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Archives of Women's Mental Health Jun 2021The Edinburgh Postnatal Depression Scale (EPDS) is used extensively as the "gold standard" perinatal depression and anxiety screening tool. This study contributes to an... (Review)
Review
The Edinburgh Postnatal Depression Scale (EPDS) is used extensively as the "gold standard" perinatal depression and anxiety screening tool. This study contributes to an emerging discussion about the tool's shortcomings, specifically around cultural suitability for use with Indigenous women. A systematic search was conducted in ProQuest, PsycINFO, MEDLINE (Web of Science), PubMed, Scopus, Informit, and CINAHL research databases, and grey literature. The quality of the body of evidence was assessed using the NHMRC Level of Evidence framework. Three studies supported the cultural validation of the EPDS with Indigenous groups in Canada (n = 2) and the USA (n = 1). The remaining eleven Australian studies demonstrated that cultural concerns were suggested by either Indigenous mothers, healthcare professionals (Indigenous and non-Indigenous), or both, though cultural concerns were more weighted from the perspectives of healthcare professionals. The quality of the evidence was not strong, and thus, there is a critical and urgent need for targeted research in this area. This review identified and recommended Indigenous-specific methodologies that can be adopted for more trustworthy, culturally safe, and effective research in this area. Given that the EPDS is currently considered gold standard in routine perinatal mental health screening practice in countries around the world, these findings raise significant concerns. Using culturally relevant research methodologies, such as the use of mixed-methods design, could lay stronger groundwork for further investigation of the broader utility and cultural relevance of the tool.
Topics: Australia; Canada; Depression, Postpartum; Female; Humans; Mass Screening; Mothers; Pregnancy; Psychiatric Status Rating Scales
PubMed: 33245435
DOI: 10.1007/s00737-020-01084-2 -
Systematic Reviews Jan 2024Intravenous iron (IV-iron) is used as an alternative to, or alongside, red blood cell transfusion (RBC-T) to treat more severe postpartum anemia (PPA), although optimal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Intravenous iron (IV-iron) is used as an alternative to, or alongside, red blood cell transfusion (RBC-T) to treat more severe postpartum anemia (PPA), although optimal treatment options remain unclear. No previous systematic reviews have examined IV-iron and RBC-T, including patient-reported outcomes and hematological responses.
METHODS
A systematic review and meta-analysis of randomized trials comparing IV-iron and RBC-T with each other, oral iron, no treatment, and placebo for the treatment of PPA. Key inclusion criteria were PPA (hemoglobin < 12 g/dL) and IV-iron or RBC-T as interventions. Key exclusion criteria were antenatal IV-iron or RBC-T. Fatigue was the primary outcome. Secondary outcomes included hemoglobin and ferritin concentrations, and adverse events. From 27th August 2020 to 26th September 2022, databases, registries, and hand searches identified studies. A fixed-effect meta-analysis was undertaken using RevMan (5.4) software. The quality of the studies and the evidence was assessed using the Cochrane Risk of Bias table, and Grading of Recommendations, Assessment, Development, and Evaluation. This review is registered with the Prospective Register of Systematic Reviews (CRD42020201115).
RESULTS
Twenty studies and 4196 participants were included: 1834 assigned IV-iron, 1771 assigned oral iron, 330 assigned RBC-T, and 261 assigned non-intervention. Six studies reported the primary outcome of fatigue (1251 participants). Only studies of IV-iron vs. oral iron (15 studies) were available for meta-analysis. Of these, three reported on fatigue using different scales; two were available for meta-analysis. There was a significant reduction in fatigue with IV-iron compared to oral iron (standardized mean difference - 0.40, 95% confidence interval (CI) - 0.62, - 0.18, I = 0%). The direction of effect also favored IV-iron for hemoglobin (mean difference (MD) 0.54 g/dL, 95% confidence interval (CI) 0.47, 0.61, I = 91%), ferritin, (MD 58.07 mcg/L, 95% CI 55.74, 60.41, I = 99%), and total adverse events (risk-ratio 0.63, 95% CI 0.52, 0.77, I = 84%). The overall quality of the evidence was low-moderate.
