Perinatal Mood Research Articles

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

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

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.
 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.
 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).
 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.

Support and services for perinatal low mood and depression: A qualitative study exploring women's and healthcare professionals' experiences.

This study aimed to explore women's experiences of support and care received from maternity healthcare professionals for perinatal low mood or depression, and healthcare professionals' experiences of providing support and care for women experiencing perinatal low mood or depression. In this qualitative study, face-to-face individual semistructured interviews and focus groups were conducted with 15 women and 19 healthcare professionals living or working in Yorkshire and the Humber, England in 2019. Thematic analysis was used to analyze the qualitative data. The following themes were identified: (1) lack of standardization in identification and support for perinatal low mood and depression; (2) unclear and nonstandardized pathways for perinatal low mood and depression; and (3) enablers and barriers of receiving support and care for perinatal low mood and depression. Providing training opportunities for healthcare professionals, especially midwives, may be helpful for filling the gray area for women who do not need a referral to mental health services but require support from healthcare professionals. Improving the variety of psychological therapies for the treatment of perinatal depression may also be helpful to meet women's expectations of treatments.

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

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

‘Call to action’ needed for improving perinatal MH programs

Although intensive perinatal mental health programs have expanded within the U.S. in recent years, too few of these programs serve women with perinatal mood and anxiety disorders (PMADs). Additionally, little is known about the programs, operations and services, the women who are served by them, and the methods of collecting outcome data, researchers stated in an open forum article published in the August issue of Psychiatric Services.

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.

Advocates call for designation of Black maternal mental health week

Black moms are at higher risk for perinatal mood and anxiety disorders than white moms, but are less likely to receive mental health treatment, according to the Shades of Blue Project, a Houston‐based nonprofit focused on improving maternal mental health outcomes for people of color. Black Maternal Mental Health Week was held July 19 through July 25. The weeklong event, hosted by the Shades of Blue project and supported by MomsRising, included an in‐person training session, a two‐day summit, a community awards brunch, and a walk and family fun day. It ended with a state of Black maternal mental health roundtable discussion. Moms, caregivers, organizational leaders and advocates support H.Res.1226, sponsored by Rep. Lisa Blunt Rochester (D‐Del.). This congressional resolution designates July 19 through July 25, 2022, as Black Maternal Mental Health Awareness Week. Among its provisions, the resolution is designed to raise public awareness and understanding around maternal mental health conditions and their disproportionate impact on Black birthing people and families. It also recognizes the need for culturally congruent treatment for maternal mental health conditions. “Our country urgently needs programs and policies that will improve Black moms’ mental health and address these shameful disparities,” stated Tina Sherman, senior campaign director for the maternal justice campaign at MomsRising.

Technology-Based Approaches for Supporting Perinatal Mental Health.

Purpose of ReviewThis review explores advances in the utilization of technology to address perinatal mood and anxiety disorders (PMADs). Specifically, we sought to assess the range of technologies available, their application to PMADs, and evidence supporting use.Recent FindingsWe identified a variety of technologies with promising capacity for direct intervention, prevention, and augmentation of clinical care for PMADs. These included wearable technology, electronic consultation, virtual and augmented reality, internet-based cognitive behavioral therapy, and predictive analytics using machine learning. Available evidence for these technologies in PMADs was almost uniformly positive. However, evidence for use in PMADs was limited compared to that in general mental health populations.SummaryProper attention to PMADs has been severely limited by issues of accessibility, affordability, and patient acceptance. Increased use of technology has the potential to address all three of these barriers by facilitating modes of communication, data collection, and patient experience.

The Lived Experience of Postpartum Anxiety During COVID-19: A Hermeneutic Phenomenological Study

The experience of pregnancy and postpartum anxiety disorders results in adverse birth outcomes and the disrupted development of infants and children. Since the COVID-19 Pandemic, the Centers for Disease Control and Prevention (CDC) has designated pregnant and postpartum women as more vulnerable to COVID-19 (CDC, 2021), and perinatal mood and anxiety disorders rates have increased. However, research regarding the lived experience of women with postpartum anxiety (PPA) during a global pandemic remains lacking. Using van Manen’s hermeneutic phenomenological research method, we interviewed eight women self-identifying as having had PPA during the COVID-19 pandemic. Analysis revealed five themes describing the lived experience of PPA during COVID-19: Wired, Trapped, Lost in Time, No Safety Net, and Doubting Myself. The lived experience of PPA was both mirrored and masked by the lived experience of a global pandemic, exacerbating PPA due to the unknown and constricting nature of the pandemic. These findings suggest the need for future research to include subjective human experiences as pivotal components in creating support practices and a deeper understanding of PPA in the context of unprecedented life events.

