Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data

The complex interaction between oestrogen receptor genes, oestradiol, and perinatal mood

INTRODUCTION

Genetic variations in oestrogen receptor (ER) genes are associated with inter-individual differences in the sensitivity of ER-α, ER-β and G protein-coupled oestrogen receptor (GPER). These sensitivity differences may modulate susceptibility to mood changes during phases of endogenous oestrogen fluctuations, thereby explaining individual vulnerability. This study examined the association between ER gene variations, oestradiol and perinatal mood disturbances.

METHODS

A total of 159 women were observed during the perinatal period, providing saliva samples for oestradiol assessment and completing self-report measures of depressive and anxiety symptoms at five time points. Polymorphisms in ER genes were determined from dried blood spots. The associations were analysed using linear mixed models.

RESULTS

The ER-α gene haplotypes were associated with perinatal mood disturbances. The CG haplotype was associated with perinatal depressive (p = 0.0162, F-test) and anxiety symptoms (p = 2.396e-05, F-test), whereas the TA haplotype was associated with perinatal anxiety symptoms (p = 0.004, F-test). The interaction between ER gene variations, oestradiol and perinatal mood disturbances was not significant.

CONCLUSIONS

ER-α gene variations are associated with an increased susceptibility to perinatal mood disturbances. Sensitivity differences in ER-α appear to play a more important role for emotional processes than those in ER-β and GPER, independently of oestradiol levels. This might be explained by ER-α's more dominant expression in the hypothalamus and amygdala.

Proposing a two-stage screening approach to distinguish between transient and enduring postnatal depressive symptoms: A prospective cohort study

Background

Screening for perinatal depression using the Edinburgh Postnatal Depression Scale (EPDS) improves detection and increases health service utilization. However, previous studies with antenatal samples indicate that positive screenings might reflect transient distress that resolves without intervention, raising concerns about over-pathologizing typical postnatal responses and inefficiencies in referral practices. Therefore, distinguishing between transient and enduring depressive symptoms for appropriate referrals to secondary services is crucial, highlighting the need for a refined screening practice.

Objectives

We aimed to assess the prevalence of transient distress among postnatal women who initially screened positive on the EPDS and evaluate the effectiveness of a refined two-stage screening approach. Three research questions were addressed: Can the "transient phenomenon" be replicated in a postnatal sample? Can initial screening data predict transient status? What are the implications of adopting a two-stage screening approach?

Methods

In a prospective cohort study, 427 postnatal women in Copenhagen who scored above the cut-off on their initial EPDS screening (EPDS-1) underwent a second screening (EPDS-2) 1-4 weeks later, without intervention in between. We analyzed the predictive power for transient versus enduring distress using EPDS-1 total scores, responses to item 10 ("self-harm item"), parity, maternal age, and a history of depression. Three screening scenarios were compared for their clinical and ethical implications: (i) a traditional single screening approach where all individuals screening positive at EPDS-1 are directly referred to secondary services, (ii) a simple two-stage approach where all positive screenings at EPDS-1 undergo a second screening before referral, and (iii) a refined two-stage screening approach where selected criteria determine immediate referral or further screening.

Results

Among women who screened positive, 29.3 % displayed transient distress with a clinically meaningful decrease in EPDS scores. An EPDS-1 score of 15 or more was the most robust predictor of enduring symptoms (OR = 6.28, 95 % CI 3.5-11.8; Absolute Risk = 90.4 %) and was used along with a positive score on item 10 as indicators of immediate referral in scenario-iii. The refined two-stage approach reduced unnecessary referrals by 24 %, directly referred 60 % of women with enduring symptoms, and effectively managed suicidal risk.

Conclusions

A substantial proportion of postnatal women experience transient symptoms that are distinguishable from enduring symptoms through a refined two-stage screening strategy. This approach significantly improves referral efficiency and minimizes over-pathologization, enhancing clinical practice in perinatal mental health.

Investigating the Microbiome in Relation to Mental Distress Across Two Points During Pregnancy: Data From U.S. and Swedish Cohorts

Background

In this study, we aimed to characterize the gut microbiome and its potential functioning in 2 populations at 2 time points during pregnancy in relation to mental distress.

Methods

During the second and third trimester, individuals from the United States and Sweden completed the Edinburgh Postnatal Depression Scale and provided fecal samples for whole-genome metagenomics. A total of 832 and 161 samples were sequenced and analyzed from the Swedish cohort and the U.S. cohort, respectively. Multiple characterizations of the microbial community were analyzed in relation to distress measured using the Edinburgh Postnatal Depression Scale. Principal coordinate analysis and distance-based redundancy analysis assessed variation in functional gut-brain modules. For the U.S. cohort, the Trier Social Stress Test was administered 8 weeks postpartum while collecting salivary cortisol.

Results

Principal coordinate analysis identified 4 sample clusters based on the gut-brain modules distinguished by functions such as short-chain fatty acid synthesis and cortisol degradation. While with distance-based redundancy analysis, mental distress subtypes did not significantly contribute to variation in gut-brain modules (p = .085 for Sweden, p = .23 for the U.S.), a U.S. sample cluster distinguished by lower cortisol degradation from another cluster with higher gut microbial cortisol degradation abundance had significantly higher odds of being associated with depression (p = .024). The U.S. sample cluster with lower gut microbial cortisol degradation abundance also had significantly higher cortisol levels after a postpartum social stressor.

Conclusions

Further studies are warranted to investigate the potential for the gut microbiome to serve as biomarkers of gut-brain axis health during pregnancy across disparate populations.

Effectiveness of expressive writing therapy for postpartum women with psychological distress: Meta-analysis and narrative review

BACKGROUND

The increasing prevalence of psychological distress among mothers is outpacing the effectiveness of conventional coping methods like cognitive behavioral therapy. The efficacy of alternatives such as writing therapy for maternal psychological well-being remains uncertain due to a lack of extensive research and inconsistent findings.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of expressive writing therapy in comparison to standard postpartum care for alleviating psychological distress, encompassing symptoms of depression, anxiety, or stress, in postpartum women.

SEARCH STRATEGY

For this purpose, seven bibliographic databases, including CINAHL, Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science, and gray literature were examined up to December 27, 2022 for randomized controlled trials, comparing expressive writing against standard care or controlled writing among postpartum women with psychological distress.

DATA COLLECTION AND ANALYSIS

Data was collected using a random effect model for meta-analysis.

RESULTS

A meta-analysis of five studies with 483 participants found that expressive writing therapy was more effective than standard care or controlled writing in reducing postpartum depression and stress among women with psychological distress. Expressive writing resulted in a significant reduction in initial depression with standard mean difference (SMD) = -0.65%, 95% confidence interval (CI) = -1.08 to -0.22, Z = 2.96, P = 0.003, in comparison to controlled writing as an intervention. Regarding expressive writing versus standard care, a narrative review was conducted due to an I2 above 75%. The results showed significant improvements compared to the baseline at the seventh day and third month post-intervention. In terms of stress scores, there was a significant difference favoring expressive writing over standard care at the first month (SMD = -0.80%, 95% CI = -1.35 to -0.24, Z = 2.81, P = 0.005) and third month (SMD = -0.53%, 95% CI = -0.86 to -0.20, Z = 3.13, P = 0.002) post-intervention. Stress scores are also greatly reduced for expressive writing versus controlled writing with SMD = -0.79%, 95% CI = -1.03 to -0.55, Z = 6.48, P < 0.00001. However, the effectiveness of expressive writing on postpartum anxiety should be interpreted cautiously due to low certainty.

CONCLUSION

Expressive writing serves as an effective alternative for non-pharmacological intervention for postpartum women with depression and stress, but more research is needed for postpartum anxiety. As substantial heterogeneity was detected, results must be interpreted cautiously. Postpartum women with psychological distress are encouraged to use expressive writing as an affordable way to promote maternal mental health for the benefit of both the mother and the child.

Cognitive behavioural therapy for intolerance of uncertainty: A study protocol for the prevention of postpartum anxiety

BACKGROUND

Mental health disorders are the most prevalent health complication experienced during pregnancy and the postpartum, with anxiety disorders being most common. Intolerance of uncertainty (IU) is a well-known feature of anxiety disorders and has recently been identified as a risk factor for the worsening of anxiety during the postpartum period. Cognitive Behavioural Therapy (CBT) is a first-line treatment for perinatal anxiety, and CBT specifically targeting IU in non-perinatal populations has demonstrated positive findings for reducing anxiety. As such, the objective of our study is to examine whether CBT targeting IU in pregnancy can reduce the risk of postpartum anxiety.

METHODS

This protocol paper outlines a proof-of-concept randomised clinical trial assessing the effectiveness of a newly developed CBT for IU (CBT-IU) protocol to reduce the risk of postpartum anxiety. Pregnant individuals identified at increased risk for postpartum anxiety (defined as a baseline score of 64 or greater on the Intolerance of Uncertainty Scale) will be randomised to receive CBT-IU or care as usual (CAU) during pregnancy and will be followed through the postpartum period (6-12 weeks). The CBT-IU protocol is a weekly, six session treatment, which includes psychoeducation, behavioural experiments, imaginal exposure, and problem-solving to target IU.

DISCUSSION

To our knowledge, this will be the first study to investigate the efficacy of a CBT protocol aimed at reducing the risk of developing postpartum anxiety. Establishing this protocol as a potentially preventative strategy will offer a new option to improve the mental health and well-being of mothers and their infants.

CLINICAL TRIAL REGISTRATION

Trial Number is NCT05691140 and accessible at https://clinicaltrials.gov/study/NCT05691140.

Experiences of intimate partner violence and antepartum depression among women seeking antenatal care in Addis Ababa, Ethiopia: findings from the MISPOD study

Despite the high prevalence of intimate partner violence (IPV) and antepartum depression, there is limited evidence on the association between the two in Ethiopia. We aimed to investigate the association between experience of IPV during and before pregnancy and depression in the third trimester of pregnancy. We surveyed women attending antenatal care clinics in 22 selected health facilities in Addis Ababa in the third trimester of pregnancy. We used a 12-item tool to measure IPV and the Edinburgh Postnatal Depression Scale (EDPS) to measure antepartum depression. We performed multivariable logistic regression analysis to determine the association between IPV and antepartum depression. Of the 399 women included, 14.5% (95% CI: 11.3-18.5%) had symptoms suggestive of antepartum depression (EDPS score ≥ 11) and 31.6% (95% CI: 27.1-36.4%) had recently experienced some form of IPV. The adjusted odds of antepartum depression was 2.24 higher among women who had experienced IPV compared to those who had not (95% CI: 1.11-4.54). Antepartum depression was higher among women aged 15-24 compared to those aged 25-34 (AOR = 2.76, 95% CI: 1.05, 7.23), women with low maternal social support compared to those with adequate support (AOR = 7.04, 95% CI: 2.07, 23.97), and women who worried very often about feeding their family compared to those who did not worry at all (AOR = 8.95, 95% CI: 3.09, 25.94). The findings highlight the need for integrated and tailored interventions to mitigate IPV and antepartum depression to address the needs of adolescent and young women, and those living in poverty or lacking social support.

