2019-nCOV distress and depressive,anxiety and OCD-type,and eating disorder symptoms among postpartum and control women

This study compared postpartum and control women on depressive, anxiety, and OCD-type symptoms, and eating disorder symptoms during the 2019-nCOV pandemic and evaluated if associations between 2019-nCOV distress and these mental health symptoms differed for postpartum compared to control women. A community sample of women, ages 18–39, who had either given birth in the past 12 months (n = 232) or had no pregnancy history (n = 137; controls), was recruited to complete an online survey about their depressive, anxiety, OCD, and eating disorder symptoms. Postpartum women reported greater OCD-type symptoms related to concerns about both contamination and responsibility for harm (ps < .05) compared to controls. After controlling for general stress and mental health history, the association between 2019-nCOV distress and OCD-type symptoms related to concerns about contamination was stronger among postpartum compared to control women (ps < .002). For all women, 2019-nCOV distress was positively related to general anxiety symptoms, total OCD-type symptoms, and OCD-type symptoms related to concerns about responsibility for harm after controlling for general stress and mental health history (ps < .03). Data are first to suggest postpartum women may be at elevated risk for OCD-type symptoms during 2019-nCOV pandemic, and pandemic distress is associated with anxiety and OCD-type symptoms among postpartum women more so than control women.

     

Cohort study of depressive moods in Thai women during late pregnancy and 6–8 weeks of postpartum using the Edinburgh Postnatal Depression Scale (EPDS)

Summary Objective: To identify depressive moods as measured by the Edinburgh Postnatal Depression Scale in late pregnancy and postpartum, explore associated factors and assess changes in depressive moods. Methods: A cohort study of 610 pregnant Thai women was conducted. The self-reporting EPDS was completed at 36–40 weeks and at 6–8 weeks postpartum. Result: The prevalence of depressive moods (scores of 10 or more on the EPDS) was 20.5% during pregnancy and 16.8% at postpartum. Factors related to depressive moods in late pregnancy included marital status, evidence of irritable moods before menstruation, and attitudes towards this pregnancy. Unmarried women, women having irritable moods before menstruation or women having negative attitudes towards this pregnancy had double risk. Related factors during the postpartum period included religion, evidence of irritable moods before menstruation, perception of pregnancy complications and attitudes towards this pregnancy (p < 0.01). Women who perceived of having complications during this pregnancy, those who had irritable moods before menstruation or had negative attitudes towards this pregnancy had also double risk. The depressive moods were significantly reduced postnatally. Conclusion: One-fifth of pregnant and postpartum women experienced depressive moods but the severity declined at postpartum.     

Is difficult childbirth related to postpartum maternal outcomes in the early postpartum period?

Unplanned, adverse events during labor or delivery may generate a negative response during the early postpartum period, resulting in disruption of usual functioning and mood. High levels of maternal depressive symptoms are associated with parenting, infant attachment, behavioral problems and cognition (Beck 2002). The purpose of this study was to examine the relationship of adverse events in labor or delivery and depressive symptoms, functional status and infant care at 2-weeks postpartum. The secondary aim was to explore the role of social support as a possible moderator in the relationship between adverse birth events and maternal outcomes. A secondary analysis of data (n = 123) was performed using data collected in a prospective, observational study examining the effects of antidepressant use during pregnancy. Adverse events did not significantly predict depressive symptoms (odds ratio = 1.34, p = .536), functional status (R² change = .001, p = .66), or infant care (R² change = .004, p = .48) at 2-weeks postpartum when controlling for depression during pregnancy, antidepressant use at delivery, education level, age, and parity. Social support had significant effects on depressive symptoms (p = .02), functional status (p = .014), and infant care (p < .001) but did not moderate the effect of adverse events when predicting depressive symptoms (odds ratio = 1.01, p = .045), functional status (R² change = .009, p = .056) and infant care (R² change < .001, p = .92). Adverse events did not predict maternal outcomes at 2-weeks postpartum. Social support was related to depressive symptoms, functional status and infant care, but did not moderate the effects of adverse events.     

