Maternal Depression In Pregnancy Research Articles

Consensus Panel Recommendations for the Pharmacological Management of Pregnant Women with Depressive Disorders.

The initiative of a consensus on the topic of antidepressant and anxiolytic drug use in pregnancy is developing in an area of clinical uncertainty. Although many studies have been published in recent years, there is still a paucity of authoritative evidence-based indications useful for guiding the prescription of these drugs during pregnancy, and the data from the literature are complex and require expert judgment to draw clear conclusions. For the elaboration of the consensus, we have involved the scientific societies of the sector, namely, the Italian Society of Toxicology, the Italian Society of Neuropsychopharmacology, the Italian Society of Psychiatry, the Italian Society of Obstetrics and Gynecology, the Italian Society of Drug Addiction and the Italian Society of Addiction Pathology. An interdisciplinary team of experts from different medical specialties (toxicologists, pharmacologists, psychiatrists, gynecologists, neonatologists) was first established to identify the needs underlying the consensus. The team, in its definitive structure, includes all the representatives of the aforementioned scientific societies; the task of the team was the evaluation of the most accredited international literature as well as using the methodology of the "Nominal Group Technique" with the help of a systematic review of the literature and with various discussion meetings, to arrive at the drafting and final approval of the document. The following five areas of investigation were identified: (1) The importance of management of anxiety and depressive disorders in pregnancy, identifying the risks associated with untreated maternal depression in pregnancy. (2) The assessment of the overall risk of malformations with the antidepressant and anxiolytic drugs used in pregnancy. (3) The evaluation of neonatal adaptation disorders in the offspring of pregnant antidepressant/anxiolytic-treated women. (4) The long-term outcome of infants' cognitive development or behavior after in utero exposure to antidepressant/anxiolytic medicines. (5) The evaluation of pharmacological treatment of opioid-abusing pregnant women with depressive disorders. Considering the state of the art, it is therefore necessary in the first instance to frame the issue of pharmacological choices in pregnant women who need treatment with antidepressant and anxiolytic drugs on the basis of data currently available in the literature. Particular attention must be paid to the evaluation of the risk/benefit ratio, understood both in terms of therapeutic benefit with respect to the potential risks of the treatment on the pregnancy and on the fetal outcome, and of the comparative risk between the treatment and the absence of treatment; in the choice prescription, the specialist needs to be aware of both the potential risks of pharmacological treatment and the equally important risks of an untreated or undertreated disorder.

Early intervention to prevent adverse child emotional and behavioural development following maternal depression in pregnancy: study protocol for a randomised controlled trial

BackgroundSubstantial evidence indicates that maternal depression during pregnancy (i.e., antenatal depression) is associated not only with maternal wellbeing but also with child emotional and behavioural development. Children of antenatally depressed women are at risk of emotional and behavioural problems, including internalising problems (e.g., anxiety and depression) and externalising problems (e.g., attention problems), that may last at least to adolescence. These enduring effects also constitute an enormous economic cost. Despite the seriousness of this problem, until recently there existed very few controlled studies evaluating whether active psychological treatment for antenatal depression can prevent adverse child outcomes. Our previous pilot randomised controlled trial (RCT) exploring the effect of cognitive behavioural therapy (CBT) for antenatal depression on child outcomes showed promising results. We aim to assess whether treating antenatal depression with an evidence-based 8-week structured CBT program can prevent or ameliorate adverse child developmental outcomes at 2 years of age.MethodsPregnant women ≤ 30 weeks gestation diagnosed with a depressive disorder are recruited and randomised to CBT or treatment as usual (TAU). The target sample size is 230 and the primary outcome measure is the infant Internalising scale of the Child Behaviour Checklist (CBCL) at 24 months of age. Secondary infant outcome measures at 24 months are the Externalising scale of the CBCL and the motor and cognitive development subscales of the Ages & Stages Questionnaire (ASQ-3). Additional secondary outcome measures are subscales of the Revised Infant Behaviour Questionnaire (IBQ-R), ASQ-3 and the ASQ-Socio-Emotional (ASQ-SE) at 3 and 12 months of age and the quality of mother-infant interaction at 3 and 24 months. Maternal measures, including demographic data, depression diagnosis, depressive and anxiety symptoms, perceived stress and parenting stress, are collected across all time points.DiscussionThe trial is ongoing and recruitment was slowed due to the COVID-19 pandemic. If results suggest a beneficial effect of antenatal depression treatment on infant outcomes, the project could have repercussions for standard antenatal care, for maternal and infant health services and for preventing the intergenerational transmission of mental health disorders.Trial registrationAustralia and New Zealand Clinical Trials Register: ACTRN12618001925235 Date Registered: 27 November 2018.

