ABSTRACT
CONTEXT: While correlations have been demonstrated between postpartum depression and psychosocial and circumstantial risk factors, some evidence exists for a similar relationship between postpartum depression and thyroid measures. OBJECTIVE: To search at 4 weeks postpartum for correlations of numerical scores on a postnatal depression screening tool and thyroid measures. METHODS: Subjects took the Edinburgh Postnatal Depression Scale (EPDS) prenatally and at 4 weeks postpartum. Participants were also given blood tests for thyroid-stimulating hormone (TSH), free thyroxine4, thyroid peroxidase, and thyroglobulin at the same testing intervals. RESULTS: Fifty-one subjects aged 18 years or older were recruited. Subjects with higher serum TSH at 4 weeks postpartum tended to have higher EPDS scores. Similarly, the 7 subjects (13.7%) with positive postnatal thyroid antibody tests were more likely than their counterparts to have higher EPDS scores. CONCLUSIONS: Presence of thyroid autoantibodies or higher TSH levels during the postpartum period may be related to depressive symptoms or dysphoric mood, even when clinical depression is not present. Either or both of these associations may contribute, along with other physiologic and psychosocial risk factors, to postpartum depression. (ClinicalTrials.gov number NCT00565032).
Subject(s)
Depression, Postpartum/blood , Thyrotropin/blood , Thyroxine/blood , Adolescent , Adult , Antibodies/blood , Female , Humans , Pilot Projects , Pregnancy , Thyroid Gland/immunology , Young AdultABSTRACT
OBJECTIVE: To search for a possible correlation between incidence of postpartum depression (PPD) and any of the following factors recorded in patient charts at the routine, 4-week postnatal visit: age, breast-feeding status, smoker/nonsmoker, marital status, preexisting depression and type of delivery. STUDY DESIGN: Data were obtained from 588 obstetric charts for women who gave birth between June 1, 2003, and June 1, 2004, at 3 university clinics in Tulsa, Oklahoma. RESULTS: Prior history of depression and smoking cigarettes were significant risk factors for an Edinburgh Postnatal Depression Scale score of 13 or higher, indicating probable PPD. CONCLUSION: Our data and previous findings warrant continued investigation in a larger study to clearly delineate these and other possible risk factors for PPD and to facilitate prophylactic patient education and intervention strategies.
Subject(s)
Depression, Postpartum/psychology , Pregnancy Complications/psychology , Smoking/adverse effects , Adult , Age Factors , Breast Feeding , Depression , Depression, Postpartum/epidemiology , Depression, Postpartum/etiology , Female , Humans , Mass Screening , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/etiology , Psychiatric Status Rating Scales , Retrospective Studies , Risk Factors , Smoking/epidemiologyABSTRACT
Amniotic fluid embolus, also known as anaphylactoid syndrome of pregnancy is a rare complication of pregnancy. When it occurs, the maternal mortality rate may be as high as 86%, and in survivors, the morbidity rate may be just as high. Hallmark clinical features include maternal cardiovascular collapse with disseminated intravascular coagulation, and fetal distress. Management centers on strategies to improve oxygenation, support circulation, and correct the coagulopathy. We report the case of a patient who developed amniotic fluid embolus and was effectively managed with aprotinin to control the coagulopathy associated with this devastating complication of pregnancy.
Subject(s)
Aprotinin/therapeutic use , Blood Coagulation Disorders/drug therapy , Blood Coagulation Disorders/etiology , Embolism, Amniotic Fluid/physiopathology , Hemostatics/therapeutic use , Adult , Blood Cell Count , Blood Coagulation Tests , Crystalloid Solutions , Female , Humans , Isotonic Solutions/therapeutic use , Plasma Substitutes/therapeutic use , Pregnancy , Uterus/physiopathologyABSTRACT
OBJECTIVE: To describe possible correlations between incidence of postpartum depression and the following patient characteristics: age, breastfeeding status, tobacco use, marital status, history of depression, and method of delivery. STUDY DESIGN: Data gathered at routine 4-week postnatal visits were obtained from the patient records of 209 women who gave birth between June 1, 2001, and June 1, 2003, at three university medical clinics in Tulsa, Okla. Inclusion criteria required that the records of potential study subjects contain data on the characteristics noted as well as patient-completed Edinburgh Postnatal Depression Scale forms. RESULTS: Formula feeding in place of breastfeeding, a history of depression, and cigarette smoking were all significant risk factors for an Edinburgh Postnatal Depression Scale score of 13 or higher, indicating probable postpartum depression. CONCLUSION: The authors' findings corroborate the results of previous investigators. To facilitate prophylactic patient education and intervention strategies, a larger study is recommended to determine risk factors for postpartum depression.
Subject(s)
Depression, Postpartum/etiology , Adult , Breast Feeding , Female , Humans , Infant , Infant Formula , Oklahoma , Retrospective Studies , Risk Factors , Smoking/adverse effectsABSTRACT
BACKGROUND: The purpose of this study was to search for correlations of scores on the visual analog scales (VAS) taken during the third week postpartum with scores on the Edinburgh Postnatal Depression Scale (EPDS) taken on approximately day 28 postpartum. METHODS: Thirty-four women filled out six visual analog scales on postpartum days 15-21 and took the EPDS at their 4-week postpartum visit to the clinic. Results were analyzed by simple linear regression and multiple backward stepwise regression. RESULTS: Responses to all six statements of the VAS correlated significantly with 4-week EPDS scores. Approximately 54% of the variability of 4-week EPDS scores can be predicted by the variability in VAS question 6. LIMITATIONS: Relatively small sample size is a moderately limiting factor of this study. CONCLUSION: Mood in the third week postpartum was predictive of EPDS score on postpartum day 28. Mood lability during the third week postpartum was a better predictor of EPDS score on day 28 than the other five measures, including feelings of sadness or anxiety. The EPDS may have potential use with an acceptable degree of accuracy earlier than the standard 4 weeks postpartum.
Subject(s)
Depression, Postpartum/diagnosis , Personality Inventory/statistics & numerical data , Psychiatric Status Rating Scales/statistics & numerical data , Adult , Depression, Postpartum/psychology , Female , Humans , Linear Models , Mass Screening/methods , Mass Screening/statistics & numerical data , Postpartum Period/psychology , Psychometrics , Risk Factors , Surveys and Questionnaires , Time FactorsABSTRACT
This review examines proposed endocrine-based etiologies of postpartum depression (PPD) and how knowledge of these etiologies may affect future treatments. It is based on a review of papers shedding light on the etiology of PPD with special emphasis on research into endocrine-related depression. A picture of PPD is starting to emerge that suggests a variety of endocrine root causes as well as psychosocial risk factors. Hormones reviewed include progesterone, estradiol and estriol, cortisol, corticotropin-releasing hormone, prolactin, thyroid-stimulating hormone and triiodothyronine/thyroxine. Other substances examined include 3 antithyroid autoantibodies. Better understanding of the physiologic bases for depressive symptoms may lead to correction of the underlying pathology of PPD rather than treatment of symptoms.