Poor sleep quality increases symptoms of depression and anxiety in postpartum women

This study evaluated the relationship between sleep quality and symptoms of depression and anxiety in women studied in pregnancy and postpartum. Scores on standardized measures of sleep (PSQI) at 6 months postpartum, and symptoms of anxiety and depression (OASIS, the PHQ9, and EPDS) were assessed by structured interviews in 116 women in pregnancy and/or postpartum. Poor sleep quality was significantly associated with greater symptoms of depression and anxiety. Women who had significantly higher OASIS (anxiety) scores (β?=?.530, p?<?.001), PHQ9 (depression) scores (β?=?.496, p?<?.001), and EPDS (postpartum depression and anxiety) scores (β?=?.585, p?<?.001) also had elevated total PSQI scores after adjustment for covariates, including prenatal depression and anxiety scores. Though inferences about causality are not feasible, these results support emerging research showing sleep quality is a risk factor for negative maternal affect in the postpartum period. Assessment of maternal sleep hygiene is worth consideration as a component of identifying women at risk for postpartum depression and anxiety.     

Maternal postpartum stress and toddler developmental delays: Results from a multisite study of racially diverse families

Maternal psychosocial stress during pregnancy can adversely influence child development, but few studies have investigated psychosocial stress during the postpartum period and its association with risk of toddler developmental delays. Moreover, given the expanding diversity of the U.S. population, and well-documented health and stress disparities for racial and ethnic minorities, research examining the effect of postpartum stress on risk of developmental delays in diverse populations is of critical importance. In this study, data from the Community Child Health Network provided the opportunity to test maternal postpartum stress as a predictor of toddler risk of developmental delay in a sample of African American, Latina and non-Hispanic White women and their toddlers (N = 1537) recruited in urban, suburban, and rural communities. Postpartum maternal stress over 1 year was operationalized as perceived stress, life events, and negative impact of life events. Regression results revealed higher risk of developmental delays in toddlers whose mothers experienced more negative life events, greater negative impact of events, and higher perceived stress over the year. Prenatal stress, pregnancy/birth complications, and postpartum depression did not explain these associations. Maternal postpartum stress may contribute to increased risk for developmental delays and is an important target for psychosocial intervention.     

Relation of Perseverative Tendency and Life Events to Depressive Symptoms: Findings from a Prospective Study in Non-referred Adolescents in Taiwan

The elucidation of individual differences in tobacco use motivation is of considerable interest. Accordingly, the present study tested the hypothesis that between-person variation in reinforcement smoking (RS)—a tendency to smoke to regulate affect—moderates the relationship between poor mood and urge to smoke. In this cross-sectional, correlational study, smokers (N = 212; ≥5 cig/day) completed measures of RS, positive affect (PA), negative affect (NA), and smoking urge. RS significantly moderated the relation between PA and urge (βs > .11, ps < .04), such that the inverse correlation between PA and urge was stronger among smokers higher in RS. NA was positively correlated with urge in the overall sample (rs = .34, ps < .0001), but RS did not moderate this relationship. The overall results were consistent across 2 measures of mood and adjusted models that controlled for demographics and smoking characteristics. Continued investigation of these moderational pathways could identify which smokers may benefit most from treatments that target mood during smoking cessation.     

Association between parity and autoimmune thyroiditis in a general female population

Background: Autoimmune thyroid disease (AIT) is more common in females than in males. Furthermore, it is well documented that the risk of thyroid autoimmunity increases during pregnancy and in the postpartum period. The objective of the present study was to analyse the association between parity and AIT by using ultrasound and serological data.

Methods: The study population included 2156 women, aged 20–79 years. Serum thyroperoxidase antibodies (anti-TPO) and thyrotropin levels were measured and thyroid ultrasonography was performed. AIT was defined according to the combined presence of a hypoechogenic thyroid pattern and positive anti-TPO levels (>200 IU/ml). Odds ratios (OR) and 95% confidence intervals (CI) were calculated.

Results: The analyses revealed an association between parity and AIT. Women with at least one pregnancy had increased odds for AIT (OR 4.6 [95%-CI 1.4–15.1], p < 0.05) compared to women who have never been pregnant. Similar results were observed using hypoechogenic thyroid pattern (OR 1.7 [95%-CI 1.0–2.9], p < 0.05) and positive anti-TPO levels (OR 1.8 [95%-CI 1.0–3.3], p = 0.05) as separate dependent variables or using number of births as alternate independent variable.

Conclusion: In this female population we found an association between parity and AIT and conclude that parity appears to be a potential risk factor for AIT.     