Exploring sex differences in fetal programming for childhood emotional disorders

In examining maternal depression, placental 11β-HSD2 mRNA expression and offspring cortisol regulation as a potential fetal programming pathway in relation to later child emotional disorders, it has become clear that sex differences may be important to consider. This study reports on data obtained from 209 participants in the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) recruited before 20 weeks of pregnancy. Maternal depressive disorders were diagnosed using the SCID-IV and maternal childhood trauma using the Childhood Trauma Questionnaire. Placental 11β-HSD2 mRNA was measured using qRT-PCR. For assessment of stress-induced cortisol reactivity, salivary cortisol samples were taken at 12 months of age. At 4 years of age, measurement of Childhood Emotional Disorders (depression and anxiety) was based on maternal report using the Preschool Age Psychiatric Assessment (PAPA) and internalizing symptoms using the Child Behavior Checklist (CBCL). Maternal depression in pregnancy and postpartum, and infant cortisol reactivity, was associated with internalizing symptoms for females only. For female offspring only, increased 12-month cortisol reactivity was also associated with increased emotional disorders at 4 years of age; however, there was no association with placental 11β-HSD2 mRNA expression. In females only, the combination of lower placental 11β-HSD2 mRNA expression and higher cortisol reactivity at 12 months of age predicted increased internalising problems. These findings suggest there may be sex differences in prenatal predictors and pathways for early childhood depression and anxiety symptoms and disorder.

COVID-19-related financial stress associated with higher likelihood of depression among pregnant women living in the United States.

ObjectivesThe COVID‐19 pandemic has led to unprecedented levels of unemployment and financial strain for many Americans. Among the individuals impacted by financial strain are pregnant women, for whom added financial stress may be particularly impactful due to the costs associated with prenatal care and providing for a newborn. Financial stress has been previously associated with elevated depression symptoms among pregnant women, which could have significant impacts on birth outcomes and long‐term offspring health. However, the impacts of COVID‐19‐associated financial stress on maternal depression in pregnancy has not been investigated.MethodsHere, we evaluated whether COVID‐19‐associated financial stress was associated with increased likelihood of a clinically significant depression score (Edinburgh Postnatal Depression Score ≥ 15) among pregnant women living in the United States during the COVID‐19 pandemic. Data come from an online survey administered to a convenience sample in April 2020 (N = 2099).ResultsForty‐three percent of participants reported experiencing financial stress as a result of the pandemic, while 24% of participants had a clinically significant depression score. COVID‐19‐related financial stress was significantly associated with increased likelihood of a clinically significant depression score, even after adjustment for covariates including participant education and income (adjusted Odds Ratio: 2.23, 95% CI = 1.80, 2.77, P < .001).ConclusionsFinancial stress caused by the COVID‐19 pandemic is associated with more than two times the likelihood of depression during pregnancy, which could impact birth outcomes and long‐term offspring health.

The effects of exposure to fluoxetine during lactation on testicular tissue and sperm parameters in mice offspring.

Fluoxetine is a selective serotonin reuptake inhibitor is commonly prescribed to treat maternal depression in pregnancy and lactation. This study aimed to investigate the effects of maternal exposure to fluoxetine via lactation on testicular tissue, sperm parameters including count, motility, viability, and normal morphology and testicular oxidative stress status in male mice offspring. Ten mice dams were divided into control and experimental groups. The control group received water and the experimental group received fluoxetine (20.00 mg kg-1) by gavage daily from postnatal days of 0-21. Histology of testis, sperm parameters and oxidative stress in the testicular tissue were analyzed at 80 days after birth in their male offspring (n = 8). Significant reductions in the body and testes weights were observed in animals exposed to fluoxetine. Additionally, fluoxetine exposure significantly reduced all sperm parameters, tubular diameter and epithelial height of the seminiferous tubules as well as Leydig cells number. Significant increases in the testicular malondialdehyde levels and percentage of sperm with chromatin/DNA damage were observed in mice exposed to fluoxetine compared to control. These findings suggest that maternal exposure to fluoxetine during lactation in mice has a negative effect on the testicular tissue of their offspring and impairs the spermatogenesis process which in turn can induce infertility.

The Consistency of Maternal Childhood Abuse Reporting in Pregnancy and the Postpartum Period.

