Postpartum Mood Disturbances Research Articles

The Role of Parenting Stress as a Mediator in the Relationship Between Postpartum Depressive Symptoms and Early Childhood Internalizing Behaviour.

Parenting stress occurs when demands of the parenting role are perceived as overwhelming and has been proposed as a mechanism through which postpartum mood disturbances may impact child psychopathology. In a prospective longitudinal birth cohort of 111 birthing parent-child dyads, this study examined whether the relationship between birthing parents' mood symptoms in infancy (3months postpartum) and their child's internalizing behaviour in early childhood (3 and 6years old) is mediated by parenting stress at 6months postpartum. The relationship between higher postpartum mood symptoms at 3months and increased internalizing behaviour at 3years of age was mediated by increased reports of parenting stress at 6months (b = .12, 95% CI = .02, .25). This association was not evident at 6years. Parenting stress in early infancy may provide a treatment target to reduce the impact of perinatal depression on early child behavior.

The association between tryptophan levels and postpartum mood disorders: a systematic review and meta-analysis

Over 50% of women experience mood disturbance in the postpartum period, with significant implications for maternal and infant health but identifying those at risk is not easily possible. The essential amino acid, tryptophan (TRP) through its neuroactive metabolites, has been implicated in the pathology of mood disorders. Thus, TRP levels tested in the peripartum period have been proposed as a potential biomarker for subsequent development of postpartum mood disturbances, in particular postpartum depression (PPD). A systematic review and meta-analysis following PROSPERO guidelines [CRD42021252462] was conducted on peer-reviewed, English language studies that measured blood levels of TRP during the postpartum period in women who were also evaluated for postpartum “blues” or PPD. Thirteen studies met the inclusion criteria, of which five studies contained sufficient data to conduct a meta-analysis. Low total TRP levels in postpartum days 1 to 5 were significantly associated with PPD (SMD: -5.39, 95%CI [-7.72, -3.05]). No significant association was found between free TRP levels in the postpartum period and PPD (SMD: -3.43, 95%CI [-7.76, 0.89]). Our findings confirm the necessity for more replicable designed studies regarding TRP and its relationship to postpartum depression. If there were greater clarity regarding TRP metabolism during pregnancy, then the next step would be to consider measuring total plasma TRP levels on postpartum days 1 to 5 to identify women at greater risk of developing PPD.

Mind-Body Techniques in Pregnancy and Postpartum.

Maternal stress can perturb physiology and psychiatric health leading to adverse outcomes. This review investigates the effectiveness of several mind-body therapies-namely biofeedback, progressive muscle relaxation, guided imagery, tai chi, and yoga-as interventions in reducing maternal stress and other pregnancy-related conditions. Through randomized trials, these techniques have shown promising benefits for reducing pain, high blood pressure, stress, anxiety, depressive symptoms, labor pain and outcomes, and postpartum mood disturbances. As these interventions are easy to implement, low cost, and safe to perform in pregnancy, they should be considered as alternative, nonpharmaceutical interventions to use during pregnancy and postpartum care.

Prevalence and associated risk factors of postpartum depression: a cross sectional study

Background Postpartum mood disturbance affects up to 85% of women, with most symptoms of this disturbance being temporary and mild. However up to one in seven women experience a persistent type of depression which is associated with major maternal and neonatal morbidity if it is not managed. Objective To estimate the prevalence of postpartum depression and to identify the associated risk factors. Methods A cross sectional study was conducted in randomly selected 3 primary health care centers affiliated to Suez governorate, Egypt. An interviewed questionnaire was used containing potential risk factors for postpartum depression. An Arabic version of the Edinburgh postnatal depression scale (EPDS) was used to screen for postpartum depression symptoms. Results A total of 237 postpartum mothers were included in the study. 139 (58.6%) of the mothers completed secondary level of education, 195 (82.3%) of them were housewives and 181 (76.4%) had cesarean section. The estimated postpartum depression prevalence was 26.6% and suicidal ideation accounted for 4.6%. Factors significantly associated with high EPDS scores were bad relationship with the husband, having >2 children, an unplanned pregnancy and unhealthy newborn; with P-values of 0.000, 0.004, 0.000, and 0.018, respectively. Discussion the prevalence of postpartum depression among Egyptian women is considered slightly high with its negative and long term consequences on the mothers and their children, accordingly screening, proper management & referral to specialist care is highly recommended.

