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Seeman MV. Women with Schizophrenia Have Difficulty Maintaining Healthy Diets for Themselves and Their Children: A Narrative Review. Behav Sci (Basel) 2023; 13:967. [PMID: 38131823 PMCID: PMC10740554 DOI: 10.3390/bs13120967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Severe psychiatric disorders such as schizophrenia are inevitably linked to unemployment, meagre per capita income, and residence in disadvantaged, poorly resourced neighbourhoods. This means difficult access to healthy food and is particularly problematic for pregnant women and mothers with children to feed. The necessity of taking antipsychotic drugs is an additional barrier to healthy eating because these drugs are associated with serious cognitive, psychological, behavioural, and metabolic sequelae. Being ill with psychosis makes it extremely difficult to maintain a healthy diet; nutritional deficiencies result, as do medical complications. The results of present literature review confirm the gravity of the problem and suggest a number of potentially useful clinical interventions.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 3G4, Canada
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Lutz BH, Santos IDSD, Domingues MR, Murray J, Silveira MFD, Miranda VIA, Silveira MPT, Mengue SS, Pizzol TDSD, Bertoldi AD. Folic acid supplementation during pregnancy and postpartum depressive symptoms. Rev Saude Publica 2023; 57:76. [PMID: 37937650 PMCID: PMC10609648 DOI: 10.11606/s1518-8787.2023057004962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/19/2022] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE To verify whether folic acid supplementation during pregnancy is associated with the occurrence of maternal depressive symptoms at three months postpartum, in the 2015 Pelotas Birth Cohort. METHODS This study included 4,046 women, who were classified into three groups: did not use folic acid supplementation during pregnancy; used during only one trimester of pregnancy; and used for two or three trimesters. Depressive symptoms were assessed at three months postpartum using the Edinburgh Postnatal Depression Scale (EPDS), at cutoff points ≥ 10 (mild symptoms) and ≥ 13 (moderate to severe intensity). RESULTS The overall prevalence of mild symptoms was of 20.2% (95%CI 19.0-21.5), and moderate and severe was 11% (95%CI 10.0-12.0). The prevalence of EPDS ≥ 10 was of 26.8% (95%CI 24.0-29.5) among women who did not use folic acid and 18.1% for both those who used it during one trimester of pregnancy (95%CI 16.1-20.1) and those who used it for two or three trimesters (95%CI 16.0-20.2). The prevalence of EPDS ≥ 13 was of 15.7% (95%CI 13.5-17.9) in those who did not use folic acid, 9.1% (95%CI 7.5-10.6) in those who used it for one trimester, and 9.4% (95%CI 7.8-11.0) in those who used it for two or three trimesters. In the adjusted analyses, there was no statistically significant association between the use of folic acid during pregnancy and the occurrence of depressive symptoms at three months postpartum. CONCLUSION There was no association between folic acid supplementation during pregnancy and postpartum depression at three months.
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Affiliation(s)
- Bárbara Heather Lutz
- Universidade Federal de Pelotas . Departamento de Medicina Social . Programa de Pós-Graduação em Epidemiologia . Pelotas , RS , Brasil
| | - Iná da Silva Dos Santos
- Universidade Federal de Pelotas . Departamento de Medicina Social . Programa de Pós-Graduação em Epidemiologia . Pelotas , RS , Brasil
| | - Marlos Rodrigues Domingues
- Universidade Federal de Pelotas . Departamento de Medicina Social . Programa de Pós-Graduação em Epidemiologia . Pelotas , RS , Brasil
- Universidade Federal de Pelotas . Programa de Pós-Graduação em Educação Física . Pelotas , RS , Brasil
| | - Joseph Murray
- Universidade Federal de Pelotas . Departamento de Medicina Social . Programa de Pós-Graduação em Epidemiologia . Pelotas , RS , Brasil
| | - Mariângela Freitas da Silveira
- Universidade Federal de Pelotas . Departamento de Medicina Social . Programa de Pós-Graduação em Epidemiologia . Pelotas , RS , Brasil
| | - Vanessa Irribarem Avena Miranda
- Universidade Federal de Pelotas . Departamento de Medicina Social . Programa de Pós-Graduação em Epidemiologia . Pelotas , RS , Brasil
- Universidade do Extremo Sul Catarinense . Programa de Pós-graduação em Saúde Coletiva . Criciúma , SC , Brasil
| | - Marysabel Pinto Telis Silveira
