Perinatal Mood Disorders Research Articles

A Systemwide Postpartum Inpatient Maternal Mental Health Education and Screening Program

ObjectiveTo expand a hospital system’s maternal mental health program to standardize screening for perinatal mood and anxiety disorders. DesignQuality improvement initiative using a continuous Plan–Do–Study–Act (PDSA) cycle. Setting/Local ProblemIn a hospital system consisting of 66 maternity care centers across the United States, there was significant variation in maternal mental health screening, referral, and education practices. The COVID-19 pandemic and increasing rates of severe maternal morbidity further elevated system-level concern about the quality of maternal mental health care being provided. ParticipantsPerinatal nurses. MethodsAn “all-or-none” bundle methodology was used to measure adherence to a system standard for maternal mental health screening, referral, and education. InterventionsA toolkit was designed internally to support streamlined implementation and ensure standardization for screening, referral, and education. This comprehensive toolkit includes screening forms, a referral algorithm, staff education, patient education literature, and a community resource list template. Training on how to use the toolkit was provided to nurses, chaplains, and social workers. ResultsThe initial system bundle adherence rate was 76% (2017) in the first year of the program. The following year, the bundle adherence rate increased to 97% (2018). Despite the disruption caused by the COVID-19 pandemic, this mental health initiative has maintained an overall adherence rate of 92% (2020–2022). ConclusionThis nurse-led quality improvement initiative has been successfully implemented across a geographically and demographically diverse hospital system. The initial and sustained high rates of adherence with the system standard for screening, referral, and education illustrate perinatal nurses’ commitment to the delivery of high-quality maternal mental health care in the acute care setting.

The Association of Perceived Labor Agentry and Depression and/or Anxiety.

Pregnancies complicated by perinatal mood disorders or a history of mental health disorder are at increased risk for complications including postpartum depression/anxiety. Patients' perceived control over childbirth is known to be an important factor for development of postpartum depression/anxiety. It is unclear whether women with preexisting and/or current depression and/or anxiety have different perceptions of control during childbirth compared with those without these comorbidities. This study aimed to evaluate the association between a current and/or prior diagnosis of depression and/or anxiety and scores on the Labour Agentry Scale (LAS), a validated tool evaluating patient's experience of control over their labor and delivery. This is a cross-sectional study of nulliparous patients admitted at term to a single center. Participants completed the LAS after delivery. A trained researcher performed detailed chart reviews for all participants. Participants were identified as having a current or historical diagnosis of depression/anxiety by self-report confirmed by chart review. Scores on the LAS were compared between those with versus without a diagnosis of depression/anxiety prior to admission for delivery. A total of 73 (44.8%) of the 149 participants held a current and/or prior diagnosis of depression and/or anxiety. Baseline demographics were similar between those with and without depression/anxiety. Mean scores on the LAS (range: 91-201) were significantly lower for those with depression/anxiety than those without a prior diagnosis (150.0 vs. 160.5, p < 0.01). Even after controlling for mode of delivery, admission indication, anesthesia, and Foley balloon usage, participants with anxiety and depression had scores that were on average 10.4 points lower on the LAS (95% confidence interval: -19.25, -1.62). Participants with a current and/or prior diagnosis of depression and/or anxiety scored lower on the LAS as compared with those without psychiatric diagnoses. Patients with psychiatric diagnoses may benefit from increased education and support during childbirth. · Control over childbirth is an important factor in the development of postpartum depression/anxiety.. · Patients with a prior or current diagnosis of anxiety and depression have lower labor agentry scores.. · These differences remained significant even when controlling for confounders such as delivery mode..

A Probiotic Intervention With Bifidobacterium longum NCC3001 on Perinatal Mood Outcomes (PROMOTE Study): Protocol for a Decentralized Randomized Controlled Trial.

