A comparison of maternal and neonatal outcomes of pregnancy with mental disorders: results of an analysis using propensity score-based weighting

Perinatal Mood and Anxiety Disorders: Evidence-Based Approaches to Screening and Management During Pregnancy and Postpartum

This is a review of the existing literature and guidelines for the screening, management, and follow-up of perinatal mood and anxiety disorders, with a focus on major depressive disorder and generalized anxiety disorder.

Effects of Psychotropic Medications Taken by Pregnant Women on Newborn Medical Condition and Lactation Method

BACKGROUND

Maternal psychiatric condition during the perinatal period is relevant to children's cognitive development and mental health. Psychotropic medications are necessary to maintain the mental health of pregnant women with psychiatric disorders, but they are often avoided due to concerns about adverse effects, such as congenital malformations and abnormal neurodevelopment. A retrospective study of pregnant women with psychiatric disorders using psychotropic medications was performed to clarify maternal and child demographic data and to investigate whether psychotropic medications affected the Apgar score and the decision to breastfeed.

METHODS

Data of pregnant women with psychiatric disorders who were referred from the Department of Obstetrics and Gynecology to the Department of Neuropsychiatry at Ehime University Hospital from January 2014 to December 2022 were collected retrospectively. Pearson's chi-squared test and multiple regression analysis were used for statistical analyses.

RESULTS

A total of 226 women were included; 194 gave birth at our hospital, of whom 79 (40.7%) were taking psychotropic drugs at the time of delivery. None of the children had malformations. There was no relationship between the use of psychotropic medications and the choice to breastfeed. Multiple regression analysis showed that only the gestational weeks at birth were significantly associated with birth weight (p < 0.001) and Apgar score (1 min: p = 0.030; 5 min: p = 0.044).

CONCLUSIONS

The use of psychotropic medications during the perinatal period appears safe and beneficial for both pregnant women with psychiatric disorders and their children, and breastfeeding should be considered even if the mother continues to take the medication. To clarify these points, prospective studies using large samples from several countries are needed.

Effect of maternal obsessive-compulsive disorder (OCD) on feto-maternal outcomes: A systematic review and meta-analysis

BACKGROUND

Mental health disorders in pregnant women have been related to unfavorable obstetric and neonatal outcomes. Obsessive-compulsive disorder (OCD) significantly distresses mothers and affects the maternal-infant bond.

OBJECTIVES

The present meta-analysis and systematic review aimed to assess the association of maternal OCD with adverse feto-maternal outcomes.

SEARCH STRATEGY

A systematic search was undertaken in the five databases-Cochrane, Embase, ProQuest, Web of Science, and PubMed-on September 5, 2023.

SELECTION CRITERIA

Studies that included pregnant women with OCD in whom the feto-maternal outcomes were reported were included in the systematic review.

DATA COLLECTION AND ANALYSIS

Two pass screening ("title-abstract screening" followed by "full-text review"), and data extraction by two authors independently using the Nested-Knowledge Auto living semi-automated systematic review platform was carried out. The decision for selected studies was reviewed by a third author. Of the 360 studies identified, eight were included for the meta-analysis. Meta-analysis was conducted using R software.

MAIN RESULTS

Of the 24 maternal and neonatal adverse outcomes assessed, 11 were found to be associated with maternal OCD, notably pre-eclampsia (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.19-1.57), antepartum hemorrhage or placental abruption (OR 1.32, 95% CI 1.13-1.54), postpartum hemporrhage (OR 1.19, 95% CI 1.08-1.31), cesarean section delivery (OR 1.32, 95% CI 1.23-1.41), emergency cesarean section (OR 1.22, 95% CI 1.15-1.30), preterm birth (OR 1.41, 95% CI 1.21-1.64), low birth weight (OR 1.41, 95% CI 1.28-1.54), low Apgar score at 5 min (OR 2.37, 95% CI 1.32-4.27), neonatal hypoglycemia (OR 1.37, 95% CI 1.23-1.53), neonatal respiratory distress (OR 1.77, 95% CI 1.44-2.16), and major congenital malformations (OR 1.37, 95% CI 1.08-1.74).