Prevalence of Perinatal Depression and Anxiety in Both Parents

New and expectant parents experience perinatal mood disorders, with consequences to parenting ability, bonding with the neonate, interpersonal relationships, and health and well-being of parents. Research shows that maternal and paternal perinatal mood disorders are associated, but no recent systematic review has addressed the prevalence of perinatal mood disorders in both mothers and fathers (parental dyad). To examine the prevalence of perinatal mood disorders in parental dyads and identify factors associated with perinatal mood disorders in parental dyads. Ovid (MEDLINE, Embase, and PsycINFO) and Web of Science were searched from January 1, 1990, to June 8, 2021, for observational studies reporting on the prevalence of perinatal depression or anxiety in a parental dyad. Studies reporting the prevalence of anxiety or depression in both members of a parental dyad were included, with diagnosis according to established criteria (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition], International Classification of Diseases, 11th Revision) or use of validated screening tools. Prevalence data were extracted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were analyzed in subgroups: antenatal depression, early postnatal depression (0-12 weeks), late postnatal depression (3-12 months), and perinatal anxiety. Pooled prevalence was calculated using a random-effects meta-analysis model. Quality assessment was performed using Joanna Briggs Institute Appraisal Checklist for Studies Reporting Prevalence Data. Data were analyzed in June 2021. Prevalence of perinatal anxiety and perinatal depression in parental dyads. Twenty-three studies were included, with data from 29 286 couples. The pooled prevalence of antenatal depression in both parents was 1.72% (95% CI, 0.96%-2.48%; P < .001). The prevalence of early postnatal depression (up to 12 weeks post partum) was 2.37% (95% CI, 1.66%-3.08%; P < .001) and the prevalence of late postnatal depression (3-12 months post partum) was 3.18% (95% CI, 2.3-4.05; P < .001). Only 3 studies reported on perinatal anxiety in both parents, precluding a quantitative analysis. In up to 3.18% of couples, both parents may concurrently experience perinatal depression. Perinatal health care must consider the mental health needs of parents, both as individuals and as a parental dyad. Further research is needed to examine outcomes in families where both parents experience perinatal mood disorders.

A Pregnant Pause: System-Level Barriers to Perinatal Mental Health Care.

Perinatal mood and anxiety disorders, defined as mood and anxiety disorders during pregnancy and the year following birth, affect one in five pregnant and postpartum individuals in the United States and are associated with substantial morbidity and mortality for both pregnant individuals and their infants. Despite this tremendous prevalence and associated disease burden, the overwhelming majority of those affected do not receive treatment. Although prior research has identified several patient-level barriers to effective treatment, the contributions of system-level factors have been underappreciated. We present a pilot study using a simulated patient approach to describe the accessibility and affordability of mental health care through the 18 clinics affiliated with U.S. reproductive psychiatry fellowship programs. Based on our experience, a prospective patient seeking care from these 18 clinics without a prior referral would only have been successful half of the time-and even then may have to wait as long as 2 months for an initial appointment. These data underscore the need for clinicians, public health professionals, and institutions to address system-level barriers that undermine effective referrals for care, including implementing "warm-handoffs" to mental health providers and ending practices that restrict appointments to existing patients within a health care system. They also reinforce the importance of contemporary federal policy efforts to address maternal health, particularly among low-income and racially minoritized communities. Key policies include expanding postpartum insurance coverage, which plays a critical role in reducing insurance disruptions that can undermine the accessibility of mental health care and other vital health services.

Premenstrual syndrome as a possible presymtomatic marker for negative outcomes of pregnancy

IntroductionHungarian Family Planning Service’s mission is decreasing the negative outcomes of pregnancy, including perinatal depression.ObjectivesChildbirth as a great irreversible life event is a normative crisis of the life, thus pregnancy and post-partum period are times of high risk for psychiatric symptoms. Stress in pre- and post-natal period has short and long-term effect on offspring. Women participating in family planning program should be evaluated for the high risk and specific preventive program are provided for them.MethodsBetween 2015-2018, 446 women were participating in family planning service. They were screened for premenstrual syndrome by using the shortened form of PAF questionnaire. We compared healthy and PMS affected patients’ data in according to the prevalence of PPD, spontaneous abortion and period needed for conception.ResultsPrevalence of PMS in our sample was 51.4%. Overage duration between wished and realized conception was 6.1 months in healthy group vs 9.2 months in PMS group. Post-natal depression was screened by Edinburgh Post-natal Scale and it showed about 4-times higher prevalence between affected women by PMS. Surprising the rate of spontaneous abortion was 2-times higher, although the absolute number is rather low for statistical validation.ConclusionsWomen affected by PMS can be considered as high risk for perinatal mood disorders and negative outcomes of pregnancy. PMS can be useful as a presymptomatic marker of perinatal depression and may be increased risk for spontaneous abortion. Psychological aspect should be included into the periconceptional care. Family planning may be an optimal solution to prevent perinatal depression and its complication.DisclosureNo significant relationships.

Faith Practices Reduce Perinatal Anxiety and Depression in Muslim Women: A Mixed-Methods Scoping Review.

