Perinatal Depression: Challenges and Opportunities

Journal of Women s Health, Journal Year: 2020, Volume and Issue: 30(2), P. 154 - 159

Published: Nov. 6, 2020

Perinatal depression (PND) is a major depressive episode during pregnancy or within 4 weeks after childbirth up to year. Risk factors for PND include stressful life events, history of depression, poor social support, unplanned and unwanted pregnancies, relationship quality, current previous abuse, low socioeconomic status. This mental disorder has been shown have negative effects on mothers' quality their intimate relationships, birth outcomes, breastfeeding likelihood, as well long-term children's cognitive emotional development. To date, no nationally representative study examined whether there are and/or racial/ethnic differences in PND. discusses the prevalence risk PND, its health consequences mothers children, reasons underreporting undertreatment, evidence different screening instruments treatment options, existing supportive policies address this United States. We conclude with outlining next steps addressing gaps literature

Language: Английский

---

Effect of Zuranolone vs Placebo in Postpartum Depression

JAMA Psychiatry, Journal Year: 2021, Volume and Issue: 78(9), P. 951 - 951

Published: June 30, 2021

Postpartum depression (PPD) is one of the most common medical complications during and after pregnancy, negatively affecting both mother child.To demonstrate efficacy safety zuranolone, a neuroactive steroid γ-aminobutyric acid receptor-positive allosteric modulator, in PPD.This phase 3, double-blind, randomized, outpatient, placebo-controlled clinical trial was conducted between January 2017 December 2018 27 enrolling US sites. Participant were women aged 18 to 45 years, 6 months or fewer post partum, with PPD (major depressive episode beginning third trimester ≤4 weeks postdelivery), baseline 17-item Hamilton Rating Scale for Depression (HAMD-17) score 26 higher. Analysis intention treat began ended March 2019.Randomization 1:1 placebo:zuranolone, 30 mg, administered orally each evening 2 weeks.Primary end point change from HAMD-17 zuranolone vs placebo at day 15. Secondary points included changes total other time points, response (≥50% reduction) remission (score ≤7) rates, Montgomery-Åsberg score, Anxiety score. Safety assessed by adverse events assessments.Of 153 randomized patients, set comprised 150 patients (mean [SD] age, 28.3 [5.4] years), 148 (98.7%) completed treatment. A 76 placebo, 77 mg. Zuranolone demonstrated significant 15 improvements (-17.8 -13.6; difference, -4.2; 95% CI, -6.9 -1.5; P = .003). Sustained differences scores favoring observed 3 (difference, -2.7; -5.1 -0.3; .03) through -4.1; -6.7 -1.4; (odds ratio, 2.63; 1.34-5.16; .005), 2.53; 1.24-5.17; .01), -4.6; -8.3 -0.8; .02), -3.9; -1.1; .006). One patient per group experienced serious event (confusional state pancreatitis group). discontinued because an none placebo.In this trial, improved core symptoms as measured generally well tolerated, supporting further development treatment PPD.ClinicalTrials.gov Identifier: NCT02978326.

Language: Английский

---

Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic

American Journal of Obstetrics and Gynecology, Journal Year: 2020, Volume and Issue: 224(4), P. 384.e1 - 384.e11

Published: Oct. 8, 2020

Randomized controlled trials document the safety and efficacy of reduced frequency prenatal visit schedules virtual visits, but real-world data are lacking. Our institution created a care delivery model incorporating these alternative approaches to continue safely providing during coronavirus disease 2019 pandemic.To evaluate institutional-level adoption patient provider experiences with model.We conducted single-site evaluation schedule visits deployed at suburban academic on March 20, 2020. We used electronic health record institution-level adoption, defined as changes in overall proportion 3 months before after implementation. To experience model, we an online survey all pregnant patients (>20 weeks' gestation) providers May Of note, domains were evaluated: (1) access, (2) quality safety, (3) satisfaction. Quantitative analyzed basic descriptive statistics. Free-text responses coded by elucidated drivers positive negative experiences.After average weekly volume fell 16.1%, from 898 761 visits; virtually increased 10.8% (97 898) 43.3% (330 761); no-show rate remained stable (preimplementation, 4.3%; postimplementation, 4.2%). those eligible, 74.8% (77 103) 15.0% (253 1690) participated surveys. Patient respondents largely white (180 253; 71.1%) privately insured (199 78.7%), reflecting study site population. The rates chronic conditions pregnancy complications also differed national prevalence. Provider predominantly (44 66; 66.7%) female (50 75.8%). Most almost reported that improved access (patients, 174 253 [68.8%]; providers, 74 77 [96.1%]). More than half 124 [53.3%]; 41 [62.1%]) believed safe. Nearly home blood pressure cuffs important for 213 231 [92.2%]; 63 66 [95.5%]). satisfaction 196 [77.5%]; 64 [83.1%]). In free-text responses, similar included perceived through decreased barriers (eg, transportation, childcare), high low-risk pandemic, better counseling. Perceived less common. These concerns unequal could deepen existing maternity inequities, lack devices cuffs) would affect dissatisfaction poor patient-provider continuity inadequate expectation setting experience.Reduced rapidly integrated into care, many providers. Future research is needed understand outcomes associated across more diverse populations outside pandemic inform broader policy decisions.

