Oxytocin: physiology, pharmacology, and clinical application for labor management.

Oxytocin is a peptide hormone that plays a key role in regulating the female reproductive system, including during labor and lactation. It is produced primarily in the hypothalamus and secreted by the posterior pituitary gland. Oxytocin can also be administered as a medication to initiate or augment uterine contractions. To study the effectiveness and safety of oxytocin, previous studies have randomized patients to low- and high-dose oxytocin infusion protocols either alone or as part of an active management of labor strategy along with other interventions. These randomized trials demonstrated that active management of labor and high-dose oxytocin regimens can shorten the length of labor and reduce the incidence of clinical chorioamnionitis. The safety of high-dose oxytocin regimens is also supported by no associated differences in fetal heart rate abnormalities, postpartum hemorrhage, low Apgar scores, neonatal intensive care unit admissions, and umbilical artery acidemia. Most studies reported no differences in the cesarean delivery rates with active management of labor or high-dose oxytocin regimens, thereby further validating its safety. Oxytocin does not have a predictable dose response, thus the pharmacologic effects and the amplitude and frequency of uterine contractions are used as physiological parameters for oxytocin infusion titration to achieve adequate contractions at appropriate intervals. Used in error, oxytocin can cause patient harm, highlighting the importance of precise administration using infusion pumps, institutional safety checklists, and trained nursing staff to closely monitor uterine activity and fetal heart rate changes. In this review, we summarize the physiology, pharmacology, infusion regimens, and associated risks of oxytocin.

Thyroid Predictors of Postpartum Mood Disorders.

Postpartum mood disorders (PMD) are currently among the leading causes of maternal postpartum morbidity and mortality. PMD include the conditions of postpartum blues (PB), postpartum depression (PPD), and postpartum psychosis. The pathogenesis of PMDs are ambiguous, and there are no reliable prenatal predictive markers despite current research efforts. Even though reliable indicators have not been found, leading ideas suggest an etiology of hormonal fluctuations. Although thyroid markers have long been linked to psychiatric disorders such as major depressive disorder (MDD), how they correlate with PMDs is still unclear. This study aimed to evaluate the pathophysiological link between thyroid function, PMDs, and the usefulness of thyroid markers as indicators of their occurrence and severity. The methodology consisted of a narrative literature review. Several inclusion and exclusion criteria were used to filter the results of literature searches in PubMed. Studies were included if they discussed any marker related to thyroid endocrinology in relation to the incidence or pathophysiology of any PMD. Both primary and secondary analyses were included. The permissive inclusion criteria were used due to the relative scarcity of research on the topic and the ambiguous pathophysiology of PMD. The results demonstrated the potential utility of thyroid autoimmunity as a predictor of late-onset PPD. Hypothyroidism, low euthyroid hormone levels, and the presence of thyroid autoantibodies were correlated with increased incidence of PPD and late postpartum depressive symptoms, past the timeline of PB. Most notably a rapid postpartum drop in cortisol level may precipitate thyroid autoimmunity in anti-thyroid peroxidase (TPO) antibody positive women, which could eventually produce a hypothyroid phase associated with depressive symptoms. There was insufficient evidence to suggest a relationship with postpartum psychosis. In conclusion, the exact pathophysiological mechanisms of PMDs remain ambiguous, but TPO-antibodies in the third trimester may be a predictor of late PPD.

A Comprehensive Review of Motherhood and Mental Health: Postpartum Mood Disorders in Focus.