Brexanolone For Postpartum Depression: A Novel Approach and a Call for Comprehensive Postpartum Care

Brexanolone recently became the first medication to be approved by the US Food and Drug Administration specifically for treating postpartum depression. In contrast to traditional antidepressants, however, brexanolone is a neurosteroid that is believed to mimic allopregnanolone, a product of endogenous progesterone. Although early clinical trials have shown success, the medication remains largely unavailable due to its extremely high cost and formulation (it must be given as a continuous intravenous infusion over 3 days in a monitored, inpatient setting). The efficacy data surrounding brexanolone are encouraging; there is also evidence, however, that postpartum depression may be mitigated by a number of social policies that provide support to new parents. We suggest a comprehensive approach to postpartum wellness that includes investing in evidence-based social interventions that may be much more accessible to the millions of Americans experiencing postpartum mood disturbance.

Postpartum Maternal Mood Among Hadza Foragers of Tanzania: A Mixed Methods Approach.

Infant and maternal mortality rates are among the highest in the world in low and middle-income countries where postpartum depression impacts at least one in five women. Currently, there is a dearth of data on maternal mood and infant health outcomes in small-scale non-industrial populations from such countries, particularly during the postnatal period. Here, we present the first investigation of postpartum maternal mood among a foraging population, the Hadza of Tanzania. We administered the Edinburgh Postnatal Depression Scale (EPDS) to twenty-three women, all with infants under the age of 12months. Semi-structured interviews on happiness and unhappiness during the post-partum period served as a validity cross-check for the EPDS. The combined results of the EPDS surveys and the interview responses suggest that a high proportion of Hadza women experience significant mood disturbances following birth and that postpartum unhappiness is associated with self-reports of pain, anxiety, and disturbed sleep patterns. These findings suggest that many of the mothers in our sample are experiencing post-partum unhappiness at levels similar to or higher than those reported for low to middle income countries in general, including Tanzania. These data are critical for improving our understanding of the etiologies of postpartum mood disturbances cross-culturally.

Association between postpartum physical symptoms and mood

ObjectivePostpartum depression may be associated with higher levels of postpartum pain, but the association with discomfort in general is unclear. We sought to describe an association between postpartum mood disturbances and quantitatively measured physical symptoms at the time of the routine postpartum encounter. MethodsWe designed a novel quantitative measurement of postpartum symptoms, the Postpartum Symptom Inventory (PSI), to allow comparison to scores of postpartum mood. Women presenting for a routine postpartum visit were asked to complete a brief questionnaire about their delivery, the 20-item PSI, and an Edinburgh Postnatal Depression Scale (EPDS). Depression scores were compared with symptom inventory scores and demographic data. ResultsTwo hundred six women responded, of whom 77% had a vaginal delivery. The most common physical symptoms experienced to a bothersome degree were fatigue (35.3%), back/hip pain (22.4%), and headache (13.2%). Twenty-nine women (14.3%) had an EPDS score of 10 or more, thereby screening positive for possible depression. Women screening positive had significantly greater total PSI scores than women who did not screen positive (20.2 vs 12.2, p < 0.001). After adjustment for history of depression and age, the odds of screening positive for depression were 3.6 times higher in women with PSI scores over 10 compared to women with lower scores [95% CI: (1.1, 11.4); p = 0.03]. ConclusionData suggest that a high level of physical symptomatology as measured by a PSI score >10 at six weeks post-delivery is associated with increased odds of screening positive for postpartum depression.

