Postpartum depression

We investigated whether informing first-time mothers about postpartum depression affects their experience and behaviour during the depression occurring in the first two weeks after birth. METHOD: 138 first-time mothers who were participants in a longitudinal study sponsored by the Swiss National Fund were retrospectively surveyed concerning postpartum depression in the week after birth (response rate: 86.9%). RESULTS: 90% of the new mothers were affected. One fourth reported severe to very severe symptoms. The most popular sources of information about postpartum depression were books (65.8%) and magazines (59.2%). 10% of the mothers received information from their gynaecologist. 33% of the mothers with severe to very severe symptoms reported that after the birth no member of the medical or paramedical professions had discussed postpartum depression with them. Among the mothers who knew about postpartum depression, 30% did not feel adequately prepared for the degree of depression. Comparisons between informed and non-informed mothers show that the informed mothers had fewer symptoms, a shorter duration, and suffered less. In addition, the following reactions were noted: the informed mothers complained less and were less likely to believe that they were alone in their suffering. Also, they tended to have less negative thought patterns, felt less powerless, and were better able to explain their feelings and behaviour. RECOMMENDATIONS: Information about postpartum depression, especially to ensure that new mothers "feel prepared for it", has a positive influence on experience and behaviour in the week after birth. Therefore, it is useful to inform women about postpartum depression before the birth. This could be integrated into the neonatal care programme offered by the woman's gynaecologist. At the same time, training for nursing staff concerning postpartum depression is recommended.     

Postpartum depression and symbiotic illusion.

Discusses the phenomenon of postpartum depression from a transgenerational perspective. The concept of symbiosis is taken from the mother's point of view as well as from the baby's. Symbiosis is defined as a delusional 2-person fantasy of mutual dependence rather than as a normal phase of development. Analysis of a case of postnatal depression is presented to illustrate the clinical and theoretical implications of this viewpoint and how it was applied in treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postpartum depression in primiparous parents.

Investigated the hypothesis that postpartum depression is a function of disruption of parents' prepartum functioning by the subsequent demands of infant caretaking. 78 primiparous middle SES married couples (mean age 25.5 yrs) completed a battery of questionnaires, including the Beck Depression Inventory, at 8 wks prepartum and 8 wks postpartum, assessing indicators of stress related to childcare. Results indicate that when the level of prepartum depression was controlled, the reported experience of positively reinforcing events was negatively related to postpartum depression for women. For men, the degree to which their infant's behavior was viewed as better than the average was negatively related to postpartum depression. The strongest predictor of depression in both men and women was prepartum depression level. It is concluded that the findings were consistent with the social stress and behavioral theories' interpretation of postpartum depression. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postpartum depression: A critical review.

A review of the literature suggests that there are 3 types of postpartum dysphoric mood states: the maternity blues (a fairly common, transient disorder), postpartum affective psychosis (relatively rare), and postpartum depression (as many as 20% of postpartum women may develop mild to moderate depression). The etiology of postpartum depression remains unclear, although numerous biological, psychological, and sociopsychological factors have been proposed as etiologically relevant. There is some empirical support for these notions, but methodological and conceptual problems hinder the development of a coherent theoretical framework for understanding the etiology, course, and treatment of the disorder. Recent data indicate a relation between stress and depression; future research into postpartum depression is needed to determine the contribution of psychosocial factors (e.g., life events and social support). Medical complications during pregnancy, infant variables, and the effect on the infant–mother relationship also need to be studied. (3 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postpartum depression: a review for perinatal social workers

Postpartum depression is a common and treatable clinical syndrome which effects up to fifty percent of all women and which can best be considered as a triad of disorders. Postpartum blues, postpartum affective disorders or major depressions, and postpartum psychosis have distinct symptoms with corresponding implications for social work interventions and treatment strategies. The role of prevention can be pivotal in terms of reducing negative impacts of psychological problems after birth and minimizing adverse consequences for the new baby and all family members.     