The journey of motherhood encompasses a profound array of emotions, experiences, and challenges that extend beyond the surface of joy and elation. This review delves into the crucial yet often underexplored realm of postpartum mood disorders, aiming to illuminate their significance and foster understanding. Postpartum mood disorders, including postpartum depression, anxiety disorders, and psychosis, impact the mental well-being of mothers during a pivotal phase of their lives. Through a comprehensive exploration, this review elucidates the various dimensions of these disorders, from their definitions and classifications to their prevalence and impact on both mothers and families. Identifying and diagnosing postpartum mood disorders is discussed in detail, shedding light on the emotional, cognitive, and physical symptoms that warrant attention. Screening and assessment tools are highlighted as essential instruments for early detection, while challenges in diagnosis, including the overlap with typical postpartum experiences and the influence of stigma, are explored. The review further delves into treatment and intervention, underscoring the importance of psychotherapy, pharmacological interventions, and individualised treatment plans. The roles of healthcare providers and mental health professionals in offering support and guidance are emphasised, emphasising the significance of a collaborative approach. Cultural and societal influences are crucial in shaping perceptions of motherhood and mental health. The review explores how these influences can create barriers to seeking help and highlights the importance of destigmatising postpartum mood disorders. It underscores the urgency of raising awareness and fostering a supportive environment that empowers mothers to seek assistance without fear of judgment. Looking toward the future, the review points to potential research directions, such as advances in understanding hormonal influences and exploring the long-term effects on maternal mental health. The overarching call to action resonates - increased awareness, support, and dismantling stigma are imperative. A hopeful vision is presented: a future where all mothers receive appropriate mental health care, no mother stands alone in her motherhood journey, and societal understanding and compassion thrive.

Postpartum Mood Disorders: Insights into Diagnosis, Prevention, and Treatment.

Postpartum mood disorders pose significant challenges to women's mental health and well-being during the postpartum period. This review article provides insights into these disorders' diagnosis, prevention, and treatment. The article begins by discussing the background information on postpartum mood disorders, their significance, and the purpose of understanding them. It then delves into the classification and types of postpartum mood disorders, emphasizing the need for accurate diagnosis and differentiation. Prevalence and incidence rates are explored to highlight the scope and impact of these disorders. The review examines various risk factors associated with postpartum mood disorders, including biological, psychological, and socioeconomic factors. Understanding these risk factors helps identify high-risk populations and guide targeted interventions. Screening and diagnosis of postpartum mood disorders are crucial for early detection and intervention. The article provides an overview of screening tools, highlights the challenges in diagnosis, and emphasizes the importance of early identification for better outcomes. Prevention strategies are explored, including antenatal education, psychosocial support programs, and the role of healthcare professionals in promoting preventive measures. Effective prevention interventions and their outcomes are discussed to guide healthcare providers and policymakers in implementing evidence-based strategies. Treatment approaches for postpartum mood disorders include pharmacological interventions, psychotherapy options, alternative and complementary therapies, and multidisciplinary approaches. The article discusses the effectiveness and considerations of each approach, highlighting the importance of individualized care. Challenges and barriers in diagnosing, preventing, and treating postpartum mood disorders are addressed, including stigma, limited access to healthcare services, and gaps in healthcare provider knowledge and training. Recommendations are provided for healthcare professionals and policymakers to overcome these challenges and improve outcomes. The review concludes by highlighting the need for future research, innovations in prevention and treatment approaches, and collaborative efforts in the field of postpartum mood disorders. Promising areas for research are identified, including long-term outcomes, understanding risk factors, and cultural considerations. The article emphasizes the importance of interdisciplinary collaboration and stakeholder engagement in advancing the field.

Effects of Drospirenone only pill contraception on postpartum mood disorders: A prospective, comparative pilot study.

OBJECTIVE: The aim of this non-randomized control study was to assess the effect of Drospirenone (DRSP) only pill (DOP) 4 mg, in a 24 active/4 placebo regimen, on the mood of postpartum women who wanted to use a hormonal contraceptive. STUDY DESIGN: Seventy-one women in the study group, and 78 in the control group, were included in intention-to-treat analyses. The depression score was assessed using the self-administrated Edinburgh Postnatal Depression Scale (EPDS) at the childbirth preparation course (T0), and at 2 (T1), 12 (T2), and 24 (T3) weeks postpartum follow-ups. RESULTS: From T0 to T1 an increase in the scores was observed in both groups: in the study group from 9.2 ± 2.5 to 10.1 ± 2.4 (p = 0.02), and in the control group from 8.7 ± 2.7 to 10.3 ± 2.2 (p < 0.001). At the T2 follow-up, the EPDS score reduction was statistically significant in the study group (p < 0.001) but not in the control group (p = 0.16). Similarly, at the T3 follow-up, the score was statistically reduced in the study (p < 0.01), but not in the control group (p = 0.35). The intergroup statistical analysis showed no differences between groups at T0 (p = 0.19) and at T1 (p = 0.55). Instead, they were statistically significant at T2 and T3 (p < 0.001). EPDS scores had no significant correlation with the mode of delivery (r = 0.2; p > 0.05) and with the mode of breastfeeding (r = 0.3; p > 0.05). On the other hand, EPDS scores demonstrated a positive correlation with the social status of single (r = 0.99; p < 0.002) and low education level (r = 0.82; p < 0.004). CONCLUSION: Postpartum mood disorders may have persistent effects that compromise the mother's health and newborn development. DRSP, used as DOP, could modulate mood disorders of the postpartum period in women with individual sensitivity to steroid levels.

