Ri-hua Xie

Prenatal Social Support, Postnatal Social Support, and Postpartum Depression

PURPOSE To assess the association of antenatal and postnatal social support with postpartum depression (PPD). METHODS We carried out a prospective cohort study of 534 pregnant women between February and September 2007 in Hunan, China. The association between prenatal and postnatal social support with PPD was examined. RESULTS A total of 103 (19.29%) women had PPD. Women with low prenatal and postnatal social support had higher rates of PPD. For prenatal support, PPD was 28.20% in the lowest quartile versus 9.90% in the highest quartile (adjusted odds ratio [OR]: 3.38, 95% confidence interval [CI]=1.64,6.98). For postnatal support, PPD was 44.10% in the lowest quartile versus 5.40% in the highest quartile (adjusted OR: 9.64, 95% CI=4.09, 22.69). CONCLUSIONS Lower or lack of social support is a risk factor of PPD. The association between postnatal social support and PPD is much stronger than that of prenatal social support.

Cesarean Section and Postpartum Depression in a Cohort of Chinese Women with a High Cesarean Delivery Rate

BACKGROUND Whether or not cesarean delivery is associated with increased risk of postpartum depression (PPD) remains unclear. METHODS We carried out a prospective cohort study between February and September 2007 in Hunan Maternal and Infant Hospital and the First Affiliated and Third Affiliated Hospitals of the Central South University in Changsha, Hunan, Peoples Republic of China. The Chinese version of the Edinburgh Postnatal Depression Scale (EPDS) was used at 2 weeks postpartum to assess PPD, with a score of ≥13 as the cutoff for PPD. RESULTS A total of 534 women were included in the final analysis, with 415 (77.7%) delivering by cesarean section (the majority of them with no medical indication). The rate of PPD was 21.7% in women who had a cesarean delivery and 10.9% in women who delivered vaginally. The increased risk of PPD in women who had cesarean sections was maintained after we adjusted for potential confounding factors or considered cesarean delivery by social indications. CONCLUSIONS Cesarean section is associated with increased risk of PPD in Chinese women with a high cesarean delivery rate.

Preeclampsia and gestational diabetes mellitus: pre-conception origins?

Preeclampsia (PE) and gestational diabetes mellitus (GDM) are two of the most common medical complications of pregnancy, with risks for both mother and child. Like many other antepartum complications, PE and GDM occur only in pregnancy. However, it is not clear if pregnancy itself is the cause of these complications or it these conditions are caused by factors that existed prior to gestation. In this paper, we hypothesize that although the clinical findings of PE and GDM are first noted during pregnancy, the origins of both conditions may actually precede pregnancy. We further hypothesize that pathophysiologic changes underlying PE and GDM are present prior to pregnancy, but remain undetected in the non-gravid state either because pregnancy is the trigger that makes these pathologies become clinically detectable or because there has been limited prospective longitudinal data comparing the pre-gravid and antepartum status of women that go on to develop these conditions. Rigorous prospective cohort studies in which women undergo serial systematic evaluation in the pre-conception period, throughout pregnancy and into the postpartum are ideally needed to test this hypothesis of pre-conception origins of PE and GDM. In this context, we are creating a pre-conception cohort, involving about 5000 couples who plan to have a baby within six months in Liuyang county in the Chinese province of Hunan. Results from this pre-conception cohort program should be able to provide definitive answer to the question of whether the underpinnings of PE and GDM originate prior to pregnancy. Ultimately, the significance of addressing this hypothesis is underscored by its potential implications for targeted interventions that could be designed to (i) prevent the deleterious effects of PE/GDM and (ii) thereby interrupt the vicious cycle of disease that links affected women and their offspring.

