Mood disorder seen in 1 in 200 new moms with no psychiatric history

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By Dennis Thompson
HealthDay Reporter

TUESDAY, Sept. 26, 2017 (HealthDay News) -- Women who have suffered from postpartum depression are more likely to go through it again after subsequent pregnancies, a new Danish study shows.

Postpartum depression occurs 27 to 46 times more frequently during subsequent pregnancies for mothers who experienced it after their first birth, researchers report.

These results show that women who have had postpartum depression in the past should prepare themselves if they get pregnant again, said lead researcher Marie-Louise Rasmussen, an epidemiologist with Statens Serum Institut in Copenhagen.

Antidepressants or psychotherapy could help cushion the blow or even head off postpartum depression, Rasmussen said.

"In theory, psychotherapy is preferred but not always sufficient and not always available. Often, the general practitioner has to add antidepressant medication," Rasmussen said. "Social support from the spouse and surroundings is also very important."

In most cases, women can expect to shake off their postpartum depression within a year, the researchers found.

"Based on this data, we would think for most women who receive treatment, their depression should be treated and resolved in six months or less," said Dr. James Murrough. He's director of the mood and anxiety disorders program at the Icahn School of Medicine at Mount Sinai in New York City.

Postpartum depression generally takes hold of a new mother within days of delivery, although sometimes depression develops during pregnancy, according to the U.S. National Institute of Mental Health.

Brain chemistry changes caused by post-delivery hormone fluctuations are a contributing cause of postpartum depression, along with the sleep deprivation experienced by most new parents, NIMH says.

Signs of postpartum depression can include feelings of sadness and hopelessness, frequent crying, anxiety or moodiness, changes in sleeping or eating patterns, difficulty with concentration, anger or rage, and loss of interest in activities that are usually enjoyable, according to the mental health institute.

A new mother with postpartum depression also might withdraw from friends or family and have difficulty forming an emotional attachment to her baby.

Rasmussen and her colleagues undertook this study to provide women facing pregnancy with better estimates of their overall risk of postpartum depression.

"Postpartum depression is a disease depriving families of a time period that should be filled with affinity, love and bonding," Rasmussen said. "Especially for women with no prior experience with psychiatric disease, this must come as a bolt out of the blue."

The researchers analyzed data from Danish national registries on more than 457,000 women who delivered their first child between 1996 and 2013 and had no prior medical history of depression.

They reviewed medical records for signs of postpartum depression -- specifically whether these women filled an antidepressant prescription or sought treatment for depression within six months after giving birth.

About 1 in every 200 women experienced postpartum depression, the researchers found.

But within a year of seeking care, only 28 percent of these women were still being treated for depression, the results showed. And four years later, that number was 5 percent.

The risk of postpartum depression in subsequent births was 15 percent for women who took antidepressants following their first birth and 21 percent for women who sought depression treatment at a hospital. That amounts to a 27 and 46 times higher risk than for women who didn't experience depression during their first pregnancy, the researchers said.

"The episodes were characterized by a relatively short treatment duration, yet a notably higher rate of later depression and recurrent episodes of postpartum depression," Rasmussen said.

The higher risk for women who've already experienced postpartum depression "suggests that there's some underlying vulnerability to develop depression in these particular individuals," Murrough said. "Basically, it's not random. If you had it before, you could have it again."

Murrough and Rasmussen urged pregnant women to discuss the risk of postpartum depression with their doctor, particularly if they suffered it before.

"It's not clear that's discussed often in standard practice, amazingly," Murrough said.

The new study was published Sept. 26 in the journal PLOS Medicine.

More information

For more on postpartum depression, visit the U.S. National Institute of Mental Health.

SOURCES: Marie-Louise Rasmussen, epidemiologist, Statens Serum Institut, Copenhagen, Denmark; James Murrough, M.D., director, Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York City; Sept. 26, 2017, PLOS Medicine

Last Updated: Sep 26, 2017

Copyright © 2017 HealthDay. All rights reserved.

Action Points

A prophylactic, postoperative course of antibiotics with cephalexin (Keflex) and metronidazole (Flagyl) reduced rates of surgical site infection (SSI) in obese women undergoing cesarean delivery, a randomized clinical trial found.

