Maternal Depression and Anxiety Across the Postpartum Year and Infant Social Engagement, Fear Regulation, and Stress Reactivity

Feldman, Ruth; Granat, Adi; Pariente, Clara; Kanety, Hannah; Kuint, Jacob; Gilboa–Schechtman, Eva

doi:10.1097/chi.0b013e3181b21651

Cited by 641 publications

(550 citation statements)

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“…Indeed, PPD/A in humans have been linked to adverse child outcomes, including later cognitive deficits and emotional disturbances (Feldman et al., 2009; Murray & Cooper, 1996; O'CONNOR, Heron, & Glover, 2002), and PPD specifically has been associated with offspring growth retardation and risk for being underweight (Rahman, Iqbal, Bunn, Lovel, & Harrington, 2004). Similarly, we observed that BCAA mothers had smaller pups at weaning.…”

Section: Discussionmentioning

confidence: 99%

Perinatal western‐type diet and associated gestational weight gain alter postpartum maternal mood

et al. 2017

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IntroductionThe role of perinatal diet in postpartum maternal mood disorders, including depression and anxiety, remains unclear. We investigated whether perinatal consumption of a Western‐type diet (high in fat and branched‐chain amino acids [BCAA]) and associated gestational weight gain (GWG) cause serotonin dysregulation in the central nervous system (CNS), resulting in postpartum depression and anxiety (PPD/A).MethodsMouse dams were fed one of four diets (high‐fat/high BCAA, low‐fat/high BCAA, high‐fat, and low‐fat) prior to mating and throughout gestation and lactation. Postpartum behavioral assessments were conducted, and plasma and brain tissues assayed. To evaluate potential clinical utility, we conducted preliminary human studies using data from an extant sample of 17 primiparous women with high GWG, comparing across self‐reported postpartum mood symptoms using the Edinburgh Postnatal Depression Scale (EPDS) for percent GWG and plasma amino acid levels.ResultsMouse dams fed the high‐fat/high BCAA diet gained more weight per kcal consumed, and BCAA‐supplemented dams lost weight more slowly postpartum. Dams on BCAA‐supplemented diets exhibited increased PPD/A‐like behavior, decreased dopaminergic function, and decreased plasma tyrosine and histidine levels when assessed on postnatal day (P)8. Preliminary human data showed that GWG accounted for 29% of the variance in EPDS scores. Histidine was also lower in women with higher EPDS scores.ConclusionsThese findings highlight the role of perinatal diet and excess GWG in the development of postpartum mood disorders.

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Section: Discussionmentioning

confidence: 99%

Perinatal western‐type diet and associated gestational weight gain alter postpartum maternal mood

et al. 2017

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“…These findings imply that neural circuits in the maternal brain that involve OT signaling and support sensitive parenting, as well as emergence of bio-behavioral synchrony, might be critically altered in ELS survivors (also see chapter 2.2.1). In the case of maternal depression, which is highly prevalent in ELS survivors, bio-behavioral synchrony is lower than in non-depressed mothers (Feldman et al, 2009), possibly due a tendency of the depressed mother to withdraw from the interaction. Accordingly, depressed mothers present with lower baseline concentrations of OT and lower OT responses following interaction with their children (Pratt et al, 2015).…”

Section: Ot Pathways In the Intergenerational Transmission Of Matementioning

confidence: 97%

“…Depressed mothers are more likely to withdraw from interactions with their child, show lower amounts of sensitive parenting (Feldman et al, 2009), and perceive infant cues as more negative than non-depressed mothers (Forman et al, 2007). In addition, maternal postpartum depression (PPD) increases the likelihood of offspring internalizing and externalizing problems (Goodman et al, 2011), insecure attachment (Carter et al, 2001), increased stress reactivity (Halligan et al, 2004), and lower social engagement and empathy (Apter-Levy et al, 2014).…”

Section: Ot and Early-life Stress (Els) – Role In Shaping Neural Cmentioning

confidence: 99%

“…The experience of sensitive parental care is indispensable for children’s stress-regulation in the first years of life (Gunnar and Donzella, 2002), likely involving actions of OT. Moreover, ELS is associated with higher infant cortisol reactivity, more negative emotionality (Feldman et al, 2009), and deficient OT signaling in social interactions (Wismer Fries et al, 2005). Importantly, effects of ELS-exposure may be long lasting and are reliable predictors for later life MDD (Heim and Binder, 2012), PPD (Meltzer-Brody et al, 2013), dysregulated HPA axis reactivity (Heim et al, 2008), as well as lower CSF (Heim et al, 2009) and plasma (Opacka-Juffry and Mohiyeddini, 2012) OT concentrations.…”

Section: Ot and Early-life Stress (Els) – Role In Shaping Neural Cmentioning

confidence: 99%

“…Interestingly, children of depressed mothers also exhibit lower baseline concentrations of OT and lower OT responses following social interaction. This intergenerational transmission of OT deficiency in children of depressed mothers corresponds to impairments in important psychosocial domains such as reduced empathy or lower readiness to engage in social interactions (Apter-Levy et al, 2014), as well as poor emotion regulation and increased cortisol reactivity (Feldman et al, 2009). As shown here, ELS-associated asynchrony in mother-child interactions represents a promising approach to investigate OT postnatal pathways of intergenerational transmission of maternal ELS.…”

