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Behavioral (externalizing) and emotional (internalizing) problems were showed to be associated with the prenatal environment. Changes in placental DNA methylation was identified as a relevant potential mechanism of such association.
We aimed to explore the associations between placental DNA methylation and child behavior in order to explore pathways that could link prenatal exposures to child behavior.
Data including 441 children of 3 years of age from the EDEN mother-child cohort. Child behavior assessed using the Strengths and Difficulties Questionnaire (SDQ). Both hypotheses-driven and exploratory analyses (including epigenome-wide association studies (EWAS) and differentially methylated regions (DMR) analyses) were conducted. The analyses were adjusted for confounding and technical factors and estimated placental cell composition. All the p-values were corrected using a false discovery rate (FDR) procedure for multiple tests.
In the hypothesis-driven analysis, cg26703534 (AHRR), was significantly associated with emotional problems (pFDR = 0.03). In the exploratory analyses, cg09126090 (pFDR = 0.04) and cg10305789 (PPP1R16B; pFDR < 0.01) were significantly associated with peer-relationship problems and 33 DMRs were significantly associated with at least one of the SDQ subscales. Placental DNA methylation showed more associations with internalizing than externalizing symptoms, especially among girls. DMRs tented to include highly methylated CpGs.
This study investigated for the first time the associations between placental DNA methylation and internalizing and externalizing symptoms in preschoolers. Further analyses, such as consortium meta-analyses would be necessary to confirm and extend our results.
The epidemiology of psychiatric disorders of the perinatal period and their mainly thymic dimension are now well established. However, the underlying physiopathology remains uncertain and poorly explored.
The purpose of this presentation is to explore the current knowledge in terms of neurobiology/neuroimaging underlying the modifications in maternal brain functioning and the links with perinatal psychiatric disorders.
A narrative review of the current international literature was carried out.
Results of the current studies suggest that during pregnancy and the postpartum period, hormones and sensory interactions with the offspring relate to complex structural and functional changes in the brain. This reproduction-related brain plasticity embraces various areas implicated in maternal caregiving, primarily regions involved in reward/motivation, salience/threat detection, emotional regulation, and social cognition such as the ability to empathize and infer the mental state of the baby. Some structural irregularities and differences in activation patterns potentially involved in the triggering of disorders are starting to be identified.
The survival of newborns is largely dependent on the mother, and her brain appears to have evolved to support mother-infant bonding and sensitive care. Brain research offers a growing scientific understanding of the neural correlates of these disorders and opens a window to their prevention and treatment.
Perinatal maternal depression and anxiety are associated with adverse maternal outcomes, and nutrition may play an important role in their emergence. Previous research shows that certain micro and macronutrients found in different dietary patterns may influence perinatal mood disorders.
This study aims to explore relationships between nutrition during pregnancy and perinatal maternal depression and anxiety symptoms using network analyses.
Using data from the French EDEN mother-child cohort, the sample consisted of 1438 women with available perinatal mental health outcomes (CES-D, STAI and EPDS) and nutritional markers collected from food frequency questionnaires. Four networks were constructed to explore the relationships between prenatal nutrient status, dietary patterns, and perinatal mental health, while accounting for important confounders.
The Healthy dietary pattern was associated with the presence of vital micronutrients, while the Western dietary pattern was consistently associated with poorer intake of vital micronutrients and contained an excess of certain macronutrients. Western dietary pattern and symptoms of postnatal depression were connected by a positive edge in both the macronutrient and micronutrient networks. Lower education levels were associated with higher Western dietary pattern scores, from which a positive edge linked to postnatal depression symptoms in both models.
A Western dietary pattern was associated with increased symptoms of postnatal depression in our adjusted network models; The Healthy dietary pattern was associated with essential micronutrients but not with symptoms of depression or anxiety. Perinatal mental health might be impacted by specific dietary patterns in the context of psychosocial and physical stress associated with pregnancy.
This presentation will review the current state of knowledge about severe maternal perinatal mental illness. Severe disorders are associated with a higher prevalence of somatic difficulties during pregnancy, poorer quality of pregnancy follow-up and potential impairment of infant care. These children are therefore very vulnerable and require specific care. We will present how graduated care coordinated and above all integrated between psychiatry, obstetrics, neonatal pediatrics and child protection services allows for early and effective preventive interventions, both for the child’s development and maternal mental health. The concept of shared parenting will be particularly developed.
