Mecanismos neuroendocrinos a la base de la asociación entre salud mental materna y lactancia / Neuroendocrine mechanisms underlying the association between maternal mental health and breastfeeding

La lactancia materna es fundamental para la salud del infante y se ve influida por diversos factores, entre ellos la salud mental materna. En particular, las madres que tienen síntomas depresivos tienen mayor riesgo de presentar dificultades de lactancia y de interrumpir tempranamente la lactancia exclusiva y la lactancia en general. Por otra parte, la lactancia materna actúa como un factor protector de la salud mental materna en algunas circunstancias, en tanto las dificultades de lactancia tienen un impacto negativo en la salud mental de la mujer. La presente revisión describe algunos de los mecanismos fisiológicos que subyacen al establecimiento y la mantención de la lactancia, asociados a la prolactina, la oxitocina, la dopamina y la serotonina, así como a la experiencia de la lactancia y la presencia de dificultades en esta área, y como estas interactúan con las dificultades emocionales de la madre. Se ofrece un modelo integrativo que considera aspectos hormonales y fisiológicos para comprender la asociación compleja y bidireccional entre el establecimiento de una lactancia exitosa y la salud mental materna.

Breastfeeding is essential for infant health and development. It is influenced by multiple factors, including maternal mental health. In particular, mothers who present depressive symptoms are at greater risk of presenting breastfeeding difficulties and presenting shorter exclusive breastfeeding and breastfeeding in general. On the other hand, breastfeeding acts as a protective factor for maternal mental health in some circumstances. Also, breastfeeding difficulties have a negative impact on womens mental health. This review describes some of the physiological mechanisms underlying the establishment and maintenance of lactation, associated with prolactin, oxytocin, dopamine, and serotonin. As well as how the lactation experience and the presence of difficulties in this area interact with the mothers emotional functioning. An integrative model is proposed, which considers hormonal and physiological aspects involved in the complex and bidirectional association between breastfeeding successful establishment and maternal mental health.

The influence of mode of delivery on neonatal and maternal short and long-term outcomes

ABSTRACT OBJECTIVE: To evaluate the impact of mode of delivery on breastfeeding incentive practices and on neonatal and maternal short and long-term complications. METHODS: A cohort study was conducted between June 2015 and April 2016 with 768 puerperal women from 11 maternities in Sergipe, interviewed in the first 24 hours, 45-60 days and 6-8 months after delivery. Associations between breastfeeding incentive practices, neonatal and maternal, both short-term and late complications, and the exposure variables were evaluated by the relative risk (95%CI) and the Fisher exact test. RESULTS: The C-section newborns had less skin-to-skin contact immediately after delivery (intrapartum C-section: 0.18, 95%CI 0.1-0.31 and elective C-section: 0.36, 95%CI 0.27-0.47) and less breastfeeding within one hour of birth (intrapartum C-section: 0.43, 95%CI 0.29-0.63 and elective C-section: 0.44, 95%CI 0.33-0.59). Newborns from elective C-section were less frequently breastfed in the delivery room 0.42 (95%CI 0.2-0.88) and roomed-in less 0.85 (95%CI 0.77-0.95). Women submitted to intrapartum C-section had greater risk of early complications 1.3 (95%CI 1.04-1.64, p = 0.037) and sexual dysfunction 1.68 (95%CI 1.14-2.48, p = 0.027). The frequency of neonatal complications, urinary incontinence and depression according to the mode of delivery was similar. CONCLUSIONS: The C-section was negatively associated with breastfeeding incentive practices; in addition, C-section after labor increased the risk of early maternal complications and sexual dysfunction.