Maternal attachment style and psychiatric history as independent predictors of mood symptoms in the immediate postpartum period

BackgroundThere is evidence that both a past history of psychiatric illness and insecure attachment put women at risk for mood disturbances in the postpartum period. The aim of this study was to ascertain whether maternal insecure attachment is a risk factor for mood symptoms in the immediate postpartum period independently of the confounding effect of maternal psychiatric history. MethodsA convenience sample of 120 mothers was assessed prenatally with the Maternal History of Mood Disturbances (MHMD), the Relationship Questionnaire (RQ), and in the first week after delivery with the Profile of Mood States (POMS). ResultsMothers with higher scores on the preoccupied and fearful attachment scales had more severe postpartum anxiety and depression symptoms but only fearful attachment remained a significant predictor of postpartum anxiety when the significant effect of maternal history of mood disturbances was included in the model. LimitationsOur diagnostic assessment focused on mood symptoms, not disorders, and we limited psychometric assessment to the immediate postpartum period and did not collect longitudinal data to ascertain whether the relationship between maternal insecure attachment and postpartum mood disturbances changed over time. ConclusionsOur results show the necessity to assess prior psychiatric symptoms in studies of maternal attachment style and postpartum mood disturbances. The finding that a mother's recall of her own psychiatric history emerged as significant predictor of postpartum mood symptoms suggests that antenatal assessment based on maternal self-report can be used in those settings where structured diagnostic interviews are not feasible.

Perinatal depression and psychosis: an update

SummaryAbout 85% of women experience some type of postpartum mood disturbance. Generally, the symptoms are mild and short-lived, but a minority of women develop depressive illness or sudden psychosis. About half of episodes of apparently postnatal depression start during pregnancy and some seemingly postpartum psychoses start before delivery. Untreated antenatal depression can lead to poor obstetric outcomes, subsequent depression in the mother, and developmental disadvantage and depression later in life in the offspring. In this article we discuss the aetiology of perinatal depression and consider recommended pharmaceutical and psychosocial management of postpartum blues, perinatal depression and postpartum psychosis.

Diminished Control and Unmet Expectations: Testing a Model of Adjustment to Unplanned Cesarean Delivery

Compared to vaginal deliveries, surgical (cesarean) deliveries are associated with more complications, longer recovery, lower satisfaction, and greater risk of postpartum mood disturbances. Despite a steep rise in rates of surgical delivery, there have been few theoretically founded investigations of the mechanisms by which delivery method has an effect on psychosocial outcome. We tested a model of adjustment to unplanned cesarean delivery, focusing on two mediators: diminished control over labor and delivery; and unmet expectations of control over childbirth. Participants were 164 women anticipating a normal vaginal childbirth. Women who delivered by unplanned surgical delivery (24% of the sample) experienced significantly lower childbirth satisfaction than women delivering vaginally. As hypothesized, the association of delivery method with childbirth satisfaction was mediated by diminished control and unmet expectations, even after controlling for other predictors. Differences were not found between delivery groups in postpartum depressed mood. Irrespective of delivery method, perceived control during labor and delivery was strongly associated with childbirth satisfaction and lower depressed mood. Findings suggest that enabling women to exert desired control over childbirth is likely to enhance satisfaction and reduce the likelihood of postpartum mood disturbance. Implications for policies relevant to hospitals, employers, insurance companies, and legal practice are discussed.

47. Immune recovery from pregnancy across the postpartum: Ex vivo cytokine synthesis and dysphoric moods

Pregnancy is associated with marked immunological changes that may extend into the postpartum and may be associated with postpartum moods. Little is known about the trajectory of postpartum immunological changes and the potential effects of such changes on mood. Mood, stress, and a panel of immune measures were collected in 89 healthy women evaluated 7 times over the first 6 postpartum months. The Profile of Mood States and the Perceived Stress scale were used, and blood was collected in the a.m. and diluted in RPMI-1640 with 1 μg/ml LPS and 1 μg/ml PHA, incubated for 16 h, and then culture supernatants were measured by Luminex multiplexing for concentrations of IFN-gamma, TNF-alpha, IL-10, IL-12, IL-4, and IL-6. Plasma levels of C-reactive protein were measured by ELISA. Dysphoric moods generally declined across the postpartum. Supernatant levels of IFN-gamma and IL-2 showed a lowest level at week one and gradually increased over the postpartum, suggesting a return of Th-1 immunity. CRP and IL-6 were highest at the week one, returning to normal by month 6, suggesting a gradual decrease in inflammation. There were significant relationships with depressive mood and ex vivo cytokine production across time. These data show unique postpartum immunological processes that may play a role in postpartum mood disturbances.

