Paternal Depression Linked To Not Being in Relationship With Mother

MedicalResearch.com Interview with:
Lisa Underwood, PhD
Research Fellow| Centre for Longitudinal Research
Growing Up in New Zealand | Who are Today’s Dads?
School of Population Health, Faculty of Medical & Health Sciences
University of Auckland  Auckland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study is part of the contemporary, longitudinal study Growing Up in New Zealand, which is tracking the development of more than 6000 children born in 2009 and 2010.

In previous reports we investigated antenatal and postnatal depression symptoms among the mothers of our cohort children. In this study we looked at the partners of those mothers to explore whether men and women have different risks for depression in each perinatal period.

Our main findings were that expectant fathers were at risk if they felt stressed or were in poor health. Elevated depression symptoms following their child’s birth, were also linked to social and relationship problems.

The strongest predictor of postnatal paternal depression was no longer being in a relationship with the child’s mother.

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Oxytocin During Labor Linked to Increased Risk of Postpartum Depression

MedicalResearch.com Interview with:

Kristina M. Deligiannidis, MD Associate Professor, Center for Psychiatric Neuroscience The Feinstein Institute for Medical Research Director, Women’s Behavioral Health, Zucker Hillside Hospital Northwell Health Associate Professor, Psychiatry and Obstetrics & Gynecology Hofstra Northwell School of Medicine

Dr. Kristina Deligiannidis

Kristina M. Deligiannidis, MD
Associate Professor
Center for Psychiatric Neuroscience
The Feinstein Institute for Medical Research
Director, Women’s Behavioral Health
Zucker Hillside Hospital Northwell Health
Associate Professor
Psychiatry and Obstetrics & Gynecology
Hofstra Northwell School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Because of effects on social behavior, including maternal behavior, oxytocin has often been seen as a potential mediator of postpartum depression and anxiety.

The original objective of our study was to examine the relationship between the use of synthetic oxytocin during and after labor and the development of depressive and anxiety disorders within the first year postpartum. We hypothesized that women exposed to synthetic oxytocin before or during labor would have a reduced risk of postpartum depressive and anxiety disorders compared with those without any exposure. Our findings told the opposite story.

We found that peripartum synthetic oxytocin exposure was associated with an increase in risk for the development of postpartum depression and anxiety.

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Thyroid Hormone Treatment In Pregnant Women With Subclinical Hypothyroidism

MedicalResearch.com Interview with:

Dr. Spyridoula Maraka Assistant professor of medicine Division of Endocrinology and Metabolism Center for Osteoporosis and Metabolic Bone Diseases University of Arkansas for Medical Sciences and the Central Arkansas Veterans Health Care System Little Rock Arkansas

Dr. Spyridoula Maraka

Dr. Spyridoula Maraka
Assistant professor of medicine
Division of Endocrinology and Metabolism
Center for Osteoporosis and Metabolic Bone Diseases
University of Arkansas for Medical Sciences and
Central Arkansas Veterans Health Care System
Little Rock Arkansas

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Subclinical hypothyroidism, a mild thyroid dysfunction, has been associated in pregnancy with multiple adverse outcomes. Our aim was to estimate the effectiveness and safety of thyroid hormone treatment among pregnant women with subclinical hypothyroidism.

Using a large national US dataset, we identified 5,405 pregnant women diagnosed with subclinical hypothyroidism. Of these, 843 women, with an average pretreatment TSH concentration of 4.8 milli-international units per liter, were treated with thyroid hormone. The remaining 4,562, with an average pretreatment TSH concentration of 3.3 milli-international units per liter, were not treated.

Compared with the untreated group, treated women were 38 percent less likely to experience pregnancy loss. However, they were more likely to experience a preterm delivery, gestational diabetes or preeclampsia. Moreover, the benefit of thyroid hormone treatment on pregnancy loss was seen only among women with higher TSH levels (4.1 to 10 mIU/L) before treatment. We also found that for women with lower levels of TSH (2.5–4.0 mIU/L), the risk of gestational hypertension was significantly higher for treated women than for untreated women.

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Does Maternal BMI Affect Offspring’s Obesity Risk?

