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Ngai FW, Xie YJ. Sleep and depression in couples during the transition to parenthood. Behav Sleep Med 2024; 22:308-318. [PMID: 37668498 DOI: 10.1080/15402002.2023.2255327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVES The objectives were to: (1) investigate the prevalence, differences and changes in sleep quality over time among Chinese couples during pregnancy and at 6 weeks and 6 months postpartum and (2) examine the association between sleep quality and depressive symptoms. METHOD This study was part of an intervention study for postnatal depression. Childbearing couples were recruited from antenatal clinics. Data on sleep and depression during pregnancy and at 6 weeks and 6 months postpartum were collected using the Pittsburgh Sleep Quality Index (PSQI) and Edinburgh Postnatal Depression Scale, respectively. RESULTS The prevalence of sleep disturbance (PSQI score > 5) during pregnancy and at 6 weeks and 6 months postpartum was 45.0%, 62.8% and 36.8%, respectively, among women and 26.4%, 36.4% and 27.3%, respectively, among men. Sleep quality declined significantly in both partners from pregnancy to 6 weeks postpartum, followed by a significant improvement by 6 months postpartum. The results revealed significant correlations between partners' scores on sleep quality across the perinatal period, with women experiencing poorer sleep quality than men. Poor sleep was associated with depressive symptoms across the perinatal period for both partners. CONCLUSIONS This study highlights the importance of screening couples for sleep disturbances throughout pregnancy and the postnatal period and assisting them to develop strategies to improve sleep quality during the transition to parenthood.
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Affiliation(s)
- Fei-Wan Ngai
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Finnegan MK, Kane S, Heller W, Laurent H. Mothers' neural response to valenced infant interactions predicts postpartum depression and anxiety. PLoS One 2021; 16:e0250487. [PMID: 33905457 PMCID: PMC8078806 DOI: 10.1371/journal.pone.0250487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/07/2021] [Indexed: 11/18/2022] Open
Abstract
It is currently unknown whether differences in neural responsiveness to infant cues observed in postpartum affective disturbance are specific to depression/anxiety or are better attributed to a common component of internalizing distress. It is also unknown whether differences in mothers’ brain response can be accounted for by effects of past episodes, or if current neural processing of her child may serve as a risk factor for development of future symptoms. Twenty-four mothers from a community-based sample participated in an fMRI session viewing their 3-month- old infant during tasks evoking positive or negative emotion. They were tracked across the ensuing 15 months to monitor changes in affective symptoms. Past and current episodes of depression and anxiety, as well as future symptoms, were used to predict differences in mothers’ hemodynamic response to their infant in positive compared to negative emotion contexts. Lower relative activation in largely overlapping brain regions involving frontal lobe structures to own infant positive vs. negative emotion was associated with concurrent (3-month) depression diagnosis and prospective (3–18 month) depression and anxiety symptoms. There was little evidence for impacts of past psychopathology (more limited effect of past anxiety and nonsignificant effect of past depression). Results suggest biased maternal processing of infant emotions during postpartum depression and anxiety is largely accounted for by a shared source of variance (internalizing distress). Furthermore, differential maternal responsiveness to her infant’s emotional cues is specifically associated with the perpetuation of postpartum symptoms, as opposed to more general phenotypic or scarring effects of past psychopathology.
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Affiliation(s)
- Megan Kate Finnegan
- Psychology Department, University of Illinois at Urbana-Champaign, Champaign, IL, United States of America
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
- * E-mail:
| | - Stephanie Kane
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States of America
| | - Wendy Heller
- Psychology Department, University of Illinois at Urbana-Champaign, Champaign, IL, United States of America
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | - Heidemarie Laurent
- Psychology Department, University of Illinois at Urbana-Champaign, Champaign, IL, United States of America
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
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Mercan Y, Tari Selcuk K. Association between postpartum depression level, social support level and breastfeeding attitude and breastfeeding self-efficacy in early postpartum women. PLoS One 2021; 16:e0249538. [PMID: 33798229 PMCID: PMC8018654 DOI: 10.1371/journal.pone.0249538] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/21/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The study was aimed at investigating the association between postpartum women's breastfeeding self-efficacy levels and their depression levels, social support levels, and breastfeeding attitudes in early postpartum period. METHODS The cross-sectional study was carried out in Kirklareli in Turkey. The population of the study consisted of 398 women aged 15-49 in the first 42 days of the postpartum period who presented to eight family health centers. The study data were collected face-to-face using the Personal Information Form, Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), Edinburgh Postnatal Depression Scale (EPDS), Multidimensional Scale of Perceived Social Support (MSPSS), and Breastfeeding Attitudes of the Evaluation Scale (BAES). RESULTS The mean age of the participants was 28.61±5.72 (Min:18, Max: 44), and the mean score they obtained from the BSES-SF was 55.13±8.39. Statistically significant differences were detected between the participants' BSES-SF scores and age groups, employment status, perceived income level, and the number of living children (p < 0.05). No statistically significant differences were detected between marital status, educational status and BSES-SF scores (p > 0.05). In the multivariate regression analysis adjusted according to the sociodemographic characteristics, BAES, EPDS and MSPSS accounted for 48.3% of the BSES-SF. A negative association was found between BSES-SF scores and EPDS scores (β = -0.178, 95% CI:-0.349, -0.006), and a positive relation between the BAES scores (β = 0.194, 95% CI: 0.163, 0.226) and the MSPSS scores (β = 0.114, 95% CI: 0.037, 0.191). CONCLUSION As the level of depression of women increases in the postpartum period, the level of breastfeeding self-efficacy decreases. The breastfeeding self-efficacy increases as the level of social support increases and as the attitudes that drive breastfeeding behavior change positively.
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Affiliation(s)
- Yeliz Mercan
- Department of Health Management, School of Health Kirklareli University, Kirklareli, Turkey
| | - Kevser Tari Selcuk
- Department of Nurition and Dietetics, Faculty of Health Sciences, Bandirma Onyedi Eylul University, Balikesir, Turkey
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Affiliation(s)
- Philip Heesen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Sharon Orbach-Zinger
- Department of Anesthesia, Beilinson Hospital, Petach Tikvah, Israel; Affiliated with Saklar Medical School, Tel Aviv University
| | - Sophie Grigoriadis
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, FG 44, Psychiatry, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Stephen Halpern
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, 63 Elm Ridge Drive, Toronto, Ontario M6B 1A2, Canada
| | - Leonid A Eidelman
- Department of Anesthesia, Beilinson Hospital, Petach Tikvah, Israel; Affiliated with Saklar Medical School, Tel Aviv University.
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Sasaki Y, Ito K, Fukumoto K, Kawamura H, Oyama R, Sasaki M, Baba T. Cerebral diffusion kurtosis imaging to assess the pathophysiology of postpartum depression. Sci Rep 2020; 10:15391. [PMID: 32958845 PMCID: PMC7505968 DOI: 10.1038/s41598-020-72310-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022] Open
Abstract
Postpartum depression (PPD), a main cause of maternal suicide, is an important issue in perinatal mental health. Recently, cerebral diffusion tensor imaging (DTI) studies have shown reduced fractional anisotropy (FA) in major depressive disorder (MDD) patients. There are, however, no reports using diffusion kurtosis imaging (DKI) for evaluation of PPD. This was a Japanese single-institutional prospective study from 2016 to 2019 to examine the pathophysiological changes in the brain of PPD patients using DKI. The DKI data from 3.0 T MRI of patients one month after delivery were analyzed; the patients were examined for PPD by a psychiatrist. The mean kurtosis (MK), FA and mean diffusivity (MD) were calculated from the DKI data and compared between PPD and non-PPD groups using tract-based spatial statistics analysis. Of the 75 patients analyzed, eight patients (10.7%) were diagnosed as having PPD. In the PPD group, FA values in the white matter and thalamus were significantly lower and MD values in the white matter and putamen were significantly higher. The area with significant differences in MD value was more extensive (40.8%) than the area with significant differences in FA value (6.5%). These findings may reflect pathophysiological differences of PPD compared with MDD.
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Affiliation(s)
- Yuri Sasaki
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3695, Japan.
| | - Kenji Ito
- Division of Ultrahigh Field MRI, Institute for Biomedical Science, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kentaro Fukumoto
- Department of Neuropsychiatry, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Hanae Kawamura
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3695, Japan
| | - Rie Oyama
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3695, Japan
| | - Makoto Sasaki
- Division of Ultrahigh Field MRI, Institute for Biomedical Science, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Tsukasa Baba
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Shiwa, Iwate, 028-3695, Japan
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Khoury JE, Bosquet Enlow M, Patwa MC, Lyons-Ruth K. Hair cortisol in pregnancy interacts with maternal depressive symptoms to predict maternal disrupted interaction with her infant at 4 months. Dev Psychobiol 2020; 62:768-782. [PMID: 32037544 PMCID: PMC7415595 DOI: 10.1002/dev.21950] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 11/01/2019] [Accepted: 01/02/2020] [Indexed: 12/12/2022]
Abstract
Disrupted maternal interaction in early infancy is associated with maladaptive child outcomes. Thus, identifying early risk factors for disrupted interaction is an important challenge. Research suggests that maternal depressive symptoms and maternal cortisol dysregulation are associated with disrupted maternal interaction, but both factors have rarely been considered together as independent or interactive predictors of disrupted interaction. In a sample of 51 women, hair cortisol concentrations (HCC) and depressive symptoms were assessed during pregnancy, and depressive symptoms were assessed again at 4-month postpartum. Maternal disrupted interaction was assessed during the Still-Face Paradigm at 4 months. Results indicated that HCC and depressive symptoms interacted to predict both maternal withdrawing and inappropriate/intrusive interaction. Withdrawing interaction was associated with high levels of HCC in pregnancy in the context of high depressive symptoms at 4 months; inappropriate/intrusive interaction was associated with high levels of HCC in the context of low depressive symptoms. Thus, high HCC potentiated both forms of disrupted interaction. Results raised questions about the meaning of very low reported depressive symptoms, and underscored the importance of chronic stress physiology and maternal depressed mood as risk factors for distinct forms of maternal disrupted interaction, both of which are deleterious for infant development.
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Abstract
Pregnancy, a sensitive time when two bodies are changing and developing simultaneously, demands careful consideration in assessing and treating mental health conditions. Add to that the restrictions on researching such a vulnerable population, psychiatric nurses face a challenge in providing evidence-based care. The current article focuses on the epidemiology of postpartum depression and long-term consequences, neurobiology of postpartum depression that guides medication selection, and treatment options for supporting postpartum women and their families. [Journal of Psychosocial Nursing and Mental Health Services, 57(11), 9-14.].