Sexual dimorphism and specificities of psychopharmacological treatment in women

The scope of gender related differences observed in mentally ill persons provides a major source of inference about the role of gonadal steroids in brain function and behavior. Reported gender dimorphism in psychiatry includes the following: prevalence of certain mental disorders specific to female gender, phenomenology and treatment characteristics, i.e. response to the applied psychopharmacotherapy. Structural and functional relationship between the hormonal system and central nervous system is closely correlated with vulnerability to various psychopathological disturbances in biologically different stages in women. It has been observed, for instance, that the association of gonadal steroid activity with serotonin is relevant to mood change in premenstrual and postpartum mood disturbances. Gender related hormonal fluctuations may cause or be correlated with the development of several gender-related psychopathological disturbances. The aim of this article is to review the literature concerning gender-related specificities of psychopharmacological treatment of some of the most important mental disorders in women, such as affective disorder in menopause, premenstrual syndrome and postpartum mood disorders.

2771 – Thyroid function and post postpartum depression

Introduction Thyroid function is known to be affected during pregnancy. Risk of depression is particularly high for women during the prenatal period. Objective Various investigators have attempted to establish a link between thyroid function and post partum depression. While the pathogenesis of postpartum mood disturbances remains unclear. Aims This study aimed to investigate whether thyroid function differs in women with postpartum depression compared to a control group. Methods In this case-control study, Forty eight patients suffering from postpartum depression according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition totally revised (DSM-IV-TR), and 65 normal controls underwent diagnostic evaluation using Structured Clinical Interview for DSM-IV-TR. Then the Persian version of Edinburgh Postnatal Depression Scale (EPDS) was completed by the participants. Finally, their thyroid functions were assessed. Data analyses were done using the SPSS program 13. Results No statistically significant differences were observed between thyroid function tests and postpartum depression. According to multiple regression analysis with stepwise method, subjects with lower serum TSH, T3RU and T3 levels tended to have higher EPDS scores (P-value=0.008). Conclusion The present study reports that those women with postpartum depression had a no greater prevalence of thyroid dysfunction than the control subjects. It seems that thyroid dysfunction should be considered in women with postpartum depression individually, but the role of thyroid as an important cause of this condition is not yet established. This suggests that future studies should concentrate on this concept in postpartum depression.

Newborn gender as a predictor of postpartum mood disturbances in a sample of Swedish women

Postpartum depression (PPD) is a condition that affects about 10% of newly delivered women. The aim of this study was to examine the possible association between offspring gender and risk for development of PPD in Sweden. The study was undertaken as part of the UPPSAT project, a population-based longitudinal study in Uppsala, Sweden. From May 2006 to June 2007, women who gave birth at Uppsala University Hospital and fulfilled the inclusion criteria were asked to participate. The participating women filled out, at three points during the first 6 months after delivery, questionnaires containing the Edinburgh Postnatal Depression Scale as well as questions concerning various lifestyle factors, medical history, breast feeding habits, social support parameters, and diet factors. No significant difference in risk of PPD in relation to baby gender could be shown 6 weeks and 6 months after delivery. However, women who gave birth to a male offspring had a significantly higher risk of self-reported depressive symptomatology 5 days after delivery. The association remained statistically significant after adjustment for possible confounders in a logistic regression model. This longitudinal study demonstrates that, in Sweden, the gender of the offspring is not associated with a higher risk for self-reported postpartum depression in the mother 6 weeks or 6 months after delivery. The birth of a baby boy, however, gives the mother a higher risk of postpartum blues 5 days after delivery.