DISCUSSION
For all outcomes, the evidence for RBC-T, compared to IV-iron, non-intervention, or dose effects of RBC-T is very limited. Further research is needed to determine whether RBC-T or IV-iron for the treatment of PPA is superior for fatigue and hematological outcomes.
Topics: Female; Humans; Pregnancy; Iron; Anemia; Blood Transfusion; Hemoglobins; Ferritins; Postpartum Period; Fatigue
PubMed: 38169415
DOI: 10.1186/s13643-023-02400-4 -
International Journal of Environmental... May 2020Previous literature has reported that patients with diabetes in pregnancy (DIP) are at risk of developing antepartum depression but the results have been inconsistent in... (Meta-Analysis)
Meta-Analysis
Previous literature has reported that patients with diabetes in pregnancy (DIP) are at risk of developing antepartum depression but the results have been inconsistent in cohort studies. We conducted a systematic review and performed a meta-analysis to quantify the association between DIP and risk of antepartum depression in cohort studies. Medline, Cinahl, and PubMed databases were searched for studies investigating DIP involving pregnant women with pre-existing diabetes and gestational diabetes mellitus and their risk of antepartum depression that were published in journals from inception to 27 December 2019. We derived the summary estimates using a random-effects model and reported the findings as pooled relative risks (RR) and confidence interval (CI). Publication bias was assessed using a funnel plot and was quantified by Egger and Begg's tests. Ten studies, involving 71,036 pregnant women were included in this meta-analysis. The pooled RR to develop antepartum depression was (RR = 1.430, 95% CI: 1.251-1.636) among women with gestational diabetes mellitus. Combining pregnant women with pre-existing diabetes mellitus and gestational diabetes mellitus, they had a significant increased risk of developing antepartum depression (RR = 1.431, 95% CI: 1.205-1.699) compared with those without it. In comparison, we found no association between pre-existing diabetes mellitus in pregnancy (RR = 1.300, 95% CI: 0.736-2.297) and the risk of developing antepartum depression. This study has a few limitations: first, different questionnaire and cut-off points were used in evaluation of depression across the studies. Second, there was a lack of data on history of depression prior to pregnancy, which lead to confounding bias that could not be solved by this meta-analysis. Third, data were dominated by studies in Western countries; this is due to the studies from Eastern countries failing to meet our inclusion criteria for statistical analysis. Women with gestational diabetes mellitus have an increased risk of developing antepartum depression compared to those without the disease. Therefore, more attention on the mental health status should be given on pregnant women diagnosed with pre-existing diabetes mellitus and gestational diabetes mellitus.
Topics: Cohort Studies; Depression; Depression, Postpartum; Depressive Disorder, Major; Diabetes, Gestational; Female; Humans; Pregnancy; Pregnancy in Diabetics; Risk
PubMed: 32466479
DOI: 10.3390/ijerph17113767 -
Annals of Palliative Medicine Apr 2022In recent years, the detection rate of pregnancy complicated with hypothyroidism [subclinical hypothyroidism (SCH) during pregnancy] has increased significantly.... (Meta-Analysis)
Meta-Analysis
Systematic review and meta-analysis of the efficacy and pregnancy outcomes of levothyroxine sodium tablet administration in pregnant women complicated with hypothyroidism.
BACKGROUND
In recent years, the detection rate of pregnancy complicated with hypothyroidism [subclinical hypothyroidism (SCH) during pregnancy] has increased significantly. Levothyroxine sodium tablet is the main drug for the treatment of SCH during pregnancy, but its effect on the treatment of SCH during pregnancy and the effect of pregnancy outcome are still controversial.
METHODS
PubMed, Web of Science, Medline, and Embase databases were screened to retrieve clinical studies on levothyroxine sodium tablets in the treatment of pregnancy complicated with hypothyroidism from the date of establishment to June 2021. Meta-analysis was performed with RevMan5.3 software. The differences in the incidence of preterm birth, miscarriage, gestational hypertension, postpartum hemorrhage, placental abruption, and abnormal neonatal weight were compared between the observation group and the control group. Heterogeneity of results was assessed with chi-square test and I2 in RevMan5.3 software.