Unveiling the Mental Health of Postpartum Women During and After COVID-19: Analysis of Two Population-Based National Maternity Surveys in Romania (2020-2025)

(1) Background: The COVID-19 pandemic caused widespread upheaval, presenting unique challenges for pregnant and postpartum women, who were already in a particularly vulnerable phase. As the COVID-19 pandemic and its public health response unfolded, it became crucial for clinicians and researchers to explore postpartum depression within the context of a global crisis. (2) Methods: We used data from two cross-sectional surveys of postnatal women conducted in our tertiary academic public hospital during the SARS-CoV-2 pandemic and the post-pandemic period, based on the retrospective assessments of two samples of mothers, each including 860 postpartum women. Our research has been conducted with the scope of evaluating postpartum depression disorder during and after the COVID-19 pandemic by using comparable data across time. (3) Results: The prevalence of postpartum depression was significantly higher among women who gave birth during the COVID-19 pandemic (major postpartum depressive disorder: 54.19%, minor depressive disorder: 15.58%), compared to pre-pandemic rates (10% in developed countries and 21-26% in developing countries) and post-pandemic rates (major depressive disorder 10.12%, minor depressive disorder 10.93%). The results of our research indicate that the COVID-19 pandemic had a major negative impact on perinatal mental health and, moreover, might have sped up an existing trend of the increasing prevalence of postpartum depression, despite the fact that the risk factors for postpartum depression disease remained consistent before, during, and after the pandemic. (4) Conclusions: Strengthening support systems during periods of heightened risk, such as during a pandemic, is crucial; therefore, policymakers and health planners should prioritize the mental health of this vulnerable group during global health crises or natural disasters, ensuring the implementation of effective mental health screenings, identification, enhanced support, follow-up, and reassurance measures to better address the challenges faced by susceptible postpartum women in future similar situations.

Parenting stress after perineal tear during childbirth: the role of physical health and depressive symptoms

Introduction

This study investigates the impact of the severity of perineal tear during childbirth on parenting stress at 10-12 weeks postpartum. Studies have shown that up to 80% of primiparous mothers may suffer a perineal tear, which can have important physical and psychological consequences. As the adjustment to parenthood can be highly demanding and stressful for primiparous parents, we hypothesized that having experienced a perineal tear during childbirth could be an additional stressor reducing the resources to cope, which could increase parenting stress. We also hypothesized that this increase in parenting stress could be explained by the consequences of the perineal tear on mothers' physical health and depressive symptoms.

Methods

This study included 155 primiparous mothers with various degrees of perineal tear (from an intact perineum to a 4th degree tear).

Results

Results showed that perineal tear was not directly associated with parenting stress at 10-12 weeks postpartum. However, we found an indirect pathway of influence through mothers' physical health and depressive symptoms. Higher degrees of perineal tear were associated with worse physical health in mothers causing an increase in depressive symptoms that, in turn, was associated with higher parenting stress.

Discussion

The results indicate that perineal tear is indirectly associated with parenting stress, through its influence on physical health and depressive symptoms. Therefore, it seems crucial to focus on managing the physical consequences of perineal tear in the first weeks postpartum, to avoid detrimental consequences on mothers' mental health and parenting.

Reducing the risk of perinatal depression using an app-based cognitive behavioral therapy program: protocol of a randomized controlled trial

Introduction

Cognitive behavioral therapy (CBT) is recognized as one of the most effective methods for reducing the risk of perinatal depression. However, the traditional face-to-face delivery format limits its accessibility. With the advent of digital technology, app-based CBT offers new possibilities, yet its preventive role in perinatal depression remains insufficiently explored. This study aims to determine if pregnant women using an app-based CBT program report reduced depressive and anxious symptoms compared to a control group.

Methods

A two-arm parallel randomized controlled trial of 290 pregnant women will be conducted at Jintang County Maternity and Child Health Hospital in Chengdu, China. Eligible participants who consent to participate will be recruited at 20-24 weeks of gestation and randomly assigned to either the intervention group, which will complete an 8-week mobile app-based CBT program (CareMom), or a control group, which will receive an attention-matched 8-week relaxation training program, also delivered via a mobile app. Randomization will be performed using a computer-generated random number sequence. Primary outcomes include changes in scores on the Edinburgh Postnatal Depression Scale, the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder 7-item from baseline to 6 weeks postpartum. Outcome analyses will be performed on both the intention-to-treat and per-protocol populations.

Discussion

This trial evaluates an app-based CBT program for reducing the risk of perinatal depression. Improved maternal mental health not only benefits the mothers themselves but also may facilitate more optimal parenting behaviors, which could exert a positive influence on the cognitive, emotional, and behavioral development of the infant.

Clinical Trial Registration

https://clinicaltrials.gov/study/NCT06672432, identifier NCT06672432.

Digital Assessment of Wellbeing in New Parents (DAWN-P): protocol of a randomised feasibility trial comparing digital screening for maternal postnatal depression with usual care screening

BACKGROUND

Meta-analyses indicate that 17% of mothers experience postnatal depression (PND) in the year following childbirth, with suicide the leading cause of direct maternal death between 6 weeks and 12 months postpartum. The consequences and costs of PND are particularly high due to impacts on infants as well as parents. If detected, PND usually responds well to psychological treatment and/or medication but national reports indicate > 50% of cases are undetected. To improve detection, we developed a digital screening system (CareLoop PND) whereby mothers use an app to monitor their mood daily using a validated measure (Edinburgh Postnatal Depression Scale; EPDS), with real-time responses uploaded to a secure server. In this paper, we describe the protocol of a study to determine feasibility of delivering a full-scale RCT comparing digital screening with standard NHS practice.

METHODS

In this single-blind randomised feasibility trial, participants (n = 80) will be recruited during late pregnancy from two NHS maternity services and randomised (1:1) to receive CareLoop PND alongside their usual NHS care, or usual care alone. Those in the experimental arm will use the CareLoop PND app daily from ≥ 36 weeks' pregnancy until 8 weeks postpartum. During this period, participants scoring above EPDS screening thresholds (via the app or standard care) will be assessed to confirm diagnosis. True positive PND cases identified by digital screening will be referred to services for support. A blinded researcher will conduct follow-up assessments using clinical and health economic measures at 8 weeks and 6 months postpartum. At 8 weeks postpartum, experimental arm participants will also provide qualitative and quantitative feedback exploring app usability, acceptability, and implementation. Feasibility of delivering a full-scale RCT will be evaluated using a priori criteria relating to app engagement, study retention and completion of candidate primary outcome measures.

CONCLUSIONS

Digital screening could increase appropriate referral to perinatal mental health care. However, prior to roll out in NHS services, evidence of efficacy and cost-effectiveness is needed. The current study protocol will determine whether a full-scale RCT examining efficacy and cost-effectiveness is feasible and will inform the design of such a trial.

TRIAL REGISTRATION

Prospective ISRCTN registration (03/07/23): ISRCTN10781027; https://www.isrctn.com/ISRCTN10781027 .

Ascorbic Acid and Esketamine for Mental Disorders in Women with Miscarriage: A Randomized Controlled Double-Blind Trial Protocol

Purpose

Pregnancy leads to vulnerabilities and susceptibilities to mental disorders. Miscarriage, as an adverse pregnancy outcome, and following curettage for treatment, add the risks of further psychiatric disorders, including depression, anxiety, insomnia, etc., and current approaches to prevention are unsatisfactory. Ketamine and its S-enantiomer esketamine can prevent postpartum depression, and esketamine even treats depressive symptoms after miscarriage curettage, but their side effects bring limitations. Ascorbic acid (AA, Vitamin C) can modulate mood and enhance ketamine's antidepressant efficacy synergistically, reducing its dosages and adverse effects potentially. The purpose of this study is to clarify the beneficial modification of AA on esketamine for preventing depression and other mental disorders in patients with miscarriage after painless curettage, as well as the interaction between AA and esketamine.

Patients and Methods

This study is a 2×2 factorial, double-blinded, randomized, controlled trial that will recruit women with miscarriage undergoing painless curettage. A total of 424 participants will be recruited and randomly 1:1:1:1 allocated to the following four groups (106 in each): Group A0K0 (normal saline and normal saline), Group A0K1 (normal saline and esketamine), Group A1K0 (AA and normal saline), and Group A1K1 (AA and esketamine). The primary outcome is the incidence of depression on postoperative day 7, assessed with the Edinburgh Postnatal Depression Scale (EPDS). The secondary outcomes include the EPDS score, assessments of anxiety, sleep, and pain, adverse events, perianesthetic data and patient satisfaction.

Discussion

This study provides the clinical trial-based evidence of the effects of AA alone or in combination/interacting with the emerging rapid-acting antidepressant esketamine on depression and other mental disorders in patients with miscarriage undergoing painless curettage. Our data are expected to suggest AA's potential application for optimizing strategies of promoting post-miscarriage mental health, and its possible adjunctive improvement of (es)ketamine's usage as antidepressants. One major limitation is that this study is a single-center study, and the results might be biased due to regional factors.

Maternal depressive symptoms in and beyond the perinatal period: associations with infant and preschooler sleep

STUDY OBJECTIVES

(1) To describe sleep in infancy and early childhood among children born to mothers with and without clinically significant depressive symptoms, and (2) to explore the relationships between maternal depressive symptoms and sleep patterns and problems during infancy and early childhood.

METHODS

Secondary analysis of longitudinal data from the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand study. Data were collected in pregnancy (T1), 12 weeks postpartum (T2), and 3 years post-birth (T3). Participants were 262 Māori and 594 non-Māori mother-child dyads. Chi-square and independent t-tests measured bivariate associations between maternal mood (T1, T2, and T3) and child sleep characteristics (T2 and T3). Binary logistic regression models examined longitudinal and concurrent associations between maternal depressive symptoms and infant and preschooler sleep. Adjusted models accounted for key socio-demographic variables, as well as infant sleep variables in preschooler models.

RESULTS

Bivariate associations were found between prior and concurrent depressive symptomology and many of the infant and preschooler sleep outcomes. In adjusted models, prenatal depressive symptoms remained independently associated with shorter-than-recommended sleep durations in preschoolers. In these models, concurrent depression was also associated with night waking, night LSRSP, and perceived sleep problems at 12 weeks postpartum, and CSHQ-determined and perceived sleep problems at 3 years post-birth.

CONCLUSIONS

Longitudinal and cross-sectional associations were found between maternal depressive symptoms and child sleep. Sleep appears to be one pathway by which maternal depression confers risk for suboptimal child health outcomes. Findings support the need for earlier and better maternal mental health services.

