Peripartum Depression Research Articles

Peripartum depression symptom trajectories, telomere length and genotype, and adverse childhood experiences

BackgroundAs a biological marker for cellular senescence, telomere length (TL) has been linked to a variety of psychiatric disorders and adverse childhood experiences (ACE), though only preliminarily to peripartum depression (PPD). The present study sought to examine the association between TL and PPD, assessing the moderating role of ACE and genetic polymorphic variations related with the telomere machinery.MethodsAdversity was self-reported, likewise were depressive symptoms evaluated at pregnancy week 17 and 32, as well as six-weeks and six-months postpartum. TL was assessed by use of qPCR in blood samples collected during delivery from females with antenatal depression resolving postpartum, females with depression persisting to postpartum, and healthy controls. Twenty haplotype-tagging Single Nucleotide Polymorphisms in the Telomerase Reverse Transcriptase (TERT) and three in the Telomerase RNA Component (TERC) genes were genotyped.ResultsTL was negatively correlated with severity of PPD symptoms at pregnancy week 32 and postpartum week 6. PPD was associated with shorter TL. Lastly, ACE, but not the TERT/TERC genotype, moderated the TL-trajectory association; with increasing ACE, individuals with persistent PPD symptoms had shorter TL, whereas the opposite pattern (longer TL) was observed in the controls.ConclusionsThe findings contribute to further understanding of PPD underpinnings, suggesting a negative relationship with TL.

History of Peripartum Depression Moderates the Association Between Estradiol Polygenic Risk Scores and Basal Ganglia Volumes in Major Depressive Disorder

The neurobiological differences between women who have experienced a peripartum episode and those who have only had episodes outside of this period are not well understood. 64 parous female patients with major depressive disorder that have either a positive (n=30) or negative (n=34) history of peripartum depression (PPD) underwent MRI acquisition to obtain structural brain images. An independent two-sample t-test comparing patients with and without a history of PPD was performed using voxel-based morphometry analysis (VBM). Additionally, polygenic risk scores (PRSs) for estradiol were calculated and a moderation analysis was conducted between 3 estradiol PRSs and PPD history status on extracted cluster volumes using IBM SPSS PROCESS macro. The VBM analysis identified larger grey matter volumes in bilateral clusters encompassing the putamen, pallidum, caudate, and thalamus in patients with PPD history compared to patients without a history. The moderation analysis identified a significant interaction of 2 estradiol PRSs and PPD history on grey matter cluster volumes with a positive effect in PPD women and a negative effect in women with no history of PPD. Our findings demonstrate that women who have experienced a peripartum episode are neurobiologically distinct from women who have no history of PPD in a cluster within the basal ganglia, an area important for motivation, decision-making, and emotional processing. Furthermore, we show that the genetic load for estradiol has a differing effect in this area based on PPD status which supports the claim that PPD is associated with sensitivity to sex steroid hormones.

Transcranial magnetic stimulation and transcranial direct current stimulation in reducing depressive symptoms during the peripartum period.

To present the latest data on the efficacy, safety, and acceptability of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in peripartum depression (PPD), complemented by notes emerging from our clinical and research experience. TMS and tDCS show promising results to manage mild to moderate depressive symptoms in the peripartum period. Evidence of TMS efficacy during pregnancy and the postpartum comes from two small randomized controlled trials (RCTs) with encouraging but still inconsistent results. Evidence of tDCS efficacy during pregnancy comes from one small RCT and in the postpartum the first RCT is just now being conducted and results are highly expected. The safety profile (with transient mild adverse effect to women and no known risk to the foetus/newborn) and acceptability by women seems overall good. However, the perspectives from health professionals and managers are unclear. Whereas TMS accelerated protocols (e.g., more than one session/day) and shorter sessions (e.g., theta burst stimulation) could address the need for fast results in PPD, home-based tDCS systems could address accessibility issues. Currently, the evidence on the efficacy of TMS and tDCS in PPD is limited warranting further research to support stronger evidence-based clinical guidelines.

Mirtazapine in pregnancy and lactation: A systematic review of adverse outcomes.