Perinatal mood disorders such as depression and anxiety are common, with subclinical symptomology manifesting as perinatal mood disturbances being even more prevalent. These could potentially affect breastfeeding practices and infant development. Pregnant and lactating women usually limit their exposure to medications, including those for psychological symptoms. Interestingly, the naturally occurring probiotic Bifidobacterium longum (BL) NCC3001 has been shown to reduce anxious behavior in preclinical models and feelings of low mood in nonpregnant human adults. During the COVID-19 pandemic, mental health issues increased, and conventionally conducted clinical trials were restricted by social distancing regulations. This study, Probiotics on Mothers' Mood and Stress (PROMOTE), aimed to use a decentralized clinical trial design to test whether BL NCC3001 can reduce symptoms of depression, anxiety, and stress over the perinatal period. This double-blind, placebo-controlled, randomized, and 3-parallel-arm study aimed to recruit 180 women to evaluate the efficacy of the probiotic taken either during pregnancy and post partum (from 28-32 weeks' gestation until 12 weeks after delivery; n=60, 33.3%) or post partum only (from birth until 12 weeks after delivery; n=60, 33.3%) in comparison with a placebo control group (n=60, 33.3%). Participants consumed the probiotic or matched placebo in a drink once daily. Mood outcomes were measured using the State-Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale questionnaires, captured electronically at baseline (28-32 weeks' gestation) and during e-study sessions over 5 further time points (36 weeks' gestation; 9 days post partum; and 4, 8, and 12 weeks post partum). Saliva and stool samples were collected longitudinally at home to provide mechanistic insights. In total, 520 women registered their interest on our website, of whom 184 (35.4%) were eligible and randomized. Of these 184 participants, 5 (2.7%) withdrew after randomization, leaving 179 (97.3%) who completed the study. Recruitment occurred between November 7, 2020, and August 20, 2021. Advertising on social media brought in 46.9% (244/520) of the prospective participants, followed by parenting-specific websites (116/520, 22.3%). Nationwide recruitment was achieved. Data processing is ongoing, and there are no outcomes to report yet. Multiple converging factors contributed to speedy recruitment and retention of participants despite COVID-19-related restrictions. This decentralized trial design sets a precedent for similar studies, in addition to potentially providing novel evidence on the impact of BL NCC3001 on symptoms of perinatal mood disturbances. This study was ideal for remote conduct: because of the high digital literacy and public trust in digital security in Singapore, the intervention could be self-administered without regular clinical monitoring, and the eligibility criteria and outcomes were measured using electronic questionnaires and self-collected biological samples. This design was particularly suited for a group considered vulnerable-pregnant women-during the challenging times of COVID-19-related social restrictions. ClinicalTrials.gov NCT04685252; https://clinicaltrials.gov/ct2/show/NCT04685252. DERR1-10.2196/41751.

Feasibility and impact of a mental health chatbot on postpartum mental health: a randomized controlled trial