The comparative effects of group prenatal care on psychosocial outcomes

To compare the psychosocial outcomes of the CenteringPregnancy (CP) model of group prenatal care to individual prenatal care, we conducted a prospective cohort study of women who chose CP group (N?=?124) or individual prenatal care (N?=?124). Study participants completed the first survey at study recruitment (mean gestational age 12.5 weeks), with 89 % completing the second survey (mean gestational age 32.7 weeks) and 84 % completing the third survey (6 weeks’ postpartum). Multiple linear regression models compared changes by prenatal care model in pregnancy-specific distress, prenatal planning-preparation and avoidance coping, perceived stress, affect and depressive symptoms, pregnancy-related empowerment, and postpartum maternal-infant attachment and maternal functioning. Using intention-to-treat models, group prenatal care participants demonstrated a 3.2 point greater increase (p?<?0.05) in their use of prenatal planning-preparation coping strategies. While group participants did not demonstrate significantly greater positive outcomes in other measures, women who were at greater psychosocial risk benefitted from participation in group prenatal care. Among women reporting inadequate social support in early pregnancy, group participants demonstrated a 2.9 point greater decrease (p?=?0.03) in pregnancy-specific distress in late pregnancy and 5.6 point higher mean maternal functioning scores postpartum (p?=?0.03). Among women with high pregnancy-specific distress in early pregnancy, group participants had an 8.3 point greater increase (p?<?0.01) in prenatal planning-preparation coping strategies in late pregnancy and a 4.9 point greater decrease (p?=?0.02) in postpartum depressive symptom scores. This study provides further evidence that group prenatal care positively impacts the psychosocial well-being of women with greater stress or lower personal coping resources. Large randomized studies are needed to establish conclusively the biological and psychosocial benefits of group prenatal care for all women.     

Depression during pregnancy and the postpartum period in adolescent and adult Portuguese mothers

Summary Objective: To study prevalence as well as risk factors for pregnancy and postpartum depression in a sample of adolescent and adult Portuguese mothers. Methods: The Edinburgh Postnatal Depression Scale (EPDS) was administered to 108 (54 adult and 54 adolescent) Portuguese women at 24–36 weeks of pregnancy and at 2–3 months postpartum. Results: Rates for EPDS > 12 are high during the 3^rd trimester of pregnancy (18.5%) and at 2–3 months postpartum (17.6%), and not significantly different between these two periods; more than 1/4 of the sample (27.8%) had an EPDS > 12 before or after delivery. Adolescent mothers presented more depressive symptoms as well as more EPDS > 12 than adult mothers, both in pregnancy (25.9% versus 11.1%) and at 2–3 months postpartum (25.9% versus 9.3%); moreover, when considering other socio-demographics, adolescent mothers were still at risk for depressive symptoms during pregnancy as well as for postpartum depression. Women depressed in pregnancy, and ones who are under 18 years old and who live with the partner, were at risk for postpartum EPDS > 12. Conclusion: Adolescent mothers seem particularly at risk for depression during pregnancy and the postpartum period, therefore, just like the women who are depressed during pregnancy, they should be better targeted in preventive and intervention measures.     

The effects of social interactions on momentary stress and mood during COVID-19 lockdowns

Objective

Social interactions are vital for our well-being, particularly during times of stress. However, previous studies linking social interactions to psychological outcomes during the COVID-19 pandemic have largely been retrospective and/or cross-sectional. Thus, we tested four preregistered hypotheses (H1–H4) concerning the real-time effect of social interactions on momentary changes in stress and mood during two COVID-19 lockdowns.

Design

We used an ecological momentary assessment approach in 732 participants in spring 2020 (burst 1) and in a subsample of these participants (n = 281) during a further lockdown in autumn/winter 2020 (burst 2).

Methods

Participants reported their stress and mood in a smartphone app five times per day for 7 days and indicated the nature and frequency of their recent social interactions.

Results

Social interactions (H1) and their frequency (H2) improved momentary affect (e.g., social interactions increased mood valence: estimate = 2.605, p < .001 for burst 1). This was particularly the case for face-to-face interactions which, compared with other types of interactions, reduced momentary stress (e.g., estimate = −2.285, p < .001 for burst 1) and boosted mood (e.g., estimate = 1.759, p < .001 for burst 1) across both lockdowns, even when controlling for the pleasantness of the interaction and the closeness of the interaction partner (H3). We also show that individual differences in people's responsiveness to different social rewards modulated the impact of social interactions on momentary mood (H4).