- Universidade Federal de Pelotas . Departamento de Fisiologia e Farmacologia . Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas . Pelotas , RS , Brasil
| | - Sotero Serrate Mengue
- Universidade Federal do Rio Grande do Sul . Faculdade de Medicina . Programa de Pós-Graduação em Epidemiologia . Porto Alegr e, RS , Brasil
| | - Tatiane da Silva Dal Pizzol
- Universidade Federal do Rio Grande do Sul . Faculdade de Medicina . Programa de Pós-Graduação em Epidemiologia . Porto Alegr e, RS , Brasil
| | - Andréa Dâmaso Bertoldi
- Universidade Federal de Pelotas . Departamento de Medicina Social . Programa de Pós-Graduação em Epidemiologia . Pelotas , RS , Brasil
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Fernández-Abascal B, Recio-Barbero M, Sáenz-Herrero M, Segarra R. Long-acting injectable aripiprazole in pregnant women with schizophrenia: a case-series report. Ther Adv Psychopharmacol 2021; 11:2045125321991277. [PMID: 35186259 PMCID: PMC8851104 DOI: 10.1177/2045125321991277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/10/2021] [Indexed: 01/30/2023] Open
Abstract
Antipsychotic long-acting formulations (LAI-AP) have emerged as a new therapeutic choice to treat patients presenting a severe mental disorder. Despite that, to date, there is a lack of safety data and studies regarding the use of LAI-AP formulations in pregnant women. Here we present the first six-case series of pregnant women with schizophrenia treated with aripiprazole-LAI reported in the literature. All patients remained psychopathologically stable through pregnancy and the postpartum period, and all of them were in treatment with aripiprazole-LAI. To date, all infants remain healthy with normal developmental milestones, without the presence of congenital malformations or adverse effects. Lack of information on safety data regarding the use of new antipsychotic formulations remains important in treating women with mental illness who desire to become pregnant. Further studies in this clinical population with a larger number of patients included remains necessary.
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Affiliation(s)
| | - Maria Recio-Barbero
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Margarita Sáenz-Herrero
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain
- Department of Psychiatry, Cruces University Hospital, Barakaldo, Spain
- Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain
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Frayne J, Hauck Y, Sivakumar P, Nguyen T, Liira H, Morgan VA. Nutritional status, food choices, barriers and facilitators to healthy nutrition in pregnant women with severe mental illness: a mixed methods approach. J Hum Nutr Diet 2020; 33:698-707. [PMID: 32391622 DOI: 10.1111/jhn.12752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although widely acknowledged that adequate maternal nutrition is important for mother and baby, limited research has focussed on women with severe mental illnesses (SMI) in pregnancy. The present study reports on nutritional factors and food choices and investigates barriers and facilitators to healthy nutritional choices by pregnant women with SMI. METHODS A prospective mixed method study was undertaken of 38 pregnant women with SMI, including a cross-sectional survey, a food frequency questionnaire and 12 postnatal qualitative interviews, with integrated analysis of all data. RESULTS Elevated rates of obesity (35%) were found, with 82% of women having above the recommended gestational weight gain. Despite perceived knowledge, 32% of women did not meet any of the Five Food Group serving recommendations for pregnancy and consumed above-recommended levels for processed (19%) and sugar snacks (51%). Thematic analysis identified four main barriers: a discrepancy between knowledge and action, food cravings, mental health, and physical health. During pregnancy, food cravings were reported in 66% of women, psychological distress in 71% and physical distress in 37%. Screening identified 19% with potential eating disordered behaviours. Despite the challenges, several facilitators were identified and covered three themes: access to a dietitian, information delivery and support, and comprehensive care. DISCUSSION Women with SMI in pregnancy struggle with issues of obesity, gestational weight gain, food cravings and possible eating disorder behaviours. They have additional challenges when pregnant, with management of their mental health and physical health having a direct impact. Interventional strategies in this population should incorporate findings from this research.