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Rincón-Cortés M, Grace AA. Adaptations in reward-related behaviors and mesolimbic dopamine function during motherhood and the postpartum period. Front Neuroendocrinol 2020; 57:100839. [PMID: 32305528 PMCID: PMC7531575 DOI: 10.1016/j.yfrne.2020.100839] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/15/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
Abstract
Initiation and maintenance of maternal behavior is driven by a complex interaction between the physiology of parturition and offspring stimulation, causing functional changes in maternal brain and behavior. Maternal behaviors are among the most robust and rewarding motivated behaviors. Mesolimbic dopamine (DA) system alterations during pregnancy and the postpartum enable enhanced reward-related responses to offspring stimuli. Here, we review behavioral evidence demonstrating postpartum rodents exhibit a bias towards pups and pup-related stimuli in reward-related tasks. Next, we provide an overview of normative adaptations in the mesolimbic DA system induced by parturition and the postpartum, which likely mediate shifts in offspring valence. We also discuss a causal link between dopaminergic dysfunction and disrupted maternal behaviors, which are recapitulated in postpartum depression (PPD) and relevant rodent models. In sum, mesolimbic DA system activation drives infant-seeking behavior and strengthens the mother-infant bond, potentially representing a therapeutic target for reward-related deficits in PPD.
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Affiliation(s)
- Millie Rincón-Cortés
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA 15217, United States.
| | - Anthony A Grace
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA 15217, United States
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Sha T, Gao X, Chen C, Li L, Cheng G, Wu X, Tian Q, Yang F, He Q, Yan Y. A prospective study of maternal postnatal depressive symptoms with infant-feeding practices in a Chinese birth cohort. BMC Pregnancy Childbirth 2019; 19:388. [PMID: 31660900 PMCID: PMC6819524 DOI: 10.1186/s12884-019-2559-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 10/14/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The first few weeks after childbirth are critical, as women may encounter lactation problems and postpartum depression during this period. However, it is still unclear whether early breastfeeding behaviours are related to the symptoms of postnatal depression (PND) in Chinese populations. Therefore, the current study aimed to investigate the association between symptoms of PND and infant feeding practices based on a large-scale Chinese cohort. METHODS A prospective study of the community-based cohort was conducted from January 2015 to December 2016. Infant feeding outcomes, including exclusive/partial breastfeeding and formula feeding, were assessed according to the WHO guidelines. Symptoms of PND were assessed by the Edinburgh Postnatal Depression Scale at 4 weeks postpartum. Multivariate generalized estimating equation models were applied to investigate the associations between depressive symptoms and infant feeding behaviours. RESULTS A total of 956 mother-infant pairs were included. Fifty-six mothers presented screen-positive symptoms of PND with a cut-off ≥10. The percentage of early breastfeeding initiation was 75.8%, while the average duration of exclusive breastfeeding was 3.90 ± 2.33 months. Postnatal depressive symptoms were associated with a shorter breastfeeding duration (8.02 vs. 6.32 months, P < 0.05) and earlier formula introduction (4.98 vs. 3.60 months, P < 0.05). After adjustments were made for covariates, postnatal depressive symptoms were associated with an increased risk of the discontinuation of exclusive and partial breastfeeding (β = - 0.049, P = 0.047 and β = - 0.082, P = 0.006, respectively). Compared to mothers without symptoms of PND, mothers with depressive symptoms were more likely to supplement formula for their infants in the first year of life (β =0.074, P = 0.016). These associations were still significant in the sensitivity analyses, using an EPDS cut-off of ≥13. CONCLUSIONS Our findings indicate that depressive symptoms at 4 weeks postpartum are associated with the cessation of exclusive and partial breastfeeding duration and the introduction of formula in the 12 months of delivery. Early psychosocial assessment and social support should be offered to mothers in the early postpartum period to indirectly prevent adverse breastfeeding outcomes.
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Affiliation(s)
- Tingting Sha
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Xiao Gao
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Cheng Chen
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Ling Li
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Gang Cheng
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Xialing Wu
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Qianling Tian
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Fan Yang
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Qiong He
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Yan Yan
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
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Axfors C, Bränn E, Henriksson HE, Hellgren C, Kunovac Kallak T, Fransson E, Lager S, Iliadis SI, Sylvén S, Papadopoulos FC, Ekselius L, Sundström-Poromaa I, Skalkidou A. Cohort profile: the Biology, Affect, Stress, Imaging and Cognition (BASIC) study on perinatal depression in a population-based Swedish cohort. BMJ Open 2019; 9:e031514. [PMID: 31641004 PMCID: PMC6830667 DOI: 10.1136/bmjopen-2019-031514] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE With the population-based, prospective Biology, Affect, Stress, Imaging and Cognition (BASIC) cohort, we aim to investigate the biopsychosocial aetiological processes involved in perinatal depression (PND) and to pinpoint its predictors in order to improve early detection. PARTICIPANTS From September 2009 to November 2018, the BASIC study at Uppsala University Hospital, Sweden, has enrolled 5492 women, in 6478 pregnancies, of which 46.3% first-time pregnancies and with an average age of 31.5 years. After inclusion around gestational week 16-18, participants are followed-up with data collection points around gestational week 32, at childbirth, as well as three times postpartum: after 6 weeks, 6 months and 1 year. At the last follow-up, 70.8% still remain in the cohort. FINDINGS TO DATE In addition to internet-based surveys with self-report instruments, participants contribute with biological samples, for example, blood samples (maternal and from umbilical cord), biopsies (umbilical cord and placenta) and microbiota samples. A nested case-control subsample also takes part in cognitive and emotional tests, heart rate variability tests and bioimpedance tests. Subprojects have identified various correlates of PND of psychological and obstetric origin in addition to factors of the hypothalamic-pituitary-adrenal axis and immune system. FUTURE PLANS In parallel with the completion of data collection (final follow-up November 2019), BASIC study data are currently analysed in multiple subprojects. Since 2012, we are conducting an ongoing follow-up study on the participants and their children up to 6 years of age (U-BIRTH). Researchers interested in collaboration may contact Professor Alkistis Skalkidou (corresponding author) with their request to be considered by the BASIC study steering committee.
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Affiliation(s)
- Cathrine Axfors
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Bränn
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | - Theodora Kunovac Kallak
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Reproductive Biology in Uppsala (CRU), Uppsala University, Uppsala, Sweden
| | - Emma Fransson
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden
| | - Susanne Lager
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Reproductive Biology in Uppsala (CRU), Uppsala University, Uppsala, Sweden
| | | | - Sara Sylvén
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | | | - Lisa Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Li D, Li Y, Chen Y, Li H, She Y, Zhang X, Chen S, Chen W, Qiu G, Huang H, Zhang S. Neuroprotection of reduced thyroid hormone with increased estrogen and progestogen in postpartum depression. Biosci Rep 2019; 39:BSR20182382. [PMID: 31406011 PMCID: PMC6722490 DOI: 10.1042/bsr20182382] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/07/2019] [Accepted: 08/08/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Postpartum depression (PPD) is a common serious mental health problem. Recent studies have demonstrated that hormone therapy serves as a promising therapeutic approach in managing PPD. The present study aims at exploring the role of thyroid hormone (TH), estrogen and progestogen in patients with PPD.Methods: Initially, PPD patients were enrolled and a PPD mouse model was established. The serum levels of estradiol (E2), progesterone (P), triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were subsequently measured. Next, in order to identify the effects of TH, estrogen and progestogen on PPD progression, mice were administrated with E2, P, contraceptives (CA), Euthyrox and methimazole (MMI). Besides, the body weight, activities, basolateral amygdala (BLA) neuron cell structure and the related gene expression of mice were analyzed.Results: The PPD patients and the mice showed elevated serum levels of T3, T4, FT3 and FT4 along with diminished E2, P and TSH levels. In the mice administered with a combination of E2, P, and MMI, decreased TH and increased estrogen and progestogen were detected, which resulted in increased body weight, normal activities, and BLA neuron cell structure. Moreover, brain-derived neurotrophic factor (BDNF) and cAMP-responsive element-binding protein (CREB) were both up-regulated in PPD mice administrated with a combination of E2, P, and MMI, which was accompanied by decreased TH and elevated estrogen and progestogen.Conclusion: Taken together, reduced TH combined with enhanced estrogen and progestogen confers neuroprotection in PPD, highlighting a potential target in prevention and treatment of PPD.
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Affiliation(s)
- Dan Li
- Gynaecology and Obstetrics, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Yangyao Li
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Yun Chen
- Department of Pharmacy, Guangzhou Red Cross Hospital Affiliated of Ji-Nan University Medical College, Guangzhou 510220, P.R. China
| | - Haiyan Li
- Department of Nursing, Guangzhou Red Cross Hospital Affiliated of Ji-Nan University Medical College, Guangzhou 510220, P.R. China
| | - Yuqi She
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Xialan Zhang
- Gynaecology and Obstetrics, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Shuang Chen
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Wanying Chen
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Guodong Qiu
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Haiqing Huang
- Department of Ultrasound, Cancer Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Shuyao Zhang
- Department of Pharmacy, Guangzhou Red Cross Hospital Affiliated of Ji-Nan University Medical College, Guangzhou 510220, P.R. China
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Pranal M, Legrand A, de Chazeron I, Llorca PM, Vendittelli F. Prevalence of maternal psychological disorders after immediate postpartum haemorrhage: a repeated cross-sectional study - the PSYCHE* study protoco. BMJ Open 2019; 9:e027390. [PMID: 31488469 PMCID: PMC6731911 DOI: 10.1136/bmjopen-2018-027390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The main objective of this study is to assess the prevalence of depression at 2, 6 and 12 months postpartum in women who have had an immediate postpartum haemorrhage (PPH) (blood loss ≥500 mL within 24 hours of delivery). The secondary objectives are to assess the prevalence of anxiety and post-traumatic stress disorder among these women and to evaluate the prevalence of psychological disorders according to the severity of the PPH. METHODS AND ANALYSIS This repeated, cross-sectional, single-centre study will take place at the Clermont-Ferrand University Hospital (France). The population will comprise a cohort of women giving birth at a term ≥22 weeks of gestation.For each woman with a PPH (exposed), two women without PPH (unexposed) will be included: the women who give birth immediately before and immediately after her. The PPH will be managed according to French guidelines. The principal endpoint is the prevalence of depression, measured by the Edinburgh Postnatal Depression Scale (EPDS). The intervention will consist of four surveys including various self-completed questionnaires: the first during the immediate postpartum (Post-Delivery Perceived Stress Inventory (PDPSI), Spielberger'sState-Trait Anxiety Inventory (STAI)-Y-A and Y-B and Mini-International Neuropsychiatric Interview (M.I.N.I.) 5.0.0), then at 2 months (EPDS, STAI-Y-A, Generalised Anxiety Disorder (GAD-7) and Revised Impact of Event Scale (IES-R)), and finally at 6 months and 1 year postpartum (EPDS, STAI-Y-A, GAD-7, M.I.N.I. 5.0.0 and IES-R). The study will include 1542 women - 514 with PPH. ETHICS AND DISSEMINATION The institutional review board (IRB) approved the study on 14 February 2017 (IRB Sud Est VI: N°AU1243).Results will be reported in peer-reviewed journals and at scientific meetings. Findings from the study will be useful for individualising medical follow-up after childbirth, especially for woman who experienced a PPH, but also more generally in increasing birth professionals' awareness of effects of trauma. The evidence obtained might also lead to modifying practices and including this recommendation in French guidelines on PPH. TRIAL REGISTRATION NUMBER NCT03120208.
