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.
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Happy Reading!
Ruta Nonacs, MD PhD
PMS AND PMDD
No articles this week
INFERTILITY AND MENTAL HEALTH
No articles this week
PSYCHIATRIC ILLNESS DURING PREGNANCY
Effect of depression and serotonin reuptake inhibitors antidepressant treatment during pregnancy on protein expression.
Comparing the placentas from depressed women treated with SRIs to those with depressive symptoms but no SRI treatment, researchers observed a downregulation of proteins related to senescence, amyloid fiber formation, and platelet activation in the SRI-treated group. This study suggests that treatment with SRIs may prevent the placental alterations observed in depression during pregnancy, such as placental senescence, platelet activation, and amyloid fiber formation, and, ultimately, pregnancy and fetal outcomes.
COVID in Pregnancy Linked to Kids’ Risk of Neurodevelopmental Disorders.
Exposure to SARS-CoV-2 infection during pregnancy was associated with a 29% greater risk of neurodevelopmental diagnosis by 3 years of age. The largest effects were observed in third-trimester exposures. Preterm birth, maternal public insurance, and Hispanic ethnicity were all associated with a significantly greater risk for neurodevelopmental disorders in exposed offspring.
ACOG President: Changing Tylenol’s Label Will Drive Baseless Fear.
Several well-designed studies have found that acetaminophen does not cause autism. One prominent Swedish study of nearly 200,000 sibling pairs concluded acetaminophen use during pregnancy had no association with autism, ADHD, or intellectual disability.
MEDICATIONS AND PREGNANCY
Maternal and offspring outcomes associated with prescribed ADHD medication in pregnancy: a systematic review.
REVIEW ARTICLE: Twelve cohort studies were included in the qualitative review. The data is conflicting. While seven studies suggested either no impact or beneficial effects, three studies suggested higher risk.
ADHD and Pregnancy: What Do Data Say on Continuing Stimulant Use?
Summary of recent data indicating that early stimulant exposure may be relatively safe, but continuation of stimulants into later trimesters can increase risks of preterm birth, hypertensive disorders, and placental complications.
Depression and antidepressant use in pregnancy and adverse maternal and offspring outcomes: a systematic review and meta-analysis.
REVIEW ARTICLE: The findings indicated that many of the adverse outcomes observed with medication may be attributable to the underlying depression itself rather than of antidepressants.
Prenatal Exposure to Antiseizure Medications and the Risk of Congenital Anomalies: A Nationwide Population-Based Study in South Korea.
Among 2,494,958 pregnancies, 5,880 (0.24%) were exposed to ASMs during the first trimester. Prenatal exposure to valproate increased the risk of congenital anomalies. Although other ASMs, even in polytherapy, did not significantly increase the overall risk of congenital anomalies, carbamazepine, levetiracetam, oxcarbazepine, and topiramate were associated with specific types of congenital anomalies.
Antipsychotic use during pregnancy and risk of gestational diabetes: an updated meta-analysis.
This updated meta-analysis suggests a significant association between antipsychotic medication use during pregnancy and an increased risk of GDM, particularly with the newer second-generation antipsychotic agents.
Educational outcomes associated with prenatal exposure to antiseizure medications: A systematic literature review and meta-analysis.
Prenatal exposure to first-generation ASMs, especially sodium valproate, was associated with increased educational support needs. Newer-generation ASMs appear to have a more favourable risk profile, though evidence remains limited.
Synthesizing Cohort Study Results to Promote Knowledge Transfer of Safety Data Regarding Gestational Antidepressant Exposure and Offspring Congenital Anomalies: A Test of Concept.
In medical publications, reassuring quantitative data regarding prenatal exposure to antidepressants and the risk of major congenital malformations are buried within a large body of data. There are ways to improve how we present information. Using a fact box provides a quantitative, visual, and verbal description of absolute risks, based on pooled estimates from cohort studies.
POSTPARTUM PSYCHIATRIC ILLNESS
Psychotropic medication continuation during pregnancy and risk of postpartum self-injurious thoughts and behaviors.
Of 7554 participants (mean age = 30.5, SD = 4.9), 116 (1.54%) experienced postpartum SITBs. Higher medication continuation during pregnancy was associated with a significantly lower hazard of postpartum SITBs (adjusted HR = 0.06, 95% CI = 0.02-0.19). Elevated risk was observed among individuals with bipolar disorder and alcohol-related substance use disorders.
Daily Screenings Help Prevent Postpartum Complications.
A program called H.E.A.R.4Mamas monitors women daily through surveys sent via text messaging to detect warning signs of postpartum complications during the first two months after delivery. Checking in regularly through text messages and phone calls has proven to be effective in detecting PPD early.
Psychotropic medication continuation during pregnancy and risk of postpartum self-injurious thoughts and behaviors.
Higher continuation of psychotropic medication during pregnancy was associated with a significantly lower hazard of postpartum self-injurious thoughts and behaviors, highlighting the potential protective role of sustained treatment.
State-of-the-art treatment of postpartum bipolar disorder.
PBD demands a multifaceted therapeutic approach, with pharmacotherapy as the cornerstone. Lithium, lamotrigine, and selected second-generation antipsychotics remain key options, guided by efficacy, lactation safety, and individualized risk-benefit assessment.
MEDICATIONS AND BREASTFEEDING
A Population-Based Cohort Study of Early Infant Feeding Initiation in Maternal Bipolar Disorder.
Maternal bipolar disorder was associated with reduced exclusive feeding with breastmilk at discharge compared to a referent group, as well as reduced intention to breastfeed, early skin-to-skin contact, and in-hospital breastfeeding support. Maternal depression/anxiety alone was not associated with lower exclusive breastfeeding at discharge.
PERINATAL SUBSTANCE USE
Neurodevelopmental challenges at age four following fetal exposure to maternal opioid maintenance treatment.
Prenatal exposure to maternal opioid maintenance treatment was linked to higher rates of developmental, emotional, and behavioral difficulties at age four, with additional risk from polysubstance exposure and environmental adversity.
MATERNAL MENTAL HEALTH AND CHILD OUTCOMES
MENOPAUSE AND MENTAL HEALTH
Plant-Based Estrogen Diminished Menopause Symptoms.
Estetrol (E4), one of four natural estrogens, significantly reduced the weighted weekly score of moderate-to-severe vasomotor symptoms in postmenopausal women in two phase III trials.
Higher Levels of FSH During Menopause Tied to Lower Hippocampal Volumes.
Higher FSH levels were associated with lower hippocampal volumes in postmenopausal women, though this study did not examine associations with cognitive function or memory.
OTHER TOPICS IN WOMEN’S MENTAL HEALTH
One Antidepressant Deprescribing Strategy Topped Others in Preventing Relapse.
A deprescribing strategy combining slow antidepressant taper with psychological support was as effective as continued treatment in preventing relapse and outperformed abrupt stopping or rapid tapering.
