| 1. |
- Asif, Sana, M.D, PhD student, et al.
(författare)
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Severe obstetric lacerations associated with postpartum depression among women with low resilience : a Swedish birth cohort study
- 2020
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 127:11, s. 1382-1390
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Women's levels of resilience and attitudes towards perineal lacerations vary greatly. Some women see them as part of the birthing process, while others react with anger, depressed mood or even self-harm thoughts. A previous study has reported increased risk of postpartum depressive (PPD) symptoms in women with severe perineal lacerations. The aim of this study was to assess the association between severe obstetric perineal lacerations and PPD. A secondary objective was to assess this association among women with low resilience.DESIGN: Nested cohort study.SETTING: Uppsala, Sweden.SAMPLE: Vaginally delivered women with singleton pregnancies (n = 2,990).METHODS: The main exposure was obstetric perineal lacerations. Resilience was assessed in gestational week 32 using the Swedish version of the Sense of Coherence Scale (SOC-29). A digital acyclic graph (DAG) was used to identify possible confounders and mediators. Logistic regression was used to estimate odds ratios and 95% confidence intervals. A sub-analysis was run after excluding women with normal or high resilience.MAIN OUTCOME MEASURES: Postpartum depression, assessed with the Depression Self-Reporting Scale (DSRS), completed at six weeks postpartum.RESULTS: There was no significant association between severe obstetric perineal lacerations and PPD at six weeks postpartum. However, a significant association was found between severe lacerations and PPD in women with low resilience (OR =4.8 95% CI = 1.2-20), persisting even after adjusting for confounding factors.CONCLUSION: Health care professionals might need to identify women with low resilience, as they are at increased risk for PPD after a severe perineal laceration.
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| 2. |
- Astor, Kim, et al.
(författare)
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Social and emotional contexts predict the development of gaze following in early infancy
- 2020
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Ingår i: Royal Society Open Science. - : The Royal Society. - 2054-5703. ; 7:9
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Tidskriftsartikel (refereegranskat)abstract
- The development of gaze following begins in early infancy and its developmental foundation has been under heavy debate. Using a longitudinal design (N = 118), we demonstrate that attachment quality predicts individual differences in the onset of gaze following, at six months of age, and that maternal postpartum depression predicts later gaze following, at 10 months. In addition, we report longitudinal stability in gaze following from 6 to 10 months. A full path model (using attachment, maternal depression and gaze following at six months) accounted for 21% of variance in gaze following at 10 months. These results suggest an experience-dependent development of gaze following, driven by the infant's own motivation to interact and engage with others (the social-first perspective).
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| 3. |
- Bazargani, Farnaz, et al.
(författare)
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Conception by means of in vitro fertilization (IVF) is not associated with nausea and vomiting of pregnancy
- 2020
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Konferensbidrag (refereegranskat)abstract
- Study question:Is there any association between mode of conception or IVF-related variables and nausea and vomiting of pregnancy (NVP)?Summary answer:Conception by means of IVF is not associated with NVP but the stage of the transferred embryo may affect NVP development.What is known already:The exact cause of NVP is unknown but risk factors including increased hormonal levels, maternal distress and anxiety disorders, also described in IVF populations, have been reported. There are only a few studies exploring NVP in IVF samples. A population-based study examining the characteristics of women who suffered from a severe form of NVP, it was reported that women with severe NVP had more often conceived through assisted reproduction techniques. So far, the relationship between NVP and IVF or different treatment related parameters in the IVF population in relation to NVP remains unclear.Study design, size, duration:The study is a longitudinal, matched - cohort, pilot