Postpartum depression affects around 12% of mothers in developed countries, with consequences for the whole family. Many women with depressive symptoms remain undetected and untreated. The aim of this study was to investigate to what extent women with depressive symptoms at 6 weeks postpartum are identified by the healthcare system, the interventions they received, and remission rates at 6 months postpartum.

Postpartum women scoring 12–30 on the Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks after delivery (n = 697) were identified from the longitudinal cohort study “Biology, Affect, Stress, Imaging and Cognition” (BASIC) in Uppsala, Sweden. A total of 593 women were included. Background and remission information at 6 months was collected from the BASIC dataset. Medical records were examined to identify interventions received.

Most women (n = 349, 58.7%) were not identified by the healthcare system as having depressive symptoms and 89% lacked any record of interventions. Remission rates at 6 months postpartum were 69% in this group. Among women identified by the healthcare system, 90% received interventions and about 50% were in remission at 6 months postpartum. The EPDS reduction during the study period was largest in the group identified by the child health services (CHS, −5.15) compared to the non-identified (−4.24, p < 0.001).

Despite screening guidelines, many women with depressive symptoms had no documentation of screening or interventions by the healthcare system. Furthermore, a significant proportion did not achieve remission despite interventions. Being identified by CHS was associated with the largest reduction of symptoms. Research is needed to understand gaps in the healthcare processes, to better identify peripartum depression.

The peripartum is a period at high risk for the onset of depressive symptoms. The prevalence of peripartum depression (PD) ranges from 6 to 20% and is burdened with high adverse birth outcomes, poor mother-infant bonding, and a high risk for suicidal ideation and attempts. However, PD is underrecognized and consequently undertreated.

We aimed at screening depressive symptoms in women during pregnancy and postpartum, and evaluating the socio-demographic and clinical characteristics associated with depressive symptoms.

199 women, 55 during pregnancy and 144 in the postpartum period, consecutively admitted to the Perinatal Mental Health Service of Ancona (Italy) were administered a socio-demographic and clinical questionnaire together with the Edinburgh Postnatal Depression Scale (EPDS). Women scoring ≥ 12 at the EPDS were considered screening positive.

Twenty women (10%) were screening-positive. These women were more often foreigners (R2=0,032; β=0,178; p=0,012), single (R2=0,026; β=0,163; p=0,022), with a positive psychiatric family history (R2=0,114; β=-0,337; p=0,001) and more frequently affected by physical comorbidities unrelated to pregnancy (R2=0,03; β=0-0,174; p=0,014). These women also had more gestational comorbidities such as gestational hypertension (R2=0,02; β=-0,154; p=0,030), shortening of uterus neck (R2=0,05; β=-0,234; p=0,001), and miscarriage threats/placental abruption (R2=0,004; β=-0,067; p=0,001).

Our study highlighted the association between depressive symptoms and potentially dangerous gestational comorbidities. Our results further stress the need to screen all women in the peripartum for the presence of depression, in order to identify those at-risk and eventually put in place strategies to prevent further complications to mothers and children.

No significant relationships.

Postpartum and peripartum depression are debilitating disorders that impact the mother and their ability to care for their children’s emotional, social, and physical needs. Current treatments include psychotherapy, pharmacotherapy, and electroconvulsive therapy. These treatments are moderately effective or come with side effects that can negatively impact mother and child. As a result, many mothers view some treatments as unacceptable while pregnant or breastfeeding. Over the last decade, repetitive transcranial magnetic stimulation (rTMS) has shown promise as an effective and safe treatment option for postpartum and peripartum depression. However, little is known regarding people’s knowledge and attitudes towards this emerging technology, with no research assessing this in Canada.

We aim to identify gaps in knowledge and to assess attitudes toward rTMS as a treatment for postpartum and peripartum depression in mental health professionals, patients, and the general public living in Canada.

A mixed methods study design will be employed. The qualitative portion will consist of individual semi-structured interviews. An inductive thematic analysis will be completed. The quantitative portion will consist of an anonymous, self-administered survey shared through REDCap. Focus groups with rTMS experts will be conducted to inform survey creation.

No resulst at this time.

Understanding gaps in knowledge and attitudes toward rTMS is the first step toward ensuring that everyone is well informed and able to access safe and effective treatments. With limited treatment options available to a postpartum and/or peripartum depression patients being well informed on all treatments is crucial towards accessing treatments that best suit their needs.

No significant relationships.

Peripartum depression (PPD) impacts around 12% of women globally and is a leading cause of maternal mortality. However, there are currently no accurate methods in use to identify women at high risk for depressive symptoms on an individual level. An initial study was done to assess the value of deep learning models to predict perinatal depression from women at six weeks postpartum. Clinical, demographic, and psychometric questionnaire data was obtained from the “Biology, Affect, Stress, Imaging and Cognition during Pregnancy and the Puerperium” (BASIC) cohort, collected from 2009-2018 in Uppsala, Sweden. An ensemble of artificial neural networks and decision trees-based classifiers with majority voting gave the best and balanced results, with nearly 75% accuracy. Predictive variables identified in this study were used to inform the development of the ongoing Swedish Mom2B study.

The aim of the Mom2be study is to use digital phenotyping data collected via the Mom2B mobile app to evaluate predictive models of the risk of perinatal depression.

