A quantitative comparison of two measures of postpartum depression.

BACKGROUND: Studies investigating the prevalence and risk factors for postpartum depression (PPD) have used different definitions. Some studies have used a high score on the Edinburgh Postnatal Depression Scale (EPDS) to define PPD, whereas others have used information on antidepressant medication use and/or diagnostic information on treatment for depression at a psychiatric hospital. We wanted to compare results using these two approaches to evaluate to what degree results can be compared. Moreover we wanted to evaluate, whether use of EPDS or PPAT (defined below) leads to identification of different risk factor profiles. METHODS: We identified women who delivered a child between 1 January 2014 and 31 December 2016 in Copenhagen or in one of the municipalities that were part of the Danish Health Visitors' Child Health Database. The potential risk factors were demographic factors and pregnancy- and obstetrical events. Outcomes of interest were an EPDS score ≥ 13, use of antidepressants (ATC: N06A) and/or a diagnosis of depression (F32) within six months after birth. Use of antidepressants and/or diagnosis of depression will be referred to as postpartum antidepressant treatment (PPAT). Agreement between EPDS ≥ 13 and PPAT was evaluated by the kappa coefficient. Associations between risk factors and the two outcomes (EPDS ≥ 13 and PPAT) were estimated by risk ratios (RR) using log-linear binomial regression. Presence of a systematic difference between RRs based on EPDS ≥ 13 (RREPDS≥13) and PPAT (RRPPAT) was evaluated in a meta-regression approach weighted by inverse-variance and with logarithm of the RRs as outcome. RESULTS: The estimated PPD prevalence using EPDS ≥ 13 was 3.2% and of PPAT 0.4%. The agreement between the two measures was small (Kappa = 0.08), but their risk factor profile was very similar with no systematic difference between them. CONCLUSIONS: Using the two different methods of case identification produced different prevalence estimates, but a similar risk factor profile. The differences in estimated prevalence and low agreement suggest that the two measures identify different potential PPD cases and using only one of the methods in defining PPD would underestimate PPD prevalence. The similar risk factor profile suggests that the considered risk factors are involved in the general development of PPD.

Metabolic Dynamics and Prediction of Gestational Age and Time to Delivery in Pregnant Women.

Metabolism during pregnancy is a dynamic and precisely programmed process, the failure of which can bring devastating consequences to the mother and fetus. To define a high-resolution temporal profile of metabolites during healthy pregnancy, we analyzed the untargeted metabolome of 784 weekly blood samples from 30 pregnant women. Broad changes and a highly choreographed profile were revealed: 4,995 metabolic features (of 9,651 total), 460 annotated compounds (of 687 total), and 34 human metabolic pathways (of 48 total) were significantly changed during pregnancy. Using linear models, we built a metabolic clock with five metabolites that time gestational age in high accordance with ultrasound (R = 0.92). Furthermore, two to three metabolites can identify when labor occurs (time to delivery within two, four, and eight weeks, AUROC ≥ 0.85). Our study represents a weekly characterization of the human pregnancy metabolome, providing a high-resolution landscape for understanding pregnancy with potential clinical utilities.

Risk factors for congenital hydrocephalus: a nationwide, register-based, cohort study.

OBJECTIVES: To investigate the associations between isolated congenital hydrocephalus (CHC) and maternal characteristics, maternal medical diseases, and medicine intake during pregnancy as well as birth characteristics of the child in a retrospective, register-based, nationwide cohort study. Furthermore, to identify the risk factors unique for isolated CHC as compared to syndromic CHC. METHODS: We established a cohort of all children born in Denmark between 1978 and 2008. Information on CHC and maternal medical diseases were obtained from the National Patient Discharge Register, maternal intake of medicine during pregnancy from the National Prescription Drug Register, and birth characteristics of the child from the Danish National Birth Register. Rate ratios (RR) of isolated and syndromic CHC with 95% CI were estimated using log-linear Poisson regression. RESULTS: In a cohort of 1928666 live-born children, we observed 1193 cases of isolated CHC (0.062/1000) born children. First-borns had an increased risk of isolated CHC compared to later-borns (1.32 95% CI 1.17 to 1.49) (0.72/1000 born children). First trimester exposure to maternal use of antidepressants was associated with a significantly increased risk of isolated CHC compared to unexposed children (RR 2.52, 95% CI 1.47 to 4.29) (1.5/1000 born children). Risk factors also found for syndromic CHC were: Male gender, multiples and maternal diabetes. CONCLUSIONS: The higher risk for isolated CHC in first-born children as well as behavioural aspects and comorbidities associated with maternal use of antidepressants, should be the targets for future research. Potential biological pathways by which antidepressants may cause hydrocephalus remain to be elucidated.

Familial aggregation of congenital hydrocephalus in a nationwide cohort.

The objective of the study was to investigate familial aggregation of primary congenital hydrocephalus in an unselected, nationwide population. Based on the Danish Central Person Register, we identified all children born in Denmark between 1978 and 2008 and their family members (up to third-degree relatives). Information on primary congenital hydrocephalus was obtained from the National Patient Discharge Register. Using binomial log-linear regression, we estimated recurrence risk ratios of congenital hydrocephalus. An alternative log-linear regression model was applied to quantify the genetic effect and the maternal effect. Of 1 928 683 live-born children, 2194 had a diagnosis of idiopathic congenital hydrocephalus (1.1/1000). Of those, 75 (3.4%) had at least one other family member with primary congenital hydrocephalus. Significantly increased recurrence risk ratios of primary congenital hydrocephalus were observed for same-sex twins, first- and second-degree relatives as follows: 34.8 (95% confidence interval: 16.4-74.0), 6.2 (95% confidence interval 4.3-8.9) and 2.2 (95% confidence interval 1.6-3.1), respectively. Recurrence risk ratio for third-degree relatives was 1.5 (95% confidence interval 0.8-2.7). A maternal component was supported by the facts that recurrence risk ratios for opposite-sex twins (37.3, 95% confidence interval 11.9-116.7) were significantly higher than other first-degree relatives and that recurrence risk ratios for maternal half-siblings (8.4, 95% confidence interval 3.7-18.7) were significantly higher than for paternal half-siblings (3.0, 95% confidence interval 0.8-12.2). This population-based study found strong evidence of familial aggregation of primary congenital hydrocephalus, which supports the existence of a genetic component to the aetiology. In addition, the pattern of association suggests that a strong maternal component contributes to the familial aggregation.