What we don't know about prenatal opioid exposure

Sparse data on how children fare after prenatal opioid exposure

August 28, 2019

Science Daily/University of Utah

'Will the baby be OK?' In cases of prenatal opioid exposure, the answer is unclear. Developmental psychologists collected and reviewed 52 publications to identify what's known so far about how prenatal opioid exposure affects childhood outcomes and development

Pregnancy can be a time of anxious uncertainty, particularly if there are any risks of complications. The question always arises, from parents, grandparents, friends and others: "Will the baby be OK?"

In cases where the baby has been exposed to opioids in the womb, the answer is unclear. As part of a National Institutes of Health initiative to study the effects of a child's environment on his or her life outcomes, University of Utah developmental psychologist Elisabeth Conradt and her colleagues collected and reviewed 52 publications to identify what's known so far about how prenatal opioid exposure affects childhood outcomes and development. The review is published in Pediatrics.

"Right now, the number one question mothers, fathers and clinicians have when they see that a mother is using opioids while pregnant is how will this opioid exposure affect the child's health?" Conradt says. "We cannot answer that question right now with the existing data that we have."

Effects at birth

For this review study, the researchers focused particularly on 11 studies of children diagnosed with neonatal opioid withdrawal syndrome, or NOWS. It's a condition diagnosed three to four days after birth and includes symptoms such as feeding problems, tremors and a high-pitched cry. Little is known about how a diagnosis of NOWS is connected to a child's neurological development throughout life.

The current question about babies exposed to opioids, Conradt says, echoes questions from the 1980s and '90s about babies exposed to crack cocaine in the womb. "What we actually found is that the effects of cocaine on these child outcomes were quite subtle," Conradt says. "Cocaine was probably a proxy for the type of environment in which the kids were raised."

The researchers found that studies of newborns with NOWS produced inconsistent results. Some showed differences in behavior between newborns exposed to buprenorphine versus those exposed to methadone. Both buprenorphine and methadone are given as treatments for opioid addiction in adults, with buprenorphine approved to treat addiction in pregnant women. Although some studies showed decreased NOWS symptoms in buprenorphine-exposed newborns, other studies found no significant differences between the two groups of newborns.

"Because the data were so tenuous and the findings were so inconsistent, we didn't feel comfortable drawing a conclusion," Conradt says. "So it's not clear what the effects of prenatal opioid exposure are at birth."

Infancy

The researchers found 21 studies looking at the development of children up to 2 years of age after prenatal opioid exposure. Conradt says that many of the studies had small numbers of children in the study, which makes it more difficult to tell whether the effects seen in the study are really due to opioid exposure or could be due to other confounding factors. One study had a sufficient size to control for confounding factors, Conradt says, with 131 children. That study found many null effects of opioid exposure on cognitive and behavioral outcomes. "We felt a little bit more comfortable saying that there may not be major effects of prenatal opioid exposure in infancy after controlling for these relevant confounders," Conradt says.

Two years and beyond

Conradt found some of the same inconsistent results in the 27 studies that looked at cognitive development beyond age 2, with some studies finding significant effects in IQ and language ability, and some finding no significant effects. But studies of behavior were more consistent. Children exposed to methadone had higher fear, aggression and anxiety, and a NOWS diagnosis was associated with lower attention. Conradt says it's not surprising that behavioral effects would emerge as children get older. "As children age, they're more challenged," she says. "They have to pay attention at school, they have to sit still, they have to control their behavior. It's not surprising that kids exposed to methadone in the womb may have a harder time with those skills."

But it's still difficult, Conradt says, to determine whether these behavior effects are directly due to opioid exposure, to the children's environment or interaction between the two over time.

Moving forward

One of the main takeaways from Conradt's study is that the existing body of work is hampered by small sample sizes and abundant confounding factors that could obscure the true effects of the opioid exposure. Conradt is part of a program that aims to resolve these issues. It's called the Environmental Influences on Child Health Outcome program, abbreviated ECHO, a nationwide research program supported by the NIH to enhance child health. It's a seven-year, 71-cohort study to examine what environmental factors before and after birth affect children's developmental outcomes.