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MESH Headings
- Adult
- Anxiety/diagnosis
- Anxiety/epidemiology
- Anxiety/etiology
- Anxiety/physiopathology
- Cross-Sectional Studies
- Delivery, Obstetric/adverse effects
- Delivery, Obstetric/methods
- Delivery, Obstetric/statistics & numerical data
- Depression, Postpartum/diagnosis
- Depression, Postpartum/epidemiology
- Depression, Postpartum/etiology
- Depression, Postpartum/physiopathology
- Female
- France/epidemiology
- Humans
- Parturition/psychology
- Postpartum Hemorrhage/diagnosis
- Postpartum Hemorrhage/psychology
- Prevalence
- Psychiatric Status Rating Scales
- Stress Disorders, Post-Traumatic/diagnosis
- Stress Disorders, Post-Traumatic/epidemiology
- Stress Disorders, Post-Traumatic/etiology
- Stress Disorders, Post-Traumatic/physiopathology
- Time Factors
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Affiliation(s)
- Marine Pranal
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- UniversitéClermont-Auvergne, CHU Clermont-Ferrand, CNRS,SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Anne Legrand
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- UniversitéClermont-Auvergne, CHU Clermont-Ferrand, CNRS,SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Ingrid de Chazeron
- Psychiatry B, CHU Clermont-Ferrand, Clermont-Ferrand, France
- UFR Medecine, EA7280, Univ Clermont 1, Clermont-Ferrand, France
| | - Pierre-Michel Llorca
- Psychiatry B, CHU Clermont-Ferrand, Clermont-Ferrand, France
- UFR Medecine, EA7280, Univ Clermont 1, Clermont-Ferrand, France
| | - Françoise Vendittelli
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- UniversitéClermont-Auvergne, CHU Clermont-Ferrand, CNRS,SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
- The AUDIPOG Sentinel Network (Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie), RTH Laennec Medical University, Lyon, France
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13
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Dudin A, Wonch KE, Davis AD, Steiner M, Fleming AS, Hall GB. Amygdala and affective responses to infant pictures: Comparing depressed and non-depressed mothers and non-mothers. J Neuroendocrinol 2019; 31:e12790. [PMID: 31489723 DOI: 10.1111/jne.12790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 08/31/2019] [Accepted: 09/03/2019] [Indexed: 12/16/2022]
Abstract
In many mammalian species, new mothers show heightened positive responsiveness to infants and their cues when they give birth. As is evident from non-human and human studies, the amygdala is a brain region implicated in both the maternal and affective neural circuitry, and is involved in processing socioemotionally salient stimuli. In humans, infants are socially salient stimuli to women, and mothers in particular. Neuroimaging studies investigating the maternal response to infant cues have identified infant-related amygdala function as an important factor in maternal anxiety/depression, in the quality of mothering and in individual differences in the motivation to mother. The present study investigated the effects of maternal status and depression on the subjective affective response and amygdala responsiveness to unfamiliar infants using functional magnetic resonance imaging. Smiling infant pictures were used in a 2 × 2 design comparing four groups of women: mothers and non-mothers, with and without depression (total of 101 women: postpartum depression [PPD] = 32, non-PPD = 25, major depression [MDD] = 15, non-MDD = 29). We undertook an anatomically defined region of interest analysis of the amygdala response for a priori defined group comparisons. We found that mothers rated infants more positively than non-mothers and non-mothers rated non-infant stimuli (scenery) more positively than mothers. In the amygdala, we found that depression elevated response to smiling unfamiliar infants in mothers but had no effect in non-mothers. Within the depressed groups, mothers (PPD) showed an elevated amygdala response to unfamiliar smiling infants compared to depressed non-mothers. Hence, our results indicate that women with PPD show an enhanced amygdala response to affectively positive infant pictures but not to affectively positive (but non-salient) pictures of scenery. Women with depression outside of the postpartum period show no change in amygdala responsiveness to either stimulus categories.
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Affiliation(s)
- Aya Dudin
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Kathleen E Wonch
- Department of Psychology, University of Toronto at Mississauga, Mississauga, ON, Canada
| | - Andrew D Davis
- Department of Psychology, Neuroscience & Behaviour (PNB), McMaster University, Hamilton, ON, Canada
| | - Meir Steiner
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Women's Health Concerns Clinic, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Alison S Fleming
- Department of Psychology, University of Toronto at Mississauga, Mississauga, ON, Canada
| | - Geoffrey B Hall
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
- Department of Psychology, Neuroscience & Behaviour (PNB), McMaster University, Hamilton, ON, Canada
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14
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Nguyen AJ, Hoyer E, Rajhans P, Strathearn L, Kim S. A tumultuous transition to motherhood: Altered brain and hormonal responses in mothers with postpartum depression. J Neuroendocrinol 2019; 31:e12794. [PMID: 31520440 DOI: 10.1111/jne.12794] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 08/26/2019] [Accepted: 09/08/2019] [Indexed: 12/19/2022]
Abstract
Postpartum depression (PPD) is a common but complex condition that is poorly understood and multifactorial in aetiology. It is a condition that can compromise the mother's care for her infant, which may pose challenges to the formation of the mother-infant bond and the infant's overall development. Past research has looked at abnormalities in the brain circuitry and hormonal profiles of mothers with PPD compared to non-depressed mothers. However, abnormalities in PPD that may specifically affect the mother's care of her infant have not been clearly assessed. Thus, the present review aims to synthesise studies of altered brain and hormonal responses in mothers with PPD in relation to their care of their infant. First, we review maternal brain responses and their relation to PPD symptomatology, focusing on the salience/fear network, reward/attachment network and default mode network. Next, we discuss oxytocin and hypothalamic-pituitary-adrenal axis hormones in the context of maternal behaviour and PPD. Finally, we synthesise these findings and propose how future studies may benefit from the combined study of both neural and hormonal activity to better understand the underlying neurobiology of maternal care in PPD.
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Affiliation(s)
- Amanda J Nguyen
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Elisabeth Hoyer
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Purva Rajhans
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Lane Strathearn
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Sohye Kim
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Center for Reproductive Psychiatry, Pavilion for Women, Texas Children's Hospital, Houston, TX, USA
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15
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Ride J. Is socioeconomic inequality in postnatal depression an early-life root of disadvantage for children? Eur J Health Econ 2019; 20:1013-1027. [PMID: 31140060 DOI: 10.1007/s10198-019-01073-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 05/13/2019] [Indexed: 06/09/2023]
Abstract
This paper investigates the role that socioeconomic inequality in postnatal depression might play in intergenerational transmission of inequality. Infants' development is thought to be particularly sensitive to mothers' mental health at this time, suggesting that greater early-life exposure to maternal depression among disadvantaged groups might be a root of later socioeconomic inequalities. Heightened contact with health services during this period presents opportunities for intervention, but higher unmet need for treatment of postnatal depression among the disadvantaged might be widening inequalities. The aim of this study is to quantify the potential contribution of postnatal depression to socioeconomic inequalities in adverse childhood health and development outcomes. Regression-based decomposition of the concentration index is used to explore the association between income inequality in postnatal depressive symptoms and income inequality in children's outcomes. Four problems of early adolescence are explored: emotional and conduct problems, special educational needs, and low self-assessed health. Data are taken from the UK Millennium Cohort Study, with a sample of 4359 mothers and children with complete data on outcomes and covariates, and a second sample of 5441 when missing covariates are filled using multiple imputation. The key finding is that socioeconomic inequality in maternal postnatal depression is a significant contributor to inequalities in special educational needs, emotional problems, and low self-assessed health for children at age 11 years, even after accounting for a range of other factors that might explain such associations. These findings highlight the importance of understanding the impact of postnatal depression interventions on inequalities, and the downstream influence on children's outcomes. Addressing inequalities in mothers' postnatal depression might be an avenue for reducing early-life disadvantage for children.
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Affiliation(s)
- Jemimah Ride
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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16
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Abstract
The experience of motherhood is most often emotionally positive and rewarding, but for many new mothers suffering from postpartum depression (PPD), this is not the case. Preclinical and clinical research has sought to uncover brain changes underlying PPD in order to gain a better understanding of how this disorder develops. This review focuses on the mesolimbic dopamine system, particularly the ventral tegmental area-nucleus accumbens pathway which has been implicated in the regulation of critical functions disrupted in PPD including mood, motivation, and mothering. Specifically, we discuss normative changes in the mesolimbic system during motherhood in both rodents and humans and how these are impacted in PPD. We also consider modulation of mesolimbic dopamine by the hypothalamic neuropeptide oxytocin and how oxytocin-dopamine interactions regulate mood and mothering during the postpartum period. In addition to providing an overview of reward mechanisms in PPD, our goal is to highlight open questions which warrant further research.
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Affiliation(s)
- Caitlin Post
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH, USA
| | - Benedetta Leuner
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH, USA.
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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17
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Lorenz TK, Cheng H, Heiman JR. Neural correlates of emotion processing comparing antidepressants and exogenous oxytocin in postpartum depressed women: An exploratory study. PLoS One 2019; 14:e0217764. [PMID: 31150502 PMCID: PMC6544275 DOI: 10.1371/journal.pone.0217764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/18/2019] [Indexed: 11/19/2022] Open
Abstract
Despite common use of antidepressants to treat postpartum depression, little is known about the impact of antidepressant use on postpartum brain activity. Additionally, although oxytocin has been investigated as a potential treatment for postpartum depression, the interaction between antidepressants and exogenous oxytocin on brain activity is unknown. We explored postpartum depressed women's neural activation in areas identified as important to emotion and reward processing and potentially, antidepressant response: the amygdala, nucleus accumbens and ventral tegmental area. We conducted a secondary analysis of a functional imaging study of response to sexual, crying infant and smiling infant images in 23 postpartum depressed women with infants under six months (11 women taking antidepressants, 12 unmedicated). Participants were randomized to receive a single dose of oxytocin or placebo nasal spray. There was significantly higher amygdala activation to sexual stimuli than either neutral or infant-related stimuli among women taking antidepressants or receiving oxytocin nasal spray. Among unmedicated women receiving placebo, amygdala activation was similar across stimuli types. There were no significant effects of antidepressants nor oxytocin nasal spray on reward area processing (i.e., in the nucleus accumbens or ventral tegmental area). Among postpartum women who remain depressed, there may be significant interactions between the effects of antidepressant use and exogenous oxytocin on neural activity associated with processing emotional information. Observed effect sizes were moderate to large, strongly suggesting the need for further replication with a larger sample.