Language: Английский

---

Screening for Depression and Suicide Risk in Adults

JAMA, Journal Year: 2023, Volume and Issue: 329(23), P. 2057 - 2057

Published: June 20, 2023

Importance Major depressive disorder (MDD), a common mental in the US, may have substantial impact on lives of affected individuals. If left untreated, MDD can interfere with daily functioning and also be associated an increased risk cardiovascular events, exacerbation comorbid conditions, or mortality. Objective The US Preventive Services Task Force (USPSTF) commissioned systematic review to evaluate benefits harms screening, accuracy treatment suicide asymptomatic adults that would applicable primary care settings. Population Asymptomatic 19 years older, including pregnant postpartum persons. Older are defined as those 65 older. Evidence Assessment USPSTF concludes moderate certainty screening for adults, persons older has net benefit. evidence is insufficient benefit adults. Recommendation recommends depression adult population, (B recommendation) current assess balance (I statement)

Language: Английский

---

Zuranolone for the Treatment of Postpartum Depression

American Journal of Psychiatry, Journal Year: 2023, Volume and Issue: 180(9), P. 668 - 675

Published: July 26, 2023

Postpartum depression (PPD) is a common perinatal complication with adverse maternal and infant outcomes. This study investigated the efficacy safety of zuranolone, positive allosteric modulator synaptic extrasynaptic GABAA receptors neuroactive steroid, as an oral, once-daily, 14-day treatment course for patients severe PPD.In this double-blind phase 3 trial, women PPD were randomized in 1:1 ratio to receive zuranolone 50 mg/day or placebo 14 days. The primary endpoint was change from baseline total score on 17-item Hamilton Depression Rating Scale (HAM-D) at day 15; key secondary endpoints HAM-D days 3, 28, 45 Clinical Global Impressions severity (CGI-S) 15. Adverse events monitored.Among 196 (zuranolone, N=98; placebo, N=98), 170 (86.7%) completed 45-day study. Treatment compared resulted statistically significant improvement depressive symptoms 15 (least squares mean [LSM] score, -15.6 vs. -11.6; LSM difference, -4.0, 95% CI=-6.3, -1.7); also reported 45. CGI-S significantly improved placebo. most (≥10%) somnolence, dizziness, sedation. No loss consciousness, withdrawal symptoms, increased suicidal ideation behavior observed.In demonstrated improvements generally well tolerated, supporting potential novel, rapid-acting oral PPD.

Language: Английский

---

Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants

Cureus, Journal Year: 2023, Volume and Issue: unknown

Published: July 4, 2023

Postpartum depression (PPD) is a common and debilitating mental health condition affecting many mothers worldwide. This review article aims to explore the complex effects of PPD on infants, focusing maternal care. The transition motherhood critical period characterized by numerous physical, psychological, social changes, making women vulnerable onset PPD. Consequently, can significantly impact mother's ability provide optimal care for her infant, leading potential adverse consequences both parties. synthesizes existing research literature topic, encompassing studies from various disciplines, including psychology, psychiatry, obstetrics, pediatrics. It begins providing an overview prevalence risk factors associated with PPD, emphasizing importance early detection intervention. caregiving behaviors, such as bonding, sensitivity, responsiveness, then examined, highlighting disruptions in mother-infant relationship. Furthermore, delves into impaired infant development, emotional, cognitive, domains. Several contributing interplay between are discussed, hormonal psychosocial stressors, influence support networks. also addresses bidirectional nature relationship, whereby characteristics behaviors exacerbate or mitigate Moreover, explores role healthcare providers implementing effective screening, assessment, treatment strategies promote maternal-infant outcomes. By consolidating current knowledge this provides valuable insights multifaceted infants. Recognizing significance understanding mechanisms through which disrupts it inform development targeted interventions detection, treatment, supportive experiencing Ultimately, improving enhancing relationships yield long-term positive mothers' infants' well-being development.

