Post-Traumatic Stress Disorder and Pregnancy

Data of 71,504 women veterans showed that women veterans with any mental health diagnosis also had a significantly higher prevalence of sexually transmitted infections, other infections (e.g., urinary tract infections), sexual pain-related conditions, and symptoms related to reproductive health, including polycystic ovarian syndrome, infertility, and sexual dysfunction. Reproductive health problems were especially correlated with women with Post-Traumatic Stress Disorder (PTSD), Major-Depressive Disorder (MDD). (Cohen, B.E., Maguen, S., Bertenthal, D., Shi, Y., Jacoby, V., & Seal, K.H. (2012). Reproductive and other health outcomes in Iraq and Afghanistan women veterans using VA health care: Association with mental health diagnosis. Women’s Health Issues, 22(5), 461-471.)

http://www.sciencedirect.com/science/article/pii/S1049386712000540

“One has to live in the present. Whatever is past is gone beyond recall; whatever is future remains beyond one’s reach, until it becomes present. Remembering the past and giving thought to the future are important, but only to the extent that they help one deal with the present.”
- S.N. Goenka

“If you don’t design your own life plan, chances are you’ll fall into someone else’s plan.”
- John Rohn

A study of 7,247 US fathers found paternal depression was associated with poverty, living with a child with special needs, poor paternal health, paternal unemployment, and maternal depression which was the highest predictor of paternal depression. (Rosenthal, D.G., Learned, N., Liu, Y.H., & Weitzman, M. (2012). Characteristics of Fathers with Depressive Symptoms.  Maternal Child Health Journal. [Epub ahead of print].  http://www.womensmentalhealth.org/posts/depression-in-fathers-toward-a-better-understanding-of-its-impact-on-the-child/

HealthDay (11/8, Dotinga) reports that according to a study in Pediatrics, “children of fathers who seem depressed are more likely to show signs of behavioral and emotional problems.” After examining “results of surveys of nearly 22,000 US children aged five to 17 and of their mothers and fathers,” researchers also found that children “whose parents both seem depressed are at particularly high risk.”

The Los Angeles Times (12/5, Roan) discusses “a sudden-onset mental illness…diagnosed as pediatric autoimmune neuropsychiatric disorder associated with streptococcus, or PANDAS. The puzzling name describes children who have obsessive-compulsive disorder that occurs suddenly — and often dramatically — within days or weeks of a simple infection, such as strep throat.”  Studies are reinforcing the belief that some psychiatric illnesses can be triggered by ordinary infections and the body’s immune response.”  Research raises the possibility that some mental illness might be cured by treating the immune system dysfunction.”

Researchers in the Netherlands studied 202 middle-aged and older adults who had moderate depressive symptoms. The therapy involved a structured review of the participant’s life, a focus on coping with past negative experiences and conflicts, retrieving positive memories, and finding positive meaning to life. The patients were encouraged to develop alternative life stories.  Life review therapy was significantly superior to treatment as usual in reducing depressive symptoms posttreatment and at 3 months follow-up; improvement persisted at 9 months follow-up. This intervention, with its focus on integrating past experiences, meaning, values, and self-efficacy, is a promising treatment for early, mild-to-moderate depression in middle-aged and older adults.
— Deborah Cowley, MD
Published in Journal Watch Psychiatry November 7, 2011

“Making others happy, through kindness of speech and sincerity of right advice, is a sign of true greatness. To hurt another soul by sarcastic words, looks, or suggestions, is despicable.”
- Paramahansa Yogananda

BBC News (10/27) reports, “Parents who joke and pretend with their children are giving them a head start in life,” according to the UK’s Stirling University.  Both activities are important in building social and life skills children need and demonstrated that “pretending and joking are two very different things and that children as young as two can tell them apart.”

“Don’t let the past steal your present”
- Cherralea Morgen

Rates of PTSD are higher in pregnant women than non-pregnant women.  Beck (2011), found in a nationwide study of 1,373 postpartum women that 9% met diagnostic criteria for PTSD while 18% had significantly elevated symptoms.  The unique psychological and physical aspects of pregnancy may exacerbate PTSD.  For women who have PTSD related to childhood abuse, preparing to become a parent can carry complex feelings and worsen anxiety.  Physical changes during pregnancy or prenatal care could trigger symptoms in women with a history of sexual abuse.  Seng investigated perinatal outcomes for 839 women with and without PTSD. infants born to mothers with PTSD had a lower mean birth weight than infants in the trauma-exposed group without PTSD or the group without a trauma history.  Additionally, Smith(2006), found that women with active PTSD symptoms in pregnancy were more likely to engage in poor health behaviors, including substance use, which may impact infant outcomes.

