A Comprehensive Review on Postpartum Depression

Association Between Infant-Mother Room-Sharing and Symptoms of Postpartum Depression: A Population-Based Study

OBJECTIVES

This study aimed to (1) examine the relationship between infant-mother room-sharing and postpartum depression (PPD) symptoms and (2) determine whether the relationship between infant-mother room-sharing and PPD symptoms varies by other maternal or infant characteristics.

METHODS

This cross-sectional study utilized de-identified secondary data from the 2016-2019 Pregnancy Risk Assessment and Monitoring System (PRAMS) (N=105,144). Frequencies and percentages were used to describe the characteristics of the study sample. Rao-Scott chi-square tests were used to examine differences in PPD symptoms and infant-mother room-sharing by maternal and infant characteristics. Multivariable logistic regression was performed to examine the independent association between infant sleeping arrangements and PPD symptoms. Pairwise interaction between infant sleeping arrangement and each covariate were included in the regression model, and stratified analyses were performed for variables with significant pairwise interactions.

RESULTS

The prevalence of PPD symptoms was 11.7%, and 79.5% reported that their infant sleeps in the same room. Significant pairwise interactions were found between infant-mother room-sharing and marital status, education, insurance, and receipt of WIC food assistance on PPD symptoms. The odds of having PPD symptoms were higher in those whose infants shared the same room compared to those whose infants slept in a different room. However, the observed association was present only in the subgroups of participants who were married, had greater than a high school level of education, had private insurance, and did not receive WIC food assistance during pregnancy.

CONCLUSIONS FOR PRACTICE

Findings suggest that infant-mother room-sharing is independently associated with increased odds of PPD symptoms.

Effects of zuranolone on next-day simulated driving in healthy adults

RATIONALE

Zuranolone is an oral positive allosteric modulator of GABAA receptors. Due to its central nervous system (CNS) activity, zuranolone may impact activities requiring complex cognition, including driving.

OBJECTIVE

Evaluate the effect of zuranolone on simulated driving performance.

METHODS

In this randomized, double-blind, active- and placebo-controlled, four-period crossover study, treatments included once-nightly zuranolone 50 mg on days 1-7, zuranolone 50 mg on days 1-6 and zuranolone 100 mg on day 7, zopiclone 7.5 mg on days 1 and 7, and placebo on days 1-7. Driving was assessed using a validated simulator. Primary endpoint was standard deviation of lateral position (SDLP), evaluated 9 h post-dose on days 2 and 8. Secondary endpoints included additional driving assessments, cognitive tests, pharmacokinetics, and safety.

RESULTS

Healthy adults (N = 67) enrolled and received ≥ 1 dose. Zuranolone 50 mg increased SDLP versus placebo on days 2 (least squares mean difference [LSMD]: 7.4 cm; p < 0.0001) and 8 (LSMD: 4.6 cm; p = 0.0106). Zuranolone 100 mg evoked a larger increase in SDLP versus placebo on day 8 (LSMD 18.9 cm; p < 0.0001). Reduced performance in other driving assessments and cognition were observed with zuranolone 50 mg on day 2; many resolved by day 8. Despite the SDLP observations, most participants judged themselves capable of driving. Frequent adverse events (≥ 20%) were CNS-related; most were mild/moderate.

CONCLUSION

Zuranolone impaired simulated driving and reduced cognitive function versus placebo 9 h after administration. Although many impairments resolved after 7 days of dosing, driving remained impaired. These results may inform prescriber decision-making.

Zuranolone for postpartum depression: a systematic review and meta-analysis of two randomized studies

Objective

To evaluate the maternal outcomes in women with postpartum depression using zuranolone, the first oral medication indicated to treat postpartum depression.

Methods

We conducted a systematic search in September 2023, on Pubmed, Embase and Cochrane Trials. We included randomized controlled trials comparing the effectiveness and safety of zuranolone versus placebo in women with postpartum depression. No time or language restrictions were applied. 297 results were retrieved, of which 11 papers were selected and fully reviewed by two authors. Review Manager 5 was used for statistical analysis and Cochrane Risk-of-bias tool for randomized trials was applied for quality assessment.

Results

We included 2 studies, with 346 women, of whom 174 (50.2%) were treated with zuranolone. Zuranolone was significantly associated to an improvement of Clinical Global Impression response rate; Hamilton Depression Rating Scale 15 days and 45-day remission, 3-day, 15-day, and 45-day symptom remission, and reduction in the dose of antidepressants. As for safety outcomes, it was noticed that zuranolone increases sedation risk, which can be dose related. No significant differences were found for other adverse events.

Conclusion

These findings suggest that zuranolone might present a safe and effective medication for out-of-hospital treatment of PPD. Sedation effects need to be further assessed.

Prevalence and Risk Factors of Postpartum Depression in Palestinian Women in the Hebron Governorate, Palestine

Background

Despite the increased interest from researchers in Postpartum depression (PPD) globally, related studies are limited in Palestine and do not provide a comprehensive understanding of PPD.

Objective

We examined the factors that determine post-partum depression among Palestinian mothers in Hebron governorate.

Methods

A cross-sectional study was conducted in 122 governmental primary healthcare clinics in Hebron Governorate. A convenient sampling method was used to collect data from 435 using a self-administered questionnaire using the Edinburg Postnatal Depression Scale.

Results

The mean EPDS scale score was 10.56 (SD 5.273), and 36.1% had a score of ≥13, indicating moderate to severe depression symptoms. The study results revealed that psychosocial factors were significantly associated with PPDS and play a crucial role in the development of PPD, such as the history of depression, being exposed to domestic violence before and during pregnancy, poor husband support, unplanned pregnancy, fear of infant's gender, and in addition to anemia than other factors.

