Comparison of the EPDS and PHQ-9 in the assessment of depression among pregnant women: Similarities and differences.

BACKGROUND: Perinatal depression has attracted increasing attention. However, a detailed investigation of the network structure of depression is still lacking. We aim to examine the similarities and differences between the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) from a network perspective. METHODS: A cross-sectional study was conducted from August 2020 to March 2022. We followed the STROBE checklist to report our research. Pregnant women (n = 2484) were recruited. All participants completed the EPDS and PHQ-9. We mainly used network analyses for statistical analysis and constructed two network models: the EPDS and PHQ-9 models. RESULTS: The detection rates of prenatal depression measured by the EPDS and PHQ-9 were 30.2 % and 28.2 %, respectively. In the EPDS network, the EPDS8 'sad or miserable' node (strength = 1.2161) was the most central node, and the EPDS10 'self-harming' node (strength = 0.4360) was the least central node. In the PHQ-9 network, the PHQ4 'fatigue' node (strength = 0.9815) was the most central node, and PHQ9 'suicide' was the least central symptom (strength = 0.5667). For both models, 'sad' acted as an important central symptom. CONCLUSIONS: Psychological symptoms may be more important in assessing depression using the EPDS, while physical symptoms may be more influential in assessing depression using the PHQ-9. For both the EPDS and PHQ-9, "sad" was an important central symptom, suggesting that it may be the most important target for further maternal depression interventions in the future.

Antenatal depression is associated with perceived stress, family relations, educational and professional status among women in South of China: a multicenter cross-sectional survey.

Background: Antenatal depression is a commonly seen mental health concern for women. This study introduced a multicenter cross-sectional survey with a large sample to provide new insights into pregnant women's depression, its socio-demographic and obstetric characteristics correlates, and its perceived stress among Chinese pregnant women. Methods: This study conducted an observational survey according to the STROBE checklist. The multicenter cross-sectional survey was performed from August 2020 to January 2021 by distributing paper questionnaires among pregnant women from five tertiary hospitals in South China. The questionnaire included socio-demographic and obstetrics information, the Edinburgh Postnatal Depression Scale, and the 10-item Perceived Stress Scale. For the analyses, the Chi-square test and Multivariate logistic regression were utilized. Results: Among 2014 pregnant women in their second/third trimester, the prevalence of antenatal depression was 36.3%. 34.4% of pregnant women reported AD in their second trimester of pregnancy, and 36.9% suffered from AD in third trimester of pregnancy. A multivariate logistic regression model indicated that unemployed women, lower levels of education, poor marital relationships, poor parents-in-law relationships, concerns about contracting COVID-19, and higher perceived stress could aggravate antenatal depression among participants (p<0.05). Conclusion: There is a high proportion of antenatal depression among pregnant women in South China, so integrating depression screening into antenatal care services is worthwhile. Maternal and child health care providers need to evaluate pregnancy-related risk factors (perceived stress), socio-demographic factors (educational and professional status), and interpersonal risk factors (marital relations and relationship with Parents-in-law). In future research, the study also emphasized the importance of providing action and practical support to reduce the experience of antenatal depression among disadvantaged sub-groups of pregnant women.

A longitudinal study of perinatal depression and the risk role of cognitive fusion and perceived stress on postpartum depression.

AIMS AND OBJECTIVES: To explore fluctuations in perinatal depression based on physiological, psychological and interpersonal dimensions to analyse risk factors across three time points: in the third trimester and at weeks 1 and 6 postpartum. BACKGROUND: Pregnant women experience depression at multiple time points and require screening. Studies have shown protective and negative factors related to postpartum depression. Cognitive fusion refers to an individual's emotions and behaviours that are regulated and influenced by that individual's own cognitive overregulation, especially when facing stress. This is an important psychological factor related to depression, but little is known about it in pregnant women. DESIGN: A longitudinal study was conducted from June 2019-July 2020, and the findings are reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. METHODS: Pregnant women (n = 207) were recruited, and a questionnaire survey was performed at 32-34 weeks of pregnancy and at weeks 1 and 6 postpartum. Repeated-measures analysis of variance was performed to analyse the changes in depression over time. Regression analysis and linear mixed modelling were used to identify risk factors. Pearson's correlation analysis was performed to analyse the relationships between variables. RESULTS: Of the pregnant women, 36.70% experienced antenatal depression and prolonged depression with the onset of postpartum depression (12.21%). Some depressive moods disappeared spontaneously after delivery (47.37%). Perceived stress was the highest risk predictor of postpartum depression (ß = 0.332), followed by cognitive fusion (ß = 0.178), which remained stable over time and might have been positively related to having a vulnerable personality (0.2 < r < 0.4). Social support plays a positive role in lowering postpartum depression (ß = -0.027). CONCLUSIONS: Changes in depression were influenced by multiple factors with stability and predictability across time. Psychological dimensions, such as perceived stress and cognitive fusion, are risk factors for developing postpartum depression and antenatal depression. RELEVANCE TO CLINICAL PRACTICE: Pregnant women can be divided into depressive cohorts according to screening at different time points to provide targeted interventions.

