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PubMed2003

Factors predictive of seizures and neurologic outcome in perinatal depression.

To identify which early clinical variables are predictive of outcome in newborns with perinatal depression, we prospectively examined newborns with persistently abnormal neurologic examinations at 48 hours and (1) arterial pH </= 7.15, (2) 5-minute Apgar </= 5, (3) requirement for positive pressure ventilation in the delivery room, or (4) fetal heart rate monitoring abnormalities. Eighty-four such infants completed neurodevelopmental assessment at 1 year. Five-minute Apgar (P = 0.0064), arterial pH (P = 0.0065) and base excess (P = 0.0003), neonatal encephalopathy grade at 48 hours and 7 days (both P = 0.0001), EEG at 48 hours and 7 days (both P = 0.0001), cranial ultrasound (US) at 48 hours (P = 0.0013) and 7 days (P = 0.0002), and the occurrence of neonatal seizures (P = 0.0001) all correlated significantly with developmental outcome, whereas fetal heart rate monitoring, mode of delivery, and presence of the non-neurologic hypoxic-ischemic encephalopathy syndrome did not. In the multivariate analysis, a combination of the 48-hour EEG and 48-hour cranial ultrasound provided the best model to predict developmental outcome, and a point system to predict developmental outcome based on these two variables is proposed.

Analysis of Variance↗
PubMed2026

Perinatal depression, maternal thyroid status and fetus/infant health and development: A systematic review.

BACKGROUND: Thyroid hormones are known to influence both maternal depression and child developmental outcomes, while maternal depression independently affects child outcomes. The potential interaction between thyroid dysfunction and depression in shaping child development remains insufficiently explored. The present study addresses such interplay. METHODS: Following PRISMA 2020 and JBI guidelines, three databases were searched through December 2025 for primary studies on maternal thyroid status, perinatal depression, and child development. Risk of bias (RoB) was assessed using validated tools. Due to clinical and methodological heterogeneity, data were synthesized narratively following SWiM guidelines. RESULTS: Eleven studies were included. Beyond independent risks for preterm birth and behavioral problems, limited evidence supports a synergistic model, while most studies likely reflect the simple co-occurrence of risks. Maternal thyroid peroxidase antibodies (TPO-Ab) were associated with child externalizing problems exclusively in the presence of clinical depression. High depressive symptoms also attenuated the cognitive benefits of prenatal iodine supplementation. Thyroid status appears to function as a risk moderator rather than a mediator. However, 50% of observational studies presented high RoB, primarily due to participant attrition. CONCLUSION: Findings are still scarce to support a synergistic risk model where specific maternal thyroid parameters (i.e. thyroid autoimmunity and iodine status) may moderate the impact of depressive symptoms on child development. Despite the high RoB in half of the studies, results highlight the need for integrated screening protocols. Simultaneously assessing mental health and thyroid status may optimize risk stratification for high-risk mother-infant dyads.

Female↗
PubMed2005

Broader skills for working with perinatal depression.

Health visitors' involvement in work with maternal depression has developed considerably over the last 10 years, with a focus upon problems in the postnatal period. In a paper last month we reported on research highlighting dilemmas that can arise for health visitors connected with a lack of an agreed conceptual framework. Conflicting roles they find themselves using when working with distressed mothers, and within a pressured organisational work setting, make it hard to give sufficient priority to such work. By focussing too narrowly on postnatal depression, other important perinatal psychological difficulties may be left unattended. We argue the need to create workplace time to address these issues by describing the provision of a training and supervision package to facilitate this. We give some informal indications of its success and some indicators of the broadening development of its membership and its content

Adult↗
PubMed2026

Assessing perinatal depression identifying abilities among maternal and child health workers in rural China using smartphone-based virtual patients: a multi-center cross-sectional study.

