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Journal of Affective Disorders Dec 2023Postpartum depression (PPD), the depressive episodes following delivery, is a serious and frequent psychiatric disorder. While numerous screening tools existed for...
BACKGROUND
Postpartum depression (PPD), the depressive episodes following delivery, is a serious and frequent psychiatric disorder. While numerous screening tools existed for depressive episodes, e.g., the Edinburgh Postnatal Depression Scale (EPDS), there are no objective biological measures for predicting PPD. Despite several studies done to identify biomarkers in PPD, there has been limited exploration into cerebrospinal fluid (CSF) which directly interfaces with the brain. Consequently, novel potential biomarkers of CSF are required to predict PPD, so as to target specific preventive interventions.
METHODS
Seventy-five parturients undergoing caesarean delivery were enrolled for CSF collection at delivery. Of the twenty-eight subjects who didn't meet any exclusion criteria, the number of the healthy parturients whose score of EPDS 6-weeks postpartum (6-wpp) < 5 and PPD patients whose EPDS 6-wpp ≥ 13 was ten respectively. Gas chromatography-mass spectrometry (GC-MS) analysis of CSF was used for metabolomic assessments.
RESULTS
We found that capric acid, dodecanoic acid, arachidic acid and behenic acid in CSF were significantly negatively correlated with PPD symptoms, meanwhile L-tryptophan had an obvious positive correlation. Moreover, these five biomarkers can be used as effective predictive biomarkers for PPD.
LIMITATIONS
The main limitations are the inclusion of only parturients who underwent caesarean sections and a small sample size.
CONCLUSIONS
This study innovatively investigated potential predictive biomarkers of PPD before the onset through intrapartum maternal CSF metabolomics, which offered a more objective approach to predict and diagnose PPD, leading to help identify high-risk parturients for early initiation of secondary prevention to reduce global PPD burden.
Topics: Female; Pregnancy; Humans; Depression, Postpartum; Risk Factors; Cesarean Section; Postpartum Period; Biomarkers
PubMed: 37730149
DOI: 10.1016/j.jad.2023.09.021 -
Medicina (Kaunas, Lithuania) Jul 2023: Breastfeeding is a characteristic process of mammals that ensures delivery of an adequate nutritional supply to infants. It is the gold standard food source during an...
: Breastfeeding is a characteristic process of mammals that ensures delivery of an adequate nutritional supply to infants. It is the gold standard food source during an infant's first months of life. Since the onset of the COVID-19 pandemic in 2020, people in quarantine have experienced a wide range of feelings, which may make isolation challenging in terms of maternal health. This study focused on the prevalence of breastfeeding practices and postpartum depression (PPD) among Mexican women during the COVID-19 pandemic. : This cross-sectional study included 586 postpartum women who completed an online survey 4-8 weeks after delivery from April to December 2020 in Guadalajara, Mexico. The aim was to identify potentially depressed mothers according to the Edinburgh Postnatal Depression Scale (EPDS) and describe their breastfeeding practices. : The mean maternal age was 30.4 ± 4.6 years, the mean EPDS score was 9.6 ± 5.0, and the PPD prevalence according EPDS scores was 27.1%. Exclusive breastfeeding (EBF) was reported by 32.3% of mothers in the first 48 h and by 70.3% of mothers 48 h after delivery. EBF was associated with a lower prevalence of PPD during the first 48 h ( = 0.015) and after the first 48 h ( = 0.001) after delivery. Skin-to-skin contact (SSC) was reported by 385 (65.7%) mothers. PPD was less frequent in mothers practicing SSC (20.3%) than it was in those not practicing SSC (40.3%) ( = 0.001). A higher percentage of mothers practiced SSC breastfed (66.9%) and used EBF (150, 79.4%) ( = 0.012 and 0.001, respectively). : Results suggest that the pandemic emergency and restrictions imposed on the population significantly affected the well-being of mothers after birth, and that these effects may have posed risks to the mental health and emotional stability of postpartum mothers. Therefore, encouraging BF or EBF and SSC may improve or limit depressive symptoms in postpartum mothers.