Research has highlighted that there are many blind spots in self-knowledge and these blind spots can have fairly negative consequences.  The construct of mindfulness, defined as paying attention to one’s current experience in a nonevaluative way, may serve as a path to self-knowledge.  Mindfulness addresses barriers to self-knowledge: informational barriers (i.e., the quantity and quality of information people have about themselves) and motivational barriers (i.e., ego-protective motives that affect how people process information about themselves).  Non-judgmental observation of one’s thoughts, feelings, and behavior reduce emotional reactivity — such as feelings of inadequacy or low self-esteem — that typically interferes with people seeing the truth about themselves.

Researchers have found that focused, nonjudgmental attention on current experiences, thoughts, and behaviors can increase awareness and self-knowledge, and reduce negative emotional reactivity. Previous research has also shown that mindfulness training is associated with positive mood and greater physical awareness. (Carlson, E. (2013). Overcoming the barriers to self-knowledge: Mindfulness as a path to seeing yourself as you really are. Perspectives on Psychological Science, 8(2), 173-186.)

http://pps.sagepub.com/content/8/2/173

HealthDay (10/5, Salamon) reports that according to a study published in Translational Psychiatry, “it appears that kids unlucky enough to get a ‘downer’ personality gene can end up with sunnier outlooks when they’re parented in a warm, positive manner.” Researchers concluded this after studying “nearly 1,900 children aged nine through 15″ carrying “a shortened version of the 5-HTTLPR gene, which…has been linked in prior research to anxiety and depression” by predisposing carriers “to lower serotonin levels in the brain.” Conversely, “‘genetically susceptible’ children who experienced unsupportive parenting showed fewer positive emotions.”

“All children are artists. The problem is how to remain an artist once he grows up.”
- Pablo Picasso

“Nothing is likely to help a person overcome or endure troubles than the consciousness of having a task in life.”
- Victor Frankl

HealthDay (12/3, Preidt) reported, “First-time mothers and fathers have a tougher time adapting to their new roles if they believe society expects them to be perfect parents,” according to a study in the Journal Personality and Individual Differences. After looking “at 182 couples who became parents between 2008 and 2010,” researchers found that mothers had less confidence and fathers felt more stress when worried about what others thought of their parenting skills.

A study of 21,993 children revealed that paternal depression was associated with increased emotional and behavioral problems in children. Maternal depression suggested a threefold increase of these same symptoms when compared with fathers.  Twenty-five percent of child participants had behavioral or emotional problems if both parents were depressed.  (Rosenthal, D.G., Learned, N., Liu, Y.H., & Weitzman, M. (2012). Characteristics of Fathers with Depressive Symptoms.  Maternal Child Health Journal. [Epub ahead of print]. http://www.womensmentalhealth.org/posts/depression-in-fathers-toward-a-better-understanding-of-its-impact-on-the-child/

Children (n= 320) who felt their lives had meaning and who described more depth and quality in their relationships reported feeling happier.  Religious practices alone had little impact on happiness ratings (Nauert, 2009, Journal of Happiness Studies)

“Logic will get you from A to B. Imagination will take you everywhere.” – Albert Einstein

Mothers who exclusively breastfed were more likely to emotionally bond with their infant during the first few months.  Breastfeeding mothers had greater neurological responses in brain regions related to empathy and care giving behavior when their infants cried compared to mothers who used formula.  Mothers who do not breastfeed may benefit from being aware of this natural tendency and compensate by finding other ways to engage in sensitive, caring interactions .   (Wiley-Blackwell. “Breastfeeding tied to stronger maternal response to baby’s cry.” ScienceDaily, 21 Apr. 2011. Web. 24 Mar. 2013.).  http://www.sciencedaily.com/releases/2011/04/110420111334.htm

Some 1300 women completed depression assessments during pregnancy and through 12 months postpartum. Nearly 40% of women who experience depression in the 12 months after childbirth also suffer from intimate partner violence, according to the British Journal of Obstetrics and Gynaecology. The authors emphasize the importance of assessing mental health regularly throughout the 12 months after childbirth. Intimate partner violence “may be an important factor for health professionals to consider” when treating women with postpartum depression.

