A closer look at perinatal depression

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Postnatal depression affects around 1 in 10 women and not only impacts on the wellbeing of the mother, but can also have long term impacts on the mental and physical health of the infant.

The authors of this Lancet paper are from the Postpartum Depression: Action Towards Causes and Treatment (PACT) consortium. This is an international group who aim to gather information about PND to explore a number of questions, including whether there are distinguishable subtypes of PND which might be relevant for treatment and prognosis, in particular taking into account comorbid anxiety.

In this post via The Mental Elf, Jill Domoney looks at the methods and results of this paper, the authors of which believe has created “an important hypothesis-generating foundation for future work”.

Full reference to the research: Putman K et al. (2017) Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an International Consortium. Lancet Psychiatry 4(6) 477-485.

A realist review to explore how low-income pregnant women use food vouchers

Ohly H, et al. (2017) BMJ Open. 7:e013731

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Objectives: To explore how low-income pregnant women use Healthy Start food vouchers, the potential impacts of the programme, and which women might experience these impacts and why.

Conclusions: This realist review suggests that some low-income pregnant women may use Healthy Start vouchers to increase their consumption of fruits and vegetables and plain cow’s milk, whereas others may use them to reduce food expenditure and save money for other things.

Read the full article here

Screening tests and early pregnancy scanning leaflets updated

Public Health England has updated and rebranded its leaflets on screening tests and pregnancy scans: 

Screening tests for you and your baby:

This booklet gives information on the screening tests offered during pregnancy and after the baby is born. It is available in English and 12 other languages.

Information about the first trimester scan:

This publication sets out early pregnancy ultrasound scan information which has been updated with rebranded artwork:

  • purpose of the scan
  • what will happen in the scan room
  • procedures for after the scan
  • what happens if a problem is found or suspected
  • what will happen if the scan cannot be completed

Better Beginnings: Improving health for pregnancy

Being healthy is the best start to pregnancy for a woman and child | NIHR

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Image source: NIHR

Preparing for pregnancy can focus attention on health, such as eating a healthy balanced diet or losing excess weight, as well as avoiding risks from smoking, alcohol and drug use. Ensuring the best care for long-term physical and mental health conditions is important for a healthy pregnancy, as well as addressing complex social needs.

Getting the best start in life for children is a UK policy priority, focused on preventing problems and early intervention to improve outcomes. NIHR research evidence into modifiable factors to influence health before, during and after pregnancy is growing and helping to inform policy and practice.

This themed review brings together NIHR research on different aspects of health before, during and after pregnancy. It features:

  • 46 published studies
  • 28 ongoing studies or interim results
  • Questions for clinicians, commissioners, public health professionals and others

Read the full overview here

Read the full report here

Psychosocial interventions for supporting women to stop smoking in pregnancy

The Cochrane Database of Systematic Reviews has published ‘Psychosocial interventions for supporting women to stop smoking in pregnancy’.

Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and is increasing in low- to middle-income countries.

Counselling, feedback and financial incentives appear to reduce the number of women smoking in late pregnancy, however the interventions and the context of the interventions need to be carefully considered. The effect of health education and social support is less clear. Most of the studies were carried out in high-income countries making it difficult to assess if the findings are applicable to other contexts. The intensity of support women received in both the intervention and comparison groups has increased over time. Many of the studies did not provide information on the number of individual women who were eligible for inclusion or were approached to take part in studies, which would have provided useful information about the general acceptability of the interventions and selection bias in the studies. The timing of the final assessment of smoking status during pregnancy also varied considerably among the studies.

The authors concluded that psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight. Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered. The effect of health education and social support is less clear.

Read more here

Imaging for the exclusion of pulmonary embolism in pregnancy

The Cochrane Database of Systematic reviews has published ‘Imaging for the exclusion of pulmonary embolism in pregnancy’.

Pulmonary embolism is a leading cause of pregnancy-related death. An accurate diagnosis in pregnant patients is crucial to prevent untreated pulmonary embolism as well as unnecessary anticoagulant treatment and future preventive measures. Applied imaging techniques might perform differently in these younger patients with less comorbidity and altered physiology, who largely have been excluded from diagnostic studies.

The objectives of the study was to  determine the diagnostic accuracy of computed tomography pulmonary angiography (CTPA), lung scintigraphy and magnetic resonance angiography (MRA) for the diagnosis of pulmonary embolism during pregnancy.

The Authors concluded that  both CTPA and lung scintigraphy seem appropriate for exclusion of pulmonary embolism during pregnancy. However, the quality of the evidence mandates cautious adoption of this conclusion. Important limitations included poor reference standards, necessary assumptions in the analysis regarding inconclusive test results and the inherent inability of included studies to identify false positives. It is unclear which test has the highest accuracy. There is a need for direct comparisons between diagnostic methods, including MR, in prospective randomized diagnostic studies.

Read the report here

Young women who are obese are often unaware of risks to fetus, experts warn

Freer, J. BMJ. 355:i5708

https://www.flickr.com/photos/doublexuan/7381025596

Image source: Jixuan Zhou – Flickr // CC BY-NC-SA 2.0

Young women who are overweight or obese are often unaware of being on a health trajectory that can cause biological risks to be passed on to unborn children, experts have warned.

An expert panel hosted by the Parliamentary Office of Science and Technology on Wednesday 19 October highlighted the increase in morbidity related to excess weight among mothers and their children over the past 10 years and the overwhelming evidence of health risks being passed from mother to child.

The panel—Lucilla Poston, head of the women’s health division at King’s College London, Mark Hanson, director of the University of Southampton’s Institute of Developmental Sciences, and Emma Reed, deputy director of the childhood obesity branch at the Department of Health for England—concluded that earlier nutritional interventions were needed for overweight and obese women in the United Kingdom.

Read the full article here