Topics: Infant; Female; Humans; Adult; Breast Feeding; Depression, Postpartum; Cross-Sectional Studies; Pandemics; COVID-19; Mexico; Mothers
PubMed: 37512141
DOI: 10.3390/medicina59071330 -
Women & Health Nov 2023Many factors negatively affect the motherhood role. Fatigue, insomnia and depression, which are among these factors, have not been investigated together in any study....
Many factors negatively affect the motherhood role. Fatigue, insomnia and depression, which are among these factors, have not been investigated together in any study. Therefore, we carried out this study to determine the effect of insomnia, fatigue and depressive symptoms on the motherhood role in primiparous mothers. In this descriptive and cross-sectional study, we included 153 women who met the inclusion criteria using the simple, random sampling method. To determine the independent variables affecting the motherhood role, we used the backward regression model. In this study, we determined that the women's spending more energy while they performed the activities of daily living in the postpartum period, their suffering from insomnia due to baby care and their depressive symptoms affected their motherhood role by 32.6 percent. We also determined that there was a moderately significant relationship between insomnia, fatigue and depressive symptoms in the postpartum period. In particular, because depressive symptoms are the variable most related with the motherhood role ( = -0.520; < .001), women should be followed-up regularly in the postpartum period from this aspect. It is also important to deal with insomnia in the early postpartum period, because it is a common problem in most women after childbirth.
Topics: Pregnancy; Female; Humans; Depression, Postpartum; Depression; Cross-Sectional Studies; Activities of Daily Living; Sleep Initiation and Maintenance Disorders; Postpartum Period; Mothers; Fatigue
PubMed: 37919971
DOI: 10.1080/03630242.2023.2276150 -
Contraception Jul 2024Depression is common during pregnancy and the year following childbirth (the perinatal period). This study assessed the association of depressive symptoms and... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Depression is common during pregnancy and the year following childbirth (the perinatal period). This study assessed the association of depressive symptoms and contraception decisions in perinatal individuals.
STUDY DESIGN
We conducted a secondary analysis using data from the PRogram in Support of Moms (PRISM) study, a cluster randomized controlled trial of active interventions which aimed to address perinatal depression. This analysis included 191 individuals aged 18-45 who screened positive for depression on the Edinburgh Postnatal Depression Scale (EPDS, score ≥10) during pregnancy or up to 3 months postpartum. We assessed contraception intent and method choice at 1-3 months postpartum. At 5-7 months postpartum, we assessed contraceptive method used and EPDS depression scores. We used logistic regressions to examine the relationship between depression and contraceptive use/method.
RESULTS
At 1-3 months postpartum, the majority of participants (76.4%) expressed an intention to use contraception. Of those, over half (53.4%) indicated a preference for higher effectiveness contraception methods. Participants with persistent depression symptoms (positive EPDS) at 5-7 months were significantly less likely to report using higher effectiveness contraceptive methods (aOR = 0.28, 95% CI = 0.11-0.70) compared to those without. Among participants with persistent depressive symptoms, 21.1% reported using a contraception method of lower effectiveness than had originally intended.
CONCLUSION
Perinatal individuals with persistent depressive symptoms at 5-7 months postpartum reported greater use of less-effective contraception methods than originally planned.
IMPLICATIONS
We found associations between perinatal depression and use of less effective contraception use. Provider discussions regarding contraception planning is important, particularly in those with perinatal depression symptoms.
Topics: Humans; Female; Adult; Contraception Behavior; Pregnancy; Young Adult; Contraception; Postpartum Period; Depression, Postpartum; Adolescent; Intention; Choice Behavior; Depression; Middle Aged; Logistic Models
PubMed: 38583583
DOI: 10.1016/j.contraception.2024.110447 -
Journal of Immigrant and Minority Health Oct 2023Postpartum depression (PPD) is the most underdiagnosed obstetric complication in the United States. Left undiagnosed and untreated, PPD can have lasting effects on the...
