Study: Screening Tools Accurately Identify Postpartum Depression – Focus Group: Urban Minority Moms

In a study led by the University of Rochester Medical Center and published online by the journal Pediatrics, researchers have determined that there is a high degree of accuracy in making the initial determination of postpartum depression (“baby blues”) in urban, minority women when using three depression screening tools.   This research was funded by the National Institute of Mental Health 

This study is reported in a recent article posted in Medical News Today.

Many women experience the so-called “baby blues.” When the feelings persist or worsen it may be clinical depression. The symptoms include insomnia, persistent sadness, lack of interest in nearly all activity, anxiety, change in appetite, persistent feelings of guilt, and thoughts of harming oneself or the baby. Postpartum depression affects up to 14 percent of new mothers in the United States, with higher rates among poor and minority women.

These screening tools have previously been evaluated but this is the first time they have been tested with a group for whom there is not much data – low-income women, especially African-American women, said Linda H. Chaudron, M.D., associate professor of Psychology, Pediatrics and of Obstetrics and Gynecology.

The three screening tools being evaluated were the Edinburgh Postnatal Depression Scale, the Beck Depression Inventory II and the Postpartum Depression Screening Scale.  By clicking on any of the links we have supplied to these tests, the reader can readily see just how simple they are and how quickly they can be administered (as reported – 5 minutes or less).

These screening tests are just that – screening mechanisms.  Healthcare providers dealing with new mothers should be mindful of using these tools and thereby be in a position to help these mothers during this difficult time in their lives.  This is not something restricted to obstetricians  – it is for all healthcare providers who come in contact with any new moms, whom they suspect may be suffering from “baby blues.”  Don’t assume all is well on the home front – ask!  It won’t take much time, but it could provide much needed help for your patients.

News – text4baby – Expectant Moms, Heard About This One?

Social Networking, cell phones, tweets, blogs – you name it – are all the rage.  Now comes news of an interesting and useful (it seems) way for expectant moms to receive weekly text messages timed according to the ‘due date’  News – text4baby.

According to the article, there are approximately 500,000 premature births in the US every year.   This very worthwhile campaign is designed to lower that awful statistic.  As we are all aware, along with prematurity come many bad outcomes for these infants.

Who’s putting this helpful information out there to these moms-to-be?

The messages, which have been vetted by government and nonprofit health experts, deal with nutrition, immunization and birth defect prevention, among other topics. The messages will continue through the baby’s first birthday.

The program has some heavy-weight sponsors – among them: Johnson & Johnson, Pfizer, WellPoint and CareFirst BlueCross and Blue Shield.  It is also noteworthy that wireless carriers including AT&T, Verizon and Sprint are waiving all fees for receiving these texts.

Here’s a little more about the thinking behind this campaign:

Organizers hope the effort can curb premature births, which can be caused by poor nutrition, excessive stress, smoking and drinking alcohol. About 500,000 babies are born prematurely in the U.S. each year, and 28,000 infants die before their first birthday, according to the Healthy Mothers, Healthy Babies Coalition. The nonprofit is among the sponsors of the campaign.

The announcement of this campaign was to have occurred this past Thursday, February 4, 2010 and will be publicized by government officials in various and sundry ways in the days, weeks and months thereafter.

We thought we would do our little bit to get the word out there.

RISKY BUSINESS: NEJM — Outcomes after Internal versus External Tocodynamometry for Monitoring Labor

In December 2003, ACOG, the American College of Obstetricians  and Gynecologists, issued a Practice Bulletin (#49) for its members, in which it recommended the use of intrauterine monitoring of contractions during augmentation or induction of labor in select patients, such as those suffering from obesity.  There were some obstetrical organizations who were recommending the routine use of internal contraction monitoring to assess contractions more accurately.

Of course, the intent behind such recommendations was ostensibly to provide the attending obstetrician with better/more accurate information with which to make clinical decisions regarding the need for an operative birth (i.e. C-section or instrument assisted birth), dosing effectively with oxytocin nad avoidance of complications in such labor situations – the common end-result being to improve fetal and maternal outcomes in such deliveries.

On the other side of the risk/benefit equation, it is only common sense that the use of an internal monitor would increase certain risks – the medical literature speaks of the most common of these as being placental and/or fetal vessel damage, infection and anaphylactic reaction.

A new study by the Academic Medical Center in Amsterdam, led by Jannet J. H. Bakker, MSc, and reported by The New England Journal of Medicine on January 28, 2010 – NEJM — Outcomes after Internal versus External Tocodynamometry for Monitoring Labor raises serious questions about the use of such monitoring when one applies a science-based risk/benefit analysis.

The study reports in pertinent part:

In summary, the results of our trial do not support the routine use of internal tocodynamometry for monitoring contractions in women with induced or augmented labor.

In this multicenter, randomized trial we found no significant difference in rates of operative delivery with internal tocodynamometry as compared with external monitoring of uterine contractions among women in whom oxytocin was used for induction or augmentation of labor. On the basis of the lower boundary of the confidence interval around the observed relative risk of the primary outcome, our data are plausibly consistent with no more than a 9% reduction and up to a 20% increase in the risk of operative delivery associated with internal tocodynamometry. For cesarean section alone, plausible results range from a 17% reduction in risk to a 30% increase in risk with internal tocodynamometry. These results are in concordance with those of three previous small trials that compared internal and external uterine monitoring (each including between 127 and 250 patients), all of which showed a nonsignificant increase in the frequency of cesarean sections in the internal-tocodynamometry group.

Our trial also showed no significant difference between the two types of monitoring in the rates of adverse neonatal outcomes, rates of use of analgesia or antibiotics, or time to delivery. Similarly, none of the earlier studies showed significant benefits in terms of other maternal or neonatal outcomes with the use of an intrauterine pressure catheter.

For a full review of the patient population, the limitations of the study, please refer to the NEJM article.

FDA announces research program for prescription drugs in pregnancy

On December 30, 2009, the FDA announced that a new collaborative research program to study the effects of prescription medications taken by women during pregnancy.  This program is called the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP) and will be a collaborative effort among the FDA, and researchers at the HMO Research Network Center for Education and Research in Therapeutics (CERT), Kaiser Permanente’s multiple research centers and Vanderbilt University.

The FDA references in its announcement an article in the American Journal of Obstetrics and Gynecology, which states  that it estimates that two-thirds of women who are pregnant take at least one prescription medication during their pregnancy.

One might think that there had been a number of clinical trials relating to medications taken during pregnancy prior to this collaborative effort; however, this appears not to be the case since there were too many concerns about the health of the mother and fetus preventing such a study in the past.

For more details  on this long-overdue research study, see the FDA’s announcement.