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Jimènez-Barragan M, Falguera-Puig G, Curto-Garcia JJ, Monistrol O, Coll-Navarro E, Tarragó-Grima M, Ezquerro-Rodriguez O, Ruiz AC, Codina-Capella L, Urquizu X, Pino Gutierrez AD. Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: a prospective cross-sectional descriptive multicentred study. BMC Pregnancy Childbirth 2024; 24:500. [PMID: 39054429 PMCID: PMC11270936 DOI: 10.1186/s12884-024-06695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 07/12/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE To assess the prevalence of anxiety and depression and their associated risk factors throughout the pregnancy and postpartum process using a new screening for the early detection of mental health problems. DESIGN A prospective cross-sectional descriptive multicentred study. Participants were consecutively enrolled at ≥ 12 weeks' gestation and followed at three different time points: at 12-14 weeks of pregnancy, at 29-30 weeks of pregnancy, and 4-6 weeks postpartum. All women completed a mental screening at week 12-14 of pregnancy consisting of two questions from the Generalised Anxiety Disorder Scale (GAD-2) and the two Whooley questions. If this screening was positive, the woman completed the Edinburgh Postnatal Depression Scale (EPDS). SETTING Seven primary care centres coordinated by a Gynaecology and Obstetrics Department in the city of Terrassa (Barcelona) in northern Spain. PARTICIPANTS Pregnant women (N = 335, age 18-45 years), in their first trimester of pregnancy, and receiving prenatal care in the public health system between July 2018 and July 2020. FINDINGS The most relevant factors associated with positive screening for antenatal depression or anxiety during pregnancy, that appear after the first trimester of pregnancy, are systematically repeated throughout the pregnancy, and are maintained in the postpartum period were: a history of previous depression, previous anxiety, abuse, and marital problems. In weeks 12-14 early risk factors for positive depression and anxiety screening and positive EPDS were: age, smoking, educational level, employment status, previous psychological/psychiatric history and treatment, suicide in the family environment, voluntary termination of pregnancy and current planned pregnancy, living with a partner and partner's income. In weeks 29-30 risk factors were: being a skilled worker, a history of previous depression or anxiety, and marital problems. In weeks 4-6 postpartum, risk factors were: age, a history of previous depression or anxiety or psychological/psychiatric treatment, type of treatment, having been mistreated, and marital problems. CONCLUSIONS Early screening for anxiety and depression in pregnancy may enable the creation of more effective healthcare pathways, by acting long before mental health problems in pregnant women worsen or by preventing their onset. Assessment of anxiety and depression symptoms before and after childbirth and emotional support needs to be incorporated into routine practice.
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Affiliation(s)
- Marta Jimènez-Barragan
- Universitat de Barcelona, Fundació Assistencial Mútua Terrassa, (Terrassa), Research Group on Sexual and Reproductive Healthcare (GRASSIR), (2021-sgr-01489), Barcelona, 08221, Spain.
- ASSIR Fundació Assistencial Mútua Terrassa, Universitat de Barcelona, Plaça Dr. Robert 5, Barcelona, 08221, Spain.