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Affiliation(s)
- Tierney K. Lorenz
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
- Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
| | - Hu Cheng
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, United States of America
| | - Julia R. Heiman
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, United States of America
- * E-mail:
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18
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Brexanolone (Zulresso) for postpartum depression. Med Lett Drugs Ther 2019; 61:68-70. [PMID: 31169804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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19
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Beck CT, Casavant S. Synthesis of Mixed Research on Posttraumatic Stress Related to Traumatic Birth. J Obstet Gynecol Neonatal Nurs 2019; 48:385-397. [PMID: 30958993 DOI: 10.1016/j.jogn.2019.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To synthesize mixed-research results (quantitative and qualitative) on posttraumatic stress in women who experienced traumatic births. DATA SOURCES PubMed, Scopus, and PsycINFO databases. STUDY SELECTION Quantitative and qualitative studies were included if they were published in English from January 1, 2009, through December 31, 2018, and focused on posttraumatic stress in the postpartum period related to traumatic childbirth. DATA EXTRACTION The final sample consisted of 59 studies: 4 qualitative and 55 quantitative. Both authors independently appraised each study using the Critical Appraisal Skills Programme. Quantitative studies were synthesized by narrative synthesis and vote counting, and qualitative studies were synthesized by content analysis. DATA SYNTHESIS In the included studies, prevalence rates of elevated posttraumatic stress ranged from 0.8% to 26%. Significant predictors of posttraumatic stress that occurred before childbirth and those that were birth related were identified. Reports of six intervention studies to decrease posttraumatic stress symptoms after traumatic births were included. These interventions focused on postnatal debriefing, expressive writing, online cognitive behavioral therapy, a brief cognitive intervention, and the implementation of the nine instinctive stages of the infant during the first hour after birth. We created four themes from the findings of the qualitative studies: Distressing Symptoms, Detrimental Effect of Posttraumatic Stress on Women's Relationships With Their Infants and Partners, Critical Influence ofSupport, and Debriefing. CONCLUSION When a woman experiences posttraumatic stress related to a traumatic birth, the entire family unit is vulnerable. Findings from quantitative predictor studies can be used to develop an instrument to screen women for risk factors for posttraumatic stress related to birth trauma. Primary interventions are needed to prevent women from experiencing traumatic births.
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20
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Nellhaus EM, Nieuwenhuizen L, Egleton R, Hansen Z, Chaffin D, Loudin S, Davies TH. History of postpartum depression as a contributor to the severity of NAS. Addict Behav 2019; 89:78-84. [PMID: 30268061 DOI: 10.1016/j.addbeh.2018.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/14/2018] [Accepted: 09/08/2018] [Indexed: 11/28/2022]
Abstract
Currently, there are no clinical tools available to accurately predict the severity of neonatal withdrawal. Studies of non-exposed neonates suggest that maternal depression and anxiety are predictive of negative short and long-term neonatal outcomes, but research is lacking in the addicted population. We studied of 109 pregnant women in medication-assisted treatment (MAT) and their neonates to determine if psychiatric conditions co-occurring with Substance Use Disorder (SUD) contributed to the severity of neonatal withdrawal. The need for pharmacological intervention, Finnegan scores, length of methadone treatment, and length of hospital stay were used to assess withdrawal severity. Categorical variables were analyzed in Stata14 using Chi Square and continuous variables were analyzed using Wilcoxon Rank Sum. Among the 110 neonates whose outcomes were reviewed, a maternal history of Postpartum Depression (PPD) was found to be correlated with increased severity of withdrawal. The neonates born to mothers with past diagnoses of PPD had more consecutive days of high Finnegan scores (95% confidence interval [CI], P = 0.003), longer length of treatment (95% CI, P = 0.006), and length of hospital stay (95% CI, P = 0.014). There was no apparent relationship between NAS severity and other psychiatric disorders. In a study of pregnant women with SUD and their neonates, we uncovered a relationship between the severity of NAS and maternal history of PPD. Our findings demonstrate that further research into these deleterious outcomes is warranted. Until then, we suggest collection of maternal history of PPD and careful screening for new cases in the SUD population.
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Affiliation(s)
- Emma M Nellhaus
- Department of Family and Community Health, Joan C Edwards School of Medicine at Marshall University, Huntington, WV, United States
| | - Louis Nieuwenhuizen
- Department of Obstetrics and Gynecology, Cabell-Huntington Hospital, Huntington, WV, United States
| | - Richard Egleton
- Department of Biomedical Sciences, Joan C Edwards School of Medicine at Marshall University, Huntington, WV, United States
| | - Zachary Hansen
- Department of Family Medicine, Valley Health Systems, Huntington, WV, United States
| | - David Chaffin
- Department of Obstetrics and Gynecology, Cabell-Huntington Hospital, Huntington, WV, United States
| | - Sean Loudin
- Department of Pediatrics, Joan C Edwards School of Medicine at Marshall University, Huntington, WV, United States
| | - Todd H Davies
- Department of Family and Community Health, Joan C Edwards School of Medicine at Marshall University, Huntington, WV, United States.
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21
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Laurent H, Goodman SH, Stowe ZN, Halperin M, Khan F, Wright D, Nelson BW, Newport DJ, Ritchie JC, Monk C, Knight B. Course of ante- and postnatal depressive symptoms related to mothers' HPA axis regulation. J Abnorm Psychol 2019; 127:404-416. [PMID: 29745705 DOI: 10.1037/abn0000348] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Given high health costs of depression during pregnancy and the first postnatal year, it is important to understand mechanisms involved in the emergence and perpetuation of symptoms during this time. In a series of 2 studies, we aim to clarify bidirectional relations between mothers' physiological stress regulation-stress-related activation of the hypothalamic-pituitary-adrenal (HPA) axis-and their course of depressive symptoms. In Study 1, 230 pregnant women recruited from a women's mental health program gave 3 saliva samples in the context of psychosocial stress at 24, 30, and 36-weeks gestation. They self-reported depressive symptoms across the three trimesters of pregnancy and first year postpartum. Multilevel models revealed women with elevated salivary cortisol during pregnancy showed a course of escalating ante- and postnatal symptoms, implicating HPA hyperactivation as a precursor to worsening mood problems. In Study 2, 54 mothers from a community sample self-reported depressive symptoms at 3, 6, 12, and 18 months postnatal. At 18 months, they participated in a dyadic stress task with their infant and gave 4 saliva samples for cortisol assay. For mothers with a lifetime depression diagnosis, an escalating course of postnatal symptoms predicted a higher, flatter cortisol response profile. Together, the results of these studies suggest that for high-risk mothers, a trajectory of worsening depression may both follow from and give rise to neuroendocrine stress hyperactivation. These findings suggest greater attention is warranted to course of depressive symptoms across the ante- and postnatal period, rather than symptom levels at any given time, to characterize health risks. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - Faaiza Khan
- Department of Psychology, University of Illinois at Urbana-Champaign
| | | | | | | | - James C Ritchie
- Department of Pathology and Laboratory Medicine, Emory University
| | - Catherine Monk
- Department of Psychiatry and Obstetrics and Gynecology, Columbia University Medical Center
| | - Bettina Knight
- Department of Psychiatry, University of Arkansas for Medical Sciences
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22
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Coll CDVN, Domingues MR, Stein A, da Silva BGC, Bassani DG, Hartwig FP, da Silva ICM, da Silveira MF, da Silva SG, Bertoldi AD. Efficacy of Regular Exercise During Pregnancy on the Prevention of Postpartum Depression: The PAMELA Randomized Clinical Trial. JAMA Netw Open 2019; 2:e186861. [PMID: 30646198 PMCID: PMC6324311 DOI: 10.1001/jamanetworkopen.2018.6861] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Interventions to reduce postpartum depression have mainly focused on enhancing screening to increase treatment rates among women. Preventive approaches are timely from a population health perspective, particularly in low- and middle-income countries where access to mental health services is limited. OBJECTIVE To assess the efficacy of regular exercise during pregnancy on the prevention of postpartum depression. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial examines a prespecified secondary outcome of the Physical Activity for Mothers Enrolled in Longitudinal Analysis (PAMELA) Study, a parallel-group, randomized clinical trial. This trial was nested in the 2015 Pelotas (Brazil) Birth Cohort Study. Between August 27, 2014, and March 14, 2016, pregnant women between 16 and 20 weeks of gestation with no contraindications to exercise were randomized 1:2 to the intervention group or control group via computer-generated randomization using a block size of 9. Data were analyzed from March 7 to May 2, 2018. INTERVENTIONS Participants assigned to the intervention were engaged in a 16-week supervised exercise program including aerobic and resistance training delivered in 60-minute sessions 3 times per week. MAIN OUTCOMES AND MEASURES Postpartum depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale 3 months after birth. A score of 12 or greater was defined as screening positive for postpartum depression. Primary analysis was performed on a complete case basis (90% of participants who had the primary end point ascertained). RESULTS A total of 639 participants (mean [SD] age, 27.1 [5.1] years; mean gestational age, 16.5 [1.5] weeks) were randomly assigned to the intervention group (n = 213) or control group (n = 426). Compliance with the protocol, defined as having engaged in at least 70% of exercise sessions, was low (40.4%). There was no significant difference in mean (SD) scores for postpartum depression between the intervention group (4.8 [3.7]) and the control group (5.4 [4.1]) (mean difference, -0.6; 95% CI, -1.3 to 0.1). There was also no significant difference in rates of postpartum depression between the intervention group (12 of 192 [6.3%]) and the control group (36 of 387 [9.3%]) (odds ratio, 0.65; 95% CI, 0.33-1.28). Instrumental variable analysis indicated that noncompliance may have attenuated the effect estimates obtained in the primary analysis. CONCLUSIONS AND RELEVANCE Moderate-intensity exercise during pregnancy did not lead to significant reductions in postpartum depression. However, noncompliance to the intervention protocol was substantial and may have led to underestimations of the possible benefits of exercise. The point estimates for this study are in the same direction as the previous randomized clinical trial on this topic. Future studies on how to promote regular exercise during pregnancy to improve compliance, particularly targeting young and less educated women, are warranted before further trials are undertaken. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02148965.