Proactive approaches to preventing postpartum depression in non-depressive pregnant women: a comprehensive scoping review

Introduction

Postpartum depression is a significant global health challenge that affects mothers, infants, and families. Although various preventive strategies show promise, comprehensive reviews evaluating interventions among pregnant women without a clinical diagnosis of depression remain limited. This scoping review aims to identify and synthesize the existing evidence on proactive postpartum depression prevention programs initiated during pregnancy.

Methods

Following PRISMA guidelines for scoping reviews, we systematically searched PubMed and Scopus, supplemented by manual reference reviews. Our search strategy combined terms related to postpartum depression, pregnancy, and preventive interventions. Studies were included if they evaluated interventions conducted during pregnancy, targeting women without a clinical diagnosis of depression, and assessed PPD outcomes using established diagnostic criteria or validated screening tools. Only English-language articles published between 2013 and 2023 were considered.

Results

A total of 49 studies met the inclusion criteria. Interventions were categorized into nine themes: psychoeducation (n = 18), home visits (n = 6), cognitive behavioral therapy (CBT) (n = 6), mindfulness (n = 6), exercise (n = 4), dietary supplements (n = 3), interpersonal therapy (IPT) (n = 4), consultation (n = 1), and inhalation aromatherapy (n = 1). Psychoeducational and mindfulness-based interventions consistently reduce PPD risk, particularly when delivered in structured, theory-driven formats and incorporating family support. Digital CBT interventions demonstrated limited effectiveness due to lower engagement, while home-visit and consultation-based interventions were effective when integrated into existing maternal healthcare despite scalability challenges. Exercise and dietary supplement interventions yielded inconsistent outcomes, indicating that factors such as adherence, duration, and intensity are crucial determinants of effectiveness.

Conclusion

Various proactive interventions are available to prevent PPD, and this scoping review systematically maps the different strategies used and their outcomes. Proactive, theory-based, and multi-component interventions, particularly psychoeducational and mindfulness programs, demonstrate promising potential. Future research should emphasize evaluating long-term outcomes, optimizing digital engagement strategies, and developing culturally tailored models to enhance scalability and accessibility across diverse populations, including low-resource settings.

The impact of ingestion of Bifidobacterium longum NCC3001 on perinatal anxiety and depressive symptoms: a randomized controlled trial

Perinatal mood disorders, including depression and anxiety, are common. Pregnant and lactating women often limit their use of medications, thus a safe and natural solution to improve mood would be welcomed. There is increasing evidence that probiotics such as Bifidobacterium longum NCC3001 can influence mental well-being of adults; however, their impact on mental health during pregnancy and after birth remains unknown. The current double-blind, placebo-controlled, randomized, 3-parallel-arm study (N = 184) evaluated the efficacy of orally consumed B. longum (BL) NCC3001 either during pregnancy and postpartum (from approximately 30 weeks' gestation until 12 weeks after delivery) or postpartum only (from birth until 12 weeks after delivery) compared to a placebo control group in reducing depressive and anxiety symptoms assessed by EPDS and STAI self-administered questionnaires in late pregnancy and across 12 weeks postpartum. Contrary to our hypothesis, we did not observe any differences between groups in mood outcomes. Mood scores showed large variability among participants, as well as notable fluctuations within individuals over the course of the study. Additionally, it should be noted that BL NCC3001 was not detected after the intervention in all of the intervention group participants. More research is needed to understand the underpinnings of perinatal mood disturbances and microbial changes, and whether probiotics could improve mood during this period.

Prenatal Cannabis Use and Depressive Symptoms

OBJECTIVE

To evaluate whether cannabis use during pregnancy was associated with depressive symptoms and whether ongoing use beyond the first trimester and higher amounts of cannabis use were associated with increased depressive symptoms.

METHODS

This was a secondary analysis of the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers to Be) study with participants enrolled from October 2010 to September 2013 at eight academic centers. Individuals with pregnancy outcome data who completed the EPDS (Edinburgh Postnatal Depression Scale) in the first and third trimesters and had available frozen stored urine samples were included. Cannabis exposure was ascertained by urine immunoassay for THC-COOH (11-nor-9-carboxy-delta-9-tetrahydrocannabinol); positive results were confirmed with liquid chromatography tandem mass spectrometry. Cannabis exposure groups for the primary analysis were classified as any exposure (positive urine assay at any of the three time points: 6 0/7-13 6/7 weeks of gestation, 16 0/7-21 6/7 weeks, and 22 0/7-29 6/7 weeks) or no exposure. In a secondary analysis, cannabis exposure was classified as no, only first trimester, or ongoing exposure beyond the first trimester. The primary outcome was depressive symptoms (EPDS score higher than 10) at 22-29 weeks of gestation. The association between cannabis exposure and later depressive symptoms was assessed with multivariable logistic. In an exploratory analysis, first-trimester urine THC-COOH was quantified to determine whether heavier use was associated with greater odds of depressive symptoms later in pregnancy.

RESULTS

Of 10,038 nuMoM2b participants, 8,424 met the inclusion criteria, and 6.4% (n=535) were exposed to cannabis. Of those exposed, 32.1% (n=172) had only first-trimester exposure, and 67.9% (n=363) had ongoing exposure. Any cannabis use was not significantly associated with later depressive symptoms (adjusted odds ratio [aOR] 1.3, 95% CI, 0.97-1.6) compared with no exposure. However, ongoing exposure beyond the first trimester was associated with later depressive symptoms (aOR 1.6, 95% CI, 1.2-2.2). Higher levels of urine THC-COOH in the first trimester and across pregnancy were associated with increased odds of subsequent depressive symptoms.

CONCLUSION

Any cannabis exposure was not associated with later-pregnancy increased depressive symptoms. However, ongoing use beyond the first trimester and higher levels of cannabis metabolite in first-trimester urine were associated with greater odds of depressive symptoms in later pregnancy. Directionality of this association cannot be determined given the study design.

Initial promise of child-parent psychotherapy in reducing stress and postpartum depression among mothers experiencing homelessness: a feasibility and pilot study

PURPOSE

Mothers experiencing homelessness undergo significant stressors in addition to parenting stress, yet the rate and treatment of postpartum depression (PPD) within this population has yet to be explored. We assessed the risk for PPD and examined the changes in PDD and parenting stress following engagement in treatment.

METHODS

Participants included 182 mothers with infants 7 months of age or younger in a shelter setting. After initial assessment of PPD and parenting stress, families participated in Child-Parent Psychotherapy (CPP). Post assessment was then conducted after 16 weeks.

RESULTS

CPP was successfully implemented with high levels of procedural and content fidelity (M = 0.99, SD = 0.04; M = 0.95, SD = 0.09, respectively), treatment satisfaction (94%; M = 4.83, SD = 0.52), and relatively moderate levels of intervention completion (53.8%). Following participation in CPP, mothers reported decreases in parenting stress (d = 0.51) and continuous PPD symptom severity (d = 0.43). The proportion of mothers with clinically elevated self-report PPD symptoms also decreased from 15.3 to 6.7% (p = .013). Lastly, improvements in total parenting stress predicted improvements in PPD symptom severity (B = 0.12, p < .001).

CONCLUSIONS

The findings highlight the relevance of screening for PPD among mothers experiencing homelessness. Most importantly, relationship-based interventions like CPP demonstrate promise in indirectly treating PPD for at-risk populations and within a shelter setting.

Postpartum Depression Epidemiology, Risk Factors, Diagnosis, and Management: An Appraisal of the Current Knowledge and Future Perspectives

Postpartum depression (PPD) is a severe mental health condition that affects women following childbirth and is marked by persistent sadness, anxiety, fatigue, and difficulty functioning. Unlike the temporary "baby blues", PPD is more severe and long-lasting, potentially leading to negative consequences for mother and child. Globally, PPD impacts approximately 10-20% of postpartum women, with prevalence influenced by genetic, hormonal, psychological, and socio-environmental factors. Early detection is crucial, with screening tools such as the Edinburgh Postnatal Depression Scale (EPDS) commonly used in clinical practice. Treatment options include pharmacological interventions such as selective serotonin reuptake inhibitors (SSRIs), psychological therapies like cognitive behavioral therapy (CBT) and interpersonal therapy (IPT), and lifestyle modifications. Despite the growing awareness of PPD, stigma remains a significant barrier to treatment, discouraging many women from seeking help. In low-income countries, where mental health care is often underfunded, accessing professionals trained in perinatal mental health presents an even greater challenge. This gap underscores the urgent need for a collaborative, multidisciplinary approach involving obstetricians, psychiatrists, pediatricians, and midwives to ensure comprehensive support and care for affected individuals.

Characterizing Social Communication Difficulties in Young Children within a Longitudinal Ecological Systems Framework

Social communication difficulties are a transdiagnostic risk factor for psychopathology. However, few studies have examined prospective risk for social communication difficulties in young children within an ecological systems framework. Our sample was 251 parent-child dyads assessed during pregnancy, postpartum, and toddlerhood (child ages 1 and 2). We leveraged observer ratings of child behavior, parent-reported questionnaires, and geocoded data. We examined prospective risk factors for social communication difficulties at ages 1 and 2, including at the level of the child (gestational age), family (household income, maternal mental health, maternal-child bonding), and neighborhood (neighborhood resources). Fewer neighborhood resources were associated with more social communication difficulties at age 1, but only among dyads with impaired maternal bonding. Lower gestational age, lower household income, and impaired maternal bonding were associated with more child social communication difficulties at age 2. Fewer neighborhood resources were also related to more social communication difficulties at age 2, specifically among families with low household incomes. Findings provide insight into families who may benefit from early intervention to reduce transdiagnostic risk for child psychopathology across ecological systems, including efforts to target maternal bonding and poverty.

Protective factors and mental health in couples who expect a child in confinement

OBJECTIVE

Adverse situations can affect the mental health and support of pregnant women and their partners, such as the COVID-19 pandemic and the resulting confinement periods. The main objective of this study was to evaluate the protective factors in the mental health of pregnant women and their partners, as well as the interrelationships of these factors, in an adverse situation, through the assessment of resilience, perceived support, anxiety, depression and stress.

METHODS

The sample consisted of 38 women with no pregnancy risk and 25 partners evaluated between gestation weeks 24 and 31. This is a cross-sectional, descriptive, correlational study.

RESULTS

The pregnant women presented lower resilience, greater social support (especially family support), and greater intensity of depression, anxiety and stress than their partners. Moreover, a mutual relationship was found, both in depression and general support, between the members of the couple.

CONCLUSION

During the confinement, pregnant women have presented greater vulnerability in mental health, despite perceiving greater social support than their partners. Greater resilience in the partners could be a relevant factor to cope with situation of adversity during pregnancy, as indicated by the relationship detected between the risk and protective factors. It would be desirable to improve the attention and care of pregnant women during prolonged periods of adversity, including the couple, and to strengthen mutual support.

