Archives of Women's Mental Health最新文献

Background and aim

Depression, anxiety, and mood disorders are common in women. Tibolone, acting as both estrogen and progestin, has shown conflicting effects in hormone therapy. This first meta-analysis of RCTs assesses Tibolone’s impact on these conditions in women.

Methods

Two reviewers independently searched Scopus, PubMed/Medline, Web of Science, and Embase up to 22 May 2024. Using the DerSimonian and Laird random-effects model, weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated. Risk of bias was assessed using the Cochrane tool, and evidence certainty was rated using the GRADE approach.

Results

Eight articles were included in the meta-analysis. Tibolone significantly reduced depression scores (WMD = -5.335, 95% CI: -9.144 to -1.525, p = 0.006), with high heterogeneity (I² = 99.8%). Greater effects were observed in trials ≤6 months. Anxiety (WMD =-1.489, CI: -3.271 to 0.294, p = 0.102, I² = 99.1%) and mood (WMD = -0.719, CI:-1.805 to 0.366, p = 0.194, I² = 76.6%) scores showed non-significant reductions.

Conclusion

Tibolone significantly improved depressive symptoms in women, with non-significant trends in anxiety and mood. However, due to high heterogeneity, risk of bias in some studies, and limited number of trials for anxiety and mood outcomes, findings should be interpreted with caution.

Purpose

During pregnancy, it is unclear whether women with attention deficit hyperactivity disorder (ADHD) should stop prescribed medication – risking relapse – or continue – risking harm to themselves and their baby. We aimed to conduct a systematic review to examine whether ADHD medications should be continued during pregnancy.

Methods

We searched MEDLINE, Embase, PsycINFO, PubMed, CINAHL, AMED, CENTRAL, Cochrane Library, NHS Knowledge and Library Hub from 1st July 2019 to 1st July 2024, without any restrictions on language, setting, or study type. We supplemented this with relevant studies identified from the references of retrieved studies. Two authors used the Newcastle-Ottawa Scale (NOS) to independently rate the quality of included studies.

Results

Twelve cohort studies were included in the qualitative review. All were deemed high quality (NOS ≥ 7). Seven studies found ADHD medication use during pregnancy had no significant negative effect on maternal or offspring outcomes. One study found continuing ADHD medication reduced the risk of various negative outcomes, and another found stopping ADHD medication may increase the risk of threatened abortion. Three studies concluded that ADHD medication use was associated with negative outcomes: pre-eclampsia, gastroschisis, omphalocele, and transverse limb deficiency. Modafinil was identified as significantly increasing the risk of congenital malformations.

Conclusion

Women taking modafinil should consider stopping it prior to pregnancy. Clinicians should discuss the risks, benefits, and uncertainties of other ADHD medications with women who are pregnant, or considering pregnancy, keeping in mind that the benefits of continuing ADHD medications- where it is effective for an individual- are likely to outweigh the risks.

Purpose

Few robust estimates of perinatal anxiety and/or depression in women who experienced anxiety and/or depression before pregnancy have been reported in the literature. This study calculated rates of perinatal anxiety and depression in women with a history of the disorders using data from the Australian Longitudinal Study on Women’s Health, the Australian Government’s Pharmaceutical Benefits Scheme and the Medicare Benefits Schedule.

Methods

The analysis included two cohorts of Australian women. The first comprised 14,247 women born between 1973 and 1978 with nine waves of data collected from 1996 to 2018. The second cohort included 17,010 women born between 1989 and 1995 with data collected from six waves between 2013 and 2019. The proportion of women who reported anxiety and/or depression before having a child and who then reported anxiety and/or depression perinatally (i.e. relapse/recurrence) was calculated for first births and for any birth.

Results

Compared to women who did not report preconception anxiety or depression, rates of perinatal anxiety and depression were higher among women reporting either condition pre-conceptually. For women in the 1973-78 cohort, the rate of perinatal anxiety was 24% (vs. 7%) and the rate of perinatal depression was 26% (vs. 10%). In the 1989-95 cohort, the rate of perinatal anxiety was 43% for women with preconception anxiety (vs. 18%) and the rate of perinatal depression was 41% for women with preconception depression (vs. 12%).

