Clinical practice guidelines with recommendations for peripartum depression: A European systematic review

Motrico, Emma; Moreno-Peral, Patricia; Uriko, Kristiina; Hancheva, Camellia; Anđelinović, Maja; Ajaz, Erilda; Apter, Gisèle; Bramante, Alessandra; Conejo-Cerón, Sonia; Christoforou, Andri; Dikmen-Yildiz, Pelin; Evagorou, Olympia; Fonseca, Ana; Lupatteli, Angela; Radoš, Sandra Nakić; Maach, Nadia Al; Rodríguez-Muñoz, María de la Fe; Žutić, Maja; Berg, Mijke P. Lambregtse–van den

doi:10.1111/acps.13478

Cited by 17 publications

(16 citation statements)

References 45 publications

(120 reference statements)

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“…In Norway, pregnant women with mental disorders are mainly followed-up by their GPs (ie, main prescribing physicians) and in moderate to severe cases, by psychiatric specialists. 37,38 Another of our study's main findings is that the fill trajectories are highly associated with the dose of AD prior to pregnancy, and women using lower doses were more likely to discontinue their treatment. Those results were observed by both the KML modelling on average daily dose and multinomial logistic regression.…”

Section: Interpretationsmentioning

confidence: 77%

Antidepressant Fill and Dose Trajectories in Pregnant Women with Depression and/or Anxiety: A Norwegian Registry Linkage Study

Trinh¹,

Nordeng²,

Bandoli³

et al. 2022

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Background: Few studies investigated longitudinal antidepressant exposure during pregnancy and included dosage in the assessment. Methods: We conducted a nationwide, registry-linkage study in Norway using data on antidepressant prescription fills in pregnancies lasting ≥32 weeks in women with a delivery between 2009 and 2018 who had a depression/anxiety diagnosis and antidepressant fills prior to pregnancy. Information on antidepressant exposure by week (measured by filled prescriptions) and prescribed average daily dose was used in longitudinal k-means trajectory modelling for a 108-week time window from six months prior to pregnancy to one year after delivery. Factors associated with trajectory group membership were examined using multinomial logistic regression models. Results: We included 8,460 pregnancies in 8,092 women. Four antidepressant fill trajectories were identified based on filled antidepressant prescriptions: two distinct discontinuing patterns, one at around the start of pregnancy (30.4%) and one around the end of pregnancy (33.8%); one continuing pattern (20.6%); and one interrupting pattern (15.2%). Using average usual daily dose, we identified low dose discontinuing (60.3%), medium dose reducing (20.6%) and high dose continuing (15.2%) patterns. The multinomial logistic regressions showed that the fill trajectory group membership was strongly associated with: antidepressant type and dose prior to pregnancy and co-medication prior to pregnancy, maternal age, marital status, parity, previous pregnancy loss, and pregnancy planning. Conclusion: Longitudinal trajectory modelling revealed distinct antidepressant fill and dosage patterns in the period around pregnancy. Knowledge about factors associated with utilization trajectories might be useful for health-care personnel counselling women about antidepressant use in pregnancy.

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Section: Interpretationsmentioning

confidence: 77%

Antidepressant Fill and Dose Trajectories in Pregnant Women with Depression and/or Anxiety: A Norwegian Registry Linkage Study

Trinh¹,

Nordeng²,

Bandoli³

et al. 2022

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“…68 Therefore, mental health during crises must be considered a vital public health concern and appropriate care is needed to prevent any negative impact. 69,70 Second, our results suggest the importance of strengthening or introducing programs for preventing and managing perinatal mental health disorders in the post-pandemic era. Clinical practice guidelines on perinatal mental health disorders must consider the impact of the pandemic or public health crisis on mental health 70 and consider special vulnerable groups, such as refugees or minority groups.…”

Section: F I G U R Ementioning

confidence: 83%

Global prevalence of perinatal depression and anxiety during the COVID‐19 pandemic: An umbrella review and meta‐analytic synthesis