BJOG article (Free abstract)

Journal Watch Psychiatry summary of 2010 study showing link between intimate partner violence during pregnancy and postpartum depression

Researchers in Sweden compared data on antenatal care and delivery method for 353 women who received psychological counseling for fear of childbirth with data for 579 women with no such fear.  They found that 16.5% of those who had fear of childbirth had cesarean delivery (CD), while 9.6% of nonfearful women did. The study (pdf) was published in Acta Obstetricia et Gynecologica Scandinavica.

A study of 2,856 women found that those who reported:  disliking breastfeeding, pain from breastfeeding, and who had more breastfeeding difficulties in the first two weeks were significantly more likely to suffer postpartum depression.  University of North Carolina School of Medicine. (“Mothers with breastfeeding difficulties more likely to suffer postpartum depression, study finds.” ScienceDaily, 19 Jul. 2011. Web. 24 Mar. 2013.). http://www.sciencedaily.com/releases/2011/07/110719111538.htm

“Change is not pleasant, but change is constant. Only when we change and grow, we’ll see a world we never know.”
- From Wisdom of The Orange Woodpecker

HealthDay (10/7, Dotinga) reports that according to a study published online Oct. 3 in the Archives of General Psychiatry, ” …long-term psychotherapies may do a better job than an antidepressant in preventing post-traumatic stress disorder (PTSD) following a traumatic event.” In a study of 242 people who had recently suffered from a traumatic event and who were experiencing severe stress, researchers discovered that “between 21 percent and 23 percent of the participants in the groups that got psychotherapy developed PTSD, while 42 percent and 47 percent of those who took the drug or placebo, respectively, developed symptoms.”

“Be present – it is the only moment that matters.”
- Peaceful Warrior

Attitudes of Canadian mothers (n= 140) requesting caesarean delivery were studied.  The four factors that best predicted attitudes of maternal caesarean upon request included fears about vaginal birth, thinking caesarean delivery was less stressful than vaginal delivery; believing vaginal birth had more negative maternal consequences, and a positive attitude of peers.

http://www.ncbi.nlm.nih.gov/pubmed/23094499

HealthDay (12/3, Preidt) reported, “Major depression and conflicts with intimate partners increase the risk of suicide among pregnant women and new mothers,” according to a study in the journal General Hospital Psychiatry, after analyzing data on “2,083 suicides among women aged 15 to 54.”

Delayed umbilical cord clamping results in better iron status for the infant than does immediate clamping, a BMJ study concludes. The researchers calculate that delayed cord clamping of 20 infants would prevent one case of iron deficiency. An editorialist reminds readers that delayed clamping allows “placental transfusion,” which increases the total blood volume by almost a third. He concludes that the study “is convincing enough to encourage a change of practice.”
BMJ article (Free)
BMJ editorial (Subscription required)

Fetuses exposed to high levels of the stress hormone, cortisol, did not show the usual negative developmental effects if the mother provided sensitive and nurturing care.  Infants who were securely attached to their mothers did not suffer from the impact of this stress hormone.  Any link between high prenatal cortisol exposure and delayed cognitive development was eliminated.  Infants exposed to high levels of stress and who had insecure attachments with their mothers were impacted negatively (University of Rochester Medical Center. “Good parenting triumphs over prenatal stress.” ScienceDaily, 26 Feb. 2010. Web. 24 Mar. 2013).  http://www.sciencedaily.com/releases/2010/02/100225140906.htm

Mothers who experienced inter-partner psychological abuse but who frequently and affectionately stroked their infants were significantly less depressed than mothers  who experienced partner psychological abuse but who did not stroke their infants often.  (Sharp H, Pickles A, Meaney M, Marshall K, Tibu F, et al. (2012) Frequency of Infant Stroking Reported by Mothers Moderates the Effect of Prenatal Depression on Infant Behavioural and Physiological Outcomes. PLoS ONE 7(10): e45446. doi:10.1371/journal.pone.0045446).