Task-sharing and telemedicine delivery of psychotherapy to treat perinatal depression: a pragmatic, noninferiority randomized trial

Task-sharing and telemedicine can increase access to effective psychotherapies. Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) is pragmatic, multisite, noninferiority, four-arm trial that tested the non-inferiority of provider (non-specialist vs. specialist providers) and modality (telemedicine vs. in-person) in delivering psychotherapy for perinatal depressive symptoms. Across three university-affiliated networks in the United States and Canada, pregnant and postpartum adult participants were randomized 1:1:1:1 to each arm (472 nonspecialist telemedicine, 145 nonspecialist in-person, 469 specialist telemedicine and 144 specialist in-person) and offered weekly behavioral activation treatment sessions. The primary outcome was depressive symptoms (Edinburgh Postnatal Depression Scale (EPDS)) and the secondary outcome was anxiety (Generalized Anxiety Disorder (GAD-7)) symptoms at 3 months post-randomization. Between 8 January 2020 and 4 October 2023, 1,230 participants were recruited. Noninferiority was met for the primary outcome comparing provider (EPDS: nonspecialist 9.27 (95% CI 8.85-9.70) versus specialist 8.91 (95% CI 8.49-9.33)) and modality (EPDS: telemedicine 9.15 (95% CI 8.79-9.50) versus in-person 8.92 (95% CI 8.39-9.45)) for both intention-to-treat and per protocol analyses. Noninferiority was also met for anxiety symptoms in both comparisons. There were no serious or adverse events related to the trial. This trial suggests compelling evidence for task-sharing and telemedicine to improve access to psychotherapies for perinatal depressive and anxiety symptoms. ClinicalTrials.gov NCT04153864.

Breastfeeding is associated with reduction in postpartum depression in the United Arab Emirates: a retrospective cross-sectional study

Postpartum Depression (PPD) is a common mental health disorder affecting mothers. Breastfeeding may be protective against PPD. Global estimates of breastfeeding and PPD rates vary, especially for women living in Middle Eastern countries. The current study aims to assess breastfeeding and PPD prevalence and to identify factors associated with reduced PPD risk within the social and cultural contexts of the UAE. We used a purposive, convenience snowball sampling technique to recruit participants. Inclusion criteria were female ≥ 18 years, mother of a child ≤ three years, and resident of Abu Dhabi, UAE. Data was collected using an online survey distributed via email and social media platforms. The survey comprised four sections: sociodemographic characteristics, breastfeeding behaviour, Edinburgh Postnatal Depression Scale (EPDS), and The International Physical Activity Questionnaire -Short Form (IPAQ-SF). Pearson chi-squared tests and binary logistic regression model were used to investigate the associations between PPD levels and potential predictors using SPSS statistical software. Variables included in the regression model were breastfeeding duration, delivery mode, BMI, education, general health, physical activity level, employment status, number of children, and age. All statistical significance was considered at p-value < 0.05. In total 403 subjects consented to participate; 204 met the inclusion criteria and were included in the final analysis (age [mean ± SD] = 31.2 ± 7.3 years). Among them, 34.8% suffered from moderate-to-severe PPD, and 66.2% breastfed their last child for > 3 months. Regression model results showed that (OR; 95% CI) college education (0.39; 0.19-0.80), having more than one child (0.40; 0.17-0.94), self-reported very good (0.43; 0.19-0.98) and excellent health (0.21; 0.08-0.51), and breastfeeding for > three months (0.46; 0.23-0.92), were significantly associated with reduced odds of moderate-to-severe PPD. None of the remaining variables -including physical activity- were significant. In conclusion, breastfeeding is significantly associated with a reduction in moderate-to-severe PPD among mothers in Abu Dhabi, UAE.

Psychological Distress in Childbearing Persons During the COVID-19 Pandemic: A Multi-Trajectory Study of Anger, Anxiety, and Depression

Psychological distress can manifest as depression, anxiety, and anger in the perinatal period. These conditions are often comorbid yet studied in isolation. A full understanding of perinatal psychopathology requires the spectrum of common psychological distress to be studied concurrently to better understand interconnected symptoms. A transdiagnostic approach provides valuable insights into how symptoms interact and cumulatively affect mental health, which can inform more effective screening and treatment strategies. This, in turn, can improve outcomes for birthing parents experiencing psychological distress. We undertook group-based multi-trajectory modeling (GBMTM) to uncover the patterns of affective disorders (anger, anxiety, and depression) over three-time points (pregnancy, 3-, and 12-months postpartum (mPP)) in a large longitudinal cohort of persons who gave birth during the COVID-19 pandemic (n = 2145). We identified five trajectory groups: high-stable (11.3%), postpartum-increase (16.0%), postpartum-decrease (21.5%), low-stable (37.9%), and minimal stable (13.2%) symptoms of anger, anxiety, and depression. Multinomial regression revealed that lower levels of sleep disturbance, less financial hardship, and lower intolerance of uncertainty predicted postpartum decreases in psychological distress compared with the high stable group. Higher levels of sleep disturbance, greater financial hardship, lower level of social support, and greater intolerance of uncertainty predicted postpartum increases in psychological distress compared with the low-stable and minimal-stable groups. Screening for psychological distress symptoms (i.e., anger, anxiety, and depression), paired with access to evidence-based management for those who screen positive, is warranted during the first postpartum year to reduce the harmful effects of unmanaged distress on families.

Neurodevelopmental Impact of Maternal Postnatal Depression: A Systematic Review of EEG Biomarkers in Infants

BACKGROUND/OBJECTIVES

Postpartum depression (PPD) significantly impacts maternal well-being and child neurodevelopment. While the etiology of PPD is well understood, the precise neurodevelopmental consequences, particularly differentiating prenatal and postnatal effects, remain unclear. This systematic review aims to synthesize the existing literature on the neurophysiological effects of maternal PPD on infant neurodevelopment, focusing on electroencephalography (EEG) biomarkers to identify consistent patterns and potential mediating factors.

METHODS

A comprehensive literature search across PubMed/MEDLINE, Web of Science, and Scopus identified studies investigating infants (0-12 months) exposed to maternal depressive symptoms (assessed via validated psychometric instruments) with quantitative EEG data. Study quality was assessed using the Newcastle-Ottawa Scale.

RESULTS

Twelve studies met the inclusion criteria. Eleven investigated EEG asymmetry, predominantly frontal alpha asymmetry (FAA). The findings consistently showed greater right FAA in the infants of mothers with PPD, suggesting increased negative affectivity and avoidance behaviors. This association was stronger with prolonged or combined prenatal/postnatal exposure. However, EEG power and connectivity findings were less consistent, with some studies reporting altered occipital power at 1 month and frontal power at 3 months in the infants of depressed mothers. No significant associations were found between maternal depression and functional connectivity.

CONCLUSIONS

This review demonstrates a robust association between maternal PPD and altered infant EEG patterns, particularly increased right FAA. However, methodological heterogeneity necessitates future research with standardized protocols and longitudinal designs to establish causality and investigate long-term effects. Further research should also explore the underlying neural mechanisms and evaluate the efficacy of targeted interventions. These findings underscore the need for early identification and intervention to mitigate the negative impact of PPD on infant neurodevelopment.

Preconception paternal mental health history as predictor of antenatal depression in pregnant women

BACKGROUND

Depression occurring during the perinatal period (PND) could affect both future mother and father. PND may lead to several adverse physical and mental health outcomes for the whole family. Several psychopathological determinants have been identified, even though few studies investigated the role of paternal mental health in the onset of maternal perinatal depression (MPND). Hence, a retrospective cohort study was carried out in order to investigate the relationship between paternal mental health and the occurrence of antenatal maternal depression as well as identifying potential sociodemographic, clinical and obstetrical predictors in the development of MPND.

METHODS

All pregnant women afferent to the Perinatal Mental Health Outpatient Service of the Unit of Clinical Psychiatry at the University Hospital of Marche, Polytechnic University of Marche, Ancona, Italy, between April 2021 to February 2022, were consecutively recruited and longitudinally screened for antenatal depression. The sample was divided in two groups, based on the screening by using the Edinburgh Postpartum Depression Scale (EPDS) for PND. A stepwise binary logistic regression analysis was performed in order to evaluate the predictors associated with the presence of antenatal depression (vs. the absence of antenatal depression).

RESULTS

A total of 106 participants among all 460 screened from April 2021 to February 2022, were retrospectively included. In our sample, a prevalence of 13.2% in antenatal depression was found. The binary logistic regression model showed that the higher maternal age (OR = 1.320; p = 0.005), gestational comorbidity (OR = 10.931; p = 0.010), pregnant women's (OR = 19.001; p = 0,001) and their partner's positive history (OR = 16.536; p = 0.004) for mental disorder significantly predicted the presence of antenatal depression in our sample.

CONCLUSIONS

Our study suggests the need to investigate the pre-existing psychopathology of the pregnant woman's partner as a potential risk factor for MPND, particularly for antenatal depression. Overall, a better understanding and investigation of all potential risk and/or protective factors for the onset and/or maintenance and/or worsening of MPND could help clinicians in early identifying treatment strategies to improve maternal mental health as well as future father's mental health.

Satisfaction with Breastfeeding and Not Frequency of Feeding is Associated with a Reduction of Postpartum Depressive Symptoms

Purpose: Postpartum depression (PPD) resembles a major depression in the postpartum period and affects 10-15% of all women after giving birth. Several studies suggest an association between a lower risk of PPD and breastfeeding. The highly stressful period of the COVID-19 pandemic has led to an increase in the incidence of mental illness in general and PPD in particular. Our aim was to investigate the relationship between breastfeeding behavior and PPD in more detail. Methods: In this context, 291 women who gave birth between April 2020 and September 2021 were surveyed up to 6 months postpartum on depressive symptoms, breastfeeding behavior, and anxieties. Results: In particular, the fact that the women stated after 6 months that their expectations of breastfeeding had been met appeared to lead to a significantly lower risk of PPD. Therefore, not breastfeeding frequency but satisfaction with breastfeeding behavior was decisive for the risk of PPD development. Significant correlations were found between different anxieties and breastfeeding behavior. Higher anxieties led to a shorter desired time of breastfeeding in months, less frequent breastfeeding per day, and less satisfaction with breastfeeding behavior. Conclusion: Our results suggest that improving the breastfeeding experience as well as reducing prepartum anxieties or treating postpartum anxieties could be a primary prevention for PPD.

The effect of peer victimisation on cognitive development in childhood: evidence for mediation via inflammation

PURPOSE

Peer victimisation, often a serious childhood stressor, has been associated with poor cognitive outcomes. The current study sought to uncover whether peer victimisation is associated with poor cognitive functioning in childhood via inflammation.