Institutional violence and quality of service in obstetrics are associated with postpartum depression

ABSTRACT OBJECTIVE To investigate the association between institutional violence in obstetrics and postpartum depression (PP depression) and the potential effect of race, age, and educational level in this outcome. METHODS This is a cross-sectional study about the health care conditions for the maternal and child population of the Federal District, Brazil, carried out in 2011. The study has used a probabilistic sample of 432 women, whose children were aged up to three months, stratified by clusters. Indicators of institutional violence and demographic characteristics have been used in a logistic regression model to estimate the probability of occurrence of postpartum depression. RESULTS The model has identified a high prevalence of postpartum depression, being it higher among non-white women and adolescent females, besides having a strong positive association between the several indicators of obstetric violence and postpartum depression. Positive interactions on a multiplicative scale have also been observed between: violence by negligence by health care professionals and race and age; physical violence from health care professionals and age; and, verbal violence from health care professionals and race. CONCLUSIONS The indicators adopted to reflect institutional violence in obstetric care are positively associated with postpartum depression, which calls for a reflection on the need to make the health care protocols adequate to the precepts of the Brazilian humanization of childbirth care policies and changes in the obstetric care model.

Actualización en depresión postparto: el desafío permanente de optimizar su detección y abordaje / An update on postpartum depression

Postpartum depression (PPD) is a common condition worldwide and most of the available information is about treatment rather than prevention. This paper is an update on prevention and treatment of PPD. A simple review of the literature and a critical review of papers’ methodology and conclusions was carried out. There is a consensus of the preeminence of psychosocial factors in the genesis of PPD. Considering the complications when the condition is not treated, it is of the utmost importance to implement early detection and management strategies. The use of psychosocial preventive interventions is an alternative that has support in the literature and should be seriously considered.

Postpartum depression among women with unintended pregnancy / Depressão pós-parto entre mulheres com gravidez não pretendida

OBJECTIVE To analyze the association between unintended pregnancy and postpartum depression.METHODS This is a prospective cohort study conducted with 1,121 pregnant aged 18 to 49 years, who attended the prenatal program devised by the Brazilian Family Health Strategy, Recife, PE, Northeastern Brazil, between July 2005 and December 2006. We interviewed 1,121 women during pregnancy and 1,057 after childbirth. Unintended pregnancy was evaluated during the first interview and postpartum depression symptoms were assessed using the Edinburgh Postnatal Depression Screening Scale. The crude and adjusted odds ratios for the studied association were estimated using logistic regression analysis.RESULTS The frequency for unintended pregnancy was 60.2%; 25.9% presented postpartum depression symptoms. Those who had unintended pregnancies had a higher likelihood of presenting this symptoms, even after adjusting for confounding variables (OR = 1.48; 95%CI 1.09;2.01). When the Self Reporting Questionnaire (SRQ-20) variable was included, the association decreased, however, remained statistically significant (OR = 1.42; 95%CI 1.03;1.97).CONCLUSIONS Unintended pregnancy showed association with subsequent postpartum depressive symptoms. This suggests that high values in Edinburgh Postnatal Depression Screening Scale may result from unintended pregnancy.

OBJETIVO Analisar a associação entre gravidez não pretendida e depressão pós-parto.MÉTODOS Estudo de coorte prospectivo realizado com 1.121 mulheres grávidas de 18 a 49 anos, acompanhadas no pré-natal pela Estratégia de Saúde da Família, Recife, PE, entre julho de 2005 e dezembro de 2006. Durante a gravidez e após o parto foram entrevistadas, respectivamente, 1.121 e 1.057 mulheres. A gravidez não pretendida foi avaliada durante a primeira entrevista e os sintomas depressivos após o parto foram avaliados utilizando-se a Edinburgh Postnatal Depression Screening Scale. Foram estimados os odds ratios simples e ajustados para a associação estudada, utilizando-se análise de regressão logística.RESULTADOS A frequência de gravidez não pretendida foi de 60,2%; 25,9% apresentaram sintomas depressivos após o parto. Aquelas com gravidez não pretendida tiveram maior chance de apresentar esse desfecho, mesmo após ajuste para variáveis de confundimento (OR = 1,48; IC95% 1,09;2,01). Ao se incluir a variável Self Reporting Questionnaire (SRQ-20), a associação diminuiu, mas manteve-se estatisticamente significativa (OR = 1,42; IC95% 1,03;1,97).CONCLUSÕES Gravidez não pretendida mostrou-se associada a sintomas depressivos após o parto. Isso sugere que valores elevados na Edinburgh Postnatal Depression Screening Scale podem resultar de gravidez não pretendida.

