Maternal psychopathology and infant development at 18 months: the impact of maternal personality disorder and depression.

OBJECTIVE: No previous longitudinal study has examined the impact of comorbid maternal personality disorder (PD) and depression on child development. We set out to examine whether maternal PD and depression assessed at 2 months post partum would be independently associated with adverse developmental outcomes at 18 months of age. METHOD: Women were recruited into the study shortly after delivery and screened for depression and PD. Those meeting criteria for depression, PD, or both conditions, were selected for assessment at 2 months post partum, together with a comparison group with neither condition (total sample, N = 200). Assessments of cognitive, social and emotional development were conducted with their children at 18 months of age. RESULTS: Maternal postpartum depression and PD were both associated with higher levels of dysregulated infant behavior. There was a significant interaction between depression and PD in the model of dysregulated behavior and the detrimental effects of maternal depression and PD were evident only among mothers with both conditions. Maternal depression was independently associated with impaired infant cognitive scores and higher levels of internalizing behavior. CONCLUSIONS: Future studies of the effects of maternal depression should also take into account the effects of comorbid maternal PD. Health professionals need to be aware of the possible co-occurrence of PD among mothers presenting with postnatal depression and that mothers with these co-occurring disorders are likely to require greater support.

Maternal personality disorder and babies' exposure to tobacco smoke.

This study examined the association between smoking practices and maternal personality disorder in a sample of 200 mothers of 2-month-old babies. Maternal personality disorder was robustly associated with allowing smoking in the home and also exposing the baby to tobacco smoke. The findings suggest that mothers with personality disorders might particularly benefit from targeting with education and advice about reducing their baby's exposure to environmental tobacco smoke in the postpartum period.

The impact of maternal depression and personality disorder on early infant care.

AIM: Previous studies have reported detrimental effects of maternal depression on infant care but have not taken into account the potential confounding effects of co-morbid personality disorder. We aimed to examine the independent effects of maternal depression and personality disorder on infant care. METHOD: Assessments with 200 mothers who had a diagnosis of depression, personality disorder, both conditions, or neither condition, when their infants were aged 2 months, included structured clinical interviews, an interview about infant care practices, and standardised measures of quality of the home environment, maternal involvement with the baby, maternal sensitivity and infant irritability. RESULTS: The presence of depression and personality disorder had significant independent detrimental effects on infant care practices and maternal involvement with the baby, while depression alone had a negative effect on quality of the home environment. CONCLUSION: Women with depression are less likely to use recommended infant care practices only when they also meet criteria for co-morbid personality disorder. Professionals working with women and babies need to consider the particular difficulties that mothers with both personality disorder and depression may have in providing satisfactory infant care.

Symptoms associated with the DSM IV diagnosis of depression in pregnancy and post partum.

Pregnancy and the postpartum may affect symptoms of depression. However it has not yet been tested how the symptoms used for the DSM IV diagnosis of depression discriminate depressed from non depressed women perinatally. A modified version of the Structured Clinical Interview for DSM IV (SCID interview) was used that allowed assessment of all associated DSM IV symptoms of depression with depressed and non depressed women in pregnancy and the postpartum period. Loss of appetite was not associated with depression either ante or postnatally. The antenatal symptom pattern was different from the postnatal. The sensitivity of the symptoms ranged from 0.7% to 51.6%, and specificity from 61.3% to 99.1%. The best discriminating symptoms were motor retardation/agitation and concentration antenatally, and motor retardation/agitation, concentration and fatigue postnatally. Depression in pregnancy and postpartum depression show significantly different symptom profiles. Appetite is not suitable for the diagnosis of depression in the perinatal period.

Foetal brain development in offspring of women with psychosis.

Cerebral ventricular enlargement and reduced cortical volume are correlates of chronic schizophrenia. We investigated whether genetic risk for psychosis related to differences in foetal brain development as measured by prenatal ultrasonography. Routine foetal cerebral measures at 19-23 weeks of gestation were compared between the offspring of 35 women with a history of psychosis and 105 control women matched for gestational age. Overall, no significant differences were found between the high-risk and control groups. There was a non-significant trend in the adjusted analysis towards increased lateral ventricular width in the offspring of mothers with psychosis.

Prenatal depression, prenatal anxiety, and spontaneous preterm birth: a prospective cohort study among women with early and regular care.

