BMJ Open

INTRODUCTION: The prevalence of postnatal depression (PND) is significant: reaching up to 20% in the general population. In mechanistic terms, the risk of PND lies in an interaction between a maternal psychophysiological vulnerability and a chronic environmental context of stress. On the one hand, repetition of stressor during pregnancy mimics a chronic stress model that is relevant to the study of the allostatic load and the adaptive mechanisms. On the other hand, vulnerability factors reflect a psychological profile mirroring mindfulness functioning (psychological quality that involves bringing one's complete and non-judgemental attention to the present experience on a moment-to-moment basis). This psychological resource is linked to protective and resilient psychic functioning. Thus, PND appears to be a relevant model for studying the mechanisms of chronic stress and vulnerability to psychopathologies.In this article, we present the protocol of an ongoing study (started in May 2017). METHODS AND ANALYSIS: The study is being carried out in five maternities and will involve 260 women. We aim to determine the predictive psychobiological factors for PND emergence and to provide a better insight into the mechanisms involved in chronic stress during pregnancy. We use a multidisciplinary approach that encompasses psychological resources and biophysiological and genetic profiles in order to detect relevant vulnerability biomarkers for chronic stress and the development of PND. To do so, each woman will be involved in the study from her first trimester of pregnancy until 12 months postdelivery. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Ile de France III Ethics Committee, France (2016-A00887-44). We aim to disseminate the findings through international conferences and international peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03088319; Pre-results

Health services research into postnatal depression : results from a preliminary cross-cultural study

Background: Little is known about the availability and uptake of health and welfare services by women with postnatal depression in different countries. Aims: Within the context of a cross- cultural research study, to develop and test methods for undertaking quantitative health services research in postnatal depression. Method: Interviews with service planners and the collation of key health indicators were used to obtain a profile of service availability and provision. A service use questionnaire was developed and administered to a pilot sample in a number of European study centres. Results: Marked differences in service access and use were observed between the centres, including postnatal nursing care and contacts with primary care services.Rates of use of specialist services were generally low.Common barriers to access to care included perceived service quality and responsiveness. On the basis of the pilot work, a postnatal depression version of the Service Receipt Inventory was revised and finalised. Conclusions: This preliminary study demonstrated the methodological feasibility of describing and quantifying service use, highlighted the varied and often limited use of care in this population, and indicated the need for an improved understanding of the resource needs and implications of postnatal depression

Perceptions of postnatal depression across countries and cultures: from a TransCultural Study of PostNatal Depression (TCS-PND)

Objectives The qualitative study was conducted within the international “Transcultural study of postnatal depression (PND)” in 17 centres located in 13 different countries. The aim was to explore perceptions of PND by lay and professional key informants, specifically regarding description of symptoms, awareness of this pathology and of possible care. Methods Broad areas of inquiry and open-ended probes were developed by the TCS-PND research group during international workshops to obtain data comparable between countries on perceptions of PND. A non-random convenience sampling method was used to recruit postpartum mothers for focus groups, and fathers and grandmothers for interviews. Influential healthcare planners and clinicians were interviewed as professional key informants in each centre. Within sites, transcripts of focus groups and interviews underwent a process of text analysis in the original language until exhaustive theme extraction was achieved. Themes (in English) from all the centres were combined into broader categories and after consensus discussions these categories were revalidated. Results and discussion Qualitative data were supplemented in each centre with sociodemographic data to address the issues of: (i) whether perceptions of PND are related to some specific cultural perception of mental heath and/or of status of parenthood and (ii) how high or low levels of general care and specificity of health policy relate to differences in perception of needs for care. Data collected using the same probes and methodology in different countries and cultures has enabled a comparative analysis of perceptions of PND. In addition it has shown that, although not described with the same words, PND is a well-recognised condition by recent mothers in all countries in this study. Data on focus groups and interviews from selected countries are given in the following abstracts to illustrate some similarities and differences in perceptions between countries

Psychotropes, grossesse et adaptation néonatale du nouveau-né Étude exploratoire (Unité Mère-Enfant Bordeaux : 2001-2007)

International audienceL'impact de la prise de psychotropes pendant la grossesse sur la santé des nouveau-nés et des nourrissons reste mal évalué. L'étude préliminaire présentée compare l'adaptation néonatale des enfants dont les mères ont pris des psychotropes pendant la grossesse et celle de ceux dont les mères n'ont pas été traitées, pour des dyades hospitalisées à l'Unité Mère-Enfant de Bordeaux en post-partum (base de données UMB-Société Marcé Francophone)

Impact of hydroxychloroquine on preterm delivery and intrauterine growth restriction in pregnant women with systemic lupus erythematosus: a descriptive cohort study

International audienceObjectiveThe aim of this study was to evaluate the effect of hydroxychloroquine (HCQ) on fetal preterm delivery and intrauterine growth restriction (IUGR) in a cohort of pregnant women with systemic lupus erythematosus (SLE).MethodsOver an 11-year period (January 1, 2001 to December 31, 2011), all women with SLE and admitted to deliver after 22 weeks of gestation to Bordeaux University Hospital (France), were retrospectively enrolled in the present study. The population was then split into two groups based on the treatment they received: HCQ exposed (HCQ+) versus HCQ non-exposed (HCQ?) group.Results118 pregnancies were included, 41 in the HCQ+ group and 77 in the HCQ? group. The rate of adverse fetal outcome was significantly lower in the HCQ+ group (p?=?0.001), particularly in terms of preterm delivery, 15.8 % versus 44.2 % (p?=?0.006), and IUGR, 10.5 % versus 28.6 % (p?=?0.03). No adverse outcomes were reported in the HCQ+ group.ConclusionHCQ reduces neonatal morbidity in women with SLE by significantly decreasing the rate of prematurity and intrauterine growth restriction