The first years of life represent a crucial period for psycho-affective development - the critical first 1000 days - because the events that happen to infants and babies during this period have psychosocial as well as epigenetic repercussions, with potential consequences throughout life and even for generations to come. The interactive circle that will develop between the skills (and/or vulnerabilities) of infants and parents and the interactive features arising from each triad, must be supported by perinatal mental health policies, of which the joint care of parents and infants in perinatal psychiatry is a pivotal element. It is necessary to develop care pathways, with systems integrated into “usual” care that take into account families from the prenatal or even pre-conceptual period to the postnatal period,
Joint care must also be scalable and thus encompass everything from parent-child psychotherapy to joint mother-baby hospitalisation. This intervention will present and discuss an example of a graduated, integrated and coordinated system of care, and will open up the perspective that perinatal clinicians must bear in mind that joint care is above all "a way of doing things", based on the notions of multidisciplinarity and prevention.
From the beginning of the pandemic, pregnant or postpartum women were considered particularly vulnerable. In France, the vast majority of joint care for parents and infants facilities have seen their services closed or the number of people cared for greatly reduced to allow for social distancing to be respected. This notion of social distancing is the antithesis of joint care work, the main objective of which is to support and care for the parent-infant bond by favoring social links Services have had to take ownership of this new situation within a few days and develop new approaches, inventing ways of supporting and linking up at a distance. This presentation will deal in detail with these changes and the solutions proposed, especially kind of home hospitalisations based on discussion groups, the development of programmes to support remote interactions, and also the development of work with fathers, who have been much more present than they usually are, due to the generalisation of teleworking.
In the perinatal period, about 15-20 % of women will present a mental health disorder. These disorders, as with all sources of psychological and physical stress in early childhood, especially the poor quality of parent-child relationships, are widely involved in predicting poor mental health in adulthood. The economic cost of perinatal mental health, corollary of this human cost, evaluated in 2014 would amount to £GBP 8.1 billion per annual birth cohort according to a UK report. This report highlights another fundamental element: 3/4 of the costs are associated with the deleterious consequences of parental psychological disorders on child development. The mechanisms involved in the relationship between parental psychiatric disorders and child development are complex. On the other hand, the influence of parental characteristics on the future of children can vary depending on social determinants such as familial income level. During the perinatal period, parental mental health represents one of the keys to the infant development. Perinatal psychiatry allows a dual approach essential to deal with the complexity of perinatal psychiatry care, combining a curative aim (care of the parent) and a preventive one (preventing the risk of dysfunction in the process of becoming parents, in parent-child relationships and of impaired child developement). This intervention wil discuss how this interactive circle must be supported by perinatal mental health policies, of which the joint care of parents and infants (from parent-child psychotherapy to joint mother-baby hospitalisation) in perinatal psychiatry is a pivotal element.
Suicide is one of the leading causes of perinatal maternal mortality (1). Maternal suicidality has a negative impact on the mother-baby relationship and child development. However, little is known about specific risk factors for perinatal suicide attempts in women with severe mental illness. In a sample of 1439 women with severe mental illness in the perinatal period and jointly admitted with their baby in a mother and baby unit, 154 (11.7%) attempted suicide, 49 in pregnancy (3.7%) and 105 (8.0%) in the post-partum period (2). Suicide attempt in pregnancy was related to alcohol use, smoking during pregnancy and a history of miscarriage, and in the post-partum period to major depressive episode or recurrent depression and younger age. Women who attempt suicide either in pregnancy or in the postnatal period could have different psychopathological and environmental profiles. Past obstetric history and addictive behaviours during pregnancy are essential elements to explore. In addition, depressive symptoms should be assessed in all women to treat major depression, as a means of preventing suicide attempt. Special attention to risk of suicide is needed during the perinatal period for women with severe mental illness. For women suffering from an acute psychiatric disorder, or a history of mental illness, multi-disciplinary management should be implemented. 1. Oates M. Suicide: the leading cause of maternal death. Br J Psychiatry. 2003;183:279-81. 2. Gressier F et al. Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses. J Psychiatr Res. 2017;84:284-291.