Infant outcomes among pregnant women who used oseltamivir for treatment of influenza during the H1N1 epidemic

OBJECTIVE This study was undertaken to examine the association between maternal oseltamivir treatment for influenza and infant outcomes during the 2009 HINI influenza pandemic. STUDY DESIGN This was a retrospective cohort study using a population-based maternal newborn database including women who gave birth to a singleton infant in the Canadian province of Ontario from November 2009 through April 2010. Risks of small for gestational age (SGA) (10th percentile and 3rd percentile), preterm birth (<37 weeks of gestation), very preterm birth (<32 weeks of gestation), and 5-minute Apgar score <7 associated with maternal exposure to oseltamivir were analyzed by multivariable regression. RESULTS A total of 55,355 women with a singleton birth were included in this study. Among them, 1237 (2.2%) women received oseltamivir for treatment or prevention of influenza during pregnancy. Women who took oseltamivir during pregnancy were less likely to have a SGA infant based on the 10th percentile for growth (adjusted risk ratio, 0.77; 95% confidence interval, 0.60-0.98). No association between maternal use of oseltamivir with SGA on 3rd percentile, preterm birth, very preterm birth, and low Apgar score was observed. CONCLUSION There is no evidence of an association between maternal use of oseltamivir for influenza and early birth, low Apgar at birth, and poor fetal growth.

Prenatal family support, postnatal family support and postpartum depression

Background:  Inadequate social support is an important determinant of postpartum depression (PPD). Social support for pregnant women consists of supports from various sources and can be measured at different gestation periods. Differentiating the effects of social support from different sources and measured at different gestation periods may have important implications in the prevention of PPD. In the family centred Chinese culture, family support is likely to be one of the most important components in social support.

Fetal sex, social support, and postpartum depression.

Objective: To examine the impact of prenatal and postnatal social support on the association between fetal sex and postpartum depression (PPD). Method: We conducted a prospective cohort study in Changsha, China, between February and September 2007. We first compared the sociodemographic and obstetric characteristics, and the prenatal and postnatal social support between women who gave birth to a female infant and those who gave birth to a male infant. We then examined the association between fetal sex and PPD by following logistic regression models: fetal sex as the independent variable; with adjustment for sociodemographic and obstetric factors; with adjustment for sociodemographic, obstetric factors, and prenatal social support; and with adjustment for sociodemographic, obstetric factors, and postnatal social support. Results: Postnatal social support scores were much lower in women who gave birth to a female infant than in those who gave birth to a male infant. The odds ratio of PPD for women who gave birth to a female infant, as compared with those who gave birth to a male infant, was 3.67 (95% CI 2.31 to 5.84). The increased risk of PPD for women who gave birth to a female infant remained after adjustment for sociodemographic and obstetric factors and prenatal social support, but disappeared after adjustment for postnatal social support score. Conclusion: We conclude that increased risk of PPD in Chinese women who give birth to a female infant is caused by lack of social support after childbirth.

New Perspective on Impact of Folic Acid Supplementation during Pregnancy on Neurodevelopment/Autism in the Offspring Children – A Systematic Review

It has been conclusively established that folic acid supplementation prior to and during early pregnancy (up to 12 weeks of gestation) can prevent neural tube defects (NTDs). We hypothesized that folate effects may extend from neuro-structural defects to alterations in neuro-behavioural and emotional skills including autism spectrum disorders (ASDs) and other developmental disorders. The objective of this review was to comprehensively evaluate evidence on the impact of folic acid on neurodevelopment other than NTDs. We conducted an online search of relevant literature compiled by the National Library of Medicine from Medline and EMBASE (searched on Dec 31, 2014: http://www.ncbi.nlm.nih.gov/entrez/query/fcgi and http://www.elsevier.com/online-tools/embase). We first created 3 files (search restricted to English literature) using the following key words: 1) folate or folic acid (171322 papers identified by this search); 2) maternal or pregnancy or pregnant or gestation or gestational or prenatal or antenatal or periconception or periconceptional (1349219 papers identified by this search); and 3) autism or autism spectrum disorders or developmental delay or development or neurodevelopment or mental or cognitive or language or personal-social or gross motor or fine motor or behaviour or intellectual or intelligence or Bayley Scale (8268145 papers identified by this search). We then merged the 3 files and reviewed the papers that addressed these three issues simultaneously. A total of 22 original papers that examined the association between folic acid supplementation in human pregnancy and neurodevelopment/autism were identified after the screening, with 15 studies showing a beneficial effect of folic acid supplementation on neurodevelopment/autism, 6 studies showed no statistically significant difference, while one study showed a harmful effect in > 5 mg folic acid supplementation/day during pregnancy. Folic acid supplementation in pregnancy may have beneficial effects on the neurodevelopment of children beyond its proven effect on NTDs.