study including 630 pregnant women with singletons without malformations, recruited during the pregnancy ultrasound in gestational week 17 (GW 17). The study was conducted between 2010-2016 at the University Hospital of Uppsala, Sweden.Participants/materials, setting, methods:The study population comprised 210 women with IVF conceived pregnancies and 420 age and parity matched women with spontaneous pregnancies. All participants self-reported sociodemographic and pregnancy-related information. IVF treatment data were obtained after scrutinization of the medical records. The outcome, NVP at GW 17, was divided into: 1) absence of NVP, 2) NVP not requiring medications and 3) NVP requiring medications. NVP was then studied in relation to exposure and to different IVF treatment-associated variables.Main results and the role of chance:The mean age of the participants was 33.7 years with 2/3 of the participants being primipara. IVF pregnant women reported more frequently comorbidities (such as hypertension, diabetes, migraine etc) (59.1% vs 49.9%), but less frequently alcohol consumption (38.4% vs 48.7%) compared to women with spontaneous pregnancies. Clinical and sociodemographic characteristics such as education, employment, smoking habits, maternal BMI, depression history, delivery fear and newborn gender, were otherwise similar between the groups. NVP with or without medications was not associated with mode of conception (p=0.889); 11.4% of women who conceived through IVF suffered from NVP requiring medications and 62.4% from unmedicated NVP vs 10.8% and 64.3% respectively of women with spontaneous pregnancies. Absence of NVP was reported by 26.2% of IVF and 24.9% of spontaneously pregnant women. However, in a subgroup analysis in the group of women who conceived through IVF, NVP was more frequently seen in the group who received cleavage stage embryos vs blastocysts (p=0.019). We could not however find any significant difference in the rate of NVP with or without medications between fresh (69.4%) or frozen/thawed embryo transfers (78.5%), nor between IVF(72.3%) and intracytoplasmic sperm injection(ICSI)(77.4%) treatments. Lastly, there was no significant difference between infertility diagnosis and NVP.Limitations, reasons for caution:The study had limited power to detect differences in NVP in relation to mode of conception. In addition, there was a missing rate of 30.5% in the reported embryo stage variable. Finally, the rate of blastocyst-transfers during that period was lower than otherwise expected with current statistics.Wider implications of the findings:It is still unclear whether IVF has an impact on the risk of NVP. However, transfer of a blastocyst may decrease the risk of developing NVP.
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| 4. |
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| 5. |
- Bränn, Emma, et al.
(författare)
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Inflammatory markers in women with postpartum depressive symptoms
- 2020
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Ingår i: Journal of Neuroscience Research. - : Wiley. - 0360-4012 .- 1097-4547. ; 98:7, s. 1309-1321
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Tidskriftsartikel (refereegranskat)abstract
- Postpartum depression (PPD) is a devastating disorder affecting not only more than 10% of all women giving birth, but also the baby, the family, and the society. Compiling evidence suggests the involvement of the immune system in the pathophysiology of major depression; yet, the immune response in perinatal depression is not as well studied. The aim of this study was to investigate the alterations in peripheral levels of inflammatory biomarkers in 169 Swedish women with and without depressive symptoms according to the Edinburgh postnatal depression scale or the M.I.N.I neuropsychiatric interview at eight weeks postpartum. Among the 70 markers analyzed with multiplex proximity extension assay, five were significantly elevated in women with postpartum depressive symptoms in the adjusted LASSO logistic regression analysis: Tumor necrosis factor ligand superfamily member (TRANCE) (OR-per 1 SD increase = 1.20), Hepatocyte growth factor (HGF) (OR = 1.17) Interleukin (IL)-18 (OR = 1.06), Fibroblast growth factor 23 (FGF-23) (OR = 1.25), and C-X-C motif chemokine 1 (CXCL1) (OR 1.11). These results indicate that women with PPD have elevated levels of some inflammatory biomarkers. It is, therefore, plausible that PPD is associated with a compromised adaptability of the immune system.
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| 6. |
- Eckerdal, Patricia, 1972-, et al.