Background: Toxic stress resulting from childhood abuse can lead to poorer physical and mental health for pregnant women and their unborn children. To provide a clinical response to these experiences, momentum to incorporate questionnaires about childhood adversity, including abuse, into patient care is building. Limiting factors to this initiative are concerns regarding the consistency of abuse reporting before age 18. The current study evaluated the consistency of retrospective child abuse reports using two different questionnaires and examined factors that predict inconsistency. Method: A sample of 1,912 women from a prospective longitudinal birth cohort reported on physical, sexual, and emotional abuse experienced before age 18 at 34-36 weeks of pregnancy using an extended questionnaire and again at 36 months postpartum using a short-form questionnaire. Psychosocial factors, including depression, anxiety, stress, and social support at both time points were assessed as predictors of potential inconsistency. Results: The majority of women were consistent in their child abuse reporting from pregnancy to the postpartum period (65.1%-90%). Higher rates of childhood abuse were reported in the postpartum period. Multivariable logistic regression revealed that higher maternal depression in pregnancy (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.01-1.08) predicted inconsistency in report of all abuse experiences, while higher social support in pregnancy predicted less inconsistency in physical abuse (OR = 0.99, 95% CI = 0.98-0.99) in particular. Higher postpartum social support was associated with less inconsistency overall, whereas higher depression was associated with increased inconsistency in physical abuse reporting (OR = 1.03, 95% CI = 1.01-1.06). Conclusions: Upon reevaluation, a questionnaire with clear adversity descriptions yielded greater retrospective reports of childhood abuse in the postpartum period. Women of higher psychosocial risk may be at greatest risk of inconsistent abuse reports. Thus, the questionnaire structure and individual characteristics of the reporter may play an important role in the report obtained.

Iron Deficiency and Risk of Maternal Depression in Pregnancy: An Observational Study.

Maternal depression during pregnancy can affect both the mother and her family. Although research has suggested that iron deficiency is associated with depression in the general population, this link has not been examined during the antenatal period. Our objective was to determine whether iron deficiency is associated with maternal depression during middle to late pregnancy. A retrospective study was conducted using the medical records of patients seen at the Women's Health Concerns Clinic at St. Joseph's Healthcare Hamilton in Hamilton, Ontario between 2009 and 2016. Women with serum ferritin data during middle to late pregnancy (>20 weeks' gestation) (N = 142) were categorized as either iron deficient (ferritin <12 µg/L) or iron sufficient. Edinburgh Postnatal Depression Scale (EPDS) scores and the odds of developing antenatal depression (EPDS ≥12) between the two groups were compared. Iron deficient pregnant women scored significantly higher on the EPDS (10.14 ± 5.69 vs. 7.87 ± 5.75; P = 0.03) and were more likely to develop antenatal depression (45% vs. 25%; P = 0.02) compared with women who were not. The odds of developing antenatal depression were two and one half times higher among iron deficient women (adjusted OR 2.51; 95% CI 1.14-5.52). These findings suggest that iron deficiency is associated with higher levels of depression during pregnancy. Although these results require replication, iron deficiency may be an important risk factor for maternal depression during pregnancy.

707: Association of maternal depression in pregnancy with clinical pathways of preterm birth

707: Association of maternal depression in pregnancy with clinical pathways of preterm birth

757: Maternal depression in pregnancy and its association with adverse perinatal outcomes

757: Maternal depression in pregnancy and its association with adverse perinatal outcomes

Maternal depression during pregnancy and offspring depression in adulthood: role of child maltreatment.

BackgroundStudies have shown that maternal depression during pregnancy predicts offspring depression in adolescence. Child maltreatment is also a risk factor for depression.AimsTo investigate (a) whether there is an association between offspring exposure to maternal depression in pregnancy and depression in early adulthood, and (b) whether offspring child maltreatment mediates this association.MethodProspectively collected data on maternal clinical depression in pregnancy, offspring child maltreatment and offspring adulthood (18–25 years) DSM-IV depression were analysed in 103 mother–offspring dyads of the South London Child Development Study.ResultsAdult offspring exposed to maternal depression in pregnancy were 3.4 times more likely to have a DSM-IV depressive disorder, and 2.4 times more likely to have experienced child maltreatment, compared with non-exposed offspring. Path analysis revealed that offspring experience of child maltreatment mediated the association between exposure to maternal depression in pregnancy and depression in adulthood.ConclusionsMaternal depression in pregnancy is a key vulnerability factor for offspring depression in early adulthood.

Family Socioeconomic Position as a Moderator of the Association Between Parental Psychopathology and Children's Outcomes: Data From France

Parental psychopathology is a known risk factor of psychological and behavioral difficulties in the offspring, however several questions regarding the nature of this relationship are yet unanswered. First, it is not clear whether the timing of parental psychopathology is relevant and particularly whether pregnancy is a period of particular vulnerability. Second, the age when the relationship between parental psychopathology and children's behavior can be observed is not yet determined. Third, the association between parental psychopathology and children's outcomes is heterogeneous, and may vary with other factors including family socioeconomic position. Based on data from the French EDEN cohort study (2000 mother-child pairs followed from pregnancy onwards, since 2004-2006), this presentation will examine the longitudinal association between maternal depression and tobacco use and children's temperament (assessed by the EAS scale at age 18 months) and psychological difficulties (assessed by the SDQ at age 3 and 5 years), as well as the moderating role of familial socioeconomic factors. Findings show that maternal tobacco use in pregnancy as well as maternal depression in pregnancy or persistent over time are associated with children's difficult temperament and behavioral difficulties (particularly symptoms of hyperactivity and inattention). Associations between maternal addictive behaviors and depression and children's outcomes may be stronger in case of family socioeconomic difficulties. These results highlight the importance of tobacco use in pregnancy and depressive symptoms that may be of subclinical level with regard to children's behavioral outcomes. The intergenerational transmission of psychopathology may be heightened in case of socioeconomic difficulties.