OBJECTIVE: To assess rural maternal and child health (MCH) workers' virtual patients (VPs)-assessed performance in identifying perinatal depression (PND) using smartphone-based VPs, and to identify factors associated with this performance in rural Hunan, China. METHODS: A multicentre cross-sectional study was conducted in Hunan Province, China. A standardized questionnaire collected demographic and work-related characteristics of rural MCH workers. Smartphone-based VPs were used to assess PND identification performance in a simulated clinical scenario. An overall score &#x2265;60 was used as a prespecified operational benchmark across consultation, ancillary assessment, diagnosis, management, and health education domains. Data were analyzed using SPSS 26.0. RESULTS: A total of 375 rural MCH workers participated, yielding an effective response rate of 90.4%. Only 25.9% met the prespecified operational benchmark for VP-assessed PND identification performance. The mean accuracy scores for consultation, ancillary assessment, diagnosis, management, and health education were 94%, 48%, 64%, 58%, and 74%, respectively. Complete consultation accuracy was higher among MCH workers from township health centers than among those from county-level MCH hospitals. MCH workers aged 18-39 years showed higher odds of complete diagnostic accuracy for PND than those aged &#x2265;40 years. CONCLUSIONS: Smartphone-based VP assessment was feasible in rural MCH settings and revealed suboptimal PND identification performance. Mobile VPs may help identify frontline performance gaps and inform targeted training, but further validation against real-world clinical performance, or standardized patient encounters is needed before large-scale implementation. These findings may support targeted capacity-building for rural MCH workers and more equitable perinatal mental health care.

Humans↗
PubMed2006

Perinatal depression--assessment and management.

BACKGROUND: Depression and anxiety often begin in pregnancy, particularly third trimester, therefore 'perinatal' rather than postnatal depression might be a better term to describe this disorder. OBJECTIVE: This article outlines an approach to assessment and management of perinatal depression. DISCUSSION: Psychological difficulties are common after childbirth and have potentially serious consequences. Treatment needs to consider the complex interplay of biology and psychology, and both mother and infant need consideration. Early, assertive identification and sensitive management, mindful of risks and benefits to both mother and infant, is the best current approach to improving outcomes.

Antidepressive Agents↗
PubMed2005

Is perinatal depression familial?

BACKGROUND: While major depressive disorder (MDD) is familial, it is not clear whether distinct familial-genetic factors influence vulnerability to depression during or after pregnancy. Here we examine familial aggregation of perinatal major depression (PND, any episode during pregnancy or the month after childbirth) and the subset of post-partum depression (PPD) in families with multiple cases of recurrent, early-onset MDD from the Genetics of Recurrent Early-Onset Depression dataset. METHODS: The dataset included 691 childbearing women who could be classified as PND (27.6%) or non-PND (NPND), of whom 328 were members of 148 sibships with two or more PND or NPND women. PND and NPND subjects were compared for differences in putative predictors. Prediction of sibling PND or PPD by the proband's history was examined using logistic regression and general estimating equation methods. RESULTS: PND was associated with fewer episodes and younger current age. Odds ratios for prediction of sibling status were significant for PND (2.28) and PPD (3.96), particularly when current age was under 46 (2.87 and 4.39, respectively). ORs for PPD were not significantly different from those for PND. The OR for PPD (3.52), but not for PND, remained significant after current age was introduced as a covariate, but not when both current age and number of episodes were included in the model. LIMITATIONS: Because detailed data were not collected for all pregnancies, we cannot determine whether current age and number of episodes mediated the observed effects due to recall bias or other factors (cohort effect, number of episodes). CONCLUSIONS: A familial component to PND, and particularly PPD, is suggested by the results. However more systematic study is needed to confirm this result. A greater understanding of both genetic and non-genetic familial factors could lead to improved prevention and clinical management.

Adult↗
PubMed2006

The HPA axis and perinatal depression: a hypothesis.

Episodes of depression and anxiety are as common during pregnancy as postpartum. Some start in pregnancy and resolve postpartum, others are triggered by parturition and some are maintained throughout. In order to determine any biological basis it is important to delineate these different subtypes. During pregnancy, as well as the rise in plasma oestrogen and progesterone there is a very large increase in plasma corticotropin releasing hormone (CRH), and an increase in cortisol. The latter reaches levels found in Cushing's syndrome and major melancholic depression. Levels of all these hormones drop rapidly on parturition.We here suggest that the symptoms of antenatal and postnatal depression may be different, and linked in part with differences in the function of the hypothalamic pituitary adrenal (HPA) axis. There are two subtypes of major depression, melancholic and atypical, with some differences in symptom profile, and these subtypes are associated with opposite changes in the HPA axis. Antenatal depression may be more melancholic and associated with the raised cortisol of pregnancy, whereas postnatal depression may be more atypical, triggered by cortisol withdrawal and associated with reduced cortisol levels. There is evidence that after delivery some women experience mild bipolar II depression, and others experience post traumatic stress disorder. Both of these are associated with atypical depression. It may also be that some women are genetically predisposed to depression of the melancholic type and some to depression of the atypical type. These women may be more or less vulnerable to depression at the different stages of the perinatal period.

