Maureen Marks

Prenatal depression, prenatal anxiety, and spontaneous preterm birth: a prospective cohort study among women with early and regular care.

Objective: This article investigates the effects of antenatal depression and anxiety on spontaneous preterm birth resulting either from preterm labor or preterm premature rupture of membranes. Methods: We conducted a prospective cohort study of 681 women with singleton pregnancies consecutively recruited between 20 and 28 weeks of gestation in the Obstetrics Department of the French University Hospital of Caen. Most were of European ethnic origin and received early and regular antenatal care. The assessment of gestational age was based on ultrasound examination (occurring before 13 weeks of gestation for 94.9% of the women). Depression and anxiety were assessed using self-administered questionnaires: the Edinburgh Postnatal Depression Scale and the Spielberger State-Trait Anxiety Inventory. Logistic regression analysis, controlling for sociodemographic factors (e.g., maternal age, occupation) and obstetric factors (e.g., previous preterm birth, cervical or vaginal infection), provided adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: Spontaneous preterm birth occurred in 31 women (4.8%). The rate of spontaneous preterm birth was significantly higher among women with high depression scores (9.7%) as opposed to other women (4.0%) even after adjustment for potential confounding factors (adjusted OR = 3.3, 95% CI = 1.2–9.2, p = .020). Anxiety was not significantly associated with the outcome. There were no significant interaction effects between psychological and biomedical factors. Conclusions: These findings provide evidence that antenatal depression is significantly associated with spontaneous preterm birth in a population of European women receiving early and regular care. CRH = corticotropin-releasing hormone; EPDS = Edinburgh Postnatal Depression Scale; STAI-Y = State-Trait Anxiety Inventory; BMI = body mass index; HPA = hypothalamic–pituitary–adrenocortical; ACTH = adrenocorticotropin hormone.

Clinical survey of a psychiatric mother and baby unit: characteristics of 100 consecutive admissions

Demographic, obstetric, clinical features and clinical outcome of 100 consecutive admissions to a psychiatric mother and baby unit are presented. Referral patterns by health services involved are also examined. 56% of admissions occurred within 2 weeks of delivery and the mean duration of admission was 2 months. Patients were categorized as having schizophrenia (n = 20), affective psychosis (n = 56) or non-psychotic disorders (n = 24) and these three groups were compared. There were few demographic and obstetric differences between diagnostic categories. The affective psychosis group were more likely to have acute illnesses with an onset and admission occurring within 2 weeks of delivery. Women with non-psychotic disorders were also most likely to become ill within 2 weeks of delivery but tended to be admitted later. Only 7% of the affective psychotic and non-psychotic women were discharged separated from their infants. Women with schizophrenia were less likely to have acute admissions and required greater input of nursing and service resources than mothers with other illnesses but 50% were discharged without their infants. More research is needed into matching models of care to the needs of mothers with different kinds of chronic, recurrent and new episodes of mental illness that present after childbirth. There are few guidelines to aid clinical staff in assessing the risk, current or future, of significant harm to an infant as a consequence of maternal mental illness, particularly of schizophrenia.

Infanticide in England and Wales.

In England and Wales children under one year of age are at four times greater risk of becoming victims of homicide than either older children or the general population. The annual rate of infant homicide (45 per million) has remained relatively constant since the Homicide Act (1957) in contrast with a progressive fall in the infant mortality rate. Details from Home Office records of all infants under a year who were the victims of homicide during 1982–1988 are presented. Infants were most at risk on the first day of life — neonates accounted for 21% of victims and 13% of the victims were between one day and one month old. Thereafter the proportion decreased steadily so that by the final quarter of the first year the risk of becoming a homicide victim equalled that of the general population. Excluding neonates, there were more male victims than female ones, especially in the first three months. A parent was the most likely perpetrator. For all neonaticides the mother was recorded as a suspect, 36% of these mothers were subsequently indicted, all but two were convicted of infanticide and all their convictions resulted in probation. For children over a day marginally more fathers than mothers were recorded as the prime suspect. Mother and father suspects were equally likely to be indicted and also equally likely to be convicted of a homicide offence. However, mothers received both less severe convictions and less severe sentences than fathers. Fathers were more likely than mothers to have killed their infants using violence which wounded. Nonetheless sentences were unrelated to the brutality of the offence: mothers who had killed with wounding violence received less severe penalties than fathers who had killed in a non-wounding way.