"We have the opportunity to collect data on over 50,000 children across hundreds of different sites across the country, and tracking their outcomes in a systematic and rigorous manner," Conradt says. U researchers Joe Stanford, Christy Porucznik and Angelo Giardino are principal investigators of the NIH ECHO pediatric cohorts in Utah. In the future Conradt, an ECHO investigator, and others will utilize the data as it becomes available to continue working toward understanding what prenatal opioid exposure means for the future of a growing generation of children.

https://www.sciencedaily.com/releases/2019/08/190828080534.htm

Sleep duration, quality may impact cancer survival rate

June 10, 2015

Science Daily/American Academy of Sleep Medicine

Pre-diagnostic short sleep duration and frequent snoring were associated with significantly poorer cancer-specific survival, particularly among women with breast cancer, new research confirms.

Results show that stratified by cancer site, short sleep duration and frequent snoring were associated with significantly poorer breast cancer-specific survival.

"Our results suggest that sleep duration is important for breast cancer survival, particularly in women who snore," said lead author Amanda Phipps, assistant professor of epidemiology at the University of Washington in Seattle, Wash. and assistant member at the Fred Hutchinson Cancer Research Center.

The research abstract was published recently in an online supplement of the journal Sleep and will be presented Wednesday, June 10, in Seattle, Washington, at SLEEP 2015, the 29th annual meeting of the Associated Professional Sleep Societies LLC.

The study group comprised of 21,230 women diagnosed with a first primary invasive cancer during follow-up from the Women's Health Initiative (WHI). Participants provided information on several sleep attributes at study baseline, including sleep duration, snoring, and components of the WHI Insomnia Rating Scale. Analyses were adjusted for age at enrollment, study arm, cancer site, marital status, household income, smoking, physical activity, and time-lag between baseline data collection and cancer diagnosis.

http://www.sciencedaily.com/releases/2015/06/150610131732.htm

Alcohol-related cues, stress strongly impact females and increase 'craving'-like behavior

April 1, 2015

Science Daily/Federation of American Societies for Experimental Biology (FASEB)

A study conducted in rats measuring risk factors that contribute to alcohol abuse suggests females are particularly sensitive to alcohol-related cues and stress which elicits a “craving” response.

"Traditionally, heavy drinking has been shown to be more prevalent in men, though more recent studies point to a narrowing in the gender gap," said Megan Bertholomey, Ph.D., a postdoctoral associate in the laboratory of Mary Torregrossa, Ph.D., at the University of Pittsburgh who conducted the research. "Further, alcohol-dependent women tend to show more negative emotional responses to drinking, including greater stress and anxiety."

To investigate sex differences in the role stress plays in alcohol abuse, the researchers first trained male and female rats to press a lever, which would then administer alcohol simultaneously paired with an audiovisual cue. After three weeks of drinking, the rats associated the cue with alcohol.

The rats then underwent a period of abstinence with no audiovisual cue and no alcohol intake; regardless of how many times they pressed the lever. However, those original alcohol-cue memories do not go away during abstinence, allowing the researchers to determine factors that can cause the rats to start responding again.

"It's well established that exposure to alcohol-associated cues and to stress can lead to reinstatement of the drug seeking response, which is thought to be a model of craving or relapse in rats," said Bertholomey, who will present the research at the American Society for Pharmacology and Experimental Therapeutics (ASPET) Annual Meeting during Experimental Biology 2015.

Prior studies show that exposure to both cues and stress can have an additive effect on the propensity to cause craving and relapse in both people and in rats, and that females trained to respond for cocaine may be more sensitive to this effect. Thus, the researchers tested whether reinstatement of alcohol responding was different in male and female rats in the presence of the alcohol-paired cue with or without an injection of a drug that increases stress. The drug used, yohimbine, also produces a stress response in humans, which assists in making comparisons across species.

The researchers found that overall, the female rats pressed more on the lever that previously led to alcohol access than the males following either cue or stress exposure alone. Strikingly, when the cues and stress were combined, females had an even greater increase in alcohol seeking behavior compared to males and when either stimulus was given alone.

The results indicate that females are more influenced by environmental cues and stress in promoting a "craving"-like response that can drive them to seek and consume alcohol. These findings provide the basis for dissecting the brain pathways that causes the interactions between cues, stress and sex in alcohol seeking and drinking behavior.

"Individuals attempting to maintain abstinence are exposed to a number of factors that elicit craving and can lead to an increased risk of relapse," said Bertholomey. "The next step for us will be to understand the mechanisms responsible for this enhanced sensitivity in females, which will direct further development of pharmacological and behavioral interventions that might reduce craving and prevent relapse."