In the Mom2B app, clinical, sociodemographic and psychometric information is collected through questionnaires, including the Edinburgh Postnatal Depression Scale (EPDS). Audio recordings are recurrently obtained upon prompts, and passive data from smartphone sensors and activity logs, reflecting social-media activity and mobility patterns. Subsequently, we will implement and evaluate advanced machine learning and deep learning models to predict the risk of PPD in the third pregnancy trimester, as well as during the early and late postpartum period, and identify variables with the strongest predictive value.

Analyses are ongoing.

Pending results.

No significant relationships.

In the peripartum period, the literature on seasonality in depression is still scarce and studies present varying findings. The aims of this study were to investigate whether seasonal patterns in postpartum depressive symptoms previously identified in a Swedish study could be replicated in a larger study, as well as to assess seasonal patterns in depressive symptoms during pregnancy.

This was a nested case-control study comprised of 4129 women who participated in the BASIC project and gave birth at Uppsala University Hospital, Uppsala, Sweden, between February 2010 and December 2015.

Women who gave birth in October–December 2011 had an increased odds of depressive symptoms at 6 weeks postpartum, when compared with women giving birth in April–June 2011 (aOR = 2.42; 95% CI: 1.12–5.26). The same pattern was found among women with a history of depression. No other seasonal patterns for depressive symptoms during pregnancy or at 6 weeks postpartum were identified.

In general, no consistent seasonal patterns were found in peripartum depressive symptoms. Whether the seasonal patterns found in some studies during certain years may be due to other factors relating to specific years and seasons, such as extreme climatic conditions or other particular events, warrants further investigation.

To quantify the relationship between screening positive for depression and several indicators of the food and nutrition environment in Bangladesh.

We used cross-sectional data from the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) trial in Bangladesh to examine the association of depression in non-peripartum (NPW) and peripartum women (PW) with food and nutrition security using multivariable logistic regression and dominance analysis.

Rural north-eastern Bangladesh.

Women of reproductive age.

Of 2599 women, 40 % were pregnant or up to 1 year postpartum, while 60 % were not peripartum. Overall, 20 % of women screened positive for major depression. In the dominance analysis, indicators of food and nutrition security were among the strongest explanatory factors of depression. Food insecurity (HFIAS) and poor household food consumption (FCS) were associated with more than double the odds of depression (HFIAS: NPW OR = 2·74 and PW OR = 3·22; FCS: NPW OR = 2·38 and PW OR = 2·44). Low dietary diversity (<5 food groups) was associated with approximately double the odds of depression in NPW (OR = 1·80) and PW (OR = 1·99). Consumption of dairy, eggs, fish, vitamin A-rich and vitamin C-rich foods was associated with reduced odds of depression. Anaemia was not associated with depression. Low BMI (<18·5 kg/m2) was also associated with depression (NPW: OR = 1·40).

Depression among women in Bangladesh was associated with many aspects of food and nutrition security, also after controlling for socio-economic factors. Further investigation into the direction of causality and interventions to improve diets and reduce depression among women in low- and middle-income countries are urgently needed.

Postpartum depression affects up to 20 % of new mothers within the first 12 months of parturition. 25-Hydroxyvitamin D (25(OH)D) has known importance in bone health, but it may also play an important role in other functions, including reproduction and fertility, immune function and mental health. This clinical commentary reviews literature evaluating 25(OH)D deficiency during pregnancy and the incidence of postpartum depressive symptomatology.

Narrative review, summary and recommendations.

A literature search revealed five relevant studies of antepartum women, three based in the USA, one in Turkey and one in Iran.

Three of the five studies measured serum 25(OH)D concentrations during the first or second trimester and discovered an association with 25(OH)D deficiency and depressive symptoms postpartum. One study determined an almost significant (P=0·058) inverse relationship with first-trimester 25(OH)D concentration and depressive symptoms postpartum, and the last study, which was a secondary analysis, did not find an association.

The Endocrine Society recommends routine vitamin D supplementation during pregnancy and lactation due to increased metabolic demand in the mother, but a recent Cochrane review recommended against screening. Vitamin D should be the target of more studies during pregnancy and the postpartum period since it appears to have an important role for both medical and mental health. Vitamin D supplementation is a relatively safe and cost-effective intervention during pregnancy, and it may prove to be important in the prevention of postpartum depression.

Major depressive disorder during pregnancy associates with potentially detrimental consequences for mother and child. The current study examined peripheral blood gene expression as a potential biomarker for prenatal depressive symptoms.

Maternal RNA from whole blood, plasma and the Beck Depression Inventory were collected longitudinally from preconception through the third trimester of pregnancy in 106 women with a lifetime history of mood or anxiety disorders. The expression of 16 genes in whole blood involved in glucorticoid receptor (GR) signaling was assessed using real-time polymerase chain reaction. In parallel, plasma concentrations of progesterone, estradiol and cortisol were measured. Finally, we assessed ex vivo GR sensitivity in peripheral blood cells from a subset of 29 women.

mRNA expression of a number of GR-complex regulating genes was up-regulated over pregnancy. Women with depressive symptoms showed significantly smaller increases in mRNA expression of four of these genes – FKBP5, BAG1, NCOA1 and PPID. Ex vivo stimulation assays showed that GR sensitivity diminished with progression of pregnancy and increasing maternal depressive symptoms. Plasma concentrations of gonadal steroids and cortisol did not differ over pregnancy between women with and without clinically relevant depressive symptoms.

The presence of prenatal depressive symptoms appears to be associated with altered regulation of GR sensitivity. Peripheral expression of GR co-chaperone genes may serve as a biomarker for risk of developing depressive symptoms during pregnancy. The presence of such biomarkers, if confirmed, could be utilized in treatment planning for women with a psychiatric history.