Iron parameters in pregnant women with beta-thalassaemia minor combined with iron deficiency anaemia compared to pregnant women with iron deficiency anaemia alone demonstrate the safety of iron supplementation in beta-thalassaemia minor during pregnancy.

In patients with beta-thalassaemia intermedia or major, hepcidin induces iron overload by continuously promoting iron absorption. There have been no studies in pregnant women with beta-thalassaemia minor combined with iron deficiency anaemia (IDA), examining whether hepcidin is inhibited by GDF15, as may occur in patients with beta-thalassaemia intermedia or major, or whether the iron metabolism characteristics and the effect of iron supplementation are consistent with simple IDA in pregnancy. We compared and analysed routine blood parameters, iron metabolism parameters, the GDF15 levels, and the hepcidin levels among four groups, namely the beta-thalassaemia (ß) + IDA, ß, IDA, and normal groups. In addition, the ß + IDA and IDA groups received iron supplementation for four weeks. We found no statistically significant correlation between hepcidin and GDF15 in any group, but a positive correlation was observed between hepcidin and ferritin. After iron supplementation, the routine blood parameters and iron metabolism parameters in the ß + IDA group were improved, and the hepcidin content was significantly increased. These results suggest that in pregnant women with beta-thalassaemia minor, hepcidin functions normally to maintain iron homeostasis, and that iron supplementation is effective and safe.

Distinct placental molecular processes associated with early-onset and late-onset preeclampsia.

Background: Patients with preeclampsia display a spectrum of onset time and severity of clinical presentation, yet the underlying molecular bases for the early-onset and late-onset clinical subtypes are not known. Although several transcriptome studies have been done on placentae from PE patients, only a small number of differentially expressed genes have been identified due to very small sample sizes and no distinguishing of clinical subtypes. Methods: We carried out RNA-seq on 65 high-quality placenta samples, including 33 from 30 patients and 32 from 30 control subjects, to search for dysregulated genes and the molecular network and pathways they are involved in. Results: We identified two functionally distinct sets of dysregulated genes in the two major subtypes: 2,977 differentially expressed genes in early-onset severe preeclampsia, which are enriched with metabolism-related pathways, notably transporter functions; and 375 differentially expressed genes in late-onset severe preeclampsia, which are enriched with immune-related pathways. We also identified some key transcription factors, which may drive the widespread gene dysregulation in both early-onset and late-onset patients. Conclusion: These results suggest that early-onset and late-onset severe preeclampsia have different molecular mechanisms, whereas the late-onset mild preeclampsia may have no placenta-specific causal factors. A few regulators may be the key drivers of the dysregulated molecular pathways.

TNF-related apoptosis-inducing ligand (TRAIL) promotes trophoblast cell invasion via miR-146a-EGFR/CXCR4 axis: A novel mechanism for preeclampsia?

INTRODUCTION: Preeclampsia (PE) is associated with failure of uterovascular transformation due to impaired trophoblast invasion. Previously, TNF-related apoptosis-inducing ligand (TRAIL) has been controversially reported to correlate with PE, but whether it regulates trophoblast invasion yet to be defined. METHODS: We treated HTR8/SVneo cells with sTRAIL at concentrations of 0.1 ng/mL, 1 ng/mL and 10 ng/mL for a 72-h time course and compared cell proliferation, apoptosis and invasion ability by CCK8 assay, flow cytometry analysis and Matrigel cell invasion assay, respectively. The expressions levels of miR-146a, CXCR4, EGFR and MMP2 were quantified by qRT-PCR and Western blot. Moreover, HTR8/SVneo cells were transfected with miR-146a mimics and miR-146a inhibitor, followed by analyzing invasion ability and gene expressions of CXCR4, EGFR and MMP2. Finally, both serum and placental samples from preeclamptic and gestational week-matched normotensive women were collected and assessed for the expression levels of TRAIL by ELISA assay and immunochemistry staining. RESULTS: sTRAIL treatment of HTR8/SVneo cells resulted in no change in proliferation or apoptosis, but dose- and time-dependently enhanced invasion. TRAIL downregulated the expressions of miR-146a and upregulated CXCR4, EGFR and MMP2. Transfection of miR-146a resulted in the inhibition of invasion and downregulation of CXCR4, EGFR and MMP2. Lastly, the expression levels of TRAIL decreased in both serum and placenta of preeclamptic pregnancies and correlated with the disease severity. DISCUSSION: TRAIL regulated miR-146a-CXCR/EGFR axis to promote the invasion of trophoblast like cells. Its deceased levels in preeclamptic sera and placenta, suggest that low levels of TRAIL might contribute to the pathogenesis of preeclampsia.

[Effect of mindfulness meditation training on anxiety, depression and sleep quality in perimenopausal women].