Alcohol use disorders are diagnosed in approximately 17 million adults in the United States, representing 9.9 and 4.6 percent of men and women in that age group, respectively, according to the National Survey on Drug Use and Health (NSDUH). The Centers for Disease Control and Prevention report that alcohol-related problems cost the United States $223.5 billion and represent the third leading cause of preventable death.

http://www.sciencedaily.com/releases/2015/04/150401132854.htm

Impact of domestic violence on women's mental health

March 31, 2015

Science Daily/University of Montreal

In addition to their physical injuries, women who are victims of domestic violence are also at a greater risk of mental health problems such as depression and psychotic symptoms. "We studied the impact of domestic violence on the risk of mental health problems, particularly depression," explained the first study author. "We also studied the role of certain factors from the victims' personal history, such as childhood abuse and economic poverty," she explained.

"We studied the impact of domestic violence on the risk of mental health problems, particularly depression," explained Isabelle Ouellet-Morin, first study author and a researcher at the Institut universitaire en santé mentale de Montréal. "We also studied the role of certain factors from the victims' personal history, such as childhood abuse and economic poverty," explained Ms. Ouellet-Morin, who is also a professor at the School of Criminology at the University of Montreal.

1,052 mothers participated in the Environmental Risk (E-Risk) Longitudinal Twin Study over 10 years. Only subjects with no previous history of depression were considered for the study. Over this decade, the researchers conducted multiple interviews to determine whether the subjects had suffered violence from their spouses and whether they suffered from mental health disorders.

Results

• ·      More than one third of the women reported suffering violence from their spouses (e.g., being pushed or hit with an object).
• ·      These women had a more extensive history of childhood abuse, abuse of illicit substances, economic poverty, early pregnancy, and an antisocial personality.
• ·      They were twice as likely to suffer from depression, even when controlling for the impact of childhood abuse.
• ·      Domestic violence had an impact not just on mood but on other mental health aspects as well. These women had a three times higher risk of developing schizophrenia-like psychotic symptoms. This risk doubled for women who were also victims of childhood abuse.

"Domestic violence is unacceptable because of the injuries it causes. We have shown that these injuries are not only physical: they can also be psychological, as they increase the risk of depression and psychotic symptoms," added Louise Arseneault, a researcher at the Institute of Psychiatry, Psychology & Neuroscience at King's College London. "Health professionals need to be very aware of the possibility that women who experience mental health problems may also be the victims of domestic violence and vice versa. Given the prevalence of depression in these victims, we need to prevent these situations and take action. These acts of violence do more than leave physical damage; they leave psychological scars as well," concluded Dr. Arseneault.

http://www.sciencedaily.com/releases/2015/03/150331074443.htm

History of depression puts women at risk for diabetes during pregnancy

March 31, 2015

Science Daily/Loyola University Health System

A history of depression may put women at risk for developing diabetes during pregnancy, according to research. This study also pointed to how common depression is during pregnancy and the need for screening and education.

"Women with a history of depression should be aware of their risk for gestational diabetes during pregnancy and raise the issue with their doctor," said Mary Byrn, PhD, RN, study co-author and assistant professor, MNSON. "Health-care providers also should know and understand the prevalence and symptoms of prenatal depression and gestational diabetes and screen and manage these women appropriately."

Loyola researchers used the Edinburgh Postnatal Depression Screen to measure symptoms of depression in 135 pregnant women attending routine prenatal care visits. Sixty-five study participants had gestational diabetes. These women were 3.79 times more likely to have a history of depression than women without gestational diabetes. In addition, 20 percent of women with gestational diabetes and 13 percent of women without gestational diabetes had significant symptoms of depression. Anxiety and perceived stress were significant predictive factors of depression for both groups.

Each year, more than 200,000 pregnancies are complicated by gestational diabetes. Pregnant women who have gestational diabetes and the added issue of depression are at an even greater risk for possible negative outcomes. Pregnant women who are depressed are more likely to practice unhealthy behaviors such as smoking, alcohol use and missing prenatal doctor visits.

The relationship between diabetes and depression is complex. Clinicians initially believed that depression in people with diabetes was due to the demands of living with a chronic illness. More contemporary thinking suggests that having depression may precipitate the onset of type 2 diabetes. Therefore, if depression is present prior to pregnancy, it may be important to monitor for the development of gestational diabetes.