Language: Английский

---

A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality

Children, Journal Year: 2022, Volume and Issue: 9(3), P. 394 - 394

Published: March 10, 2022

Background: U.S. maternal and infant mortality rates constitute an important public health problem, because these surpass those in developed countries are characterized by stark disparities for racial/ethnic minorities, rural residents, individuals with less privileged socioeconomic status due to social determinants of (SDoH). Methods: A critical review the literature was performed determine multilevel SDoH factors leading a life course lens. Results: Black mothers infants fared worst terms rates, likely accumulation experienced as result structural racism across course. Upstream contributors mortality. More research is needed on effectiveness continuous quality improvement initiatives maternal–infant dyad, expanding programs such paid maternity leave, quality, stable affordable housing, safety-nets (Medicaid, CHIP, WIC), reducing Finally, it address gaps individual, interpersonal, community, societal factors, they affect related disparities. Conclusion: Key at multiple levels health. These shape perpetuate lifespan implicated

Language: Английский

---

Effect of brexanolone on depressive symptoms, anxiety, and insomnia in women with postpartum depression: Pooled analyses from 3 double-blind, randomized, placebo-controlled clinical trials in the HUMMINGBIRD clinical program

Journal of Affective Disorders, Journal Year: 2022, Volume and Issue: 320, P. 353 - 359

Published: Sept. 30, 2022

Brexanolone is currently the only treatment specifically approved for postpartum depression (PPD) in United States, based on results from one Phase 2 and two 3 double-blind, randomized, controlled trials HUMMINGBIRD program.Adults with PPD randomized to a 60-h infusion of brexanolone 90 μg/kg/h (BRX90) or placebo were included these post hoc analyses. Data change baseline (CFB) 17-item Hamilton Rating Scale Depression (HAMD-17) total score, HAMD-17 Anxiety/Somatization Insomnia subscales, Clinical Global Impression Improvement (CGI-I) scale pooled. Response rates (≥50 % reduction baseline) CGI-I (score 1 2) scales time response analyzed.Patients receiving BRX90 (n = 102) versus 107) achieved more rapid (median, 24 vs 36 h; p 0.0265), an Hour-60 cumulative rate 81.4 67.3 %; similar 0.0058), 61.7 %. CFB subscales also favored placebo, starting at Hour through Day 30 (all < 0.05), both higher BRX90.The study was not powered assess exploratory outcomes.Brexanolone associated improvement depressive symptoms anxiety insomnia compared women PPD. These data continue support use treat adults

Language: Английский

---

Association between urban green space and postpartum depression, and the role of physical activity: a retrospective cohort study in Southern California

The Lancet Regional Health - Americas, Journal Year: 2023, Volume and Issue: 21, P. 100462 - 100462

Published: March 6, 2023

Little research exists regarding the relationships between green space and postpartum depression (PPD). We aimed to investigate PPD exposure, mediating role of physical activity (PA). Clinical data were obtained from Kaiser Permanente Southern California electronic health records in 2008–2018. ascertainment was based on both diagnostic codes prescription medications. Maternal residential exposures assessed using street view-based measures vegetation types (i.e., tree, low-lying vegetation, grass), satellite-based [i.e., Normalized Difference Vegetation Index (NDVI), land-cover space, tree canopy cover], proximity nearest park. Multilevel logistic regression applied estimate association PPD. A causal mediation analysis performed proportion mediated by PA during pregnancy total effects In total, we included 415,020 participants (30.2 ± 5.8 years) with 43,399 (10.5%) cases. Hispanic mothers accounted for about half population. reduced risk associated exposure street-view measure [500 m buffer, adjusted odds ratio (OR) per interquartile range: 0.98, 95% CI: 0.97–0.99], but not NDVI, greenness, or a Compared other coverage showed stronger protective (500 OR = 0.97–0.99). The proportions attributable ranged 2.7% 7.2% across indicators. Street decreased observed primarily due increased coverage, rather than grass. Increased plausible pathway linking lower National Institute Environmental Health Sciences (NIEHS; R01ES030353).

Language: Английский

---

Racial And Ethnic Inequities In Postpartum Depressive Symptoms, Diagnosis, And Care In 7 US Jurisdictions

Health Affairs, Journal Year: 2024, Volume and Issue: 43(4), P. 486 - 495

Published: April 1, 2024

Understanding whether racial and ethnic inequities exist along the postpartum mental health care continuum is vital because inequitable identification of depression can lead to referral receipt care. We aimed expand on existing cross-sectional single-state data documenting potential disparities in Using early (from two six months) late twelve fourteen survey from seven US jurisdictions, we documented patterns depressive symptoms, perinatal mood anxiety disorder (PMAD) diagnosis, overall by identity. Of 4,542 people who delivered live births 2020, 11.8 percent reported symptoms. Among sample with these only 25.4 receiving a PMAD 52.8 some form There were no significant differences diagnosis race ethnicity. Respondents identifying as Asian; Native Hawaiian or Pacific Islander; Southwest Asian, Middle Eastern, North African; Hispanic; non-Hispanic Black significantly less likely than White respondents receive care, demonstrating stark management Policies mandating reimbursing universal screening, facilitating connection reducing insurance coverage gaps, enhancing clinician training culturally responsive may promote equitable

Language: Английский

---