Risk factors for peripartum depression in women with multiple sclerosis

Background: Peripartum depression (PPD) is underexplored in multiple sclerosis (MS). Objective: To evaluate prevalence of and risk factors for PPD in women with MS. Methods: Retrospective single-center analysis of women with MS with a live birth. Prevalence of PPD was estimated with logistic regression with generalized estimating equations (GEE). GEE evaluated predictors of PPD (e.g. age, marital status, parity, pre-pregnancy depression/anxiety, antidepressant discontinuation, sleep disturbance, breastfeeding, relapses, gadolinium-enhancing lesions, and disability). Factors significant in univariable analyses were included in multivariable analysis. Results: We identified 143 live births in 111 women (mean age 33.1 ± 4.7 years). PPD was found in 18/143 pregnancies (12.6%, 95% CI = 7.3–17.8). Factors associated with PPD included older age (OR 1.16, 95% CI = 1.03–1.32 for 1-year increase), primiparity (OR 4.02, CI = 1.14–14.23), pre-pregnancy depression (OR 3.70, CI = 1.27–10.01), sleep disturbance (OR 3.23, CI = 1.17–8.91), and breastfeeding difficulty (OR 3.58, CI = 1.27–10.08). Maternal age (OR 1.17, CI = 1.02–1.34), primiparity (OR 8.10, CI = 1.38–47.40), and pre-pregnancy depression (OR 3.89, CI = 1.04–14.60) remained significant in multivariable analyses. Relapses, MRI activity, and disability were not associated with PPD. Conclusion: The prevalence of PPD in MS appeared similar to the general population, but was likely underestimated due to lack of screening. PPD can affect MS self-management and offspring development, and prospective studies are needed.

Association between Self-Reported Bruxism, Peripartum Depression and Myogenous Temporomandibular Disorders among Postpartum Women in Turkey

Summary Background/Aim: It is possible to find studies in the literature evaluating the relationship among self-reported bruxism, psychological factors, and myogenous temporomandibular disorder. In addition, the relationship between these issues has not yet been clarified. The objective of this study was to evaluate the association between peripartum depression, self-reported bruxism, and myogenous temporomandibular disorders among postpartum women in Turkey. Material and Methods: This study included 220 women, whom were asked about their bruxism behaviour during day and during sleep. Besides, all of them assessed with Short-Form Fonseca’s Anamnestic Index for myogenous temporomandibular disorder and the Edinburgh postnatal depression scale for peripartum depression. Results: The results showed that, self-reported bruxism was observed at a statistically significantly higher rate (94.3%) in peripartum depression group. 86.5% of the patients with self-reported bruxism had myogenous temporomandibular disorder (p<0.001). As a result, 80.0% of the patients with peripartum depression had myogenous temporomandibular disorder (p<0.001). Conclusions: In conclusion, a significant relationship has been found between peripartum depression and self-reported bruxism, self-reported bruxism and myogenous temporomandibular disorder, and peripartum depression and myogenous temporomandibular disorder. The present study is the first to evaluate the relationship between peripartum depression, self-reported bruxism, and myogenous temporomandibular disorder so it could be considered as a pilot attempt, and further studies using more representative samples are encouraged.

Analysis of Online Peripartum Depression Communities: Application of Multilabel Text Classification Techniques to Inform Digitally-Mediated Prevention and Management

Peripartum depression (PPD) is a significant public health problem, yet many women who experience PPD do not receive adequate treatment. In many cases, this is due to social stigmas surrounding PPD that prevent women from disclosing their symptoms to their providers. Examples of these are fear of being labeled a “bad mother,” or having misinformed expectations regarding motherhood. Online forums dedicated to PPD can provide a practical setting where women can better manage their mental health in the peripartum period. Data from such forums can be systematically analyzed to understand the technology and information needs of women experiencing PPD. However, deeper insights are needed on how best to translate information derived from online forum data into digital health features. In this study, we aim to adapt a digital health development framework, Digilego, toward translation of our results from social media analysis to inform digital features of a mobile intervention that promotes PPD prevention and self-management. The first step in our adaption was to conduct a user need analysis through semi-automated analysis of peer interactions in two highly popular PPD online forums: What to Expect and BabyCenter. This included the development of a machine learning pipeline that allowed us to automatically classify user post content according to major communication themes that manifested in the forums. This was followed by mapping the results of our user needs analysis to existing behavior change and engagement optimization models. Our analysis has revealed major themes being discussed by users of these online forums- family and friends, medications, symptom disclosure, breastfeeding, and social support in the peripartum period. Our results indicate that Random Forest was the best performing model in automatic text classification of user posts, when compared to Support Vector Machine, and Logistic Regression models. Computerized text analysis revealed that posts had an average length of 94 words, and had a balance between positive and negative emotions. Our Digilego-powered theory mapping also indicated that digital platforms dedicated to PPD prevention and management should contain features ranging from educational content on practical aspects of the peripartum period to inclusion of collaborative care processes that support shared decision making, as well as forum moderation strategies to address issues with cyberbullying.