METHODS

Data from 4583 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) were analysed. Path analysis was conducted to determine whether inflammation, measured using IL-6 and CRP levels (age 9), mediates the effects of peer victimisation (age 8), even after controlling for other stressors, on multiple cognitive outcomes, including working memory (age 10), reading (accuracy, speed, and comprehension) (age 9), spelling (age 9), response inhibition (age 10), attentional control (age 11), and selective attention (age 11).

RESULTS

IL-6 and CRP partially mediated the effects of peer victimisation on working memory, reading accuracy, and selective attention. IL-6 partially mediated the effect of peer victimisation on reading comprehension, while CRP partially mediated the effect of peer victimisation on reading speed. All effects were small. Inflammation did not mediate the effects of peer victimisation on spelling, response inhibition or attentional control.

CONCLUSION

Peer victimisation may impact on some aspects of children's cognitive functioning via inflammation. The cognitive outcome specificity observed warrants further research.

Transdiagnostic internet cognitive behavioural therapy for anxiety and depressive symptoms in postnatal women: protocol of a randomized controlled trial

BACKGROUND

Nearly 20% of women will be confronted with anxiety or depressive disorders during the perinatal period and this may lead to adverse outcomes for both mother and child. Cognitive behavioural therapy (CBT) is the psychological intervention with the most empirical support for the clinical management of anxiety and depressive disorders. Anxiety and depression frequently occur in women during the perinatal period, and there is growing evidence that internet-delivered CBT (iCBT) could be an acceptable and effective intervention. THIS WAY UP, an Australian digital mental health service, has developed a program for postnatal anxiety and depression. This study protocol aims to examine the acceptability and efficacy of a French-Canadian adaptation of the program.

METHODS/DESIGN

The research team propose to conduct a mixed hybrid type 1 pragmatic randomized clinical trial and implementation study to replicate the findings of the trial conducted in Australia by Loughnan et al. (2019), as well as explore barriers and facilitators to potential large-scale implementation. TREATMENT AND CONTROL CONDITIONS: a) postnatal anxiety and depression iCBT program with three lessons to complete in a six-week period, added to treatment-as-usual (TAU); b) TAU. Participants will include French-speaking women with probable postnatal depression or anxiety as per the Generalized Anxiety Disorder-7 (GAD-7) or the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome measures will be the GAD-7 and the EPDS. Secondary outcome measures will comprise self-reported instruments to evaluate psychological distress, quality of life, mother-child experience, and treatment experience. Qualitative interviews with participants and health professionals will provide insights on acceptability and delivery of the iCBT program.

STATISTICAL ANALYSIS

Statistical analysis will follow intent-to-treat principles. A mixed model regression approach will be used to account for between- and within-subject variations in the analysis of the effects of iCBT compared to TAU only intervention.

DISCUSSION

The study will generate important data of efficacy and acceptability to patients, clinicians, and decision-makers to inform the scaling-up of the postnatal iCBT intervention in Canada.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT06778096, prospectively registered on 2025/01/16.

Effect of postpartum depression, anxiety and social support on maternal self-efficacy: comparing undocumented migrant, documented migrant and Swiss-born mothers

Introduction

Postpartum depression and anxiety negatively affect maternal sense of self-efficacy, which may jeopardize mother-infant bonding. Migrant women are at two to three times higher risk for postpartum depression and anxiety. Therefore, they may experience lower maternal self-efficacy, but studies on the subject are lacking. The aims of this study were (1) to compare two groups of economic migrants of differing legal status in Geneva, Switzerland, to native Swiss women in terms of postpartum depression and anxiety rates, as well as maternal sense of self-efficacy, and (2) to examine the effects of postpartum depression, anxiety, and social support on maternal self-efficacy in the three groups.

Methods

A sample of 25 undocumented migrant women, 42 documented migrant women, and 41 Swiss women were interviewed at 3 months postpartum. Depression was assessed with the Edinburgh Postpartum Depression Scale and anxiety with the State-Trait Anxiety Inventory. Maternal self-efficacy was assessed with the Maternal Self-Efficacy Scale. ANOVAs and multiple regression analysis were used to test mean-level differences among the three groups and identify factors associated with low maternal self-efficacy.

Results

Legal status was associated with living conditions and influenced the rates of postpartum distress. Swiss women and documented migrant women showed low depression and anxiety rates, whereas nearly half of the sample of undocumented women reported high levels of postpartum depression and anxiety. However, despite poor postpartum mental health, undocumented women showed a higher sense of maternal self-efficacy than did documented migrants and Swiss natives. The relationship between postpartum depression, maternal self-efficacy, social support, and legal status is discussed.

Preliminary impact of an mHealth education and social support intervention on maternal health knowledge and outcomes among postpartum mothers in Punjab, India

BACKGROUND

Significant disruptions in the perinatal continuum of care occur postpartum in India, despite it being a critical time to optimize maternal health and wellbeing. Group-oriented mHealth approaches may help mitigate the impact of limited access to care and the lack of social support that characterize this period. Our team developed and pilot tested a provider-moderated group intervention to increase education, communication with providers, to refer participants to in-person care, and to connect them with a virtual social support group of other mothers with similarly aged infants through weekly calls and text chat.

METHODS

We analyzed the preliminary effectiveness of the pilot intervention on maternal health knowledge through 6 months postpartum among 135 participants in Punjab, India who responded to baseline and endline surveys. We described change in knowledge of maternal danger signs, birth preparedness, postpartum care use, postpartum physical and mental health, and family planning use over time between individuals in group call (synchronous), other intervention (asynchronous), and control groups.

RESULTS

Participant knowledge regarding danger signs was low overall regarding pregnancy, childbirth and the postpartum period (mean range of 1.13 to 2.05 at baseline and 0.79 to 2.10 at endline). Synchronous participants had a significantly higher increase over time in knowledge of danger signs than asynchronous and control group participants. Birth preparedness knowledge ranged from mean 0.89-1.20 at baseline to 1.31-2.07 at follow-up, with synchronous participants having significantly greater increases in comparison to the control group. Synchronous participants had nearly three-fold increased odds of postpartum health check with a clinical provider than asynchronous participants (OR 2.88, 95% CI 1.07-7.74). No differences were noted in postpartum depressive and anxiety symptoms.

CONCLUSIONS

Preliminary effectiveness results are promising, yet further robust testing of the MeSSSSage intervention effectiveness is needed. Further development of strategies to support health knowledge and behaviors and overcoming barriers to postpartum care access can improve maternal health among this population.

Internet-Based Cognitive Behavioral Therapy for Preventing Postpartum Depressive Symptoms Among Pregnant Individuals With Depression: Multicenter Randomized Controlled Trial in China

BACKGROUND

Women are particularly vulnerable to depression during pregnancy, which is one of the strongest risk factors for developing postpartum depression (PPD). Addressing antenatal depressive symptoms in these women is crucial for preventing PPD. However, little is known about the effectiveness of internet-based cognitive behavioral therapy (ICBT) in preventing PPD in this high-risk group.

OBJECTIVE

This study aims to evaluate the short- and long-term effects of ICBT in preventing PPD among women with antenatal depressive symptoms.

METHODS

Participants were screened for antenatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) and randomly allocated (1:1) to either the ICBT group (receiving weekly online modules starting antenatally and continuing into early postpartum) or the control group (observed without treatment). Follow-up assessments were conducted up to 12 months postpartum, and data were analyzed using generalized estimating equations. The primary outcome was the prevalence of depressive symptoms at 6 weeks postpartum. A subgroup analysis based on the severity of antenatal depressive symptoms was also performed. The secondary outcomes included the long-term effects of ICBT on maternal depression, as well as its impact on anxiety, sleep quality, social support, parenting stress, co-parenting relationships, and infant development.

RESULTS

Between August 2020 and September 2021, 300 pregnant individuals were recruited from 5 centers across China. No significant differences were observed in depressive symptoms at 6 weeks postpartum (P=.18) or at any longer-term follow-up time points (P=.18). However, a post hoc subgroup analysis showed that participants with antenatal EPDS scores of 10-12 in the ICBT group had a lower risk of developing depression during the first year postpartum (odds ratio 0.534, 95% CI 0.313-0.912; P=.02), but this was not observed for participants with more severe depression. Additionally, this subgroup demonstrated higher levels of co-parenting relationships (P=.02).

CONCLUSIONS

Among individuals with antenatal depression, ICBT did not prevent the development of PPD. However, ICBT may be a preferable option for those with mild to moderate antenatal depressive symptoms. Future research is needed to explore modifications to ICBT to address more severe depressive symptoms.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000033433; https://www.chictr.org.cn/showproj.html?proj=54482.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-022-06728-5.

Improving Postpartum Depression Screening Rates Using a Quality Improvement Framework in a Community-based Academic Primary Care Clinic

Introduction

Maternal postpartum depression (PPD) is the most common diagnosis during the postpartum period, with a higher incidence in underserved populations. Though PPD often goes undiagnosed, prompt diagnosis has a positive impact on several measures of children's health and development, as well as maternal health. To increase routine screening per American Academy of Pediatrics recommendations, we implemented a multipronged quality improvement (QI) initiative centered around a newborn coordinator embedded in our primary care clinic.

Methods

A multidisciplinary team implemented a QI initiative in a community-based academic primary care clinic. We used the plan-do-study-act method and other QI tools to improve our processes and p-type control charts to monitor improvements. The interventions centered on workflow changes and staff education with aims to increase our PPD screening rates to 75%, maintain appropriate referral rates for parents with positive PPD screeners above 90%, and ensure no disparity in rates of screening regardless of race/ethnicity, language, and insurance status.

Results

PPD screening rates for all well child care visits from birth to age 6 months increased from a mean of 16 % at baseline to 72%. Additionally, we maintained a referral rate for positive PPD screens above 90%. Our health equity analysis did not demonstrate any disparity in our screening rates.

Conclusions

Applying a combination of education and process workflow changes can successfully increase screening rates for PPD in a community-based academic primary care clinic.

The impact of relationship factors on antenatal depression in the context of the COVID-19 pandemic

BACKGROUND

Antenatal depression is the most prevalent pregnancy-associated mental health disorder. Previous studies have identified several risk factors for antenatal depression, including partner support. However, during the COVID-19 pandemic, many relationship dynamics changed. This study examined the extent to which relationship factors had an impact on antenatal depression in comparison with other well-researched factors in the context of the pandemic.

METHODS

A secondary analysis was conducted using data from the P3 Cohort in Calgary, a longitudinal cohort study based in Alberta, Canada. Pregnant people (n = 872) completed self-report questionnaires and validated scales about sociodemographic, psychological, and relationship characteristics. Antenatal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression was used to assess the impact of reported characteristics on antenatal depression. Tests of model fit were used to examine whether the inclusion of variables related to relationship quality improved model fit after accounting for other known risk factors.