| | - Gemma Falguera-Puig
- Atenció a la Salut Sexual i Reproductiva Metropolitana Nord, Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
- Research Group on Sexual and Reproductive Healthcare (GRASSIR), (2021-sgr-01489), Barcelona, 08007, Spain
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | | | - Olga Monistrol
- Faculty of Nursing and Physiotherapy, University of Lleida, Iguada, Spain
| | | | - Mercè Tarragó-Grima
- Midwife, Sexual and Reproductive Health Clinic (ASSIR) CAP Rambla Terrassa, Mollet, Spain
| | | | - Anna Carmona Ruiz
- Department of Obstetrics and Gynaecology, Fundació Sanitària Mollet, Mollet, Spain
| | - Laura Codina-Capella
- Department of Obstetrics and Gynaecology, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
| | - Xavier Urquizu
- Department of Obstetrics and Gynaecology, Fundació Sanitària Mollet, Mollet, Spain
| | - Amparo Del Pino Gutierrez
- Departament de Salut Pública, Facultat de Medicina i Ciències de la Salut, Salut Mental i Materno-infantil, Universitat de Barcelona, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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2
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Mwita M, Patten S, Dewey D. Prevalence and predictors of postpartum depression and generalized anxiety symptoms among women who delivered at a tertiary hospital in Mwanza Tanzania: a cross-sectional study. DISCOVER MENTAL HEALTH 2024; 4:21. [PMID: 38849688 PMCID: PMC11161451 DOI: 10.1007/s44192-024-00074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 06/03/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Postpartum depression and anxiety are major public health concerns that affect 3-39% of women after childbearing and can adversely affect maternal and child health. Most studies have investigated postpartum depression and anxiety and their associated factors among women 4-12 weeks after delivery. There is a scarcity of research among women immediately after delivery from low- and middle-income countries, the gap this study aimed to fill. METHODS A descriptive cross-sectional study was conducted among 386 postpartum women within one week after delivery. The Edinburg Postnatal Depression Scale was used to assess depressive symptoms and the Generalized Anxiety Disorder - 7 scale was used to screen for symptoms of generalized anxiety disorder. Participants were systematically selected from the postnatal wards and interviewed by trained research assistants from November 2019 to March 2020. RESULTS Using standard cut points, the prevalence of depressive and anxiety symptoms was 25.39%, and 37.31% respectively. Having a baby with a weight of 2.5 kgs or more and having partner support were associated with decreased odds of both depression and anxiety symptoms. In contrast, complications during delivery, caesarian section, marital status, and partner violence, were associated with increased odds of depressive and anxiety symptoms post-delivery. CONCLUSION There was a high prevalence of postpartum depression and anxiety symptoms among the study participants in the first week post-delivery, with delivery complications and outcome and psychosocial supports identified as associated factors for depression and anxiety symptoms. These findings highlight the need for early screening to identify those at risk for appropriate intervention.
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Affiliation(s)
- Matiko Mwita
- Catholic University of Health and Allied Sciences (CUHAS), Mwanza, Tanzania.
- Psychiatry Department, Bugando Medical Centre (BMC), Mwanza, Tanzania.
- Department of Psychiatry, Catholic University of Health and Allied Sciences, P.O.Box 1464, Mwanza, Tanzania.
| | - Scott Patten
- Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Canada
| | - Deborah Dewey
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Canada
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Asali F, Abu Mahfouz I, Al-Marabhah L, Alatoom S, Al Takriti L, Eisheh ZA, Al Kuran O, Jaber H. Correlates of higher anxiety scores reported by women admitted for elective caesarean section. Heliyon 2023; 9:e18143. [PMID: 37501957 PMCID: PMC10368820 DOI: 10.1016/j.heliyon.2023.e18143] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/16/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
Background An elective caesarean section (CS) has been associated with high anxiety scores, and there are associations between higher anxiety scores and younger age, primigravidae, higher educational level, and previous experience with anaesthesia. In this study, the aim is to measure anxiety scores associated with an elective CS using two measuring scales and identify women's characteristics and obstetrics variables that are associated with higher scores. Methods A cross-sectional study was conducted between Nov 15, 2019 and Nov 15, 2020. Women were included if they were 18 years of age or more, had viable pregnancies, and were admitted for an elective CS. Anxiety scores were measured on admission using the visual analogue scale for anxiety (VASA) and then the State-Trait Anxiety Inventory (STAI-Y). Associated factors were studied using logistic regression analyses. Results Three hundred women were recruited. Means (SD) for the participant's age and gestation age were 30.5 (5.7) years and 37.6 (1.4) weeks, respectively. Additionally, 29.3% of the participants having a CS were primigravidae and 62.3% were for maternal indications. Furthermore, 55%, 59%, and 61% of the women had scores above the means of VASA and STAI-S components 1 and 2, respectively.Variables that showed statistically significant associations with higher anxiety scores were that the woman's age was 25-34, the CS was for foetal indications, the choice of anaesthesia was general, and the source of information for the choice of anaesthesia was a layperson. Conclusion Higher anxiety scores are prevalent among women admitted for an elective CS. STAI-Y and VASA correlated well, and the short VASA may replace the lengthy STAI-Y in clinical practice. Identification of women with risk factors may help in implementing strategies to reduce anxiety.
