A 2016 Review - Unicef UK · A 2016 Review Kathleen Kendall-Tackett, PhD, IBCLC, ... Dave et al....
Transcript of A 2016 Review - Unicef UK · A 2016 Review Kathleen Kendall-Tackett, PhD, IBCLC, ... Dave et al....
Review of Current Studies
• Incidence • Adult Adversities • Depression and preterm
birth • Birth Interventions • Depression and
Breastfeeding Cessation • Breastfeeding protects
maternal mental health
Depression
Immigrant
Disaster Survivors
Ethnic Minority
Lower Income
Intimate Partner
Violence
Adult Adversities
31% had depression in the first 4 years Risk factors: young maternal age, stressful life events, adversity, IPV, and low income
1,507 Australian mothers, longitudinal study, 3 mos to 4 years
Woolhouse et al., 2015, Brit J Ob Gyn, 122, 312-321
• Depression is common in parents • High risk the first year • By age 12, 39% mothers and 21% of
fathers have been depressed
86,957 UK mothers and fathers, pregnancy to age 12
Dave et al. 2010 Arch Ped Adolescent, 164(11), 1038-1044
In the past 2 weeks, • 34% depressed
mood • 36% anhedonia
Declercq et al. 2008. New mothers speak out. New York: Childbirth Connection.
Listening to Mothers II, Nat’l representative US sample, N=1,573
CDC study found depression less likely to be diagnosed and treated: young women, African Americans, Hispanics, and other non-White women
Centers for Disease Control and Prevention, 2015. Mental health among women of reproductive age.
Korea • 49% (Lee & Hwang,
2015)
• 41% Pregnancy, 61% 4 weeks postpartum (Park et al., 2015)
Vietnam • 16%-20% (Murray
et al., 2015)
Lee & Hwang, 2015. Taiwanese J Ob Gyn, 54, 355-363; Murray et al., 2015, BMC Preg Childbirth, 234; Park et al., 2015. Asian Nurs Res, 9, 219-225
Han Chinese 18% (N=5391; Yang
et al., 2015)
India 23% (Patel et al., 2002)
Pakistan v Malawi 27% Pakistan, 3% Malawi (Zafar
et al., 2015)
Patel et al., 2002. Am J Psychi, 159, 43-47; Yang et al., 2015. J Affect Dis, 183, 339-346; Zafar et al., 2015. PLoS One, 10
Mothers in Turkey
• 14% (Danaci et al. 2002)
• 14% at 6 weeks (Kirpinar et al., 2010)
• 15% (Turkcapar et al., 2015)
Danaci et al., 2002. Soc Psychiatry Psychiatric Epidem, 37, 125-129; Kirpinar et al., 2010, J Clin Nurs, 19, 422-431; Turkcapar et al., 2015, BMC Preg Childbirth
8 studies of immigrant, asylum-seeking women, Canada Up to 42% (Collins et al., 2011)
24 studies, 13,749 women 20% of immigrants had PPD, twice that of native-born population (Falah-Hassani et al., 2015)
Collins et al., 2011. Arch Wom Mental Health, 14, 3-11; Falah-Hassani et al., J Psychiat Res, 70, 67-82
5,162 pregnant women, Montreal
• 15% reported IPV • More common in
poorest pregnant women
• Combo of immigrant status
and IPV increased risk of PPD by 7 times
• For native-born women,
IPV increased risk 4.78 times
Miszkurka et al., 2012, Arch Wom Ment Health, 15, 387-396
Review 67 articles
VAW during pregnancy increased risk of PMADs 3 times Antenatal depression increased the risk of IPV 3 to 5 times
Howard et al., 2013. PLoS Med, 10(5)
Latina women: 118 no IPV, 92 IPV Assessed during pregnancy, and 3, 7, and 13 months postpartum
44% met criteria for depression
IPV better predictor of postpartum depression than depression in pregnancy
Valentine et al. 2011. Arch Women’s Ment Health, 14, 135-143
Review of 43 studies of child abuse and partner violence
Alvarez-Segura et al. 2014, Arch Women’s Ment Health, 17, 343-357
Lifetime depression
Depression during
pregnancy
Postpartum depression
Child abuse + partner violence=More severe depression
317 new mothers after Sichuan earthquake
• 20% PTSD symptoms, 10% full criteria
• 29% PPD at 8 months, not higher than general population
Qu et al., 2012. Arch Wom Ment Health, 15, 49-55
Pregnant women in NOLA with high v low exposure to Hurricane Katrina
• 14% v 1% had PTSD • 32% v 12%
depression
Xiong et al., 2010. Am J Disas Med, 5, 181-187
35%
23%
25%
17%
Major Causes of Newborn Deaths
Preterm birth Asphyxia Infection Other
Save the Children, 2013, State of the World’s Mothers
Dayan et al. 2006, Psychosom Med, 68, 938-946
4% for non-depressed
women
9.7% for depressed
women
681 French pregnant women, 20-28 weeks gestation
7.4% no PTSD
8% previous
PTSD
9.2% current
PTSD
16,334 deliveries at VA Hospital 2000-
2012
Shaw et al. 2014, Obstet Gynecol, 124(6), 1111-1119
Rate of Preterm Birth
PTSD and major
depression increased the risk of preterm
birth by 4 times
Yonkers et al. 2014, JAMA Psychiatry, 71(8), 897-904
2,654 women in U.S.
