Is there a higher prevalence of mood and anxiety disorders among pregnant women during the COVID-19 pandemic? A comparative study.

OBJECTIVE: This study aimed to compare data on mood and anxiety disorders of pregnant women before and during the COVID-19 pandemic. METHODS: The study sample included 253 women evaluated on their first postpartum day during the COVID-19 pandemic. Mood and anxiety disorders were determined by the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Data from sample was compared with data from previous study that was completed and published prior to the COVID-19 pandemic. RESULTS: The prevalence rate of mood and anxiety disorders during the COVID-19 pandemic was 7.1% and 13.0%, respectively. The most common specific disorder was generalized anxiety disorder (7.1%). Compared to period before the COVID-19 pandemic, the prevalence of mood and anxiety disorders in the current sample was not significantly different. CONCLUSION: Results of this study suggest that pregnant women may have not be under higher risk for mood and anxiety disorders during the COVID-19 pandemic compared to before the pandemic.

Foetal umbilical cord brain-derived neurotrophic factor (BDNF) levels in pregnancy with gestational diabetes mellitus.

The aim of our study was to investigate whether gestational diabetes mellitus (GDM) affects brain-derived neurotrophic factor (BDNF) levels in foetal umbilical cord blood. A total of 96 participants were divided into a GDM group (n = 43) and a non-diabetic control group (n = 53). Cord blood samples of approximately 5 cc were taken immediately after the foetal umbilical cord was clamped during delivery in order to determine BDNF levels. While the mean age, body mass index, birth weight, rate of caesarean delivery, rate of infant macrosomia, and neonatal intensive care unit admission of women with GDM were significantly higher compared to the non-diabetic control group (p < .05), pregnancy complications were comparable between the groups (p > .05). Although no significant differences were noted between the groups with respect to cord blood BDNF levels (0.79 ± 0.37 ng/ml vs. 0.69 ± 017 ng/ml, p = .122), cord blood BDNF values were higher in female infants compared to male infants (0.85 ± 0.33 ng/ml vs. 0.66 ± 0.23 ng/ml, p = .001) and in patients using insulin compared to those not using insulin in the GDM group (0.78 ± 0.14 ng/ml vs. 0.62 ± 0.09 ng/ml, p < .001). This study found that GDM has no effect on cord blood BDNF levels. More in-depth studies with larger series are needed to validate the results of the present study.Impact statementWhat is already known on this subject? Gestational diabetes mellitus (GDM) negatively affects the foetal neurodevelopment due to inflammation and oxidative stress caused by hyperglycaemia. Brain-derived neurotrophic factor (BDNF) expression has been shown to modulate oxidative stress and inflammation, and there may be a relationship between varying BDNF concentrations and GDM.What do the results of this study add? Our study showed that no significant differences were noted between the groups with respect to cord blood BDNF levels, cord blood BDNF values were higher in female infants compared to male infants, and in patients using insulin compared to those not using insulin in the GDM group.What are the implications of these findings for clinical practice and/or further research? GDM negatively affects the foetal neurodevelopment due to inflammation and oxidative stress caused by hyperglycaemia. BDNF expression has also been shown to modulate oxidative stress and inflammation, and there may be a relationship between varying BDNF concentrations and GDM. The association between BDNF expression and GDM has not been clearly elucidated in the literature. More in-depth studies with larger series are needed to determine this relationship.

The course and clinical correlates of panic disorder during the postpartum period: a naturalistic observational study

Objective: To investigate the course of panic disorder and its demographic and clinical correlates during the postpartum period. Methods: Data were collected from 38 consecutive postpartum women diagnosed with panic disorder. Psychiatric assessments were carried out on the first day after delivery and at 6-8 weeks postpartum. During the first assessment, the Panic and Agoraphobia Scale (PAS), Hospital Anxiety and Depression Scale (HADS), Coping Orientation to Problems Experienced (COPE), Multidimensional Scale of Perceived Social Support (MSPSS), and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) were administered to the participants. PAS was also administered at the second assessment. Results: The mean PAS score reduced significantly from baseline to the second assessment. Logistic regression analysis indicated that a shorter duration of panic disorder independently predicted a ≥ 50-point decrease in the severity of panic symptoms during the postpartum period. Conclusion: These findings suggest that patients with a short duration of illness may experience significant alleviation in the severity of panic symptoms during the postpartum period.