Thirty days after C-section delivery, the rate of SSI was 6.4% in the treatment group versus 15.4% in the placebo group (between group difference 9%, 95% CI 2.9%-15%, P=0.01), reported Carri Warshak, MD, of the University of Cincinnati College of Medicine in Ohio, and colleagues.

The relative risk of SSI was reduced by 59% in the treatment group versus the placebo group (RR 0.41, 95% CI 0.22-0.77, P=0.01), they wrote in the Journal of the American Medical Association.

C-section deliveries are the most frequently performed surgeries in the U.S., Warshak's group said. Approximately 1.3 million were performed in 2010. Previous research has shown that 3% to 12% of all C-section deliveries are complicated by surgical site infections, and that infection risk increases with increasing maternal weight, they said.

"Obesity is an independent risk factor for SSI despite recommended preoperative antibiotic regimens. Limited studies have addressed optimal antibiotic regimens for the prevention of SSI among obese women," the investigators wrote. "Various postpartum antibiotic combinations and durations have been studied with conflicting benefit, but no studies have specifically addressed the obese population.

"This study was the first to our knowledge to evaluate the use of a prophylactic postcesarean course of cephalexin-metronidazole for prevention of SSI in an obese population," they said. "Cephalexin and metronidazole have high oral bioavailability and pharmacoeconomic advantages and are generally well tolerated, supporting the drug combination as a choice for postpartum prophylactic coverage."

Anatomic factors associated with obesity, such as skin folds and increased tissue pressure, or the bioactive qualities of adipose tissue, which secretes hormones, chemokines, and cytokines, may be why obesity increases SSI risk, the investigators said.

The single-center, double-blind study enrolled 403 pregnant women with a BMI≥ 30 and a final plan for C-section delivery. They were enrolled from October 2010 through December 2015 and followed through February 2016. Their mean age was 28 and mean BMI was 39.7.

Study participants were randomly assigned to receive oral cephalexin, 500mg, and metronidazole, 500mg (n=202), versus an identical-appearing placebo (n=201) every 8 hours for a total of 48 hours following C-section delivery. The primary outcome was SSI, defined as any superficial incisional, deep incisional, or organ/space infections within 30 days after C-section delivery.

All participants received 2 g of intravenous cefazolin (Ancef, Kefzol) prior to surgery, which was the standard of care at the time of the study. The overall SSI rate in the study was 10.9% (95% CI 7.9%-14%). No serious adverse events were reported in the treatment or placebo groups, the investigators said.

Cellulitis was the only secondary outcome significantly reduced with prophylactic antibiotics, Warshak's group reported. Cellulitis occurred in 12 participants in the treatment group (5.9%, 95% CI 2.7%-9.2%) versus 27 in the placebo group (13.4%, 95% CI 8.9%-18.2%). The mean difference was 7.5% (95% CI 1.7%-13.0%). The relative risk was 0.44 (95% CI 0.23-0.84). There were no significant differences between treatment and placebo for other secondary outcomes, including rates of incisional morbidity, fever of unknown etiology, wound separation, or endometritis.

In an accompanying editorial, David Calfee, MD, and Amos Grünebaum, MD, both of Weill Cornell Medicine in New York City, agreed with the authors' conclusions. "The results of this study suggest that a 2-day course of oral cephalexin and metronidazole after cesarean delivery may be an effective strategy to prevent postcesarean SSI among obese women," they wrote.

However, Calfee and Grünebaum added several caveats. "When determining if and how the results of this study should alter current clinical practice, it is important to recognize that the results of this study are quite different from those of several previous studies conducted in other surgical patient populations in which no benefit from postoperative antimicrobial prophylaxis was found and on which current clinical guidelines for antimicrobial prophylaxis are based," they wrote. "The explanation for this difference may be as simple as the identification in the current study of a very specific, high-risk group of patients for which the intervention is effective."

"However, several questions are worthy of additional consideration and study," they said. "For example, were glycemic control, maintenance of normothermia, and preoperative bathing routinely implemented? Would the same benefit be seen among obese women who receive a higher preoperative dose of cefazolin (ie, 3 g), as recommended in current clinical practice guidelines?"