A potential role for insulin treatment during pregnancy in reducing postpartum psychological distress in maternal obesity: an administrative population health study

Background Studies have found an association between obesity and an increased risk for peripartum depression, which has also been linked to decreased placental lactogen levels. In addition, women with obesity treated for gestational diabetes with insulin were found to have increased levels of placental lactogen. Treatment options exist for perinatal and postpartum depression however they pose a risk to the developing offspring. Thus, prevention as well as markers for early identification of peripartum depression are needed. Therefore, our study objective is to identify the association between insulin treatment in pregnancy and the risk of postpartum psychological distress (abbreviated here as PPD) among cohorts of women with and without obesity. Methods Administrative health data (2002/03–2018/19) were used to identify a cohort of women (age 15+ years) who gave birth (N = 250,746) and had no pre-existing mood/anxiety disorders or diabetes (N = 222,863 excluded). Women were then divided into two groups: lean (N = 17,975) and with obesity (N = 9908), which was identified by a recorded maternal weight of > 38 to < 65.6 kg and ≥ 85 to < 186 kg (respectively). The risk of PPD within one year after delivery with and without insulin treatment was assessed by Poisson regression analysis. Models were adjusted for maternal age group (at pregnancy start date) and area-level income (at delivery). Results The unadjusted risk of PPD was higher in the obesity group (8.56%; 95% CI 8.00–9.15) than in the lean group (6.93%; 95% CI 6.56–7.33). When no insulin treatment was given during pregnancy, mothers with obesity had a significantly higher risk of PPD than the lean group (aRR 1.27; 95% CI 1.17–1.39; p < 0.0001). However, when women with obesity and insulin treatment were compared to the lean group with no insulin treatment, no significant difference in the risk of PPD was observed between the groups (aRR 1.30; 95% CI 0.83–2.02; p = 0.248). Conclusion This is the first study to demonstrate a positive association between insulin treatment in pregnancy among women with obesity and reduced PPD rates, suggesting insulin as a possible preventative measure. However, the biological mechanism behind the observed positive effect of insulin on PPD rates remains to be investigated.

Repetitive transcranial magnetic stimulation treatment for peripartum depression: systematic review & meta-analysis

Background Peripartum depression is a common disorder with very high potential hazards for both the patients and their babies. The typical treatment options include antidepressants and electroconvulsive therapy. However, these treatments do not ensure the safety of the fetus. Recently, repetitive transcranial magnetic stimulation has emerged as a promising treatment for neuropathies as well as depression. Nevertheless, many studies excluded pregnant women. This systematic review was conducted to confirm whether repetitive transcranial magnetic stimulation was a suitable treatment option for peripartum depression. Methods We performed a systematic review that followed the PRISMA guidelines. We searched for studies in the MEDLINE, PsycINFO, EMBASE, and Cochrane library databases published until the end of September 2020. Eleven studies were selected for the systematic review, and five studies were selected for quantitative synthesis. Data analysis was conducted using Comprehensive Meta-Analysis 3 software. The effect size was analyzed using the standardized mean difference, and the 95% confidence interval (CI) was determined by the generic inverse variance estimation method. Results The therapeutic effect size of repetitive transcranial magnetic stimulation for peripartum depression was 1.394 (95% CI: 0.944–1.843), and the sensitivity analysis effect size was 1.074 (95% CI: 0.689–1.459), indicating a significant effect. The side effect size of repetitive transcranial magnetic stimulation for peripartum depression was 0.346 (95% CI: 0.214–0.506), a meaningful result. There were no severe side effects to the mothers or fetuses. Conclusions From various perspectives, repetitive transcranial magnetic stimulation can be considered an alternative treatment to treat peripartum depression to avoid exposure of fetuses to drugs and the severe side effects of electroconvulsive therapy. Further research is required to increase confidence in the results.