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Affiliation(s)
- Fida Asali
- FRCOG, Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Ismaiel Abu Mahfouz
- FRCOG, Obstetrics and Gynaecology, Faculty of Medicine, Al Balqa Applied University, Al Salt, Jordan
| | | | - Shirin Alatoom
- JBOG, Obstetrics and Gynaecology, Specialty Hospital, Amman, Jordan
| | - Lana Al Takriti
- JBOG, Obstetrics and Gynaecology, Specialty Hospital, Amman, Jordan
| | | | - Oqba Al Kuran
- FRCOG, Obstetrics and Gynaecology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Hatim Jaber
- Community Medicine, Faculty of Medicine, Al Balqa Applied University, Al Salt, Jordan
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Burgess R, Costantini I, Bornstein MH, Campbell A, Cordero Vega MA, Culpin I, Dingsdale H, John RM, Kennedy MR, Tyson HR, Pearson RM, Nabney I. A Quantitative Evaluation of Thin Slice Sampling for Parent-Infant Interactions. JOURNAL OF NONVERBAL BEHAVIOR 2023; 47:117-210. [PMID: 37162792 PMCID: PMC10163135 DOI: 10.1007/s10919-022-00420-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/20/2023]
Abstract
Behavioural coding is time-intensive and laborious. Thin slice sampling provides an alternative approach, aiming to alleviate the coding burden. However, little is understood about whether different behaviours coded over thin slices are comparable to those same behaviours over entire interactions. To provide quantitative evidence for the value of thin slice sampling for a variety of behaviours. We used data from three populations of parent-infant interactions: mother-infant dyads from the Grown in Wales (GiW) cohort (n = 31), mother-infant dyads from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort (n = 14), and father-infant dyads from the ALSPAC cohort (n = 11). Mean infant ages were 13.8, 6.8, and 7.1 months, respectively. Interactions were coded using a comprehensive coding scheme comprised of 11-14 behavioural groups, with each group comprised of 3-13 mutually exclusive behaviours. We calculated frequencies of verbal and non-verbal behaviours, transition matrices (probability of transitioning between behaviours, e.g., from looking at the infant to looking at a distraction) and stationary distributions (long-term proportion of time spent within behavioural states) for 15 thin slices of full, 5-min interactions. Measures drawn from the full sessions were compared to those from 1-, 2-, 3- and 4-min slices. We identified many instances where thin slice sampling (i.e., < 5 min) was an appropriate coding method, although we observed significant variation across different behaviours. We thereby used this information to provide detailed guidance to researchers regarding how long to code for each behaviour depending on their objectives.
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Affiliation(s)
- Romana Burgess
- Digital Health Engineering Group, Faculty of Engineering, Merchant Venturers Building, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK
| | - Ilaria Costantini
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK
| | - Marc H. Bornstein
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD USA
| | - Amy Campbell
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK
| | - Miguel A. Cordero Vega
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK
| | - Iryna Culpin
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK
| | - Hayley Dingsdale
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, UK
| | - Rosalind M. John
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, UK
| | - Mari-Rose Kennedy
- Centre for Ethics in Medicine, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hannah R. Tyson
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, UK
| | - Rebecca M. Pearson
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK
- Bristol NIHR Biomedical Research Centre, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Ian Nabney
- Digital Health Engineering Group, Faculty of Engineering, Merchant Venturers Building, University of Bristol, Bristol, UK
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Vikhareva O, Nedopekina E, Sjöström K. Anxiety reduction through obstetric consultation combined with Ultrasound Examination in women after Cesarean section. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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6
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Garay SM, Sumption LA, John RM. Prenatal health behaviours as predictors of human placental lactogen levels. Front Endocrinol (Lausanne) 2022; 13:946539. [PMID: 36157466 PMCID: PMC9500170 DOI: 10.3389/fendo.2022.946539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022] Open
Abstract
Placental lactogen (hPL) is a key hormone of pregnancy responsible for inducing maternal adaptations critical for a successful pregnancy. Low levels of placental lactogen have been associated with lower birth weight as well as symptoms of maternal depression and anxiety. Lower placental lactogen has been reported in women with higher body mass index (BMI) but it is unclear whether prenatal health behaviours predict hPL levels or if hPL is associated with infant weight outcomes. This study utilised data from the longitudinal Grown in Wales cohort, based in South Wales. Participants were recruited at the pre-surgical appointment for an elective caesarean section. This study incorporates data from recruitment, post-delivery and a 12 month follow-up. Measures of maternal serum hPL were available for 248 participants. Analysis included unadjusted and adjusted linear and binary regression. Unadjusted, prenatal smoking and a Health Conscious dietary pattern were associated with hPL levels, however this was lost on adjustment for BMI at booking, Welsh Index of Multiple Deprivation (WIMD) score and placental weight. When stratified by maternal BMI at booking, a Health Conscious dietary pattern remained associated with increased hPL levels in women with a healthy BMI (p=.024, B=.59. 95% CI=.08,1.11) following adjustment for WIMD score and placental weight. When adjusted for a wide range of confounders, maternal hPL was also associated with increased custom birthweight centiles (CBWC) (p=.014, B=1.64. 95% CI=.33,2.94) and increased odds of large for gestational age deliveries (p=<.001, Exp(B)=1.42. 95% CI=1.17,1.72). This study identified that consuming a Health Conscious dietary pattern in pregnancy was associated with increased hPL, within women of a healthy BMI. Moreover, higher hPL levels were associated with increased CBWC and increased odds of delivering a large for gestational age infant. This improves the current limited evidence surrounding the nature of hPL in these areas.