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Affiliation(s)
| | - Marlos Rodrigues Domingues
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | - Diego Garcia Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fernando Pires Hartwig
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | | | | | - Shana Ginar da Silva
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Andréa Dâmaso Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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23
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Fox M, Sandman CA, Davis EP, Glynn LM. A longitudinal study of women's depression symptom profiles during and after the postpartum phase. Depress Anxiety 2018; 35:292-304. [PMID: 29394510 PMCID: PMC5889323 DOI: 10.1002/da.22719] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/22/2017] [Accepted: 12/17/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND An issue of critical importance for psychiatry and women's health is whether postpartum depression (PPD) represents a unique condition. The Diagnostic and Statistical Manual of Mental Disorders asserts that major depressive disorder (MDD) may present with peripartum onset, without suggesting any other differences between MDD and PPD. The absence of any distinct features calls into question the nosologic validity of PPD as a diagnostic category. The present study investigates whether symptom profiles differ between PPD and depression occurring outside the postpartum phase. METHODS In a prospective, longitudinal study of parturient women (N = 239), we examine the manifestation of depression symptoms. We assess factor structure of symptom profiles, and whether factors are differentially pronounced during and after the postpartum period. RESULTS Factors were revealed representing: Worry, Emotional/Circadian/Energetic Dysregulation, Somatic/Cognitive, Appetite, Distress Display, and Anger symptoms. The factor structure was validated at postpartum and after-postpartum timepoints. Interestingly, the Worry factor, comprising anxiety and guilt, was significantly more pronounced during the postpartum timepoint, and the Emotional/Circadian/Energetic Dysregulation factor, which contained sadness and anhedonia, was significantly less pronounced during the postpartum period. CONCLUSIONS These results suggest that PPD may be a unique syndrome, necessitating research, diagnosis, and treatment strategies distinct from those for MDD. Results indicate the possibility that Worry is an enhanced feature of PPD compared to depression outside the postpartum period, and the crucial role of sadness/anhedonia in MDD diagnosis may be less applicable to PPD diagnosis.
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Affiliation(s)
- Molly Fox
- Department of Anthropology, University of California Los Angeles, Los Angeles, CA 90095
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90095
| | - Curt A. Sandman
- Department of Psychiatry & Human Behavior, University of California Irvine, Orange, CA 92868
| | | | - Laura M. Glynn
- Department of Psychology, Chapman University, Orange, California 92866
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24
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Nephew BC, Febo M, Huang W, Colon-Perez LM, Payne L, Poirier GL, Greene O, King JA. Early life social stress and resting state functional connectivity in postpartum rat anterior cingulate circuits. J Affect Disord 2018; 229:213-223. [PMID: 29324369 PMCID: PMC5807174 DOI: 10.1016/j.jad.2017.12.089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/22/2017] [Accepted: 12/31/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Continued development and refinement of resting state functional connectivity (RSFC) fMRI techniques in both animal and clinical studies has enhanced our comprehension of the adverse effects of stress on psychiatric health. The objective of the current study was to assess both maternal behavior and resting state functional connectivity (RSFC) changes in these animals when they were dams caring for their own young. It was hypothesized that ECSS exposed dams would express depressed maternal care and exhibit similar (same networks), yet different specific changes in RSFC (different individual nuclei) than reported when they were adult females. METHODS We have developed an ethologically relevant transgenerational model of the role of chronic social stress (CSS) in the etiology of postpartum depression and anxiety. Initial fMRI investigation of the CSS model indicates that early life exposure to CSS (ECSS) induces long term changes in functional connectivity in adult nulliparous female F1 offspring. RESULTS ECSS in F1 dams resulted in depressed maternal care specifically during early lactation, consistent with previous CSS studies, and induced changes in functional connectivity in regions associated with sensory processing, maternal and emotional responsiveness, memory, and the reward pathway, with robust changes in anterior cingulate circuits. LIMITATIONS The sample sizes for the fMRI groups were low, limiting statistical power. CONCLUSION This behavioral and functional neuroanatomical foundation can now be used to enhance our understanding of the neural etiology of early life stress associated disorders and test preventative measures and treatments for stress related disorders.
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Affiliation(s)
- Benjamin C Nephew
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, 200 Westborough Road, North Grafton, MA 01536, USA.
| | - Marcelo Febo
- Department of Psychiatry, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Wei Huang
- Center for Comparative NeuroImaging, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Luis M Colon-Perez
- Department of Psychiatry, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Laurellee Payne
- Center for Comparative NeuroImaging, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Guillaume L Poirier
- Center for Comparative NeuroImaging, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Owen Greene
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, 200 Westborough Road, North Grafton, MA 01536, USA
| | - Jean A King
- Center for Comparative NeuroImaging, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA
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Caparros-Gonzalez RA, Romero-Gonzalez B, Strivens-Vilchez H, Gonzalez-Perez R, Martinez-Augustin O, Peralta-Ramirez MI. Hair cortisol levels, psychological stress and psychopathological symptoms as predictors of postpartum depression. PLoS One 2017; 12:e0182817. [PMID: 28846691 PMCID: PMC5573300 DOI: 10.1371/journal.pone.0182817] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/25/2017] [Indexed: 02/04/2023] Open
Abstract
Postpartum depression affects a huge number of women and has detrimental consequences. Knowing the factors associated with postpartum depression during pregnancy can help its prevention. Although there is evidence surrounding behavioral or psychological predictors of postpartum depression, there is a lack of evidence of biological forecasters. The aim of this study was to analyze the sociodemographic, obstetric, and psychological variables along with hair cortisol levels during the first, second, and third trimesters of pregnancy that could predict postpartum depression symptoms. A sample of 44 pregnant women was assessed during 3 trimesters of pregnancy and the postpartum period using psychological questionnaires and hair cortisol levels. Participants were divided into 2 groups: a group with postpartum depression symptoms and a group with no postpartum depression symptoms. Results showed significant positive differences between groups in the first trimester regarding the Somatization subscale of the SCL-90-R (p < .05). In the second trimester, significant differences were found in the Somatization, Depression, Anxiety, and GSI subscales (p < .05). In the third trimester significant differences between both groups were found regarding pregnancy-specific stress. We found significant positive differences between groups regarding hair cortisol levels in the first and the third trimester. Hair cortisol levels could predict 21.7% of the variance of postpartum depression symptoms. In conclusion, our study provided evidence that psychopathological symptoms, pregnancy-specific stress, and hair cortisol levels can predict postpartum depression symptoms at different time-points during pregnancy. These findings can be applied in future studies and improve maternal care in clinical settings.
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Affiliation(s)
- Rafael A. Caparros-Gonzalez
- Brain, Mind and Behavior Research Center (CIMCYC), Faculty of Psychology, University of Granada. Granada. Spain
- Gynecology and Obstetrics Department, Hospital de Poniente, El Ejido, Spain
- * E-mail: (RACG); (BRG); (RGP)
| | - Borja Romero-Gonzalez
- Brain, Mind and Behavior Research Center (CIMCYC), Faculty of Psychology, University of Granada. Granada. Spain
- * E-mail: (RACG); (BRG); (RGP)
| | | | - Raquel Gonzalez-Perez
- Department of Pharmacology, CIBERehd, School of Pharmacy, Instituto de Investigación Biosanitaria ibs.GRANADA, University of Granada, Granada, Spain
- * E-mail: (RACG); (BRG); (RGP)
| | - Olga Martinez-Augustin
- Department of Biochemistry and Molecular Biology II, CIBERehd, School of Pharmacy, Instituto de Investigación Biosanitaria ibs.GRANADA, University of Granada, Granada, Spain
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Abstract
Premenstrual syndrome (PMS) and related disorders, and postpartum depression (PPD) can affect women to the extent that their quality of life and that of their near ones can be severely impaired. This review focuses on the different theories regarding the etiologies of PMS and PPD, and attempts to draw a link between the two. Theories focus mainly on hormonal and cytokine factors throughout different phases in the female reproductive cycle. Changes in this symptomatology during pregnancy are also reviewed, as are changes in hormones and cytokine levels. Hypotheses are thus developed as to why the symptoms experienced in PMS often subside during pregnancy yet may recur and be exacerbated after birth, giving rise to the symptoms experienced in PPD.
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Affiliation(s)
- Rebecca Stoner
- a Department of Anatomy , Faculty of Medicine and Surgery, University of Malta , Msida , Malta
| | - Victoria Camilleri
- a Department of Anatomy , Faculty of Medicine and Surgery, University of Malta , Msida , Malta
| | - Jean Calleja-Agius
- a Department of Anatomy , Faculty of Medicine and Surgery, University of Malta , Msida , Malta
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Ferguson EH, Di Florio A, Pearson B, Putnam KT, Girdler S, Rubinow DR, Meltzer-Brody S. HPA axis reactivity to pharmacologic and psychological stressors in euthymic women with histories of postpartum versus major depression. Arch Womens Ment Health 2017; 20:411-420. [PMID: 28251369 PMCID: PMC5441453 DOI: 10.1007/s00737-017-0716-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/10/2017] [Indexed: 12/29/2022]
Abstract
It is unclear whether women with a history of postpartum depression (PPD) have residual, abnormal hypothalamic-pituitary-adrenal (HPA) axis reactivity, as has been reported in major depression (MDD). Further unclear is whether the abnormalities in HPA axis reactivity associated with MDD represent a stable, underlying predisposition or a state-dependent phenomenon. This study sought the following: (1) to determine if euthymic postpartum women with a history of depression have an abnormal HPA axis reactivity to pharmacologic and psychological challenges and (2) to compare HPA reactivity in women with histories of PPD versus MDD. As a secondary objective, we wanted to determine the influence of trauma history on HPA axis function. Forty-five parous (12-24 months postpartum), euthymic women with history of MDD (n = 15), PPD (n = 15), and controls (n = 15) completed pharmacologic (dexamethasone/corticotropin-releasing hormone (CRH) test [DEX/CRH]) and psychological (Trier social stress test [TSST]) challenges during the luteal phase. Outcome measures were cortisol and adrenocorticotropic hormone (ACTH) response after DEX/CRH, and blood pressure, heart rate, epinephrine, norepinephrine, and cortisol response during the TSST. All groups had robust cortisol and ACTH response to DEX/CRH and cortisol response to TSST. Groups did not differ significantly in cortisol or ACTH response to DEX/CRH or in blood pressure, heart rate, epinephrine, norepinephrine, or cortisol response to TSST. Cortisol/ACTH ratio did not differ significantly between groups. Trauma history was associated with decreased cortisol response to DEX/CRH in women with histories of MDD, which was not significant after correction (F 8,125, p = 0.02, Greenhouse-Geisser corrected p = 0.11). Currently euthymic women with histories of MDD or PPD did not demonstrate residual abnormal stress responsivity following administration of either a pharmacologic or psychological stressor.
