Pregnancy ; Female ; Humans ; COVID-19/epidemiology* ; Singapore ; Telemedicine ; SARS-CoV-2 ; Parturition

Infant social, emotional and neurological development is shaped by the mother-child dyad. Dysfunction in this bond, as well as maternal mental health problems, can negatively impact child development. The family physician is well-placed to spot dysfunction in the mother-child dyad and screen for postnatal depression during well-child visits. If any issues are identified, the family physician can provide support and help the mother-child dyad to access community resources and specialist psychiatric services.

Objective: This is the first Singaporean study to examine prescribing practices among clinicians treating women with antenatal psychiatric conditions. This study aims to describe the characteristics of pregnant women who were prescribed psychotropic for new-onset antenatal psychiatric conditions. It also examines psychotropic prescription patterns and explores associations between antidepressant/benzodiazepine prescription and clinical characteristics. Methods: Pregnant women who were seen by psychiatrists from the Mental Wellness Service at the Kandang Kerbau (KK) Women’s and Children’s Hospital over a four-year period for new-onset antenatal psychiatric conditions, and who were prescribed psychotropic medication, were eligible for inclusion in the study. Demographic and obstetric information, psychiatric diagnoses and prescription of psychotropic were recorded in a database. Descriptive analyses were performed and associations between antidepressant/benzodiazepine prescription and clinical characteristics were studied. Results: A total of 110 patients were included in the study. The majority of the subjects were diagnosed with antenatal depression. Most of the subjects were prescribed an antidepressant in combination with Promethazine. Low-dose Dothiepin was the antidepressant of choice. Subjects with antenatal depression were more likely to be prescribed antidepressants (odds ratio (OR) 5.30, 95% confidence interval (CI) 2.29-12.27; p<0.01) while subjects with an adjustment disorder were less likely to be prescribed antidepressants (OR 0.11, 95% CI 0.02-0.52; p=0.001). No significant associations were found between antidepressant prescription and diagnoses of antenatal anxiety or mixed depression-anxiety. Nulliparous subjects were less likely to be prescribed an antidepressant or benzodiazepine, compared to subjects with a history of previous births (OR 0.35, 95% CI 0.16-0.79; p=0.01 and OR 0.91, 95% CI 0.84-0.98; p=0.03 respectively). Conclusions: Future studies of psychotropic prescription for pregnant psychiatric patients should examine severity of symptoms at presentation, timing of first presentation in relation to gestational age, patients’ willingness to accept medication and response to psychotherapy. More studies are needed to explore the association between parity and antidepressant prescription.

INTRODUCTION: Expectant mothers may appear anxious even during healthy pregnancies. Unfortunately, little is known about antenatal anxiety, and affected women may remain undetected and untreated. This study aimed to examine the prevalence, incidence, course and associations of high state anxiety in routine obstetric care. MATERIALS AND METHODS: This was an observational prospective cohort study at a large maternity unit. Obstetric outpatients with low-risk singleton pregnancies were recruited during first trimester consultations. Participants provided sociodemographic data and completed the State-Trait Anxiety Inventory (STAI) and Edinburgh Postnatal Depression Scale. The STAI was re-administered at each subsequent trimester. RESULTS: Prevalence and incidence of  high state anxiety among 634 completers were 29.5% (95% CI 25.6%-33.6%) and 13.9% (95% CI 9.9%-18.0%), respectively. Anxiety was persistent in 17.0% (95% CI 14.3%-20.2%) and transient in 26.3% (95% CI 23.1%-29.9%). Only persistently anxious participants had high mean second trimester state anxiety scores. Odds for anxiety of greater persistence increased by 29% (95% CI 24%-35%) per 1-point increase in first trimester depression scores, and decreased by 36% (95% CI 7%-56%) with tertiary education. CONCLUSION Antenatal anxiety symptoms are common even in normal pregnancies, especially among women with depression and lower education. Our study indicates value in exploring diagnostic criteria and quantitative measures for antenatal anxiety.
Adult ; Anxiety Disorders ; diagnosis ; epidemiology ; Cohort Studies ; Confidence Intervals ; Depressive Disorder ; diagnosis ; epidemiology ; Female ; Humans ; Odds Ratio ; Pregnancy ; Pregnancy Complications ; diagnosis ; epidemiology ; Pregnancy Outcome ; Pregnancy Trimester, First ; Prenatal Diagnosis ; Prevalence ; Prospective Studies ; Risk Assessment ; Severity of Illness Index ; Singapore