Both the editorialists and the authors said a chief study limitation was its single-center design, which raises the possibility of site-specific confounders, so that the results might not be generalizable to other obstetric practices.

The study was funded by the University of Cincinnati Department of Obstetrics and Gynecology.

Warshak and co-authors disclosed no relevant relationships with industry.

Calfee disclosed support from Merck, Sharpe, and Dohme.

• Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

• Primary Source

  Journal of the American Medical Association

  Source Reference: Valent AM, et al "Effect of post-cesarean delivery oral cephalexin and metronidazole on surgical site infection among obese women: a randomized clinical trial" JAMA 2017;318:1026-1034; DOI:10.1001/jama.2017.10567.

• Secondary Source

  Journal of the American Medical Association

  Source Reference: Calfee DP and Grünebaum A "Postoperative antimicrobial prophylaxis following cesarean delivery in obese women: An exception to the rule?" JAMA 2017; 318:1012-1013.

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Rubin KH, et al. J Clin Endocrinol Metab. 2017;doi:10.1210/jc.2017-01354.

August 31, 2017

Women with polycystic ovary syndrome are four times more likely to develop type 2 diabetes compared with women without the syndrome, and the increased risk may be associated with BMI, insulin and glucose levels, according to a study of women in Denmark.

“Many women with PCOS are obese, but the risk for the development of diabetes in PCOS is unknown,” Dorte Glintborg, MD, PhD, of the department of endocrinology at Odense University Hospital, said in a press release. “In this study, we found that the risk of developing diabetes is four times greater and that diabetes is diagnosed 4 years earlier in women with PCOS compared to controls.”

Glintborg and colleagues evaluated data on women with PCOS from the National Patient Register (PCOS Denmark; n = 18,477) including a subgroup of women with PCOS examined at Odense University Hospital, as well as three age-matched controls per participant (n = 54,680). Researchers sought to determine the risk for development of type 2 diabetes in women with PCOS and whether age, number of births and prescriptions for oral contraceptives modify the effects. Median follow-up was 11.1 years.

Participants in PCOS Denmark were more likely to develop type 2 diabetes than controls (HR = 4; 95% CI, 3.7-4.3), and the risk remained elevated when gestational diabetes was excluded from analysis (HR = 3.5; 95% CI, 3.2-3.8).

Prescriptions for oral contraceptives were associated with a higher risk for type 2 diabetes (HR = 1.4; 95% CI, 1.3-1.6); however, oral contraceptives were not associated with type 2 diabetes when gestational diabetes was excluded from the analysis. The risk for type 2 diabetes was decreased with higher numbers of births.

Participants in PCOS Denmark were younger than controls at type 2 diabetes diagnosis (median age, 31 years vs. 35 years; P < .001); similarly, more participants were younger than 40 years in PCOS Denmark compared with controls (82% vs. 66%; P < .001).

Compared with controls who developed type 2 diabetes, participants in PCOS Denmark who developed diabetes had a lower prevalence of oral contraceptive prescriptions, higher prevalence of metformin prescriptions and a lower number of births.

BMI, HbA1c, fasting blood glucose, 2-hour blood glucose, homeostasis model assessment of insulin resistance and triglyceride values were positively associated with type 2 diabetes development in multiple regression analyses.

“The increased risk of developing [type 2 diabetes] in PCOS is an important finding,” Glintborg said. “Diabetes may develop at a young age, and screening for diabetes is important, especially in women who are obese and have PCOS.” – by Amber Cox

Disclosures: The authors report no relevant financial disclosures.

August 31, 2017 – The U.S. Preventive Services Task Force posted today a final research plan on screening for syphilis infection in pregnant women. The draft research plan for this topic was posted for public comment from June 8, 2017 to July 5, 2017. The Task Force reviewed all of the comments that were submitted and took them into consideration as it finalized the research plan. To view the final research plan, please go to https://www.uspreventiveservicestaskforce.org/Page/Document/final-research-plan/syphilis-infection-in-pregnancy-screening1.

AMIGAS is a bilingual educational outreach intervention designed to help promotoras (community health workers) and other lay health educators increase cervical cancer screening among Hispanics who have rarely or never had a Pap test. Updated materials are now available for download.