Perinatal mood disorders are common yet underdiagnosed and un- or undertreated. Barriers exist to accessing perinatal mental health services, including limited availability, time, and cost. Automated conversational agents (chatbots) can deliver evidence-based cognitive behavioral therapy content through text message-based conversations and reduce depression and anxiety symptoms in select populations. Such digital mental health technologies are poised to overcome barriers to mental health care access but need to be evaluated for efficacy, as well as for preliminary feasibility and acceptability among perinatal populations. To evaluate the acceptability and preliminary efficacy of a mental health chatbot for mood management in a general postpartum population. An unblinded randomized controlled trial was conducted at a tertiary academic center. English-speaking postpartum women aged 18 years or above with a live birth and access to a smartphone were eligible for enrollment prior to discharge from delivery hospitalization. Baseline surveys were administered to all participants prior to randomization to a mental health chatbot intervention or to usual care only. The intervention group downloaded the mental health chatbot smartphone application with perinatal-specific content, in addition to continuing usual care. Usual care consisted of routine postpartum follow up and mental health care as dictated by the patient's obstetric provider. Surveys were administered during delivery hospitalization (baseline) and at 2-, 4-, and 6-weeks postpartum to assess depression and anxiety symptoms. The primary outcome was a change in depression symptoms at 6-weeks as measured using two depression screening tools: Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale. Secondary outcomes included anxiety symptoms measured using Generalized Anxiety Disorder-7, and satisfaction and acceptability using validated scales. Based on a prior study, we estimated a sample size of 130 would have sufficient (80%) power to detect a moderate effect size (d=.4) in between group difference on the Patient Health Questionnaire-9. A total of 192 women were randomized equally 1:1 to the chatbot or usual care; of these, 152 women completed the 6-week survey (n=68 chatbot, n=84 usual care) and were included in the final analysis. Mean baseline mental health assessment scores were below positive screening thresholds. At 6-weeks, there was a greater decrease in Patient Health Questionnaire-9 scores among the chatbot group compared to the usual care group (mean decrease=1.32, standard deviation=3.4 vs mean decrease=0.13, standard deviation=3.01, respectively). 6-week mean Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7 scores did not differ between groups and were similar to baseline. 91% (n=62) of the chatbot users were satisfied or highly satisfied with the chatbot, and 74% (n=50) of the intervention group reported use of the chatbot at least once in 2 weeks prior to the 6-week survey. 80% of study participants reported being comfortable with the use of a mobile smartphone application for mood management. Use of a chatbot was acceptable to women in the early postpartum period. The sample did not screen positive for depression at baseline and thus the potential of the chatbot to reduce depressive symptoms in this population was limited. This study was conducted in a general obstetric population. Future studies of longer duration in high-risk postpartum populations who screen positive for depression are needed to further understand the utility and efficacy of such digital therapeutics for that population.

Videoconference-delivered group acceptance commitment therapy for perinatal mood and anxiety disorders: facilitators views and recommendations

ABSTRACT Objectives To examine, in depth, the perspectives of facilitators of a videoconference-delivered group Acceptance Commitment Therapy (ACT) intervention for perinatal women with moderate-severe mood and/or anxiety disorders. Design Qualitative study. Methods Thematic analysis was used to analyse semi-structured interviews with seven facilitators and post-session reflections with six facilitators. Results Four themes were generated. First, there are barriers to accessing psychological therapies during the perinatal period and improvements are required. Second, COVID-19 has accelerated the provision of remote therapies, including videoconference-delivered group therapy, enabling a continuity of service, and facilitating diversification of treatment access and choice. Third, there are benefits of videoconference-delivered group ACT in the perinatal period, with reservations. Attending a group via videoconference is perceived to be less exposing, and offers normalisation, social support, empowerment, and flexibility. Facilitators also shared reservations including whether service users would prioritise videoconference-delivered group therapy, concerns about limited non-verbal cues and the therapeutic alliance, reporting a lack of an evidence base, and technology challenges when working online. Finally, facilitators offered recommendations for videoconference-delivered group therapy best practice in the perinatal period, including the provision of equipment and data, contracts for attendance and suggestions to maximise engagement and group cohesion. Conclusions This study raises important considerations regarding the use of videoconference-delivered group ACT in the perinatal context. There are opportunities afforded by videoconference-delivered group therapies, which is important and timely given the increased drive towards improving access to perinatal services and psychological therapies, and the need for ‘COVID-proof’ therapies. Recommendations for best practice are offered.