Estimating the Economic Costs of Antidepressant Discontinuation during Pregnancy

Depression is a major public health concern that results in a wide range of economic costs to people, their families, and the health care system. Our study sought to determine the direct medical costs incurred by the Ontario government owing to cessation of antidepressant therapy during pregnancy. We conducted an economic evaluation by making assumptions based on data obtained from Statistics Canada, federal and provincial government reports, and relevant depression literature. The analysis included the number of pregnant women with depression residing in Ontario and, subsequently, the number of those women who experienced depressive relapse during pregnancy owing to discontinuation of antidepressant medication. The cost of physician services, hospitalizations, and the birth of preterm and low birth weight infants (2 adverse outcomes associated with untreated depression during pregnancy) were also taken into consideration. An estimated 2953 pregnant women with depression in Ontario annually discontinue antidepressant therapy and subsequently have a depressive relapse. An estimated $20 546 982 is spent annually in Ontario on untreated maternal depression in pregnancy; this is the total after subtracting the cost of risks associated with treated depression during pregnancy ($3 144 053). Safe treatment options for the management of depression during pregnancy should be actively explored as treated depression translates into cost savings for the Ontario government and society as a whole. Beyond this cost, depression interferes with the quality of childrearing, maternal responsiveness to infants, and other determinants essential for optimal child development.

The Impact of Maternal Depression in Pregnancy on Early Child Development

Postpartum depression – a common condition – has been associated with developmental problems in the offspring of affected women. Because many women who are depressed following childbirth also were depressed while pregnant, a study was planned to examine the relationship, if any, between depressive symptoms during pregnancy and child development at age 18 months. This prospective cohort study, the Avon Longitudinal Study of Parents and Children, enrolled 9244 pregnant women and children. Data were collected at 18 and 32 weeks’ gestation and 8 weeks and 8 months postnatally using a self-report measure of depression, the Edinburgh Postnatal Depression Scale. The major measure of outcome at age 18 months was a modified Denver Development Screening Test. The overall incidence of developmental delay in these children was 9%. Fourteen percent of women were depressed on at least one occasion antenatally but not at either of the postnatal assessments. Another 5% of women were depressed postnatally but not before childbirth. Only 1.4% of women were depressed both before and after giving birth. Persistent depression (both preand postpartum) was associated with developmental delay; the odds ratio was 1.34, with a 95% confidence interval of 1.11–1.62. These findings support the view that the mother’s psychological well-being during pregnancy has significant implications for the child’s development. Some changes in child development previously ascribed to postpartum depression may be in part a result of depressive symptoms during pregnancy. Obstetricians, midwives, and general practitioners all are able to take an active role in identifying maternal depression.

The impact of maternal depression in pregnancy on early child development

Postpartum depression in mothers is associated with developmental problems in their children. Many women who are depressed following childbirth are also depressed during pregnancy. The aim of this study was to examine the associations between maternal depressive symptoms during pregnancy and child development at 18 months of age. A prospective cohort study, Avon Longitudinal Study of Parents and Children. The former county of Avon, southwest England. All pregnant women in the defined area with delivery dates between April 1991 and December 1992, 9244 women and their children. Data were collected antenatally, at 18 and 32 weeks of gestation and at 8 weeks and 8 months postnatally, through postal questionnaires, including a self-report measure of depression (Edinburgh Postnatal Depression Scale [EPDS]). By the time their child was 18 months old, women completed five further questionnaires about their children's health and development. Child development at 18 months using a modified Denver Developmental Screening Test (modified DDST). Applying the standard 12/13 cutoff, 1565 (14%) women were depressed antenatally but not at either time-points postnatally. Employing the modified DDST, 893 (9%) children were developmentally delayed at 18 months of age. Persistent depression (EPDS > or = 10 at both time-points) is associated with developmental delay (adjusted OR 1.34, 95% CI 1.11-1.62). Applying the 12/13 and 14/15 cutoffs gave similar results. After further adjustment for postnatal depression, the effect sizes were slightly attenuated. These findings highlight the importance of depression in pregnancy. Some effects on child development attributed to postpartum depression are caused in part by depressive symptoms during pregnancy.