Postpartum Mental Health and Breastfeeding Practices: An Analysis Using the 2010–2011 Pregnancy Risk Assessment Monitoring System

Evidence suggests that women with postpartum depression (PPD) are at risk for early breastfeeding cessation, but previous studies have been limited by small samples. The objective of this analysis is to estimate the association between PPD symptoms and breastfeeding using a national, stratified, random sample of U.S. mothers

Obstetrical, pregnancy and socio-economic predictors for new-onset severe postpartum psychiatric disorders in primiparous women

Background Childbirth is a potent trigger for the onset of psychiatric illness in women including postpartum depression (PPD) and postpartum psychosis (PP). Medical complications occurring during pregnancy and/or childbirth have been linked to postpartum psychiatric illness and sociodemographic factors. We evaluated if pregnancy and obstetrical predictors have similar effects on different types of postpartum psychiatric disorders. Method A population-based cohort study using Danish registers was conducted in 392 458 primiparous women with a singleton delivery between 1995 and 2012 and no previous psychiatric history. The main outcome was first-onset postpartum psychiatric episodes. Incidence rate ratios (IRRs) were calculated for any psychiatric contact in four quarters for the first year postpartum. Results PPD and postpartum acute stress reactions were associated with pregnancy and obstetrical complications. For PPD, hyperemesis gravidarum [IRR 2.69, 95% confidence interval (CI) 1.93–3.73], gestational hypertension (IRR 1.84, 95% CI 1.33–2.55), pre-eclampsia (IRR 1.45, 95% CI 1.14–1.84) and Cesarean section (C-section) (IRR 1.32, 95% CI 1.13–1.53) were associated with increased risk. For postpartum acute stress, hyperemesis gravidarum (IRR 1.93, 95% CI 1.38–2.71), preterm birth (IRR 1.51, 95% CI 1.30–1.75), gestational diabetes (IRR 1.42, 95% CI 1.03–1.97) and C-section (IRR 1.36, 95% CI 1.20–1.55) were associated with increased risk. In contrast, risk of PP was not associated with pregnancy or obstetrical complications. Conclusions Pregnancy and obstetrical complications can increase the risk for PPD and acute stress reactions but not PP. Identification of postpartum women requiring secondary care is needed to develop targeted approaches for screening and treatment. Future work should focus on understanding the contributions of psychological stressors and underlying biology on the development of postpartum psychiatric illness

Post-Traumatic Stress Disorder (PTSD): Prevalence and Diagnosis in Outpatient Gynecology

Post-traumatic stress disorder (PTSD) is an often debilitating form of anxiety disorder triggered by personal experience of a serious trauma. Women are more than twice as likely as men to develop PTSD. Though one in four women exposed to a traumatic event develops PTSD, no brief tools are available to facilitate identification of PTSD in primary care settings. Our objectives were: 1) to document the prevalence of a history of serious trauma among women seeking routine annual gynecologic care in an academic continuity care setting, and; 2) to evaluate a brief 4-item instrument assessing PTSD symptoms, called the SPAN, as a potential tool for triaging women with a history of trauma for further evaluation. We conducted a cross-sectional survey of English-speaking women scheduled for annual care visits over a 9-month period; and conducted structured clinical interviews as a gold-standard for PTSD diagnosis among a sample of women who reported a history of trauma. The interviewer was blind to SPAN scores. Seventy-six percent of annual care patients (n=292) completed the written survey while waiting for their visit. Ninety women (31%) reported a history of one or more traumatic events including rape, sexual assault, physical assault, and severe motor vehicle accidents. Average age was 34 years, 49% were African American, and 46% were unmarried. Among the 90 women with a history of trauma, 63 agreed to be contacted and we were able to complete the psychiatric assessment for 32. In this convenience sample of 32 women, 25 (78%) met criteria for current PTSD, and 31 of 32 met criteria for other psychiatric comorbidity. Additionally, 68% were not receiving any psychiatric care. Compared to the gold standard for PTSD, SPAN had a sensitivity of 72%, specificity of 74%, positive predictive value of 90% and likelihood ratio of 2.52. Trauma was common in this population. Including a trauma screening question and the SPAN items on written clinic intake surveys has promise for use as a triage tool. Use could meaningfully increase detection of PTSD and other psychiatric morbidity among women receiving routine preventive care.Master of Public Healt

"Passing through difficult times":Perceptions of perinatal depression and treatment needs in Malawi - A qualitative study to inform the development of a culturally sensitive intervention