Reproductive hormones and postpartum mood disturbances in Greek women

Aim. Postpartum mood disturbances are common among Greek women, with postpartum depression (PPD) being as high as 19%. This study aimed to investigate whether sex steroid hormone levels affect the incidence of postpartum mood disturbances.Materials and methods. Fifty-seven women were evaluated for postpartum mood disturbances using the Postpartum Blues Questionnaire and the Edinburgh Postnatal Depression Scale on the 1st and 6th week. Serum estradiol, progesterone and testosterone concentrations were measured upon admission for delivery and daily until the fourth postpartum day. We then studied the association between hormone levels and the scores in the two psychometric scales.Results. Testosterone was the only hormone that was marginally associated with psychometric scoring in simple regression analysis. (Postpartum Blues during days 1–4: b = 4.291, 95% C.I. −0.796 to 9.377 and p-value = 0.096). Women with lower testosterone drops had higher scores in Postpartum Blues Questionnaire. This association, however, lost statistical significance in the multivariable analysis after adjusting for pregnancy duration. In multiple regression analysis, only pregnancy duration had the most constant adverse effect on psychometric scores: The shorter the duration of pregnancy, the higher the scores for Postpartum Blues. (r = −0.39, p < 0.01).Conclusions. Our findings do not indicate an association between the occurrence of postpartum mood disorders and sex steroid hormone levels. Preterm labour may be associated with a higher risk of postpartum mood disturbances.

Subjective perception of sleep, but not its objective quality, is associated with immediate postpartum mood disturbances in healthy women.

This study investigated whether there was a relationship between disrupted sleep and postpartum mood disturbances in women during the week after delivery. Sleep and mood were measured during the third trimester (Time-1) and one week postpartum (Time-2) in a 2-stage longitudinal design. Participants were recruited from an antenatal clinic in a regional Melbourne hospital. Forty-four healthy women at low risk for postpartum depression. N/A. Objective sleep was measured by actigraphy and subjective sleep by the Pittsburgh Sleep Quality Index; mood was assessed by the Depression Anxiety Stress Scale, the Hospital Anxiety Depression Scale, and the Positive and Negative Affect Schedule. Sleep and mood questionnaires were administered at Time-1 and Time-2. Wrist actigraphy was collected for one week at both times. After delivery, both objective and subjective nighttime sleep significantly worsened with decreased total sleep time and sleep efficiency, while daytime napping behavior significantly increased. On average, mood improved across all scales after delivery, although 45.95% of the sample experienced deterioration of mood. Regression analyses showed little relationship between Time-1 and Time-2 objective nighttime sleep, and postpartum mood. Variables that related to both Time-1 and Time-2 subjective perception of sleep, including subjective nighttime sleep, sleep-related daytime dysfunction, and daytime napping behavior, were significant predictors of postpartum mood. The perception of poor sleep, and the conscious awareness of its impact during wake-time, might share a stronger relationship with the occurrence of immediate postpartum mood disturbances than actual sleep quality and quantity.

Thyroid function and postpartum mood disturbances in Greek women

Background Postpartum mood disturbances are very common with postpartum blues being as high as 44.5% among Greek women. This study aimed to investigate whether thyroid function within the normal range affects the incidence of postpartum mood disturbances. Methods In a cross-sectional study in the maternity ward of Aretaieion Hospital, 57 Greek women were evaluated for postpartum mood swings by the Maternity Blues Questionnaire and the Edinburgh Postnatal Depression Scale on the first and sixth week postpartum. Serum Free T4, Free T3 and TSH concentrations as well as thyroglobulin and thyroid peroxidase antibodies were measured on admission for delivery and daily until the fourth postpartum day. We examined the association between hormone and antibody levels, and scores in the two scales evaluating postpartum mood disturbances. Results Prepartum serum FT3 and FT4 correlated negatively with blues scores in the first week postpartum (blues on day 4: with FT3, rho = − 0.44, p ≤ 0.01; with FT4 rho = − 0.36, p ≤ 0.01). Women with lower FT3 and FT4 levels belonged to the high scoring group (high scoring group: FT3 = 1.22 pg/ml, FT4 = 0.66 ng/dl; low scoring group: FT3 = 1.64 pg/ml, FT4 = 0.73 ng/dl). Serum FT3 showed a negative independent correlation with postpartum blues scores in the first postpartum days. No association was found between thyroid antibody levels and mood scores. Conclusion Our findings indicate an association between the occurrence of postpartum mood disorders and antenatal thyroid function. Within normal limits, lower levels of serum FT3 and FT4 are associated with increased incidence of mood disturbances in the first postpartum week.