Postpartum anxiety and depression: onset and comorbidity in a community sample

A community-based sample of 107 women completed the Beck Anxiety Inventory, Beck Depression Inventory, State-Trait Anxiety Inventory, and Edinburgh Postnatal Depression Scale at 14 weeks postpartum and at 30 weeks postpartum. The point prevalence of anxiety was 8.7% at 14 weeks and 16.8% at 30 weeks postpartum. The point prevalence of depression was 23.3% at 14 weeks and 18.7% at 30 weeks postpartum. The incidence of anxiety during this time period was 10.28%, and the incidence of depression was 7.48%, indicating high incidences of both postpartum anxiety and depression later in the postpartum period. The Edinburgh Postnatal Depression Scale was found to have a strong correlation with the State Anxiety Scale of the State-Trait Anxiety Inventory (r = .73 at 14 weeks, r = .82 at 30 weeks), suggesting that the Edinburgh Postnatal Depression Scale may be a good screening instrument for anxiety as well as depression.     

Postpartum depression: how much do obstetric nurses and obstetricians know?

Postpartum depression affects 10 to 15 percent of all mothers. A study of 725 obstetric nurses and 204 obstetricians was conducted using a reliable two-factor scale to measure their knowledge and awareness of postpartum depression. Nurses were more aware than physicians of the emotional impact of postpartum depression. Nurses who demonstrated more empathy and who believed education of postpartum depression does not increase a mother's risk were more aware of the postpartum phenomenon than nurses who were less empathic and who did not hold the same belief. Younger and women physicians recognized the psychosocial antecedents to postpartum depression to a greater degree than did older and men physicians. These findings offer potential use in the training of perinatal health care professionals and in the education of pregnant women about postpartum depression.     

Postpartum hemorrhage]

Risk assessments for nongenotoxic chemicals assume a threshold below which no adverse outcomes are seen. However, when an endogenous chemical, such as 17ss-estradiol (E2), occurs at a concentration sufficient to cause an effect, the threshold is already exceeded. Under these circumstances, exogenous estradiol is not expected to provide a threshold dose. This principle is demonstrated for E2 in the red-eared slider, a turtle with temperature-dependent sex determination. In this species, gonadal sex is determined by egg incubation temperature; female development requires endogenous estrogen produced by elevated temperature. While normal production of females by endogenous estrogens is not an adverse effect, exogenous estrogens can sex reverse presumptive males, which can be an adverse effect. A large dose-response study was conducted using seven doses and a vehicle control (starting n = 300/group); a single E2 dose was applied to the eggshell of recently laid eggs. Animals were sexed after hatching. The incubation temperature chosen, 28.6 degrees C, generates a minority of females. Thus, the criteria for testing the threshold hypothesis were met, i.e., there is evidence that there is endogenous estrogen and that it generates an irreversible response. The lowest E2 dose tested, 400 pg/egg (40 ng/kg), sex reversed 14.4% of the animals, demonstrating very low dose sensitivity. The data were fit with a modified Michaelis-Menten equation, which provided an estimate of 1.7 ng/egg for endogenous estradiol. The median effective dose (ED50) was 5.0 +/- 2.0 ng/egg (95% confidence limits), of which 1.7 ng/egg was endogenous estradiol and 3.3 ng/egg came from the applied estradiol. There was no apparent threshold dose for E2. A smaller replication confirmed these results. These results provide a simple biologically based dose-response model and suggest that chemicals which act mechanistically like E2 may also show no threshold dose. If so, even low environmental concentrations of such chemicals may carry risk for sex reversal.     

Postpartum thyroiditis and Basedow disease

BACKGROUND: The postpartum period is characterized by a rebound in autoimmunity secondary to immune tolerance induced by pregnancy, creating favorable conditions for flare up of Graves' disease or autoimmune thyroiditis. Postpartum thyroiditis is a recognized clinical entity. CASE REPORT: Six years after onset of Graves' disease treated with antithyroid drugs, a 25-year-old woman had a high serum level of antithyroperoxidase antibodies a few months before she became pregnant. Six weeks after delivery, she developed signs of hyperthyroidism and goiter. The diagnosis of postpartum thyroiditis was retained. Her condition regressed spontaneously to euthyroidism then hypothyroidism. DISCUSSION: The therapeutic options involved underline the importance of distinguishing between Graves' disease and postpartum thyroiditis. The diagnosis of postpartum thyroiditis is based on history taking, clinical findings, and laboratory tests, especially isotope uptake.     