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Garcia-Martin I, Penketh RJA, Garay SM, Jones RE, Grimstead JW, Baird DM, John RM. Symptoms of Prenatal Depression Associated with Shorter Telomeres in Female Placenta. Int J Mol Sci 2021; 22:7458. [PMID: 34299077 PMCID: PMC8306199 DOI: 10.3390/ijms22147458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Depression is a common mood disorder during pregnancy impacting one in every seven women. Children exposed to prenatal depression are more likely to be born at a low birth weight and develop chronic diseases later in life. A proposed hypothesis for this relationship between early exposure to adversity and poor outcomes is accelerated aging. Telomere length has been used as a biomarker of cellular aging. We used high-resolution telomere length analysis to examine the relationship between placental telomere length distributions and maternal mood symptoms in pregnancy. METHODS This study utilised samples from the longitudinal Grown in Wales (GiW) study. Women participating in this study were recruited at their presurgical appointment prior to a term elective caesarean section (ELCS). Women completed the Edinburgh Postnatal Depression Scale (EPDS) and trait subscale of the State-Trait Anxiety Inventory (STAI). Telomere length distributions were generated using single telomere length analysis (STELA) in 109 term placenta (37-42 weeks). Multiple linear regression was performed to examine the relationship between maternally reported symptoms of depression and anxiety at term and mean placental telomere length. RESULTS Prenatal depression symptoms were significantly negatively associated with XpYp telomere length in female placenta (B = -0.098, p = 0.026, 95% CI -0.184, -0.012). There was no association between maternal depression symptoms and telomere length in male placenta (B = 0.022, p = 0.586, 95% CI -0.059, 0.103). There was no association with anxiety symptoms and telomere length for either sex. CONCLUSION Maternal prenatal depression is associated with sex-specific differences in term placental telomeres. Telomere shortening in female placenta may indicate accelerated placental aging.
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Affiliation(s)
- Isabel Garcia-Martin
- Division of Biomedicine, Cardiff School of Biosciences, Cardiff University, Cardiff, Wales CF10 3AX, UK; (I.G.-M.); (S.M.G.)
| | - Richard J. A. Penketh
- Department of Obstetrics and Gynaecology, University Hospital Wales, Cardiff, Wales CF14 4XW, UK;
| | - Samantha M. Garay
- Division of Biomedicine, Cardiff School of Biosciences, Cardiff University, Cardiff, Wales CF10 3AX, UK; (I.G.-M.); (S.M.G.)
| | - Rhiannon E. Jones
- Division of Cancer and Genetics, Cardiff School of Medicine, Cardiff University, Cardiff, Wales CF14 4XW, UK; (R.E.J.); (J.W.G.); (D.M.B.)
| | - Julia W. Grimstead
- Division of Cancer and Genetics, Cardiff School of Medicine, Cardiff University, Cardiff, Wales CF14 4XW, UK; (R.E.J.); (J.W.G.); (D.M.B.)
| | - Duncan M. Baird
- Division of Cancer and Genetics, Cardiff School of Medicine, Cardiff University, Cardiff, Wales CF14 4XW, UK; (R.E.J.); (J.W.G.); (D.M.B.)
| | - Rosalind M. John
- Division of Biomedicine, Cardiff School of Biosciences, Cardiff University, Cardiff, Wales CF10 3AX, UK; (I.G.-M.); (S.M.G.)
