Tag: postpartum depression

Categories : Mental Health Obstetrics & GynaecologyTags :

Surrogates Have an Increased Risk of a Mental Illness Diagnosis

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People who are gestational carriers (or “surrogates”) appear more likely to be diagnosed with a new mental illness during and after pregnancy, according to new research from ICES, McGill University, and the Research Institute of the McGill University Health Centre. 

As the number of births by surrogacy increases, this is the first large study using Ontario-based health data to explore the mental health challenges faced by some surrogates. 

Despite guidelines requiring mental health screening, the researchers found that nearly 1 in 5 gestational carriers had a prior mental illness diagnosis before pregnancy—including some with serious conditions that may have made them ineligible to carry a pregnancy for someone else. 

“Our findings underscore the importance of adequate screening and counselling of potential gestational carriers before pregnancy about the possibility of a new-onset mental illness, or exacerbation of a prior mental-illness during or after pregnancy,” says lead author Dr. Maria Velez, an adjunct scientist at ICES, associate professor at McGill University, and scientist at the Research Institute of the McGill University Health Centre. 

The study, published in JAMA Network Open, included 767 406 births at more than 20 week’s gestation in Ontario, Canada between 2012 and 2021 among women without known mental illness before pregnancy. Comparison groups included 97.6% (748,732) who were conceived without assistance, 2.3% (17,916) by IVF and 0.1% (758) using gestational carriers. 

Gestational carriers were more likely to have previously given birth, resided in a lower-income area, and had higher rates of obesity and chronic hypertension. 

Adequate mental health support needed 

The incidence rate per 100 person-years of new-onset mental illness was 5.2 among non-gestational carriers with unassisted conception, 5.0 among non-gestational carriers who conceived by IVF, and 6.9 among gestational carriers. 

The findings were even more pronounced for mental illness that was newly diagnosed through an emergency department encounter or a hospitalisation, compared to an outpatient mental illness diagnosis. 

“Unfortunately, fewer than half of those who visit the emergency room for mental health concerns after childbirth receive timely follow-up care which leaves many, especially gestational carriers, at risk during a vulnerable period,” says Velez. 

The authors say that they hope this study will inform future guidelines that ensure adequate mental health support for gestational carriers during and after pregnancy. 

Source: ICES

Categories : Lab Tests and Imaging Mental HealthTags :

Postpartum Depression Discovery Opens Door to Blood Test, Earlier Treatment

On By ModernMedia
Photo by Alina Matveycheva

New postpartum depression research from the School of Medicine and Weill Cornell Medicine could lead to a blood test to identify women at risk and possibly even to a preventive treatment.

The research, published in Neuroposychopharmacology, suggests that pregnant women may have characteristic levels of certain molecules in their blood that can warn that they are at risk of developing postpartum depression (PPD). These molecules, called neuroactive steroids, are derived from progesterone.

Measuring those molecules via a simple blood test could let doctors get women treatment for PPD sooner – possibly even before symptoms appear, the researchers say. “Studying postpartum depression gives us a way to identify biological changes that occur before someone becomes depressed because the timing of postpartum depression is predictable,” said researcher Jennifer Payne, MD, an expert in reproductive psychiatry at UVA Health and the University of Virginia School of Medicine.

Understanding Postpartum Depression 

Postpartum depression affects 10% to 15% of new moms.

“Postpartum is the only time in people’s lifespans when we know there is a biological trigger which guarantees that a certain percentage of people will become ill,” said Weill Cornell’s Lauren Osborne, MD, who co-led the study with Payne. “If we can untangle this biology and find predictors for it, not only will we be helping women, but it may give us a step up in trying to find predictors for other psychiatric illnesses also.”

It’s unclear why some women develop postpartum depression, but the new findings suggest that an imbalance in the body’s metabolism of progesterone may be a factor. 

About the Study

To better understand the role of progesterone, the researchers focused on the hormone and on its “metabolic pathway” in the body. The scientists measured levels of neuroactive steroids derived from progesterone in the blood of 136 women during their second and third trimesters. Of these, 33 went on to develop postpartum depression after giving birth.

