January 22nd, 2010 
Stress, history of depression, lack of social support and unintended pregnancy are among the major factors that contribute to increased risk of depression in pregnant women, a new study shows.
Other important factors are maternal anxiety, domestic violence and having public insurance coverage, said the University of Michigan researchers, who reviewed 159 studies conducted between 1980 and 2008.
The study appears in the January issue of the American Journal of Obstetrics & Gynecology.
Depression, which occurs in about 12.7 percent of pregnant women, can cause problems for mothers and babies, including pre-term delivery, preeclampsia, sleep disturbances and disrupted mother-infant bonding.
It’s important for physicians to know how to identify depression in pregnant women, said the study authors, who noted that not all women who test positive on depression screening tests have or will develop clinical depression.
“We are hoping that [health-care] providers can use the presence or absence of risk factors such as those identified in our study to enhance their assessments for depression in addition to the information they obtain from the screening test,” study author Dr. Christie A. Lancaster, a clinical lecturer in the obstetrics and gynecology department at U-M, said in a news release.
Related
- Drugs for depression, anxiety tied to preterm birth
Pregnant women who take certain drugs for depression or anxiety may have heightened risks of preterm delivery or other birth complications, according to a new study.
Researchers found that among nearly 3,000 women who gave birth in Washington State, those who started taking antidepressants known as selective serotonin reuptake inhibitors (SSRIs) in the second or third trimester had a higher risk of preterm birth.
Compared with their counterparts not on the medications, these women were nearly five times more likely to deliver prematurely.
The same risk was not seen, however, among women who started on an SSRI before pregnancy or during the first trimester. SSRIs include drugs like sertraline (Zoloft), paroxetine (Paxil) and fluoxetine (Prozac).
The researchers also found a higher risk of preterm delivery among women who took anti-anxiety drugs known as benzodiazepines, regardless of when they began treatment.
Those drugs, which include medications like lorazepam (Ativan) and alprazolam (Xanax), were linked to higher risks of other complications as well – including low birth weight, newborn respiratory distress and a low Apgar score, a standard measure of newborn health.
The findings of the study are published in the American Journal of Obstetrics & Gynecology.
Exactly what the study means for women on SSRIs or benzodiazepines is not entirely clear. A major limitation is that it could not estimate the benefits of treatment, lead researcher Dr. Ronit Calderon-Margalit, of the Hebrew University-Hadassah School of Public Health in Jerusalem, noted in an email to Reuters Health.
Any risks of using the medications during pregnancy need to be balanced against the risks of leaving depression and anxiety disorders untreated.
“It is very important to have other studies of the risks associated with (these) drugs, but also of benefits associated with treating mothers,” said Calderon-Margalit, who was at the University of Washington in Seattle at the time of the study.
In addition, SSRIs did not appear to present equal risks for all women. Calderon-Margalit described the antidepressant findings as “mostly reassuring” for women who start the drugs before pregnancy or in the first trimester — as most SSRI users in the study had.
The study included 2,793 pregnant women, 11 percent of whom used a psychiatric medication during pregnancy. Of these, 138 were on an SSRI, while 85 used a benzodiazepine.
Among women who were not on any medication, 9 percent gave birth prematurely, versus nearly half of women on benzodiazepines.
Meanwhile, 14 percent of women on SSRIs had a preterm birth, but the elevated risk turned out to be concentrated among those who started an antidepressant after the first trimester. Of those 21 women, 16 delivered prematurely.
Several other birth complications, often related to preterm birth, were also higher-than-average among women on benzodiazepines.
Seventeen percent of their newborns suffered respiratory distress syndrome and one-third ended up in the neonatal intensive care unit. Those figures were 3 percent and 6 percent, respectively, among newborns whose mothers had not used psychiatric medications during pregnancy.
Calderon-Margalit pointed out that most women on benzodiazepines used lorazepam (Ativan), so it is possible that the risks are associated mainly with that drug. However, further research is needed to determine whether any particular medications carry particular risks.
- Glucose Challenge in Pregnancy Could Predict Heart Disease
A glucose challenge test given to pregnant women may also show if they have an increased risk of heart disease in the future, a new study has found.
This finding is important because doctors might be able to begin using current screening procedures for gestational diabetes to identify women who are at risk for developing heart disease later in life, the researchers said. Heart disease is the number-one killer of women in the United States and Canada.
While women with gestational diabetes — a condition leading to temporarily high blood sugars during pregnancy — have a higher risk of cardiovascular disease than those without, no one knew if mild glucose intolerance in pregnancy is associated with heart disease, the study authors noted.
Gestational diabetes is an important risk factor for future type 2 diabetes. Pregnant women are generally screened for gestational diabetes with a glucose challenge test in the second trimester. If the result is abnormal, they have an oral glucose tolerance test to confirm the diagnosis, according to information in a news release about the study, which is published in the current issue of the Canadian Medical Association Journal.
For the study, researchers examined data on 435,696 women in Ontario who gave birth between April 1994 and March 1998. All of the women were followed until March 31, 2008, and the study excluded women who had preexisting diabetes.
“Women who had an abnormal glucose challenge test but then did not have gestational diabetes had an increased risk of future cardiovascular disease compared to the general population, but a lower risk than women who actually did have gestational diabetes,” co-author Dr. Baiju Shah, of the Institute for Clinical and Evaluative Sciences in Toronto, said in a news release from the journal’s publisher.