Peripartum depression is common and treatment with mirtazapine may be indicated. However, evidence on its safety in pregnancy and lactation is fragmented. The objective of this systematic review was to evaluate the literature on the safety of mirtazapine in pregnancy and lactation. PubMed, Embase, Medline, PsycInfo, and clinicaltrials.gov were searched for 'antidepressants' or 'mirtazapine' in combination with 'pregnancy', 'lactation' or 'offspring'. No restrictions on type of study were applied and selection was performed by two independent reviewers using Covidence. Two reviewers extracted data and performed risk of bias assessment and evidence synthesis was performed for each outcome individually. The protocol was registered at PROSPERO (registration number CRD42021275127). The initial search yielded 15,380 articles after removal of duplicates. After screening based on title and abstract, 431 articles remained for full text review. Of these, 41 studies were included (15 cohort studies, one case-control study, 11 case series, and 14 case reports). In most studies, the outcomes in mirtazapine-exposed pregnancies were comparable to controls. However, results on congenital malformations and spontaneous abortion were conflicting. Neonatal adaptation syndrome was reported after mirtazapine exposure in late pregnancy. Data on mirtazapine exposure during lactation were scarce. We identified no substantial evidence indicating that mirtazapine exposure is associated with adverse outcomes in pregnancy or in offspring, other than neonatal adaptation syndrome. However, overall quality of evidence was low, and results on congenital malformations and spontaneous abortions were conflicting. Data on mirtazapine exposure through breastfeeding were limited and did not allow for conclusions.

Health economic evaluation of an electronic mindfulness-based intervention (eMBI) to improve maternal mental health during pregnancy – a randomized controlled trial (RCT)

BackgroundAnxiety and depression are the most prevalent psychiatric diseases in the peripartum period. They can lead to relevant health consequences for mother and child as well as increased health care resource utilization (HCRU) and related costs. Due to the promising results of mindfulness-based interventions (MBI) and digital health applications in mental health, an electronic MBI on maternal mental health during pregnancy was implemented and assessed in terms of transferability to standard care in Germany. The present study focused the health economic outcomes of the randomized controlled trial (RCT).MethodsThe analysis, adopting a payer’s and a societal perspective, included women of increased emotional distress at < 29 weeks of gestation. We applied inferential statistics (α = 0.05 significance level) to compare the intervention group (IG) and control group (CG) in terms of HCRU and costs. The analysis was primarily based on statutory health insurance claims data which covered the individual observational period of 40 weeks.ResultsOverall, 258 women (IG: 117, CG: 141) were included in the health economic analysis. The results on total health care costs from a payer’s perspective indicated higher costs for the IGi compared to the CG (Exp(ß) = 1.096, 95% CI: 1.006–1.194, p = 0.037). However, the estimation was not significant after Bonferroni correction (p < 0.006). Even the analysis from a societal perspective as well as sensitivity analyses did not show significant results.ConclusionsIn the present study, the eMBI did neither reduced nor significantly increased health care costs. Further research is needed to generate robust evidence on eMBIs for women suffering from peripartum depression and anxiety.Trial registrationGerman Clinical Trials Register: DRKS00017210. Registered on 13 January 2020. Retrospectively registered.

Certified Midwives and Nurse-Midwifes’ Knowledge and Attitudes about Peripartum Depression Management – The Effectiveness of a Peripartum Depression Management Training

Certified Midwives and Nurse-Midwifes’ Knowledge and Attitudes about Peripartum Depression Management – The Effectiveness of a Peripartum Depression Management Training

Development and validation of the Peripartum depression scale

BackgroundPeripartum depression (PPD) is the most common peripartum mental health problem. However, none of the available questionnaires evaluates depressive symptoms according to the latest DSM-5-TR (APA, 2022). Peripartum Depression Scale (PDS) is a new measure of PPD developed according to DSM-5-TR full criteria and postpartum-specific symptoms described in the literature. The aim of this study was to validate a new scale to assess depression in pregnancy and postpartum. MethodsIn this online cross-sectional study, 513 pregnant women and 751 women within the 12 months postpartum completed a new PDS consisting of 43 items from Criterion A, rated on a four-point scale, and seven items on the remaining DSM-5-TR criteria. They also completed Edinburgh Postnatal Depression Scale (EPDS), Depression, Anxiety and Stress Scale (DASS), and General Data Questionnaire. ResultsConfirmatory factor analysis confirmed that the one-factor model had a poor fit, but the 9-factor with a second-order factor in postpartum sample and 10-factor model with a second-order factor in pregnant sample, on the same 42-item version of scale, had a good fit to the data. The reliability of McDonald's ω of .96 was very high in both pregnant and postpartum women. Convergent and known-groups validity was demonstrated; however, correlations with stress were high. LimitationsClinical interview was not administered. ConclusionPeripartum Depression Scale is a 42-item instrument which is shown to be a valid and reliable measure to assess depression symptoms both during pregnancy and the full postpartum year according to DSM-5-TR criteria and current literature on peripartum-specific symptoms.