Infant sex, family support and postpartum depression in a Chinese cohort

Objectives To assess the impact of prenatal and postnatal family support on the association between infant sex and postpartum depression (PPD). Design Prospective cohort study. Setting Pregnant women seen at Hunan Maternal and Infant Hospital, the First Affiliated and the Third Affiliated Hospitals of the Central South University in Changsha, Hunan, Peoples Republic of China from February to September 2007. Participants 534 Pregnant women who were consecutively recruited from the participating hospital during their prenatal visits at 30–32 weeks of gestation and who completed the 2 weeks postpartum survey, with no recorded major psychiatric disorders and obstetric and/or pregnancy complications. Main outcome measure PPD, which was defined as a score of 13 or higher of the Edinburgh Postnatal Depression Scale. Results Postnatal family support scores were much lower in women who gave birth to a female infant, and the OR of PPD was 3.67 (95% CI 2.31 to 5.84) for them as compared to women who gave birth to a male infant. After adjusting by postnatal support from all family members, husband and parents, the ORs of PPD for women who gave birth to a female infant decreased to 2.06 (95% CI 1.20 to 3.53), 2.89 (95% CI 1.76 to 4.77) and 2.20 (95% CI 1.28 to 3.77), respectively. Discussion Increased risk of PPD in Chinese women who gave birth to a female infant can be explained to large extent by inadequate or poor postpartum support from family members, particularly husband and parents.

Association between labetalol use for hypertension in pregnancy and adverse infant outcomes

OBJECTIVE Labetalol and methyldopa are the two antihypertensive drugs most frequently used to control blood pressure for hypertensive disorders of pregnancy. The objective of this study was to assess if labetalol is associated with poor infant outcomes. STUDY DESIGN Retrospective population-based cohort study using the linked maternal/infant databases in the Province of Saskatchewan. Women with a diagnosis of a hypertensive disorder of pregnancy who delivered a singleton in Saskatchewan from January 1, 1990 to December 31, 2005 and who were dispensed only labetalol or only methyldopa were included in the study. Occurrences of small for gestational age (SGA)<10th percentile, SGA<3rd percentile, preterm birth, stillbirth, hospitalization for respiratory distress syndrome (RDS), sepsis, and seizure during infancy, and infant death were compared. Multiple logistic regression analysis was performed to adjust for potential confounding. RESULTS A total of 1223 eligible women were included in the final analysis. Among them, 300 received labetalol only and 923 received methyldopa only during pregnancy. For women with chronic hypertension, the rate of hospitalization for RDS, sepsis, and seizure during infancy was significantly higher for infants born to mothers who were dispensed labetalol only as compared with infants born to mothers who were dispensed methyldopa only (adjusted odds ratio (OR) 1.51, 95% confidence interval (CI) 1.02-2.22). CONCLUSION Compared with methyldopa, the use of labetalol for chronic hypertension of pregnancy may be associated with increased rate of hospitalization during infancy.

Beta-Blockers increase the risk of being born small for gestational age or of being institutionalised during infancy

To compare infant outcomes between mothers with hypertension treated by beta‐blockers alone and by methyldopa alone during pregnancy.