RESULTS

Overall, 18.23% of participants experienced antenatal depression. Relationship factors including relationship unhappiness (OR = 1.98 [95% CI: 1.06-3.69]), having an upsetting partner (OR = 2.00 [95% CI: 1.17-3.40]), and having a lower quality of relationships with close friends and family (OR = 1.76 [95% CI: 1.14-2.73]) were associated with antenatal depression; however, inclusion of these relationship factors did not improve model fit after accounting for other known predictors.

CONCLUSION

Overall, relationship factors were not associated with antenatal depression during the pandemic after accounting for other known risk factors. Stress and anxiety caused by the pandemic may have overshadowed the impact of relationship factors, or relationship factors may have contributed to higher levels of stress and anxiety more generally within our sample.

Healing hearts: mind-body therapy for mothers after stillbirth's silent grief

Introduction

Approximately 0.75% of pregnancies end with stillbirth, often leading to depression, anxiety, posttraumatic stress symptoms and suicidality. Knowledge regarding effective treatment options is lacking. In this retrospective cohort study we present a mind-body group therapy treatment protocol that was adapted for women and their partners who suffered stillbirth and report on its clinical effectiveness. Additionally, we identified demographic and clinical factors that were associated with clinical response.

Methods

Sixty-one women who coped with stillbirth were enrolled to a mind-body group therapy. Questionnaires assessing symptoms of depression, anxiety, and post-traumatic stress were administered to the women before and after the group intervention.

Results

As expected, we found high rates of depression, state and trait anxiety and post-traumatic symptoms in our cohort before mind-body group therapy. At completion of treatment, the symptoms of depression, state anxiety, post-traumatic stress and suicidality significantly decreased. Improvement in symptoms of depression and post-trauma at follow-up was positively associated with severity of symptoms at baseline and with antidepressants treatment, and negatively associated with the number of children. Time since stillbirth was positively associated with the degree of improvement in posttraumatic symptoms only.

Conclusions

Our findings suggest that mind-body group therapy may be associated with improvements in depression, post-traumatic stress symptoms, state anxiety, and suicidal ideation in women following stillbirth. Further research, including a control group is crucial for understanding of effective tools to treat this at-risk population.

Is an improvement in anaemia and iron levels associated with the risk of early postpartum depression? A cohort study from Lagos, Nigeria

BACKGROUND

Anaemia and depression are common conditions which affect pregnant and postpartum women. Evidence points to associations between anaemia and iron deficiency during pregnancy, and mental health disorders like depression. However, it is unclear the association between improvement in anaemia severity or iron levels during pregnancy and incidence of postpartum depression.

OBJECTIVES

This study examined association between improvement in anaemia severity and iron levels during pregnancy after four weeks of treatment and the incidence of depression at two weeks postpartum.

METHODS

This cohort study nested within a clinical trial in Lagos Nigeria, included 438 anaemic (haemoglobin concentration < 11 g/dL) pregnant women at 20-32 weeks' gestation without depression followed up until two weeks postpartum. Participants received either intravenous or oral iron treatment at enrolment. Repeat screening for anaemia and iron deficiency (serum ferritin < 30ng/mL) was done at four weeks post-treatment. The outcome, depression (score > 10), was measured at two weeks postpartum using validated Edinburgh Postnatal Depression Scale. Associations between improvement in anaemia severity and iron levels after four weeks post-enrolment versus depression at two weeks postpartum were examined using logistic regression analysis, adjusting for confounders.

RESULTS

Mean age of women was 29.5 ± 5.6years. Median haemoglobin concentration of 9.3 (IQR: 8.8-9.8)g/dL and median serum ferritin 44.4 (IQR: 22.1-73.7)ng/mL at enrolment. Prevalence of postpartum depression was 5.8% (95%CI: 3.8-8.5%). There was a non-significant association between improvement in anaemia severity at four weeks post-enrolment and postpartum depression, aOR: 0.15 (95%CI: 0.02-1.15). The odds for postpartum depression was nearly five times higher in women who had postpartum haemorrhage, aOR: 4.90 (95%CI: 1.18-20.36). In the subgroup with iron deficiency (n = 148), no association was found between an improvement in iron levels four weeks post-enrolment and the odds for postpartum depression, aOR: 1.14 (95%CI: 0.09-3.93).

CONCLUSION

Improvement in anaemia severity during late pregnancy was non-significantly associated with lower risk for postpartum depression; no association between improvement in iron levels and postpartum depression. It is likely that an improvement in anaemia severity in early pregnancy will lessen the burden of postpartum depression; however, this study is limited by sample size to draw this conclusion.

Genetic Variants in Oxytocinergic System Genes and Their Association with Postpartum Depression Susceptibility

One of the most frequent forms of maternal morbidity following childbirth is postpartum depression. Postpartum depression (PPD), a disabling condition as a major public health concern, has a significant negative impact on the child's emotional, mental as well as intellectual development if left undiagnosed and untreated, which can later have long-term complications. The oxytocin system is an excellent candidate gene system in the maternal context. Differences in vulnerability of mothers for the onset of postpartum psychiatric disorders could be influenced by individual differences in the genetic profile of each one. In this original research, we aimed to explore if there are any possible contributions of genetic variation on both the oxytocin receptor gene (OXTR) and the oxytocin gene (OXT) to the occurrence of postpartum depression, aiming to provide the latest evidence and determine which genetic polymorphisms significantly create a susceptibility for this condition. A total of 100 mothers were preliminarily genotyped before they completed the Edinburgh Postnatal Depression Scale Questionnaire (EPDS) at 6 weeks postpartum. DNA was extracted from peripheral blood samples of the participants (N = 100) and evaluated for the oxytocin gene (OXT_rs2740210; OXT_rs4813627) and oxytocin receptor gene (OXTR_ rs237885) single nucleotide polymorphisms. The results highlighted a significant interaction between the oxytocin OXT_rs2740210 genotype and maternal postpartum depression in mothers with the CC genotype but not in those with AA/AC genotypes. This reveals that an interaction of vulnerable genotypes (CC genotype of OXT_rs2740210, C allele in genotype of OXT_rs2740210, G allele in genotype of OXT_rs4813627) with an environmental burden or other risk factors would predispose the mothers to develop postpartum depression. We found no significant association between the interaction effect of the oxytocin receptor gene OXTR_rs237885 genotype depending on the occurrence of maternal postpartum depression. These findings prove the implication of the oxytocinergic system gene variants in vulnerability for postpartum depression and indicate the need for future studies adopting a multilevel approach in order to increase understanding.

Perceived and internalized smoking stigma among pregnant women: association with smoking reduction, reactance to smoking health warnings, and intention to discuss smoking with health professionals

BACKGROUND

Tobacco is an addictive substance associated with numerous serious health effects during pregnancy. Pregnant women who smoke face considerable social disapproval, which could be a barrier to seeking healthcare and ultimately to smoking cessation. This study explored how perceived stigma (i.e., smokers' beliefs about negative judgments of them) and internalized stigma (i.e., internalization of stigmatizing attitudes toward them) may be associated with smoking reduction during pregnancy, reactions to smoking health warnings, and the intention to discuss smoking with health professionals.

METHODS

A total of 83 pregnant French women who smoke were recruited from maternity wards and online. Participants filled out self-administered online questionnaires assessing smoking dependance (Cigarette Dependance Scale, CDS-5), perceived and internalized smoking stigma (Pregnant Smoker Stigma Scale - Self Stigma, P3S-SS), depressive symptoms (Edinburgh Postnatal Depression Scale, EPDS), reactance to smoking health warnings (shortened version of the Reactance to Health Warnings Scale), and intention to discuss smoking with health professionals (dedicated questionnaire).

RESULTS

In multiple regression analyses that controlled for depressive symptoms and dependance scores, perceived stigma was associated with more reactance (β = 0.35) and less smoking reduction (β = -0.31), whereas internalized stigma was associated with less reactance (β = - 0.0.28). Finally, reactance was associated with less intention to discuss smoking with healthcare professionals (β = -0.26).

CONCLUSIONS

These results suggest that perceived stigma may influence reactance to health warnings and smoking reduction during pregnancy, while also indicating that reactance could reduce the intention to consult healthcare professionals. Public health stakeholders should consider how to address the stigmatization of people who smoke, particularly pregnant women, in health communication strategies.

Prevalence of psychiatric disorders during pregnancy-a feasibility study at second trimester ultrasound in the general population (GROUP study): study protocol

INTRODUCTION

During the perinatal period, women have an increased risk for psychiatric disorders, which are highly prevalent in this context. In addition, there are significant delays in diagnosing these conditions, worsening their prognosis and increasing their societal burden. Studies describing psychiatric disorders in the perinatal period often focus on specific disorders; only postpartum depression and, to a lesser extent, anxiety disorders are studied. There are also very few evaluations conducted by clinicians based on a semistructured interview, relying on the diagnostic criteria of international nosography.

METHODS AND ANALYSIS

This multicentric prospective study will recruit 140 adult pregnant women based on randomly selected second trimester (T2) ultrasound consultations. The primary outcome is the prevalence of any psychiatric disorder assessed with a standardised psychiatric assessment, the Mini-International Neuropsychiatric Interview (M.I.N.I.). Within 10 days after the T2 ultrasound appointment, we will conduct the M.I.N.I., collect demographic data, evaluate suicidal behaviour with the Columbia-Suicide Severity Rating Scale, describe negative life events from the past year using the Paykel questionnaire and evaluation of social deprivation (Evaluation of the Deprivation and Inequalities of Health in Healthcare Centres score). Participants will also complete self-administered psychiatric questionnaires that screen for specific pathologies. We will build a biological sample collection. At two months post partum, we will repeat the questionnaires, adding an assessment of mother-child bonding. Patients can choose between in-person or telemedicine visits on both occasions.

ETHICS AND DISSEMINATION

All participants will be required to provide written informed consent. The study has received ethical approval from the French National Committee ('Comité de Protection des Personnes Ouest VI') (approval number: 23.03919.000236). Results will be disseminated through peer-reviewed journal publications and at scientific conferences and meetings.

TRIAL REGISTRATION NUMBER

NCT06297252.

Obsessive-compulsive disorder (OCD) symptoms during pregnancy and postpartum: prevalence, stability, predictors, and comorbidity with peripartum depression symptoms

BACKGROUND

Pregnancy and postpartum are considered vulnerable periods for new parents to develop obsessive-compulsive disorder (OCD). The aim of this study was threefold: (1) to establish the prevalence of OCD symptoms and its course in the peripartum period; (2) to examine comorbidity with depressive symptoms; and (3) to investigate which sociodemographic, obstetric, and individual characteristics are predictors of OCD symptoms.

METHODS

A longitudinal study included 397 women during pregnancy (T1) and 6-12 weeks postpartum (T2). Participants filled out the obstetrical and demographic sheet, Anxiety Sensitivity Index (ASI), Emotional Stability subscale from the International Personality Item Pool-50 (IPIP-50), Brief Resilience Scale (BRS) all at T1, and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Edinburgh Postpartum Depression Scale (EPDS) at T1 and T2.