The course and clinical correlates of panic disorder during the postpartum period: a naturalistic observational study.

OBJECTIVE: To investigate the course of panic disorder and its demographic and clinical correlates during the postpartum period. METHODS: Data were collected from 38 consecutive postpartum women diagnosed with panic disorder. Psychiatric assessments were carried out on the first day after delivery and at 6-8 weeks postpartum. During the first assessment, the Panic and Agoraphobia Scale (PAS), Hospital Anxiety and Depression Scale (HADS), Coping Orientation to Problems Experienced (COPE), Multidimensional Scale of Perceived Social Support (MSPSS), and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) were administered to the participants. PAS was also administered at the second assessment. RESULTS: The mean PAS score reduced significantly from baseline to the second assessment. Logistic regression analysis indicated that a shorter duration of panic disorder independently predicted a ≥ 50-point decrease in the severity of panic symptoms during the postpartum period. CONCLUSION: These findings suggest that patients with a short duration of illness may experience significant alleviation in the severity of panic symptoms during the postpartum period.

The impact of maternal major depression, anxiety disorders and their comorbidities on gestational age, birth weight, preterm birth and low birth weight in newborns.

BACKGROUND: The present study compared the impact of maternal major depression, anxiety disorders and their comorbidities on gestational age and birth weight of infants. METHODS: A total of 1119 women consisting of 26 women with only major depression, 125 women with only anxiety disorder, 36 women with major depression plus an anxiety disorder and 932 women without any psychiatric disorders were included in the study. Psychiatric diagnoses were determined by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. RESULTS: The comorbid group had the highest proportion of newborns with preterm birth and low birth weight. Moreover, these newborns had the lowest birth weight and gestational age. LIMITATIONS: Cross-sectional study design. CONCLUSIONS: The study results suggest that comorbidity between major depression and anxiety disorders during pregnancy may have noteworthy negative effects on birth weight and gestational age.

The course and clinical correlates of obsessive-compulsive disorder during the postpartum period: A naturalistic observational study.

BACKGROUND: In this study, we aimed to investigate the course of obsessive-compulsive disorder (OCD) and the demographic and clinical correlates associated with significant changes in symptom severity in postpartum women. METHODS: Data were collected form 37 consecutive postpartum women who were diagnosed with OCD during psychiatric interviews by means of the Structured Clinical Interview for DSM-IV (SCID-I). Psychiatric assessments were carried out on the first day after delivery and at 6 to 8 weeks in the postpartum period. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was administered at both assessments while the Hospital Anxiety and Depression Scale (HADS), Coping orientation to problems Experienced (COPE) and Multidimensional Scale of Perceived Social Support (MSPSS) and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), were administered to the participants at the first assessment. RESULTS: The mean score of Y-BOCS was significantly reduced from the baseline to the 6-8 week postpartum period. The proportion of patients with a decreaseof at least 35% in the total score of Y-BOCS during the postpartum period was 43.2%. When the patient groups with and without ≥35% decrease in the total score of Y-BOCS were compared, the group showing the decrease had a higher score of COPE-supression of competing activities, COPE-humor and TEMPS-A-hyperthymic affective temperament and more frequently reported a decrease in the severity of OCD symptoms after a previous childbirth. Logistic regression analysis indicated that the last two variables could accurately predict a ≥ 35 decrease in the severity of OCD symptoms during the postpartum period. LIMITATIONS: The study has relatively small sample size. CONCLUSIONS: The current results suggest that patients with OCD who exhibit hyperthymic affective temperament character and a decrease in symptoms following a previous childbirth may experience a significant alleviation in the severity of obsessive-compulsive symptoms during the postpartum period.