BACKGROUNDHyperglycemia is associated with adverse pregnancy outcomes. However, the relationships between them remain ambiguous. This study aimed to analyze the effect of different oral glucose tolerance test (OGTT) results on adverse perinatal outcomes.

METHODSThis retrospective cohort study included data from 15 hospitals in Beijing from June 20, 2013 to November 30, 2013. Women with gestational diabetes mellitus (GDM) were categorized according to the number and distribution of abnormal OGTT values, and the characteristics of adverse pregnancy outcomes were evaluated. Chi-square test and logistic regression analysis were used to determine the associations.

RESULTSIn total, 14,741 pregnant women were included in the study population, 2927 (19.86%) of whom had GDM. As the number of hyperglycemic values in the OGTT increased, the risk of cesarean delivery, preterm births, large-for-gestational age (LGA), macrosomia, and neonatal complications significantly increased. Fasting hyperglycemia had clear associations with macrosomia (odds ratios [OR s]:1.84, 95% confidence intervals [CI s]: 1.39-2.42,P < 0.001), LGA (OR: 1.70, 95% CI: 1.29-2.25,P < 0.001), and cesarean delivery (OR: 1.33, 95% CI: 1.15-1.55,P < 0.001). The associations were stronger as fasting glucose increased. GDM diagnosed by hyperglycemia at OGTT-2 h was more likely to lead to preterm birth (OR: 1.50, 95% CI: 1.11-2.03,P < 0.01).

CONCLUSIONSVarious characteristics of OGTTs are associated with different adverse outcomes. A careful reconsideration of GDM with hierarchical and individualized management according to OGTT characteristics is needed.

Birth Weight ; physiology ; Blood Glucose ; metabolism ; Body Mass Index ; Cesarean Section ; Chi-Square Distribution ; Diabetes, Gestational ; blood ; physiopathology ; Female ; Fetal Macrosomia ; blood ; physiopathology ; Glucose Tolerance Test ; methods ; Humans ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Premature Birth ; blood ; physiopathology ; Retrospective Studies

INTRODUCTIONAntenatal major depression is a relatively common and potentially debilitating illness, but knowledge of its treatment outcomes and strategies is still lacking. This study aimed to explore the clinical profiles and treatment outcomes of patients with antenatal major depression, to look for patterns and associations that could guide subsequent research and clinical applications.

METHODSFrom May 2006 to November 2010, 118 consecutive patients with antenatal major depression were naturalistically assessed over eight months of individualised therapy, and their characteristics were assessed as potential predictors of treatment outcome.

RESULTSAll participants accepted supportive counselling and case management, although only 51 (43.2%) participants accepted low-dose antidepressant therapy. Overall, 95 (80.5%) of them were successfully discharged, while 12 (10.2%) required extended treatment into the postnatal period. An equation for prognosticating the need for extended treatment was obtained using multiple logistic regression analysis, which incorporated three predictors: previous depression (odds ratio [OR] 12.4, 95% confidence interval [CI] 1.40-110; p = 0.024); maternal age < 26 years or > 35 years (OR 6.88, 95% CI 1.67-28.4; p = 0.008); and no use of antidepressant (OR 6.94, 95% CI 0.79-60.9; p = 0.080). Among participants with previous depression and at either extreme of maternal age, the number needed to treat with antidepressants to avert extended treatment was three.

CONCLUSIONThe majority of women with antenatal major depression recovered after receiving short-term treatment. Those with previous depression and who were of relative extreme maternal age were most likely to benefit from antidepressant treatment to expedite recovery.

