Social peril and medico-legal risks in depression

TB prevention strategies and unanswered questions for pregnant and postpartum women living with HIV: the need for improved evidence.

Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine

Leveraging Telehealth in the United States to Increase Access to Opioid Use Disorder Treatment in Pregnancy and Postpartum During the COVID-19 Pandemic.

Lithium during pregnancy.

The purpose of this study was to test the hypothesis that disturbances in levels of plasma melatonin differentiate pregnant and postpartum women with major depression from matched pregnant and postpartum healthy comparison women. Participants were 25 pregnant women (10 with major depression, 15 healthy) and 24 postpartum women (13 with major depression, 11 healthy). Healthy comparison women were matched on the number of weeks pregnant or postpartum. Plasma melatonin levels for each subject were measured every 30 minutes, in dim light (<30 lux), from 6:00 p.m. to 11:00 a.m. The values of plasma melatonin levels were log-transformed, and calculations were determined for the following measures: baseline and synthesis onset and offset times, duration, peak concentration, and area under the curve. Groups were compared by analyses of covariance, with age, number of weeks pregnant or postpartum, breast-feeding status, and body mass index as covariates. Morning melatonin levels from 2:00 a.m. to 11:00 a.m. were significantly lower in pregnant women with major depression relative to healthy pregnant women. However, these levels were significantly higher in postpartum women with major depression across time intervals relative to postpartum healthy women. Pregnant but not postpartum women with a personal or family history of depression, regardless of their current diagnosis, had significantly earlier melatonin synthesis and baseline offset times relative to women without a family history of depression. In pregnant healthy women but not pregnant women with major depression, melatonin levels increased during the course of pregnancy. This association was not found among postpartum women with major depression or postpartum healthy women. Plasma nocturnal melatonin concentrations, particularly during morning hours, were lower in depressed pregnant women but elevated in depressed postpartum women relative to matched healthy comparison women. In addition, melatonin timing measures were advanced in pregnant women with a personal or family history of depression. These findings implicate disturbances in the regulation of the melatonin generating system in pregnancy and postpartum depression.

Background Based on what is known at this time, pregnant women are at an increased risk of severe illness from COVID-19 compared to nonpregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes. To investigate the effects of coronavirus disease 2019 (COVID-19) on mortality of pregnant and postpartum women, we performed a systematic review of available published literature on pregnancies affected by COVID-19. Methods Web of Science, SCOPUS, and MEDLINE- databases were searched for original studies concerning the effect of COVID-19 on mortality of pregnant and postpartum women published by July 10, 2020. Meta-analyses of proportions were used to combine data and report pooled proportions. Results 117 studies with a total of 11758 pregnant women were included. The age ranged between 15 and 48 years. Most subjects were infected with SARS-CoV-2 in the third trimester. Disease severity was not reported in 1125 subjects. Maternal mortality was 1.3%. In 100% of fatal cases with adequate data, fever alone or with cough was one of the presenting symptoms. Also, dyspnea (58.3%) and myalgia (50%) were the most common symptoms. Sore throat (8.3%) and gastrointestinal symptoms (anorexia, nausea) (8.3%) were rare. The rate of comorbidities was 20% among COVID-19 deaths. The majority of COVID-19-infected women who died had cesarean section (58.3%), 25% had a vaginal delivery, and 16.7% of patients were not full term. Conclusion COVID-19 infection in pregnant women was associated with higher rates (and pooled proportions) of cesarean section and mortality. Because new data are continuously being generated and published, the findings of this study can be complete and updated with new researches. The results of this study can guide and improve prenatal counseling of COVID-19-infected pregnant women.

Intensive care unit admissions for pregnant and nonpregnant women with coronavirus disease 2019

Depression Screening of Perinatal Women: An Evaluation of the Healthy Start Depression Initiative

Safety of influenza vaccines in pregnant women

Postpartum depression (PPD) is a serious mental health condition affecting mothers after childbirth, potentially impacting both maternal well-being and infant development. This study examines the influence of social support on the risk of postpartum depression among pregnant women using a qualitative approach through a literature review (library research). The research systematically analyzes existing studies on the relationship between social support and postpartum depression, focusing on different types of support, including emotional, informational, instrumental, and companionship support. Findings indicate that strong social support networks, particularly from partners, family members, and healthcare providers, significantly reduce the likelihood of developing PPD. Emotional support plays a crucial role in alleviating feelings of loneliness and anxiety, while informational and instrumental support aid in improving coping mechanisms during the postpartum period. The study also highlights the cultural and socioeconomic factors influencing the availability and perception of social support. The findings suggest that interventions aimed at strengthening social support systems could be effective in preventing postpartum depression. Additionally, healthcare professionals should integrate social support assessments into prenatal and postnatal care to identify women at risk and provide necessary interventions. Future research should explore more culturally diverse perspectives and longitudinal studies to better understand the long-term impact of social support on postpartum mental health. By emphasizing the importance of social support, this study contributes to the broader discourse on maternal mental health and highlights the need for comprehensive support systems for pregnant and postpartum women.