Diurnal pattern of cortisol output in postnatal depression

This study investigated the diurnal output of saliva cortisol in women with symptoms of depression postnatally. Twenty-one depressed and 30 non-depressed women at 7.5 weeks postpartum, and 21 non-perinatal controls, collected saliva at waking, 30 min, and 3 and 12h postwaking. Women who were not depressed postnatally showed a pattern of cortisol secretion over the day similar to non-perinatal controls. There was a significant difference in diurnal pattern between postnatally depressed and postnatally non-depressed women, due to a difference in the first two time points (waking and +30 min): compared to the other two groups who each had a significant increase in cortisol levels from waking to +30 min, the depressed women had significantly higher cortisol levels at waking and no increase at +30 min. The lack of a morning rise in the depressed women is similar to that reported for posttraumatic stress disorder and chronic fatigue syndrome and may reflect a response, in vulnerable women, to the marked cortisol withdrawal that occurs after delivery.

Maternal Psychopathology and Infant Development at 18 Months: The Impact of Maternal Personality Disorder and Depression

OBJECTIVE No previous longitudinal study has examined the impact of comorbid maternal personality disorder (PD) and depression on child development. We set out to examine whether maternal PD and depression assessed at 2 months post partum would be independently associated with adverse developmental outcomes at 18 months of age. METHOD Women were recruited into the study shortly after delivery and screened for depression and PD. Those meeting criteria for depression, PD, or both conditions, were selected for assessment at 2 months post partum, together with a comparison group with neither condition (total sample, N = 200). Assessments of cognitive, social and emotional development were conducted with their children at 18 months of age. RESULTS Maternal postpartum depression and PD were both associated with higher levels of dysregulated infant behavior. There was a significant interaction between depression and PD in the model of dysregulated behavior and the detrimental effects of maternal depression and PD were evident only among mothers with both conditions. Maternal depression was independently associated with impaired infant cognitive scores and higher levels of internalizing behavior. CONCLUSIONS Future studies of the effects of maternal depression should also take into account the effects of comorbid maternal PD. Health professionals need to be aware of the possible co-occurrence of PD among mothers presenting with postnatal depression and that mothers with these co-occurring disorders are likely to require greater support.

Infanticide in Scotland

Details from Scottish Office records of all infants under a year who were the victims of homicide in Scotland during 1978–1993 are presented and compared with results from studies of infant homicide in England and Wales. Although Scottish homicide rates in the total population are much higher than those in England and Wales, the annual Scottish infanticide rate (43/million) is remarkably similar to that of England and Wales (45/million). In addition, characteristics of victims and perpetrators are also similar between the two regions. As with England and Wales, in Scotland the younger the infant the greater the risk of becoming the victim of homicide (83% were killed within 6 months of birth); male babies were more frequently killed than female ones; a parent was the most frequent perpetrator (93% of offences); mothers tended to kill neonates but for infants older than a day more fathers than mothers were recorded as the main accused. Mothers and fathers were convicted of similar offences but fathers were less likely to receive non-custodial sentences. Differences in sentencing appeared to be related to either gender-related differences in attributions as to the motivation for the offence, or to the level of violence used against the victim. Offences of mothers were most frequently recorded as being motivated by mental illness, those by fathers as due to rage. Fathers were more likely to have killed by kicking or hitting, mothers by some form of suffocation.

Symptoms associated with the DSM IV diagnosis of depression in pregnancy and post partum

Pregnancy and the postpartum may affect symptoms of depression. However it has not yet been tested how the symptoms used for the DSM IV diagnosis of depression discriminate depressed from non depressed women perinatally. A modified version of the Structured Clinical Interview for DSM IV (SCID interview) was used that allowed assessment of all associated DSM IV symptoms of depression with depressed and non depressed women in pregnancy and the postpartum period. Loss of appetite was not associated with depression either ante or postnatally. The antenatal symptom pattern was different from the postnatal. The sensitivity of the symptoms ranged from 0.7% to 51.6%, and specificity from 61.3% to 99.1%. The best discriminating symptoms were motor retardation/agitation and concentration antenatally, and motor retardation/agitation, concentration and fatigue postnatally. Depression in pregnancy and postpartum depression show significantly different symptom profiles. Appetite is not suitable for the diagnosis of depression in the perinatal period.

Changes in neurite outgrowth but not in cell division induced by low EMF exposure: influence of field strength and culture conditions on responses in rat PC12 pheochromocytoma cells.