Clinical Application of Narrative Therapy in the Treatment of Perinatal Mood and Anxiety Disorder

Pregnancy and postpartum are full of developmental change for both women and their families. Family members are adjusting to their new roles in the family and women are beginning to define their abilities as a mother and caretaker. For some women, their experience during this time is convoluted by the experience of a perinatal mood and/or anxiety disorder (PMAD). In these cases, women's self of competency or mastery in their role as a mother can become entangled, leading to insecurities along with their depression or anxiety symptoms. Medication treatments and psychotherapy interventions have been established to address the mood and anxiety symptoms and to support the family system. However, a treatment is needed that addresses the PMAD symptoms and the internalization of women's feelings and emotions experienced during this impressionable and often defining time. In this article, we explore the use of Narrative Family Therapy as a way to help women deconstruct unhelpful narratives they may have created during pregnancy and postpartum. A case study is provided to illustrate how Narrative Family Therapy can be used to emotionally reauthor women's stories, and construct new meanings by separating their PMAD symptoms from their identity as a mother.

Perinatal Mental Health Disorders: A Review of Lessons Learned from Obstetric Care Settings.

Perinatal mental health has garnered significant attention within obstetrics over the last couple of decades as the long- and short-term morbidities of untreated perinatal mental health disorders on both the mother and fetus/neonate have become increasingly apparent. There have been major strides in increasing screening for perinatal mental health disorders, clinician comfort with prescribing common psychiatric medications, and integrating mental health professionals into prenatal care via health services approaches such as the collaborative care model. Despite these advances, however, gaps still remain in the tools used for screening and diagnosis, obstetric clinician training in diagnosis and management of perinatal mood and anxiety disorders, as well as patient access to mental health care during pregnancy and especially postpartum. Herein we review the state of perinatal mental health from the perspective of the obstetric provider and identify areas of ongoing innovation.

Perinatal mood and anxiety disorders: biomarker discovery using plasma proteomics

Perinatal mood and anxiety disorders encompass a range of mental health disorders that occur during pregnancy and up to 1 year postpartum, affecting approximately 20% of women. Traditional risk factors, such as a history of depression and pregnancy complications including preeclampsia, are known. Their predictive utility, however, is not specific or sensitive enough to inform clinical decision-making or prevention strategies for perinatal mood and anxiety disorders. Better diagnostic and prognostic models are needed for early identification and referral to treatment. This study aimed to determine if a panel of novel third-trimester plasma protein biomarkers in pregnant women can be used to identify those who have a high predisposed risk for perinatal mood and anxiety disorders within 3 months postpartum. We studied 52 women (n=34 with a risk for perinatal mood and anxiety disorders and n=18 controls) among whom mental health screening was conducted at 2 time points, namely in the third trimester and again at 3 months postdelivery. An elevated perinatal mood and anxiety disorder risk was identified by screening individuals with above-validated cutoffs for depression (Edinburgh Postnatal Depression Scale ≥12), anxiety (Overall Anxiety Severity and Impairment Scale ≥7), and/or posttraumatic stress disorder (Impact of Events Scale >26) at both time points. Plasma samples collected in the third trimester were screened using the aptamer-based SomaLogic SomaScan proteomic assay technology to evaluate perinatal mood and anxiety disorder-associated changes in the expression of 1305 protein analytes. Ingenuity Pathway Analysis was conducted to highlight pathophysiological relationships between perinatal mood and anxiety disorder-specific proteins found to be significantly up- or down-regulated in all subjects with perinatal mood and anxiety disorder and in those with perinatal mood and anxiety disorders and no preeclampsia. From a panel of 53 significant perinatal mood and anxiety disorder-associated proteins, a unique 20-protein signature differentiated perinatal mood and anxiety disorder cases from controls in a principal component analysis (P<.05). This protein signature included NCAM1, NRCAM, and NTRK3 that converge around neuronal signaling pathways regulating axonal guidance, astrocyte differentiation, and maintenance of GABAergic neurons. Interestingly, when we restricted the analysis to subjects without preeclampsia, a 30-protein signature differentiated perinatal mood and anxiety disorder cases from all controls without overlap on the principal component analysis (P<.001). In the nonpreeclamptic perinatal mood and anxiety disorder group, we observed increased expression of proteins, such as CXCL11, CXCL6, MIC-B, and B2MG, which regulate leucocyte migration, inflammation, and immune function. Participants with perinatal mood and anxiety disorders had a unique and distinct plasma protein signature that regulated a variety of neuronal signaling and proinflammatory pathways. Additional validation studies with larger sample sizes are needed to determine whether some of these molecules can be used in conjunction with traditional risk factors for the early detection of perinatal mood and anxiety disorders.