Caffieri,

Gómez‐Gómez,

Barquero‐Jimenez

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionThe prevalence of depression and anxiety symptoms in pregnant and postpartum women during the COVID‐19 pandemic was assessed by several systematic reviews (SRs) and meta‐analyses which provided contrasting and different results. We aimed to summarize the evidence relating to the global prevalence of anxiety and depression among pregnant and postpartum women during the COVID‐19 pandemic.Material and methodsAn umbrella review of SRs and meta‐analyses was performed. Searches were conducted in electronic databases up to April 2023. SRs and meta‐analyses reporting the prevalence of perinatal anxiety and depression during the COVID‐19 pandemic were selected for eligibility. Primary studies extracted from eligible meta‐analyses were included in the quantitative synthesis. The research protocol was registered on PROSPERO (CRD42020173125).ResultsA total of 25 SRs (198 primary studies) and 12 meta‐analyses (129 primary studies) were included in the qualitative and quantitative synthesis, respectively. Studies involved data from five continents and 45 countries. The pooled prevalence of antenatal and postpartum depression was 29% (n = 55; 95% CI: 25%–33%) and 26% (n = 54; 95% CI: 23%–30%), respectively. In the case of anxiety, the pooled antenatal and postnatal prevalence was 31% (n = 44; 95% CI: 26%–37%; n = 16; 95% CI: 24%–39%). Differences emerged between continents, with Africa having the highest prevalence of perinatal depression and Oceania and Europe having the highest prevalence of antenatal and postnatal anxiety. The prevalence also varied depending on the assessment tools, especially for antenatal anxiety. A medium‐high quality of the studies was observed. One SR assessed strength‐of‐evidence, reporting very low strength.ConclusionsDuring the COVID‐19 pandemic, depression and anxiety were common, affecting almost one in three perinatal women globally. A high heterogeneity and a risk of publication bias were found, partially due to the variety of assessment tools and cut‐offs. The results may not be generalized to minorities. Studies on the prevalence of clinical diagnoses are needed. Based on our results it is not possible to firmly affirm that the COVID‐19 pandemic was the main factor that directly increased perinatal depression and anxiety during the past few years. Future studies should study other factors' impact.

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“…Research shows that many of the European countries do not report specific clinical recommendations or specific guidelines for managing peripartum depression even for women living under normal conditions. Additionally, the existing guidelines vary a lot in the number and themes of clinical recommendations ( Motrico et al, 2022 ). Therefore, the results from this study could assist The European Union and other nations’ policymakers to Create a set of rules and strategies to help reduce the occurrence of mental health issues during pregnancy and childbirth in the Ukrainian crisis and other potential armed conflicts and war-forced migration to EU countries.…”

Section: Discussionmentioning

confidence: 99%

The impact of the war in Ukraine on the perinatal period: Perinatal mental health for refugee women (pmh-rw) protocol

et al. 2023

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BackgroundThe aim of the Perinatal Mental Health for Refugee Women (PMH-RW) Project is to investigate the impact of the war on perinatal mental health: anxiety, post-traumatic stress, depression, and birth trauma symptoms. It will also evaluate the factors that serve as protective elements for the development of these potential diagnoses (such as personality traits, social support, sociodemographic characteristics, and access to medical/mental health services).MethodAn international observational cohort study with baseline data is being assessed in Ukraine (for internal refugees) and several European Countries (for external refugees). The study includes as participants both pregnant women and those who have recently given birth (with babies up to 1 year old). The assessment includes measures on depression (EPDS), anxiety (GAD-7), experiences during birth (City Birth Questionnaire), post-traumatic stress symptoms [Impact of events scale—revised (PTSD-R)], Personality (10-Item Personality Inventory-TIPI), and a questionnaire for socio-demographic data which also such social support.ConclusionThis study will provide needed information for determining the impact of the Ukrainian Crisis on perinatal mental health by studying potential risk and protective factors. The data collected will be used to inform policymakers with useful information that can be used in the development of plans to protect and promote the mental health of the perinatal refugees impacted by this event. Also, it is our hope that data collected from this study will serve to plant the seeds for further research regarding the impact of the crisis in Ukraine on the offspring and to analyze how these events are affecting further generations.Clinical Trial RegistrationClinicalTrials.gov, Identifier: NCT05654987.

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Clinical practice guidelines with recommendations for peripartum depression: A European systematic review

Cited by 17 publications

References 45 publications

Antidepressant Fill and Dose Trajectories in Pregnant Women with Depression and/or Anxiety: A Norwegian Registry Linkage Study

Antidepressant Fill and Dose Trajectories in Pregnant Women with Depression and/or Anxiety: A Norwegian Registry Linkage Study

Global prevalence of perinatal depression and anxiety during the COVID‐19 pandemic: An umbrella review and meta‐analytic synthesis

The impact of the war in Ukraine on the perinatal period: Perinatal mental health for refugee women (pmh-rw) protocol

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