MedicalResearch.com Interview with:

Dr Rebecca Richmond PhD

Dr Rebecca Richmond

Dr Rebecca Richmond PhD
Senior Research Associate in the CRUK Integrative Cancer Epidemiology Programme
MRC Integrative Epidemiology Unit
School of Social and Community Medicine
University of Bristol

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have been involved in earlier work which applied the same methods used here (using genetic variants to provide causal evidence) and showed that higher maternal pregnancy body mass index (BMI) causes greater infant birth weight. The paper here aimed to build on that earlier research and asked whether maternal BMI in pregnancy has a lasting effect, so that offspring of women who were more overweight in pregnancy are themselves likely to be fatter in childhood and adolescence. Our aim was to address this because an effect of an exposure in pregnancy on later life outcomes in the offspring could have detrimental health consequences for themselves and future generations. However, we did not find strong evidence for this in the context of the impact of maternal BMI in pregnancy on offspring fatness.

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Maternal Mortality and Morbidity Increased on Weekends

MedicalResearch.com Interview with;
Dr. Amirhossein Moaddab
Postdoctoral Research Fellow at Baylor College of Medicine
Houston, Texas

MedicalResearch.com: What is the background for this study?

Response: Based on data from the Centers for Disease Control and Prevention, the United States maternal mortality ratio is three to four times higher than that of most other developed nations. Previous studies from the demonstrated a possible association between weekend hospital admissions and higher rates of mortality and poor health outcomes.

We investigated differences in maternal and fetal death ratios on weekends compared to weekdays and during different months of the year. In addition we investigated the presence of any medical and obstetrics complications in women who gave birth to a live child and in their offspring by day of delivery.

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Does Limiting Weight Gain in Pregnancy Reduce Complications?

MedicalResearch.com Interview with:

Alan Peaceman, MD Professor and Chief of Maternal Fetal Department of Obstetrics and Gynecology Northwestern Feinberg School of Medicin

Dr. Alan Peaceman

Alan Peaceman, MD
Professor and Chief of Maternal Fetal
Department of Obstetrics and Gynecology
Northwestern Feinberg School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Excess maternal weight gain during pregnancy is very common in the United States, and has been associated with a number of pregnancy complications, including gestational diabetes, maternal hypertension, excess fetal size, and cesarean delivery.

Children born to mothers who gained excessively during pregnancy are at much higher risk of developing obesity themselves. We performed a randomized trial where half of the women received an intensive intervention of diet and exercise counseling in an effort to limit their weight gain. Compared to the control group, those in the intervention gained on average 4 pounds less and were more likely to gain within recommended guidelines. Despite this improvement, however, we did not see any improvement in any of the pregnancy complications.

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Hypertension in Pregnancy Linked To Early Mortality

MedicalResearch.com Interview with:
Dr. Lauren Theilen, MD

Obstetrics/Gynecology specialist
Salt Lake City, Utah.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Women with a history of hypertensive disease of pregnancy are known to have increased risk of mortality from cardiovascular and other causes.

Our study shows that hypertensive disease of pregnancy is strongly associated with deaths due to diabetes, heart disease, and stroke. The association is strongest for early mortality – deaths occurring before age 50 – and life expectancy decreases with increasing number of affected pregnancies.

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Glucose Supplementation Reduced Length of Induced Labor

MedicalResearch.com Interview with:
Dr Josianne Paré MD, FRCSC

Département d’obstétrique-gynécologie
Faculté de médecine et des sciences de la santé de l’université de Sherbrooke
3001 12e avenue Nord, Sherbrooke (Québec), J1H 5N4

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prolonged labor is a significant cause of maternal and fetal morbidity and very few interventions are known to shorten labor course. Skeletal muscle physiology suggests that glucose supplementation might improve muscle performance in case of prolonged exercise and this situation is analogous to the gravid uterus during delivery. Therefore, it seemed imperative to evaluate the impact of adding carbohydrate supplements on the course of labor.

