Effectiveness of psychosocial interventions for hypertensive disorders in pregnancy: A systematic review and meta-analysis

Objective: Studies on psychosocial interventions for perinatal mental health and wellbeing are mostly limited to the postpartum period. However, the physiological changes associated with hypertensive disorders in pregnancy predisposes women to severe psychological distress and adverse birth outcomes. This review investigated the effectiveness of psychosocial interventions for hypertensive disorders during pregnancy. Methods: Cochrane CENTRAL, Embase, MEDLINE, MIDIRS, CINAHL, PsycINFO, PsycArticles, and Web of Science were searched up to 22nd August 2021. Effect sizes on relevant health outcomes were pooled in a meta‐analysis using STATA software. Results: Eight randomised trials involving 460 participants met the inclusion criteria. Included studies adopted several interventions ranging from music, exercise, cognitive behavioural therapy (CBT), spiritual care education and psychoeducation. The pooled effect showed a significant reduction in anxiety (d= −0.35 [−0.58, −0.11], p=0.004) and depression (d= −0.37 [−0.57, −0.17], p=0.0003). Spiritual care education significantly reduced postpartum stress disorder (d= −62.00 [−93.10, −30.90], p= 0.0001). However, CBT showed no effect on gestational stress (d= −2.20 [-4.89, 0.48], p= 0.11). Conclusion: This study provides satisfactory evidence that psychosocial interventions may likely reduce anxiety and depression associated with hypertensive disorders in pregnancy. However, the evidence is very uncertain about its effect on neonatal outcomes.

Like Mother Like Child: Do Fearful Sows Have Fearful Piglets?

Gestational and early life experiences affect subsequent behavioural and physical development. The objective of the current study was to investigate associations between gilts’ fear of humans, gestational stress level, and feeding and maternal behaviour, as well as how these related to aspects of the personality and growth of their offspring. A total of 37 gilts were used. Four human approach tests were performed between d 104 and d 111 of gestation to classify gilts as fearful or friendly. Gilt feeding behaviour and salivary cortisol concentration was measured between d 90 and d 108 of gestation, and gilt nursing behaviour assessed at d 13 of lactation. Piglets were subject to a back test at d 13 of age, to an open field test and a human approach test at d 20 of age, and growth was monitored to weaning (d 26 of age). Gilts classified as having a fearful behavioural profile had higher cortisol levels than friendly gilts (p < 0.05). Human fear level did not affect reproductive performance or the growth of offspring (p > 0.05). The offspring of friendly gilts tended to have a more active response to the back test (p = 0.09), less freezing response in the open field test (p < 0.05), and received human contact more than piglets from fearful gilts (p < 0.05). The present study shows that gilt human fear level is linked to their stress levels, which can affect the personality of their piglets.

The combination of fluoxetine and environmental enrichment reduces postpartum stress-related behaviors through the oxytocinergic system and HPA axis in mice

Gestational stress can increase postpartum depression in women. To treat maternal depression, fluoxetine (FLX) is most commonly prescribed. While FLX may be effective for the mother, at high doses it may have adverse effects on the fetus. As environmental enrichment (EE) can reduce maternal stress effects, we hypothesized that a subthreshold dose of FLX increases the impact of EE to reduce anxiety and depression-like behavior in postpartum dams exposed to gestational stress. We evaluated this hypothesis in mice and to assess underlying mechanisms we additionally measured hypothalamic–pituitary–adrenal (HPA) axis function and brain levels of the hormone oxytocin, which are thought to be implicated in postpartum depression. Gestational stress increased anxiety- and depression-like behavior in postpartum dams. This was accompanied by an increase in HPA axis function and a decrease in whole-brain oxytocin levels in dams. A combination of FLX and EE remediated the behavioral, HPA axis and oxytocin changes induced by gestational stress. Central administration of an oxytocin receptor antagonist prevented the remediating effect of FLX + EE, indicating that brain oxytocin contributes to the effect of FLX + EE. These findings suggest that oxytocin is causally involved in FLX + EE mediated remediation of postpartum stress-related behaviors, and HPA axis function in postpartum dams.