To describe associations between adolescents’ frequency of vegetable consumption, food parenting practices and socioemotional family characteristics, and to explore potential mediated relationships that may contribute to an understanding of the family processes involved.
Cross-sectional survey among adolescents aged 13–15 years.
A survey questionnaire including self-report measures on adolescents’ frequency of vegetable consumption, perceived food parenting practices (i.e. family dinner frequency, maternal/paternal healthy eating guidance (HEG), maternal/paternal social support for vegetable consumption) and socioemotional family characteristics (i.e. general family functioning and level of cohesion and conflict within the family) was distributed in a convenience sample of secondary school students.
Four hundred forty students from five secondary schools in eastern Norway completed the questionnaire.
Results from multiple linear regression analysis revealed positive and statistically significant associations between adolescents’ frequency of vegetable consumption, maternal HEG and family cohesion. A partial indirect (mediated) association between family cohesion and adolescents’ frequency of vegetable consumption, working through maternal HEG, was also found.
Results from the present study suggest that perceived family cohesion may influence adolescents’ frequency of vegetable consumption both directly and indirectly. However, there is a need for continued investigation of family-related factors influencing adolescent eating. In particular, the role of socioemotional family characteristics should be further scrutinised in future studies.
At least at the larger hospitals specialised gero-psychiatric units have been introduced, usually taking care of those at age 65y and higher. The advantages of this approach have been discussed and examined. The patients’ view has only rarely been investigated and mostly only from a single perspective (e.g. patient satisfaction on gero-psychiatric wards).
We performed semistructured qualitative interviews in our hospital in a balanced sample of (n=14) patients at 18-40y, (n=10) patients at 41-60y, (n=16) patients at 61-75y, (n=8) patients over 75y. There were (n=) 24 male and (n=) 24 female patients. 12 patients hat been treated exclusively in old age psychiatry, and 10 patients had been treated in old age psychiatry after their 65th birthday.
The majorities of the patients saw advantages in mixed sex and age care for the younger and for the older patients. Disadvantages where not seen for younger patients, however for the elderly the view was ambivalent (26 yes versus 22 no). Female and higher age patients and those with multiple hospitalisations tended to expect more disadvantages. While a mixed ward would be regarded as more (stimulating), disadvantages could be the combination of aggressive young and frail elderly patients as well as the overburdening of the staff.
This is the first investigation on patient view on the segregation of old age psychiatric patients. Further studies should lead to a consumer guided care provision allowing specialisation as well as defending ageism.
Le terme de « dépression » est communément associé à tout trouble de l’humeur de la période périnatale. Pourtant, les rares travaux étudiant les profils évolutifs des symptômes dépressifs depuis la grossesse jusqu’à plusieurs années post-partum suggèrent qu’il existerait différents type de trajectoires . Les résultats des travaux issus de la cohorte bordelaise MATQUID qui seront présentés (597 patientes suivies depuis le dernier trimestre de la grossesse jusqu’aux 2 ans de l’enfant) suggèrent également l’existence de 4 profils différents pour la symptomatologie dépressive périnatale, en termes d’intensité et de facteurs de risque .
Au-delà de la problématique sémiologique, l’accès aux soins de ces patientes reste une question d’actualité. Les différents plans de périnatalité français avaient, entre autres, pour objectifs d’améliorer l’accès aux soins de ces patientes, qui reste limité . Une analyse des données concernant les mères de la cohorte Étude Longitudinale Française depuis l’Enfance (ELFE) ont montré que environ 12 % des femmes enceintes en France en 2011 déclaraient présenter des « difficultés psychologiques » et n’avaient pourtant qu’un accès limité aux soins psychiques (25,4 % de ces femmes déclarant des difficultés psychologiques rapportaient avoir bénéficié d’une consultation prénatale avec un spécialiste de la santé mentale, 10,6 % l’utilisation d’un traitement psychotrope, et 6,4 % les deux) .
Les résultats de ces différents travaux soulignent la nécessité d’affiner la connaissance de la sémiologie des troubles dépressifs périnataux, pour permettre aux patientes d’accéder à des parcours de soins plus spécifiques.
This study assessed the underexplored factors associated with significant improvement in mothers’ mental health during postpartum inpatient psychiatric care.
