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Depression, Pregnancy, Rates, Risks, Consequences
Affective illness is common in women, and the puerperium is a time of particular vulnerability. Gender differences in the expression of affective disorders have been attributed to the impact of hormonal influence, socialization, and genetics. Dramatic fluctuations in gonadal hormones that occur following childbirth, influences the increased incidence of mood disorders during this time. Numerous tools including the Edinburgh Postpartum Depression Scale can be used to screen for depression during pregnancy and postpartum. While screening tools may assist with appropriately identifying women who should be further assessed, their use alone does not significantly increase treatment seeking in women, even when their providers are notified about risk. Many studies demonstrate that only a small number (18%) of women who meet criteria for major depressive disorder seek treatment during pregnancy and postpartum. Additionally, common symptoms of depression (sleep, energy and appetite change) may be misinterpreted as normative experiences of pregnancy. Treatment engagement is important as untreated depression during pregnancy may have unfavorable outcomes for both women and children. Complications of pregnancy associated with depression include: inadequate weight gain, under utilization of prenatal care, increased substance use, and premature birth. Human studies demonstrate that perceived life-event stress, as well as depression and anxiety predicted lower birth weight, decreased Apgar scores, and smaller head circumference, and small for gestational age babies. Postpartum depression (PPD) is a common clinical disorder occurring in 15% of deliveries, making it one of the most frequent conditions to complicate pregnancy. Risk factors include past personal or family history of depression, sing marital status, poor health functioning, lower SES, and alcohol use. Women who have a prior history of postpartum depression, particularly with features of bipolarity or psychosis may be at particularly high risk
2. Wisner KL, Perel JM, Findling RL. Antidepressant treatment during breast-feeding. Am J Psychiatry 1996;153:1132-1137.
3. Kendell R, Chalmers JC, Platz C. Epidemiology of puerpereal psychoses. Br J Psychiatry 1987;150: 662-673.
4. Miller IW, Keitner GI, Schatzberg AF, et al. The treatment of chronic depression, part 3: psychosocial functioning before and after treatment with sertraline or imipramine. J Clin Psychiatry 1998;59(11): 608-19.
5. Altshuler LL, Cohen LS, Moline ML, et al. Treatment of depression in women: a summary of the expert consensus guidelines. J Psychiatr Pract 2001;May7(3):185-208.
6. Marcus SM, Flynn HA, Blow FC, et al. Depressive symptoms among pregnant women screened in obstetrics settings. J Women's Health 2003;12(4):373-80.
7. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1977;1(3):385-401.
8. Hoffman S, Hatch MC. Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women. Health Psychol 2000;19(6):535-43.
9. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987;150:782-6.
10. Holden JM, Sagovsky R, Cox JL. Counselling in a general practice setting: controlled study of health visitor intervention in treatment of postnatal depression. BMJ 1989; 298(6668):223-6.
11. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Archives of General Psychiatry 1961; 4:11.
12. Spitzer RL, Williams JB, Gibbon M, et al. The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Arch Gen Psychiatry 1992; 49(8): 624-9.
13. Williams JB, Gibbon M, First MB, et al. The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability. Arch Gen Psychiatry 1992; 49(8):630-6.
14. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision. Washington, D.C. American Psychiatric Association. 2000. p.356.
15. Marcus SM, Barry KL, Flynn HA, et al. Improving detection, prevention and treatment of depression and substance in childbearing women: Critical variables in pregnancy and pre- pregnancy planning. 1998: University of Michigan Clinical Ventures Grant through Faculty Group Practice Pilot Data.
16. Flynn HA, Blow FC, Marcus SM. Rates and predictors of depression treatment among pregnant women in hospital-affiliated obstetrics practices. Gen Hosp Psychiatry 2006; 28(4):289-95.
17. Marcus SM, Flynn HA. Depression, antidepressant medication and functioning outcomes among pregnant women. Int J Gynaecol Obstet 2008;100(3):248-51.
