Malin Eberhard-Gran

Review of validation studies of the Edinburgh Postnatal Depression Scale.

Objective:  To review validation studies of the Edinburgh Postnatal Depression Scale (EPDS).

Depression in postpartum and non-postpartum women: prevalence and risk factors

Objective:  The aim of the study was to assess the prevalence of depression in postpartum women as compared with non‐postpartum women, and to identify risk factors of depression in both groups.

The Edinburgh Postnatal Depression Scale: validation in a Norwegian community sample.

This study was undertaken to validate a Norwegian translation of the Edinburgh Postnatal Depression Scale (EPDS). The EPDS was validated against the DSM-IV criteria for major depression, derived from the PRIME-MD, in an interview study of 56 women selected from a community-based questionnaire study of 310 women 6 weeks postpartum. A score of > or =10 on the EPDS scale identified all women with major depression, giving a sensitivity of 100% (95% confidence interval; 72%-100%) and a specificity of 87% (95% confidence interval; 77%-95%). The EPDS scores were strongly correlated with the Montgomery-Asberg Depression Rating Scale in the subsample of women interviewed (n=56) and with the Hopkins Symptom Check List (SCL-25) scores in the questionnaire study (n=310). Our results with regard to the sensitivity and specificity estimates are comparable with prior validation studies; however, the confidence intervals around the estimates are wide. Nevertheless, this study confirms that the EPDS is a valid clinical screening instrument for detecting postpartum depression.

Fear of childbirth; the relation to anxiety and depression

Abstract  Objective. To study the associations of anxiety and depression with fear of childbirth. Design. A cross‐sectional questionnaire study. Setting. Prenatal public healthcare in Norway. Sample. Pregnant women (n=1642) recruited during November 2008 until April 2010. Methods. Data were collected by a postal questionnaire at pregnancy week 32. Fear of childbirth was measured by the Wijma Delivery Expectancy Questionnaire (W‐DEQ) and by a numeric rating scale. Symptoms of anxiety were measured by the Hopkins Symptom Check List (SCL‐25) and symptoms of depression by the Edinburgh Postnatal Depression Scale (EPDS). Main outcome measure. Fear of childbirth. Results. Eight per cent (137 of 1642) of the women had fear of childbirth (W‐DEQ≥85), 8.8% (145 of 1642) had anxiety (SCL‐anxiety≥18) and 8.9% (146 of 1642) had depression (EPDS≥12). More than half (56.2%) of the women with fear of childbirth did not have anxiety or depression; however, presence of anxiety or depression increased the prevalence of fear of childbirth (odds ratio 2.4, 95% confidence interval 1.1–5.2 and odds ratio 8.4, 95% confidence interval 4.8–14.7, respectively). Women with both anxiety and depression had the highest prevalence of fear of childbirth (odds ratio 11.0, 95% confidence interval 6.6–18.3). Similar associations of anxiety and depression were estimated by using the numerical rating scale for measuring fear of childbirth. Conclusions. Presence of anxiety and depression increased the prevalence of fear of childbirth; however, the majority of women with fear of childbirth had neither anxiety nor depression.

Pregnancy outcome after exposure to antidepressants and the role of maternal depression: results from the Norwegian Mother and Child Cohort Study.

Abstract Results of previous studies on the safety of antidepressants during pregnancy have been conflicting. The primary objective of this study was to investigate whether first-trimester exposure to antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), was associated with increased risk of congenital malformations. The secondary objective was to examine the effects of exposure to antidepressants during pregnancy on birth weight and gestational age. We included 63,395 women from the Norwegian Mother and Child Cohort Study. The women had completed 2 self-administered questionnaires at gestational weeks 17 and 30 on medication use and medical, sociodemographic, and psychological factors. Data on pregnancy outcome were retrieved from the Medical Birth Registry of Norway. Of the 63,395 women, 699 (1.1%) reported using antidepressants during pregnancy, most frequently SSRIs (0.9%). Exposure to SSRIs during the first trimester was not associated with increased risk of congenital malformations in general (adjusted odds ratio [OR], 1.22; 95% confidence interval [CI], 0.81–1.84) or cardiovascular malformations (adjusted OR, 1.51; 95% CI, 0.67–3.43). Exposure to antidepressants during pregnancy was not associated with increased risk of preterm birth (adjusted OR, 1.21; 95% CI, 0.87–1.69) or low birth weight (adjusted OR, 0.62; 95% CI, 0.33–1.16). This study does not suggest a strongly increased risk of malformations, preterm birth, or low birth weight following prenatal exposure to antidepressants. Without adjustments for level of maternal depression and various sociodemographic and lifestyle factors, antidepressant use during pregnancy would wrongly have been associated with an increased risk of preterm birth.