Postnatal depression is a major public health problem with clearly established adverse effects in child outcomes. This study examines the 4-year outcomes of a screening and early intervention programme, in relation to improvement in symptoms, functioning and health quality of life. Women were prospectively recruited up to 6 months postdelivery, using the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool. High-scorers (EPDS >13), were offered psychiatric consultation, and those with borderline scores (EPDS 10-12) were provided counselling, and offered follow-up phone counselling by the assigned case manager. Outcome measures were obtained at baseline, and at 6 months or discharge if earlier, for levels of symptoms, functioning, and health quality of life. From 2008 to 2012, 5245 women were screened, with 307 (5.9%) women with EPDS >13 receiving intervention. Of these, 70.0% had depression, 4.6% anxiety and 3.4% psychosis. In the depression subgroup, the net change was improvement of 93.4% EPDS symptom scores, 92.2% Global Assessment of Functioning (GAF) scores, and 88.3% visual analogue scale (EQ VAS) health quality of life scores. Outcome scores across diagnostic categories demonstrated median changes of 10 points on EPDS, 20 points on GAF, and 25 points on EQ VAS, reflecting 73.9%, 36.4% and 41.7% change from baseline scores. Women with psychosis showed the biggest (80.0%) relative change in GAF functioning scores from baseline to discharge but had the lowest median change in EPDS symptom scores. A screening and intervention programme rightly-sited within an obstetric setting can improve clinical outcomes because of early detection and intervention.
Adult ; Anxiety Disorders ; diagnosis ; therapy ; Case Management ; Counselors ; Delivery of Health Care ; Depression, Postpartum ; diagnosis ; therapy ; Early Medical Intervention ; Female ; Health Status ; Humans ; Mass Screening ; Obstetrics ; Outcome Assessment (Health Care) ; Prospective Studies ; Psychiatry ; Psychotic Disorders ; diagnosis ; therapy ; Puerperal Disorders ; diagnosis ; therapy ; Quality of Life ; Referral and Consultation ; Singapore

BACKGROUNDOptimizing treatment outcomes for depression requires understanding of how evidence-based treatments are utilized in clinical practice. Antipsychotic medications concurrent with antidepressant treatment are frequently used in major depression, but few studies have investigated trends and patterns of their use over time. This study aimed to examine the prescription patterns of antipsychotic medications for major depression in China from 2002 to 2012 and their association with treatment satisfaction and quality of life (QOL).

METHODSA total of 3655 subjects with major depression treated in 45 Chinese psychiatric hospitals/centers nationwide were interviewed between 2002 and 2012. Patients' socio-demographic and clinical characteristics including psychopathology, medication side effects, satisfaction with treatment and QOL were recorded using a standardized protocol and data collection.

RESULTSThe frequency of antipsychotic use was 24.9% in the whole sample; the corresponding figures were 17.1%, 20.3%, and 32.8% in 2002, 2006, and 2012, respectively (χ2 = 90.3, df = 2, P < 0.001). Multiple logistic regression analyses revealed that patients on concurrent antipsychotics had significantly more delusions or hallucinations, longer illness duration, greater side effects, and more likely to be treated as inpatients and in major hospitals (i.e., Level-III hospital). Antipsychotic use was associated with lower treatment satisfaction while there was no significant difference with respect to physical and mental QOL between the antipsychotic and nonantipsychotic groups.

CONCLUSIONSConcurrent antipsychotic use was found in about one in four treated depressed patients in China, which has increased over a 10-year period. Considering the association of drug-induced side effects and the lack of patients' and relatives' satisfaction with antipsychotic treatment, further examination of the rationale and appropriateness of the use of antipsychotics in depression is needed.

Adult ; Antipsychotic Agents ; therapeutic use ; Depressive Disorder, Major ; drug therapy ; Female ; Humans ; Male ; Middle Aged ; Personal Satisfaction ; Psychotropic Drugs ; therapeutic use ; Quality of Life

Humans ; Immunotherapy ; Neoplasms