Maternal mental health and early childhood development: Exploring critical periods and unique sources of support.

BACKGROUND: The objective of this study was to explore associations between maternal depression and anxiety during early sensitive periods, child social-emotional and behavioral problems and the moderating roles of financial, instrumental, and partner emotional support. METHODS: Analyses was conducted using data from the Fragile Families and Child Wellbeing Study. Hierarchical linear regression modeling was used to explore associations between maternal depression and anxiety at 1- and 3-years postpartum, three unique types of social support, and childhood behavioral problems at 5-years of age (n = 2,827). RESULTS: Mothers who were depressed at one or both timepoints, compared to nondepressed mothers, reported higher externalizing behavioral problems scores of 1.96 and 2.90, and internalizing behavioral problems scores of 1.16 and 2.20, respectively, at 5-years of age (both p < .01), after controlling for covariates. Financial, instrumental, and partner emotional support were independently and inversely associated with behavioral problems (p < .05); however, none of these types of support moderated the relationship between maternal depression and behavioral problems, after controlling for covariates. IMPLICATIONS: Promoting maternal mental health as well as different sources of support throughout the first five years of life, instead of one critical period, may help to reduce the burden of chronic disease in the next generation.

Trasfondo: El objetivo de este estudio fue explorar las asociaciones entre la depresión y ansiedad maternas durante los tempranos períodos sensibles, los problemas socioemocionales y de conducta del niño y los papeles moderadores del apoyo económico, instrumental y emocional de su compañero. Métodos: Se llevaron a cabo análisis usando datos del Estudio del Bienestar de las Familias Frágiles y del Niño. Se usó un modelo de regresión lineal jerárquico para explorar las asociaciones entre la depresión y ansiedad maternas al año y a los tres años posteriores al parto, tres tipos exclusivos de apoyo social, así como también los problemas de conducta en la niñez a los 5 años de edad (n = 2,827). Resultados: Las madres que tenían depresión en uno o ambos momentos temporales, comparadas con las madres que no tenían depresión, reportaron más altos puntajes de problemas de externalización de conducta de 1.96 y 2.90, y puntajes de internalización de conducta de 1.16 y 2.20, respectivamente, a los 5 años de edad (ambos p<.01), después del control por covariables. El apoyo económico, instrumental y emocional del compañero se asociaron independiente e inversamente con problemas de conducta (p<.05); sin embargo, ninguno de estos tipos de apoyo sirvió de moderador de la relación entre la depresión materna y los problemas de conducta, luego del control por covariables. Implicaciones: El promover la salud mental materna, así como diferentes fuentes de apoyo a lo largo de los primeros cinco años de vida, en vez de un período crítico, pudiera ayudar a reducir la carga de enfermedad crónica en la siguiente generación.

Contexte: L'objectif de cette étude était d'explorer les liens entre les liens entre la dépression maternelle et l'anxiété maternelle durant des périodes sensibles, les problèmes socio-émotionnels et de comportement de l'enfant et les rôles modérateurs du soutien émotionnel, financier, et instrumental du partenaire. Méthodes: Des analyses ont été faites en utilisant des données de l'Étude Familles Fragiles et Bien-Être de l'enfant. Une modélisation de régression linéaire hiérarchique a été utilisée pour explorer les liens entre la dépression maternelle et l'anxiété à un an et à trois années postpartum, trois types uniques de soutien social, et les problèmes de comportement de l'enfance à l'âge de 5 ans (n = 2827). Résultats: Les mères qui ont été déprimées à un ou deux temps d'évaluation, comparées aux mères non-déprimées, ont fait preuve de scores de problèmes de comportement d'externalisation plus élevés de 1,96 et 2,90 et de scores de problèmes de comportement d'internalisation de 1,16 et 2,20, respectivement, à 5 ans (les deux p<,01), après le contrôle des covariables. Implications: La promotion de la santé mentale maternelle ainsi que de différentes sources de soutien au travers des cinq premières années de vie, au lieu d'une période critique, peut aider à réduire le poids de la maladie chronique chez la génération qui suit.