The effects of low electromagnetic field (EMF) exposure (4.5-15.8 microT, 50 Hz AC) on neurite outgrowth and cell division in rat PC12 pheochromocytoma cells were examined. The study involved two separate experimental series in which culture conditions during exposure to the magnetic fields differed. In series 1 (14 experiments in which culture conditions were not strongly conducive to cell differentiation [15% serum]), exposure to 4.5-8.25 microT for 23 h significantly inhibited neurite outgrowth by 21.5 +/- 1.3% (by Manova, p = 0.003). In contrast, in series 2 (12 experiments in which culture conditions promoted cellular differentiation [4% serum]), exposure to 4.35-8.25 microT for 23 h significantly stimulated neurite outgrowth by 16.9 +/- 1.1% (by Manova, p = 0.009). Thus, in both series, exposure to a narrow range of low EMF has significant, but opposite effects on neurite outgrowth. Exposure to higher fields, 8.25-12.5 microT (series 1) and 8.25-15.8 microT (series 2) had no significant effect on neurite outgrowth. These data, when considered with other reports, suggest that neuronal differentiation can be altered by low level EMF exposure. While this may not be detrimental, it merits further research. At present, the reasons for the significant changes in neurite outgrowth being confined to the same narrow field strength are unclear. As stated above, culture conditions in series 2 were more conducive to cell differentiation than those in series 1. This is reflected in the lower number of cells in control samples in series 2, at the end of the 23-h incubation, than in series 1 (- 16.9 +/- 1.7%, p = 0.003). As the same numbers were plated in both series, the medium used in series 1 allows more of the PC12 cells to divide; this is consistent with some cells reverting to a non-neuronal adrenal chromaffin phenotype [L. Greene, A. Tischler. Establishment of a noradrenergic clonal line of rat adrenal pheochromocytoma cells which respond to nerve growth factor. Proc. Natl. Acad. Sci. U. S. A., 73 (1976) 2424-2426]. Exposure to both ranges of magnetic fields (4.35-8.25 and 8.25-15.8 microT) has no effect on cell division. Thus, there is no evidence in this study that there is a mitogenic effect arising from low EMF exposure.

Assessing psychosocial risk in pregnant/postpartum women using the contextual assessment of maternity experience (CAME) : Recent life adversity, social support and maternal feelings

BackgroundThe Contextual Assessment of Maternity Experience (CAME) interview was developed to characterise the psychosocial context relevant to the maternity experience by providing a detailed picture of women’s lives during the transition to motherhood. More specifically, it was designed to enable the assessment of major risk factors for emotional disturbances in pregnant and postpartum women, especially depression, within the same instrument and using a coherent methodological framework.MethodThe CAME assesses three domains relevant to motherhood: 1) recent life adversity or stressors; 2) the quality of social support and key relationships including partner relationship; and 3) maternal feelings towards pregnancy, motherhood and the baby. Two high-risk samples of inner-city London women were used to test the psychometric qualities of the CAME components.ResultsOverall, the internal consistencies of the relevant components were high in both samples examined. The validity of the three components of the measure was evidenced by their association with either maternal characteristics or parenting assessments.ConclusionIt was concluded that the CAME shows promise as a measure of the psychosocial risk factors involved in the maternity experience for future research in this field.

The DSM IV diagnoses of melancholic and atypical depression in pregnancy.

Atypical and melancholic subtypes of depression based on the Diagnostic and Statistical Manual (DSM) IV are important concepts, especially for biological psychiatry. The aim of this study was to determine whether the symptoms used for the diagnoses of atypical and melancholic depression can distinguish these subtypes during pregnancy. A modified version of the Structured Clinical Interview for DSM IV (SCID interview) was used that allowed assessment of all DSM IV symptoms of melancholic and atypical depression with depressed and non-depressed women in pregnancy. A Swiss cohort of 449 women was interviewed. Four diagnostic groups were compared: women with melancholic, atypical or non specified depression, and those without depression. Seventeen per cent of the cohort met SCID criteria for a depressive episode of depression at least once in pregnancy, with melancholic depression 2.4%, atypical depression 4.4% and non specified depression 10.2%. Many of the symptoms used to distinguish atypical and melancholic depression did not discriminate between these groups during pregnancy. However some, such as mood reactivity, distinct quality of mood and sleep pattern, did discriminate. Differential diagnosis between melancholic and atypical depression in pregnancy needs to be based on pregnancy specific definitions. The possible therapeutic consequences and the neurobiological basis for these findings warrant further research.