RESULTS
Nine articles with a total of 2,873 pregnant women were included. The Cochrane assessments were all grade B and above, and the Jadad scale scores were all >3 points. The incidences of preterm birth, abortion, postpartum hemorrhage, and low birth weight infants in the pregnant women treated with levothyroxine sodium were lower than those in the control group [odds ratio (OR) =0.42, 0.34, 0.40, and 0.08, respectively; 95% confidence interval (CI): 0.30-0.58, 0.23-0.52, 0.22-0.74, and 0.01-0.51, respectively; Z=5.23, 5.08, 2.97, and 2.70, respectively; P<0.00001, <0.00001, =0.003, and =0.007, respectively].
DISCUSSION
Levothyroxine sodium in the treatment of SCH can significantly reduce the incidence of premature birth, miscarriage, postpartum hemorrhage, and low birth weight infants. Due to the limited number of included studies, it remained to be further verified whether levothyroxine sodium treatment in SCH patients would affect the incidence of gestational hypertension.
Topics: Abortion, Spontaneous; Female; Humans; Hypertension, Pregnancy-Induced; Hypothyroidism; Infant, Newborn; Placenta; Postpartum Hemorrhage; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Sodium; Tablets; Thyroxine
PubMed: 35523752
DOI: 10.21037/apm-22-269 -
PloS One 2024Approximately 10 to 20% of pregnant women worldwide experience perinatal depression (PND), a depressive episode with onset during pregnancy or after childbirth. We...
BACKGROUND
Approximately 10 to 20% of pregnant women worldwide experience perinatal depression (PND), a depressive episode with onset during pregnancy or after childbirth. We performed a systematic review to identify, summarize and discuss studies on inflammatory biomarkers described in relation to PND.
METHOD
Inclusion criteria defined the selection of observational studies written in English, French, Spanish or Portuguese, that evaluate analytical levels of inflammatory molecules (protein levels) in biological fluids in women, with a diagnosis of depression using ICD/DSM diagnostic criteria or depressive symptoms assessed by standardized psychometric instruments, during pregnancy and/or postpartum. Case reports, experimental studies, reviews, qualitative analysis, meta-analysis, gray literature or replicated data were excluded. Three electronic databases were used for search (Pubmed, Web of Science and PsychInfo) and quality assessment of selected studies were performed using the Newcastle-Ottawa Scale. Data extraction included study design; number of subjects; obstetric information; tools and timepoints of depression and inflammatory markers assessment.
RESULTS
56 studies (sample size for cross-sectional and case-control studies ranging from 10 to 469; sample size for longitudinal studies ranging from 26 to 467), where the major aim was to analyze the association between depression and inflammatory biomarkers during pregnancy and postpartum period were included in this systematic review. Overall, the findings of our systematic review lend support to the hypothesis that several inflammatory markers may be associated with peripartum depressive symptoms. The associations were somewhat different looking at pregnancy compared to the delivery time-point and postpartum, and mainly referred to increased levels of IL-6, IL-8, CRP and TNF-α among depressed.
DISCUSSION
In summary, our systematic review findings provide evidence supporting the hypothesis that several inflammatory markers may correlate with peripartum depressive symptoms. However, our work also highlighted notable differences in the timing of biological sampling for inflammatory markers and in the methodologies used to assess depression during the perinatal period. Additionally, variations were observed in how inflammatory biomarkers and depression were approached, including their classification as exposure or outcome variables, and the timing of assessments. It is essential for future research to investigate the influence of biological fluids and the timing of assessments for both inflammatory biomarkers and depression to gain a deeper understanding of their association. This comprehensive exploration is pivotal for elucidating the intricate relationship between inflammation and perinatal depression.
Topics: Humans; Female; Pregnancy; Biomarkers; Pregnancy Complications; Depression; Inflammation; Depression, Postpartum
PubMed: 38820411
DOI: 10.1371/journal.pone.0280612 -
PloS One 2020Postnatal depression (PND) is a major cause of negative health-related behaviors and outcomes during infancy, childhood and adolescent period. In Africa, the burden of... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Postnatal depression (PND) is a major cause of negative health-related behaviors and outcomes during infancy, childhood and adolescent period. In Africa, the burden of postnatal depression is high. However, it is under-investigated hence under-treated. To fill this information gap and to advise further interventions, we aimed at analyzing its epidemiology in Africa.