Higher rates of depression and anxiety are reported among women who belong to racial and ethnic minority groups, contributing to adverse birth outcomes, and remains a taboo topic within the global Muslim community. Non-pharmacological coping mechanisms such as prayer may be employed to reduce perinatal depression and anxiety, however the literature is sparse on the use of this intervention among pregnant Muslim women. Therefore, we aimed to conduct a scoping review examining the use of Muslim faith practices on anxiety and depression in perinatal period. Nine studies were identified that demonstrate that Muslim faith practices reduce perinatal anxiety and depression symptoms. These studies demonstrate that prayers and other faith-based practices, including reciting parts of the Quran, saying a Dua, and listening to audio recordings of prayers are all effective in decreasing anxiety, depression, stress, pain and fear in Muslim women during pregnancy, during childbirth, during an unexpected cesarean section, and when experiencing infant loss. Despite the scoping review's small sample size, findings confirm that incorporation of faith practices effectively reduces perinatal depression and anxiety among Muslim women and should be utilized in clinical settings for non-pharmacological management of perinatal mood disorders.

Pilot Testing a Brief Partner-Inclusive Hybrid Intervention for Perinatal Mood and Anxiety Disorders.

The necessity of hybrid and more accessible options for perinatal mood and anxiety disorders (PMADs) has taken on increased urgency in the wake of the COVID-19 pandemic and its lasting impacts. In the New Family Wellness Project (NFWP), participants engage in a hybrid in-person and teletherapy six-session intervention for new parents early in their postpartum period. This small, phase 1 clinical research examined early outcomes of the NFWP's cognitive behavioral intervention on adverse mental health outcomes (i.e., perinatal depression and anxiety, overall mental illness symptoms) and adaptive outcomes and protective factors (i.e., relational health, social support, flourishing, self-efficacy). Despite a small sample size (N = 12), paired t-tests yielded significant effects for improvements in mental health symptoms at posttest, as well as marginally significant improvements in postpartum anxiety and self-efficacy. Findings suggest the brief, partner-inclusive, hybrid intervention shows promise for further study. Lessons learned from this small phase 1 clinical study and recommendations for revising the intervention prior to future trials are discussed.

Maternal anxiety symptoms associated with increased behavioral synchrony in the early postnatal period.

The presence of perinatal mood and anxiety disorders has typically been associated with decreases in the quality of mother-infant interactions. However, maternal anxiety symptoms during the postpartum period have been less studied than other mental health disorders like depression. In the current study, we examined associations among symptoms of maternal anxiety, maternal perceived stress, and mother-infant behavioral synchrony in the early postnatal period. Eighty-one mother-infant dyads participated in this study when the infants were 3months old. Surveys were given to obtain demographic information and current maternal mental health symptoms, and dyads completed a 5-min free-play task to measure behavioral synchrony. Results indicated that maternal anxiety symptoms were positively associated with behavioral synchrony, but only for mothers reporting moderate levels of perceived stress. These findings highlight the differential impact of maternal postpartum mental health on behavioral synchrony and suggest that higher maternal anxiety symptoms during the postnatal period may play an adaptive role in fostering more dynamic mother-infant interactions.

The Burden of Maternal Mental Health During COVID-19: Impact Analysis Through Perinatal Mood and Anxiety Disorders Screening [A272

INTRODUCTION: The American College of Obstetrics and Gynecology (ACOG) recommends screening for depression and anxiety at least once during the perinatal period and again during postpartum checks. The delivery of validated screening tools varies amongst institutions and individual obstetricians. The objectives of this study were to assess our institution's baseline screening rates and the impact of the COVID-19 pandemic on maternal mental health. METHODS: Our patient population was pregnant and postpartum patients at Carilion Clinic from January 2019 to July 2020. Data collected from medical records included scores of the Edinburgh Perinatal Depression Screening (EPDS), Personal Health Questionnaire (PHQ) 2 and 9, demographics, and psychiatric history. Screening rates and incidence of mood disorders were compared between pre– and intra–COVID-19 cohorts. RESULTS: Of the 850 women included, 43.5% (n=370) were screened during perinatal visits and 49.8% (n=424) postpartum. Screenings were completed more frequently during postpartum checks pre–COVID-19 compared to during the pandemic with PHQ-2 (27.4% vs. 16.1%, P=.0001) and PHQ-9 (10.3% vs. 5.4%, P=.011). More women screened positive for depression at perinatal checks during the pandemic compared to pre-pandemic (13.2% vs. 4.7%, P=.0377). CONCLUSION: The COVID-19 pandemic has affected rates of maternal depression screening and has significant mental health impacts on this population. This study reveals baseline rates of screening in perinatal and postpartum visits at our institution, which is critical to delivery of quality care. This information will help inform strategies to increase rates of screening and ensure that mental health needs are being addressed, especially in times of emergency.