SETTING: Antenatal care (ANC) and postpartum care (PPC) clinic in Manhiça District, Mozambique.OBJECTIVE: To estimate the prevalence of TB among pregnant and post-partum women and describe the clinical characteristics of the disease in a rural area of Southern Mozambique.METHODS: We conducted a cross-sectional TB prevalence study among pregnant and post-partum women recruited from September 2016 to March 2018 at the Manhiça Health Care Center (MHC). We recruited two independent cohorts of women consecutively presenting for routine pregnancy or post-partum follow-up visits.RESULTS: A total of 1,980 women from the ANC clinic and 1,010 from the PPC clinic were enrolled. We found a TB prevalence of 505/100,000 (95% CI: 242-926) among pregnant women and 297/100,000 (95% CI: 61-865) among post-partum women. Among HIV-positive pregnant women, TB prevalence was 1,626/100,000 (95% CI: 782-2,970) and among postpartum HIV-positive women, TB prevalence was 984/100,000 (95% CI: 203-2,848).CONCLUSIONS: The burden of TB was not higher in postpartum women than in pregnant women. Most TB cases were detected in HIV-positive women. TB screening and diagnostic testing among pregnant and postpartum women attending ANC and PPC clinics in Manhiça District is acceptable and feasible.

Purpose/AimTo evaluate the outcomes of a program designed to standardize mental health screenings and facilitate entry to mental health care for low‐income inner‐city pregnant and postpartum women.Research Questions1) Identify the most common stressors affecting pregnant and postpartum women 2) Determine the percentage of women who engage in mental health care and whether adherence with mental health care varies by setting or pregnancy status; and 3) Describe the changes in depressive symptoms from early pregnancy to 6 weeks postpartum.Significance/BackgroundUndetected and untreated depression is associated with poorer maternal and neonatal outcomes. Unfortunately, mental health resources are limited, particularly for vulnerable women living in impoverished communities. Our program was designed to maximize mental health resources. Key elements include: 1) provider training, 2) co‐located mental health services, and 3) inclusion of a mental health “meet‐and‐greet” visit into the primary care visit for women in crisis.MethodsData on depressive symptoms, reasons for referral to mental health services, and adherence to care were abstracted from the medical records of pregnant and postpartum women receiving care from January 1, 2010 to June 30, 2012.FindingsOur protocol resulted in high rates of screening for and adherence to mental health care; 95.0% of pregnant women (n = 425) and 90.0% of postpartum women (n = 269) were screened for depressive symptoms. Higher rates of depressive symptoms, as measured by a positive Patient Health Questionnaire‐2 (PHQ‐2) score, were seen prenatally (43%) than in early postpartum (7%), although clinical depression was more common postpartum than during pregnancy. For women who continued care and were rescreened postpartum (n = 118), 48% had depressive symptoms neither in pregnancy nor postpartum, 41% experienced depressive symptoms only in pregnancy, 6% reported symptoms after birth not in pregnancy, and 5% were symptomatic in both time periods. Fifty percent of referrals were prompted by significant psychosocial factors such as personal or family stress, need for concrete services, and prior history of depression, anxiety, or trauma. Compliance with recommended care was significantly higher for care offered on‐site (P &lt; .01). Of the pregnant (n = 110) and postpartum (n = 22) women referred for mental health services, 57.8% of pregnant women and 84.2% of postpartum women were known to have kept their appointments in‐house compared to only 11.1% of pregnant and 33.3% of postpartum women who were referred to another facility.DiscussionOur results highlight differences in the prevalence of depressive symptoms and clinical depression in pregnant and postpartum women. In‐house mental health services were associated with significantly higher attendance rates for mental health care. Implementing a standardized screening and referral system, with the majority of services provided on‐site, resulted in high screening rates and compliance with mental health care.