Effect of Maternal Depression on Brain-derived Neurotrophic Factor Levels in Fetal Cord Blood.

OBJECTIVE: : We aimed to assess the association between cord blood brain-derived neurotrophic factor (BDNF) concentration and maternal depression during pregnancy. METHODS: : A total of 48 pregnant women, admitted for elective caesarean section to Department of Obstetrics and Gynecology, The Konya Research and Training Hospital and Konya Necmettin Erbakan University Meram Medical Faculty, were included in this study. The study group included 23 women diagnosed as having depression during pregnancy and the control group included 25 pregnant women who did not experience depression during pregnancy. RESULTS: : The groups had similar sociodemographic characteristics. Cord blood BDNF concentration was significantly lower in babies born to mothers with major depression as compared with those in the control group. We didn’t find any correlation between the umbilical cord blood BDNF levels and BDI scores. CONCLUSION: : The results suggest that the existence of major depression in pregnant women may negatively affect fetal circulating BDNF levels.

Prevalence of mood and anxiety disorders during pregnancy: A case-control study with a large sample size.

This study aimed to compare pregnant and non-pregnant women in terms of the current prevalence of mood and anxiety. The study sample included 1154 women evaluated on the first day postpartum and 328 control subjects. Mood and anxiety disorders were determined by structured psychiatric interview. The prevalence rate of any mood or anxiety disorder was 18.2% during pregnany. Generalized anxiety disorder, obsessive-compulsive disorder, panic disorder and comorbidity among anxiety disorders were more prevalent during pregnancy compared to the control subjects. The present results suggest that pregnant women may be at increased risk of depression and anxiety disorders.

Neonatal outcomes in pregnant women with untreated and treated panic disorder.

OBJECTIVE: The objective of the present study was to compare neonatal outcomes including gestational age, birth weight and hospitalization of newborns of pregnant women with treated with antidepressants and untreated panic disorder. METHODS: The study sample included 146 pregnant women (44 patients with panic disorder treated with antidepressants, 52 patients with untreated panic disorder, and 50 healthy controls). Panic disorder was diagnosed by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. RESULTS: The highest proportions of preterm birth (28.8%), low birth weight (34.6%) and requirement of neonatal care (25.0%) were observed in infants of untreated patients. Pharmacotherapy group and control subjects had similar neonatal outcomes. Compared with infants of healthy subjects and the pharmacotherapy group, infants of untreated patients had significantly lower birth weight and gestational age at delivery. In addition, newborns of untreated patients had higher rate of hospitalization at the neonatal care unit. CONCLUSION: Our results suggest that treatment with pharmacotherapy of panic disorder during pregnancy may have beneficial effects on the risk of negative neonatal outcomes due to maternal panic disorder in the infants.

Micronuclei frequencies in lymphocytes and cervical cells of women with polycystic ovarian syndrome.

OBJECTIVE: The aim of this study was to determine micronucleus (MN) frequencies in exfoliated cervical cells and peripheral blood lymphocytes of women with polycystic ovarian syndrome (PCOS). MATERIALS AND METHODS: Fifteen patients with PCOS and 11 healthy control patients were included in the study. Cervical smears and peripheral blood were collected from all patients. Specimens were analyzed for MN frequencies and compared between the groups. In addition to MN, other nuclear anomalies connected with both genotoxicity and cytotoxicity were evaluated. RESULTS: The MN frequencies in cervical smear and peripheral blood lymphocytes were compared in patients with PCOS and normal controls. There was no statistically significant difference between the groups regarding micronucleus frequency in peripheral blood lymphocytes (p=0.239). The mean MN scores in exfoliated cervical cells of patients with PCOS and normal controls were 1.19±0.57 and 0.74±0.34, respectively. The difference regarding micronucleus frequencies in cervical cells was statistically significant between the groups (p=0.032). CONCLUSION: Although study group is small, our study results support that there is an increased micronucleus frequency in cervical exfoliated cells of PCOS patients; this is a determinant of genetic hazard in the disease.