CSF and plasma cytokines at delivery and postpartum mood disturbances

BackgroundImmune activation has been shown to be involved in the pathophysiology of anxiety states and major depression and pregnancy is associated with a characteristic immune activation to sustain the fetus. Despite the possibility of a relation between immune parameters and postpartum mood disturbance, few studies have explored this association. Further, no study to-date has examined CSF. MethodsFifty-six Greek parturients were recruited and a detailed medical and obstetric history was recorded. All of them completed the Postpartum Blues Questionnaire (on admission and on days 1–4 postpartum) and the Edinburgh Postnatal Depression Scale (at first and sixth week postpartum). At delivery, a blood sample and a CSF sample while puncturing for epidural analgesia were taken from 33 participants; blood samples only were obtained from the rest of the 23 parturients. TNF-a and IL-6 were quantified with an ELISA assay. ResultsA multiple regression analysis of psychometric scores depending on cytokine levels revealed that cytokine levels were positively associated with depressive mood during the first four days postpartum (p=0.035 for CSF IL-6, p=0.025 for CSF TnF-a, p=0.023 for serum TnF-a) and also at sixth week postpartum (p=0.012 for CSF IL-6, p=0.072 for CSF TnF-a). Pregnancy duration had an adverse association to psychometric scores. ConclusionsIt is suggested that immune mechanisms may play a role in the etiopathology of postpartum depressive mood shifts. The role of a “rebound” reaction of the maternal immune system postnatal should be further investigated.

A Pilot Study Assessing the Relationship Between Child Harming Thoughts and Postpartum Depression

This pilot study explored relationships between postpartum mood and child harming thoughts. Fifty mothers from an outpatient pediatric office completed the Edinburgh Postnatal Depression Scale (EPDS), Postpartum Depression Predictors Inventory-Revised (PDPI-R), and Beck Anxiety Inventory (BAI). Participants also completed the Child Thoughts Inventory (CTI), a modified version of the Yale-Brown Obsessive-Compulsive Inventory (Y-BOCS) and Florida Obsessive-Compulsive Inventory (FOCI). Results indicated significant positive correlations between postpartum depression and anxiety and frequency and intensity of child harming thoughts. In addition, having a poor self-view was significantly correlated with intensity of child harming thoughts and previous anxiety was correlated with both frequency and intensity of child harming thoughts. Despite the fact that mothers experiencing postpartum mood disturbances rarely harm their infants the findings of this pilot study suggest that these women may have frequent and intense ego-dystonic thoughts about harming their children. Results also suggest that postpartum depression and anxiety may share similar cognitive processes.

Psychosocial sequelae of cesarean delivery: Review and analysis of their causes and implications

A growing number of children around the world are being born by surgical delivery, or cesarean section. Concerns over rising rates of cesareans have focused on the risk of death and medical complications associated with surgical delivery but have largely neglected psychosocial and behavioral factors that affect and are affected by cesarean delivery. We summarize research which indicates that women who deliver by cesarean section have more negative perceptions of their birth experience, their selves, and their infants, exhibit poorer parenting behaviors, and may be at higher risk for postpartum mood disturbance compared to women delivering infants vaginally. We also review evidence that suggests that cesareans adversely influence women's moods and perceptions by restricting the control that they can exercise over birth and by violating expectations about childbirth. Based on these findings, we recommend ways to reduce the aversiveness of cesareans, offer recommendations for future research, and discuss implications of escalating rates of cesareans, including medically non-indicated cesareans by request.