Lauderdale, 2006. Demography, 43,185-201
Pregnant women in CA
Following September 11, women with Arabic last names were twice as likely to have a low birthweight baby • Not true for the prior year
Coussons-Read et al. 2005, Psychosom Med, 67, 625-631
IL-6 and TNF-α ripen the cervix
IL-6 and TNF-α high in stressed and
depressed mothers
Smuts et al. 2003, Obstet Gyn, 101, 469-479
291 low-income moms
DHA-enriched eggs increased gestation length by 6 days (+
2.3 days)
• No difference in
–PPD at 6 weeks or 6 months
–Child cognitive or language development at 18 months
• “more women in the DHA group were induced or had cesareans because they were post-dates”
Makrides et al. 2010, JAMA, 304, 1675-1683
2,399 pregnant women from Australia, 800 mg DHA, 100 EPA, or vegetable oil placebo from 21 weeks gestation to birth
Women with moderate-to-high stress and high social support had less than half the rate of preterm birth
Retrospective case-control study , 1,027 preterm births, 1,282 full-term births, mothers from LA
Ghosh et al, 2010, Arch Women’s
Ment Health, 13, 327-338
• ACEs associated with low social support
• High social support associated with low CRP
Runsten 2013 Nordic J Psychiatry: Apr 30
Study of 116 women in Finland with depression
Rowlands & Redshaw, 2012
More breastfeeding problems at 3 months following forceps-assisted and unplanned cesarean births
5,332 mothers in the UK
Rowlands & Redshaw 2012, BMC Preg Childbirth, 12, 128
Epidurals had small effect on early
breastfeeding but no effect on
neonatal outcomes
Gizzo et al. 2012, Breastfeeding Med, 7, 262-268
317 with epidurals 617 no epidurals
Cesareans (vs. vaginal) at <32 weeks associated with lower milk volume at Day 4 and less exclusive breastfeeding at NICU
discharge
Murase et al., 2014, J Hum Lact, 30(4), 425-435
Induction of labor Opioid pain medications
Emergency cesarean
Bai et al., 2013, J Midwif Wom Health,
58(1), 25-32
1,280 mothers and infants from Hong Kong
Any Exclusive
• Epidurals associated with partial breastfeeding and breastfeeding difficulties in the first week postpartum
• Women who had epidurals twice as likely to stop breastfeeding by 24 weeks
Prospective study of 1280 Australian women, 1 to 24 weeks postpartum
Torvaldsen et al., 2006, Int Breastfeed J, 1:24
Feeding Method by Delivery Type
83
71 69 70 69
15
26 24
27 28
2 3
7
2 4
0102030405060708090
Vaginal Asst.Vaginal
Unplanned Planned Emergency
Breastfeeding Mixed Formula-Feeding
Kendall-Tackett et al. 2015, Clin Lact, 6(3), 87-96
Epidural by Feeding Method
42
65 68 58
35 32
0
10
20
30
40
50
60
70
80
Breastfeed Mixed Formula
Epidural No Epidural
Kendall-Tackett et al. 2015, Clin Lact, 6(3), 87-96
Other Pain Medications by Feeding Method
24
35 40
76
65 60
0
10
20
30
40
50
60
70
80
Breastfeed Mixed Formula-Feed
Pain Meds No Pain Meds
Kendall-Tackett et al. 2015, Clin Lact, 6(3), 87-96
Epidurals 214 mothers from China
15 depressed with epidural 37 depressed
without epidural
Ding et al., 2014, Anesthes Analges, 119, 383-392
No Epidural
Epidural
PPD
PPD
185 women in Finland
At one week postpartum No difference at 4 months
Hiltunen et al. 2004, Acta Obstet Gynecol Scand, 83, 257-261
25%-28% depression
30%-37% anxiety
Following elective
cesarean
Kuo et al., 2014, PLoS ONE, 9, e86653
Ease of Labor by PPD
0
0.2
0.4
0.6
0.8
1
1.2
Very easy Moderate Verydifficult