(författare)
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Epidural analgesia during Childbirth and Postpartum depressive symptoms : A population-based longitudinal cohort study
- 2020
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Ingår i: Anesthesia and Analgesia. - 0003-2999 .- 1526-7598. ; 130:3, s. 615-624
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Severe pain has been linked to depression, which raises the question of whether epidural analgesia (EDA) during childbirth is associated with a reduced risk of postpartum depression (PPD). This association has been explored previously, but the studies were restricted by small sample sizes and the inability to control for relevant confounders. This study aimed to investigate the association between the administration of EDA and the development of PPD after adjusting for sociodemographic, psychosocial, and obstetric variables.METHODS: Data were retrieved from the Biology, Affect, Stress, Imaging and Cognition (BASIC) project (2009-2017), a population-based longitudinal cohort study of pregnant women conducted at Uppsala University Hospital, Sweden. The outcome was PPD at 6 weeks postpartum, defined as a score of >= 12 points on the Edinburgh Postnatal Depression Scale (EPDS). Information was collected through medical records and self-reported web-based questionnaires during pregnancy and 6 weeks after childbirth. Only primiparous women with spontaneous start of childbirth were included (n = 1503). The association between EDA and PPD was examined in multivariable logistic regression models, adjusting for sociodemographic, psychosocial, and obstetric variables. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs).RESULTS: Of the 1503 women included in the analysis, 800 (53%) reported use of EDA during childbirth. PPD at 6 weeks postpartum was present in 193 (13%) women. EDA was not associated with higher odds of PPD at 6 weeks postpartum after adjusting for suspected confounders (age, fear of childbirth, antenatal depressive symptoms; adjusted OR [aOR] = 1.22; 95% CI, 0.87-1.72).CONCLUSIONS: EDA was not associated with the risk of PPD at 6 weeks postpartum after adjusting for sociodemographic, psychosocial, and obstetric variables. However, these findings do not preclude a potential association between PPD and childbirth pain or other aspects of EDA that were not assessed in this study.
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| 7. |
- Edvinsson, Åsa, 1982-, et al.
(författare)
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Placental glucocorticoid receptors are not affected by maternal depression or SSRI treatment.
- 2020
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 125:1, s. 30-36
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Tidskriftsartikel (refereegranskat)abstract
- Background: Prenatal depression is common, with an estimate that up to one in five pregnant women suffers from depressive symptoms. Maternal depression is associated with poor pregnancy outcomes such as preterm birth and low birth-weight. Such outcomes possibly affect offspring development. Previous studies suggest placental RNA levels of the glucocorticoid receptor are altered by maternal depression or anxiety; this stress may affect the placenta of male and female foetuses differently. However, it is unknown if the protein levels and activity of this receptor are additionally affected in women with depressive symptoms or being pharmacologically treated for depression.Methods: In this study, we investigated whether the glucocorticoid receptor (NR3C1) in the placenta is affected by maternal depression and/or selective serotonin reuptake inhibitor (SSRIs) treatment. Placentas from 45 women with singleton, term pregnancies were analysed by Western blot to determine glucocorticoid receptor levels, and by DNA-binding capacity to measure glucocorticoid receptor activation.Results: There were no differences in levels of the glucocorticoid receptor or activity between groups (control, depressive symptoms, and SSRI treatment; n = 45). Similarly, there was no difference in placental glucocorticoid receptor levels or activity dependent upon foetal sex.Conclusion: Maternal depression and SSRI treatment do not affect the glucocorticoid receptors in the placenta.
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| 8. |
- Fransson, Emma, PhD, 1973-, et al.
(författare)
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Maternal perinatal depressive symptoms trajectories and impact on toddler behavior : the importance of symptom duration and maternal bonding
- 2020
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Ingår i: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 273, s. 542-551
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Maternal perinatal depression is a public health problem affecting mothers and children worldwide. This study aimed to increase the knowledge regarding the impact of timing of maternal depression on child behavioral difficulties at 18 months, taking into consideration child gender and maternal bonding.METHODS: Data from a Swedish population-based longitudinal mother-infant study (n = 1,093) were used for linear regression modeling. Associations between antenatal depression, postpartum depression, persistent depression and child behavioral problems were assessed.RESULTS: Maternal antenatal and persistent depression were associated with higher Child Behavior Checklist scores. Girls were affected to a greater degree. Postpartum bonding mediated most of the negative effects of postpartum and persistent depression on child behavior; not the effects of antenatal depression, however.LIMITATIONS: Child behavioral problems were reported by the mother. Information regarding paternal depressive symptoms was lacking.CONCLUSION: Different onset and timing of maternal depression showed distinct associations with child behavioral problems. The effects of antenatal depression were not mediated by maternal bonding, indicating underlying mechanisms possibly related to fetal programming. Screening of depressive symptoms even during pregnancy would be important in routine care in order to early identify and treat depression.