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8
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Dingsdale H, Nan X, Garay SM, Mueller A, Sumption LA, Chacón-Fernández P, Martinez-Garay I, Ghevaert C, Barde YA, John RM. The placenta protects the fetal circulation from anxiety-driven elevations in maternal serum levels of brain-derived neurotrophic factor. Transl Psychiatry 2021; 11:62. [PMID: 33462179 PMCID: PMC7813890 DOI: 10.1038/s41398-020-01176-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/16/2020] [Accepted: 11/30/2020] [Indexed: 01/30/2023] Open
Abstract
Brain-derived neurotrophic factor (BDNF) plays crucial roles in brain function. Numerous studies report alterations in BDNF levels in human serum in various neurological conditions, including mood disorders such as depression. However, little is known about BDNF levels in the blood during pregnancy. We asked whether maternal depression and/or anxiety during pregnancy were associated with altered serum BDNF levels in mothers (n = 251) and their new-born infants (n = 212). As prenatal exposure to maternal mood disorders significantly increases the risk of neurological conditions in later life, we also examined the possibility of placental BDNF transfer by developing a new mouse model. We found no association between maternal symptoms of depression and either maternal or infant cord blood serum BDNF. However, maternal symptoms of anxiety correlated with significantly raised maternal serum BDNF exclusively in mothers of boys (r = 0.281; P = 0.005; n = 99). Serum BDNF was significantly lower in male infants than female infants but neither correlated with maternal anxiety symptoms. Consistent with this observation, we found no evidence for BDNF transfer across the placenta. We conclude that the placenta protects the developing fetus from maternal changes in serum BDNF that could otherwise have adverse consequences for fetal development.
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Affiliation(s)
- Hayley Dingsdale
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
| | - Xinsheng Nan
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
| | - Samantha M Garay
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
| | - Annett Mueller
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, UK
| | - Lorna A Sumption
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
| | - Pedro Chacón-Fernández
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
- Hospital Universitario Virgen Macarena-FISEVI, University of Seville, E41009, Seville, Spain
| | | | - Cedric Ghevaert
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, UK
| | - Yves-Alain Barde
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
| | - Rosalind M John
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK.
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9
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Garay SM, Sumption LA, Pearson RM, John RM. Risk factors for excessive gestational weight gain in a UK population: a biopsychosocial model approach. BMC Pregnancy Childbirth 2021; 21:43. [PMID: 33423656 PMCID: PMC7798251 DOI: 10.1186/s12884-020-03519-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 12/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Gestational weight gain (GWG) can have implications for the health of both mother and child. However, the contributing factors remain unclear. Despite the advantages of using a biopsychosocial approach, this approach has not been applied to study GWG in the UK. This study aimed to investigate the risk factors of excessive GWG in a UK population, employing a biopsychosocial model. METHODS This study utilised data from the longitudinal Grown in Wales (GiW) cohort, which recruited women in late pregnancy in South Wales. Specifically, data was collected from midwife recorded notes and an extensive questionnaire completed prior to an elective caesarean section (ELCS) delivery. GWG was categorised according to Institute of Medicine (IOM) guidelines. The analysis was undertaken for 275 participants. RESULTS In this population 56.0% of women had excessive GWG. Increased prenatal depression symptoms (Exp(B)=1.10, p=.019) and an overweight (Exp(B)=4.16, p<.001) or obese (Exp(B)=4.20, p=.010) pre-pregnancy BMI, consuming alcohol in pregnancy (Exp(B)=.37, p=.005) and an income of less than £18,000 (Exp(B)=.24, p=.043) and £25-43,000 (Exp(B)=.25, p=.002) were associated with excessive GWG. CONCLUSION GWG is complex and influenced by a range of biopsychosocial factors, with the high prevalence of excessive weight gain in this population a cause for concern. Women in the UK may benefit from a revised approach toward GWG within the National Health Service (NHS), such as tracking weight gain throughout pregnancy. Additionally, this research provides evidence for potential targets for future interventions, and potentially at-risk populations to target, to improve GWG outcomes.