Peripartum Predictors of the Risk of Postpartum Depressive Disorder: Results of a Case-Control Study.

BACKGROUND: The study aimed at the identification of the risk factors present during delivery, which might be present in prophylactic programs concerning postpartum mood disorders. MATERIAL AND METHOD: This was a retrospective comparative study. The study material included data retrieved from the medical records of patients hospitalized in the Teaching Department of Gynecology and Obstetrics of Professor Orlowski Hospital in Warsaw, in the years 2010-2017. The EPDS data of 604 patients were analyzed. The study group included 75 women who obtained at least 12 points in the EPDS and the control group was made up of 75 women who obtained no more than 5 points in the EPDS. RESULTS: The women in whom we noted an increased risk of developing mood disorders had blood loss >1000 mL and had a significantly longer stage II and III of labor than the control group. Other risk factors were cesarean section, vaginal delivery with the curettage of the uterine cavity, slightly lower APGAR scores (0.4 pts), and lower birth weight (approximately 350 g) of the child. Women at a low risk of postpartum mood disorders more commonly underwent episiotomy during delivery (76%). CONCLUSIONS: Increased supervision and support should be offered to women who experienced the above-mentioned risk factors.

Perinatal Predictors of Postpartum Depression: Results of a Retrospective Comparative Study.

Postpartum mood disorders occur in a considerable number of women with the most common postpartum disorder being baby blues. The study aimed at the identification of the risk factors present before delivery, which may be comprised in prophylactic programs concerning postpartum mood disorders. The research material includes data retrieved from the medical record of patients delivering in Warsaw in the years 2010-2017 who routinely completed Edinburgh Postnatal Depression Scale (EPDS) after delivery. Data of 604 patients were analyzed. The study group included 75 women who obtained at least 12 points in EPDS, which constituted 12.4% of the whole group (mean = 14.92, SD = 3.05). The control group was made up of 75 women who obtained no more than 5 points in EPDS. A significant correlation was reported between the parity and their order vs. the risk of developing postpartum mood disorders. Women with an increased risk delivered at about 37 gestational weeks, while women in whom the risk of such disorders was low delivered at about 39 gestational weeks. No increased risk was noted in women with premature rupture of membranes. Primigravidas and women who delivered prematurely were the most predisposed to developing postpartum depression and should undergo screening tests in the perinatal period.

An IL-6 receptor antagonist attenuates postpartum anhedonia, but has no effect on anhedonia precipitated by subchronic stress in female rats.

RATIONALE: Nearly 60-80% of women experience some form of sadness, anxiety, or anhedonia in the weeks following the birth of a child (Patel et al. 23(2):534-42, 2012; Degner 10: 359;j4692, 2017); however, the exact mechanisms that precipitate these changes in mood postpartum are still unknown. It is well-known that the function of the peripheral immune system is significantly altered during pregnancy in order to protect the developing fetus from being rejected by the maternal immune system (Fallon et al. 17(1):7-17, 2002), and we have recently found a dramatic change in the central immune system during and just after pregnancy in female rats (Sherer et al. 66:201-209, 2017). We observed anhedonia in Sprague-Dawley rat dams on the day of birth that is associated with an increase in interleukin (IL)-6 expression in the brain on the day of birth (Posillico and Schwarz 298(Pt B):218-28, 2016). OBJECTIVES: The goal of the current experiments was to determine whether inhibiting the IL-6 receptor could prevent onset of this postpartum anhedonia, or anhedonia precipitated by subchronic stress in non-pregnant females. RESULTS: Treatment with an IL-6 receptor antibody attenuated postpartum anhedonia as characterized by a decrease in sucrose preference. In contrast, this antibody had no effect on the decrease in sucrose preference induced following a week of forced swim stress in non-pregnant female rats. CONCLUSIONS: The results of these studies suggest that the molecular mechanisms that underlie the onset of anhedonia following birth or mild stress in female rats may be distinct.

Mom doesn't care: When increased brain CRF system activity leads to maternal neglect in rodents.