Postpartum depression (PPD) is the most underdiagnosed obstetric complication in the United States. Left undiagnosed and untreated, PPD can have lasting effects on the infant and the mother. A quality improvement project was conducted to improve rates of screening and referrals with postpartum Latinx immigrant mothers. Community health workers were designated to assist with PPD screening and referral for behavioral health services, at a pediatric patient-centered medical home, using a referral process algorithm (Byatt, N., Biebel, K. & Straus, J. Postpartum Depression Screening Algorithm for Pediatric Providers During Well-Child Visits, MCPAP for Moms: Promoting maternal mental health during and after pregnancy, N/A (2014)). Using chi analysis of pre and post implementation findings, results demonstrated a 21% increase in screening of eligible postpartum mothers. Referrals for behavioral health services also increased from 9 to 22% of patients that screened positive. Community Health Workers were an asset in increasing screening and referral practices for PPD in a Latinx immigrant population. Further research efforts will assist to remove further barriers to PPD screening and treatment.
Topics: Female; Infant; Pregnancy; Humans; Child; United States; Depression, Postpartum; Quality Improvement; Mothers; Mass Screening; Referral and Consultation; Emigrants and Immigrants; Hispanic or Latino
PubMed: 37300761
DOI: 10.1007/s10903-023-01503-3 -
JAMA Apr 2024
Topics: Female; Humans; Depression, Postpartum; Mass Screening
PubMed: 38563838
DOI: 10.1001/jama.2024.1634 -
Psychological Medicine Aug 2023Childbirth may be a traumatic experience and vulnerability to posttraumatic stress disorder (PTSD) may increase the risk of postpartum depression (PPD). We investigated...
BACKGROUND
Childbirth may be a traumatic experience and vulnerability to posttraumatic stress disorder (PTSD) may increase the risk of postpartum depression (PPD). We investigated whether genetic vulnerability to PTSD as measured by polygenic score (PGS) increases the risk of PPD and whether a predisposition to PTSD in PPD cases exceeds that of major depressive disorder (MDD) outside the postpartum period.
METHODS
This case-control study included participants from the iPSYCH2015, a case-cohort of all singletons born in Denmark between 1981 and 2008. Restricting to women born between 1981 and 1997 and excluding women with a first diagnosis other than depression ( = 22 613), 333 were identified with PPD. For each PPD case, 999 representing the background population and 993 with MDD outside the postpartum were matched by calendar year at birth, cohort selection, and age. PTSD PGS was calculated from summary statistics from the Psychiatric Genomics Consortium with LDpred2-auto. Odds ratios (ORs) were estimated using conditional logistic regression adjusted for parental psychiatric history and country of origin, PGS for MDD and age at first birth, and the first 10 principal components.
RESULTS
The PTSD PGS was significantly associated with PPD (OR 1.42, 95% CI 1.20-1.68 per standard deviation increase in PTSD PGS) compared to healthy female controls. Genetic PTSD vulnerability in PPD cases did not exceed that of matched female depression cases outside the postpartum period (OR 1.10, 95% CI 0.94-1.30 per standard deviation increase).
CONCLUSIONS
Genetic vulnerability to PTSD increased the risk of PPD but did not differ between PPD cases and women with depression at other times.
Topics: Infant, Newborn; Female; Humans; Depression, Postpartum; Depressive Disorder, Major; Stress Disorders, Post-Traumatic; Case-Control Studies; Risk Factors; Postpartum Period
PubMed: 35811373
DOI: 10.1017/S0033291722002045 -
The American Journal of Psychiatry Sep 2023
Topics: Male; Female; Humans; Adverse Childhood Experiences; Depression, Postpartum; Systemic Racism; Suicidal Ideation; Sexual Behavior
PubMed: 37654112
DOI: 10.1176/appi.ajp.20230565 -
The association between adverse childhood experiences and perinatal depression symptom trajectories.American Journal of Obstetrics &... Aug 2023Having a history of adverse childhood experiences is associated with an increased risk for treatment-resistant depression in the general population. Whether this...
BACKGROUND
Having a history of adverse childhood experiences is associated with an increased risk for treatment-resistant depression in the general population. Whether this relationship is true in the perinatal context is unknown.
OBJECTIVE
This study aimed to examine the association between adverse childhood experiences and the trajectories of antenatal and postpartum depression among people enrolled in a perinatal collaborative care program for mental healthcare.