A pilot acceptability evaluation of MomMind: A digital health intervention for Peripartum Depression prevention and management focused on health disparities.

Health disparities cause significant strain on the wellbeing of individuals and society. In this study, we focus on the health disparities present in the condition of Peripartum Depression (PPD), a significant public health issue. While PPD can be managed through therapy and medication, many women do not receive adequate PPD treatment due to issues of social stigma and limited access to healthcare resources. Digital health technologies can offer practical tools for PPD management. However, current solutions do not integrate behavior theory and are rarely responsive to the transient information needs stemming from women's unique sociodemographic, clinical and psychosocial profiles. We describe a pilot acceptability evaluation of MomMind, a health-disparities focused digital health intervention for the prevention and management of PPD. A crucial MomMind advantage is its basis on behavior change theory and patient engagement as enabled by the Digilego digital health framework. Following an internal usability evaluation, MomMind was evaluated by patients through cross-sectional acceptability surveys, pre-and-post PPD health literacy surveys, and interviews. Survey respondents included n = 30 peripartum women, of whom n = 16 (53.3%) were Hispanic and n = 17 (56.7%) of low-income. Survey results show that 96.6% of participants (n = 29) approved and welcomed MomMind, and 90% (n = 27) found MomMind to be an appealing intervention. Additionally, significant improvements (p< = 0.05) were observed in participants' PPD health literacy, specifically their ability to recognize PPD symptoms and knowledge of how to seek PPD information. Interview main themes include MomMind's straightforward design and influence of others (family members, providers) on use of technology. Results suggest that enhancement of a digital health framework with health literacy theory can support production of digital health solutions acceptable to vulnerable populations. This study incorporates existing theories from different disciplines into a unified approach for mitigating health disparities, and produced a novel solution for promotion of health in a vulnerable population.

Patterns of peripartum depression and anxiety during the pre-vaccine COVID-19 pandemic

BackgroundPregnant people are vulnerable to new or worsening mental health conditions. This study aims to describe prevalence and course of depression and anxiety symptoms in pregnancy during the pre-vaccine COVID-19 pandemic.MethodsThis is a prospective cohort study of pregnant individuals with known or suspected COVID-19. Participants completed Edinburgh Postnatal Depression Scale (EPDS) and Generalized-Anxiety Disorder-7 (GAD-7) questionnaires, screening tools for depression and anxiety, at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum. Prevalence of elevated depressive and anxiety symptoms at each visit was described. Univariable logistic regression analysis was used to determine the association between demographic and clinical factors and those with elevated depression or anxiety symptoms.Results317 participants were included. The prevalence of elevated antepartum depression symptoms was 14.6%, 10.3%, and 20.6% at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum, respectively. The rate of elevated anxiety symptoms was 15.1%, 10.0%, and 17.3% at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum, respectively. A prior history of depression and/or anxiety (p’s < 0.03), as well as higher EPDS and GAD-7 scores at enrollment (p’s < 0.04) associated with elevated depression and anxiety symptoms throughout pregnancy and the postpartum period. Quarantining during pregnancy was associated with elevated anxiety symptoms at 34weeks gestational age in univariate (P = 0.027) analyses. COVID-19 diagnosis and hospitalization were not associated with elevated depression or anxiety symptoms.ConclusionsElevated depression and anxiety symptoms were prevalent throughout pregnancy and the postpartum period, particularly in those with prior depression and/or anxiety and who quarantined. Strategies that target social isolation may mitigate potential adverse consequences for pregnant people, and continued vigilance in recognition of depression and anxiety in pregnancy should be considered.