RESULTS

In this sample, 15.1% of women reported OCD symptoms during pregnancy and 15.1% in the postpartum, with 9.8% of women who had symptoms at both time points. However, the majority of women experienced symptoms of mild severity, according to the Y-BOCS. Of the women experiencing OCD symptoms, 33% and 43% had comorbid depressive symptoms in pregnancy and the postpartum period, respectively. The level of OCD symptoms significantly decreased after childbirth. None of the sociodemographic or obstetric variables were a significant predictor of OCD symptoms during pregnancy or postpartum. After controlling for current depression symptoms, higher psychological concerns of anxiety sensitivity (but not physical and social concerns) and higher neuroticism were significant predictors of higher levels of OCD symptoms both at T1 and T2. At the same time, higher resilience was a significant predictor of lower levels of OCD symptoms only at T1.

CONCLUSION

One in six women has OCD symptoms in the peripartum period, with substantial comorbidity with depression symptoms. Women who are high on neuroticism and anxiety sensitivity are prone to OCD symptoms, while resilience is a significant protective factor.

CLINICAL TRIAL NUMBER

Not applicable.

Integrating postnatal care into the redesign of group care beyond birth

BACKGROUND

Globally, alarmingly high rates of maternal and infant mortality and morbidity persist. A constellation of health system and social factors contribute to this, including poor quality and barriers to accessing health care, including preventive services. As such, there have been calls for a redesign of maternal and child health (MCH) services. Although group care has primarily been tested in antenatal settings, it offers a promising redesign that optimizes maternal and child health care, survival, and well-being. The purpose of this study was to produce a blueprint of an adapted group care model that integrates postnatal maternal care, well-child care, and family engagement to be adapted to realities of different settings.

METHODS

Using a human-centered design approach and the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME), we employed qualitative methods to adapt CenteringParenting® (retaining its three core pillars of health assessment, interactive learning, and community building), and co-create the blueprint for group care beyond birth that can be used across settings. We initiated the process through face-to-face workshops during a global meeting on group care, followed by six online incubator sessions with key stakeholders from 13 countries during which we used qualitative methods of free listing, pile sorting, and ranking. We conducted a rapid qualitative analysis to produce a blueprint.

RESULTS

Participants collaboratively modified the content, format, and evaluation of CenteringParenting® with the goal of creating a blueprint that integrates postnatal and pediatric care into group care that can be further adapted and implemented across diverse settings and contexts. The blueprint consists of suggested timing of visits over two years after birth, suggested visit content, and evaluation metrics for research and practice.

CONCLUSIONS

The resulting group care beyond birth blueprint offers a strategy to redesign maternal and infant/child health services that can positively transform postnatal care and provide essential services to postpartum people. Adaptation of the blueprint to local realities is expected. Future research is recommended to test the model's acceptability, feasibility, and effectiveness across settings. Using this blueprint, we can build the evidence base to support this model aiming to improve maternal and infant/child health outcomes.

Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l'humeur, des troubles anxieux et des troubles connexes périnatals

BackgroundThe Canadian Network for Mood and Anxiety Treatments (CANMAT) publishes clinical practice guidelines for mood and anxiety disorders. This CANMAT guideline aims to provide comprehensive clinical guidance for the pregnancy and postpartum (perinatal) management of mood, anxiety and related disorders.MethodsCANMAT convened a core editorial group of interdisciplinary academic clinicians and persons with lived experience (PWLE), and 3 advisory panels of PWLE and perinatal health and perinatal mental health clinicians. We searched for systematic reviews of prevention and treatment interventions for perinatal depressive, bipolar, anxiety, obsessive-compulsive and post-traumatic stress disorders (January 2013-October 2023). We prioritized evidence from reviews of randomized controlled trials (RCTs), except for the perinatal safety of medications where reviews of large high-quality observational studies were prioritized due to the absence of RCT data. Targeted searches for individual studies were conducted when systematic reviews were limited or absent. Recommendations were organized by lines of treatment based on CANMAT-defined levels of evidence quality, supplemented by editorial group consensus to balance efficacy, safety, tolerability and feasibility considerations.ResultsThe guideline covers 10 clinical sections in a question-and-answer format that maps onto the patient care journey: case identification; organization and delivery of care; non-pharmacological (lifestyle, psychosocial, psychological), pharmacological, neuromodulation and complementary and alternative medicine interventions; high-risk clinical situations; and mental health of the father or co-parent. Equity, diversity and inclusion considerations are provided.ConclusionsThis guideline's detailed evidence-based recommendations provide clinicians with key information to promote the delivery of effective and safe perinatal mental healthcare. It is hoped that the guideline will serve as a valuable tool for clinicians in Canada and around the world to help optimize clinical outcomes in the area of perinatal mental health.

COVID-19 prevention strategies and compliance among postnatal adolescent mothers with postnatal depression and generalised anxiety in rural Malawi: a cross-sectional study

OBJECTIVES

This study examines the relationship between adolescent mothers' mental health problems (postnatal depression and generalised anxiety) and adherence to COVID-19 public health prevention strategies in rural Malawi. It is part of a larger previously published study investigating the impact of social and cultural factors on the mental health in adolescent mothers.

DESIGN

A cross-sectional study was conducted from September 2021 to March 2022. The Edinburgh Postnatal Depression Scale (EPDS) and the Generalised Anxiety Disorder-7 (GAD-7) were used to identify the risk of postnatal depression (PND) and generalised anxiety disorder (GAD), respectively. Participants also responded to questions about their perception of COVID-19 and how they practiced the recommended COVID-19 prevention strategies.

SETTING

The study was conducted at a rural hospital in Lilongwe, Malawi.

PARTICIPANTS

Adolescent postnatal mothers aged 19 years and below, with children aged less than 1 year, who understood the study and could consent.

RESULTS

Adolescent mothers (n=395) completed the researcher-administered survey. The mean age was±17 (SD 1.157). Most participants had recently given birth to their first child (91%, n=358). Almost half (45%, n=113) of participants agreed with the COVID-19 prevention strategies recommended by the Malawian government. However, overall adherence to public health COVID-19 prevention strategies, including hand hygiene practices, was low among adolescent mothers. Participants with probable GAD and probable PND were more likely to practice COVID-19 prevention strategies than participants with low GAD-7 or EPDS scores, except for restrictions on religious gatherings.

CONCLUSIONS

Adolescent perception of the potential threats or risks of COVID-19 was low. However, adolescents with probable PND and probable GAD reported higher adherence to some COVID-19 prevention strategies than adolescents without PND and GAD. The findings support the need for policies that integrate mental health within the public health response due to the potential direct and indirect effects the pandemic might have on perinatal mothers' mental health. Additionally, recommended pandemic responses should be appropriate and relevant to the social environment.

Translation and Validation of the Edinburgh Postnatal Depression Scale for Eritrea: A Screening Tool for Postpartum Depression in Primary Health Care Facilities

Introduction

Postpartum depression (PPD) is a mood disorder characterized by symptoms such as changes in sleep and eating patterns, fatigue, sadness, crying, anxiety, and guilt. The Edinburgh Postnatal Depression Scale (EPDS) was developed to be used as a self-report questionnaire for English-speaking populations to screen for postnatal depression. This study aims to translate, validate, and adapt the EPDS into Eritrean settings.

Methods

This study employed a cross-sectional study design to evaluate the performance of the EPDS as a screening tool by using a sample of 380 mothers from four primary healthcare facilities. The standard Diagnostic and Statistical Manual of Mental Disorders was used as a criterion to assess depression in postpartum women.

Results

Postpartum depression was identified in 28 (7.4%) of the mothers based on the standard Diagnostic and Statistical Manual of Mental Disorders. The translated Tigrinya version EPDS has good internal consistency with Cronbach's alpha of 0.712. The exploratory factor analysis identified three factors, confirming the EPDS's multidimensionality. The area under the receiver operating characteristic curve was 0.87, and optimal sensitivity and specificity combination was found at 10/11 score cut-off points, 85.7% and 88%, respectively.

Conclusion

The Eritrean version of EPDS has proven to be a valid and reliable instrument for the identification of postpartum depression in clinical settings.

Exploring stress and depressive symptoms in pregnancy and the IL-1β, IL-6, and C-reactive protein pathway: Looking for possible biomarker targets

Background

Individuals undergo significant stress throughout pregnancy and are at high risk for depressive symptoms. Elevated stress and depressive symptoms are associated with inflammatory processes and adverse maternal-infant outcomes. However, the biological processes associated with psychosocial outcomes and the maternal immune system remain unclear. As such, we aimed to examine associations among perceived stress, depressive symptoms, salivary IL-1β, IL-6, and CRP levels, and hair and salivary cortisol levels during the second and third trimesters of pregnancy.

Methods

We conducted an ancillary study consisting of 37 pregnant individuals. Participants collected salivary samples and measures of perceived stress and depression at 17-19 weeks, 25-27 weeks, and 32-34 weeks gestation. We collected a one-time hair sample between 36 and 40 weeks. Provided salivary samples were used to detect changes in cortisol, IL-1β, IL-6, and CRP levels. Hair was used to detect changes in cortisol levels throughout pregnancy.

Results

Elevated levels of perceived stress and depressive symptoms are associated with increased salivary CRP levels, respectively (p = 0.0142, p = 0.0008). Salivary and hair cortisol increased significantly throughout the second and third trimesters of pregnancy (p = 0.0004 and p < 0.0001). We also observed variations in IL-6 during pregnancy (p = 0.029) and significant increases between 25 and 27 weeks (p = 0.016).

Conclusion

Salivary samples may provide a non-invasive measurement of alterations in cytokine and cortisol levels in pregnant individuals reporting elevated stress and depressive symptoms. These may be candidate biomarkers for mechanistic study possibly aiding providers in early detection of deleterious immunological processes which could result in adverse maternal-infant outcomes.

Dysphoric Milk Ejection Reflex: Measurement, Prevalence, Clinical Features, Maternal Mental Health, and Mother-Infant Bonding

Introduction: Dysphoric milk ejection reflex (D-MER) is a condition affecting lactating women, characterized by abrupt emotions of dysphoria that start shortly before or during milk let-down and progress for several minutes. Research on D-MER, especially with quantitative methodology, is minimal. This study aimed to validate an instrument for D-MER-related emotions, examine its prevalence and clinical features, and explore differences in maternal mental health and mother-infant bonding between mothers with and without D-MER. Methods: A total of 711 women up to 12 months postpartum participated in an online cross-sectional study. Participants fulfilled the D-MER Questionnaire (D-MERq), Edinburgh Postnatal Depression Scale, Depression, Anxiety, and Stress Scales, and the Postpartum Bonding Questionnaire. Results: The analysis showed that D-MERq had high reliability and good discriminant and divergent validity. The prevalence of D-MER was 5.9%. For the majority, D-MER manifested intensely, accompanied mostly by agitation- and anxiety-related emotions, and 45% of mothers discontinued breastfeeding due to D-MER. Mothers experiencing D-MER had higher levels of depression, anxiety, stress, previous psychiatric diagnoses, and more mother-infant bonding difficulties compared with mothers without D-MER. Conclusion: These findings demonstrate that D-MERq is a valuable tool with good psychometric properties and suitable for clinical and research use to facilitate early identification and better understanding of this phenomenon. D-MER affects a noteworthy number of women and is associated with impaired mental health, bonding difficulties, and breastfeeding discontinuation. This highlights the importance of health care providers recognizing D-MER to ensure better outcomes and a more positive breastfeeding experience.