Development of a Prediction Model for Postpartum Depression: Based on the Mediation Effect of Antepartum Depression

PURPOSE: This study was done to develop a prediction model for postpartum depression by verifying the mediation effect of antepartum depression. A hypothesized model was developed based on literature reviews and predictors of postpartum depression by Beck. METHODS: Data were collected from 186 pregnant women who had a gestation period of more than 32 weeks and were patients at a maternity hospital, two obstetrics and gynecology specialized hospitals, or the outpatient clinic of K medical center. Data were analysed with descriptive statistics, correlation and exploratory factor analysis using the SPSS/WIN 18.0 and AMOS 18.0 programs. RESULTS: The final modified model had good fit indices. Parenting stress, antepartum depression and postpartum family support had statistically significant effects on postpartum depression, and defined 74.7% of total explained variance of postpartum depression. Antepartum depression had significant mediation effects on postpartum depression from stress in pregnancy and self-esteem. CONCLUSION: The results of this study suggest that it is important to develop nursing interventions including strategies to reduce parenting stress and improve postpartum family support in order to prevent postpartum depression. Especially, it is necessary to detect and treat antepartum depression early to prevent postpartum depression as antepartum depression can affect postpartum depression by mediating antepartum factors.

Predictors of fetal demise after trauma in pregnant Saudi Arabian women

The prevalence of postnatal depression in Bahrain is unknown and screening for known risk factors does not take place. This study estimated the prevalence of postnatal depressive symptoms and the associated risk factors among a random sample of Bahraini women attending primary health care centres with their babies for the 8-week child check-up. The Arabic version of the Edinburgh Postnatal Depression Scale [EPDS] was used with a cut-off score of >/=12 for depression. The prevalence of postnatal depressive symptoms among 237 mothers was 37.1%. No significant relationships were identified between depression symptoms and any of demographic variables or pregnancy/birth characteristics studied. However, several psychosocial risk factors were significantly associated with postnatal depression and, after multiple regression analysis, a history of depressive symptoms and perceived lack of support from the husband remained significant factors. Further studies that include diagnostic assessments are needed to confirm these findings

[Postpartum depression and related factors: a 4.5 months]

One of the mental disorders in pregnancy and the period after it, is postpartum depression which can be a threat for security and health of mother and infant. With regard to this matter the study was conducted to investigate the prevalence of postpartum depression and related factors. This research is a descriptive-analytical study which was conducted in gynecology and obstetric department in Imam Ali Hospital in Zahedan city, Southeast of Iran. The participants were 300 women selected randomly and were evaluated four times [immediately after delivery, 4 weeks after the first assessment, 6 weeks after the second assessment and 8 weeks after the third assessment] with Beck Depression Inventory and demographic questionnaire. Mother under treatment for psychological problem, mother whose babies present serious health problem, BDI score less than 14 and mothers don't have number for calling was excluded from the study. The data was analyzed by SPSS. In this study 33.7% were depressed and it was observed that there was a significant relation between the mother age, kind of delivery, infant's gender, mother' education, history of previous depression and psychotropic drugs using [P<0.05]. Postpartum depression is relatively frequent. Adjustment of any of factors which have role in this disorder, can be useful in decreasing the incidence of the illness

[Relationship between delivery method and postpartum depression]

Introduction: Postpartum depression is a prevalent disorder with different etiologies, among them mode of delivery. The present study was conducted to determine relationship between mode of delivery and depression in women at 2 and 8 weeks postpartum