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Affiliation(s)
- Elizabeth H Ferguson
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA.
| | - Arianna Di Florio
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Brenda Pearson
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
| | - Karen T Putnam
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
| | - Susan Girdler
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, CB#7160, Chapel Hill, NC, 27599-7160, USA
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Avraham Y, Hants Y, Vorobeiv L, Staum M, Abu Ahmad W, Mankuta D, Galun E, Arbel-Alon S. Brain neurotransmitters in an animal model with postpartum depressive-like behavior. Behav Brain Res 2017; 326:307-321. [PMID: 28300619 DOI: 10.1016/j.bbr.2017.01.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 02/01/2023]
Abstract
Post-Partum Depression (PPD) occurs in 15% of pregnancies and its patho-physiology is not known. We studied female BALB/c ("depressive") and C57BL/6 (control) mice as a model for PPD and assessed their behavior and correlates with brain neurotransmitters (NTs) - norepinephrine, dopamine, serotonin and intermediates, during the pre-pregnancy (PREP), pregnancy (PREG) and post-partum (PP) periods. Depressive-like behavior was evaluated by the Open Field (OFT), Tail Suspension (TST) and Forced Swim (FST) tests. Neurotransmitters (NTs) were determined in the striatum (care-giving), hippocampus (cognitive function) and hypothalamus (maternal care & eating behavior). In the BALB/c mice, while their performance in all behavioral tests was significantly reduced during pregnancy and P-P indicative of the development of depressive-like responses, no changes were observed in the C57BL/6 mice. Changes in NTs in BALB/C were as follows: PREP, all NTs in the three brain areas were decreased, although an increase in dopamine release was observed in the hippocampus. PREG: No changes were observed in the NTs except for a decrease in 5-HT in the striatum. P-P: striatum, low 5-HT, NE and dopamine; Hippocampus: low 5-HT, NE and high Dopamine; hypothalamus: all NTs increased, especially NE. Following pregnancy and delivery, the BALB/c mice developed depressive-like behavior associated with a significant decrease in 5-HT, dopamine and NE in the striatum and 5-HT and NE in the hippocampus. Dopamine increased in the latter together with a significant increase in all NTs in the hypothalamus. These findings suggest that the development of PPD may be associated with NT changes. Normalization of these alterations may have a role in the treatment of PPD.
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Affiliation(s)
- Y Avraham
- Department of Metabolism and Human Nutrition, Braun School of Public Health, Hadassah-Hebrew University Medical School, Jerusalem, Israel.
| | - Y Hants
- Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - L Vorobeiv
- Department of Metabolism and Human Nutrition, Braun School of Public Health, Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - M Staum
- Department of Metabolism and Human Nutrition, Braun School of Public Health, Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Wiessam Abu Ahmad
- Department of Metabolism and Human Nutrition, Braun School of Public Health, Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - D Mankuta
- Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - E Galun
- Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - S Arbel-Alon
- Hadassah Hebrew University Hospital, Jerusalem, Israel
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Yin H, Xia A, Lei J. [Progress in study on the correlation of polyunsaturated fatty acids, vitamin D and homocysteine with
postpartum depression]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2016; 41:1096-1100. [PMID: 27807334 DOI: 10.11817/j.issn.1672-7347.2016.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Postpartum depression(PPD) is a common emotional disorder in the puerperium, which has negative impact on women, infants and family. There is growing evidence that abnormal concentration of a number of nutrients (including polyunsaturated fatty acids, vitamin D and homocysteine) is associated with depression in postpartum population. Further studies on the mechanisms for the functions of nutrients and regulation of nutritional states in the puerperium will be of great value in the prevention, early diagnosis and treatment of PPD.
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Affiliation(s)
- Hang Yin
- Xiangya Nursing School, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Aibin Xia
- Department of Obstetrics, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Jun Lei
- Xiangya Nursing School; Department of Obstetrics, Third Xiangya Hospital, Central South University, Changsha 410013, China
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30
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Abstract
Excessive gestational weight gain and postpartum weight retention are implicated in future morbidity in women. To understand whether psychosocial stressors contribute to weight retention, we used data collected in a cohort of postpartum women and analyzed measures of stress, depression, social support, and health-related quality of life. Depressive symptoms at delivery and worse health-related quality of life and lower stress at 3 months postpartum were associated with 3-month weight retention. Interventions targeting depression and improving quality of life may further reduce weight retained.
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Affiliation(s)
- Neal D Goldstein
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA
| | - Stephanie Rogers
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA
| | - Deborah B Ehrenthal
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA.
- Value Institute, Christiana Care Health System, Newark, DE, USA.
- Department of Obstetrics and Gynecology and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 1010 Mound Street, McConnell Hall 4th floor, Madison, WI, USA.
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31
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Soe NN, Wen DJ, Poh JS, Li Y, Broekman BFP, Chen H, Chong YS, Kwek K, Saw SM, Gluckman PD, Meaney MJ, Rifkin-Graboi A, Qiu A. Pre- and Post-Natal Maternal Depressive Symptoms in Relation with Infant Frontal Function, Connectivity, and Behaviors. PLoS One 2016; 11:e0152991. [PMID: 27073881 PMCID: PMC4830615 DOI: 10.1371/journal.pone.0152991] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/22/2016] [Indexed: 11/19/2022] Open
Abstract
This study investigated the relationships between pre- and early post-natal maternal depression and their changes with frontal electroencephalogram (EEG) activity and functional connectivity in 6- and 18-month olds, as well as externalizing and internalizing behaviors in 24-month olds (n = 258). Neither prenatal nor postnatal maternal depressive symptoms independently predicted neither the frontal EEG activity nor functional connectivity in 6- and 18-month infants. However, increasing maternal depressive symptoms from the prenatal to postnatal period predicted greater right frontal activity and relative right frontal asymmetry amongst 6-month infants but these finding were not observed amongst 18-month infants after adjusted for post-conceptual age on the EEG visit day. Subsequently increasing maternal depressive symptoms from the prenatal to postnatal period predicted lower right frontal connectivity within 18-month infants but not among 6-month infants after controlling for post-conceptual age on the EEG visit day. These findings were observed in the full sample and the female sample but not in the male sample. Moreover, both prenatal and early postnatal maternal depressive symptoms independently predicted children's externalizing and internalizing behaviors at 24 months of age. This suggests that the altered frontal functional connectivity in infants born to mothers whose depressive symptomatology increases in the early postnatal period compared to that during pregnancy may reflect a neural basis for the familial transmission of phenotypes associated with mood disorders, particularly in girls.
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Affiliation(s)
- Ni Ni Soe
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Daniel J. Wen
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Joann S. Poh
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore, Singapore
| | - Yue Li
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Birit F. P. Broekman
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Helen Chen
- KK Women’s and Children’s Hospital and Duke-National University of Singapore, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore, Singapore
- Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kenneth Kwek
- KK Women’s and Children’s Hospital and Duke-National University of Singapore, Singapore, Singapore
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Peter D. Gluckman
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore, Singapore
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Michael J. Meaney
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore, Singapore
- Douglas Mental Health University Institute, McGill University, Montréal, Canada
| | - Anne Rifkin-Graboi
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore, Singapore
| | - Anqi Qiu
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
- Clinical Imaging Research Centre, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore, Singapore
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de Rezende MG, Garcia-Leal C, de Figueiredo FP, Cavalli RDC, Spanghero MS, Barbieri MA, Bettiol H, de Castro M, Del-Ben CM. Altered functioning of the HPA axis in depressed postpartum women. J Affect Disord 2016; 193:249-56. [PMID: 26773916 DOI: 10.1016/j.jad.2015.12.065] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/18/2015] [Accepted: 12/26/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The present study aimed to evaluate the relationship between the functioning of the hypothalamic-pituitary-adrenal (HPA) axis and major depressive episodes in the remote postpartum period. METHODS The sample (mean age, 28.0±5.3 years) consisted of 37 depressed postpartum women (DPP), 42 euthymic postpartum women (EPP) and 25 non-postpartum healthy women (HC). Salivary cortisol samples were collected immediately after awakening and 30min, 3 and 12h later, at approximately the sixth month postpartum (mean, 169.6±60.3 days). RESULTS Differences in cortisol levels were observed at awakening (DPP<EPP=HC), at 30min (DPP<EPP<HC), at 3h (DPP=EPP<HC) and at 12h (DPP>EPP=HC). The relative increment in the cortisol awakening response (CARi%) was significantly higher in HC (113.5±94.3) than in EPP (63.1±69.8) and DPP (32.2±49.6). The relative reduction in diurnal variation (DVr%) was lower in DPP (56.5±41.8) than in EPP (75.6±22.4) and HC (75.1±13.0). LIMITATIONS The main limitation was cortisol collection on a single day and without measurement at midnight. CONCLUSIONS Our findings suggest that the remote postpartum period involves attenuation of HPA axis reactivity; this dysregulation is more pronounced in the presence of DPP, which is associated with a reduction in cortisol diurnal variation. Abnormalities in the neuroendocrine system related to stress processing, present even several months after delivery, can represent vulnerability to mental disorders. Thus, improvements in the mental health care of postpartum women are needed.
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Affiliation(s)
- Marcos Gonçalves de Rezende
- Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
| | - Cybele Garcia-Leal
- Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Marco Antonio Barbieri
- Puericulture and Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Heloisa Bettiol
- Puericulture and Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Margaret de Castro
- Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Departments of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Haim A, Albin-Brooks C, Sherer M, Mills E, Leuner B. The effects of gestational stress and Selective Serotonin reuptake inhibitor antidepressant treatment on structural plasticity in the postpartum brain--A translational model for postpartum depression. Horm Behav 2016; 77:124-31. [PMID: 25997412 PMCID: PMC4651861 DOI: 10.1016/j.yhbeh.2015.05.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/30/2015] [Accepted: 05/11/2015] [Indexed: 12/12/2022]
Abstract
This article is part of a Special Issue "Parental Care". Postpartum depression (PPD) is a common complication following childbirth experienced by one in every five new mothers. Although the neural basis of PPD remains unknown, previous research in rats has shown that gestational stress, a risk factor for PPD, induces depressive-like behavior during the postpartum period. Moreover, the effect of gestational stress on postpartum mood is accompanied by structural modifications within the nucleus accumbens (NAc) and the medial prefrontal cortex (mPFC)-limbic regions that have been linked to PPD. Mothers diagnosed with PPD are often prescribed selective serotonin reuptake inhibitor (SSRI) antidepressant medications and yet little is known about their effects in models of PPD. Thus, here we investigated whether postpartum administration of Citalopram, an SSRI commonly used to treat PPD, would ameliorate the behavioral and morphological consequences of gestational stress. In addition, we examined the effects of gestational stress and postpartum administration of Citalopram on structural plasticity within the basolateral amygdala (BLA) which together with the mPFC and NAc forms a circuit that is sensitive to stress and is involved in mood regulation. Our results show that postpartum rats treated with Citalopram do not exhibit gestational stress-induced depressive-like behavior in the forced swim test. In addition, Citalopram was effective in reversing gestational stress-induced structural alterations in the postpartum NAc shell and mPFC. We also found that gestational stress increased spine density within the postpartum BLA, an effect which was not reversed by Citalopram treatment. Overall, these data highlight the usefulness of gestational stress as a valid and informative translational model for PPD. Furthermore, they suggest that structural alterations in the mPFC-NAc pathway may underlie stress-induced depressive-like behavior during the postpartum period and provide much needed information on how SSRIs may act in the maternal brain to treat PPD.