Peripartum Depressive Symptoms in Fathers during the COVID-19 Pandemic.

Background: This research investigates peripartum depression in fathers during COVID-19, focusing on how pandemic-related distress is associated with paternal depressive symptoms and the quality of father-child feeding interactions. The primary objective was to understand if the pandemic has influenced depressive symptoms in new fathers and how these symptoms impact their interactions with their children, especially during feeding. Methods: Utilizing a cross-sectional design, the research employs online surveys and remote observation to gather data from 243 Italian fathers. The analysis involves established psychometric tools like the Symptoms Check-List/90R and the Peritraumatic Distress Index to assess the severity of depressive symptoms and their correlation with father-child interaction exchanges, observed through the SVIA. Results: The fathers' peritraumatic distress due to COVID-19 was significantly and positively associated with the level of their depressive symptoms and negatively correlated with the quality of their feeding interactions with their children. Moreover, elevated levels of peritraumatic stress were notably predictive of higher instances of depressive symptoms in the fathers. Further, higher levels of stress associated with COVID-19 were predictive of a poorer quality of father-child interactions. Conclusions: This research highlights the need for inclusive perinatal support programs, offering foundational insights into paternal mental health during pandemics.

Unplanned pregnancy and risk of peripartum depression: a prospective cohort study in Saudi pregnant women attending antenatal care clinic

Background: Few studies have been conducted on unintended pregnancies and peripartum depression in Saudi Arabia. This study aimed to evaluate the relationship between unplanned pregnancies and peripartum depression among pregnant women in Jeddah, Saudi Arabia. Methods: This prospective cohort study included pregnant women attending an antenatal care clinic in 2021. The London Measure of Unplanned Pregnancy was used to assess the prevalence of unplanned pregnancy, and the Edinburgh Postnatal Depression Scale (EPDS) was used to assess antenatal and postnatal depression. Results: A total of 236 participants were included, of which 25.8% had unplanned pregnancies, 36.0% had ambivalent pregnancies, and 38.1% had planned pregnancies. EPDS results revealed that 77.5% and 73.35% of the females were negative for antenatal and postnatal depression, respectively. A history of stressful events (P=0.001), husband (P=0.020), and family support (P=0.007) was significantly associated with antenatal EPDS score, whereas age (P=0.005), type of delivery (P=0.019), and family support (P=0.031) were significantly associated with the postnatal score. Conclusion: Unplanned pregnancies may affect the perinatal mental health of women. We demonstrated the importance of family or husbands’ support for women with perinatal depression. In addition, our research showed that pregnancy at an early age is a risk factor for postnatal depression. Therefore, these women should be closely monitored not only during their pregnancy but also during the first postpartum year.

Impact of Peripartum Depression and Anxiety Symptoms on Unplanned Cesarean or Operative Vaginal Births: A Prospective Observational Study

Impact of Peripartum Depression and Anxiety Symptoms on Unplanned Cesarean or Operative Vaginal Births: A Prospective Observational Study

Digital health technologies for high-risk pregnancy management: three case studies using Digilego framework.

High-risk pregnancy (HRP) conditions such as gestational diabetes mellitus (GDM), hypertension (HTN), and peripartum depression (PPD) affect maternal and neonatal health. Patient engagement is critical for effective HRP management (HRPM). While digital technologies and analytics hold promise, emerging research indicates limited and suboptimal support offered by the highly prevalent pregnancy digital solutions within the commercial marketplace. In this article, we describe our efforts to develop a portfolio of digital products leveraging advances in social computing, data science, and digital health. We describe three studies that leverage core methods from Digilego digital health development framework to (1) conduct large-scale social media analysis (n = 55 301 posts) to understand population-level patterns in women's needs, (2) architect a digital repository to enable women curate HRP related information, and (3) develop a digital platform to support PPD prevention. We applied a combination of qualitative coding, machine learning, theory-mapping, and programmatic implementation of theory-linked digital features. Further, we conducted preliminary testing of the resulting products for acceptance with sample of pregnant women for GDM/HTN information management (n = 10) and PPD prevention (n = 30). Scalable social computing models using deep learning classifiers with reasonable accuracy have allowed us to capture and examine psychosociobehavioral drivers associated with HRPM. Our work resulted in two digital health solutions, MyPregnancyChart and MomMind are developed. Initial evaluation of both tools indicates positive acceptance from potential end users. Further evaluation with MomMind revealed statistically significant improvements (P < .05) in PPD recognition and knowledge on how to seek PPD information. Digilego framework provides an integrative methodological lens to gain micro-macro perspective on women's needs, theory integration, engagement optimization, as well as subsequent feature and content engineering, which can be organized into core and specialized digital pathways for women engagement in disease management. Future works should focus on implementation and testing of digital solutions that facilitate women to capture, aggregate, preserve, and utilize, otherwise siloed, prenatal information artifacts for enhanced self-management of their high-risk conditions, ultimately leading to improved health outcomes.