Are Major Depression and Generalized Anxiety Disorder Associated With Oligohydramnios in Pregnant Women? A Case-Control Study.

PURPOSE: This study examined the prevalence of major depression and generalized anxiety disorder (GAD) in pregnant women with and without a diagnosis of oligohydramnios. DESIGN AND METHODS: The study sample included 53 pregnant women with a diagnosis of oligohydramnios and 80 healthy pregnant women subjects. Major depression and GAD were diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I). FINDINGS: Pregnant women with oligohydramnios had higher scores of depressive and anxiety symptom, and a higher prevalence rate of major depression (24.5% vs. 6.2%) and GAD (30.2% vs. 3.2%). PRACTICE IMPLICATIONS: The results of the present study suggest that oligohydramnios appears to be associated with both major depression and GAD in pregnant women.

Effects of anesthesia type on short-term postoperative cognitive function in obstetric patients following cesarean section.

OBJECTIVE: We aimed to compare the effects of general and spinal anesthesia on cognitive functions in pregnant patients undergoing elective cesarean section. MATERIAL AND METHODS: Seventy-five American Society of Anesthesiology (ASA) I pregnant patients aged 18-40 years who were scheduled to undergo elective cesarean section were divided into three groups. Group sevoflurane (Group S) and Group desflurane (Group D) were administered general anesthesia, whereas Group regional (Group R) was administered spinal anesthesia. Hemodynamic variables, bispectral index, oxygen saturation were measured at baseline, after induction, spinal injection, and during the surgery. Extubation and eye opening time and Aldrete scores were recorded. Mini-mental state examination, Trieger dot test, and clock drawing test were performed one day before the surgery and repeated at the 1(st), 3(rd) and 24(th) h postoperatively. RESULTS: There was no statistically significant difference among the groups in terms of demographic data and duration of surgery (p>0.05). Durations of anesthesia for Group S, Group R, and Group D were significantly different (p<0.05). Duration of anesthesia for Group R was significantly longer than for Groups S and D (p<0.0001). Aldrete recovery scores and total remifentanil consumption were significantly higher in Group D than in Group S (p<0.05). Extubation and eye opening times were significantly shorter in Group D than in Group S (p<0.01). According to TDT, statistical significance was found among Group S, Group R, and Group D at the 3rd and 24th h postoperatively (p<0.05), and there was a statistically high significant difference in Groups S and R (p<0.0001). CONCLUSION: We concluded that general anesthesia with sevoflurane or desflurane and spinal anesthesia had no effects on cognitive functions in patients undergoing cesarean operation.

The evaluation of recombinant LH supplementation in patients with suboptimal response to recombinant FSH undergoing IVF treatment with GnRH agonist down-regulation.

We aimed to evaluate the clinical efficacy of r-LH supplementation to r-FSH in patients with suboptimal response to ovarian stimulation undergoing assisted reproduction with GnRH-a downregulation and stimulation with r-FSH. One-hundred thirty-seven patients were included in the study; among them 52 showed normal ovarian response to stimulation and composed the control group (Group 1), and 85 showed suboptimal response to stimulation and were divided into two groups. For Group 2 (n = 50), 75 IU/L r-LH was added to the treatment, for Group 3 (n = 35) r-FSH dose was increased by 75 IU/L. IVF results were compared between the groups. Implantation rates were 34.8% in control group, and 36.1% and 15% in LH supplementation group and increased-dose r-FSH group, respectively. Implantation rates were statistically significantly higher in Groups 1 and 2 compared to Group 3 (p < 0.02). Pregnancy rate was noticed in 64.7% of Group 1, 57.8% of Group 2 and at 32.4% of Group 3. Pregnancy rate was significantly higher in Group 2 than Group 3 (p < 0.05). r-LH supplementation is an option for improving IVF outcome in patients with suboptimal ovarian response to ovulation induction with r-FSH during GnRH agonist down-regulation. Particularly, r-LH is recommended as it may have a beneficial action on implantation in selected group.

