Anti-thyroid peroxidase antibodies during pregnancy and postpartum. Relation to postpartum thyroiditis

The frequency of autoantibodies to thyroid microsomes (MAb), thyroid peroxidase (TPOAb) and thyroglobulin (TgAb) was studied in 736 women during and after pregnancy. The aim was to study the relationship between TPO Ab and post-partum thyroid disease, and to compare their behaviour with MAb. Seventy-five (10%) were either MAb or TgAB positive, of whom 36 were sampled serially at 18, 30 and 36 weeks of pregnancy and 1, 6 and 12 months post partum. Twenty of the antibody negative mothers were selected at random for controls. Twelve of the 36 antibody positive mothers developed post-partum thyroid dysfunction (group 1), 24 did not (group 2) compared with none of the 20 controls (group 3). Six months post partum, TPO Ab titres rose overall in both groups 1 and 2, but only in those with measurable TPO Ab during the first trimester. A TPO Ab was less frequently positive than MAb, but the difference was not statistically significant. TPO Ab are not superior to MAb for predicting post partum thyroid disease in pregnant women.     

Psychological reactions to ultrasound. Examination during pregnancy

Twenty women underwent ultrasound examination three times during low-risk pregnancy. Before and after ultrasonography, the Symptom Questionnaire was applied to evaluate changes in psychological distress. Anxiety, depression, somatic symptoms, and hostility significantly decreased after the patients received video and verbal feedback during the first ultrasound examination. Such changes were consistently observed also during the subsequent two examinations.     

Mood instability during pregnancy and postpartum: a systematic review

Archives of Women's Mental Health - Perinatal mood instability (MI) is a common clinical observation in perinatal women, and existing research indicates that MI is strongly associated with a...     

Brief report: frequency of maternal cocaine use during pregnancy and infant neurobehavioral outcome

OBJECTIVE: To examine the effects of frequency of prenatal maternal cocaine use on infant neurobehavioral outcome beyond the immediate postpartum period, controlling for other substance use. METHODS: At 2 weeks postpartum, the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) was administered to infants (N = 55) and their mothers were asked about their prenatal drug use. Mother/infant dyads were placed in one of two groups based on the number of days of reported cocaine use during pregnancy: high frequency (n = 23, > 75th percentile reported days of use) or low frequency (n = 32, < 75th percentile). RESULTS: Infants in the high frequency cocaine group had worse BNBAS excitability scores than infants in the low frequency cocaine group, when other substance use was controlled statistically. CONCLUSIONS: High frequency of maternal cocaine use during pregnancy is associated with poorer infant neurobehavioral outcome beyond the early postpartum period, when other substance use is controlled.     

Peripartum cocaine use and adverse pregnancy outcome

The objective of the study was to analyze possible adverse effects of peripartum cocaine use on maternal and fetal outcomes. Informed consent was given by 720 (97%) of 740 women who delivered consecutively at a large urban public hospital to test an umbilical cord blood sample for the presence of non-medically administered drugs of abuse and alcohol and to be interviewed for the study. Samples were tested for the presence of a cocaine metabolite (benzoylecgonine-BZE) by radioimmunoassay. The presence of other substances of abuse (alcohol, methamphetamine, opiates) resulted in exclusion from the sample of 143 subjects. Thus, in this cohort analysis, drug-free controls (N = 469) were compared to those positive for cocaine only (N = 108). Peripartum exposure to cocaine only, and no other substances of abuse, was associated with an increased frequency of abruptio placentae (1.9% vs 0% for control, P < 0.004), thick meconium stained amniotic fluid (3.9% vs 0.7% for controls, P < 0.006), premature rupture of membranes (P < 0.02), genitourinary anomalies (OR = 3.6, P < 0.05), abdominal wall defects (OR = 4.4, P < 0.01) and increased frequency of low birth weight (OR = 2.0, P < 0.02). These are important findings because previous studies have been complicated by the confounding effects of other substances of abuse. Am. J. Hum. Biol. 11:598–602, 1999. © 1999 Wiley-Liss, Inc.     