Materials and Methods: In this prospective analytic study [2007-2008], a total of 420 women visited at health centers in Amol city who met inclusion criteria were recruited through non-probability sampling and filled the questionnaire of Edinburgh postpartum scale [EPDS] during the third trimester of pregnancy. Women who had EPDS score>12 were excluded. Three hundred cases were followed 2 and 8 weeks postpartum and completed questionnaires on demographics, delivery, postpartum, and infant characteristics and Edinburgh postpartum depression scale. Data were analyzed using by SPSS software, chi-square, T-test, Mann-Whitney, and Linear regression

Results: There was no significant difference between two groups in their education, occupation, economic status, and wanted/unwanted pregnancy, satisfaction from husband and family support. At 2[nd] week postpartum, prevalence of postpartum depression was 10.3% and there was no significant difference between 2 groups. At 8[th] week postpartum the prevalence of depression was 13% and there was no significant difference between the 2 groups in the mean score of postpartum depression at 2[nd], 8[th] weeks

Conclusion: Regarding the high prevalence of postpartum depression, the screening, recognition and assessment of this disorder is important. Health care providers should consider educating women during pregnancy and postpartum

Perturbaciones psíquicas postparto: pueden los profesionales de la salud ayudar a prevenir efectos negativos a largo plazo / Post-partum psychic alterations: can health professionels help prevent long-term negative effects

La presencia de perturbaciones psíquicas en el embarazo y puerperio son frecuentes. En muchos casos suelen no ser detectadas y en consecuencia quedar sin tratamiento. Es frecuente observar madres que durante las primeras semanas postparto desarrollan un estado depresivo generalizado, el baby blues, que desaparece espontáneamente durante los días siguientes. Su prevalencia llega hasta el 80 por ciento. Trastornos de ansiedad y sintomatología de tipo obsesivo-compulsiva son otros cuadros psicopatológicos frecuentes. Sólo 1-2 de cada 1000 mujeres desarrollan psicosis puerperal. También puede encontrarse con frecuencia el suicidio o suicidio ampliado. La perturbación psíquica postparto diagnosticada con mayor frecuencia es la depresión. Estas patologías no difieren en su etiología ni en su desarrollo de los cuadros que se presentan en otro momento de la vida. Su característica distintiva son los síntomas, relacionados a la maternidad y al bebé y el nacimiento como evento desencadenador. Sus efectos pueden afectar a corto, mediano y largo plazo el desarrollo emocional y cognitivo de los niños. Debido a la baja especificidad de los factores de riesgo y a la estigmatización social es difícil establecer estrategias de prevención efectivas, por eso es fundamental la detección y tratamiento temprano. Muchas madres afectadas no consultan servicios de salud mental, pero sí recurren a otros profesionales de la salud por aparentes problemas de salud propios o del bebé. De ahí la importancia clave de los profesionales de salud en la detección y derivación a servicios adecuados para ayudarlas.

Occurrence of post natal depression and its determinants: as reported at Abbasi Shaheed hospital

This study was conducted in order to assess the magnitude of the postnatal depression [PND] at Abbasi Shaheed hospital during 2004-2006 and also to explore the causes of PND A total of 600 subjects were selected through convenient sampling frame at Gyne unit I during postnatal follow up and their mental health was assessed by using Edinburg scale of postnatal depression. The females were contacted at 3 weeks, 8 weeks and 12 weeks of delivery. Most of them were interviewed and examined in the Gynae OPD and some non complaints were contacted on telephone. There were 21 variables in the ESPND and a score of 13 or more was taken as a cut off for established post natal depression. The diagnosed cases of depression were referred to psychiatry department for further advice and treatment. It was found that 11% of the female had postnatal depression during 12 weeks of observation and majority of the participants 64% were of 20-25 years old. The causes among the cases [n=67] found to be overlapping but in 63% it was related to the repeated birth of female child, in 37% of the cases it was previous depressive illness while in 52% unplanned pregnancy was claimed to be the cause. Souse related problem was seen in 32% of the cases. Post Natal Depression was found to be a significant problem among women reporting at government teaching hospital. Repeated birth of female child and unplanned pregnancy were the significant causes in all cases. But due to limitations of the study design Used in this study, it was difficult to relate one single cause to the outcome and subsequent research using analytical design would be preferred

