Vitamin D Deficiency and Antenatal and Postpartum Depression: A Systematic Review.

Vitamin D has been implicated in antenatal depression (AD) and postpartum depression (PPD) in many studies; however, results have been inconsistent due to the complexity of this association. We searched the MEDLINE, Embase, PsycINFO, and Maternity and Infant Care databases for literature addressing associations between vitamin D and AD and PPD. Two independent authors reviewed titles and abstracts of the search results and selected studies for full review. Data were extracted, and a quality rating was done using the Newcastle-Ottawa Scale (NOS) on the selected studies. A total of 239 studies were identified; 14 were included in the review. The quality assessment of the included studies ranged from moderate to high. Of the studies on PPD, five of nine (55%) showed a significant association between vitamin D and PPD. Five of seven (71%) studies on AD showed a significant association with vitamin D status. As the included studies used different effect estimates and statistical analyses to report the association, it was not possible to transform the existing data into one single effect measure to employ meta-analytic techniques. While results of this systematic review vary, they indicate a significant association between vitamin D status and AD and PD.

The effect of perinatal depression treatment for mothers on parenting and child development: A systematic review.

Antenatal and postpartum depression are very common and have significant consequences for mothers and their children. This review examines which antenatal depression (AD) and postpartum depression (PPD) treatment interventions are most efficacious in improving parenting and/or child development. CINAHL, Scopus, Cochrane Systematic Reviews, Cochrane Controlled Trials, Medline (OVID), Embase (OVID), PsychINFO, PsycARTICLES, AMED, and reference lists were searched. Randomized controlled trials (RCTs) and quasi-experimental studies assessing the effect of AD, PPD, or both treatment interventions on parenting and/or child development were included. Meta-analysis was conducted using random effects when possible. Thirty-six trials (within 40 articles) met criteria for review. Interventions include interpersonal psychotherapy (IPT), cognitive behavioural therapy (CBT), peer support, maternal-child interaction guidance, and other interventions, such as massage. For AD, IPT, CBT, and massage produced large effects on parenting (e.g. adjustment and attention toward infant) and child development (e.g. behaviour). For PPD, maternal-child interaction guidance and psychotherapeutic group support produced large effects on parenting (e.g. sense of competence) and child development (e.g. cortisol). However, meta-analysis revealed nonsignificant effects of IPT on maternal-child attachment and CBT on parenting stress. Promising findings exist for IPT, CBT, maternal-child interaction guidance, massage, and psychotherapeutic group support for specific parenting and/or child development outcomes. Additional RCTs using measures already employed in the literature are required to conduct necessary meta-analysis and fully elucidate treatment effects.

Maternal sensitivity and social support protect against childhood atopic dermatitis.

BACKGROUND: Many studies have identified associations between qualities of maternal-child relationships and childhood asthma, but few have examined associations with childhood atopic dermatitis (AD), a common precursor to asthma. Moreover, maternal psychological distress, including prenatal and postnatal depression, anxiety and stress, may increase risk, while social support from partners may reduce risk for childhood AD. We sought to uncover the association between maternal-infant relationship qualities (maternal sensitivity towards infant behavioral signals, controlling behavior, and unresponsiveness) and child AD after accounting for risk (i.e., prenatal and postnatal maternal depression, anxiety and stress) and protective (i.e., social support) factors. METHODS: We conducted a secondary analysis of data collected on a subsample of 242 women and their infants enrolled during pregnancy in the ongoing Alberta Pregnancy Outcomes and Nutrition cohort study. Inclusion criteria required mothers to be >16 years of age, English speaking and <22 weeks gestational age at enrollment. Data on depression, anxiety and stress in the prenatal and postnatal periods and physician diagnosis of childhood AD at 18 months were gathered via maternal report. Maternal sensitivity, unresponsiveness and controlling behaviours were assessed via videotaped observations using the Child-Adult Relationship Experimental (CARE)-Index at 6 months of infant age. RESULTS: Higher maternal sensitivity, or the inability of the mother to appropriately understand and respond to infant needs based on behavioral signals, predicted reduced odds of AD independent of and in combination with low prenatal and postnatal anxiety and high paternal support. After adjustment, higher maternal controlling behaviours and unresponsiveness also predicted greater odds of AD. CONCLUSIONS: Low maternal sensitivity is a risk factor for childhood AD, independently and in combination with perinatal anxiety and low social support. Thus, interventions that improve maternal-infant relationship quality, especially sensitivity, reduce anxiety and improve social support from partners could reduce odds of childhood AD.

Efficacy and safety of damage control in experimental animal models of injury: protocol for a systematic review and meta-analysis.

BACKGROUND: Although abbreviated surgery with planned reoperation (damage control surgery) is now widely used to manage major trauma patients, the procedure and its component interventions have not been evaluated in randomized controlled trials (RCTs). While some have suggested the need for such trials, they are unlikely to be conducted because of patient safety concerns. As animal studies may overcome several of the limitations of existing observational damage control studies, the primary objective of this study is to evaluate the efficacy and safety of damage control versus definitive surgery in experimental animal models of injury. METHODS/DESIGN: We will search electronic databases (Medline, Embase, PubMed, Web of Science, Scopus, and the Cochrane Library), conference abstracts, personal files, and bibliographies of included articles. We will include RCTs and prospective cohort studies that utilized an animal model of injury and compared damage control surgery (or specific damage control interventions or adjuncts) to definitive surgery (or specific definitive surgical interventions). Two investigators will independently evaluate the internal and external/construct validity of individual studies. The primary outcome will be all-cause mortality. Secondary outcomes will include blood loss amounts; blood pressures and heart rates; urinary outputs; core body temperatures; arterial lactate, pH, and base deficit/excess values; prothrombin and partial thromboplastin times; international normalized ratios; and thromboelastography (TEG) results/activated clotting times. We will calculate summary relative risks (RRs) of mortality and mean differences (for continuous outcomes) using DerSimonian and Laird random effects models. Heterogeneity will be explored using subgroup meta-analysis and meta-regression. We will assess for publication bias using funnel plots and Begg's and Egger's tests. When evidence of publication bias exists, we will use the Duval and Tweedie trim and fill method to estimate the potential influence of this bias on pooled summary estimates. DISCUSSION: This study will evaluate the efficacy and safety of damage control in experimental animal models of injury. Study results will be used to guide future clinical evaluations of damage control surgery, determine which animal study outcomes may potentially be generalizable to the clinical setting, and to provide guidelines to strengthen the conduct and relevance of future pre-clinical studies.