The Fetus and Maternal Depression: Implications for Antenatal Treatment Guidelines

Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Clinical Obstetrics and Gynecology (Impact Factor: 1.77). 10/2004; 47(3):535-46. DOI: 10.1097/01.grf.0000135341.48747.f9
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    • "In addition, women with limited or no social support (Demyttenaere et al. 1995; Jesse and Swanson 2007; Kearns et al. 1997; Lancaster et al. 2010; Lee et al. 2007; Leigh and Milgrom 2008; Rudnicki et al. 2001; Seguin et al. 1995; Westdahl et al. 2007), low socioeconomic status (Bolton et al. 1998; Holzman et al. 2006; Kearns et al. 1997; Marcus et al. 2003), public insurance (Canady et al. 2008; Jesse 2003; Jesse et al. 2005; Kermode et al. 2000; Lancaster et al. 2010), poor coping skills or sense of control (Bernazzani et al. 1997; Da Costa et al. 2000; Demyttenaere et al. 1995; Rudnicki et al. 2001), low self-esteem (Jesse and Swanson 2007; Jesse et al. 2005; Lee et al. 2007; Leigh and Milgrom 2008; Ritter et al. 2000), chronic stress (Jesse and Swanson 2007; Monk et al. 2008; Mora et al. 2009; Paarlberg et al. 1996; Seguin et al. 1995), alcohol or substance abuse problems (Marcus et al. 2003; Mora et al. 2009; Pajulo et al. 2001), or a history of childhood or adult abuse (Benedict et al. 1999; Holzman et al. 2006; Jesse and Swanson 2007; Lancaster et al. 2010; Leigh and Milgrom 2008; Nayak and Al-Yattama 1999) are more susceptible to having antepartum mental health problems. Pregnant women are also at an increased risk if they are unmarried (Bolton et al. 1998; Marcus et al. 2003; Orr et al. 2006; Westdahl et al. 2007), not living with a partner (Canady et al. 2008; Hobfoll et al. 1995; Lancaster et al. 2010; Marcus et al. 2003; Orr et al. 2006; Rich-Edwards et al. 2006; Seguin et al. 1995), or are unhappy in their marriage (Bilszta et al. 2008; Gotlib et al. 1989; Henry et al. 2004; Lee et al. 2007; Records and Rice 2007). Women who report stressful life events (Lancaster et al. 2010; Leigh and Milgrom 2008; Rubertsson et al. 2003; Seguin et al. 1995) or an unplanned or unwanted pregnancy (Lancaster et al. 2010; Lee et al. 2007; Mora et al. 2009; Rich-Edwards et al. 2006) are also at a greater risk according to previous research. "
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    ABSTRACT: Mental health problems disproportionately affect women, particularly during childbearing years. We sought to estimate the prevalence of antepartum mental health problems and determine potential risk factors in a representative USA population. We examined data on 3,051 pregnant women from 11 panels of the 1996-2006 Medical Expenditure Panel Survey. Poor antepartum mental health was defined by self report of mental health conditions or symptoms or a mental health rating of "fair" or "poor." Multivariate regression analyses modeled the odds of poor antepartum mental health; 7.8% of women reported poor antepartum mental health. A history of mental health problems increased the odds of poor antepartum mental health by a factor of 8.45 (95% CI, 6.01-11.88). Multivariate analyses were stratified by history of mental health problems. Significant factors among both groups included never being married and self-reported fair/poor health status. This study identifies key risk factors associated with antepartum mental health problems in a nationally representative sample of pregnant women. Women with low social support, in poor health, or with a history of poor mental health are at an increased risk of having antepartum mental health problems. Understanding these risk factors is critical to improve the long-term health of women and their children.
    Archives of Women s Mental Health 10/2010; 13(5):425-37. DOI:10.1007/s00737-010-0176-0 · 2.16 Impact Factor
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    ABSTRACT: Pregnancy has historically been described as a time of emotional well-being, providing "protection" against psychiatric disorder. However, systematic delineation of risk of relapse in women who maintain or discontinue pharmacological treatment during pregnancy is necessary. To describe risk of relapse in pregnant women who discontinued antidepressant medication proximate to conception compared with those who maintained treatment with these medications. A prospective naturalistic investigation using longitudinal psychiatric assessments on a monthly basis across pregnancy; a survival analysis was conducted to determine time to relapse of depression during pregnancy. A total of 201 pregnant women were enrolled between March 1999 and April 2003 from 3 centers with specific expertise in the treatment of psychiatric illness during pregnancy. The cohort of women was recruited from (1) within the hospital clinics, (2) self-referral via advertisements and community outreach detailing the study, and (3) direct referrals from the community. Participants were considered eligible if they (1) had a history of major depression prior to pregnancy, (2) were less than 16 weeks' gestation, (3) were euthymic for at least 3 months prior to their last menstrual period, and (4) were currently or recently (<12 weeks prior to last menstrual period) receiving antidepressant treatment. Of the 201 participants, 13 miscarried, 5 electively terminated their pregnancy, 12 were lost to follow-up prior to completion of pregnancy, and 8 chose to discontinue participation in the study. Relapse of major depression defined as fulfilling Structured Clinical Interview for DSM-IV [Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition] Diagnosis (SCID) criteria. Among the 201 women in the sample, 86 (43%) experienced a relapse of major depression during pregnancy. Among the 82 women who maintained their medication throughout their pregnancy, 21 (26%) relapsed compared with 44 (68%) of the 65 women who discontinued medication. Women who discontinued medication relapsed significantly more frequently over the course of their pregnancy compared with women who maintained their medication (hazard ratio, 5.0; 95% confidence interval, 2.8-9.1; P<.001). Pregnancy is not "protective" with respect to risk of relapse of major depression. Women with histories of depression who are euthymic in the context of ongoing antidepressant therapy should be aware of the association of depressive relapse during pregnancy with antidepressant discontinuation.
    JAMA The Journal of the American Medical Association 02/2006; 295(5):499-507. DOI:10.1001/jama.295.5.499 · 35.29 Impact Factor
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    American Journal of Psychiatry 07/2006; 163(6):954-6. DOI:10.1176/appi.ajp.163.6.954 · 12.30 Impact Factor
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