Hormones and cognitive functioning during late pregnancy and postpartum: a longitudinal study

This longitudinal study investigated the possible influence of estradiol (E?), progesterone (P), testosterone (T), cortisol (CORT), and prolactin (PRL) levels on cognitive functioning during late pregnancy and the early postpartum period. The performance of 55 pregnant women on a battery of neuropsychological tests, tested once during the third trimester of pregnancy and once during the early postpartum period, was compared with that of 21 nonpregnant controls matched for age and education. Women in the pregnancy group had significantly lower scores than the controls during both the pre- and postpartum visits on tasks of verbal recall and processing speed. CORT levels were significantly associated, in an inverted-U function, with verbal recall scores at both the pregnancy and at postpartum periods and with spatial abilities at postpartum only. During pregnancy, PRL levels were associated in both a linear and an inverted-U function with scores on tests of paragraph recall and in a linear function with scores on tests of executive function. At postpartum, E? and CORT were negatively associated in a linear fashion with attention scores. These findings provide new evidence that fluctuating hormone levels during late pregnancy and early postpartum may modulate selected cognitive abilities.     

Psychological treatment of postpartum depression: a meta-analysis

Postpartum depression is a widespread and disruptive depressive disorder seriously affecting the lives of new mothers and their families. We conducted a meta-analysis of controlled and comparative studies of psychological treatments of postpartum depression. Seventeen studies were included. The mean standardized effect size of all psychological treatments compared to control conditions was 0.61 (95% CI: 0.37 approximately 0.85). Several subgroup analyses were conducted. Studies with waiting list control groups had a larger mean effect size (0.96; 95% CI: 0.63 approximately 1.29) than studies with a care-as-usual control group (0.41; 95% CI: 0.25 approximately 0.58). No definite conclusions can be drawn about the longer term effects. Too few studies were available to draw conclusions about the relative effects of psychological treatments compared to pharmacological and other treatments.     

孕期受虐相关的社会心理因素

目的:通过调查孕期受虐相关社会心理因素,探讨家暴态度、家暴目睹经历、意外怀孕和流产史与孕期受虐的关系,为今后进一步研究提供参考.方法:用虐待评估问卷(AAS),对846名孕妇进行家庭暴力筛查,96名孕妇筛查为受虐者,从无受虐者中抽取匹配对照者150名,用简易应对方式问卷(SCSQ)、社会支持评定量表(SSRS)、自尊量表(SES)和艾森克人格问卷(EPQ)进行心理评估,并比较孕期受虐者和无受虐者间相关社会心理特征的差异性.结果:孕期受虐总的发生率为11.3％,精神暴力为主要形式(占所有被调查者的7.0％).受虐组孕妇的流产史(19.8％)、意外怀孕(91.9％)、家暴认可态度(70.9％)和家暴目睹史(93.0％)的发生率均高于无受虐者(1.5％～42.3％,P ＜0.001),受虐组孕妇的积极应对、SSRS、SES和EPQ的内外向得分均低于无受虐者(均P＜0.05),而消极应对和EPQ的神经质或情绪稳定性得分高于无受虐者(均P＜0.01).孕期精神暴力和性暴力与流产史、意外怀孕、家暴认可态度、家暴目睹史呈正相关(r=0.21～0.35,Ps＜0.05).回归分析显示,丈夫有吸烟史(OR=2.82)、经济状况较好(OR=10.39)、家暴认可态度(OR =57.90)、家暴目睹史(OR=45.32)、意外怀孕(OR=45.45)、流产史(OR =4.03)、主观支持缺乏(OR=3.45)者孕期发生受虐的可能性更大(P＜0.05).结论:本研究提示,经济状况较好、丈夫有吸烟史、家暴认可、有家暴目睹史、意外怀孕、有流产史以及缺乏主观支持的孕妇,孕期越有可能发生受虐待.     

Prevalence of suicidality during pregnancy and the postpartum

Summary This review examined the available prevalence estimates of suicidality (suicide deaths, attempts, and ideation including thoughts of self harm) in pregnancy and the postpartum. Studies that used defined community or clinic samples were identified through multiple electronic databases and contacts with primary authors. Definitions of and measurement of suicide deaths, intentional self-harming behavior, suicide attempts, and thoughts of death and self-harm were varied and are described with each study. While suicide deaths and attempts are lower during pregnancy and the postpartum than in the general population of women, when deaths do occur, suicides account for up to 20% of postpartum deaths. Self-harm ideation is more common than attempts or deaths, with thoughts of self-harm during pregnancy and the postpartum ranging from 5 to 14%. The risk for suicidality is significantly elevated among depressed women during the perinatal period, and suicide has been found to be the second or leading cause of death in this depressed population.     

