Preconception depression and anxiety symptoms and maternal-infant bonding: a 20-year intergenerational cohort study

The impact of maternal depression and anxiety on well-baby visit attendance: a retrospective cohort study of 6,699 PRAMS participants from 2016-2021

PURPOSE

The objective of this study was to determine the independent effects of maternal mental health difficulties (MHD) during the preconception, prenatal, and postnatal periods on well-baby visit (WBV) attendance in a population-wide sample through retrospective analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data.

METHODS

This secondary analysis utilized data from the 2016 - 2021 New Jersey PRAMS, yielding 6,699 participants (mean age = 30.8 years). Survey-weighted means, confidence intervals, and percentages were used to describe sociodemographic, mental health, and WBV variables across all participants. Logistic regression with complex survey weights and multiple imputation of missing data was implemented to test associations between sociodemographic factors, maternal MHDs, and WBV attendance.

RESULTS

The weighted prevalence of missing the 1-week checkup or having never attended a WBV during the first six months postpartum was 4.3% (95% CI: 3.8% - 5.0%; n = 260) and 1.4% (1.1% - 2.0%; n = 98), respectively. Preconception depression (n = 553; 7.7%, 7.0% - 8.0%), prenatal depression (n = 481; 6.5%, 5.9% - 7.0%;), preconception anxiety (n = 1,007; 15.2%, 14.2% - 16.0%), and prenatal anxiety (n = 570; 8.44%, 7.7% - 9.0%) were not associated with 1-week checkup attendance. However, women with preconception depression were more than twice as likely to have never attended a WBV (OR = 2.43, 1.01 - 5.82). Multiple social determinants and demographic variables were associated with greater odds of missing WBVs, including middle household income, receiving government-issued health insurance or being uninsured, Hispanic ethnicity, and Spanish as a primary language.

CONCLUSIONS

Preconception depression, middle household income, receiving government-issued health insurance, being uninsured, Hispanic ethnicity, and Spanish as a primary language may decrease attendance of WBVs, and the mediating role of preconception depression in infant health outcomes warrants further investigation.

Amphetamine use and mental health difficulties across adolescence and young adulthood: An integrative data analysis of four Australasian cohort studies

BACKGROUND AND AIMS

The use of amphetamines (including amphetamine and methamphetamine) has been consistently associated with mental health difficulties; however, the direction of potential causal relationships has not yet been established. This study aimed to assess the direction relationships between illicit amphetamine use and mental health difficulties across adolescence and young adulthood.

DESIGN

Observational study of four population-level cohorts participating in the Monitoring Illicit Substance Use (MISUse) Consortium.

SETTING

Australia and New Zealand.

PARTICIPANTS

A total of 7527 participants (51% female) were used: Christchurch Health and Development Study (n = 1056), Australian Temperament Project (n = 1644), Victorian Adolescent Health Cohort Study (n = 1943) and International Youth Development Study (n = 2884).

MEASUREMENTS

Assessments were used to derive binary indicators of amphetamine use (≥monthly) and mental health difficulties during both adolescence (age 10-17 years) and young adulthood (age 18-30 years).

FINDINGS

Associations were estimated as Risk Ratios (RRs) with 95% confidence internals (CIs) using G-computation procedures, while accounting for 15 potential confounding factors and interactions between exposure and both study cohort and participant sex. The risk of mental health difficulties in young adulthood was 21% greater (RR = 1.21, 95% CI = 1.04, 1.41) for those who reported monthly or more frequent amphetamine use in adolescence. The risk of monthly or higher amphetamine use in young adulthood was 19% greater (RR = 1.19, 95% CI = 0.99, 1.45) in those who reported mental health difficulties in adolescence. There was also some evidence to suggest that in males the strongest association was from amphetamine use to mental health difficulties (RR = 1.24, 95% CI = 0.95, 1.60), while in females the strongest association was from mental health difficulties to amphetamine use (RR = 1.33, 95% CI = 0.99, 1.78).

CONCLUSIONS

There appears to be a bidirectional association between monthly or more frequent amphetamine use and mental health difficulties from adolescence to young adulthood.