CONCLUSION

OCD in pregnant women might be associated with multiple adverse feto-maternal outcomes.

Systematic review and meta-analysis of risk of gestational diabetes in women with preconception mental disorders

There is a well-established bidirectional association between Type 2 diabetes and mental disorder and emerging evidence for an increased risk of perinatal mental disorder in women with gestational diabetes (GDM). However, the relation between mental disorder prior to pregnancy and subsequent risk of GDM remains relatively unexplored. This is a systematic review and meta-analysis of the risk of GDM in women with a range of preconception mental disorders. Peer-reviewed literature measuring odds of GDM and preconception mood, anxiety, psychotic and eating disorders was systematically reviewed. Risk of bias was assessed using a checklist. Two independent reviewers were involved. 22 observational studies met inclusion criteria; most were retrospective cohorts from English speaking, high income countries. 14 studies were at high risk of bias. There was evidence for an increased risk of GDM in women with schizophrenia (pooled OR 2.44; 95% CI 1.17,5.1; 5 studies) and a reduced risk of GDM in women with anorexia nervosa (pooled OR 0.63; 95% CI 0.49,0.80; 5 studies). There was some limited evidence of an increased risk in women with bipolar disorder. There was no evidence for an association with preconception depression or bulimia nervosa on meta-analysis. There were insufficient studies on anxiety disorders for meta-analysis. This review indicates that there is not a significant risk of GDM associated with many preconception mental disorders but women with psychotic disorders represent a group uniquely vulnerable to GDM. Early detection and management of GDM could improve physical and mental health outcomes for these women and their children.

Genome-wide association study identifies a novel maternal gene × stress interaction associated with spontaneous preterm birth

BACKGROUND

Maternal stress is potentially a modifiable risk factor for spontaneous preterm birth (sPTB). However, epidemiologic findings on the maternal stress-sPTB relationship have been inconsistent.

METHODS

To investigate whether the maternal stress-sPTB associations may be modified by genetic susceptibility, we performed genome-wide gene × stress interaction analyses in 1490 African-American women from the Boston Birth cohort who delivered term (n = 1033) or preterm (n = 457) infants. Genotyping was performed using Illumina HumanOmni 2.5 array. Replication was performed using data from the NICHD genomic and Proteomic Network (GPN) for PTB research.

RESULTS

rs35331017, a T-allele insertion/deletion polymorphism in the protein-tyrosine phosphatase receptor Type D (PTPRD) gene, was the top hit that interacted significantly with maternal lifetime stress on risk of sPTB (P_G × E = 4.7 × 10^-8). We revealed a dose-responsive association between degree of stress and risk of sPTB in mothers carrying the insertion/insertion genotype, but an inverse association was observed in mothers carrying the heterozygous or deletion/deletion genotypes. This interaction was replicated in African-American (P_G × E = 0.088) and Caucasian mothers (P_G × E = 0.023) from the GPN study.

CONCLUSION

We demonstrated a significant maternal PTPRD × stress interaction on sPTB risk. This finding, if further confirmed, may provide new insight into individual susceptibility to stress-induced sPTB.

IMPACT

This was the first preterm study to demonstrate a significant genome-wide gene-stress interaction in African Americans, specifically, PTPRD gene variants can interact with maternal perceived stress to affect risk of spontaneous preterm birth. The PTPRD × maternal stress interaction was demonstrated in African Americans and replicated in both African Americans and Caucasians from the GPN study. Our findings highlight the importance of considering genetic susceptibility in assessing the role of maternal stress on spontaneous preterm birth.