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Affiliation(s)
- S. M. Garay
- grid.5600.30000 0001 0807 5670Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX UK
| | - L. A. Sumption
- grid.5600.30000 0001 0807 5670Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX UK
| | - R. M. Pearson
- grid.5337.20000 0004 1936 7603Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, BS8 2BN UK
| | - R. M. John
- grid.5600.30000 0001 0807 5670Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX UK
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10
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Sumption LA, Garay SM, John RM. Low serum placental lactogen at term is associated with postnatal symptoms of depression and anxiety in women delivering female infants. Psychoneuroendocrinology 2020; 116:104655. [PMID: 32247203 DOI: 10.1016/j.psyneuen.2020.104655] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/07/2020] [Accepted: 03/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Placental endocrine insufficiency may increase the risk of depression and anxiety during pregnancy and/or after birth. This study investigated the association between serum human placental lactogen (hPL) and measures of perinatal mental health, accounting for selective serotonin-reuptake inhibitor (SSRI) usage. METHOD Caucasian women with singleton, term pregnancies recruited at their pre-surgical appointment prior to an elective caesarean section (ELCS) were studied. Serum hPL levels were measured by ELISA in maternal blood collected at the pre-surgical appointment. Depression and anxiety scores were derived from Edinburgh Postnatal Depression Scale (EPDS) and the trait subscale of the State-Trait Anxiety Inventory (STAI) questionnaires completed at recruitment and three postnatal time points. Data was analysed by unadjusted and adjusted multiple linear regression. RESULTS In adjusted linear regressions, term maternal serum hPL levels were negatively associated with postnatal EPDS and STAI score ten weeks postnatal for mothers who had girls (B= -.367, p = .022, 95% CI -.679, -.056; and B= -.776, p = .030, 95% CI -1.475, -.077 respectively). Excluding women prescribed SSRIs strengthened the relationship at 10 weeks and uncovered an earlier association between hPL and mood scores within one week of delivery (EPDS B= -.357, p = .041, 95 % CI -.698, -.015; and STAI B= -.737, p = .027, 95 % CI -1.387, -.086). In mothers who had boys, there were no associations between hPL and mood scores at any time point. CONCLUSION Low hPL at term associated with postnatal depression and anxiety symptoms exclusively in mothers of girls. Insufficiency in hPL may contribute to maternal mood symptoms.
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Affiliation(s)
- Lorna A Sumption
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX, United Kingdom
| | - Samantha M Garay
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX, United Kingdom
| | - Rosalind M John
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX, United Kingdom.
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Creeth HDJ, John RM. The placental programming hypothesis: Placental endocrine insufficiency and the co-occurrence of low birth weight and maternal mood disorders. Placenta 2020; 98:52-59. [PMID: 33039032 DOI: 10.1016/j.placenta.2020.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 12/21/2022]
Abstract
Polypeptide hormones and steroid hormones, either expressed by the placenta or dependant on the placenta for their synthesis, are key to driving adaptations in the mother during pregnancy that support growth in utero. These adaptations include changes in maternal behaviour that take place in pregnancy and after the birth to ensure that offspring receive appropriate care and nutrition. Placentally-derived hormones implicated in the programming of maternal caregiving in rodents include prolactin-related hormones and steroid hormones. Neuromodulators produced by the placenta may act directly on the fetus to support brain development. A number of imprinted genes function antagonistically in the placenta to regulate the development of key placental endocrine lineages expressing these hormones. Gain-in-expression of the normally maternally expressed gene Phlda2 or loss-of-function of the normally paternally expressed gene Peg3 results in fewer endocrine cells in the placenta, and pups are born low birth weight. Importantly, wild type dams carrying these genetically altered pups display alterations in their behaviour with decreased focus on nurturing (Phlda2) or heightened anxiety (Peg3). These same genes may regulate placental hormones in human pregnancies, with the potential to influence birth weight and maternal mood. Consequently, the aberrant expression of imprinted genes in the placenta may underlie the reported co-occurrence of low birth weight with maternal prenatal depression.
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Affiliation(s)
- H D J Creeth
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
| | - R M John
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK.