Corticotropin-Releasing Hormone↗
PubMedDate not supplied

Perinatal depression.

Explore the source record for details and available documents.

Depression, Postpartum↗
PubMed2007

Complex emotions, complex problems: understanding the experiences of perinatal depression among new mothers in urban Indonesia.

In this article, we explore how Javanese women identify and speak of symptoms of depression in late pregnancy and early postpartum and describe their subjective accounts of mood disorders. The study, conducted in the East Java region of Indonesia in 2000, involved in-depth interviews with a subgroup of women (N = 41) who scored above the cutoff score of 12/13 on the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy, at six weeks postpartum, or on both occasions. This sample was taken from a larger cohort study (N cohort = 488) researching the sociocultural factors that contribute to women's emotional well-being in early motherhood. The women used a variety of Indonesian and Javanese terms to explain their emotional states during pregnancy and in early postpartum, some of which coincided with the feelings described on the EPDS and others of which did not. Women attributed their mood variations to multiple causes including: premarital pregnancy, chronic illness in the family, marital problems, lack of support from partners or family networks, their husband's unemployment, and insufficient family income due to giving up their own paid work. We argue for the importance of understanding the context of childbearing in order to interpret the meaning of depression within complex social, cultural, and economic contexts.

Adolescent↗
PubMed2005

Early intervention for perinatal depression.

OBJECTIVE: This study was undertaken to design a process that effectively identifies and facilitates early intervention for women in an obstetrics clinic who are at risk for postpartum depression. STUDY DESIGN: Under this new program, labeled ISIS (Identify, Screen, Intervene, Support), we educated our new obstetric patients and clinic staff about postpartum depression through patient education classes, departmental lectures, and handouts. Then, we implemented simple procedures to identify risk factors for depression at intake and screened for depressive symptoms at the 32-week visit using the Edinburgh Postnatal Depression Scale (EPDS). In addition, we facilitated treatment of at-risk or symptomatic patients with the introduction of a social work consultant in the clinic setting. RESULTS: In an obstetric chart review, 75% of our patients were screened for depression in pregnancy. Ten percent of these women demonstrated symptoms of depression warranting further evaluation. CONCLUSION: Preliminary data from our multidisciplinary approach suggest that educating, screening, and appropriately treating or referring these women can take place in a busy obstetric clinic.

Depression↗
PubMed1999

Clinical Implications of Perinatal Depression.

The evaluation of the depressed newborn as a possible role in intrapartum asphyxia must be based on the objective findings of the fetal heart rate tracing, umbilical cord blood gas, and newborn neurologic function. Using these points as a basis for long-term followup, the following principles have been elucidated: Intrapartum asphyxia is an uncommon cause of childhood neurologic disfunction, the intrapartum insult necessary to cause long-term neurologic dysfunction is profound, and the child who does not manifest encephalopathy in the newborn period will not suffer long-term neurologic dysfunction that can be attributed to intrapartum asphyxia.

Acid-Base Imbalance↗
PubMed2003

Clinical management of perinatal depression: focus on paroxetine.

The literature on antidepressant use during pregnancy and lactation is replete with review articles and clinical decision algorithms. Remarkably, a limited number of such articles include the methodological advances that have served to define the extent of fetal and neonatal exposure to antidepressants. For this review, MEDLINE search for original research articles focusing on obstetrical, neonatal, and infant outcomes associated with antidepressant use was conducted. These articles were scrutinized to include those with data on the selective serotonin reuptake inhibitors (SSRIs) and limited to breast-feeding studies that included infant serum concentrations.Sixty-seven articles were identified that included a total of 3050 cases of SSRI use during pregnancy and 240 cases of use during lactation. The amount of obstetrical outcome data available for each SSRI was proportional to the duration of time each medication has been available. In contrast, the lactation data were heavily weighted toward sertraline and paroxetine relative to other antidepressants. The myriad of confounds, failure to control for maternal depression, lack of prospective documentation of other medications, and environmental exposures preclude any definitive conclusions. There was no clear association between SSRI exposure and obstetrical complications or poor outcome. In contrast, the amniotic fluid, umbilical cord, and nursing infant sera literature demonstrated significantly different exposures to individual medications.

Adult↗