PurposeThis study was conducted to explore the perceptions of perinatal women and key maternal care health workers about perinatal depression and the health service needs required to inform development of a culturally sensitive and acceptable psychosocial intervention.MethodsThis qualitative study used a descriptive exploratory design; it is the first phase of a larger mixed methods study aimed at adapting a psychosocial intervention for perinatal depression. We conducted in-depth interviews with 22 women who screened positive for depression using a locally validated Chichewa version of the Edinburgh Postnatal Depression Scale at antenatal and postnatal clinics in 1 rural and 1 urban health care setting in Lilongwe District, Malawi. We also conducted 10 key informant interviews with maternal care health workers. Informed consent was obtained from all participants. An interview guide was used to guide enquiry about perceptions of perinatal depression and health service needs. Interviews were transcribed, translated and analysed using content analysis approach.ResultsPerinatal depression was recognized as a common mental health problem that affected self-care activities and functioning of women in the perinatal period. Financial difficulties, relationship problems (polygamy, lack of support, neglect, and infidelity), traumatic events (intimate partner violence and loss) and fear of birth outcomes were identified as causes of depression. All study participants acknowledged the need for support and an intervention that will address the identified challenges. Additionally, they viewed strengthening the health delivery system as crucial to effectively address their needs and gaps identified in the system.ConclusionThe results of this study support plans to develop a family focused intervention for perinatal depression in Malawi addressing relationship, psychosocial and economic issues. It also highlights the importance of strengthening the health delivery system especially at primary care level where the majority of women access care in Malawi and across Sub-Saharan Africa

The effect of antidepressants on fertility

Information on the effects of different pharmaceuticals on fertility is sparse. Human and animal models indicate that antidepressant use could have a negative effect on fertility through alteration of levels of the neurosteroid, allopregnanolone

The long-term psychiatric and medical prognosis of perinatal mental illness

The perinatal period provides an important window into a woman’s long-term health. Perinatal mental illness is a common condition conferring potential serious long-term psychiatric and medical consequences for the mother and family. It is known that childbirth acts as a powerful trigger for depressive episodes in some women, and that women with histories of a mood disorder are particularly vulnerable. Some evidence links perinatal mental illness with obstetrical complications and reduced lactation initiation and duration. Therefore, perinatal mental illness may be a marker for long-term risk, and may contribute directly to subsequent cardiometabolic disease through both neuroendocrine mechanisms and the effects of mental illness on health behaviours. In clinical practice, these associations underscore the importance of screening and treating women with perinatal mental illness to ensure best possible long-term outcomes. Early screening and treatment may both mitigate the primary disease process and reduce the risk of comorbid medical conditions

Optimizing the treatment of mood disorders in the perinatal period

The perinatal period is a time of high risk for women with unipolar and bipolar mood disorders. We discuss treatment considerations for perinatal mood disorders, including unipolar and bipolar depression as well as postpartum psychosis. We further explore the unique issues faced by women and their families across the full trajectory of the perinatal period from preconception planning through pregnancy and following childbirth. Treatment of perinatal mood disorders requires a collaborative care approach between obstetrics practitioners and mental health providers, to ensure that a thoughtful risk : benefit analysis is conducted. It is vital to consider the risks of the underlying illness versus risks of medication exposure during pregnancy or lactation. When considering medication treatment, attention must be paid to prior medication trials that were most efficacious and best tolerated. Lastly, it is important to assess the impact of individual psychosocial stressors and lifestyle factors on treatment response

A Biopsychosocial Conceptual Framework of Postpartum Depression Risk in Immigrant and U.S.-born Latina Mothers in the United States

In this review, we offer a conceptual framework that identifies risk factors of postpartum depression (PPD) in immigrant and U.S.-born Latinas in the U.S. by focusing on psychosocial and neuroendocrine factors. While the evidence of the impact psychosocial stressors have on the development of PPD have been well documented, less is known about the biological etiology of PPD or how these complex stressors jointly increase the risk of PPD in immigrant and U.S.-born Latinas in the U.S

Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence

Perinatal psychiatric episodes comprise various disorders and symptom severity, which are diagnosed and treated in multiple treatment settings. To date, no studies have quantified the incidence and prevalence of perinatal psychiatric episodes treated in primary and secondary care, which we aimed to do in the present study. We designed a descriptive prospective study and included information from Danish population registers to study first-time ever and recurrent psychiatric episodes during the perinatal period, including treatment at psychiatric facilities and general practitioners (GPs). This was done for all women who had records of one or more singleton births from 1998 until 2012. In total, we had information on 822 439 children born to 491 242 unique mothers. Results showed first-time psychiatric episodes treated at inpatient facilities were rare during pregnancy, but increased significantly shortly following childbirth (0.02 vs 0.25 per 1000 births). In comparison, first-time psychiatric episodes treated at outpatient facilities were more common, and showed little variation across pregnancy and postpartum. For every single birth resulting in postpartum episodes treated at inpatient psychiatric facilities, 2.5 births were followed by an episode treated at outpatient psychiatric facility and 12 births by GP-provided pharmacological treatment. We interpret our results the following way: treated severe and moderate psychiatric disorders have different risk patterns in relation to pregnancy and childbirth, which suggests differences in the underlying etiology. We further speculate varying treatment incidence and prevalence in pregnancy vs postpartum may indicate that the current Diagnostic and Statistical Manual of Mental Disorders-5 peripartum specifier not adequately describes at-risk periods across moderate and severe perinatal psychiatric episodes