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Savory K, Garay S, Sumption L, Kelleher J, Daughters K, Janssen A, Van Goozen S, John R. Prenatal symptoms of anxiety and depression associated with sex differences in both maternal perceptions of one year old infant temperament and researcher observed infant characteristics. J Affect Disord 2020; 264:383-392. [PMID: 32056774 PMCID: PMC7005670 DOI: 10.1016/j.jad.2019.11.057] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/29/2019] [Accepted: 11/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sex differences in the behaviour of children exposed to prenatal maternal depression and anxiety have been reported. This study compared depression and anxiety symptoms reported by mothers at term with maternal perceptions of one year old male and female infant temperament and with researcher observed infant characteristics, identifying differences for males and females with both approaches. METHODS Infant behaviour and temperament was assessed via maternally completed questionnaires including Infant Behavioural Questionnaire Revised - Short form and by researcher administered subcomponents of Laboratory Temperament Assessment Battery and Bayley Scales of Infant Development III. RESULTS For female infants, higher prenatal scores for depression and anxiety were associated with maternal perceptions of lower bonding, higher aggression and negativity, and lower soothability (n = 67 mother-infant dyads). In the laboratory assessment, intensity of escape was the only female infant factor significantly associated with maternal mood (n = 41). For male infants, there was minimal association between prenatal mood scores and maternal perceptions (n = 46) whereas in the laboratory assessment (n = 35) depression scores were associated with expressive language, facial interest and facial fear while anxiety scores were associated with expressive and receptive language, parent behaviour and facial fear. LIMITATIONS Findings may be restricted to a single ethnicity or mode of delivery. Fewer infants attended the infant assessment. A laboratory setting may mask symptomatology in females. CONCLUSIONS Atypical maternal perceptions may present a barrier to the early identification of male infants impacted by maternal depression and anxiety.
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Affiliation(s)
- K. Savory
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX United Kingdom
| | - S.M. Garay
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX United Kingdom
| | - L.A. Sumption
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX United Kingdom
| | - J.S. Kelleher
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX United Kingdom
| | - K. Daughters
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, CF24 4HQ United Kingdom
| | - A.B. Janssen
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX United Kingdom
| | - S. Van Goozen
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, CF10 3AT United Kingdom
| | - R.M. John
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX United Kingdom,Corresponding author.
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13
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Garay SM, Savory KA, Sumption LA, Penketh RJ, Jones IR, Janssen AB, John RM. Seasonal variation in salivary cortisol but not symptoms of depression and trait anxiety in pregnant women undergoing an elective caesarean section. Psychoneuroendocrinology 2019; 108:14-19. [PMID: 31181440 PMCID: PMC6854466 DOI: 10.1016/j.psyneuen.2019.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Seasonal changes in mood and behaviour are commonly reported in the general population but considerably less is known regarding seasonality and pregnancy. This study investigated the relationship between seasons and depression and anxiety symptoms, salivary cortisol concentrations, custom birthweight centiles (CBWC) and placenta weight for pregnant women living in South Wales. METHODS This study utilised data from the longitudinal Grown in Wales (GiW) cohort. Women were recruited at the presurgical elective caesarean section (ELCS) appointment, when they provided saliva samples and completed the Edinburgh Postnatal Depression Scale (EPDS) and trait subscale of the State-Trait Anxiety Inventory (STAI). Data on birthweight and placental weight was extracted from medical notes. Seasonal data was available for 316 participants. RESULTS No association was identified between seasons and EPDS (p = .178), STAI scores (p = .544), CBWC (p = .683) or placental weight (p = .857). Significance was identified between seasons and salivary cortisol concentration (p<.001), with highest levels in autumn and winter. Adjusted linear regression identified spring (B=-.05, p=.007, 95% CI -.09, -.01) and summer (B=-.06, p = .001, 95% CI -09, -.02) compared to autumn, and spring (B=-.05, p=.009, 95% CI -.09, -.01) and summer (B=-.06, p=.002, 95% CI -.10, -.02) compared to winter to be associated with decreased cortisol concentrations. CONCLUSION This study found no association between season and maternally-reported mental health symptoms, birthweight by CBWC or placental weight but did between season and term salivary cortisol. This finding will have implications for studies that do not account for seasonality when using salivary cortisol as a biomarker.