Peripartum Mood Clinic Referral Rates Pre- and Post-COVID

Background: Peripartum depression is a common complication of pregnancy with the potential for dangerous consequences to maternal and infant health if left untreated. The COVID-19 pandemic increased the incidence of mental health disorders globally with an even greater effect on peripartum mothers. Disparities in access to mental health services may further exacerbate health care outcomes for affected individuals. Aims: The aim of this study is to evaluate Edinburgh Postpartum Depression Scale (EPDS) scores pre- and post-COVID-19 to determine if mental health worsened post-COVID and assess how certain demographics were affected compared to others. Methods: This is a retrospective cohort study of all pregnant patients referred to the Perinatal Mood Disorder Program at a large academic hospital in Indianapolis between March 1, 2019 to March 1, 2021. March 1, 2020 was the date used to determine our pre- and post-COVID groups, as it was near this time an official coronavirus outbreak was declared. Referral criteria were based on EPDS score and clinical gestalt. A convenience The sample of the population was assessed with EPDS score as the primary outcome. Demographic information including zip code of residence, psychiatric history, obstetric and newborn outcomes were also captured. Descriptive analysis, t-test and χ2 test were performed with statistical significance determined as p&lt;0.05. Results: There were 1,487 total pregnant patients referred with 733 referred pre-COVID and 754 post-COVID. Six hundred patients were sampled for analysis – 288 pre-COVID and 312 post-COVID. There were no statistically significant differences in age, ethnicity and race between groups. The mean EPDS score was not statistically significant between the groups (9.71 and 9.81, p 0.84). The four zip codes with the highest referral rates to the mood clinical also corresponded to areas within Indianapolis with the highest levels of poverty. Conclusion: Edinburgh Postpartum Depression Scale scores were not different between pregnant patients pre- and post-COVID. There was also no difference in demographic characteristics between groups. The pandemic exacerbated existing barriers to treatment of peripartum mood disorders, highlighting the responsibility of clinicians and policymakers to support, identify, and facilitate treatment for this vulnerable population to prevent both short and long-term repercussions.

1079 The Impact of Physical Activity During Pregnancy on Peripartum Depression

1079 The Impact of Physical Activity During Pregnancy on Peripartum Depression

Trends in Risk Factors for Peripartum Depression in Socio-economically Disadvantaged Childbearing Community

Introduction: Perinatal depression is defined as a depressive episode(s) during the pregnancy and/or postpartum period up to one year. Studies have shown that childbearing people in urban settings experience a higher burden of social factors, such as low socioeconomic status, which may influence the likelihood of developing perinatal depression. Of note, episodes of perinatal depression have been shown to negatively impact child development. Our study has identified population trends in Center for Epidemiological Studies Depression Scale (CES-D) scores &gt;10 during perinatal periods alongside significant social risk factors for people served by LSA Family Health Service providing skilled home-based nursing visits to reduce adverse outcomes. Methods: A retrospective chart review of nursing notes from 2009-2017 was conducted for this cross-sectional study. Outcome measures included antepartum (AP) and postpartum (PP) Center for Epidemiological Studies Depression Scale (CES-D) scores, with a score of &gt; 10, suggesting a positive risk for developing depression. Data were grouped and analyzed using Microsoft Excel and SPSS software (SPSS version 23). Data have been presented as yearly population percentages scoring &gt;10 on their CES-D screen. Results: The maternal outreach program (MOP) enrolled 1,183 birthing individuals from 2009-2017. The mean parental age was 27 years. 70% were Latinx (n=829) and 20.88% (n=247) were Black. Spanish was the primary language for 43.62% (n=516) of participants. Among CES-D screens completed in the antepartum period, 4.5% to 24.6% of the population met criteria over the 9-year study period for risk of developing depression. Positive CES-D screens completed postpartum ranging from 11.9% to 27.2% during the study period. Significant risk factors for positive postpartum CES-D screens were postpartum risk assessment score (p=0.03), increased gestational age (p=0.05), low income (p=0.03), teen/inexperienced parents (p=0.003), and low education levels (p=0.04). Conclusion: Trends of positive antepartum and postpartum depression screens in this population have fluctuated over the study period; however, we have identified significant risk factors for positive postpartum screens. Screening for postpartum depression risk factors is important to identify birthing parents who may most benefit from mental health interventions.

