Does non-pharmacological therapy for antenatal depression reduce risks for the infant?

3D printed models in pregnancy and its utility in improving psychological constructs: a case series

Background

3D printing is being utilized in almost every aspect of medicine. 3D printing has especially been used in conjunction with 3D ultrasonography to assist in antenatal assessment and presurgical planning with fetal malformations. As printing capabilities improve and applications are explored there may be more advantages for all parents to visualize and touch 3D printed models of their fetus.

Case presentation

We present three cases involving 3D printed models and four different but interrelated psychological constructs- antenatal depression, antenatal anxiety, maternal-fetal attachment, and paternal-fetal attachment. Each case shows for the first time possible beneficial effects within these prevalent and significant problems.

Conclusions

The degree to which the anxiety, depression, and attachment scores improved after the presentation of the 3D printed models is encouraging. Randomized controlled trials utilizing 3D printed models to improve psychological constructs should be supported considering the findings within these four cases.

Obstetric complications in bipolar disorder: Psychiatric factors and the risk of caesarean section

Bipolar Disorder (BD) is a chronic psychiatric condition with somatic morbidity that requires continuous mood stabilizing treatment to prevent relapses. Pregnant women with BD have shown an increased rate of caesarean section (C-Section) in comparison with women without BD. Because specific differentiated profiles between mothers with BD that require C-Section and those that do not require C-Section have not been largely discussed, we aim to explore the risk factors associated with the type of delivery in pregnant women with BD. A prospective cohort study was conducted at the Perinatal Mental Health Unit. 100 pregnant women with BD were followed throughout their pregnancy by obstetric and psychiatric services at the same hospital. The cohort was developed in order to compare psychiatric and obstetric outcomes between women with BD that required C-Section (N = 40) versus women that did not require C-Section (N = 60). Final regression models showed an increased risk for obstetric complications during labour (OR 4,52, 95% CI 1,66-12,29), higher rates of hypothyroidism (OR 3,73, 95% CI 1,04-13,73) and treatment with lithium + antidepressant (OR 4,24, 95% CI 1,34-13,40) amongst the C-Section group when compared to the non-C-Section group. In our sample, women with BD treated with lithium plus antidepressant, with hypothyroidism and without obstetric complications have a 70,5% probability of C-Section. In conclusion, psychopharmacology and thyroid function might help understanding which women with BD will have more probability of C-Section. The implementation of more targeted interventions in selected patients might be useful to avoid complications during delivery.

The effect of maternal antidepressants on third trimester uteroplacental hemodynamics and the neonatal abstinence syndrome: a retrospective cohort study

The objective of this study is to determine whether maternal antidepressant use during pregnancy influences uteroplacental hemodynamics, thereby affecting fetal growth and gestational age at delivery. The secondary aim was to determine the incidence of neonatal abstinence syndrome (NAS) among infants exposed to antidepressant medications. The charts of women who received obstetrical care and had a history of depression from January 2014 to December 2016 at Mount Sinai Hospital in Toronto, Canada, were reviewed. Exclusion criteria were substance abuse; narcotic or lithium use at the time of delivery.In total, 205 women met the inclusion criteria (92 took antidepressants; 113 women did not). There were no significant differences in umbilical artery pulsatility index (PI), gestational age at delivery, or birth weight when comparing women based on antidepressant use. A small proportion (18%) of neonates had mild withdrawal symptoms; one baby had a score (≥ 8) consistent with severe NAS. In women with a history of depression, there was no difference in uteroplacental hemodynamics as measured by third trimester Doppler ultrasonography when comparing women who took antidepressant medication versus those who did not. The large majority of babies who were exposed to antidepressants in utero did not show withdrawal symptoms. These results lend support for the relative safety of antidepressants during pregnancy.

Comparison of two different treatments in depressed pregnant women: fetal growth characteristics and neonatal outcomes

Background In this pilot study, the effects of selective serotonin reuptake inhibitors (SSRIs) and psychological intervention on fetal growth characteristics and neonatal outcomes were evaluated in two different groups of women affected by prenatal depression. Methods Forty-seven pregnant women diagnosed with major depression were divided into two different treatment groups according to the severity of their depression. The first group was treated with a combination of pharmacotherapy and psychological support. The second group (milder depression) was treated with psychological support only. The control group (CG) was made up of 26 healthy pregnant women. All of the patients and controls were assessed by means of a structured clinical interview and different self-reported questionnaires. Fetal ultrasonography assessments were performed in the second and third trimesters. Neonatal outcomes were evaluated at delivery. Results The infants of both treatment groups showed significant alterations in fetal biometry and a higher rate of low birth weight (LBW) with respect to controls. The infants of the patients treated with psychological support showed only a significantly higher rate of head circumference, <10th percentile with respect to controls. No significant difference was found between the two patient groups when fetal growth characteristics and neonatal outcomes were taken into account. Conclusion The data obtained from this study shed light on the effects of pharmacological and psychological treatment of prenatal depression on fetal growth.