- Acupuncture Found Effective Against Depression During Pregnancy
In a study to be presented February 4 at the Society for Maternal-Fetal Medicine’s (SMFM) annual meeting, The Pregnancy Meeting ™, in Chicago, researchers will unveil findings that show that acupuncture may be an effective treatment for depression during pregnancy.
“Depression during pregnancy is an issue of concern because it has negative effects on both the mother and the baby as well as the rest of the family,” said Dr. Schnyer, one of the study’s authors.
About 10% of pregnant women meet criteria for major depression and almost 20% have increased symptoms of depression during pregnancy. The rates of depression in pregnant women are comparable to rates seen among similarly aged non-pregnant women and among women during the postpartum period, but there are far fewer treatment studies of depression during pregnancy than during the postpartum period.
Dealing with depression is difficult for pregnant women because the use of anti-depressants poses concerns to the developing fetus and women are reluctant to take medications during pregnancy.
In the study, an evaluator-blinded randomized trial, 150 participants who met the Diagnostic & Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for Major Depressive Disorder were randomized to receive either acupuncture specific for depression (SPEC, n=52) or one of two active controls: control acupuncture (CTRL, n=49) or massage (MSSG, n=49). Treatments lasted eight weeks (12 sessions). Junior acupuncturists masked to treatment assignment needled participants at points prescribed by senior acupuncturists. Massage therapists and patients were not blinded. The primary outcome was the Hamilton Rating Scale for Depression, administered by blinded raters at baseline and after four and eight weeks of treatment. Data were analyzed using mixed effects models and by intent-to-treat.
The results showed that the women who received SPEC experienced a significantly greater decrease in depression severity compared to the combined controls or CTRL acupuncture alone. They also had a higher response rate (63.0%) than the combined controls or CTRL acupuncture alone. Symptom reduction and response rates did not differ significantly between controls (CTRL 37.5% and MSSG 50.0%). Mild and transient side effects were reported by 43/150 participants (4 in MSSG; 19 in CTRL, 20 in SPEC). Significantly fewer participants reported side-effects in MSSG than the two acupuncture groups.
“The results of our study show that the acupuncture protocol we tested could be a viable treatment option for depression during pregnancy” said Dr. Schnyer.
- Excessive Weight Gain During Pregnancy Raises Gestational Diabetes Risk
Excessive weight gain during pregnancy, especially the first trimester, may increase a woman’s risk of gestational diabetes, say U.S. researchers.
Their three-year study included 345 pregnant women with gestational diabetes and 800 pregnant women without gestational diabetes, which is defined as glucose intolerance that typically occurs during the second or third trimester of pregnancy.
After the researchers adjusted for a number of factors — age at delivery, previous births, pre-pregnancy body-mass index and race/ethnicity — they found that women who gained more weight during pregnancy than recommended by the U.S. Institute of Medicine were 50 percent more likely to develop gestational diabetes, compared to those whose weight gain was within or below the IOM recommendations.
The link between pregnancy weight gain and gestational diabetes was strongest among overweight and non-white women.
The study was published online Feb. 22 in the journal Obstetrics & Gynecology.
Gestational diabetes — which causes complications in as many as 7 percent of pregnancies in the United States — can lead to early delivery, cesarean section and type 2 diabetes in the mother. It also increases the child’s risk of developing diabetes and obesity later in life.
- Siblings key in pregnancy-related diabetes risk
Women with a family history of diabetes who are free from the disease themselves are more likely to develop pregnancy-related diabetes, a new study confirms.
And the risks associated with having a brother or sister who is diabetic are much higher than having one or even two parents with the disease, Dr. Catherine Kim of the University of Michigan Medical School in Ann Arbor and her colleagues found.
The increased demands placed on the body during pregnancy can cause some women to develop abnormally high blood sugar. The condition, known medically as gestational diabetes, typically gets better after a woman delivers her baby, but it increases her risk of developing type 2 diabetes later on.
The more relatives a person has with type 2 diabetes, the greater their risk of developing the condition themselves. But little is known about how a woman’s family history of the condition affects her risk of developing gestational diabetes.
To investigate, Kim and her team looked at 4,566 women participating in the National Health and Nutrition Examination Survey, all of whom had at least one child. Ninety-seven percent had never been diagnosed with diabetes, about 1 percent had gestational diabetes only, and 2 percent had type 2 diabetes.
Having a mother or father with diabetes increased the likelihood of having diabetes or gestational diabetes to a similar degree, the researchers report in the American Journal of Obstetrics and Gynecology. But while having two parents with diabetes boosted the likelihood of having diabetes eight-fold, this only doubled the likelihood of gestational diabetes.
On the other hand, having a diabetic brother or sister increased gestational diabetes risk more than seven-fold, but only slightly upped type 2 diabetes risk.
“The odds of increased most markedly when a sibling was affected,” Kim and her team write. And when the researchers accounted for early-life factors such as education and poverty, the risk associated with having a diabetic sibling actually increased. “Sibling-only history may be a greater risk factor than previously documented,” they say.
The findings suggest, the researchers say, that gestational diabetes may follow a different pattern of inheritance than type 2 diabetes, which is closely associated with being overweight or obese.
Further investigation of these patterns could help identify women who are at particularly high risk of developing type 2 diabetes after having the gestational form of the condition, they add, “and thus target them for future prevention interventions.”