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| 9. |
- Hesselman, Susanne, 1973-, et al.
(författare)
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Association of maternal attention deficit hyperactivity disorder and preterm birth : a cohort study.
- 2020
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 127:12, s. 1480-1487
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) affects 3-7% of women of childbearing age. Whether ADHD is associated with an increased risk of preterm birth is unclear.DESIGN: National register-based cohort study.SETTING: Sweden.POPULATION: Nulliparous women giving birth to singleton infants 2007-2014 (n = 377 381).METHODS: Women were considered to have ADHD if they had been dispensed at least one prescription for ADHD medication, i.e. a central nervous system stimulant or non-stimulant drugs for ADHD, prior to, during or after pregnancy (2005-2014). Women with ADHD were compared with women without ADHD in regard to prevalence, severity and mode of onset of preterm birth. Logistic regression models were used, estimating adjusted odds ratios (aOR) with 95% confidence intervals (CI). Adjustments were made for maternal age and country of birth (model 1), and in addition for body mass index (BMI), education, alcohol or substance use disorders, and pre-gestational medical and psychiatric co-morbidity (model 2).MAIN OUTCOME MEASURES: Preterm birth (<37 weeks).RESULTS: During the study period, 6327 (1.7%) women gave birth and had ADHD according to our definition. These women had a higher rate of preterm birth compared with women without ADHD (7.3 versus 5.8%, aOR model 2: 1.17; 95% CI 1.05-1.30). ADHD was particularly associated with very (<32 weeks) preterm births, and associations were seen with both spontaneous and medically indicated onsets.CONCLUSIONS: Women with ADHD (i.e. who had been dispensed ADHD medication at any time in 2005-2014) had an increased risk of preterm birth.TWEETABLE ABSTRACT: Women with ADHD have a higher risk of preterm birth but most of it is due to modifiable risk factors.
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| 10. |
- Levis, B., et al.
(författare)
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Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women : systematic review and meta-analysis of individual participant data
- 2020
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Ingår i: Bmj. - : BMJ. - 0959-8138 .- 0959-8138 .- 1756-1833. ; 371
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Tidskriftsartikel (refereegranskat)abstract
- AbstractObjective To evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression in pregnant and postpartum women.Design Individual participant data meta-analysis.Data sources Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (from inception to 3 October 2018).Eligibility criteria for selecting studies Eligible datasets included EPDS scores and major depression classification based on validated diagnostic interviews. Bivariate random effects meta-analysis was used to estimate EPDS sensitivity and specificity compared with semi-structured, fully structured (Mini International Neuropsychiatric Interview (MINI) excluded), and MINI diagnostic interviews separately using individual participant data. One stage meta-regression was used to examine accuracy by reference standard categories and participant characteristics.Results Individual participant data were obtained from 58 of 83 eligible studies (70%; 15 557 of 22 788 eligible participants (68%), 2069 with major depression). Combined sensitivity and specificity was maximised at a cut-off value of 11 or higher across reference standards. Among studies with a semi-structured interview (36 studies, 9066 participants, 1330 with major depression), sensitivity and specificity were 0.85 (95% confidence interval 0.79 to 0.90) and 0.84 (0.79 to 0.88) for a cut-off value of 10 or higher, 0.81 (0.75 to 0.87) and 0.88 (0.85 to 0.91) for a cut-off value of 11 or higher, and 0.66 (0.58 to 0.74) and 0.95 (0.92 to 0.96) for a cut-off value of 13 or higher, respectively. Accuracy was similar across reference standards and subgroups, including for pregnant and postpartum women.Conclusions An EPDS cut-off value of 11 or higher maximised combined sensitivity and specificity; a cut-off value of 13 or higher was less sensitive but more specific. To identify pregnant and postpartum women with higher symptom levels, a cut-off of 13 or higher could be used. Lower cut-off values could be used if the intention is to avoid false negatives and identify most patients who meet diagnostic criteria.Registration PROSPERO (CRD42015024785).
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