Conclusions

This study extends findings from cross-sectional and retrospective studies by highlighting the real-time affective benefits of social interactions during COVID-19 lockdown. The results have important implications for the (self-) management of stress and mood during psychologically demanding periods.     

The effect of relaxation exercises training on pregnancy-related anxiety after perinatal loss: A pilot randomized control trial✰

BackgroundPregnancy-related anxiety is quite frequent during pregnancy after perinatal loss, and it is likely to cause negative effects on the mother and the foetus. amongst independent nursing practices, progressive muscle relaxation exercises are considered to be one of alternative treatment methods to relax pregnant women physically and psychologically.PurposeThe aim of this study is to examine the effect of progressive muscle relaxation exercises on the pregnancy-related anxiety levels of pregnant women who have experienced a perinatal loss.MethodsOne hundred and four pregnant women who had experienced a perinatal loss were randomly assigned to an intervention group (n = 31) or a control group (n = 33) and participated in a 12-week trial. The intervention group received training on progressive muscle relaxation exercises, while the control group was provided only with routine healthcare services. The Pregnancy-Related Anxiety Questionnaire-R2 was used to evaluate the level of pregnancy-related anxiety.ResultsThe intervention group showed improvement in comparison to the control group at the end of the intervention. After the intervention, the measured levels of “pregnancy related anxiety”, “fear of giving birth”, and “worries about bearing a handicapped child” significantly decreased in the intervention group compared to the pre-intervention levels and the control group, and the difference between the groups was statistically significant (p<0.001, p<0.001, and p<0.001, respectively). However, there were no significant differences in the levels of concern about own appearance between the groups after the intervention (p>0.05).ConclusionAccording to the results of the study, progressive muscle relaxation led to a decrease in the pregnancy-related anxiety levels of the pregnant women who had experienced a perinatal loss.     

HIV-infected mothers’ perceptions of uncertainty,stress, depression and social support during HIV viral testing of their infants

To explore relationships between mothers’ uncertainty about infant HIV serostatus with stress, distress, depressive symptoms, and social support during infant HIV testing. This prospective longitudinal study of 20 HIV-infected mothers involved a prenatal visit and five postpartum visits clustered around infant HIV viral testing. Maternal uncertainty about infant HIV serostatus significantly decreased over time (p < 0.001). Before testing, uncertainty was inversely related to social support (r = −0.67), and positively related to perceived stress (r = 0.54), interpersonal social conflict (r = 0.57), symptom distress (r = 0.62), and depressive symptoms (r = 0.50); these relationships persisted throughout the infant testing period. Mothers with depressive symptoms during pregnancy demonstrated significantly more uncertainty within a few weeks after birth than mothers without depressive symptoms (p < 0.05). Several weeks after learning their infants were HIV negative, mothers’ uncertainty was only associated with social conflict (r = 0.49). Maternal uncertainty about infant HIV status declined significantly over time. There were no changes in perceptions of stress, distress or social support. Mothers with depressive symptoms experienced greater uncertainty about infants’ HIV status. Strategies to enhance support and treat depressive symptoms may reduce the uncertainty, stress, and distress HIV-infected mothers experience during viral testing of their infants.     

Impact of Pregnancy and Vaginal Delivery on the Passive and Active Mechanics of the Rat Vagina

Remodeling of vaginal extracellular matrix and smooth muscle likely plays a critical role in reducing the risk of maternal injury during vaginal delivery by altering the mechanical properties to increase distension and reduce stress. Long-Evans rats were divided into five groups to examine the passive mechanical and active contractile properties throughout pregnancy and postpartum: virgin (n = 17), mid-pregnant (Day 14–16, n = 12), late-pregnant (Day 20–22, n = 14), immediate postpartum (0–2 h after delivery, n = 14), and 4 week postpartum (n = 15). Longitudinal sections of vaginal tissue were loaded to failure uniaxially for passive mechanical or active contractile properties were examined. For passive mechanics, the tangent modulus decreased 45% by mid-pregnancy and immediately postpartum (p < 0.001). The ultimate strain continuously increased up to 43% higher than virgin animals (p = 0.007) in the immediate postpartum group. For active mechanics, the maximal contractile force was 36–56% lower through immediate postpartum animals, and was significantly more sensitive to K⁺ throughout pregnancy and postpartum (p = 0.003). The changes observed in the passive and active properties of the rat vagina are consistent with what would be expected from a tissue that is remodeling to maximize its ability to distend at the time of vaginal delivery to facilitate passage of the fetus with minimal injury.     