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0045446

“Be as simple as you can be; you will be astonished to see how uncomplicated and happy your life can become.”
- Paramahansa Yogananda

Women who received strong social support from their families during pregnancy did not manifest sharp increases in a stress hormone, protecting them rom developing postpartum depression.  This was not true for women with poor social support from their families.  (Association for Psychological Science. “Stress hormone foreshadows postpartum depression in new mothers.” ScienceDaily, 4 Mar. 2013. Web. 24 Mar. 2013.)  http://www.sciencedaily.com/releases/2013/03/130304161623.htm

Physical contact between mother and infant after birth, including rooming together after labor, helps strengthen their bond and supports breastfeeding in the short term.  Mothers who remained close to their infant were more likely to breastfeed up to six months,  (Health Behavior News Service, part of the Center for Advancing Health. “Keeping mom and baby together after delivery beneficial.” ScienceDaily, 13 Sep. 2012. Web. 24 Mar. 2013. http://www.sciencedaily.com/releases/2012/09/120913173028.htm

Columbia University School of Nursing found that female participants who preferred home birth with a midwife more often viewed themselves as active and engaged in their delivery and desired a collaborative role with their healthcare provider.  Participants who feared a painful delivery and viewed their role more passively were more likely to prefer a caesarean delivery, an in-hospital delivery, and pain medication.  Female perceptions of their role in delivery and the role of healthcare predicts delivery.  Arcia, A. US nulliparas’ perceptions of roles and of the birth experience as predictors of their delivery preferences. Midwifery Journal. Published online on February 13, 2013. doi:10.1016/j.midw.2012.10.002

http://www.midwiferyjournal.com/article/S0266-6138%2812%2900182-9/abstract

Reuters (11/14) reports that, according to a study at the American Heart Association meeting, women who experienced abuse early in life may face a higher likelihood of heart problems as adults.  HealthDay (11/14, Dallas) reports that the researchers found that “women who were repeatedly raped as children or teenagers were at 62 percent higher risk for heart disease.” Participants “who suffered severe physical abuse as children or teens had a 45 percent increased risk for heart disease.”

A study of ten thousand women found depression in 14% of mothers.  Among these participants, 40.1% experienced postpartum depression, 33.4% experienced depression while pregnant, and 26.5% experienced depression before pregnancy and 19.3% expressed thoughts of self-harm. Nearly 66% had a comorbid anxiety disorder and 22.6% met diagnostic criteria for bipolar disorder.  Younger, publicly insured, less educated, single, and African-American women were more likely to meet criteria for depression.  Wisner, K., Sit, D., McShea, M., Rizzo, D., Zoretich, R., Hughes, C., … & Eng, H. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry. 1-9. Published online March 13, 2013. doi:10.1001/jamapsychiatry.2013.87.

http://archpsyc.jamanetwork.com/article.aspx?articleid=1666651

“Every person, especially every woman, should be alone sometime during the year, some part of each week, and each day.”
- Anne Morrow Lindberg

Women who experienced severe pain during their first 2 weeks of breast-feeding were twice as likely to be depressed by 2 months postpartum as were mothers who experienced no pain with early breast-feeding.
Mothers who received lactation support for moderate or severe pain with early breast-feeding were significantly less likely to develop postpartum depression than were those who did not receive lactation support.
— Eleanor Bimla Schwarz, MD, MS
Published in Journal Watch Women’s Health August 18, 2011

A study of 2,206 women found those with more fear of childbirth experienced longer labors, more vaginal instrumental deliveries, and more cesarean sections.   Although women with a fear of labor but who had the intention of birthing vaginally were still more likely to deliver vaginally than women without fear (Adams, Eberhard-Gran, Eskild. 2012, BJOG: An International Journal of Obstetrics & Gynecology).

“Your work is to discover your work and then, with all your heart, to give yourself to it.”
- Buddha

Homicide and suicide during pregnancy account for more maternal deaths than do obstetric causes.  Pregnancy-associated violent death — often a tragic result of conflict with an intimate partner — is an important cause of maternal death.
— Allison Bryant, MD, MPH
Published in Journal Watch Women’s Health December 8, 2011

A study analyzed the emotional impact and stress factors for 445 women who had difficulty conceiving. About a third reported anxiety as soon as they tried to get pregnant, half reported feeling ashamed and “like a failure” as a woman, and 68% reported they never imagined they would have trouble conceiving. Participants going through fertility treatment reported anxiety around injections, sex, and negative emotions, and feared their relationship would deteriorate.  However, women who received treatment reported greater closeness to their partner (33% vs. 19%) and most participants felt their partner supported them, especially those receiving fertility therapy (63%).

Plataforma SINC. “Fear of treatment puts stress on women undergoing fertility therapy.” ScienceDaily, 3 Oct. 2012. Web. 24 Mar. 2013. http://www.sciencedaily.com/releases/2012/10/121003111151.htm