Maternal depression and child development

Question 1

What is the prevalence of postpartum depression?

Answer 1

13%

Question 2

What are the postpartum blues?

Answer 2

a relatively common emotional disturbance with crying, confusion, mood lability, anxiety and depressed mood. The symptoms appear during the first week postpartum, last for a few hours to a few days and have few negative sequelae

Question 3

What is postpartum psychosis?

Answer 3

to a severe disorder beginning within four weeks postpartum, with delusions, hallucinations and gross impairment in functioning. Symptoms must last at least 1m and result in impairment of symptoms

Question 4

What is postpartum depression?

Answer 4

depression begins in or extends into the postpartum period and core features include dysphoric mood, fatigue, anorexia, sleep disturbances, anxiety, excessive guilt and suicidal thoughts. The diagnosis requires that symptoms be present for at least one month and result in some impairment in the woman’s functioning

Question 5

What are risk factors for postpartum depression?

Answer 5

1. Hx of mood disorders
2. Depression symptoms during the pregnancy
3. FamHx psychiatric d/o
4. Negative life events
5. Poor marital relationships
6. Special needs infant
7. Medically “fragile” infant
8. Lack of social support
9. Drug abuse
10. Personal and family psychopathology

Question 6

What are consequences of maternal depression prenatally?

Answer 6

Inadequate prenatal care, poor nutrition, higher preterm birth, low birth weight, pre-eclampsia and spontaneous abortion

Question 7

What are consequences of maternal depression to the infant?

Answer 7

Behavioral: Anger and protective style of coping, passivity, withdrawal, self-regulatory behaviour, and dysregulated attention and arousal

Cognitive: lower cognitive performance

Question 8

What are consequences of maternal depression to the toddler?

Answer 8

Behavioral: Passive noncompliance, less mature expression of autonomy, internalizing and externalizing problems, and lower interaction

Cognitive: Less creative play and lower cognitive performance

Question 9

What are consequences of maternal depression to the school aged child?

Answer 9

Behavioral: Impaired adaptive functioning, internalizing and externalizing problems, affective disorders, anxiety disorders and conduct disorders

Academic: ADHD and lower IQ scores

Question 10

What are consequences of maternal depression to the adolescent?

Answer 10

Behavioral: Affective disorders (depression), anxiety disorders, phobias, panic disorders, conduct disorders, substance abuse and alcohol dependence

Academic: ADHD, LD

Question 11

What are contextual risk factors for worsening parental depression and maladaptive parenting?

Answer 11

1. Marital conflict
2. Stressful life events
3. Limited social support
4. Poverty
5. Lower social class
6. Lower maternal education

Question 12

What is the role of fathers

Answer 12

Can buffer effects of maternal depression in the child

Question 13

What characteristics make the child more resilient

Answer 13

1. Female
2. Easy going and robust temperament
3. Social and cognitive skills to receive positive attention from adults other than depressed mother
4. Understanding of maternal depression

Question 14

What pharmacotherapy options are available?

Answer 14

SSRI and TCA are effective and may be used during pregnancy and lactation

Question 15

What behavioral options are available?

Answer 15

Social support and home visiting interventions are successful in improving mood

Family therapy can be every effective

Psychotherapy can be effective

St. John’s Wort can be effective for mild to moderate depression

Question 16

What are trigger questions to elicit information about postpartum depression?

Answer 16

1. How are you feeling about being a new mother?
2. Are you enjoying your baby?
3. Do you find that your baby is easy or difficult to care for?
4. How are things going in your family?
5. Are you getting enough rest?
6. How is your appetite?
7. During the past month, have you often been bothered by feeling down, depressed or hopeless?
8. During the past month, have you often been bothered by having little interest or pleasure in doing things?

Question 17

What are conclusions?

Answer 17

1. Postpartum depression occurs in approximately 13% of women, and often goes unrecognized. When it is recognized, there is often a long lapse of time between referral and psychiatric evaluation and treatment because of the lack of resources.
2. The infant of a depressed mother is at risk for developing insecure attachment, negative affect and dysregulated attention and arousal.
3. Toddlers and preschoolers of depressed mothers are at risk for developing poor self-control, internalizing and externalizing problems, and difficulties in cognitive functioning and in social interactions with parents and peers.
4. School-age and adolescent children of depressed parents are at risk for impaired adaptive functioning and psychopathology, including conduct disorders, affective disorders and anxiety disorders. They are also at risk for ADHD and learning disabilities.
5. Contextual risk factors such as poverty, marital conflict and stressful life events may exacerbate parental depression and child behaviour problems. On the other hand, some children develop resiliency through an easy-going temperament, good social cognitive skills and understanding of the parent’s illness.
6. Experience with SSRIs during pregnancy and lactation is limited, but no major malformations or physical and developmental risks to the fetus or the breastfed infant have been described. The risks of the mother’s depression seem to outweigh the low risks of antidepressant medication on the fetus or the breastfed infant.

Question 18

What are the recommendations?

Answer 18

1. Through the surveillance of the well-being and development of infants and children, the physician should stay alert to signs of mother-child interaction difficulties, and behavioural and developmental problems in the child. Under such circumstances, they should keep in mind the possibility of maternal depression, ask a few screening questions and facilitate contact with the mother’s physician or psychiatric services.
2. Mothers who have taken antidepressant medication during pregnancy should be reassured that much of the evidence to date shows that there is no increased risk of teratogenicity or fetal anomalies.
3. Mothers who have taken antidepressant medication during pregnancy should be reassured about the neuro-development of their child because long-term studies have not shown adverse effects, except for subtle differences whose clinical significance remains to be confirmed.
4. Mothers who have taken antidepressant medication during lactation should be reassured that much of the evidence to date shows that there are no neurological or developmental abnormalities in children exposed to such medication through breast milk.
5. Mothers should be told that data on St John’s Wort are scarce and that such herbal remedies should not be taken during pregnancy and lactation.