Gaining a deeper understanding of social determinants of preterm birth by integrating multi-omics data

In the US, high rates of preterm birth (PTB) and profound Black-White disparities in PTB have persisted for decades. This review focuses on the role of social determinants of health (SDH), with an emphasis on maternal stress, in PTB disparity and biological embedding. It covers: (1) PTB disparity in US Black women and possible contributors; (2) the role of SDH, highlighting maternal stress, in the persistent racial disparity of PTB; (3) epigenetics at the interface between genes and environment; (4) the role of the genome in modifying maternal stress-PTB associations; (5) recent advances in multi-omics studies of PTB; and (6) future perspectives on integrating multi-omics with SDH to elucidate the Black-White disparity in PTB. Available studies have indicated that neither environmental exposures nor genetics alone can adequately explain the Black-White PTB disparity. Preliminary yet promising findings of epigenetic and gene-environment interaction studies underscore the value of integrating SDH with multi-omics in prospective birth cohort studies, especially among high-risk Black women. In an era of rapid advancements in biomedical sciences and technologies and a growing number of prospective birth cohort studies, we have unprecedented opportunities to advance this field and finally address the long history of health disparities in PTB. IMPACT: This review provides an overview of social determinants of health (SDH) with a focus on maternal stress and its role on Black-White disparity in preterm birth (PTB). It summarizes the available literature on the interplay of maternal stress with key biological layers (e.g., individual genome and epigenome in response to environmental stressors) and significant knowledge gaps. It offers perspectives that such knowledge may provide deeper insight into how SDH affects PTB and why some women are more vulnerable than others and underscores the critical need for integrating SDH with multi-omics in prospective birth cohort studies, especially among high-risk Black women.

The Relationship between Maternal Personality Disorder and Early Birth Outcomes: A Systematic Review and Meta-Analysis

(1) Background: Women with personality disorder are at risk of social and emotional problems which impact deleteriously on everyday functioning. Moreover, a personality disorder diagnosis has been established to have an adverse impact upon pregnancy outcomes and child health. Understanding this impact is critical to improving both maternal and child outcomes. This systematic review and meta-analysis will evaluate the contemporary evidence regarding these relationships. (2) Methods: Prospero and Cochrane were searched for any systematic reviews already completed on this topic. Academic Search Premier, CINAHL Complete, MEDLINE, PsycARTICLES, PsycINFO via the EBSCO host, and the Web of Science Core Collection were searched to include research articles published between 1980 and 2019. A total of 158 records were identified; 105 records were screened by reviewing the abstract; 99 records were excluded; 6 full text articles were assessed for eligibility; 5 records were included in the review. (3) Results: All the included studies reported on preterm birth. The meta-analysis indicates significant risk of preterm birth in women with personality disorder (overall odds ratio (OR) 2.62; CI 2.24–3.06; p < 0.01). Three studies reported on low birth weight, with the meta-analysis indicating a raised risk of low birth weight of the babies born to women with personality disorder (overall OR 2.00 CI 1.12–3.57 (p = 0.02)). Three studies reported on appearance, pulse, grimace, activity, and respiration (APGAR) score, with the meta-analysis of OR’s indicating a risk of low APGAR score in women with personality disorder (overall OR 2.31; CI 1.17–4.55; p = 0.02). (4) Conclusions: The infants of women with personality disorder are at elevated risk of preterm birth, low birth weight and low APGAR score.

Development of Perinatal Mental Illness in Women With Gestational Diabetes Mellitus: A Population-Based Cohort Study

OBJECTIVES

To examine the relationship between gestational diabetes mellitus (GDM) and the development of mental illness (affective and anxiety disorders) during pregnancy and 1 year postpartum.

METHODS

We linked clinical and administrative databases of mothers who delivered in Alberta, Canada, between April 1, 2000, and March 31, 2009, to identify diagnoses of GDM and mental illness. Women with prepregnancy type 1 or type 2 diabetes were excluded. We used generalized estimating equation models to examine the effect of GDM on the development of new-onset mental illness in 2 separate periods: during pregnancy and during the first postpartum year. Generalized estimating equation models were adjusted for age, overweight, smoking, rural residence, ethnicity, median household income, nulliparity, preeclampsia or eclampsia, neonatal death, infant neonatal intensive care unit stay, prior chronic medical conditions and fiscal year.