18. Miller LJ. Clinical strategies for the use of psychotropic drugs during pregnancy. Psychiatr Med 1991;9(2):275-98.
19. Flynn HA, Chermack ST. Prenatal alcohol use: the role of lifetime problems with alcohol, drugs, depression, and violence. J Stud Alcohol Drugs 2008; 69(4):500-9. 20. Marcus SM, Flynn HA, Blow FC, et al. Depressive symptoms among pregnant women screened in obstetrics settings. J Women's Health (Larchmt) 2003;12(4): 373-80.
21. Kelly RH, Russo J, Holt VL, et al. Psychiatric and substance use disorders as risk factors for low birth weight and preterm delivery. Obstet Gynecol 2002;100(2):8.
22. Steer R, Scholl T, Hediger M, et al. Self-reported depression and negative pregnancy outcomes. J Clin Epidemiol 1992; 45(10):1093.
23. Zuckerman B, Bauchner H, Parker S, et al. Maternal depressive symptoms during pregnancy, and newborn irritability. J Dev Behav Pediatr 1990;Aug;11(4).
24. Sandman CA, Wadhwa PD, Dunkel-Schetter C, et al. Psychobiological influences of stress and HPA regulation on the human fetus and infant birth outcomes. Ann N Y Acad Sci 1994; Oct 31(739):198-210.
25. Teixeira JM, Fisk NM, Glover V. Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. BMJ 1999;16: 318(7117): 53- 163.
26. Uno H, Lohmiller L, Thieme C, et al. Brain damage induced by prenatal exposure to dexamethasone in fetal rhesusmacaques. I. Hippocampus. Brain Res Dev Brain Res 1990; 53(2):157-67.
27. Stowe ZN, Nemeroff CB. Women at risk for postpartum-onset major depression. Am J Obstet Gynecol 1995;172(2):639-45.
28. Wolkind S, Zajicek-Colean E, Ghodsian J. Continuities in maternal depression. Int J Fam Psychol 1988; 1:167-181.
29. Greden JF, ed. Treatment of Recurrent Depression. Review of Psychiatry. Eds. J.M. Oldham and M.B. Riba. Vol. 20. 2001, American Psychiatric Publishing, Inc.: Washington, D.C.
30. Cohen LS. Pharmacologic treatment of depression in women: PMS, pregnancy, and the postpartum period. Depress Anxiety 1998; 8 Suppl 1: 18-26.
31. Marcus SM, Flynn HA, Barry KL, et al. Depression in pregnancy and postpartum: a review of critical issues. Postgraduate Obstetrics and Gynecology 2000; 20(13):1-8.
32. Marcus SM, Flynn HA, McDonough S, et al. Antidepressant medication and depression status: impact on neonatal outcomes. 2007 Poster Presentation, American Academy of Child and Adolescent Psychiatry: Boston, MA.
33. Heringhausen J, Marcus SM., Muzik M, McDonough SC, Flynn HA, Hoffman R, Bertram H, Vasquez DM, Armitage R. Neonatal sleep patterns and relationship to maternal depression. 2008 Poster Presentation, American Academy of Child and Adolescent Psychiatry: Chicago, IL.
34. Campbell SB, Brownell CA, Hungerford A, et al. The course of maternal depressive symptoms and maternal sensitivity as predictors of attachment security at 36 months. Dev Psychopathol 2004;16(2):231-52.
35. Campbell SB, Cohn JF, Meyers T. Depression in first-time mothers: Mother-infant interaction and depression chronicity. Developmental Psychology 1995;31(3):349-357.
36. DeMulder EK, Radke-Yarrow M. Attachment with affectively ill and well mothers: Concurrent behavioral correlates. Development and Psychopathology 1991;3(3):227-242.
37. NICHD, E.C.C.R.N. Chronicity of maternal depressive symptoms, maternal sensitivity, and child functioning at 36 months. Dev Psychol. 1999;Sept 35(5):1297-1310.
38. Cohn JF, Campbell SB. Influence of maternal depression on infant affect regulation, in Rochester Symposium on Developmental Psychopathology: A developmental approach to affective disorders, D. Cicchetti and S.L. Toth, Editors. 1992, University of Rochester Press: Rochester, NY. p. 103-130.
39. Zahn-Waxler C, Ianotti R, Cummings EM, et al. Antecedents of behavior problems in children of depressed mothers. Developmental Psychology 1990; 26:271-291.