Addressing Perinatal Mood and Anxiety Disorders (PMADs) in rural places: A knowledge infrastructure

Researchers and policymakers concerned with Addressing Perinatal Mood and Anxiety Disorders (PMADs) in rural places tend to implicitly center on rural physical and informational infrastructures. As a result, distance, professional shortages, and digital barriers are largely foregrounded in recommended interventions and initiatives. This manuscript recognizes but also exceeds these dimensions by turning to “knowledge infrastructure.” As we demonstrate, a knowledge infrastructure framework illuminates the often-overlooked relationships, routine interactions, and non-dominant forms of expertise that enable a wide range of stakeholders, including but not limited to medical professionals, to mitigate many of the risks and barriers associated with perinatal mental health care in rural spaces. Bringing together anthropological theory, health policy, and qualitative interviews with over 75 individuals across a rural region in the U.S., our findings outline the ways in which critical mental health supports reach diverse perinatal individuals, shape community awareness, and reflect trusted forms of expertise in an otherwise professionally and socio-economically marginalized rural context. By presenting these data through a knowledge infrastructure framework, this manuscript highlights novel practices and new entry points for meaningful, rurallyrelevant interventions that benefit individual health and community wellbeing.

Психосоматические расстройства, ассоциированные с функциональными нарушениями репродуктивной системы женщины в различные возрастные периоды

Psychosomatic disorders, along with other medical, somatic, and socio-economic issues, play an important role in fertility decline worldwide. Research has conclusively shown that there is a two-way relationship between a women’s reproductive function and mental health, necessitating the development of interdisciplinary teams that include gynecologists, reproductive and mental health specialists. Objective. To identify the main forms of psychosomatic disorders related to changes in the female reproductive system. It was shown that psychosomatic disorders can manifest in close connection with the menstrual cycle (stress-induced menstrual disorders, premenstrual dysphoric disorder), during pregnancy and postpartum (perinatal mood disorders, primarily depression), and during the menopausal period (involutional hysteria and involutional melancholia). Data are presented on the prevalence of the disorders discussed, their pathogenesis, clinical presentation, and approaches to diagnosis. Key words: psychosomatics, reproductive health, hypothalamic amenorrhea, premenstrual dysphoric disorder, perinatal depression, climacteric syndrome.

Anxiety and perinatal mood disorders in patients with and without a history of preterm birth

Anxiety and perinatal mood disorders in patients with and without a history of preterm birth

Implementing an Undergraduate Nursing Elective Advanced Perinatal Course and Its Effect on Perceived Perinatal Nursing Knowledge and Self-Efficacy Levels of Students Who Aim to Enter a Perinatal Specialty as New Graduate Nurses

Nursing schools face challenges within maternal/newborn practicum courses for undergraduate nursing students, such as a lack of consistent clinical sites or experiences that capture the high acuity needs of perinatal environments. Additionally, perinatal units face challenges in orienting and retaining new graduate nurses, while new graduate nurses entering perinatal units may be likely to experience feelings of insecurity or self-doubt due to perceived inadequate preparation for such specialties (Lesher et al., 2021). There are multiple negative impacts that may stem from a lack of confident and competent novice perinatal nurses. The rise in maternal morbidity and mortality rates in the United States are of particular concern, and knowledge gaps on behalf of novice perinatal nurses may result in the lack of skills and confidence in recognizing complications and intervening appropriately, potentially jeopardizing patient safety. The literature suggests that perinatal units face challenges in effectively orientating new graduate nurses, leading to burnout and financial burdens (Dickerson et al., 2022). Recognizing the potential benefits of improving preparation for students interested in entering a perinatal specialty as new graduates, such as improved patient outcomes and increased staff retention, this study aims to analyze the impact of an elective advanced perinatal course on student perception of knowledge and self-efficacy levels for those who aim to enter a perinatal specialty as a new graduate nurse. Content will be focused on advancing knowledge of normal physiologic birth, high-risk obstetrical and newborn considerations, obstetric emergencies, perinatal mood and anxiety disorders, bereavement care, diversity/equity/inclusion care, and resiliency tips.