RESULTS

Of 326,723 pregnancies, 3.7% (12,140) were affected by GDM. Compared to women without GDM, women with GDM had a higher prevalence of, but did not have an increased risk for, new-onset mental illness during pregnancy (16.1% vs. 14.1%; OR 1.06, 95% CI 0.98 to 1.13) or postpartum (23.3% vs. 22.1%; OR 1.03, 95% CI 0.97, 1.10).

CONCLUSIONS

In this large population-based cohort of women in Alberta, GDM was not associated with an increased risk for developing new-onset mental illness during pregnancy or postpartum.

Maternal psychiatric disorders and risk of preterm birth

PURPOSE

To study the effect of maternal psychiatric disorders (depression, anxiety disorder, bipolar disease, schizophrenia, unspecified psychiatric disorder, and comorbid conditions) and odds of preterm birth.

METHODS

The Consortium on Safe Labor (2002-2008), an observational cohort with 12 centers from across the United States included 223,394 singleton pregnancies with clinical data obtained from electronic medical records and maternal diagnoses of psychiatric disorders from maternal discharge summaries. Length of gestation was based on the best clinical estimate and categorized as birth less than 39, less than 37, less than 34, and less than 28 weeks' gestation. The adjusted odds ratios (ORs) with 95% confidence intervals of birth were estimated by logistic regression with generalized estimating equations.

RESULTS

Any maternal psychiatric disorder was associated with odds of birth less than 39 weeks' gestation (odds ratio [OR] = 1.32, 95% confidence interval = 1.28-1.37), less than 37 weeks' gestation (OR = 1.45, 1.38-1.52), less than 34 weeks' gestation (OR = 1.47, 1.35-1.59), and less than 28 weeks' gestation (OR = 1.57, 1.36-1.82). Specifically, odds of birth less than 37 weeks' gestation were associated with maternal depression (OR = 1.31, 1.23-1.40), anxiety disorder (OR = 1.68, 1.41-2.01), depression with anxiety disorder (OR = 2.31, 1.93-2.78), bipolar disease (OR = 1.54, 1.22-1.94), bipolar disease with depression and/or anxiety disorder (OR = 1.70, 1.30-2.22), and unspecified psychiatric disorder (OR = 1.52, 1.41-1.64).

CONCLUSIONS

Maternal psychiatric disorders, especially comorbid psychiatric conditions, were associated with increased likelihood of preterm birth.

Psychiatric outcomes after childbirth: can posttraumatic growth protect me from disordered eating symptoms?

PURPOSE

While many studies on mood disorder and posttraumatic stress disorder (PTSD) following childbirth have been conducted, little is known regarding posttraumatic growth (PTG) and disordered eating in the postpartum period. This study aims to (a) identify the typology of women following childbirth based on anxiety, depressive, PTSD symptoms and level of PTG and (b) evaluate whether these profiles differ on disordered eating symptoms.

METHODS

Up to 2 years after childbirth, 306 French-speaking mothers [mean age (SD) = 29.4 (4.6) years] completed questionnaires assessing PTSD, depressive, anxiety and disordered-eating symptoms and level of posttraumatic growth.

RESULTS

Four profiles were highlighted: a first one labeled growing cluster (22.2 % of the sample, n = 68), a second one labeled low level of symptoms cluster (37.6 % of the sample, n = 115), a third one labeled vulnerable cluster (21.6 % of the sample, n = 66) and a last one labeled anxious-depressed-traumatized cluster (18.6 % of the sample, n = 57). Our findings also highlight an impact of these profiles on disordered eating symptoms, suggesting that disordered eating in postpartum would not be the result of pregnancy.

CONCLUSION

Consistent with our expectation, our findings suggest a potential protective role of posttraumatic growth on the development of disordered eating symptoms. Further researches focusing on traumatic experience, disordered eating and posttraumatic growth in postpartum are warranted.