Child developmental outcomes associated with postpartum depression and anxiety in low and middle-income countries: a systematic review

AIMS

This systematic review aims to summarize the findings of empirical studies conducted in low- and middle-income countries (LMICs) examining the relationship between postpartum depression and anxiety, and child developmental outcomes measured at 24 months of child's age.

METHODS

The study was performed as per PRISMA guidelines for a systematic review. EBESCO, ProQuest, PubMed, Science Direct, Google Scholar, and BMJ databases were examined, along with a forward and backward examination of the citations published. The New Ottawa scales (NOS) was used to assess the quality of the studies. The findings of the studies were integrated using a narrative synthesis approach.

RESULTS

The systematic review revealed that there are 14 studies examining the impact of postpartum depression (n=14) and postpartum anxiety (n=2) across different domains of child development in LMICs. Studies varied regarding the severity and duration of maternal depression, the context and nature of evaluation, and motherinfant characteristics which are important to understand the association between postpartum depression and anxiety and infant development. Maternal depression is negatively associated with language development, socio-emotional and behavioural development while its association with motor and cognitive development is inconsistent. The impact of maternal anxiety on infant development was examined in two studies, and both have identified a negative association. However, the results of the current review need to be interpreted within the scope and limitations of the methodologies adopted by each study details of which are elaborated in the manuscript.

CONCLUSION

Postpartum depression and anxiety can have a wide range of effects on child development. Therefore, periodic infant developmental assessments should become part of routine psychiatric evaluation. There is a need for uniform guidelines for conducting studies and reporting data related to postpartum mental health and child development.

Validation of the Edinburgh Postnatal Depression Scale and its 3-item anxiety subscale, and the Generalised Anxiety Disorder-7 item for screening of postpartum depression and anxiety in women in Malta

BACKGROUND & AIM

Perinatal mental health disorders are common complications of pregnancy and the postpartum period. The value of screening for their early detection is well-recognized, but to-date, research-validated mental health measures for postpartum women in Malta are lacking. In this prospective cross-sectional study, we assessed the validity of the Edinburgh Postnatal Depression Scale (EPDS), an EPDS subscale (EPDS-3A), and the Generalised Anxiety Disorder-7 item (GAD-7) as screening measures for postpartum depression and anxiety. The optimal cut points were calculated.

METHODS

243 randomly selected women from birth to 12 months postnatally self-completed the EPDS and the GAD-7. For women scoring ≥10 in at least one of the questionnaires, the Mini International Neuropsychiatric Interview (MINI) was applied to confirm or refute a diagnosis of depression and/or anxiety disorder based on DSM-5 criteria. Total EPDS, EPDS-3A and GAD-7 scores were analysed against MINI outcomes using receiver operator curve (ROC), and area under curves (AUCs) were determined. Sensitivity, specificity, positive and negative predictive values, likelihood ratios and Youden's indices were calculated across a range of cut-off values.

FINDINGS

Both the EPDS and GAD-7 had significant AUCs (>0.8) and Youden's indices (>0.6), contrary to the EPDS-3A. When screening for postnatal depression with the EPDS, the optimal cut-off is 11/12 (sensitivity 75 %; specificity 87.6 %). For postnatal anxiety, the recommended GAD-7 cut-off is 8/9 (sensitivity 79.2 %; specificity 85.3 %).

CONCLUSION

Both the EPDS and GAD-7 are valid screening measures for postpartum depression and anxiety, respectively. These findings can inform the implementation of postpartum screening programs to improve maternal healthcare in Malta.

Association of contraception use and pregnancy intention with perinatal depression risk among Omani mothers-a longitudinal cohort study

Background

Unplanned pregnancy is significantly associated with an increased risk of perinatal depression (antenatal and postnatal depression), emphasizing its prevalence and its potentially detrimental effects on both maternal and child health. This study aimed to investigate the association of contraception use and pregnancy intention with the risk of perinatal depression among Omani mothers.

Methods

A prospective longitudinal study design was employed to investigate perinatal depression risk in mothers attending antenatal health care services in Oman. Perinatal depression risk was assessed using the Edinburgh Postpartum Depression Scale during the third trimester and postpartum visits. Multiple linear regression analyses were utilized to explore relationships between the risk of perinatal depression and pregnancy-related factors, contraception use, and sociodemographic variables.

Results

The study involved 300 participants with a mean age of 30.8 years (SD = 5.47). The majority of participants reported planned pregnancy (74.0%), no use of contraception (66.0%), and being multiparous (72.7%). A significantly higher proportion (87.8%) of women with planned pregnancies were primiparous (p < 0.001). Besides family structure (core family, p = 0.025) and monthly income (1,000 OMR or below, p = 0.021), mothers who were pregnant for the first time (p < 0.001), and those who were primiparous (p < 0.001) did not use contraception. The regression models showed a significant association between the antenatal and postnatal depression scores (p < 0.001, 95% CI 0.401-0.603) according to the Edinburgh Postpartum Depression Scale.

Conclusions

The findings suggest that women with unplanned pregnancies warrant attention for early detection and preventive interventions, irrespective of their emotional stance. Incorporating routine mental health screening into perinatal care can facilitate early detection, and targeted interventions, contributing to improved maternal mental well-being.

Perinatal Depression, Labor Anxiety and Mental Well-Being of Polish Women During the Perinatal Period in a War and Economic Crisis

Objective: The armed conflict in Ukraine and its impact on Europe's economy have led to an war and economic crisis, potentially affecting the mental health of women during the perinatal period. This study aimed to assess the severity of depressive symptoms and labor anxiety among Polish women in perinatal period during this crisis.

Methods: From June 2, 2022, to April 11, 2023, 152 women completed three sets of online surveys-two during pregnancy (before 33 weeks and/or between 33 and 37 weeks) and one postpartum (4 weeks after childbirth). The questionnaires used to evaluate the anxiety and depressive symptoms included Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI-2), Labor Anxiety Questionnaire (LAQ), and team-developed questionnaires evaluating war-related anxiety (WAQ) and global situation anxiety (GSAQ) Statistical analyses included U-Mann Whitney, Kruskal-Wallis, Wilcoxon signed-rank, Friedman tests and Spearman's correlations, with a significance level set at p < .05.

Results: Among Polish pregnant women aged 23-43, 31.6% of participants experienced depressive symptoms, while 70.4% reported increased labor-related anxiety. Additionally, 24.3% experienced significant anxiety due to the war, and 25% suffered from severe anxiety related to the global situation. Positive correlations were noted between EPDS and GSAQ scores (R = 0.34, p < .001) and LAQ and WAQ scores (R = 0.21, p = .008).

Conclusions: The prevalence of perinatal depression is high during war and economic crisis, underscoring the urgent need to improve screening for perinatal depression in Poland. Further, the manuscript did not discuss symptom patterns across the three time points.

Restless legs syndrome without insomnia and antenatal depressive symptoms

BACKGROUND

Restless legs syndrome (RLS) with insomnia is presumed to be associated with antenatal depression. RLS without insomnia, however, has not been investigated in association with antenatal depression. We aimed to examine whether RLS without insomnia during pregnancy is associated with antenatal depressive symptoms.

METHODS

This cross-sectional study used data from a randomized controlled trial (RCT) assessing antenatal depressive symptoms among Japanese pregnant women. The participants were 2,108 women who attended the RCT at 16-20 weeks of pregnancy. RLS, insomnia, and antenatal depressive symptoms were assessed using the Cambridge-Hopkins questionnaire short form, Insomnia Severity Index, and Edinburgh Postnatal Depression Scale, respectively. Associations of antenatal depressive symptoms with RLS and insomnia were examined using logistic regression analysis, adjusting for age, partner, education, children, and planned pregnancy.

RESULTS

Of the total participants, 206 (9.8%) had antenatal depressive symptoms; 80 (3.8%) had RLS. The mean age (standard deviation) was 30.4 (4.6) years. RLS was positively associated with antenatal depressive symptoms: the odds ratio was 2.30 (95% confidence interval, 1.28-4.16). RLS without insomnia was positively associated with antenatal depressive symptoms, as well as insomnia without RLS and RLS with insomnia: the odds ratio was 2.44 (95% confidence interval, 1.09-5.46) for RLS without insomnia, 3.83 (2.78-5.28) for insomnia without RLS, and 5.80 (2.42-13.92) for RLS with insomnia, compared to neither RLS nor insomnia.

CONCLUSIONS

We observed the positive association between RLS without insomnia and antenatal depressive symptoms, suggesting the importance of assessing and treating RLS without insomnia during pregnancy for the reduction of antenatal depressive symptoms.

Mother-infant stress contagion? Effects of an acute maternal stressor on maternal caregiving behavior and infant cortisol and crying

BACKGROUND

Postpartum maternal distress has been associated with adverse infant outcomes. A potential pathway of how maternal distress affects infant outcomes could be alterations in maternal caregiving behavior. However, the associations between maternal distress, caregiving behavior, and infant outcomes have never been tested in a controlled experiment. This preregistered study utilized an experimental design to investigate the effects of an acute maternal stressor on infant cortisol and crying and the possible mediating role of maternal caregiving behavior.

METHODS

Mother-infant dyads (N = 91) participated in a lab visit at 8 weeks postpartum, where mothers were separated from their infants to either perform a Trier Social Stress Test (TSST) or a control task. The task was immediately followed by a mother-infant interaction to assess maternal caregiving behavior and infant cortisol and crying.

RESULTS

Our structural equation model found no differences between conditions (stressor/control) on maternal caregiving behavior and infant response to maternal stress. Secondary findings revealed that higher quality of maternal caregiving behavior was related to lower levels of infant crying and lower cortisol levels at the end of the visit, but not cortisol at reunion.

CONCLUSIONS

Our findings do not support the occurrence of mother-infant stress contagion in this experimental setting but do indicate a link between maternal caregiving behavior and infant behavioral and cortisol responses. Given the high prevalence of maternal mental health problems and their possible negative association with offspring development, further (experimental) research is needed to understand just how maternal postpartum distress affects young infants.