misri S.  Can J Psychiatry. 2017 May;62(5):318-326.

Factors that predicted full recovery from depression included the absence of maternal health concerns, low total parental stress, and few child behavioural issues, whereas low levels of spousal stress were a significant factor in achieving full recovery from anxiety.


The effect of antidepressants on fertility.

Casilla-Lennon MM, Meltzer-Brody S, Steiner AZ.  Am J Obstet Gynecol. 2016 Sep;215(3):314.e1-5.

These data suggest that antidepressants may reduce the probability of a woman with a history of depression to conceive naturally. Future studies are needed to differentiate the extent to which this association is due to the antidepressant itself versus the underlying depression.


Postpartum Depression, Risk Factors, and Child’s Home Environment Among Mothers in a Home Visiting Program
Sampson M, Duron JF, Mauldin RL, et al. J Child Fam Stud (2017).

In a population of families at high risk for child maltreatment, elevated PPD symptoms at 3?months postpartum were predicted by elevated depressive symptoms during pregnancy (OR?=?4.34) and being unemployed (OR?=?1.37).


Trajectories of Externalizing and Internalizing Behaviors in Preterm Children Admitted to a Neonatal Intensive Care Unit.

Gerstein ED, Woodman AC, Burnson C, Cheng ER, Poehlmann-Tynan J.  J Pediatr. 2017 May 19.

Children born prematurely followed 1 of 3 distinct developmental trajectories for both internalizing and externalizing behavior problems. The most severe behavior problems started early in development and were associated with increased child dysregulation, maternal depression, and lower socioeconomic status.

 

 

 

 

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