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Affiliation(s)
- Samantha M. Garay
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX, United Kingdom
| | - Katrina A. Savory
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX, United Kingdom
| | - Lorna A. Sumption
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX, United Kingdom
| | - Richard J.A. Penketh
- Department of Obstetrics and Gynaecology, University Hospital Wales, Cardiff, Wales, CF144XW, United Kingdom
| | - Ian R. Jones
- National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, Wales, CF14 4XN, United Kingdom
| | - Anna B. Janssen
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX, United Kingdom
| | - Rosalind M. John
- Biomedicine Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX, United Kingdom,Corresponding author.
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Goischke HK. Comorbidities in multiple sclerosis-a plea for interdisciplinary collaboration to improve the quality of life of MS patients. Degener Neurol Neuromuscul Dis 2019; 9:39-53. [PMID: 31354380 PMCID: PMC6584285 DOI: 10.2147/dnnd.s204555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 04/15/2019] [Indexed: 12/21/2022] Open
Abstract
The negative influence of comorbidities on the quality of life of people with multiple sclerosis is evident and the problem is increasingly acknowledged by numerous international studies in long-term care. One therapeutic option would be an add-on therapy with vitamin D (VD), with the aim of achieving a therapeutically effective dose. The individually required VD dose must be tested, since the response to a certain dose is subject to variations between individuals. A possible toxicity with increased 1.25(OH)D3 (active VD metabolite) is largely prevented by increased activity of 24-hydroxylase (CYP24A1). Monitoring of serum VD levels as well as serum calcium and phosphate levels (optional Ca excretion in 24-hour urine, Ca creatinine ratio in urine) provides safety and is necessary because possible mutations on the (catabolic) CYP24A1 gene can lead to a partial or total loss of 24-hydroxylase activity and provoke hypercalcemia/hyperphosphatemia. The main therapeutic objective is to maintain functional and social independence by using drugs with a high safety profile. The prevention and optimal management of comorbidities can influence the quality of life of patients with MS (PwMS) when included in patient care. Adequate measures can reduce the burden of MS only if the risk of comorbidity is reduced through targeted monitoring, early detection and diagnosis. Such a strategy will contribute to influencing the premature mortality of patients with MS. If VD is recognized as a "multipurpose steroid hormone", it could also be used to maintain cognitive function and prevent premature possible dementia, especially as there is evidence that VD deficiency correlates with brain atrophy (hippocampus). At present, MS therapy is still a balancing act between therapeutically efficient action and the management of unexpected side effects, with VD add-on therapy being almost unproblematic and most likely to be accepted by PwMS.
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The Grown in Wales Study: Examining dietary patterns, custom birthweight centiles and the risk of delivering a small-for-gestational age (SGA) infant. PLoS One 2019; 14:e0213412. [PMID: 30861017 PMCID: PMC6413917 DOI: 10.1371/journal.pone.0213412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/20/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives Maternal lifestyles, including diet, have been linked to infant birthweight. However, customised birthweight centiles (CBWC), which more accurately identify small babies that have increased fetal growth restriction and are at higher risk of newborn morbidity and later life health complications, are rarely considered when studying maternal diet. This study investigated maternal dietary patterns and their impact on infant CBWC within a cohort of women living in South Wales. Methods This study utilised cross-sectional data from the longitudinal Grown in Wales (GiW) cohort. Women 18–45 years old were recruited the morning prior to an elective caesarean section (ELCS). Women completed a food frequency questionnaire (FFQ). Additional data on pregnancy and birth outcomes was extracted from medical notes. Data from 303 participants was analysed. Results ‘Western’ and ‘Health conscious dietary patterns were identified. The ‘Health Conscious’ dietary pattern was significantly associated with maternal BMI, age, education, income and exercise. Adjusted regression analyses indicated that greater adherence to a ‘Health Conscious’ dietary pattern was significantly associated with increased CBWC (AOR = 4.75 [95% CI: 1.17, 8.33] p = .010) and reduced risk of delivering a small-for-gestational age (SGA) infant (AOR = .51 [95% CI: .26, .99] p = .046). Conclusion A healthier diet was significantly associated with higher birthweight using CBWC and a reduced risk of delivering an SGA infant suggesting that birthweight will be improved in areas of Wales by focused support encouraging healthier dietary habits.
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