Section: Ot Pathways In the Intergenerational Transmission Of Matementioning

confidence: 99%

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Oxytocin pathways in the intergenerational transmission of maternal early life stress

Toepfer

Heim

Entringer

et al. 2017

Neuroscience & Biobehavioral Reviews

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Severe stress in early life, such as childhood abuse and neglect, constitutes a major risk factor in the etiology of psychiatric disorders and somatic diseases. Importantly, these long-term effects may impact the next generation. The intergenerational transmission of maternal early life stress (ELS) may occur via pre-and postnatal pathways, such as alterations in maternal-fetal-placental stress physiology, maternal depression during pregnancy and postpartum, as well as impaired mother-offspring interactions. The neuropeptide oxytocin (OT) has gained considerable attention for its role in modulating all of these assumed transmission pathways. Moreover, central and peripheral OT signaling pathways are highly sensitive to environmental exposures and may be compromised by ELS with implications for these putative transmission mechanisms. Together, these data suggest that OT pathways play an important role in the intergenerational transmission of maternal ELS in humans. By integrating recent studies on gene-environment interactions and epigenetic modifications in OT pathway genes, the present review aims to develop a conceptual framework of intergenerational transmission of maternal ELS that emphasizes the role of OT.

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Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery

Chen,

Guo,

et al. 2024

JAMA Netw Open

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ImportancePostpartum depression (PPD) is one of the most common mental health conditions during the perinatal and postpartum periods, which can have adverse effects on both mother and infant.ObjectiveTo investigate the efficacy of perioperative adjunctive esketamine administration after cesarean deliveries in the prevention of PPD.Design, Setting, and ParticipantsA single-center, double-blind, placebo-controlled, randomized clinical trial was conducted from January 1, 2022, to January 1, 2023, at Fujian Provincial Hospital among 298 women aged 18 to 40 years, with an American Society of Anesthesiologists grade I to III classification and singleton full-term pregnancies who were scheduled for elective cesarean deliveries. Primary analyses were performed on a modified intention-to-treat basis.InterventionsPatients were randomly assigned to the esketamine (n = 148) and control (n = 150) groups. Those in the esketamine group received a single intravenous injection of 0.25 mg/kg of esketamine immediately after fetal delivery, followed by 50 mg of esketamine as an adjuvant in patient-controlled intravenous analgesia for 48 hours after surgery. Saline was given to the control group of patients.Main Outcomes and MeasuresThe primary outcome was assessments of PPD symptoms by using the Edinburgh Postnatal Depression Scale (EPDS) at postpartum day 7. Positive screening for PPD was defined as a score of 10 or more points on the EPDS. In addition, the EPDS was analyzed as a continuous variable to evaluate depressive symptoms. Secondary outcomes included the Numeric Rating Scale (NRS) of postoperative pain, along with safety evaluations including adverse events and clinical assessments at postpartum days 14, 28, and 42.ResultsA total of 298 pregnant women were included, with 150 in the control group (median age, 31.0 years [IQR, 29.0-34.0 years]) and 148 in the esketamine group (median age, 31.0 years [IQR, 28.0-34.0 years]). The prevalence of depression symptoms was significantly lower among patients given esketamine compared with controls (23.0% [34 of 148] vs 35.3% [53 of 150]; odds ratio, 0.55; 95% CI, 0.33-0.91; P = .02) on postpartum day 7. In addition, the esketamine group also showed a significantly lower change in EPDS scores (difference of least-squares means [SE], −1.17 [0.44]; 95% CI, −2.04 to −0.31; effect size, 0.74; P = .008). However, there were no differences between the groups in the incidence of positive screening results for PPD or in changes from the baseline EPDS scores at postpartum days 14, 28, and 42. There were no differences in NRS scores at rest and on movement except on movement at 72 hours postoperatively, when scores were significantly lower in the esketamine group (median, 3.0 [IQR, 2.0-3.0] vs 3.0 [IQR, 3.0-3.5]; median difference, 0 [95% CI, 0-0]; P = .03).Conclusions and RelevanceThese results suggest that intravenous administration of esketamine during the perioperative period of elective cesarean delivery can improve depression symptoms during the early postpartum period. However, this antidepression effect may not be universally applicable to patients with low EPDS scores.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2100054199

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Maternal Depression and Anxiety Across the Postpartum Year and Infant Social Engagement, Fear Regulation, and Stress Reactivity

Cited by 641 publications

References 31 publications

Perinatal western‐type diet and associated gestational weight gain alter postpartum maternal mood

Perinatal western‐type diet and associated gestational weight gain alter postpartum maternal mood

Oxytocin pathways in the intergenerational transmission of maternal early life stress

Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery

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