OBJECTIVE: This article investigates the effects of antenatal depression and anxiety on spontaneous preterm birth resulting either from preterm labor or preterm premature rupture of membranes. METHODS: We conducted a prospective cohort study of 681 women with singleton pregnancies consecutively recruited between 20 and 28 weeks of gestation in the Obstetrics Department of the French University Hospital of Caen. Most were of European ethnic origin and received early and regular antenatal care. The assessment of gestational age was based on ultrasound examination (occurring before 13 weeks of gestation for 94.9% of the women). Depression and anxiety were assessed using self-administered questionnaires: the Edinburgh Postnatal Depression Scale and the Spielberger State-Trait Anxiety Inventory. Logistic regression analysis, controlling for sociodemographic factors (e.g., maternal age, occupation) and obstetric factors (e.g., previous preterm birth, cervical or vaginal infection), provided adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Spontaneous preterm birth occurred in 31 women (4.8%). The rate of spontaneous preterm birth was significantly higher among women with high depression scores (9.7%) as opposed to other women (4.0%) even after adjustment for potential confounding factors (adjusted OR = 3.3, 95% CI = 1.2-9.2, p = .020). Anxiety was not significantly associated with the outcome. There were no significant interaction effects between psychological and biomedical factors. CONCLUSIONS: These findings provide evidence that antenatal depression is significantly associated with spontaneous preterm birth in a population of European women receiving early and regular care.

Assessing psychosocial risk in pregnant/postpartum women using the Contextual Assessment of Maternity Experience (CAME)--recent life adversity, social support and maternal feelings.

BACKGROUND: The Contextual Assessment of Maternity Experience (CAME) interview was developed to characterise the psychosocial context relevant to the maternity experience by providing a detailed picture of women's lives during the transition to motherhood. More specifically, it was designed to enable the assessment of major risk factors for emotional disturbances in pregnant and postpartum women, especially depression, within the same instrument and using a coherent methodological framework. METHOD: The CAME assesses three domains relevant to motherhood: 1) recent life adversity or stressors; 2) the quality of social support and key relationships including partner relationship; and 3) maternal feelings towards pregnancy, motherhood and the baby. Two high-risk samples of inner-city London women were used to test the psychometric qualities of the CAME components. RESULTS: Overall, the internal consistencies of the relevant components were high in both samples examined. The validity of the three components of the measure was evidenced by their association with either maternal characteristics or parenting assessments. CONCLUSION: It was concluded that the CAME shows promise as a measure of the psychosocial risk factors involved in the maternity experience for future research in this field.

Estrogen administration does not reduce the rate of recurrence of affective psychosis after childbirth.

BACKGROUND: High rates of postpartum relapse occur in women with histories of bipolar or schizoaffective disorder. These relapses may be triggered by the postdelivery fall in circulating estrogen through alteration of central neurotransmitter (especially dopaminergic) systems. This study tested the hypothesis that estrogen administration after childbirth would prevent postpartum relapse and would alter dopamine receptor sensitivity. METHOD: Twenty-nine pregnant women with a Research Diagnostic Criteria diagnosis of hypomania (bipolar II), mania (bipolar I), or schizoaffective disorder participated in an open clinical trial. Three transdermal dose regimens of estrogen (17beta-estradiol) were tested. Starting doses were 200 (N = 13), 400 (N = 3), and 800 (N = 13) micro g/day, beginning within 48 hours after delivery and reduced by one half every 4 days for a total of 12 days. On the fourth day after starting estradiol therapy (before relapse occurred), subjects participated in a neuroendocrine challenge test that measured the sensitivity of the central nervous system (tubero-infundibular) dopaminergic system (plasma prolactin and growth hormone responses to apomorphine). RESULTS: Estradiol at all dose regimens did not reduce the rate of relapse. However, of the 12 women who relapsed, those who had taken the highest dose of estradiol (800 micro g/day) needed less subsequent psychotropic medication (fewer chlorpromazine equivalents) and were discharged sooner than those who had taken either of the 2 lower doses. No differences in neuroendocrine responses to apomorphine were detected between women receiving the high-dose and the lower-dose regimens. CONCLUSION: The results do not support the hypothesis that a fall in circulating concentrations of estrogens precipitates relapse in subjects at risk of postpartum affective psychosis. The use of prophylactic estrogen in such circumstances is therefore highly questionable.