Systematic Review of Online Interventions to Reduce Perinatal Mood and Anxiety Disorders in Underserved Populations.

Systematic Review of Online Interventions to Reduce Perinatal Mood and Anxiety Disorders in Underserved Populations.

Symptoms of perinatal mood disorders in expectant parents with a diagnosis of a congenital anomaly

Symptoms of perinatal mood disorders in expectant parents with a diagnosis of a congenital anomaly

The first trimester plasma copper-zinc ratio is independently related to pregnancy-specific psychological distress symptoms throughout pregnancy

ObjectivesHigh plasma copper (Cu) and low zinc (Zn) levels have been associated with depression. However, most studies used low sample sizes and a cross-sectional design, and perinatal data are scarce. We investigated the possible association between pregnancy-specific psychological distress and the plasma CuZn ratio using a prospective design. MethodsPregnancy-specific distress symptoms were assessed at each trimester by means of the Tilburg Pregnancy Distress Scale, negative affect subscale, in 2036 pregnant women. Cu and Zn were assessed at 12 wk of gestation in plasma samples by inductively coupled plasma mass spectrometry. Growth mixture modeling determined trajectories of women's pregnancy-specific negative affect (P-NA) symptoms, which were entered in a multiple logistic regression analysis as dependent variable and the CuZn ratio as independent variable. ResultsTwo P-NA symptom classes were found: 1) persistently low (n = 1820) and 2) persistently high (n = 216). A higher CuZn ratio was independently associated with persistently high P-NA symptom scores (odds ratio = 1.52; 95% confidence interval, 1.13–2.04) after adjustment for confounders. A sensitivity analysis was performed excluding all women with high P-NA scores at 12 wk of gestation (>1 SD above the mean P-NA score). In the 1719 remaining women, a higher CuZn ratio significantly predicted the development of increasing P-NA symptom scores after adjustment for confounders (odds ratio = 1.40; 95% confidence interval, 1.04–1.95). ConclusionsA higher CuZn plasma ratio is an independent determinant of developing pregnancy-specific distress symptoms throughout pregnancy, suggesting that micronutrients could be used as novel biomarkers for psychological distress research of perinatal mood disorders.

Investigating the impact of eye movement desensitization and reprocessing (EMDR) in reducing birth trauma symptoms

Background: Childbirth-related traumatic experiences are an overlooked area of psychological suffering, often leading to Post-Traumatic Stress Disorder, Perinatal Mood and Anxiety Disorders, and difficulties in bonding between mother and baby. This study aimed to evaluate the effectiveness of Eye Movement Desensitization and Reprocessing as a brief psychological intervention in reducing Birth Trauma symptoms.&#x0D; Methodology: Using a prospective experimental longitudinal design, 12 women residing in Singapore with Birth Trauma symptoms received three 90-minute eye-movement and desensitization (EMDR) sessions over two weeks on average. Participants were assessed through two trauma self-report questionnaires and underwent a brief Autonomic Nervous System (ANS) assessment.&#x0D; Results: Post-treatment assessment showed significant differences in mean trauma scores with a 76% reduction on the Modified Perinatal PTSD Questionnaire (z = -3.061, p = .002) and 70% reduction on the Impact of Event Scale Revised (z = -3.061, p = 0.002). Skin conductance response changes from baseline to stressor reduced by 4% but were not statistically significant (z = -.863, p = 0.39).&#x0D; Conclusion: Brief EMDR has shown promise as an effective treatment for Birth Trauma. Larger controlled randomized studies are required to evaluate the effectiveness of EMDR when compared to a placebo control group.