Kendall-Tackett et al. 2015, Clin Lact, 6(3), 87-96
Perceived Labor Pain by PPD
0.75
0.8
0.85
0.9
0.95
1
1.05
Low pain Moderate pain High pain
Kendall-Tackett et al. 2015, Clin Lact, 6(3), 87-96
Impact of Epidural on PPD
0.75
0.8
0.85
0.9
0.95
1
Yes No
Kendall-Tackett et al. 2015, Clin Lact, 6(3), 87-96
• Significantly related to depressive symptoms – Epidurals – Postpartum hemorrhage – Postpartum surgery
• Even after controlling for – All other birth interventions – Primip v multip – Number of hours in labor – Income – Education – History of depression – History of sexual assault – Current anxiety – Current anger/irritability
Depression by Birth Type
0.750.8
0.850.9
0.951
1.051.1
Kendall-Tackett et al. 2015, Clin Lact, 6(3), 87-96
Houston et al. 2015, Am J Obstet Gynecol, 212, e1-7
160 patients, 24-36 weeks gestation
Po
stp
artu
m D
ep
ress
ion
Preferred vaginal birth
d
Anxiety at 3 months
reduced odds of exclusive
breastfeeding by 11% at 6
months
Adedinsewo et al. 2014, J Hum Lact, 30(1), 102-109
Complex pregnancy was associated with
>30% lower odds of exclusive
breastfeeding
2400 births in U.S. Supportive
hospital practices increased odds of any or exclusive breastfeeding by
2 to 4 times
Kozhimannil et al. 2014. PLoS One, 9(8), e104820
Intended to breastfeed and did
Intended to breastfeed and did not
ALSPAC sample, Avon UK, 14,541 pregnancies
Borra et al, 2014, Matern Child Health J, DOI 10.1007/s10995-014-1591-z
PPD
PPD
More depression if mothers
had not intended to breastfeed
but did Borra et al, 2014, Matern Child Health J, DOI
10.1007/s10995-014-1591-z
We
ll-b
ein
g
Aff
iliat
ion
Bo
nd
ing
Oxytocin
De
pre
ssio
n &
an
xiet
y
Alie
nat
ion
Ho
stili
ty &
str
ife
Stress
Mothers’ Depression
0.5
1
1.5
Breastfeeding Mixed Formula
Kendall-Tackett et al., 2011, Clin Lact, 2(2), 22-26
N=6,410
Minutes to Fall Asleep
19.61 22.36
27.05
0
5
10
15
20
25
30
Breastfed Mixed Formula
Kendall-Tackett et al., 2011, Clin Lact, 2(2), 22-26
N=6,410
6.61
6.41
6.3
6.2
6.3
6.4
6.5
6.6
6.7
Breastfeeding Mixed Formula
Hours Mothers Sleep
Kendall-Tackett et al., 2011, Clin Lact, 2(2), 22-26
N=6,410
0.853
1.11
0
0.2
0.4
0.6
0.8
1
1.2
Current Depression
No Sexual Assault Sexual Assault
Kendall-Tackett et al., 2013, Breastfeed Med, 8(1), 16-22
N=6,410, 994 sexual assault survivors
Percentage who are Breastfeeding
78.6 78.9
70
80
No Sexual Assault Sexual Assault
Kendall-Tackett et al., 2013, Breastfeed Med, 8(1), 16-22
N=6,410, 994 sexual assault survivors
6.63
6.52
6.44
6.16
6
6.1
6.2
6.3
6.4
6.5
6.6
6.7
No assault Sexual assault
Hours Mothers Sleep
Breastfeeding
Mixed/Formula
Kendall-Tackett et al., 2013, Breastfeed Med, 8(1), 16-22
18.73
23.87
22.07
27.01
18
20
22
24
26
28
No assault Sexual assault
Minutes to Get to Sleep
Breastfeeding
Mixed-/Formula
Kendall-Tackett et al., 2013, Breastfeed Med, 8(1), 16-22
0.8
1.07 1.03
1.25
0.7
0.8
0.9
1
1.1
1.2
1.3
No Assault Sexual Assault
Depression
Breastfeeding
Mixed/Formula
Kendall-Tackett et al., 2013, Breastfeed Med, 8(1), 16-22
1.49 1.51
1.53
1.69
1.35
1.4
1.45
1.5
1.55
1.6
1.65
1.7
1.75
No Assault Sexual Assault
Angry or Irritable
Breastfeeding
Mixed/Formula
Kendall-Tackett et al., 2013, Breastfeed Med, 8(1), 16-22
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Kathleen Kendall-Tackett Kathy Kendall-Tackett
@UptySciChick
Kathleen Kendall-Tackett
Email: [email protected]