Accordingly, we conducted a single centre prospective double-blind randomized-controlled trial comparing the use of parental IV of dextrose 5% with normal saline to normal saline in induced-nulliparous women. A total of 193 patients (96 in the dextrose with normal saline [NS+D] group and 97 in the normal saline group [NS] were analysed in the study. The median total duration of labor was 76 minutes shorter in the NS+D group (499 versus 423 minutes, p = 0.024) than in the NS group. There was no difference in the rate of caesarean section, instrumented delivery, APGAR score or arterial cord pH.

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Link Between Antidepressants During Pregnancy and Birth Defects

MedicalResearch.com Interview with:
Anick Bérard PhD FISPE

Research chair FRQ-S on Medications and Pregnancy and
Director, Réseau Québécois de recherche sur le médicament (RQRM)
and Professor, Research Chair on Medications, Pregnancy and Lactation
Faculty of Pharmacy University of Montreal and
Director, Research Unit on Medications and Pregnancy
Research Center CHU Ste-Justine 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have over 20 years of research showing that antidepressant use during the first trimester of pregnancy increases the risk of major congenital malformations. However, it still remains that controversies exist because we are not sure which of this increased risk is due to maternal depression. Therefore, we have only studied depressed pregnant women – some of them did not take antidepressant during pregnancy.

We were able to show that among depressed pregnant women, those who took antidepressants were at increased risk of having children with malformations – especially those taking citalopram. We were also able to show that many SSRIs, SNRI and tricyclic antidepressants put women at increased risk of having children with various malformations due to their similar mechanism of action (serotonin inhibition in utero).

MedicalResearch.com: What should readers take away from your report?

Response: Depression is a serious condition that requires medical attention during pregnancy. However, given that up to 85% of depressed pregnant women have mild to moderate depression – other treatment (other than antidepressants) options need to be considered. If a woman finds out she is pregnant and is taking antidepressants however, no abrupt discontinuation is suggested and a discussion with a health care provider is advised.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Very few data on the benefits of antidepressant use during pregnancy is available within depressed pregnant women with mild to moderate depression. Our study results taken together with all the body of literature on this topic should lead to other research on the benefits and risks of other forms of treatment for depression such as psychotherapy.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Anick Bérard, Jinping Zhao and Odile Sheehy. Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: An updated analysis of the Quebec Pregnancy Cohort. BMJ Open, January 2017 DOI: 10.1136/bmjopen-2016-01337

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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New Scoring System Guides Surgical Risks During Pregnancy

MedicalResearch.com Interview with:
Adam Sachs MD

Assistant Professor of Anesthesiology
University of Connecticut School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: When women undergo appendectomy or cholecystectomy during pregnancy they are obviously concerned about the well being of their fetus. Unfortunately, the majority of the data available to council pregnant women is outdated and medical practice has significantly changed since their publication.

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Women Who Can Become Pregnant Should Take Folic Acid

MedicalResearch.com Interview with:

Dr. Alex Kemper, MD, MPH, MS Member,US Preventive Services Task Force Professor of Pediatrics and Professor in Community Medicine Department of Pediatrics Duke University School of Medicine

Dr. Alex Kemper

Dr. Alex Kemper, MD, MPH, MS
Member,US Preventive Services Task Force
Professor of Pediatrics and Professor in Community Medicine
Department of Pediatrics
Duke University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: Neural tube defects, where the brain or spinal cord do not develop properly in a baby, can occur early in pregnancy, even before a woman knows she is pregnant. Taking folic acid before and during pregnancy can help protect against neural tube defects. Most women do not get enough folic acid in their diets, so most clinicians recommend that any woman who could become pregnant take a daily folic acid supplement.

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High Outdoor Heat Early in Pregnancy May Raise Risk of Congenital Heart Defects

MedicalResearch.com Interview with:

Nathalie Auger MD MSc FRCPC Montréal, Québec

Dr. Nathalie Auger

Nathalie Auger MD MSc FRCPC
Montréal, Québec

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We carried out this study because congenital heart defects take a large share of birth defects, but not much is known on its risk factors.

In previous research, we found that very high temperatures in the summer were associated with a greater risk of stillbirth. We sought to determine whether elevated outdoor heat could also be linked with congenital heart defects in a sample of about 700,000 pregnancies.

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