METHODS
We searched observational studies conducted in Africa and published in between 01/01/2007 and 30/06/2018 in CINHAL, MEDLINE, PsycINFO, Psychiatry online, PubMed, SCOPES, and Emcare databases. We assessed the quality of the studies using the Newcastle Ottawa Scale (NOS) and included studies with good quality. We evaluated the heterogeneity using the Higgins I2 statistics. We used a random-effects model to pool estimates. We assessed publication bias using the funnel plot and Egger's test statistics and adjusted using Tweedie's and Duval Trim and Fill analysis. The protocol has been registered in the PROSPERO (Protocol No. CRD42018100461).
RESULTS
Nineteen studies involving 40,953 postnatal mothers were part of this systematic review and meta-analysis. The overall pooled prevalence of PND was 16.84% (95% CI: 14.49% -19.19%). The odds of having PND was higher among women with a poor obstetric condition (POR = 2.11; 95% CI: 1.11-4.01) and history of adverse birth and infant health outcomes (POR = 2.85; 95% CI: 1.29-6.25). Having a history of common mental health disorders (POR = 2.47; 95% CI: 1.51-4.04), poor social support (POR = 2.06; 95% CI: 1.05-4.05), lower economic status (POR = 2.38; 95% CI: 1.75-3.23), and those who had exposure to a different form of intimate partner violence (POR = 2.87; 95% CI: 1.60-5.16) had higher odds of PND.
CONCLUSION
While robust prevalence studies are scarce, our review indicated a high prevalence rate of postnatal depression. The analysis also identified postpartum women at increased risk of PND. Therefore, there is a need to design and escalate comprehensive strategies to decrease its burden, focusing on those women at risk of PND.
Topics: Africa; Depression, Postpartum; Female; Humans; Intimate Partner Violence; Mental Disorders; Odds Ratio; Prevalence; Social Support; Socioeconomic Factors
PubMed: 32343736
DOI: 10.1371/journal.pone.0231940 -
Journal of the American Heart... Jul 2020Background The use of extracorporeal life support (ECLS) has expanded to include unique populations such as peripartum women. This systematic review aims to (1) quantify...
Background The use of extracorporeal life support (ECLS) has expanded to include unique populations such as peripartum women. This systematic review aims to (1) quantify the number of cases and indications for ECLS in women during the peripartum period reported in the literature and (2) report maternal and fetal complications and outcomes associated with peripartum ECLS. Methods and Results This review was registered in PROSPERO (CRD42018108142). MEDLINE, Embase, and CINAHL were searched for case reports, case series, and studies reporting cases of ECLS during the peripartum period that reported one or more of the following outcomes: maternal survival, maternal complications, fetal survival, and/or fetal complications. Qualitative assessment of 221 publications evaluated the number of cases, clinical details, and maternal and fetal outcomes of ECLS during the peripartum period. There were 358 women included and 68 reported fetal outcomes in cases where the mother was pregnant at the time of cannulation. The aggregate maternal survival at 30 days was 270 (75.4%) and at 1 year was 266 (74.3%); fetal survival was 44 (64.7%). The most common indications for ECLS overall in pregnancy included acute respiratory distress syndrome 177 (49.4%), cardiac failure 67 (18.7%), and cardiac arrest 57 (15.9%). The most common maternal complications included mild to moderate bleeding 66 (18.4%), severe bleeding requiring surgical intervention 48 (13.4%), and intracranial neurologic morbidity 19 (5.3%). The most commonly reported fetal complications included preterm delivery 33 (48.5%) and neonatal intensive care unit admission 19 (27.9%). Conclusions Reported rates of survival in ECLS in pregnant and postpartum women are high and major complications relatively low.