This study analyzed clinical improvement in a prospective cohort of 869 women jointly admitted with their infant to 13 psychiatric Mother-Baby Units (MBUs) in France between 2001 and 2007. Predictive variables tested were: maternal mental illness (ICD-10), sociodemographic characteristics, mental illness and childhood abuse history, acute or chronic disorder, pregnancy and birth data, characteristics and mental health of the mother's partner, and MBU characteristics.
Two thirds of the women improved significantly by discharge. Admission for 25% was for a first acute episode very early after childbirth. Independent factors associated with marked improvement at discharge were bipolar or depressive disorder, a first acute episode or relapse of such an episode. Schizophrenia, a personality disorder, and poor social integration (as measured by occupational status) were all related to poor clinical outcomes.
Most women improved significantly while under care in MBUs. Our results emphasize the importance of the type of disease but also its chronicity and the social integration when providing postpartum psychiatric care.
Few studies of the effects of postnatal depression on child development have considered the chronicity of depressive symptoms. We investigated whether early postnatal depressive symptoms (PNDS) predicted child developmental outcome independently of later maternal depressive symptoms.
In a prospective, longitudinal study, mothers and children were followed-up from birth to 2 years; repeated measures of PNDS were made using the Edinburgh Postnatal Depression Scale (EPDS); child development was assessed using the Bayley Scales II. Multilevel modelling techniques were used to examine the association between 6 week PNDS, and child development, taking subsequent depressive symptoms into account.
Children of mothers with 6 week PNDS were significantly more likely than children of non-symptomatic mothers to have poor cognitive outcome; however, this association was reduced to trend level when adjusted for later maternal depressive symptoms.
Effects of early PNDS on infant development may be partly explained by subsequent depressive symptoms.
Pregnant women are vulnerable to the deleterious impact of environmental stressors. The aims were to identify the environmental and pregnancy characteristics independently associated with prenatal psychological distress and access to mental health care.
We used data from the French cohort Étude Longitudinale Française depuis l’Enfance (ELFE), a nationally representative cohort of children followed-up from birth to adulthood. Information about prenatal psychological status and access to mental health care was collected during the maternity stay. Maternal/pregnancy characteristics independently associated with psychological distress and access to mental health care were explored using multivariate analyses.
Of the 15,143 mothers included, 12.6% reported prenatal psychological distress. Prenatal distress was more frequent in women with very low economical status, alcohol/tobacco use, unplanned/unwanted pregnancy, late pregnancy declaration, multiparity and complicated pregnancy (high number of prenatal visits, prenatal diagnosis examination, obstetrical complications). Of the women reporting prenatal distress, 25% had a prenatal consultation with a mental health specialist and 11% used psychotropic drugs during pregnancy. Decreased likelihood to consult a mental health specialist was found in young women, with intermediate educational level and born abroad.
Causal inferences should be made cautiously as the questionnaire did not collect information on the temporal sequence between psychological distress and associated characteristics.
Women with social and obstetrical vulnerabilities are at increased risk of poor mental health during pregnancy. Improving mental health care access during pregnancy is a public health priority.
School-based interventions and policies encourage youths to include and consume fruits and vegetables at lunchtime via school lunches, but limited research has examined how these behaviours compare when youths have home-packed lunches. The objective of the present study was to compare fruit and vegetable contents and consumption among students having school or home-packed lunches over the school week.
Participants were observed over five consecutive days at school lunchtime. Trained analysts estimated students’ lunchtime fruit and vegetable contents and consumption using digital imaging. Mixed models examined associations between fruit and vegetable dietary behaviours and lunch source (school v. home-packed), controlling for student gender, grade and school.
Three elementary schools in northern California, USA.
Fourth-, fifth- and sixth-grade students (nchildren 315; nobservations 1421).
Students were significantly less likely to have and to consume fruits and vegetables (all P<0·05) when having home-packed lunches, compared with when having school lunches. Among those who did have or did consume these foods, having a home-packed lunch was associated with consuming significantly less fruit (P<0·05) but no differences for other dietary outcomes.
The study adds to a growing body of literature indicating shortfalls in fruit and vegetable contents and consumption associated with having a home-packed lunch, relative to having a school lunch. Findings suggest that school-based interventions, particularly when targeting home-packed lunches, should focus on whether or not these foods are included and consumed, with less emphasis on quantities.