Quantitative assessment of olfactory experience during pregnancy.

Results of the National Geographic Smell Survey were used to investigate the effects of pregnancy on olfactory perception and odor-related behavior. The responses to test odors and survey questions of 13,610 pregnant and 277,228 nonpregnant U.S. women between 20 and 40 years of age were analyzed. In comparison to nonpregnant women, pregnant women rated their own sense of smell lower, more often rated the test odors less pleasant smelling, more often classified the test odors as inedible, were less likely to report odor-evoked memories, and used perfume and cologne less frequently. Differences in odor detection and intensity rating did not favor either group.     

Psychological response to amniocentesis: I. Mood state and adaptation to pregnancy

The responses of a group of pregnant women undergoing amniocentesis and control women not having the procedure were studied using objective, self-report measures of mood state, attitudes toward pregnancy, and maternal-fetal attachment. Questionnaires were completed on three occasions: after genetic counseling (time-1), after amniocentesis (time-2), and 1 wk after communication of results (time-3) for amniocentesis subjects, and at comparable points in the pregnancy for control subjects. Amniocentesis and control subjects differed markedly in their pattern of change in anxiety scores over time, with amniocentesis subjects being more anxious than control subjects at time-2 and less anxious at time-3. Results were similar but less pronounced for depression scores, whereas there were smaller differences between groups on measures of anger and confusion. Unusual patterns of mood state changes were seen in the control group, which were related to a history of previous fetal loss. The groups did not differ in their attitudes toward pregnancy, but amniocentesis subjects showed a greater relative increase in attachment to the fetus than did control subjects. Overall, amniocentesis subjects were faring as well or better on every measure taken at time-3 and were showing improvement on all measures. In contrast, control subjects were demonstrating a trend toward increasing mood disturbance. These results suggest that any amniocentesis-related psychological disturbances are only transient and are outweighed by the receipt of normal results, which appear to enhance emotional adaptation to pregnancy.     

Treating nicotine dependence during pregnancy and postpartum: understanding clinician knowledge and performance

This study investigated the relationship of clinicians' knowledge of treatments for nicotine dependence during pregnancy and postpartum and explored what provider characteristics are associated with knowledge levels. Survey data from community health center (CHC)-based prenatal, pediatric (PED), and WIC program (Special Supplemental Nutrition Program for Women, Infants, and Children) providers participating in a randomized clinical study were used. Providers reported low awareness of the health risks of smoking to the developing fetus/child of pregnant and postpartum women and of the effectiveness of nicotine replacement therapy (NRT) for doubling quit rates. Obstetric (OB) and WIC providers were more aware than PED providers that provider-delivered interventions are effective. Confidence in using counseling steps was significantly associated with general and NRT-related knowledge. NRT-related knowledge, but not general knowledge, was associated with higher performance of intervention steps. Educational programs targeting OB, WIC, and PED providers' knowledge about effective smoking cessation counseling strategies and their confidence in being effective with patients are needed.     

A longitudinal study of sleep stages in young women during pregnancy and postpartum.

We conducted a longitudinal polysomnographic study in five healthy primiparous subjects, whose sleep was first recorded between 8 and 16 weeks of gestation, then every 2 months until parturition and at 1 month postpartum. The first 6 hours of sleep were used for statistical analysis. In contrast to previous studies, we found no reduction in stage 4 sleep with pregnancy. Slow-wave sleep (comprising stages 3 and 4), was significantly higher at 27-39 weeks of gestation than at 8-16 weeks, as predicted by the restorative theory of sleep. There was no significant difference in rapid eye movement (REM) sleep time. When compared to a group of normal ovulating women, however, REM sleep time decreased during the last two months of pregnancy and, although there was no change in sleep onset latency, the time spent awake during the first six hours of sleep was increased. Future research into the effects of cortisol and progesterone is indicated.     