STUDY DESIGN
This retrospective cohort study included all pregnant and postpartum people who were referred to and enrolled in a perinatal collaborative care program for mental healthcare and who delivered at a single, quaternary care institution between March 2016 and March 2021. Individuals referred to the collaborative care program were linked with a care manager and had access to evidence-based mental health treatment such as a psychiatric consult, pharmacotherapy, and psychotherapy. All individuals enrolled in the collaborative care program underwent adverse childhood experience screens at intake. A score of >3 on the validated Adverse Childhood Experiences Questionnaire was defined as a high adverse childhood experience score. Depression symptom monitoring occurred via electronic Patient Health Questionaire-9 screening every 2 to 4 weeks, and escalation of care was recommended for those without evidence of improvement. Antenatal depression trajectories were determined by comparing the earliest available prenatal Patient Health Questionaire-9 score closest to the time of referral to collaborative care with the latest Patient Health Questionaire-9 score before delivery. Postpartum trajectories were determined by comparing the earliest postpartum Patient Health Questionaire-9 score after delivery with the latest score before 12 weeks' postpartum. Depression trajectories were categorized as improved, stable, or worsened based on whether the Patient Health Questionaire-9 scores changed by at least 2 standard deviations (ie, 5 points on the Patient Health Questionaire-9 scale). Bivariable and multivariable analyses were performed.
RESULTS
Of the 1270 people who met the inclusion criteria, 294 (23.1%) reported a high adverse childhood experience score. Those with a high adverse childhood experience score were more likely to experience a worsened antenatal depression trajectory than those with a low adverse childhood experience score (10.3% vs 4.3%; P=.008). This association persisted after adjusting for potential confounders (adjusted odds ratio, 2.39; 95% confidence interval, 1.05-5.46). There was no significant difference in the postpartum depression trajectories between those with a high and those with a low adverse childhood experience score.
CONCLUSION
Having a high adverse childhood experience score is associated with a worsened antenatal depression trajectory for those enrolled in a collaborative care program. Given its high prevalence, future research should evaluate effective modalities of perinatal depression prevention and treatment specific for pregnant people with a history of adverse childhood experiences.
Topics: Humans; Female; Pregnancy; Depression, Postpartum; Depression; Adverse Childhood Experiences; Retrospective Studies; Postpartum Period
PubMed: 37247667
DOI: 10.1016/j.ajogmf.2023.101039 -
International Journal of Qualitative... Dec 2023Postpartum Depression (PPD) -a common health problem for mothers' postpartum increases the risk of negative interaction between mothers and infants as it reduces the...
PURPOSE
Postpartum Depression (PPD) -a common health problem for mothers' postpartum increases the risk of negative interaction between mothers and infants as it reduces the former's ability to respond to the latter's needs appropriately. Migrant mothers exhibit a higher prevalence of risk factors for PPD. Hence, this study aimed to investigate migrant mothers' life experiences pertaining to motherhood and PPD.
METHODS
Qualitative interviews were conducted with 10 immigrant mothers in the south of Sweden during 2021.
RESULTS
The qualitative content analysis revealed the following main themes: 1) PPD (two sub themes-psychosomatic symptoms and burden of responsibility due to feelings of loneliness); 2) mistrust of social services (one sub-theme-afraid of losing their children and Swedish social services' lack of understanding); 3) inadequate healthcare (two sub-themes-limited healthcare literacy for migrant mothers and language barrier; 4) women's coping strategy for well-being (two sub-themes-better awareness and understanding of the Swedish system and society, and freedom and independence in the new country).
CONCLUSIONS
PPD, mistrust of social services, and inadequate healthcare lacking personal continuity were common among immigrant women, thus precipitating discrimination-including lack of access to services because of limited health literacy, cultural differences, language barriers, and insufficient support.
Topics: Child; Infant; Humans; Female; Sweden; Depression, Postpartum; Life Change Events; Adaptation, Psychological; Emigrants and Immigrants
PubMed: 36880807
DOI: 10.1080/17482631.2023.2187333