Existing evidence on the burden of mental health problems among pregnant and postpartum women living with HIV, a vulnerable population in sub-Saharan Africa (SSA), is limited and fragmented, affecting the development of context-sensitive and integrated interventions. This systematic review aims to provide an up-to-date and comprehensive synthesis of available evidence to estimate the burden and identify the determinants of mental health problems among pregnant and postpartum women living with HIV across countries in sub-Saharan Africa. We will retrieve all relevant studies (published and unpublished) through searches in PubMed, Embase, PsycINFO, CINAHL, LILACS, Google Scholar, Scopus and Web of Science from inception to 30th June 2024, without language restriction. We will use the following search terms 'mental health disorder', 'mental health problem', 'pregnant women', 'postpartum women' and 'HIV' nested with all applicable alternate terms and the names of countries in SSA for running the searches. We will also search HINARI, African Index Medicus, African Journals Online, Academic Search Premier, medRxiv, ProQuest, EBSCO Open Dissertations, and reference lists of relevant studies. We will contact experts in the field for potentially relevant unpublished studies. All retrieved articles from the electronic databases and grey literature will be collated and deduplicated using Endnote and exported to Rayyan QCRI. Two reviewers will independently select studies using a pretested study selection flow chart developed from the pre-specified eligibility criteria. Two reviewers will extract data using a pretested data extraction form and assess the risk of bias in the included studies using the risk of bias tool for prevalence studies by Hoy et al. (2012). Any disagreements will be resolved through discussion between the reviewers. Binary outcomes (prevalence and incidence of mental health problems among pregnant and postpartum women living with HIV) will be evaluated using pooled proportions (for non-comparative studies) and odds ratio (OR) or risk ratio (RR) (for comparative studies), and mean difference for continuous outcomes, all will be reported with their 95% confidence intervals (CIs). Heterogeneity will be assessed graphically for overlapping CIs and statistically using the I2 statistic. If substantial heterogeneity is found, random-effects model meta-analysis will be performed; otherwise, fixed-effect meta-analysis will be employed. We will conduct subgroup analysis (to assess the impact of heterogeneity) and sensitivity analyses to test the robustness of the generated effect estimates to the quality domains. The overall level of evidence will be assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). The review is expected to produce an up-to-date and comprehensive synthesis of the available evidence, allowing for the generation of country-specific estimates of the burden of mental health problems among mothers living with HIV across SSA populations. Also, the review will attempt to identify the determinants of mental health problems among pregnant and postpartum women living with HIV, to shed light on the factors that contribute to the occurrence of mental health problems in this vulnerable population. The systematic review protocol has been registered in the International Prospective Register for Systematic Reviews (PROSPERO), with registration ID CRD42023468537.

Diastasis Recti (DR) is a common muscular condition often present during and after pregnancy. This cross-sectional correlational study investigated the prevalence of DR among pregnant and postpartum women. A total of 250 pregnant and postpartum women were recruited using convenience sampling technique from obstetrics and gynaecology department, Aminu Kano Teaching Hospital, Kano, Nigeria. Age, body mass, height, BMI, parity, trimester, duration of DR postpartum, location of DR and DR status was recorded for each participant. Presence of DR was confirmed using the finger width method. Descriptive statistics of mean, SD, percentage were used to describe the data and determine the prevalence. Inferential statistics of Pearson’s and Spearman’s correlation were used to analyse the relationship between prevalence of DR and age, parity and duration of DR postpartum. Chi square was computed to determine the difference in prevalence of DR across trimesters. The result of this study indicated high prevalence of DR in post-partum and pregnant women (84% and 64.7% respectively); the most common location of DR was at the umbilicus in both pregnant and postpartum women. Prevalence of DR was high among the multigravida; and a significant relationship was found between prevalence of DR and age and parity of participants. There was a significant difference in prevalence of DR across the trimesters. It can be concluded that prevalence of DR among pregnant and postpartum women is high; age and parity are determinants of DR prevalence. Evaluation of DR should be considered as routine assessment in both pregnant and postpartum women.

A cross-sectional comparative study was conducted among 2017 women surveyed, including 584 pregnant women, 528 postpartum women, and 906 women who had never been pregnant (the comparative group) from Poland, Greece, Turkey, Belarus, and Russia. The sample selection was purposive. Surveys were collected between November 2021 and December 2022. The study used the Beck Depression Inventory (BDI) Scale, the Satisfaction with Life Scale (SWLS), the Edinburgh Postpartum Depression Scale (EPDS), the GHQ-28 (General Health Questionnaire), the Schwarzer Generalized Self-Efficacy Scale (GSES), and the KompOs Personal Competence Scale. A significantly lower risk of depression was observed in postpartum women in Poland and amongst pregnant women in Turkey. Pregnant women in Turkey (28.9 points) presented the highest satisfaction with life, while the lowest satisfaction was found amongst pregnant women in Poland and Greece (25.2 and 25.1 points, respectively). In Poland and Belarus, a higher risk of depression was noticed in women who had undergone an artificial abortion. In Turkey, a positive correlation was found in pregnant women concerning the number of children they had with a measure of depression and a negative correlation with life satisfaction. In Greece, non-pregnant women showed no correlation between mental status and scores on the GSES. Scores on satisfaction with SWLS were positively correlated with a sense of power, and the strength of the correlation was similar to results on the BDI and GHQ measures. Postpartum depression, according to the EPDS, was also the most severe in Turkish women. The highest risk of depression was shown in the control group and amongst pregnant and postpartum women in Turkey and Greece, and the lowest such risk was in Poland. Pregnant and postpartum women showed by far the highest satisfaction with life in Turkey and the lowest in women from Greece. The risk of depression, the level of satisfaction with life, and the mental health of pregnant women were not influenced by the type of last delivery. However, the duration of the last delivery influenced the group from Belarus, and having children affected the mental health of women in the group from Turkey.