Pregnancy-Onset Panic Disorder: Incidence, Comorbidity and Associated Factors.

INTRODUCTION: The present study aimed to investigate the incidence rate of pregnancy-onset panic disorder (POPD) among Turkish pregnant women using a diagnostic interview. Additionally, we examined whether the independent socio-demographic or clinical risk factors were associated with the risk of panic disorder in these women. METHODS: The study sample comprised 1475 consecutive pregnant women who presented to the obstetric outpatient clinics of two research centers. The rate of POPD in these participants was 1.3% (Group 1, n=20). The 20 women with POPD were compared with 250 pregnant women without pregnancy-onset depression or anxiety (Group 2; controls). Panic disorder and other anxiety or mood disorders were determined by means of the Structured Clinical Interview for DSM-IV. Comorbid Axis II disorders were diagnosed with the Structured Clinical Interview for DSM-III-R Personality Disorders. RESULTS: The incidence rate of panic disorder was 1.3% (n=20). In group 1, 55% (n=11) of the women with POPD had an additional mood or anxiety disorder. In addition, the prevalence rate of any cluster C personality disorder, including avoidant, passive-aggressive and obsessive-compulsive personality disorders, were significantly greater in the group 1 women with POPD than the control pregnant women without a panic disorder (group 2). CONCLUSION: The women with POPD were more likely than the controls to have a cluster C Axis II disorder and a history of a pre-existing anxiety or mood disorder.

Neuroinflammation in the fetus exposed to maternal obsessive-compulsive disorder during pregnancy: a comparative study on cord blood tumor necrosis factor-alpha levels.

OBJECTIVE: The relationship between maternal psychiatric disorders and fetal neurodevelopment is unclear. Obsessive-compulsive disorder (OCD) is relatively frequent during pregnancy. The study aimed to investigate whether maternal OCD during pregnancy affects fetal circulating tumor necrosis factor-alpha (TNF-α) levels, an important pro-inflammatory cytokine, by comparing cord blood TNF-α levels in newborn infants of women with and without OCD. METHODS: The study sample included 7 women with OCD and 30 healthy women. OCD and other psychiatric diagnoses were screened by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The blood sample for the determination of TNF-α level was obtained from the umbilical cord during delivery. RESULTS: Cord blood TNF-α levels in newborn infants exposed to maternal OCD were significantly higher compared to non-exposed infants. Maternal anxiety symptom level was found to positively correlate with cord blood TNF-α levels in newborn infants of women with OCD. CONCLUSION: The study results imply that maternal OCD during pregnancy may lead to neuroinflammation in the developing fetal brain through higher levels of circulating TNF-α.

Maternal generalized anxiety disorder during pregnancy and fetal brain development: a comparative study on cord blood brain-derived neurotrophic factor levels.

OBJECTIVES: The study aimed to investigate whether maternal GAD during pregnancy affects fetal circulating brain-derived neurotrophic factor (BDNF), which plays important roles in neuronal development, by comparing cord blood BDNF levels in newborn infants of women with and without GAD. METHODS: Study sample included 19 women with GAD and 25 women without any psychiatric disorder. GAD and other psychiatric diagnoses were screened by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The blood sample for the determination of BDNF level was obtained from the umbilical cord during delivery. RESULTS: Cord blood BDNF levels in newborn infants of healthy women were approximately two-fold compared to newborn infants of women with GAD, and the difference was statistically significant. The duration of GAD during pregnancy was the only variable correlating with cord blood BDNF levels. CONCLUSIONS: The study results imply that prolonged maternal GAD during pregnancy may negatively influence neurodevelopment of the fetus through lower levels of circulating BDNF.