Tailoring screening protocols for perinatal depression: prevalence of high risk across obstetric services in Western Australia

Given what appears to be an ever-increasing list of concerning consequences of perinatal depression, longitudinal studies have much to offer when considering the timing and efficacy of prevention and intervention strategies. The course of depressive symptomatology across the perinatal period at four obstetric services was investigated utilising Western Australian data collected as part of the beyondblue National Postnatal Depression Program. Pregnant women completed one or two Edinburgh Postnatal Depression Scale (EPDS) assessments during pregnancy and a demographic and psychosocial risk factors questionnaire. One or two EPDS assessments were administered within 12 months postpartum. Prevalence of high risk scores across gestational ages ranged from 14% to 5% during pregnancy and 6% to 9% in the postnatal period. For women who were screened twice, the prevalence of high risk scores appeared earlier and decreased with advancing gestation (p = 0.026). The prevalence of postnatal high risk increased after 12 weeks postpartum (p = 0.029). Screening protocols for depressive symptomatology during pregnancy may need to be fine-tuned across individual hospitals, and take into account gestational ages, in order to be most effective. As depressive symptomatology persists postnatally, screening protocols may need to extend beyond 12 weeks postpartum.     

The efficacy of classical massage on stress perception and cortisol following primary treatment of breast cancer

To investigate the efficacy of classical massage on stress perception and mood disturbances, 34 women diagnosed with primary breast cancer were randomized into an intervention or control group. For a period of 5 weeks, the intervention group (n = 17) received biweekly 30-min classical massages. The control group (n = 17) received no additional treatment to their routine health care. The Perceived Stress Questionnaire (PSQ) and the Berlin Mood Questionnaire (BSF) were used and the patients’ blood was collected at baseline (T1), at the end of the intervention period (T2), and 6 weeks after T2 (T3). Compared with control group, women in the intervention group reported significantly lower mood disturbances, especially for anger (p = 0.048), anxious depression (p = 0.03) at T2, and tiredness at T3 (p = 0.01). No group differences were found in PSQ scales, cortisol and serotonin concentrations at T2 and T3. However, perceived stress and cortisol serum levels (p = 0.03) were significantly reduced after massage therapy (T2) compared with baseline in the intervention group. Further research is needed to validate our findings.     

Increased Numbers of Circulating Interferon-γ-and Interleukin-4-Secreting Cells During Normal Pregnancy

PROBLEM: Systemic immune responses during normal pregnancy are suggested to deviate toward secretion of T helper (Th)2-like cytokines. METHOD OF STUDY: Blood samples from 11 healthy Primigravidae in their first, second, and third trimesters, and 8 weeks postpartum were examined. Peripheral blood mononuclear cells were separated and the numbers of interferon (IFN)-γ- and interleukin (IL)-4-secreting cells were identified by using the enzyme-linked immunospot test. RESULTS: In all three trimesters of pregnancy, and also postpartum, the numbers of IFN-γ-and IL-4-secreting cells were significantly higher compared with nonpregnant controls (Mann-Whitney; P < 0.001). The numbers of IFN-γ-and IL-4-secreting cells gradually increased as the pregnancy progressed compared with postpartum (Kruskas-Wallis; P < 0.01 and P < 0.05, for IFN-γ and IL-4, respectively). The ratios of IFN-γ/IL-4 during pregnancy and postpartum were unchanged, and also when compared with nonpregnant controls. CONCLUSION: The results indicate a systemic up-regulation of both Th1- and Th2-like immune responses during normal pregnancy.     