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Affiliation(s)
- J Frayne
- Medical School, Division of General practice, The University of Western Australia, Crawley, WA, Australia.,Department of Obstetrics, Women and Newborn Health Service, Subiaco, WA, Australia
| | - Y Hauck
- Department of Nursing and Midwifery Education and Research, Women and Newborn Health Service, Subiaco, WA, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - P Sivakumar
- Department of Nutrition and Dietetics, Women and Newborn Health Service, Subiaco, WA, Australia
| | - T Nguyen
- Medical School, Division of Psychiatry, The University of Western Australia, Crawley, WA, Australia.,Peel and Rockingham, Kwinana Mental Health Services, Rockingham, WA, Australia
| | - H Liira
- Medical School, Division of General practice, The University of Western Australia, Crawley, WA, Australia
| | - V A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,Centre for Clinical Research in Neuropsychiatry, Medical School, Division of Psychiatry, The University of Western Australia, Crawley, WA, Australia
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Beks H, Binder MJ, Kourbelis C, Ewing G, Charles J, Paradies Y, Clark RA, Versace VL. Geographical analysis of evaluated chronic disease programs for Aboriginal and Torres Strait Islander people in the Australian primary health care setting: a systematic scoping review. BMC Public Health 2019; 19:1115. [PMID: 31412846 PMCID: PMC6694647 DOI: 10.1186/s12889-019-7463-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/08/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Targeted chronic disease programs are vital to improving health outcomes for Indigenous people globally. In Australia it is not known where evaluated chronic disease programs for Aboriginal and Torres Strait Islander people have been implemented. This scoping review geographically examines where evaluated chronic disease programs for Aboriginal people have been implemented in the Australian primary health care setting. Secondary objectives include scoping programs for evidence of partnerships with Aboriginal organisations, and use of ethical protocols. By doing so, geographical gaps in the literature and variations in ethical approaches to conducting program evaluations are highlighted. METHODS The objectives, inclusion criteria and methods for this scoping review were specified in advance and documented in a published protocol. This scoping review was undertaken in accordance with the Joanna Briggs Institute (JBI) scoping review methodology. The search included 11 academic databases, clinical trial registries, and the grey literature. RESULTS The search resulted in 6894 citations, with 241 retrieved from the grey literature and targeted organisation websites. Title, abstract, and full-text screening was conducted by two independent reviewers, with 314 citations undergoing full review. Of these, 74 citations evaluating 50 programs met the inclusion criteria. Of the programs included in the geographical analysis (n = 40), 32.1% were implemented in Major Cities and 29.6% in Very Remote areas of Australia. A smaller proportion of programs were delivered in Inner Regional (12.3%), Outer Regional (18.5%) and Remote areas (7.4%) of Australia. Overall, 90% (n = 45) of the included programs collaborated with an Aboriginal organisation in the implementation and/or evaluation of the program. Variation in the use of ethical guidelines and protocols in the evaluation process was evident. CONCLUSIONS A greater focus on the evaluation of chronic disease programs for Aboriginal people residing in Inner and Outer Regional areas, and Remote areas of Australia is required. Across all geographical areas further efforts should be made to conduct evaluations in partnership with Aboriginal communities residing in the geographical region of program implementation. The need for more scientifically and ethically rigorous approaches to Aboriginal health program evaluations is evident.
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Affiliation(s)
- Hannah Beks
- Deakin Rural Health, Deakin University, School of Medicine, Geelong, Victoria, Australia
| | - Marley J Binder
- Deakin Rural Health, Deakin University, School of Medicine, Geelong, Victoria, Australia
| | - Constance Kourbelis
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, Australia
| | - Geraldine Ewing
- Deakin Rural Health, Deakin University, School of Medicine, Geelong, Victoria, Australia
| | - James Charles
- Institute of Koorie Education, Deakin University, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Yin Paradies
- Faculty of Arts and Education, Deakin University, Burwood, Victoria, Australia
| | - Robyn A Clark
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, Australia
| | - Vincent L Versace
- Deakin Rural Health, Deakin University, School of Medicine, Geelong, Victoria, Australia.
- National Centre for Farmer Health, Western District Health Service, Hamilton, Victoria, Australia.
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Abstract
Perinatal mental disorders are common and can impact adversely both on maternal functioning and on foetal and neonatal outcomes. For the more severe disorders, such as schizophrenia, bipolar disorder and severe depression, medication may be needed during pregnancy and breastfeeding, and there is a growing but complex evidence based on the effects of psychotropic medication on the foetus and neonate. In addition, the neonatologist needs to be aware of the co-morbid problems that women with mental disorders are more likely to have as these may also impact on the neonate. Close liaison with family physicians and primary care where there are concerns about mental health is important to ensure maternal mental health is optimal for the mother and her infant.
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Affiliation(s)
- Hind Khalifeh
- Section of Women's Mental Health, King's College London, PO31 De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Ruth Brauer
- Section of Women's Mental Health, King's College London, PO31 De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Hilary Toulmin
- Wellcome Trust Research Training Fellow, Centre for the Developing Brain/Division of Imaging Sciences and Biomedical Engineering, King's College London-King's Health Partners, St Thomas' Hospital, London SE1 7EH, United Kingdom.
| | - Louise M Howard
- Section of Women's Mental Health, King's College London, PO31 De Crespigny Park, London SE5 8AF, United Kingdom.