Is depression associated with glucose tolerance abnormality in pregnant women? A cross-sectonal study.

This study aims to examine the association between glucose tolerance abnormality and depression and anxiety in pregnant women. One hundred and sixty-seven women with gestational ages ranging from 24 to 28 weeks were screened with the 50 g oral glucose challenge test. All participants were assessed with the Beck Depression Inventory and the Beck Anxiety Inventory. The rate of depression was higher in women with abnormal glucose results (44.3%) than in women with normal glucose results (21.7%). Similarly, depressed women had higher glucose levels than non-depressed women. Findings suggest that depression and anxiety may be associated with glucose tolerance abnormality in pregnant women.

Alternative surgical approach for the management of uterine prolapse in young women: preliminary results.

AIM: To demonstrate an alternative surgical approach for the management of uterine prolapse in young women by a technique that was previously defined for post-hysterectomy vaginal vault suspension in published work and also to demonstrate successful operative results. METHODS: The study population consisted of 12 women aged 28-41 years who had stage 4 uterine prolapse and who were surgically treated by abdominal hysteropexy using autogenous rectus fascia strips. Operative results and postoperative follow-up Pelvic Organ Prolapse Quantification and Prolapse Quality of Life results were recorded. RESULTS: Mean age of patients was 35.5 ± 4.1 years (range, 28-41). Mean parity in the study group was 2.6 ± 1.0 (range, 1-5). Mean operation time was 32.0 ± 5.2 min (range, 25-42). All patients were discharged on the postoperative 3rd day and no complications were observed postoperatively. Mean follow-up period was 20 ± 7.0 months (range, 12-36). All of the patients had complete remission for uterine prolapse and none of the patients had complaints related to the operation. CONCLUSION: Abdominal hysteropexy operation using rectus fascia strips provides a safe and alternative approach for the management of uterine prolapse in young women who desire to preserve their uterus. But further analysis is needed to confirm our results.

Axis I and Axis II diagnoses in women with PCOS.

OBJECTIVE: The objective was to determine the current prevalence of Axis I and Axis II psychiatric diagnoses in patients with polycystic ovary syndrome (PCOS). METHOD: The study sample included 73 patients with PCOS and 73 control subjects. Psychiatric disorders were determined by structured clinical interviews. RESULTS: The rate of any Axis I psychiatric disorder (28.8% vs. 15.1%), social phobia (13.7% vs. 2.7%), generalized anxiety disorder (11.0% vs. 1.4%), any Axis II psychiatric disorder (23.3% vs. 9.6%) and avoidant personality disorder (12.3% vs. 1.4%) was significantly more common in the patient group compared to the control group. Of women with PCOS, 21 (28.8%) had at least one Axis I and 17 (23.3%) had at least one Axis II diagnosis. The most common Axis I disorder was social phobia (13.7%) and the most common Axis II disorder was avoidant personality disorder (12.3%) in women with PCOS. Social phobia, generalized anxiety disorder, and avoidant personality disorder were significantly more common in the patient group compared to the control group. CONCLUSION: Our results suggest that a considerable proportion of women with PCOS also present with anxiety and personality disorders.

Successful treatment of uterine prolapse by abdominal hysteropexy performed during cesarean section.

PURPOSE: Uterine prolapse complicating pregnancy is extremely rare. This report presents the surgical correction of uterine prolapse during cesarean section. CASE: We report a case of a 33-year-old woman with twin gestation who admitted to obstetric clinic with labor pain and total uterine prolapse at 33 weeks of gestation. An emergent cesarean section was performed for the indication of acute fetal distress. At the same operation, following cesarean delivery, abdominal hysteropexy using rectus fascia strips was performed successfully. On control performed 6 months later, patient was examined and it was detected uterine prolapse had regressed and babies were uneventful. CONCLUSION: This surgical method offers effective treatment of uterine prolapse.