Thyroid dysfunction: a risk factor associated with post-partum depression?

OBJECTIVES: to investigate the prevalence of post partum depression and its correlation with thyroid dysfunction in mothers. METHODS: a descriptive, cross-cutting observational study carried out among 292 women between the 31st and 180th days post partum, attending public health units in the Metropolitan Region of Vitória, in the State of Espírito Santo, Brazil. The sample was analyzed for socio-demographic and clinical-obstetric characteristics. A depressive disorder was defined by a score greater than or equal to twelve on the Edinburgh Post-Partum Depression Scale (EPDS). The thyroid was assessed using serum dosages of thyroid stimulating hormone, (TSH), free thyroxin (T4 free) and anti-peroxidase antibodies (TPO). Evaluation of the results was carried out using descriptive analysis and the χ2 test, with a level of significance of 5%. RESULTS: 115 women (39.4%) scored higher than 12 on the EPDS and were thereby deemed to be depressed; 117 (60.6%) scoring lower than 12 were considered not to be depressed. The prevalence of post-partum depression in the group with thyroid dysfunction was 36% and 40% in the group without thyroid dysfunction. There was no statistically significant difference in the frequency of depression between patients with or without thyroid dysfunction (χ2=0.131;p=0.717). CONCLUSIONS: the frequency of PPD was high but no association was observed between post-partum depression and thyroid dysfunction.OBJETIVOS: estudar prevalência de depressão pósparto e sua correlação com alterações tireoidianas maternas. MÉTODOS: estudo observacional descritivo transversal realizado com 292 mulheres entre 31 e 180 dias após o parto, atendidas em unidades de saúde pública da Região Metroplitana de Vitória, Espírito Santo, Brasil. Analisou-se a amostra segundo características sociodemográficas e clínico-obstétricas. Definiu-se transtorno depressivo pelo escore igual ou superior a 12 na Escala de Depressão Pós-Parto de Edimburgo (EPDS). A avaliação tireoidiana foi realizada por dosagens séricas de hormônio tireo-estimulante (TSH), tiroxina livre (T4 livre) e dos anticorpos anti-peroxidase (TPO). Para avaliação dos resultados utilizamos técnicas de análise descritiva e teste do χ2, adotando nível de significância de 5%. RESULTADOS: 115 mulheres (39,4%) apresentaram escores iguais ou superiores a 12 na EPDS, sendo consideradas deprimidas; 117 (60,6%), com escores inferiores a 12, foram consideradas não deprimidas. A prevalência de depressão pós-parto no grupo com alterações tireoidianas foi de 36% e no grupo sem alterações tireoidianas foi de 40%. Não houve diferença estatisticamente significante na frequência de depressão entre as pacientes com e sem alterações tireoidianas (χ2=0,131;p=0,717). CONCLUSÕES: a frequência de DPP foi elevada, não sendo observada associação entre depressão pós-parto e alterações tireoidianas

Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6 months after uterine evacuation?

Objective. To compare the outcomes of Brazilian patients with molar pregnancy who continue human chorionic gonadotropin (hCG) surveillance with those treated with chemotherapy when hCG was still positive, but falling at 6 months after uterine evacuation. Methods. Retrospective chart review of 12,526 patients with hydatidiform mole treated at one of nine Brazilian reference centers from January 1990 to May 2016. Results. At 6 months from uterine evacuation', 96 (0.8%) patients had hCG levels raised but falling. In 15/96 (15.6%) patients, chemotherapy was initiated immediately per FIGO 2000 criteria, while 81/96 (84.4%) patients were managed expectantly. Among the latter, 65/81 (80.2%) achieved spontaneous remission and 16 (19.8%) developed postmolar gestational trophoblastic neoplasia (GTN). Patients who received chemotherapy following expectant management required more time for remission (11 versus 8 monthsp = 0.001), had a greater interval between uterine evacuation and initiating chemotherapy (8 versus 6 monthsp < 0.001), and presented with a median WHO/FIGO risk score higher than women treated according to FIGO 2000 criteria (4 versus 2, p = 0.04), but there were no significant differences in the need for multiagent treatment regimens (1/15 versus 3/16 patients, p = 0.60). None of the women relapsed, and no deaths occurred in either group. Conclusion. In order to avoid unnecessary exposure of women to chemotherapy, we no longer follow the FIGO 2000 recommendation to treat all patients with molar pregnancy and hCG raised but falling at 6 months after evacuation. Instead, we pursue close hormonal and radiological surveillance as the best strategy for these patients. (C) 2016 Elsevier Inc. All rights reserved.Carlos Chagas Filho Foundation under the Brazilian Ministry of Science and TechnologyDonald P. Goldstein MD Trophoblastic Tumor Registry EndowmentDyett Family Trophoblastic Disease Research and Registry EndowmentUniv Fed Fluminense, Rio de Janeiro Trophoblast Dis Ctr, Antonio Pedro Univ Hosp, Matern Sch,Matern Ward Santa Casa Misericordia Ri, Rio De Janeiro, RJ, BrazilUniv Fed Fluminense, Postgrad Program Med Sci, Niteroi, RJ, BrazilUniv Fed Rio de Janeiro, Matern Sch, Postgrad Program Perinatal Hlth, Fac Med, Rio De Janeiro, RJ, BrazilSao Paulo State Univ, Trophoblast Dis Ctr, Clin Hosp, Botucatu Med Sch,Dept Gynecol & Obstet, Botucatu, SP, BrazilUniv Fed Sao Paulo, Paulista Sch Med, Sao Paulo Hosp, Trophoblast Dis Ctr, Sao Paulo, SP, BrazilUniv Sao Paulo, Sao Paulo Clin Hosp, Trophoblast Dis Ctr, Sao Paulo, SP, BrazilCaxias Do Sul Univ, Caxias Do Sul Trophoblast Dis Ctr, Gen Hosp Caxias Do Sul, Sch Med,Ctr Biol & Hlth Sci, Caxias Do Sul, MS USAIrmandade Santa Casa Misericordia Hosp, Porto Alegre Trophoblast Dis Ctr, Mario Totta Matern Ward, Porto Alegre, RS, BrazilGoias Fed Univ, Goias Trophoblast Dis Ctr, Clin Hosp Goias, Goiania, Go, BrazilHarvard Med Sch, Brigham & Womens Hosp, New England Trophoblast Dis Ctr, Div Gynecol Oncol,Dept Obstet & Gynecol & Reprod, Boston, MA USASão Paulo Hospital Trophoblastic Disease Center, Paulista School of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, BrazilWeb of Scienc