孕期心理干预对预防产后焦虑、抑郁疗效观察

目的探讨孕期心理干预对预防产后焦虑、抑郁的疗效,为孕期保健指导提供参考。方法将420例初产妇随机分为研究组(给予孕期心理干预指导)和对照组(给予常规孕期指导),比较两组分别于入组时、产后1个月的焦虑自评量表(SAS)评分及抑郁自评量表(SDS)评分;比较产后7 d、15 d及30 d爱丁堡产后抑郁领表(EPDS)评分。结果两组入组时SAS及SDS评分比较差异无统计学意义;产后1个月,研究组SAS及SDS评分均低于对照组,且两组比较差异有统计学意义(t=-8.258,-8.836;P0.05);研究组产后7 d、15 d及30 dEPDS评分均低于对照组,且两组比较差异有统计学意义(t=-2.513,-3.201,-2.640;P0.05)。结论孕期心理干预及健康保健指导有助于降低产妇产后焦虑抑郁发生率,促进产妇产后的身心健康。     

Lipid lowering through work stress reduction

Swedish civil servants, who reported considerable stress while working in larger government authorities, were randomized into either a work stress reduction intervention or a control group. Four work units constituted the intervention group (n = 94), and one unit formed the control group (n = 35). Participants in the two groups were of similar age and two thirds were women. Psychosocial, lifestyle, and physiological assessments were made before, during, and after the 8-month intervention period. A significant decrease in apolipoprotein B/apolipoprotein A I ratio (p < 0.05) occurred in the intervention group but not in the control group. No changes were seen in either group in smoking, eating, exercise, relative weight, or other lifestyle factors, which could explain the lipid profile changes. Stimulation from and autonomy over work increased in the intervention group (p < 0.01) but remained the same in the control group. Results have implications for the efficacy of work stress interventions in decreasing coronary risk. This study was supported by a grant from the Swedish Work Environment Fund.     

Infant sleep and feeding patterns are associated with maternal sleep,stress, and depressed mood in women with a history of major depressive disorder (MDD)

Our goal was to examine associations of infant sleep and feeding patterns with maternal sleep and mood among women at risk for postpartum depression. Participants were 30 women (age?±?SD?=?28.3?±?5.1 years) with a history of MDD (but not in a mood episode at enrollment) who completed daily sleep diaries, wore wrist actigraphs to estimate sleep, and had their mood assessed with the Hamilton Depression Rating Scale (HAM-D-17) during four separate weeks of the perinatal period (33 weeks pregnancy and weeks 2, 6, and 16 postpartum). They logged their infants’ sleep and feeding behaviors daily and reported postnatal stress on the Childcare Stress Inventory (CSI) at week 16. Mothers’ actigraphically estimated sleep showed associations with infant sleep and feeding patterns only at postpartum week 2. Shorter duration of the longest infant-sleep bout was associated with shorter maternal sleep duration (p?=?.02) and lower sleep efficiency (p?=?.04), and maternal sleep efficiency was negatively associated with the number of infant-sleep bouts (p?=?.008) and duration of infant feeding (p?=?.008). Neither infant sleep nor feeding was associated with maternal sleep at 6 or 16 weeks, but more disturbed infant sleep and more frequent feeding at 6 weeks were associated with higher HAM-D scores at 6 and 16 weeks and higher CSI scores. Sleep in the mother-infant dyad is most tightly linked in the early postpartum weeks, but mothers continue to experience disturbed sleep and infant sleep and feeding behaviors continue to be associated with mothers’ depressive symptoms and stress ratings as long as 16 weeks postpartum. These data imply that interventions designed to improve maternal sleep and postpartum mood should include both mothers and infants because improving infant sleep alone is not likely to improve maternal sleep, and poor infant sleep is linked to postpartum depression and stress.     

An open trial with cognitive behavioral therapy for blood- and injection phobia in pregnant women—a group intervention program

Around 7% of pregnant women suffer from blood- and injection phobia. The aim was to investigate if cognitive behavior group therapy (CBT) is effective in treating pregnant women’s blood- and injection phobia. Thirty pregnant women with blood- and injection phobia according to DSM-IV took part in an open treatment intervention. A two-session cognitive behavior group therapy was conducted. As controls, 46 pregnant women with untreated blood- and injection phobia and 70 healthy pregnant women were used. Repeated measures ANOVA were performed. The scores for the CBT treatment group on the “Injection Phobia Scale-Anxiety” were reduced both after each treatment session and postpartum (p < 0.001). Anxiety and depressive symptoms were also reduced (p < 0.001). Cognitive-behavior group therapy for pregnant women with blood- and injection phobia is effective and stable up to at least 3 months postpartum. It seems also to reduce anxiety and depressive symptoms during pregnancy.