Use of Psychotropic Medications in Treating Mood Disorders during Lactation Practical Recommendations

Many new mothers who need antidepressant or mood-stabilising drug treatment may wish to breastfeed their infants, but are hesitant to do so because of possible harmful effects of the medication on the infant. This article reviews current data on drug excretion into breast milk and the effects on the breast-fed child, and provides recommendations for the use of the different psychotropic drugs in lactating women.Relevant literature was identified through systematic searches of MEDLINE, EMBASE and the Science Citation Index Expanded (ISI) from 1966 to February 2005. The present knowledge is based on the accumulation of case studies. No randomised controlled trials in breast-fed infants have been performed and there is a lack of long-term follow-up studies.Use of SSRIs and TCAs (except doxepin) is compatible with breastfeeding. However, if treatment with an SSRI is started in the postpartum period, fluoxetine and citalopram may not be drugs of first choice. With regard to other antidepressants, such as venlafaxine, trazodone, mirtazapine, reboxetine, moclobemide and other MAOIs, very little knowledge exists. Breastfeeding should be avoided while using lithium. Carbamazepine and sodium valproate (valproic acid) are generally better tolerated by the breast-fed infant than lithium. Data on lamotrigine are still sparse. Knowledge is also scarce on the novel antipsychotics and thus recommendations in lactating women cannot be made for these agents. It is unwise to expose infants unnecessarily to drugs that may have severe adverse effects. As such, clozapine should probably be avoided because of the risk of agranulocytosis.Our knowledge of the impact of drug exposure through breast milk is still limited. Infant drug exposure is, however, generally higher during pregnancy through placental passage than through breast milk. Despite the low dosage transfered to the infant through breast milk, premature infants and infants with neonatal diseases or inherited disturbances in metabolism may be vulnerable to such exposure.

Depression during pregnancy and after delivery: a repeated measurement study.

The aim of this study was to examine the risk of depression in the postpartum period (first four months after delivery) as compared to the remaining postnatal year and the pregnancy period.All postpartum women from two municipalities in Norway were included in a questionnaire study of mental health (n = 416). Over 50% of the women (n = 259) answered an identical questionnaire at an additional time either before or after the postpartum period. The level of depression was measured by the Edinburgh Postnatal Depression Scale (EPDS) and the Hopkins Symptom Check List-25 items (SCL-25).The point prevalence of depression (EPDS ≥ 10) in the first four months postpartum did not differ significantly as compared to other time periods during pregnancy and the postnatal year. This finding remained also after controlling for other risk factors of depression; high score on the life event scale, prior depression and poor partner relationship. There was a non-significant trend of lower prevalence of depression during early pregnancy and after the first eight postnatal months.In conclusion, our findings suggest that the first four months postpartum were not distinguished by higher depression prevalence as compared to other time periods during pregnancy and the first postnatal year.

A comparison of anxiety and depressive symptomatology in postpartum and non-postpartum mothers

Abstract.Background:The aim of the study was to compare the distribution of symptoms of anxiety and depression among postpartum as compared with non-postpartum mothers, and to estimate the impact of the postpartum period on the risk of anxiety and depression when adjusted for other risk factors.Methods:A questionnaire survey approaching all women 18–40 years of age in two municipalities in Norway during the period 1998–1999 was conducted. A total of 2,730 women were included, of whom 416 were in the postpartum period. Only women with one or more deliveries (n = 1,794) were included in the multivariate analyses.Results:The crude prevalence of anxiety and depression was lower in postpartum as compared to non-postpartum mothers. However, when controlling for other risk factors, the odds ratio for anxiety was 1.2 (95% CI: 0.6–2.3) and for depression 1.8 (95% CI: 1.1–2.9) during the postpartum period.Conclusion:The overall risk of anxiety appeared to be the same in both groups, whereas the risk of depression was increased in the postpartum group.

The impact of previous birth experiences on maternal fear of childbirth

This study aimed to assess the relation between fear of childbirth and previous birth experiences.

Pelvic girdle pain in pregnancy: The impact on function

Background. The aim of this study was to determine the prevalence of self‐reported pelvic girdle pain in pregnancy and study the impact on function, the use of crutches, and waking up at night, according to location of pain. Methods. A population‐based questionnaire study was performed among all women 18–40 years in two communities in Norway in 1998–99. A total of 1,817 women with a prior delivery constituted the study sample. Pelvic girdle pain was grouped into five categories: pain in anterior pelvis, in posterior pelvis, in anterior and unilateral posterior pelvis, in anterior and bilateral posterior pelvis (a complete pelvic girdle syndrome), and pelvic pain with no information on location. Results. A total of 46% (843/1,817) reported pelvic girdle pain in pregnancy at one location or more. Nineteen percent reported pain in anterior pelvis only, 14% in posterior pelvis only, 4% in anterior and unilateral posterior pelvis, and 5% reported a complete pelvic girdle syndrome. A total of 7% of all pregnant women used crutches during pregnancy and 15% reported waking up at night frequently due to pelvic girdle pain. A complete pelvic girdle syndrome, as compared to pain in the anterior pelvis only, was strongly associated with the use of crutches (adjusted odds ratio (OR) 4.3; 95% confidence interval (CI) 2.5–7.4) and with waking up at night due to pain (OR 4.6; 95% CI 2.7–7.2). Conclusion. Pain related to the pelvic joints is common among pregnant women in Norway and may cause serious functional problems.