Postpartum onset of panic disorder

Cyclin D1 (cycD1) expression was defined immunohistochemically using monoclonal antibody DCS-6 and polyclonal antiserum H-295 in 50 glioma biopsies. The number of positive nuclei was higher for H-295 than for DCS-6, with a ratio of 3:1. The labelling index (LI) was compared to the grade of histological malignancy and to Ki-67 MIB-1 LI. The LI for cycD1 increased with histological malignancy, in parallel with the increase in MIB-1 LI. In most tumours, the maximum LI for cycD1 and MIB-1 were found in the same areas. The mean MIB-1 LI: mean cycD1 LI ratio does not vary in the three grades of astrocytic tumours. However, in this study the correlation between the two LIs was not statistically significant. Staining for cycD1 antigen does not necessarily imply that the gene is overexpressed since other molecular mechanisms can also be responsible for cell cycle deregulation. In invasive areas, the cycD1 LI is frequently higher than in solid tumour, either because more tumour cells are positive or because reactive astrocytes and activated microglia express cycD1. The relative contribution of neoplastic and reactive cells remains to be defined.     

Postpartum mood disorders: clinical perspectives

Mood disorders are common in women. A prepregnancy personal history of mood disorder (bipolar or major depression), premenstrual syndrome, or (possibly) postpartum blues places a woman at high risk for a postpartum exacerbation of symptoms. Untreated or unrecognized postpartum mood disorders can lead to serious psychologic and social consequences, in some cases even leading to suicide or infanticide. Women at risk for postpartum mood disorders need to be referred for psychiatric consultation before pregnancy and parturition. Informed, professional collaboration offers the best opportunities for prevention, as well as the earliest recognition and treatment of emergent symptoms.     

Postpartum myocardial infarction induced by Parlodel

The authors report the case of a 28 year old woman who developed antero-septoapical myocardial infarction in the post-partum period. This was detected by surface ECG and echocardiography performed after a systemic embolism. The infarction followed treatment with Parlodel for inhibition of lactation. Coronary angiography, performed one month post-partum, was normal and the methergin test was negative. The physiopathological mechanism of myocardial infarction resulted from the association of an iatrogenic spastic phenomenon favourised by the patient restarting to smoke and the physiological arterial hyperactivity of the post-partum period. This mechanism raises the question of preventive measures in cases of inhibition of lactation in the post-partum period, notably stopping smoking.     

Postpartum hemorrhage of the uterine artery rupture

Fatty masses, especially solid lipomas, in the paediatric abdomen are very rare. We present such a case, that of an 11-year-old boy who was admitted with abdominal pain and distension. The pre-operative diagnosis of lipoma was suggested by US and CT. The diagnosis of simple lipoma arising in the leaves of the small bowel mesentery, without immature cells, was verified microscopically after the operation. The tumour was enucleated from the mesenterium leaving the intestine intact. We underline the importance of US and CT as pre-operative diagnostic tools.     

Postpartum hemorrhage producing acute ischemic optic neuropathy

The effect of pretreatment of two carbamates, pyridostigmine and physostigmine on dynamic pulmonary mechanics has been studied in rats exposed to sarin aerosols. Sign-free dose of pyridostigmine (0.075 mg/kg, i.m.) or physostigmine (0.1 mg/kg, i.m.) did not significantly alter the parameters of the dynamic pulmonary mechanics 20 min after treatment. However, sarin (51.2 mg/m3, for 15 min) depressed the respiratory rate, air flow and minute volume and enhanced the transthoracic pressure and tidal volume. Pretreatment with carbamates 20 min prior to sarin exposure significantly modified or counteracted the above induced changes. It is concluded that the protective effect of carbamates is mainly due to the correction of respiratory changes caused by sarin aerosols in rats.     

Childhood depression, stressors and parental depression

The relationship between depression and stressors and the relationship between depression in children and depression in their parents were investigated. Depressed children aged 7-11 years (n = 20) were compared with clinical non-depressed children (n = 88) and normal children (n = 55). Children, mothers and fathers in the three groups were tested. Measures included the Children's Depression Inventory, Recent Life Events Scale, Stressor Scale and Beck Depression Inventory. The findings showed that children and mothers in the depressed group reported more stressors than other children and other mothers while fathers of children in the depressed group did not report more stressors. The findings also showed that mothers of depressed children were more depressed than mothers of normal children while there were no differences between the scores of fathers in the three groups.