Mental Health during the Interpregnancy Period and the Association with Pre-Pregnancy Body Mass Index and Body Composition: Data from the INTER-ACT Randomized Controlled Trial

Mental health problems and obesity are two common complications during pregnancy and postpartum. The preconception period is considered an appropriate period for prevention. Therefore, insights into interpregnancy mental health and the impact on weight and body composition are of interest to developing effective weight management strategies. The primary aim of this study is to assess the difference in women's mental health during the interpregnancy period and the association with pre-pregnancy body mass index (BMI) and body composition. The secondary aim is to study whether this association is affected by socio-demographic factors, interpregnancy interval and sleep. The study is a secondary analysis of the INTER-ACT e-health-supported lifestyle trial. Women were eligible if they had a subsequent pregnancy and mental health measurements at 6 weeks after childbirth and at the start of the next pregnancy (n = 276). We used univariate analyses to assess differences in mental health and performed regression analysis to assess their association with pre-pregnancy BMI and body composition at the start of the next pregnancy. Our results show a statistically significant increase in anxiety and depressive symptoms between 6 weeks after childbirth and the start of the next pregnancy (sSTAI-6 ≥ 40: +13%, p =≤ 0.001; GMDS ≥ 13: +9%, p = 0.01). Of the women who were not anxious at 6 weeks after childbirth (sSTAI < 40), more than one-third (39%) developed anxiety at the start of the next pregnancy (p =≤ 0.001). Regression analysis showed that sense of coherence (SOC-13) at the start of the next pregnancy was independently associated with women's pre-pregnancy BMI and fat percentage. We believe that the development of preconception lifestyle interventions that focus on both weight reduction and support in understanding, managing and giving meaning to stressful events (sense of coherence) may be of added value in optimizing women's preconception health.

Associations between maternal psychological distress and mother-infant bonding: a systematic review and meta-analysis

PURPOSE

Maternal psychological distress and mother-infant bonding problems each predict poorer offspring outcomes. They are also related to each other, yet the extensive literature reporting their association has not been meta-analysed.

METHODS

We searched MEDLINE, PsycINFO, CINAHL, Embase, ProQuest DTG, and OATD for English-language peer-reviewed and grey literature reporting an association between mother-infant bonding, and multiple indicators of maternal psychological distress.

RESULTS

We included 133 studies representing 118 samples; 99 samples (110,968 mothers) were eligible for meta-analysis. Results showed concurrent associations across a range of timepoints during the first year postpartum, between bonding problems and depression (r = .27 [95% CI 0.20, 0.35] to r = .47 [95% CI 0.41, 0.53]), anxiety (r = .27 [95% CI 0.24, 0.31] to r = .39 [95% CI 0.15, 0.59]), and stress (r = .46 [95% CI 0.40, 0.52]). Associations between antenatal distress and subsequent postpartum bonding problems were mostly weaker and with wider confidence intervals: depression (r = .20 [95% CI 0.14, 0.50] to r = .25 [95% CI 0.64, 0.85]), anxiety (r = .16 [95% CI 0.10, 0.22]), and stress (r = .15 [95% CI - 0.67, 0.80]). Pre-conception depression and anxiety were associated with postpartum bonding problems (r = - 0.17 [95% CI - 0.22, - 0.11]).

CONCLUSION

Maternal psychological distress is associated with postpartum mother-infant bonding problems. Co-occurrence of psychological distress and bonding problems is common, but should not be assumed. There may be benefit in augmenting existing perinatal screening programs with well-validated mother-infant bonding measures.

A Network Analysis of Multiple Preconception Health Behaviors in Chinese Women

BACKGROUND

A healthy preconception lifestyle, consisting of multiple health behaviors, is crucial for preventing adverse health outcomes in mothers and offspring. Although knowledge about the pattern of inter-behavior relations may provide insights for nudging multiple health behavior changes, this has not been adequately explored in the existing literature. Adopting a network perspective, the present study conceptualized multiple health behaviors as a behavior network (i.e., behaviors as nodes, inter-behavior relations as edges) and utilized network analysis to investigate the pattern of interrelations of preconception health behaviors in a large sample of Chinese women.

