Paola Ciolli

Ethylglucuronide in the urine as a marker of alcohol consumption during pregnancy: Comparison with four alcohol screening questionnaires

Ethyl glucuronide (EtG) is an ethanol metabolite and EtG is used as a biomarker of alcohol drinking. EtG can be detected in the blood and in several biological matrices including urine, hair and nails. Alcohol consumption during pregnancy is a strong risk factor for fetus health so in the recent years different strategies to reveal alcohol use have been planning including the use of screening questionnaires as the AUDIT-C, T-ACE and TWEAK. The present study aims to investigate in pregnant women the specificity and predictive value of the AUDIT-C, T-ACE and TWEAK plus a food diary in use in Sapienza University Hospital compared with the results of urine EtG measurement. Seventy pregnant women were enrolled and examined. Urine samples were provided by pregnant women immediately after the interviews. EtG determinations were performed by Enzyme Immunoassay with a cut-off established at 100ng/mL. Data show that 34.28% of the enrolled pregnant women overcame the EtG cut off. No direct correlation was found between EtG data and the alcohol screening interviews showing lower levels of alcohol consumption, although T-ACE revealed the same at risk percentage. However, a significant concordance was observed with food diary data and T-ACE only in patients with higher EtG urinary concentration. This study provides clinical evidence that the diagnosis of maternal alcohol consumption during pregnancy only based on indirect methods, such as questionnaires and food diary, may significantly underestimate alcohol use.

Perinatal Depression and Patterns of Attachment: A Critical Risk Factor?

Background. This study aims to verify if the presence and severity of perinatal depression are related to any particular pattern of attachment. Methods. The study started with a screening of a sample of 453 women in their third trimester of pregnancy, who were administered a survey data form, the Edinburgh Postnatal Depression Scale (EPDS) and the Experience in Close Relationship (ECR). A clinical group of subjects with perinatal depression (PND, 89 subjects) was selected and compared with a control group (C), regarding psychopathological variables and attachment patterns. Results. The ECR showed a prevalence of “Fearful-Avoidant” attachment style in PND group (29.2% versus 1.1%, p < 0.001); additionally, the EPDS average score increases with the increasing of ECR dimensions (Avoidance and Anxiety). Conclusion. The severity of depression increases proportionally to attachment disorganization; therefore, we consider attachment as both an important risk factor as well as a focus for early psychotherapeutic intervention.

Modelli di attaccamento e personalità nella depressione post partum

AIMS This study investigates the prevalence of post partum depression (PPD) in a sample of Roman women, and the role of socio-demographic variables, personality structure and maternal attachment patterns, in order to identify primary and secondary prevention strategies. METHODS Data were collected in two phases. During the third trimester of pregnancy, a sample of 453 women completed a socio-demographic data sheet and the Edinburgh Postnatal Depression Scale (EPDS). Among the patients scoring 12 or more at EPDS, 15 entered the second phase of the study and completed SCID-II and Adult Attachment Interview. PPD diagnosis was confirmed by the SCID-I. The study group was compared with a control group. RESULTS Among the 453 women who were evaluated, 92 (20.3%) scored ≥12 at EPDS, 39 has been enrolled and 15 entered the study. Presence of depressive symptoms was associated with: complications in pregnancy, previous psychiatric disorders, family and marital conflicts. 66.6% of depressed mothers showed more than one diagnosis on Axis II (particularly avoidant/dependent + borderline or histrionic + dependent). The AAI showed a prevalence of insecure (33.3%) and unresolved/disorganized (46.6%) attachment pattern in the clinical group. DISCUSSION AND CONCLUSIONS Our results suggest that psychological factors such as personality structure and attachment patterns are not only involved in post natal affective disorders, but have a key role in the onset and development of PPD.

The Influence of Mother’s Personality on the Decision about the Elective Cesarean Section: A Pilot Study with a Sample of 16 New Mothers

Objective: To investigate the psychological profile of a sample of new mothers, who requested an elective caesarean section (CS), compared with a group of women who had a CS in emergency. Furthermore, the study examined psychiatric, environmental, medical and obstetrical risk factors related to the mother’s choice of an elective CS, in order to develop specific intervention strategies. Methods: A sample of 16 mothers aged 34.88 ± 8.53 years were enrolled and assessed using a semi-structured face-to-face interview, the Minnesota Personality Inventory Test-2 (MMPI-2) and the Edinburgh Postnatal Depression Scale (EPDS). The sample was divided in two groups: cases (8 women who had an elective CS) and controls (8 women who had a CS in emergency). Results: The analysis identified a statistical significance among the two groups with a higher prevalence in cases’s group of: previous mood disorders (100% of the cases group), maternal comorbidities (100% of the cases group), neuroticism (MMPI-2’s scale ‘NEGE’: p=0.013), ‘defensive’ attitude (MMPI-2’s scale ‘K’: p=0.013), hypochondria (MMPI-2’ scale ‘Hs’: p=0.046), health concerns (MMPI-2’s scale ‘Hea’: p=0.013) and depression (MMPI-2’s scales ‘D’: p=0.012 and ‘Dep’: p=0.023; EPDS’s scores: p=0.007), with a general tendency to have higher scores of psychopathology (p=0.033). No statistical significance was found concerning socio-demographic information and obstetrical risk factors. Conclusion: Women who chose CS without medical indications showed more somatic anxiety levels, expressed with a hypochondriac rumination and an obsessive way to control their body. This seems associated with more neuroticism and more symptoms of depression which may lead to a higher risk of develop postnatal depression. Gynaecologists should pay attention to the reasons behind the mother’s choice of an election CS by ensuring a detailed psychological counselling and try to mitigate levels of anxiety and fears related to the childbirth.