Trauma-Informed Care for Obstetric and Gynecologic Settings.

Trauma is common among those seeking Ob-Gyn care and may have pervasive impact on obstetrical and gynecological health, social functioning, and healthcare engagement. While guidelines exist on the detection and treatment of perinatal mood and anxiety disorders within Ob-Gyn care, the role of Ob-gyn clinicians in identifying and addressing patients' traumatic experiences and related symptoms is less clearly delineated. This manuscript provides an overview of trauma-related symptoms in the context of Ob-Gyn care and practical guidance of clinicians aiming to improve their detection and response to trauma in their clinical practice. Posttraumatic stress disorder (PTSD) describes a psychiatric illness which develops as a response to a traumatic event. Women who have experienced trauma are also at increased risk for borderline personality disorder and other psychiatric comorbidities. Postpartum PTSD has particular relevance to obstetrical care. Screening for trauma in Ob-Gyn care can provide an opportunity to address risk and offer targeted intervention. Several brief evidence-based screening tools are available. Individuals who screen positive require assessment of immediate safety and targeted referrals. Trauma informed care describes an approach to healthcare aimed to enhance physical and emotional safety for patients and clinicians. Given the prevalence and the potentially devastating and enduring impact of trauma and trauma-related symptoms, there is a critical need to address trauma within Ob-Gyn care. By recognizing the signs of trauma and initiating or referring to appropriate treatments, Ob-Gyn clinicians have a unique opportunity to better understand their patients and to improve their care.

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

Gut microbiota: Linking nutrition and perinatal depression.

Perinatal depression is a mood disorder that is reported in women during pregnancy (prenatal) and after childbirth (postnatal). The onset of perinatal depression is associated with changes in reproductive hormones, stress hormones and neurosteroids. These chemical compounds can be modulated by the gut microbiota, which may affect maternal mental health during the perinatal period via the gut-brain-axis. Recent studies suggest that nutritional and dietary interventions (vitamin D, ω-3 fatty acids, iron, and fiber) effectively prevent or mitigate maternal depression and anxiety, but their efficacy is confounded by various factors, including the gut microbiota. Probiotics are efficacious in maintaining microbiota homeostasis, and thus, have the potential to modulate the development of perinatal mood disorders, despite no evidence in human. Therefore, clinical trials are warranted to investigate the role of probiotic supplementation in perinatal depression and behavioral changes. This article reviews the interplay between nutrition, gut microbiota and mood and cognition, and the evidence suggesting that probiotics affect the onset and development of perinatal depression.

No association between perinatal mood disorders and hypertensive pregnancies.

Mental health disorders such as anxiety and/or depression are the most common mental health disorders seen among reproductive aged women and can increase during pregnancy. Many sociodemographic risk factors have been associated with anxiety and/or depression in pregnancy, which can lead to adverse maternal and infant outcomes including the risk of a hypertensive pregnancy. The current study prospectively examined self-reported anxiety, depression and stress in pregnant women without a history of fetal loss or mood disorders beginning at 20–26 weeks. At each study visit, circulating immune factors associated with perinatal mood disorders were measured in blood samples that were collected. A total of 65 women were eligible for data analysis, 26 of which had hypertensive pregnancies. There was not a significant difference in self-reported depression, anxiety or stress between hypertensive disorders of pregnancy and normotensive women. Black women were more likely to have a hypertensive pregnancy and develop a perinatal mood disorder compared to non-black women. Both the inflammatory cytokines interleukin-17 and tumor necrosis factor-alpha were increased in patients with perinatal mood disorders. However, additional research is needed in a larger sample to truly understand the relationship between these factors along with the underlying etiologies and the associated outcomes.