Two neuroactive steroids seem to affect the risk of developing PPD – pregnanolone and isoallopregnanolone. Pregnanolone acts on a particular cellular receptor to reduce stress. Isoallopregnanolone, on the other hand, acts on the same receptor to increase stress.

In the third trimester, women who went on to develop PPD had a lower pregnanolone/progesterone ratio and a higher isoallopregnanolone/pregnanolone ratio compared with those who did not, the researchers found. Elevated progesterone levels in late pregnancy were also associated with a higher risk of PPD.

Next Steps

The researchers plan to attempt to replicate their results in a larger, more diverse group of women in hopes of developing a clinical test to predict the risk of PPD. Further, they say their work could lead to a preventive treatment – possibly one of two prescription drugs, brexanolone and zuranolone, already available to treat PPD.

“We don’t know if these drugs would work as a preventive measure for people who are at risk of developing postpartum depression, but based on our findings, they have the potential to prevent [its] development,” Osborne said.

Source: University of Virginia Health System

Categories : Mental Health Obstetrics & GynaecologyTags :

Simple Cognitive-behavioural Intervention Reduces Postpartum Depression

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Results from a large clinical trial published in Nature Medicine show that an intervention for anxiety provided to pregnant women living in Pakistan significantly reduced the likelihood of the women developing moderate-to-severe anxiety, depression, or both six weeks after birth. The unique intervention was administered by non-specialised providers who had the equivalent of a bachelor’s degree in psychology – but no clinical experience. The results suggest this intervention could be an effective way to prevent the development of postpartum mental health challenges in women living in low-resource settings.

“In low resource settings, it can be challenging for women to access mental health care due to a global shortage of trained mental health specialists,” said Joshua A. Gordon, MD, PhD, Director of the National Institute of Mental Health, part of the National Institutes of Health.

“This study shows that non-specialists could help to fill this gap, providing care to more women during this critical period.”

Led by Pamela J. Surkan, PhD, ScD, of Johns Hopkins Bloomberg School of Public Health, Baltimore, the study was conducted in the Punjab Province of Pakistan between April 2019 and January 2022.

Pregnant women with symptoms of at least mild anxiety were randomly assigned to receive either routine pregnancy care or a cognitive behavioral therapy (CBT)-based intervention called Happy Mother-Healthy Baby. The researchers assessed the participants (380 women in the CBT group and 375 women in the routine care group) for anxiety and depression six weeks after the birth of their child.

The researchers found that 9% of women in the intervention group developed moderate-to-severe anxiety compared with 27% of women in the routine care group.

Additionally, 12% percent of women in the intervention group developed depression compared with 41% of women in the routine care group.

“Postpartum depression not only harms mothers, it is also associated with poorer physical growth and delayed cognitive development in their children,” said Dr Surkan.

“The link between maternal and child health highlights the critical importance of developing effective ways to address postpartum anxiety and depression.”

The Happy Mother-Healthy Baby intervention was created using input from pregnant women in a hospital in Rawalpindi, Pakistan.

Pregnant women took part in six intervention sessions where they learned to identify anxious thoughts and behaviors, such as thoughts about possible miscarriage, and to practice replacing them with helpful thoughts and behaviors.

The first five sessions were conducted in early to mid-pregnancy, and the sixth session occurred in the third trimester.

Prior research suggests that up to 30% of women in the Global South, which includes South America, Africa, and most of southern Asia, report experiencing anxiety during pregnancy.

Anxiety during pregnancy predicts the development of anxiety and depression after birth, making the prenatal period a prime target for intervention.

However, it can be challenging for women living in low-resource settings to access trained clinical care.

The findings from this study demonstrate that an intervention such as Happy Mother-Healthy Baby could be an effective way to help prevent the development of postpartum depression and anxiety in settings where specialist clinical care may be hard to access.

“In the future, we can build on these findings through implementation research. Having identified an intervention that works, the next step is to figure out the best ways to deliver effective treatment to the people who need it, bridging the gap between science and practice,” said Dr Surkan.

Source: NIH/National Institute of Mental Health