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Affiliation(s)
- Achikam Haim
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | | | - Morgan Sherer
- Department of Psychology, The Ohio State University, Columbus, OH 43210, USA
| | - Emily Mills
- Department of Psychology, The Ohio State University, Columbus, OH 43210, USA
| | - Benedetta Leuner
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Department of Psychology, The Ohio State University, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University, Columbus, OH 43210, USA.
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Abstract
The nosology of postpartum depression (PPD) is controversial. We review the evidence and arguments for and against the recognition of PPD as a distinct disorder and discuss the etiopathogenic and diagnostic validity of PPD as a distinct disorder, including its utility and indications for further research. Although multiple epidemiological and clinical studies have found that depression is more common following childbirth than at other times in a woman's life, there is conflicting evidence for the validity of PPD as a distinct disorder. PPD is likely to be a complex phenotype, encompassing several disorders with different disease pathways. It is plausible that for a sub-group of vulnerable women, childbirth triggers episodes of depression. However, even within this group, the mechanisms underpinning the mood disturbances are likely complex and heterogeneous. The distinction between depression occurring in the perinatal period and depression at other times is important for both research and clinical practice. Research should differentiate between episodes that begin during pregnancy and postpartum, as the pathogenetic factors involved may differ and require specialized treatment.
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Affiliation(s)
- Arianna Di Florio
- Department of Psychiatry, University of North Carolina at Chapel Hill, Campus Box #7160, Chapel Hill, NC, 27599, USA,
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35
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Shivalli S, Gururaj N. Postnatal depression among rural women in South India: do socio-demographic, obstetric and pregnancy outcome have a role to play? PLoS One 2015; 10:e0122079. [PMID: 25848761 PMCID: PMC4388688 DOI: 10.1371/journal.pone.0122079] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/24/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Postnatal depression (PND) is one of the most common psychopathology and is considered as a serious public health issue because of its devastating effects on mother, family, and infant or the child. OBJECTIVE To elicit socio-demographic, obstetric and pregnancy outcome predictors of Postnatal Depression (PND) among rural postnatal women in Karnataka state, India. DESIGN Hospital based analytical cross sectional study. SETTING A rural tertiary care hospital of Mandya District, Karnataka state, India. SAMPLE PND prevalence based estimated sample of 102 women who came for postnatal follow up from 4th to 10th week of lactation. METHOD Study participants were interviewed using validated kannada version of Edinburgh Postnatal Depression Scale (EPDS). Cut-off score of ≥ 13 was used as high risk of PND. The percentage of women at risk of PND was estimated, and differences according to socio-demographic, obstetric and pregnancy outcome were described. Logistic regression was applied to identify the independent predictors of PND risk. MAIN OUTCOME MEASURES Prevalence, Odds ratio (OR) and adjusted (adj) OR of PND. RESULTS Prevalence of PND was 31.4% (95% CI 22.7-41.4%). PND showed significant (P < 0.05) association with joint family, working women, non-farmer husbands, poverty, female baby and pregnancy complications or known medical illness. In binomial logistic regression poverty (adjOR: 11.95, 95% CI:1.36-105), birth of female baby (adjOR: 3.6, 95% CI:1.26-10.23) and pregnancy complications or known medical illness (adjOR: 17.4, 95% CI:2.5-121.2) remained as independent predictors of PND. CONCLUSION Risk of PND among rural postnatal women was high (31.4%). Birth of female baby, poverty and complications in pregnancy or known medical illness could predict the high risk of PND. PND screening should be an integral part of postnatal care. Capacity building of grass root level workers and feasibility trials for screening PND by them are needed.
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Affiliation(s)
- Siddharudha Shivalli
- Department of Community Medicine, Yenepoya Medical College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India
- * E-mail:
| | - Nandihal Gururaj
- Department of Community Medicine, Yenepoya Medical College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India
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Glynn LM, Davis EP, Sandman CA. New insights into the role of perinatal HPA-axis dysregulation in postpartum depression. Neuropeptides 2013; 47:363-70. [PMID: 24210135 DOI: 10.1016/j.npep.2013.10.007] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 10/26/2022]
Abstract
Postpartum depression affects 10-20% of women following birth and exerts persisting adverse consequences on both mother and child. An incomplete understanding of its etiology constitutes a barrier to early identification and treatment. It is likely that prenatal hormone trajectories represent both markers of risk and also causal factors in the development of postpartum depression. During pregnancy the maternal hypothalamic-pituitary-adrenal axis undergoes dramatic alterations, due in large part, to the introduction of the placenta, a transient endocrine organ of fetal origin. We suggest that prenatal placental and hypothalamic-pituitary-adrenal axis dysregulation is predictive of risk for postpartum depression. In this model the positive feedback loop involving the systems regulating the products of the HPA axis results in higher prenatal levels of cortisol and placental corticotropin-releasing hormone. Greater elevations in placental corticotropin-releasing hormone are related to a disturbance in the sensitivity of the anterior pituitary to cortisol and also perhaps to decreased central corticotropin-releasing hormone secretion. Secondary or tertiary adrenal insufficiencies of a more extreme nature, which emerge during the prenatal period, may be predictive of an extended or more pronounced postpartum hypothalamic-pituitary-adrenal refractory period, which in turn represents a risk factor for development of postpartum depression. In addition to reviewing the relevant existing literature, new data are presented in support of this model which link elevated placental corticotropin-releasing hormone with low levels of ACTH at 3-months postpartum. Future research will further elucidate the role of hypothalamic-pituitary-adrenal axis dysregulation in postpartum depression and also whether prenatal placental and hypothalamic-pituitary-adrenal profiles might prove useful in the early identification of mothers at risk for postpartum mood dysregulation.
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Affiliation(s)
- Laura M Glynn
- Crean School of Health and Life Sciences, Chapman University, United States; Department of Psychiatry and Human Behavior, University of California, Irvine, United States.
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Lombardo C. [After the birth, everything is not always rosy!]. Krankenpfl Soins Infirm 2013; 106:65-67. [PMID: 24479228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Hayakawa N, Koide T, Okada T, Murase S, Aleksic B, Furumura K, Shiino T, Nakamura Y, Tamaji A, Ishikawa N, Ohoka H, Usui H, Banno N, Morita T, Goto S, Kanai A, Masuda T, Ozaki N. The postpartum depressive state in relation to perceived rearing: a prospective cohort study. PLoS One 2012. [PMID: 23185582 PMCID: PMC3503974 DOI: 10.1371/journal.pone.0050220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The relationship between perceived rearing and the postpartum depressive state remains unclear. We aimed to examine whether perceived rearing is a risk factor for postpartum depression as measured by the Edinburgh Postnatal Depression Scale (EPDS), and whether the score of perceived rearing is affected by depressive mood (the state dependency of perceived rearing). Methods Pregnant women (n = 448, mean age 31.8±4.2 years) completed the EPDS as a measure of depressive state in early pregnancy (T1), late pregnancy (around 36 weeks), and at 1 month postpartum (T2), and the Parental Bonding Instrument (PBI) at T1 as a measure of perceived rearing. Changes in the EPDS and the PBI scores from T1 to T2 were compared between the non depressive (ND) group and the postpartum depressive (PD) group. Results There were no significant differences in any PBI category for perceived rearing between the ND and PD groups at T1. EPDS scores did not change significantly from T1 to T2 in the ND group but increased significantly in the PD group. The PBI maternal care score increased significantly in the ND group (p<0.01), while decreasing in the PD group (p<0.05). Additionally, in both the ND and PD groups, significant negative correlation was observed regarding change in the EPDS and PBI maternal care scores from T1 to T2 (r = −0.28, p = 0.013). Conclusions The present study suggests that perceived rearing is not a strong risk factor for postpartum depression as measured by the EPDS. Furthermore, the results indicated the state dependency of the PBI maternal care score.
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Affiliation(s)
- Norika Hayakawa
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Faculty of Policy Studies, Nanzan University, Seto, Japan
| | - Takayoshi Koide
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Okada
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
- * E-mail:
| | | | - Branko Aleksic
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kaori Furumura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Shiino
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukako Nakamura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ai Tamaji
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoko Ishikawa
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Harue Ohoka
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hinako Usui
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naomi Banno
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tokiko Morita
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Atsuko Kanai
- Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan
| | - Tomoko Masuda
- Graduate School of Law, Nagoya University, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Kaplan PS, Danko CM, Kalinka CJ, Cejka AM. A developmental decline in the learning-promoting effects of infant-directed speech for infants of mothers with chronically elevated symptoms of depression. Infant Behav Dev 2012; 35:369-79. [PMID: 22721737 PMCID: PMC3914005 DOI: 10.1016/j.infbeh.2012.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 01/11/2012] [Accepted: 02/28/2012] [Indexed: 11/30/2022]
Abstract
Infants of mothers who varied in symptoms of depression were tested at 4 and 12 months of age for their ability to associate a segment of an unfamiliar non-depressed mother's infant-directed speech (IDS) with a face. At 4 months, all infants learned the voice-face association. At 12 months, despite the fact that none of the mothers were still clinically depressed, infants of mothers with chronically elevated self-reported depressive symptoms, and infants of mothers with elevated self-reported depressive symptoms at 4 months but not 12 months, on average did not learn the association. For infants of mothers diagnosed with depression in remission, learning at 12 months was negatively correlated with the postpartum duration of the mother's depressive episode. At neither age did extent of pitch modulation in the IDS segments correlate with infant learning. However, learning scores at 12 months correlated significantly with concurrent maternal reports of infant receptive language development. The roles of the duration and timing of maternal depressive symptoms are discussed.