OBJECTIVE: To explore the effect of mindfulness meditation training for improving anxiety, depression and sleep disorders in perimenopausal women. METHODS: Intervention by menopause meditation training was delivered in 121 perimenopausal women with anxiety, depression or sleep disorders in Baiyun District, Guangzhou. Before and after the intervention, the Self-rating Anxiety Scale, Self-rating Depression Scale and Pittsburg Sleep Quality Index were used for assessment of changes in the conditions of the women. RESULTS: After menopausal meditation training, the perimenopausal women showed significant improvement in the mean scores of Self-rating Anxiety Scale (48.26 ± 6.47; t=3.865, P < 0.01), Selfrating Depression Scale (50.27 ± 6.54; t=4.541, P < 0.01) and Pittsburgh Sleep Questionnaire (10.64 ± 4.38; t=5.596, P < 0.01). The symptom remission rates differed significantly among the women with different self-practice frequencies (P < 0.01). The remission rates of anxiety, depression and sleep disorder increased significantly with the frequency of self-exercise (P < 0.01). CONCLUSIONS: Mindfulness meditation training can effectively alleviate the symptoms of anxiety and depression and improve the quality of sleep in perimenopausal women, and the frequency of the exercise is positively correlated with the improvements. Mindfulness meditation training can be an effective intervention for improving the mental health of perimenopausal women.

Adsorption behaviours and mechanisms of heavy metal ions' impact on municipal waste composts with different degree of maturity.

Composting may change the adsorption characteristics and mechanisms of organic materials due to their differences in organic chemical functional groups and surface structures. The adsorption properties of heavy metals onto the municipal solid waste compost (MSW-C) and its secondary fermentation form (MSW-SC) were comparatively investigated in single, binary and multiple solutions by batch experiments. In the single-metal system, the maximum adsorption capacities of Cu, Zn, Cd and Ni onto MSW-SC were 29.2, 26.3, 38.1 and 22.0 mg g-1, respectively, and showed higher than that of MSW-C. The adsorption fitted best with the pseudo-second-order kinetics and Langmuir isotherms. The competitive adsorption results indicated that the composts exhibited good selectivity in the adsorption of Cu over Cd, Zn and Ni; thus, for the quaternary-metal systems, the adsorption sequence was Cu > Zn > Cd > Ni. Humic acid content, cation exchange capacity and surface area were increased following the secondary composting. FTIR analysis indicated amine and aromatic compounds were main binding sites accounting for metal sorption. SEM-EDX analysis suggested that the MSW-SC had rough surfaces and stronger adsorption capacity. Decreasing percentage of exchangeable metals was found in the metal-loaded MSW-SC based on a speciation analysis. This study highlights the interactive impacts of different metals during adsorption by compost with different maturity, the secondary composting process was a multifunctional improvement of sorption characteristics and MSW-SC was developed to be a highly efficient biosorbent.

[Prenatal diagnosis of single umbilical artery: implications for chromosomal abnormalities and neonatal outcome].

OBJECTIVE: To investigate the implications of a prenatal diagnosis of single umbilical artery (SUA) for chromosomal abnormalities and neonatal outcomes. METHODS: From January, 2008 to June, 2012, color Doppler ultrasound identified 44 fetuses with SUA. Prenatal diagnoses with amniocentesis or umbilical blood sampling were subsequently ordered for routine chromosome karyotyping and the newborns were followed up for assessing the neonatal outcomes. RESULTS: Of all the 44 fetuses, 24 had uncomplicated SUA, and 20 had other concurrent abnormalities (including 8 with abnormal ultrasound soft indexes and 12 with chromosomal abnormalities). The two groups of fetuses showed significant differences in gestational weeks at delivery and incidence of chromosomal abnormalities but not in neonatal weight, placenta weight or APGAR score. CONCLUSIONS: Fetuses with a prenatal diagnosis of SUA and other development abnormities need to undergo prenatal chromosomal examination. For fetuses with uncomplicated SUA, careful ultrasound examination is necessary to avoid missed diagnosis of potential congenital abnormalities.

[Hysterectomy after cardiopulmonary resuscitation in patients with obstetric hemorrhagic shock].

OBJECTIVE: To explore the indication of hysterectomy after successful resuscitation of cardiac arrest due to obstetric hemorrhagic shock. METHODS: A retrospective analysis was conducted in 13 patients with cardiac arrest due to obstetric hemorrhagic shock in 7 hospitals of Guangzhou, including 12 patients undergoing hysterectomy and 1 undergoing uterine artery embolization. RESULTS: s After successful cardiopulmonary resuscitation, only 4 of the 13 patients undergoing hysterectomy or uterine artery embolization for continuing uterus hemorrhage survived. CONCLUSION: Detailed plans and emergency measures should be formulated in the management of high-risk pregnancies. Early diagnosis and active treatment of obstetric hemorrhagic shock with hysterectomy or uterine artery embolization are critical in preventing cardiac arrest and improving the survival of the patients.