For many women, the side effects of menopause don't call it a day when they do.

Between 40 and 60 percent of women in perimenopause and early menopause face issues with sleep because of this physical change. The majority also report hot flashes and night sweats, which can be disruptive to falling and staying asleep.

A new study published in Menopause: The Journal of The North American Menopause Society has found that low-dose hormone therapy may be effective in easing sleep issues in this population. The goal of the study was twofold: find out how two forms of hormone therapy affect sleep quality and assess the ties between hot flashes, sleep quality and hormone therapy.

"Poor sleep quality over time affects more than just mood," says Virginia Miller, Ph.D., director of Mayo Clinic's Women's Health Research Center and the study's corresponding author. "Sleep deprivation can lead to cardiovascular disease, among other health risks. There can be serious consequences -- mental and physical -- if you're not getting quality sleep over a long period of time."

The study looked at two forms of hormone therapy -- oral estrogen (conjugated equine estrogen) and a patch (17 beta-estradiol) -- to find out how their use affected sleep quality. The participants were part of the Kronos Early Estrogen Prevention Study, and all were recently menopausal women. The women self-reported on the quality of their sleep using the Pittsburgh Sleep Quality Index. They also recorded the intensity of hot flashes and night sweats during this time.

The women were found to have improved sleep quality over four years when using low-dose hormone therapy -- twice the improvement of those in the placebo group.

Researchers also found that sleep quality improved with changes in hot flashes and night sweats, but Dr. Miller says it remains difficult to determine if the low sleep quality is caused by these symptoms or if they are a consequence of poor sleep.

"Menopause affects such a large portion of the population, so it is important to keep researching how we can best promote a woman's overall health during this phase in her life," says Dr. Miller.

Source:

https://newsnetwork.mayoclinic.org/discussion/study-finds-hormone-therapy-improves-sleep-quality-for-recently-menopausal-women/

(Reuters Health) - For women, greater access to primary care providers may be linked to a lower risk of sexually transmitted infections (STIs), a U.S. study suggests.

“A lack of health care access can translate to more people with undiagnosed and untreated STIs,” said lead study author Danielle Haley of the University of North Carolina at Chapel Hill.

“Regular screening can help ensure that people who have an STI are aware of the infection and get proper treatment,” Haley said by email. “Screening also helps identify and treat sex partners who may also have STIs.”

Haley’s team examined data on 666 women in five southern states (Alabama, Florida, Georgia, Mississippi and North Carolina) who joined a study about HIV.

Overall, these women typically lived in communities where about 74% of residents had primary care providers, the study team reports in Sexually Transmitted Diseases, online August 2.

Women were 43 years old on average, and 71% were HIV-positive when they joined the study between 2013 and 2015; the vast majority were black.

Overall, about 11% of the women had at least one STI confirmed in lab tests.

After accounting for insurance and individual patient characteristics, each four-percentage-point increase in neighborhood residents with primary care providers was associated with 39% lower odds that women would have an STI.

Researchers didn’t find an association between women’s odds of having a STI and the proportion of residents in their communities who had health insurance.

Access to primary care influenced the odds of STIs regardless of socioeconomic status, the study also found.

One limitation of the study is that it was too small to tell how access to care influenced the odds of specific STIs, only the overall chances that women might get at least one STI, the authors note. Because so many of the participants were HIV-positive and had agreed to be part of a long-term study, their odds of STIs also might not be the same as those of other women.

Even so, the findings underscore the importance of routine checkups, said Dr. William Miller, a public health researcher at the Ohio State University in Columbus who wasn’t involved in the study.

“They should see their physician regularly and talk about their sex life with the physician, even if the physician doesn’t bring it up,” Miller said by email.

Women still have options if they lack insurance or a primary care provider, Miller added. Many county and city health departments provide STI screenings and treatment, as do nonprofit clinics.

And they shouldn’t forget prevention.

“To protect themselves, it’s still all about condoms, a message that has been lost a bit in recent years,” Miller said.

Each year, an estimated 20 million new STIs occur in the U.S. alone, half among young people ages 15 to 24, according to the Centers for Disease Control and Prevention.

SOURCE: bit.ly/2vgvpCF

Sex Transm Dis 2017.

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