Using an Electronic Mindfulness-based Intervention (eMBI) to improve maternal mental health during pregnancy: Results from a randomized controlled trial

Prevalence rates of peripartum depression and anxiety are high and correlate with adverse maternal and neonatal outcomes. Mindfulness-based interventions (MBI) have been shown to reduce mental distress during pregnancy.A multicenter, randomized controlled study was conducted after screening for depressive symptoms. The intervention group (IG) was given access to an 8-week supervised eMBI between weeks 29 and 36 of pregnancy and followed up to 5 months postpartum. Psychometric data were collected using the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI), the Pregnancy-Related Anxiety Questionnaire (PRAQ-R), the Freiburg Mindfulness Inventory (FMI-14) as well as the Patient Health Questionnaire (PHQ).Out of 5299 pregnant women, 1153 scored >9 on the EPDS and N = 460 were included in the RCT. No significant interaction effects for depressive symptoms and anxiety were found. Pregnancy- and birth-related anxiety decreased significantly in the IG and 6 weeks after birth, the rate of women at risk for adverse mental outcome was significantly lower compared to the CG. Mindfulness scores improved significantly in the IG.The eMBI program did not show effective regarding general depressive or anxiety symptoms, however, positive results were demonstrated regarding pregnancy and birth-related anxiety and the prevention of postpartum depression.

Cohort profile: the U-BIRTH study on peripartum depression and child development in Sweden

PurposeThe current U-BIRTH cohort (Uppsala Birth Cohort) extends our previous cohort Biology, Affect, Stress, Imaging and Cognition (BASIC), assessing the development of children up to 11 years after birth. The...

Paternal peripartum depression: emerging issues and questions on prevention, diagnosis and treatment. A consensus report from the cost action Riseup-PPD

ABSTRACT Introduction Paternal peripartum depression (P-PPD) is a serious and understudied public health problem associated with impaired family functioning and child development. The lack of recognition of P-PPD may result in limited access to both information and professional help. Objective The aim of the study was to review studies on paternal peripartum depression and to identify issues and questions where future research and theory formation are needed. Methods A literature search for systematic reviews, meta-analyses and primary studies was conducted using PubMed, Web of Science, Embase, Scopus, Medline, PsychInfo and Informit databases. Key results within the retrieved articles were summarised and integrated to address the review objectives. Results Based on the literature, the knowledge related to prevalence, screening, risk factorsunique to fathers, management strategies and outcomes of P-PPD is lacking. Currently, there is no consensual understanding of the definition of P-PPD and recommendations for dealing with P-PPD. Limited data were available regarding the barriers preventing fathers from accessing support systems. Conclusion Emerging issues that need to be addressed in future research include: P-PPD definition and pathogenetic pathways; prevention strategies and assessment tools; self-help seeking and engagement with interventions; the cost-effectiveness of P-PPD management; needs of health professionals; effect on child development, and public awareness. Future studies and clinical practice should account the complexities that may arise from the father’s perceptions of health care services. Results from this review highlights the critical issues on how to plan, provide and resource health services, to meet the health needs of fathers.

12.4 Maternal Peripartum Depression Predicts Child Behavioral Screening in Primary Care at 4 Years

12.4 Maternal Peripartum Depression Predicts Child Behavioral Screening in Primary Care at 4 Years