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Taylor CL, Stewart R, Ogden J, Broadbent M, Pasupathy D, Howard LM. The characteristics and health needs of pregnant women with schizophrenia compared with bipolar disorder and affective psychoses. BMC Psychiatry 2015; 15:88. [PMID: 25886140 PMCID: PMC4406022 DOI: 10.1186/s12888-015-0451-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/19/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Most women with psychotic disorders and bipolar disorders have children but their pregnancies are at risk of adverse psychiatric and fetal outcome. The extent of modifiable risk factors - both clinical and socio-demographic - is unclear as most studies have used administrative data or recruited from specialist tertiary referral clinics. We therefore aimed to investigate the socio-demographic and clinical characteristics of an epidemiologically representative cohort of pregnant women with affective and non-affective severe mental illness. METHODS Women with severe mental illness were identified from a large electronic mental health case register in south London, and a data linkage with national maternity Hospital Episode Statistics identified pregnancies in 2007-2011. Data were extracted using structured fields, text searching and natural language processing applications. RESULTS Of 456 pregnant women identified, 236 (51.7%) had schizophrenia and related disorders, 220 (48.3%) had affective psychosis or bipolar disorder. Women with schizophrenia and related disorders were younger, less likely to have a partner in pregnancy, more likely to be black, to smoke or misuse substances and had significantly more time in the two years before pregnancy in acute care (inpatient or intensive home treatment) compared with women with affective disorders. Both groups had high levels of domestic abuse in pregnancy (recorded in 18.9%), were from relatively deprived backgrounds and had impaired functioning measured by the Health of the Nation Outcome Scale. Women in the affective group were more likely to stop medication in the first trimester (39% versus 25%) whereas women with non-affective psychoses were more likely to switch medication. CONCLUSIONS A significant proportion of women, particularly those with non-affective psychoses, have modifiable risk factors requiring tailored care to optimize pregnancy outcomes. Mental health professionals need to be mindful of the possibility of pregnancy in women of childbearing age and prescribe and address modifiable risk factors accordingly.
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Affiliation(s)
- Clare L Taylor
- Section of Women's Mental Health/Women's Health Academic Centre, Department of Health Service and Population Research, King's College London, Institute of Psychiatry, London, UK.
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, UK.
| | - Jack Ogden
- Section of Women's Mental Health/Women's Health Academic Centre, Department of Health Service and Population Research, King's College London, Institute of Psychiatry, London, UK.
| | | | | | - Louise M Howard
- Section of Women's Mental Health/Women's Health Academic Centre, Department of Health Service and Population Research, King's College London, Institute of Psychiatry, London, UK.
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Jones I, Chandra PS, Dazzan P, Howard LM. Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet 2014; 384:1789-99. [PMID: 25455249 DOI: 10.1016/s0140-6736(14)61278-2] [Citation(s) in RCA: 283] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The perinatal period is associated with an increased risk of severe mental disorders. We summarise the evidence regarding the epidemiology, risk factors, and treatment of severe mental illness in relation to childbirth, focusing on bipolar disorder, affective psychosis, and schizophrenia. We discuss women with ongoing chronic conditions and those with the onset of new episodes of post-partum psychosis. Despite the importance of perinatal episodes, with suicide a leading cause of maternal death, few studies are available to guide the management of women with severe mental disorders in pregnancy and the post-partum period. However, general principles of management are discussed, including the need for an individual risk-benefit analysis for each woman.
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Affiliation(s)
- Ian Jones
- National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK.
| | - Prabha S Chandra
- National Institute of Mental Health and Neurosciences (NIMHNS), Bangalore, India
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - Louise M Howard
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
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Adverse obstetric and neonatal outcomes in women with severe mental illness: to what extent can they be prevented? Schizophr Res 2014; 157:305-9. [PMID: 24934903 DOI: 10.1016/j.schres.2014.05.030] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 04/29/2014] [Accepted: 05/17/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Women with schizophrenia and bipolar disorder are at a higher risk of obstetric and neonatal complications. The aim of this study was to better understand the factors that may influence these adverse outcomes. METHOD We examined obstetric and neonatal outcomes of pregnant women with schizophrenia and bipolar disorder and factors possibly influencing these outcomes. A retrospective review of the medical history of 112 women with a DSM-IV diagnosis of schizophrenia or bipolar disorder was undertaken. Data for controls were extracted from the hospital's electronic birth record data. RESULTS Women with schizophrenia and bipolar disorder presented later for their first antenatal visit and had higher rates of smoking and illicit drug use than the control group. They also had higher rates of pre-eclampsia and gestational diabetes. Their infants were less likely to have Apgar scores 8-10 at both 1 and 5minutes and were more likely to be admitted to special care/neonatal intensive care nursery than the infants of controls. The rate of pre-term birth was significantly increased in the women with schizophrenia and bipolar disorder. Pre-term birth and admission to special care/neonatal intensive care were predicted by smoking and illicit drug use. CONCLUSION These data point to potentially modifiable factors as significant contributors to the high rate of adverse obstetric and neonatal outcomes in women with mental illness. Comprehensive management of women with mental illness prior to, during pregnancy and in the postnatal period may have long-term benefits for their offspring.
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