Topics: Adult; Extracorporeal Membrane Oxygenation; Female; Humans; Infant; Infant, Newborn; Maternal Mortality; Perinatal Mortality; Postpartum Period; Pregnancy; Pregnancy Complications; Puerperal Disorders; Risk Factors; Time Factors; Treatment Outcome; Young Adult
PubMed: 32578471
DOI: 10.1161/JAHA.119.016072 -
Journal of Affective Disorders Feb 2022Certain personality traits increase vulnerability to depression, but the evidence linking personality and postpartum depression (PPD) is less robust. This systematic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Certain personality traits increase vulnerability to depression, but the evidence linking personality and postpartum depression (PPD) is less robust. This systematic review aimed to identify personality traits that increase the risk of PPD.
METHODS
We systematically reviewed studies retrieved from PubMed/Medline, PsycINFO, Scopus, CINAHL, and Cochrane, following the PRISMA guidelines for reporting. We carried out a meta-analysis on the association between neuroticism and PPD.
RESULTS
A total of 34 studies were analyzed. Of these, 31 considered at least one trait associated with PPD; 10 studies considered at least one trait not associated with PPD. The meta-analysis included 13 studies, concluding that neuroticism was associated with PPD (OR: 1.37; 95%CI: 1.22-1.53; p<0.001).
LIMITATIONS
Study design and approach to personality assessment influence results. Prospective longitudinal studies of persons with no prior history of mood disorder would provide stronger evidence about whether particular personality traits predict PPD. Most studies reviewed used self-report measures to assess personality. Study design and approach to personality assessment influence results, and indications of publication bias were found.
CONCLUSIONS
Neuroticism is the personality trait most widely studied in relation to PPD. Our meta-analysis found this trait is strongly related with PPD. Moreover, vulnerable personality style and trait anxiety are also associated with PPD. Screening for these traits might help identify women at risk, improving prevention, early detection, and possibly treatment.
Topics: Depression, Postpartum; Female; Humans; Personality; Personality Disorders; Prospective Studies; Risk Factors
PubMed: 34763034
DOI: 10.1016/j.jad.2021.11.010 -
American Journal of Obstetrics and... Jul 2024Care bundles are a promising approach to reducing postpartum hemorrhage-related morbidity and mortality. We assessed the effectiveness and safety of care bundles for... (Review)
Review
OBJECTIVE
Care bundles are a promising approach to reducing postpartum hemorrhage-related morbidity and mortality. We assessed the effectiveness and safety of care bundles for postpartum hemorrhage prevention and/or treatment.
DATA SOURCES
We searched MEDLINE, Embase, Cochrane CENTRAL, Maternity and Infant Care Database, and Global Index Medicus (inception to June 9, 2023) and ClinicalTrials.gov and the International Clinical Trials Registry Platform (last 5 years) using a phased search strategy, combining terms for postpartum hemorrhage and care bundles.
STUDY ELIGIBILITY CRITERIA
Peer-reviewed studies evaluating postpartum hemorrhage-related care bundles were included. Care bundles were defined as interventions comprising ≥3 components implemented collectively, concurrently, or in rapid succession. Randomized and nonrandomized controlled trials, interrupted time series, and before-after studies (controlled or uncontrolled) were eligible.
METHODS
Risk of bias was assessed using RoB 2 (randomized trials) and ROBINS-I (nonrandomized studies). For controlled studies, we reported risk ratios for dichotomous outcomes and mean differences for continuous outcomes, with certainty of evidence determined using GRADE. For uncontrolled studies, we used effect direction tables and summarized results narratively.
RESULTS
Twenty-two studies were included for analysis. For prevention-only bundles (2 studies), low-certainty evidence suggests possible benefits in reducing blood loss, duration of hospitalization, and intensive care unit stay, and maternal well-being. For treatment-only bundles (9 studies), high-certainty evidence shows that the E-MOTIVE intervention reduced risks of composite severe morbidity (risk ratio, 0.40; 95% confidence interval, 0.32-0.50) and blood transfusion for bleeding, postpartum hemorrhage, severe postpartum hemorrhage, and mean blood loss. One nonrandomized trial and 7 uncontrolled studies suggest that other postpartum hemorrhage treatment bundles might reduce blood loss and severe postpartum hemorrhage, but this is uncertain. For combined prevention/treatment bundles (11 studies), low-certainty evidence shows that the California Maternal Quality Care Collaborative care bundle may reduce severe maternal morbidity (risk ratio, 0.64; 95% confidence interval, 0.57-0.72). Ten uncontrolled studies variably showed possible benefits, no effects, or harms for other bundle types. Nearly all uncontrolled studies did not use suitable statistical methods for single-group pretest-posttest comparisons and should thus be interpreted with caution.