Effects of a Postpartum Back Pain Relief Program for Korean Women / 간호학회지

PURPOSE: Despite the high prevalence of back pain and its subsequent effects in post-partum women, intervention programs are scarce. The purpose of this study was to test the effects of a back-pain-reducing program on post-partum women who experienced low-back pain during pregnancy. METHODS: A non-equivalent control-group pretest-posttest design was used. Pregnant women who attended a hospital for prenatal check-ups and experienced back pain participated in an intervention program (n=27), and the results were compared with women in a control group from another hospital (n=25). RESULTS: At 8 weeks post-partum, the pain intensity, functional limitations were lower in the intervention group than in the control group. However, differences in mean change of the pain intensity and functional limitations between 36 and 39 weeks of gestation and at 8 weeks post-partum were not statistically significant between the groups. Moreover, the flexibility, post-partum functional status, and post-partum depression did not differ significantly between the groups. CONCLUSIONS: A back-pain-relief program in this study was not effective to reduce the back-pain intensity in post-partum women and to decrease the associated functional limitations. The implications for nursing practice and directions for future research are discussed.

Postpartum depression in clients at health care centers in Sari

This study was aimed to determine the prevalence and pertaining contributors of postpartum depression [PD] in clients referring to the Health Care Centers in Sari city, Iran. 422 pregnant women at their third trimester referred to ten antenatal care units from Feb. 2001 to Aug. 2002. Mothers were further followed up 6-8 weeks after childbirth. The data was collected using Edinburgh Postpartum Depression Scale [EPDS], short form of Spielberger's State Anxiety Inventory, General Health Questionnaire [GHQ-28] and a demographic questionnaire. According to the EPDS the prevalence of PD was 22% [n=92] during 6-8 weeks after delivery. Also, 30% of the mothers were depressed during the third trimester of pregnancy. Based on the GHQ data analysis, 37% [n=157] and 31% [n=132] of the samples were suspected to have a psychiatric morbidity in the third trimester and 6-8 weeks postpartum, respectively. There was a significant relationship between postpartum depression and stressful life events, family support, baby's health problems, perceived ability to nurse the baby, and the problems at delivery. The prevalence of depression and psychiatric disorders are higher during pregnancy and decrease postpartum

Disforia pós-natal: revisão sistemática dos ensaios clínicos / Maternity blues: a systematic review of clinical trials

A Disforia pós-natal (DPN) consiste de síndrome depressiva leve e transitória altamente prevalente no puerpério. Há dúvidas se deve ser considerada uma doença ou uma condição meramente fisiológica, que não mereceria a atenção médica. Foi feita revisão sistemárica sobre a DPN, utilizando as bases de dados Medline, Lilacs, PsychInfo e Biblioteca Cochrane, referente ao período de 1980 a 2003, incluindo-se apenas ensaios clínicos com amostras de no mínimo 10 pacientes com esse diagnóstico. Em diversos estudos, especialmente os relacionados à etiologia, encontramos diferenças entre puérperas com e sem DPN, o que parece indicar não se tratar de uma condição normal. Os resultados de outros estudos apontam para uma possível ligação entre a DPN e os transtornos do humor

Depresion postparto realidad en el sistema publico de atencion de salud

La depresión postparto es un problema de salud pública con prevalencia que oscilan entre un 10 y 15% en la literatura mundial. Durante el puerperio existen cambios bioquímicos y estrés que pueden desencadenar estos trastornos. No existen trabajos a nivel nacional que enfoquen este problema. Realizamos un estudio prospectivo a nivel de atención primaria para evidenciar la real incidencia, y algunos factores de riesgo para esta condición.