Previous findings have been mixed regarding the relationship between maternal depressive symptoms and child cognitive development. The objective of this study was to systematically review relevant literature and to perform a meta-analysis.
Three electronic databases (PubMed, EMBASE, PsycINFO) were searched. Initial screening was conducted independently by two reviewers. Studies selected for detailed review were read in full and included based on a set of criteria. Data from selected studies were abstracted onto a standardized form. Meta-analysis using the inverse variance approach and random-effects models was conducted.
The univariate analysis of 14 studies revealed that maternal depressive symptoms are related to lower cognitive scores among children aged ⩽56 months (Cohen's d = −0.25, 95% CI −0.39 to −0.12). The synthesis of studies controlling for confounding variables showed that the mean cognitive score for children 6–8 weeks post-partum whose mothers had high depressive symptoms during the first few weeks postpartum was approximately 4.2 units lower on the Mental Developmental Index (MDI) of the Bayley Scales of Infant and Toddler Development (BSID) compared with children with non-symptomatic mothers (B̂ = −4.17, 95% CI −8.01 to −0.32).
The results indicated that maternal depressive symptoms are related to lower cognitive scores in early infancy, after adjusting for confounding factors. An integrated approach for supporting child cognitive development may include program efforts that promote maternal mental health in addition to family economic wellbeing, responsive caregiving, and child nutrition.
Clostridium difficile infection (CDI) in hospitalized patients is generally attributed to the current stay, but recent studies reveal high C. difficile colonization rates on admission.
To determine the rate of colonization with toxigenic C. difficile among intensive care unit patients upon admission as well as acquired during hospitalization, and the risk of subsequent CDI.
Prospective cohort study from April 15 through July 8, 2013. Adults admitted to an intensive care unit within 48 hours of admission to the Johns Hopkins Hospital, Baltimore, Maryland, were screened for colonization with toxigenic C. difficile. The primary outcome was risk of developing CDI.
Among 542 patients, 17 (3.1%) were colonized with toxigenic C. difficile on admission and an additional 3 patients were found to be colonized during hospitalization. Both colonization with toxigenic C. difficile on admission and colonization during hospitalization were associated with an increased risk for development of CDI (relative risk, 10.29 [95% CI, 2.24–47.40], P=.003; and 15.66 [4.01–61.08], P<.001, respectively). Using multivariable analysis, colonization on admission and colonization during hospitalization were independent predictors of CDI (relative risk, 8.62 [95% CI, 1.48–50.25], P=.017; and 10.93 [1.49–80.20], P=.019, respectively), while adjusting for potential confounders.
In intensive care unit patients, colonization with toxigenic C. difficile is an independent risk factor for development of subsequent CDI. Further studies are needed to identify populations with higher toxigenic C. difficile colonization rates possibly benefiting from screening or avoidance of agents known to promote CDI.
Infect. Control Hosp. Epidemiol. 2015;36(11):1324–1329
Maternal depression in the pre- and postpartum period may set women on a course of chronic depressive symptoms. Little is known about predictors of persistently elevated depressive symptoms in mothers from pregnancy onwards. The aims of this study are to determine maternal depression trajectories from pregnancy to the child's fifth birthday and identify associated risk factors.
Mothers (N = 1807) from the EDEN mother–child birth cohort study based in France (2003–2011) were followed from 24–28 weeks of pregnancy to their child's fifth birthday. Maternal depression trajectories were determined with a semi-parametric group-based modelling strategy. Sociodemographic, psychosocial and psychiatric predictors were explored for their association with trajectory class membership.
Five trajectories of maternal symptoms of depression from pregnancy onwards were identified: no symptoms (60.2%); persistent intermediate-level depressive symptoms (25.2%); persistent high depressive symptoms (5.0%); high symptoms in pregnancy only (4.7%); high symptoms in the child's preschool period only (4.9%). Socio-demographic predictors associated with persistent depression were non-French origin; psychosocial predictors were childhood adversities, life events during pregnancy and work overinvestment; psychiatric predictors were previous mental health problems, psychological help, and high anxiety during pregnancy.
Persistent depression in mothers of young children is associated to several risk factors present prior to or during pregnancy, notably anxiety. These characteristics precede depression trajectories and offer a possible entry point to enhance mother's mental health and reduce its burden on children.