CONCLUSION
The E-MOTIVE intervention improves postpartum hemorrhage-related outcomes among women delivering vaginally, and the California Maternal Quality Care Collaborative bundle may reduce severe maternal morbidity. Other bundle designs warrant further effectiveness research before implementation is contemplated.
Topics: Humans; Postpartum Hemorrhage; Female; Pregnancy; Patient Care Bundles
PubMed: 38336124
DOI: 10.1016/j.ajog.2024.01.012 -
Acta Obstetricia Et Gynecologica... Feb 2021Pregnant women with a body mass index (BMI) ≥40 kg/m are at an increased risk of requiring planned- and unplanned cesarean deliveries (CD). The aim of this systematic... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Pregnant women with a body mass index (BMI) ≥40 kg/m are at an increased risk of requiring planned- and unplanned cesarean deliveries (CD). The aim of this systematic review is to compare outcomes in women with BMI ≥ 40 kg/m based on planned and actual mode of birth.
MATERIAL AND METHODS
Five databases were searched for English and French-language publications until February 2019, and all studies reporting on delivery outcomes in women with BMI ≥ 40 kg/m , stratified by planned and actual mode of birth, were included. Risk-of-bias was assessed using the Newcastle-Ottawa Scale. Relative risks (RR) and 95% confidence intervals were calculated using random-effects meta-analysis.
RESULTS
Ten observational studies were included. Anticipated vaginal birth vs planned CD (5 studies, n = 2216) was associated with higher risk for postpartum hemorrhage (13.0% vs 4.1%, P < .001, numbers needed to harm (NNH = 11), I = 0%) but lower risk for wound complications (7.6% vs 14.5%, P < .001, numbers needed to treat (NNT = 15), I = 58.3%). Planned trial of labor vs repeat CD (3 studies, n = 4144) was associated with higher risk for uterine dehiscence (0.94% vs 0.42%, P = .04, NNH = 200, I = 0%), endometritis (5.1% vs 2.2%, P < .001, NNH = 35, I = 0%), prolonged hospitalization (one study, 30.3% vs 26.0%, P = .003, NNH = 23), low five-minute Apgar scores (4.9% vs 1.7%, RR 2.95 (2.03, 4.28), NNH = 30, I = 0%) and birth trauma (1.1% vs 0.2%, P < .001, NNH = 111, I = 0%). Successful vaginal birth vs intrapartum CD (n = 3625) was associated with lower risk of postpartum hemorrhage (15.1% vs 70%, P < .001, NNT = 2, I = 0%), wound complications (one study, 0% vs 4.4%, P = .007, NNT = 23), prolonged hospitalization (one study, 1.9% vs 6.7%, 0.04, NNT = 21) and low five-minute Apgar scores (one study, 1.0% vs 5.6%, P = .03, NNT = 22), but more birth trauma (5.9% vs 0.6%, P = .005, NNH = 19, I = 0%). Compared groups had dissimilar demographic characteristics. Although studies scored 6-7/9 on risk-of-bias assessment, they were at high-risk for confounding by indication.
CONCLUSIONS
Evidence from observational studies suggests clinical equipoise regarding the optimal mode of delivery in women with BMI ≥ 40 kg/m and no prior CD. This question is best answered by a randomized trial. Based on an unplanned subgroup analysis, for women with BMI ≥ 40 kg/m and prior CD, repeat CD may be associated with better clinical outcomes.
Topics: Apgar Score; Birth Injuries; Body Mass Index; Cesarean Section; Delivery, Obstetric; Endometritis; Female; Humans; Infant, Newborn; Length of Stay; Obesity, Maternal; Obesity, Morbid; Postpartum Hemorrhage; Pregnancy; Surgical Wound Dehiscence
PubMed: 32997801
DOI: 10.1111/aogs.14011