Risk factors for intimate partner violence during pregnancy and postpartum

This longitudinal investigation examined potential risk factors for intimate partner violence (IPV) among women during pregnancy and 6 weeks postpartum. A sample of 180 pregnant women was collected in order to investigate (1) whether associations between partner alcohol misuse, partner jealousy, partner suspicion of infidelity, and stress were associated with IPV victimization; (2) the indirect effects of alcohol misuse on these relationships; and (3) factors related to changes in IPV victimization over time. At baseline, partner alcohol misuse was associated with each type of IPV victimization and the combination of partner alcohol misuse, partner jealousy, and partner suspicion of infidelity was most strongly associated with severe physical victimization. Partner alcohol misuse mediated the relationship between partner jealousy and psychological and severe physical victimization. At follow-up, partner jealousy and stress were related to women’s psychological victimization and partner alcohol misuse was related to women’s severe physical victimization. Findings suggest that partner alcohol misuse is a risk factor for women’s IPV victimization during pregnancy and jealousy and that stress may increase risk for some types of IPV. Findings also suggest that intervention should target parents early in pregnancy in order to reduce the risk for future IPV.     

Screening for bipolar disorder during pregnancy and the postpartum period

Bipolar disorder is a significant mental health problem among perinatal women; however, little attention has been devoted to methods of screening for bipolar disorder during this phase of women’s life cycle. There is a need for reliable and valid screening instruments for perinatal women. This paper presents a review of 11 self-report measures used to screen bipolar disorder in the general population and discusses their applicability to screening among perinatal women. Published psychometric data, including reliability, sensitivity, specificity, and positive predictive value of each self-report instrument, is presented and critiqued. We make recommendations for screening in clinical practice and highlights priorities for future research. The need for more research in this area is emphasized.     

Decreased startle modulation during anticipation in the postpartum period in comparison to late pregnancy

Knowledge about healthy women’s psychophysiological adaptations during the large neuroendocrine changes of pregnancy and childbirth is essential in order to understand why these events have the potential to disrupt mental health in vulnerable individuals. This study aimed to compare startle response modulation, an objective psychophysiological measure demonstrated to be influenced by anxiety and depression, longitudinally across late pregnancy and the postpartum period. The acoustic startle response modulation was assessed during anticipation of affective images and during image viewing in 31 healthy women during gestational weeks 36–39 and again at 4 to 6 weeks postpartum. No startle modulation by affective images was observed at either time point. Significant modulation during anticipation stimuli was found at pregnancy assessment but was reduced in the postpartum period. The women rated the unpleasant images more negative and more arousing and the pleasant images more positive at the postpartum assessment. Self-reported anxiety and depressive symptoms did not change between assessments. The observed postpartum decrease in modulation of startle by anticipation suggests a relatively deactivated defense system in the postpartum period.     

Personality characteristics related to treatment decisions among inpatient alcoholics: a non-relationship.

A battery of standard personality and experimental research scales was administered to 110 male alcoholic inpatients. No differences were found on the 30 scale scores derived from the tests among three groups with differential treatment dispositions: (1) those who discontinued treatment after a 2-week evaluation period; (2) those who chose to remain for a 60-day treatment program, but discontinued prior to completion; and (3) those who chose and did complete the 60-day program. It was suggested that attrition from an inpatient alcoholism program might be predicted better by a multivariate approach that used demographic, life history, psychosocial and personality variables as predictors.     

The association between maternal cocaine use during pregnancy and physiological regulation in 4- to 8-week-old infants: an examination of possible mediators and moderators

OBJECTIVE: To examine the association between maternal cocaine use during pregnancy and physiological measures of regulation, which included heart rate (HR) and respiratory sinus arrhythmia (RSA). METHODS: Potential mediators and moderators of this association were explored. Participants were 141 mother-infant dyads (77 cocaine exposed and 64 nonexposed) recruited at birth. Average infant HR and RSA was assessed at 4-8 weeks of age during a 15 minute period of sleep. RESULTS: Results indicated a dose-dependent effect of prenatal exposure to cocaine on RSA. There was no evidence that fetal growth or other prenatal exposure to substances mediated this association or that fetal growth or maternal age moderated this association. Regression analyses also indicated that birth weight (BW), but not birthlength (BL), head circumference (HC) or other substance use, mediated the association between prenatal exposure to cocaine and heart rate. CONCLUSIONS: These results suggest that cocaine exposure is associated with physiological regulation at 4-8 weeks of age and highlight the importance of considering level of exposure when assessing infant outcomes.