Conclusion

A high prevalence of PPD was found among Palestinian women in this study. The study proposes screening women for trauma or domestic violence and assessing their social support, inquiring about pregnancy intention, and discussing family planning. Delivering iron supplements to pregnant or postpartum anemic women is important. Women who have a history of depression, domestic abuse, or lack social support should receive psychological and medical treatment. Mental health services must be included in the after-birth care protocol to train primary health clinic staff to recognize and treat PPD.

Safety assessment of brexanolone in the FAERS database: real adverse event analysis and discussion of side effects

BACKGROUND

Postpartum depression (PPD) is linked to hormonal changes. Brexanolone, the first FDA-approved drug for PPD, is a potential treatment. This study analyzes Brexanolone's safety using the FAERS database, highlighting its adverse effects and potential risk factors.

METHODS

We analyzed FAERS data from Q3 2019 to Q3 2023, evaluating adverse reactions to Brexanolone. The analysis includes demographics, reporting regions, reporter identities, and types of adverse reactions.

RESULTS

Most reports are from the United States, with consumers and physicians as primary reporters. Adverse reactions mainly involve severe systemic diseases, administration site reactions, injuries, intoxication, operational complications, and mental disorders. Specific adverse reactions include incorrect drug monitoring, PPD, intrusive thoughts, delayed treatment efficacy, sedation complications, product discontinuation, misuse, infusion site leakage and pain, and medication errors.

CONCLUSION

The study confirms known safety information about Brexanolone and provides comprehensive data for medical practices and public health decisions. However, relying on spontaneous reports may introduce biases and incomplete information. Continued monitoring and reporting of adverse reactions to newer drugs like Brexanolone remain crucial.

The efficacy of zuranolone versus placebo in postpartum depression and major depressive disorder: a systematic review and meta-analysis

BACKGROUND

Zuranolone, an oral version of allopregnanolone and neurosteroid, is a novel drug for the treatment of major depressive disorder (MDD) and postpartum depression (PPD).

AIM

The purpose of this systematic review and meta-analysis was to assess the efficacy of zuranolone in the treatment of MDD and PPD.

METHOD

A systematic search was conducted using EBSCOhost to simultaneously search Academic Search Premier, APA PsycArticles, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL Ultimate, and MEDLINE with Full Text. Two independent reviewers screened the articles and completed a full-text review using Covidence. The quality of each study was assessed using the Cochrane Risk of Bias tool for randomized trials (RoB 2). A meta-analysis was then conducted using Review Manager (RevMan v5.4) software.

RESULTS

The initial search yielded 127 results, with 6 articles fitting our inclusion and exclusion criteria. All 6 studies, comprising 1707 participants, had an overall low risk of bias. There was a significant decrease in HAM-D scores for MDD at 15 days versus placebo (MD - 2.40, 95% CI - 3.07 to - 1.63; p < .001). When pooling data for PDD, there was an overall significant decrease in HAM-D scores at 15 days versus placebo (MD - 4.06, 95% CI - 4.25 to - 3.87; p < .001).

CONCLUSION

The results suggest that zuranolone can improve symptoms of PPD at 15 days; however, results were not clinically significant for MDD. Future research is needed to evaluate the long-term efficacy of zuranolone in PPD and the treatment efficacy in MDD.

Ecological factors affecting first-time mothers' satisfaction with Sanhujoriwons (postpartum care centres) from South Korea: a cross-sectional and correlational study

BACKGROUND

In South Korea, commercial postpartum care centres, known as Sanhujoriwons, have emerged as important institutions aiding mothers' physical recovery after childbirth. Although previous studies have measured mothers' satisfaction level with Sanhujoriwons, this study applies Bronfenbrenner's ecological model to identify the factors influencing first-time mothers' satisfaction with Sanhujoriwons.

METHODS

This descriptive correlational study involved 212 first-time mothers admitted to Sanhujoriwons for two weeks with their new-borns (healthy babies weighing at least 2.5 kg) after giving birth after 37 weeks of pregnancy. Data were collected using a self-report questionnaire at five postpartum care centres in the metropolitan area of South Korea from October to December 2021, on the day of the mothers' discharge. This study considered ecological factors such as perceived health status, postpartum depression, childcare stress, maternal identity at the individual level; partnership with Sanhujoriwon staff at the microsystem level; and the Sanhujoriwons' education support system at the exo-system level. The data were analysed using descriptive statistics, t-test, one-way ANOVA, correlation analysis, and hierarchical regression analysis using the SPSS 25.0 Win program.

RESULTS

The mean score of satisfaction with Sanhujoriwons was 59.67 ± 10.14 out of 70, indicating a high level of satisfaction. The hierarchical regression analysis showed that satisfaction with Sanhujoriwons was significantly affected by the perceived health status (β = 0.19, p < 0.001), partnership between mothers and the caregivers (β = 0.26, p < 0.001), and education support system of the Sanhujoriwons (β = 0.47, p < 0.001). The explanatory power of the model for these variables was 62.3%.

CONCLUSIONS

Our results indicate that not only the mother's health status but also the educational support system of postpartum care centres and partnerships are important for improving first-time mothers' satisfaction with postpartum care centres. Thus, when developing an intervention program for postpartum care centres, practitioners should focus on developing various kinds of support and strategies to improve the physical health condition of mothers, build partnerships between mothers and care staff, and improve the quality of the educational support offered to mothers. Further studies to develop and test the effectiveness of such intervention programs are strongly suggested.