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Affiliation(s)
- Peter S Kaplan
- Department of Psychology, University of Colorado Denver, United States.
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Tanaeva KK, Dobriakova IV, Dubynin VA, Kamenskiĭ AA. [Selective D1-receptor antagonist SCH23390 decreases maternal reactions in rats upon acute and chronic injections in postpartum period]. Eksp Klin Farmakol 2012; 75:3-6. [PMID: 23012987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The influence of the D1-receptor antagonist SCH23390 on the maternal behavior of female rats has been studied. It is established that a comparatively high dose of the drug (acute injections) significantly decreases both the locomotor activity and manifestations of the parental care. Lower dosages do not affect the locomotor activity, but still suppress the maternal behavior (after both acute and chronic injections of SCH23390). The obtained results are discussed in terms of the analysis of the maternal motivation mechanisms and the development of the D1-induced postpartum depression.
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Affiliation(s)
- Heidi Neale
- University Hospitals Coventry and Warwickshire NHS Trust
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O'Keane V, Lightman S, Patrick K, Marsh M, Papadopoulos AS, Pawlby S, Seneviratne G, Taylor A, Moore R. Changes in the maternal hypothalamic-pituitary-adrenal axis during the early puerperium may be related to the postpartum 'blues'. J Neuroendocrinol 2011; 23:1149-55. [PMID: 22004568 DOI: 10.1111/j.1365-2826.2011.02139.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Most women experience time-limited and specific mood changes in the days after birth known as the maternity blues (Blues). The maternal hypothalamic-pituitary-adrenal (HPA) axis undergoes gradual changes during pregnancy because of an increasing production of placental corticotrophin-releasing hormone (CRH). The abrupt withdrawal of placental CRH at birth results in a re-equilibration of the maternal HPA axis in the days post-delivery. These changes may be involved in the aetiology of the Blues given the central role of the HPA axis in the aetiology of mood disorders in general, and in perinatal depression in particular. We aimed to test the novel hypothesis that the experience of the Blues may be related to increased secretion of hypothalamic adrenocorticotrophic hormone (ACTH) secretagogue peptides, after the reduction in negative-feedback inhibition on the maternal hypothalamus caused by withdrawal of placental CRH. We therefore examined hormonal changes in the HPA axis in the days after delivery in relation to daily mood changes: our specific prediction was that mood changes would parallel ACTH levels, reflecting increased hypothalamic peptide secretion. Blood concentrations of CRH, ACTH, cortisol, progesterone and oestriol were measured in 70 healthy women during the third trimester of pregnancy, and on days 1-6 post-delivery. Blues scores were evaluated during the postpartum days. Oestriol, progesterone and CRH levels fell rapidly from pregnancy up to day 6, whereas cortisol levels fell modestly. ACTH concentrations declined from pregnancy to day 3 post-delivery and thereafter increased up to day 6. Blues scores increased, peaking on day 5, and were positively correlated with ACTH; and negatively correlated with oestriol levels during the postpartum days, and with the reduction in CRH concentrations from pregnancy. These findings give indirect support to the hypothesis that the 'reactivation' of hypothalamic ACTH secretagogue peptides may be involved in the aetiology of the Blues.
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Affiliation(s)
- V O'Keane
- Trinity Health Sciences Building, Tallaght Hospital (AMNCH), Dublin, Ireland.
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Cochereau A. [Breastfeeding, a factor in preventing postpartum depression]. Soins Pediatr Pueric 2011:7. [PMID: 21702197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
MESH Headings
- Breast Feeding/psychology
- Cytokines/blood
- Depression, Postpartum/nursing
- Depression, Postpartum/physiopathology
- Depression, Postpartum/prevention & control
- Depressive Disorder, Major/nursing
- Depressive Disorder, Major/physiopathology
- Depressive Disorder, Major/prevention & control
- Female
- Humans
- Hypothalamo-Hypophyseal System/physiopathology
- Infant
- Infant, Newborn
- Risk Factors
- Stress, Psychological/complications
- Stress, Psychological/nursing
- Stress, Psychological/physiopathology
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Abstract
In this article, we apply a relational lens to a grounded theory meta-data-analysis of qualitative studies on postpartum depression (PPD) conducted between 1999 and 2005. Women in all studies report feeling that they have failed to live up to cultural standards for a "good mother." Central to this experience is a sense that these negative feelings could not be spoken. The analysis shows how constructions of motherhood and the reactions of others combine with feelings of incompetence to precipitate isolation from others. Women survive depression through support that validates their experience and promotes eventual reconnection with others. Conclusions emphasize the need for persons trained to facilitate relational connection to develop interventions that address the interpersonal contexts of PPD.
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Affiliation(s)
- Carmen Knudson-Martin
- Departmentof Counseling and Family Sciences, Loma Linda University, Loma Linda, California 92350, USA.
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Complojer M, Schweigkofler H, Schwitzer J, Scherer A, Schwitzer GO, Schiefenhövel W. [The preconditions of postpartum dysphoria]. Neuropsychiatr 2009; 23:35-41. [PMID: 19272290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Postpartum dysphoria (Baby Blues) is a puerperal-disease of mothers who have recently given birth; its prevalence in western industrialized countries ranges from 26 to 85% The baby-blues may begin during the first week after birth, lasts a few days and disappears without any medical treatment. Therefore there is still little research dealing with this phenomenon. The present study was carried out in Brixen, Italy, in the framework of the international Munich-Postpartum-Project and was done by means of a questionnaire. It showed that these women who had to face an insecure social environment after hospital discharge, had symptoms of a dysphoria. For that reason the Blues seems to be a phenomenon of socially distressed women.
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Affiliation(s)
- Mirjam Complojer
- Psychiatrischer Dienst des Krankenhauses, Brixen- Psychosomatische Ambulanz.
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Deckert GH. Depression and Oklahoma's poor health status: a connection? J Okla State Med Assoc 2008; 101:305-306. [PMID: 19177991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
There is clearly a connection between depression and cardiovascular disease, and suicide, obesity, and diabetes. Maternal depression has a considerable impact on both the mother and the child. A brief review of scientific findings in this regard leads to two conclusions. First, the high incidence of depression in Oklahoma contributes to its poor health status. Second, our physicians can make a difference by increased attention to the possibility of depression in their patients regardless of specialty.
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Abstract
Postpartum depression (PPD) is a potentially debilitating disorder that develops in a significant percentage of women during the first year after giving birth. Women afflicted with PPD experience long-term consequences, including sadness, guilt, and despair. Offspring may be affected as well. Several investigators have tested psychosocial risk factors for the development of PPD; however, substantial amounts of variance in PPD have gone unexplained with regression on psychosocial variables alone. Likewise, interventions for PPD that have focused on psychosocial risk factors alone have been largely unsuccessful. The unexplained variance and disappointing treatment success could well be due to investigators' failure to address relevant biological changes occurring during the postpartum period. Two biological systems that are affected significantly and remain in flux during the postpartum period are the innate immune system and the hypothalamic-pituitary-adrenal (HPA) axis. Bidirectional interactions between these two systems are well established, and it is generally acknowledged that dysfunction in either system can lead to depression in nonpregnant, nonpostpartum populations. To date, little research has pursued the contribution of these interacting systems to the development of PPD. The purpose of this paper is to review the psychoneuroimmunology of PPD. The central hypothesis presented is that dysregulation in either system individually or in their bidirectional interaction is associated with the development of PPD.
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Herring SJ, Rich-Edwards JW, Oken E, Rifas-Shiman SL, Kleinman KP, Gillman MW. Association of postpartum depression with weight retention 1 year after childbirth. Obesity (Silver Spring) 2008; 16:1296-301. [PMID: 18369338 PMCID: PMC2761642 DOI: 10.1038/oby.2008.71] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the extent to which early postpartum depression is associated with weight retention 1 year after childbirth. METHODS AND PROCEDURES In a prospective cohort study of 850 women enrolled in Project Viva, mothers reported depressive symptoms on the Edinburgh Postnatal Depression Scale (EPDS) at midpregnancy and 6 months postpartum. A score >12 indicated probable depression. We assessed associations of antenatal and postpartum depression with risk of substantial weight retention (at least 5 kg) 1 year after childbirth. RESULTS Seven-hundred thirty-six women (87%) were not depressed during or after pregnancy, 55 (6%) experienced antenatal depression only, 22 (3%) experienced both antenatal and postpartum depression, and 37 (4%) experienced postpartum depression only. At 1 year, participants retained a mean of 0.6 kg (range -16.4 to 25.5), and 12% retained at least 5 kg. In multivariate logistic regression analyses, after adjustment for weight-related covariates, maternal sociodemographics, and parity, new-onset postpartum depression was associated with more than a doubling of risk of retaining at least 5 kg (odds ratio (OR): 2.54, 95% confidence interval (CI): 1.06, 6.09). Antenatal depression, either alone or in combination with postpartum depression, was not associated with substantial weight retention. DISCUSSION New-onset postpartum depression was associated with substantial weight retention in the first postpartum year. Interventions to manage depressive symptoms may help reduce excess weight retained postpartum and aid in the prevention of obesity among women.
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Affiliation(s)
- Sharon J Herring
- Obesity Prevention Program, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim HealthCare, Boston, Massachusetts, USA.
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Grote NK, Bledsoe SE. Predicting postpartum depressive symptoms in new mothers: the role of optimism and stress frequency during pregnancy. Health Soc Work 2007; 32:107-18. [PMID: 17571644 DOI: 10.1093/hsw/32.2.107] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
During the transition to motherhood, women typically show favorable psychological adjustment after the first child is born, whereas 10 percent to 26 percent of women are at risk of developing clinically significant postpartum depressive symptoms. Little is known about which individuals are especially protected against the emergence of postpartum depressive symptoms during this time. Using a "risk and resilience" theoretical framework, we expected that optimism during pregnancy would be associated with less postpartum depression severity, controlling for antenatal depressive symptoms. We also predicted that optimism would buffer the relations between four dimensions of stress frequency during pregnancy (financial, spousal, physical, and occupational) and the development of postpartum depressive symptoms. Using data from three panels of a longitudinal study of married couples across the transition to first parenthood, we found that optimism of expectant mothers during pregnancy was associated with decreased depression severity at six months and 12 months postpartum. The data also showed that when women experienced high frequencies of financial, spousal, and physical stress during pregnancy, those who were optimistic were much less at risk of developing clinically significant depressive symptoms at six months and 12 months postpartum compared with those who were pessimistic. Implications for enhancing optimism across the transition to motherhood through culturally relevant social work practice are discussed.
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Affiliation(s)
- Nancy K Grote
- School of Social Work, University of Pittsburgh, PA 15260, USA.
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