Conclusions

Given the high rates of perinatal relapse or recurrence in women with preconception anxiety and/or depression, as well as the well-established risks to the health and development of their offspring, supporting these women to remain asymptomatic during the perinatal period is a priority.

Purpose

Suicidal behavior during pregnancy, including ideation, planning, and attempts, represents a significant but under-researched public health concern linked to adverse maternal and fetal outcomes such as preterm labor, low birth weight, and stillbirth. This systematic review and meta-analysis (SRMA) aimed to synthesize evidence on the association between suicidal behavior during pregnancy and feto-maternal outcomes, addressing existing gaps in the literature.

Materials and methods

The SRMA, following PRISMA 2020 guidelines, included observational studies that reported maternal and fetal outcomes among pregnant women exhibiting suicidal behaviour (suicidal ideation, planning, or attempts). Four databases (PubMed, Embase, Web of Science, and Cochrane) were searched up to April 30, 2025, and 18 studies were included. Risk of bias assessment was done using the Newcastle-Ottawa scale. Data were analysed using random-effects models to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs).

Results

From the 18 studies included for the SRMA, a total of 30749705 participants were analysed, with 6557 in the suicidal behaviour group. Suicidal behaviour significantly increased the risk of preterm labor (RR = 1.78, 95% CI: 1.7–1.86), preterm birth (RR = 1.40, 95% CI: 1.26–1.55), fetal anomaly (RR = 1.84, 95% CI: 1.22–2.77) and Low Birth Weight (RR = 1.83, 95% CI: 1.67–2.02), with no heterogeneity observed (I² = 0%). Stillbirth risk was markedly elevated (RR = 11.92, 95% CI: 10.32–13.77). Other outcomes, such as placental abruption and postpartum hemorrhage, also demonstrated increased risks. All the outcomes had a low to very low certainty of evidence.

Conclusion

Suicidal behaviour during pregnancy poses significant risks to maternal and fetal health, emphasizing the need for early identification and interventions. Addressing maternal mental health must be prioritized in prenatal care to improve outcomes for both mother and child. Others: The protocol was registered in the PROSPERO (ID: CRD42024539860).

Purpose

Although the relationship between previous pregnancy loss and perinatal depression has been explored, most previous research has been cross-sectional and has not utilized diagnostic evaluation techniques. This study longitudinally examined the relationship using the self-administered web-based World Health Organization Composite International Diagnostic Interview 3.0.

Methods

This study used data from a control group of pregnant women in a randomized controlled trial conducted between November 2019 and March 2020. An accelerated failure time model with Weibull distribution was conducted to evaluate the impact of previous pregnancy loss by number (never, once, and two or more times) on the onset of perinatal depression from 18 ± 2 weeks (baseline) to 3 months postpartum.

Results

The final analysis included 2,347 participants. The risk of developing perinatal depression was significantly higher for those with two or more previous pregnancy losses compared to those with no previous pregnancy loss (adjusted models: time ratio 0.17, 95% CI 0.03–0.86, p = 0.033). No statistically significant difference was found between those with one pregnancy loss and those with no previous pregnancy loss (adjusted models: time ratio 0.99, 95% confidence interval [CI] 0.24–4.04, p = 0.990).

Conclusion

Women who experienced repeated pregnancy loss had an elevated risk of diagnosable perinatal depression. Thus, it is crucial to consider interventions targeting pregnant women who have experienced repeated pregnancy loss to prevent perinatal depression.

Purpose

Oral contraceptives (OCs) are commonly used for the treatment of polycystic ovarian syndrome (PCOS). However, the therapeutic effects of OCs on cognitive function have not been explored extensively. This study aimed to determine the changes in cognitive function in PCOS patients treated with three cycles of combined oral contraceptives (COCs) containing estrogen and progesterone.

Methods

Drug-naive PCOS patients (N = 35), aged 18–35 years, were evaluated at baseline and three months after treatment with COC containing levonorgestrel (0.15 mg) plus ethinyl estradiol (30 µg). Working memory (WM), attention, and executive function domains of cognition were assessed using the auditory and visual digit span test (DST), continuous performance test-identical pair (CPT-IP), and trail-making test (TMT), respectively.