METHOD

We used the data of a population-based cohort study in China to estimate the behavior network. An analytic sample included 41,127 Chinese women who were surveyed about their adoptions of multiple health behaviors during the preconception period.

RESULTS

Network analysis revealed a relatively dense behavior network and visualized the network structure of multiple preconception health behaviors. Subsequent centrality analysis identified three central behaviors (i.e., avoiding second- or third-hand smoke, reducing psychosocial stress, and reducing alcohol) that had distinctively stronger connections to other behaviors.

CONCLUSIONS

Preconception health behaviors were strongly interconnected, and certain behaviors had stronger influences than others within the behavior network. Our findings highlight the strong inter-relatedness of preconception health behaviors. This study also encourages targeting the three central behaviors in preconception lifestyle promotions because this may bring more secondary improvements on other non-targeted behaviors and thereby achieve comprehensive lifestyle change.

Potential Benefits of Anthocyanins in Chronic Disorders of the Central Nervous System

Anthocyanins have been shown to be effective in chronic diseases because of their antioxidant and anti-inflammatory effects together with changes in the gut microbiota and modulation of neuropeptides such as insulin-like growth factor-1. This review will examine whether these mechanisms may be effective to moderate the symptoms of disorders of the central nervous system in humans, including schizophrenia, Parkinson's disease, Alzheimer's disease, autism spectrum disorder, depression, anxiety, attention-deficit hyperactivity disorder and epilepsy. Thus, anthocyanins from fruits and berries should be considered as complementary interventions to improve these chronic disorders.

Exposure to War Prior to Conception: Maternal Emotional Distress Forecasts Sex-Specific Child Behavior Problems

Objectives: Exposure to maternal stress during the prenatal period adversely affects child outcomes. Recent investigations have shifted to an even earlier period, the preconception period, to better understand the role of this formative period in human health and disease. We investigated the links between maternal emotional distress following preconception exposure to war, and child outcomes at age 10. Material and Methods: Before becoming pregnant, mothers were exposed to missile bombardment on the north of Israel in the 2006 war. Mothers who conceived within 12 months after the war were recruited and compared to mothers who conceived during the same period but lived in Israel but outside missile range. During the initial assessment, mothers completed a questionnaire on emotional distress. At 10 years of age, mothers and children (N = 68) reported on child socio-emotional outcomes. Results: Multiple regression analyses revealed that, in girls, higher maternal emotional distress following preconception war exposure predicted more internalizing and externalizing behavior problems, and more behavior regulation problems. In boys, maternal emotional distress was not significantly related to outcomes. Conclusion: Maternal emotional distress following preconception exposure to war forecasts sex-specific child behavioral problems as reported by the mother and the child. Though the results warrant cautious interpretation because of the relatively small sample size and differential attrition, our findings add to the small but growing body of research on the consequences of maternal stress exposure prior to conception for the next generation.

Psychological Interventions for Prenatal Anxiety in Latinas and Black Women: A Scoping Review and Recommendations

Anxiety symptoms are common among pregnant women worldwide. In the United States, prenatal anxiety symptoms tend to be elevated among Black and Latin American women as compared to non-Latina White women. Despite the high prevalence of anxiety and associations with adverse maternal and offspring outcomes, interventions have not been developed or tailored sufficiently to Black women or Latinas who need efficacious treatment. This article provides a scoping review of articles published since 2017 that test the effects of randomized and non-randomized psychological interventions designed to reduce prenatal anxiety in samples comprised primarily of ethnic/racial minority women. We also review published protocols of planned psychological interventions to reduce prenatal anxiety in order to highlight novel approaches. In addition to summarizing intervention efficacy and participant acceptability, we highlight gaps in the literature which, if addressed, could improve perinatal mental health equity. Finally, we discuss future directions in prenatal anxiety intervention science beginning preconception including intervention design and prevention models.