Mothers are the primary caregivers in mammals, ensuring their offspring's survival. This strongly depends on the adequate expression of maternal behavior, which is the result of a concerted action of "pro-maternal" versus "anti-maternal" neuromodulators such as the oxytocin and corticotropin-releasing factor (CRF) systems, respectively. When essential peripartum adaptations fail, the CRF system has negative physiological, emotional and behavioral consequences for both mother and offspring often resulting in maternal neglect. Here, we provide an elaborate and unprecedented review on the implications of the CRF system in the maternal brain. Studies in rodents have advanced our understanding of the specific roles of brain regions such as the limbic bed nucleus of the stria terminalis, medial preoptic area and lateral septum even in a CRF receptor subtype-specific manner. Furthermore, we discuss potential interactions of the CRF system with other neurotransmitters like oxytocin and noradrenaline, and present valuable translational aspects of the recent research.

Screening for postpartum anxiety: A quality improvement project to promote the screening of women suffering in silence.

BACKGROUND: Postpartum anxiety is a mental health problem that has largely been ignored by maternity care providers despite an estimated incidence as high as 28.9%. Though postpartum anxiety may or may not be accompanied by depression, and while screening for postpartum depression has become more common place, postpartum anxiety is often not assessed or addressed. PURPOSE: The purpose of this pilot quality improvement project was to implement a screening, treatment and referral program for postpartum anxiety in the birth centre environment. PROCEDURES: Midwives from 10 geographically diverse birth centres, and all members of the American Association of Birth Centres, were recruited to participate in the project. An online video was developed which detailed postpartum anxiety, screening through use of the anxiety subscale of the Edinburgh Postnatal Depression Scale and a toolkit for treatment and/or referral for screen positive patients. Participants entered patient scores into the Perinatal Data Registry of the American Association of Birth Centres. Individual interviews of midwives were conducted following the 10-week pilot period. MAIN FINDINGS: There were a total of 387 participants across 9 participating sites. Among all screened participants with follow-up data, (n = 382), 9.69% (n = 37) were lost to follow-up. Among all participants screened with the Edinburgh Postpartum Depression Scale -3A and Edinburgh Postpartum Depression Scale (n = 318), 12.58% (n = 40) had a positive Edinburgh Postpartum Depression Scale -3A score of greater than six. Of all screened participants with an Edinburgh Postpartum Depression Scale score, 15 (6.98%) had a Edinburgh Postpartum Depression Scale score of less than 12 and an Edinburgh Postpartum Depression Scale -3A score greater than six, and would have not received follow up care if only screened for postpartum depression. Midwife participants expressed heightened awareness of the need to screen and felt screening was easy to integrate into clinical practice. CONCLUSIONS: The Edinburgh Postpartum Depression Scale -3A is a valid, easy-to-use tool which should be considered for use in clinical practice. Modification of the electronic health record can serve as an important impetus triggering screening and treatment. It is important that clinicians are educated on the prevalence of postpartum anxiety, its risk factors, symptoms and implications.

High serum testosterone levels during postpartum period are associated with postpartum depression.

In view of the reported cases of mood disorders that occur in mothers following childbirth and believing that sex steroid hormones contribute to mood and behavioral changes, this study has been aimed to explore the role of sex steroid hormones as an etiological factor for postpartum depression (PPD). This study was conducted at JIPMER, Puducherry, India between January 2010 and 2011. 103 women were recruited in the study after childbirth, out of which 62 women who were believed to be suffering from PPD were categorized as cases and the remaining 41 with no mood changes as controls, using Edinburgh Postpartum Depression Scale (EPDS) (cases had EPDS score ≥10 at 24-28h, controls had score <10 at 24-48h postpartum). The hormones estimated in these two groups included estradiol, progesterone and testosterone, and their levels were compared between these two groups. A significantly high testosterone levels were observed in cases with PPD at 24-28h when compared to controls. Estradiol and progesterone levels did not show significant difference between cases and controls. ROC analysis done at 24-28h showed that testosterone levels beyond 42.71ng/mL predict the development of PPD with 79% sensitivity, 63% specificity, 68% positive predictive value, 74% negative predictive value with AUC being 0.708. This study shows that there is an association between persistent high serum testosterone level in women following childbirth and PPD.