Results

The DST results showed improvements in the maximal digit span (ML) of the auditory (p = 0.0039) and visual (p = 0.0005) WM tasks after treatment. Improvements were also observed in the mean span (MS) of the auditory (Cohen’s d = 0.94, p = 0.0009) and visual (Cohen’s d = 0.90, p < 0.0001) DST after treatment. In CPT-IP test, the mean reaction time (RT) of hit rate (Cohen’s d = 0.64, p = 0.01) and random errors (Cohen’s d = 0.64, p = 0.01) showed a significant decrease after treatment. After treatment, TMT showed a significant decrease in all parameters, except trail 1 errors (p = 0.1079).

Conclusions

This preliminary study suggests that three months of COCs treatment in PCOS patients improves cognitive performance in the domains of WM, attention, and executive function. However, the lack of a control group and short follow-up period limits the strength of our findings.

Purpose

Infant temperament is influenced by environmental factors, such as maternal depression and anxiety. However, the association between maternal sleep and infant temperament is unclear. We examined the associations between maternal postpartum sleep and maternal perception of infant temperament and the moderating effect of maternal depression and anxiety over 6 months following delivery.

Methods

Postpartum women with a history of depression (N = 166) completed the Pittsburgh Sleep Quality Index, Edinburgh Postnatal Depression scale, Generalized Anxiety Disorder Scale-7, and Infant Behavior Questionnaire-Very Short Form once per month for 6 months post-delivery. Associations between maternal sleep and infant temperament and interactions with maternal anxiety and depression were tested via 2-level multilevel models.

Results

At the month-level, shorter sleep duration and greater sleep disturbance were significantly associated with higher infant negative affectivity, and shorter sleep duration, greater sleep disturbance, and lower sleep efficiency were associated with significantly lower infant orienting/regulation (p’s < 0.05). At the person-level, lower sleep efficiency and greater sleep disturbance were significantly associated with higher infant negative affectivity (p’s < 0.05). Both person-level effects were significantly moderated by depression symptoms, whereas only the effect of sleep efficiency was moderated by anxiety symptoms (p’s < 0.05).

Conclusions

Maternal perception of infant orienting/regulation may be sensitive to acute sleep disruption, whereas maternal perception of infant negative affectivity is linked both acute and trait-like maternal sleep disruption. Lower depression symptoms may buffer trait-like effects of maternal sleep disruption on perception of infant negative affectivity, whereas higher anxiety symptoms may be sensitizing. These findings highlight the importance of maternal sleep health for infant outcomes.

Purpose

While interventions to mitigate and prevent perinatal maternal distress exist, none are personalized based on participants’ daily experiences and intervention response. This study compared maternal distress outcomes (depressive symptoms, anxiety symptoms, perceived stress) between perinatal individuals receiving a personalized mobile health-enhanced cognitive-behavioral intervention and individuals receiving usual prenatal care.

Methods

Pregnant individuals ≤ 22 weeks’ gestation recruited from six prenatal care clinics were randomized to the intervention or usual prenatal care. Intervention participants received a 12-session adaptation of the Mothers and Babies intervention (MB-P), personalized by just-in-time stress reduction and mindfulness content based on elevated physiologic or self-reported stress. Primary outcomes were depressive and anxiety symptoms, and perceived stress. Secondary outcomes were behavioral activation, decentering of thoughts, social support, and mood regulation. Outcomes were measured at baseline, one-week post-intervention, one month postpartum, and three months postpartum. An intent-to-treat approach using mixed-effects models guided analysis.

Results

Forty-nine individuals were randomized to MB-P and fifty-one to usual prenatal care. Participants were 70% White, 33.7 years old on average, and 16.2 weeks gestation. At three months postpartum, intervention participants had lower depressive symptomatology (d = 0.43) and less perceived stress (d = 0.46) than controls. Intervention participants exhibited greater behavioral activation three months postpartum (d = 0.41), greater decentering post-intervention (d = 0.37), and greater mood regulation post-intervention (d = 0.56) and three months postpartum (d = 0.55).

Conclusion

MB-P improved maternal depression and anxiety and mechanisms of behavioral activation, decentering, and mood regulation when compared to usual prenatal care. Future research should examine MB-P impact compared to standard MB without just-in-time content.

Trial registration: Clinical Trials.gov, NCT05052281.