"Depression may also contribute to the poor self-management of gestational diabetes and potentially increase the chance for complications during pregnancy," said Sue Penckofer, PhD, RN, study co-author and professor, MNSON. "We must further explore the relationship between diabetes and depression to help understand and improve prenatal care and outcomes for women and infants."

http://www.sciencedaily.com/releases/2015/03/150331121245.htm

Stress management techniques improve long-term mood and quality of life for women with breast cancer

March 23, 2015

Science Daily/Wiley

A new study shows that providing women with skills to manage stress early in their breast cancer treatment can improve their mood and quality of life many years later.

At the turn of the century, 240 women with a recent breast cancer diagnosis participated in a randomized trial that tested the effects of a stress management intervention developed by Michael Antoni, PhD, of the University of Miami. Dr. Antoni and his team found that, compared with patients who received a one-day seminar of education about breast cancer, patients who learned relaxation techniques and new coping skills in a supportive group over 10 weeks experienced improved quality of life and less depressive symptoms during the first year of treatment.

In their latest report, the researchers found that the women who received the stress management intervention had persistently less depressive symptoms and better quality of life up to 15 years later. "Women with breast cancer who participated in the study initially used stress management techniques to cope with the challenges of primary treatment to lower distress. Because these stress management techniques also give women tools to cope with fears of recurrence and disease progression, the present results indicate that these skills can be used to reduce distress and depressed mood and optimize quality of life across the survivorship period as women get on with their lives," said lead author Jamie Stagl, who is currently at Massachusetts General Hospital, in Boston.

Stagl noted that breast cancer survivors in the stress management group reported levels of depression and quality of life at the 15-year follow-up that were similar to what is reported by women without breast cancer. Also, the intervention was helpful for women of various races and ethnic backgrounds. "This is key given the fact that ethnic minority women experience poorer quality of life and outcomes after breast cancer treatment," said Stagl.

As survival rates increase for breast cancer, the question of how to maintain psychosocial health becomes increasingly salient. The current findings highlight the possibility that psychologists and social workers may be able to "inoculate" women with stress management skills early in treatment to help them maintain long-term psychosocial health.

"Because depressive symptoms have been associated with neuroendocrine and inflammatory processes that may influence cancer progression, our ongoing work is examining the effects of stress management on depression and inflammatory biomarkers on the one hand, and disease recurrence and survival on the other," said Dr. Antoni.

http://www.sciencedaily.com/releases/2015/03/150323075936.htm

Low vitamin D levels, depression linked in young women

March 18, 2015

Science Daily/Oregon State University

There is a relationship between low levels of vitamin D and depression in otherwise healthy young women, a new study shows.

OSU researchers found that young women with lower levels of vitamin D were more likely to have clinically significant depressive symptoms over the course of a five-week study, lead author David Kerr said. The results were consistent even when researchers took into account other possible explanations, such as time of year, exercise and time spent outside.

"Depression has multiple, powerful causes and if vitamin D is part of the picture, it is just a small part," said Kerr, an associate professor in the School of Psychological Science at OSU. "But given how many people are affected by depression, any little inroad we can find could have an important impact on public health."

The findings were published recently in the journal Psychiatry Research. Co-authors are Sarina Saturn of the School of Psychological Science; Balz Frei and Adrian Gombart of OSU's Linus Pauling Institute; David Zava of ZRT Laboratory and Walter Piper, a former OSU student now at New York University.

Vitamin D is an essential nutrient for bone health and muscle function. Deficiency has been associated with impaired immune function, some forms of cancer and cardiovascular disease, said Gombart, an associate professor of biochemistry and biophysics, principal investigator with the Linus Pauling Institute and international expert on vitamin D and the immune response.

People create their own vitamin D when their skin is exposed to sunlight. When sun is scarce in the winter, people can take a supplement, but vitamin D also is found in some foods, including milk that is fortified with it, Gombart said. The recommended daily allowance of vitamin D is 600 IU per day. There is no established level of vitamin D sufficiency for mental health.

The new study was prompted in part because there is a widely held belief that vitamin D and depression are connected, but there is not actually much scientific research out there to support the belief, Kerr said.

"I think people hear that vitamin D and depression can change with the seasons, so it is natural for them to assume the two are connected," he said.

According to Kerr and his colleagues, a lot of past research has actually found no association between the two, but much of that research has been based on much older adults or special medical populations.

Kerr's study focused on young women in the Pacific Northwest because they are at risk of both depression and vitamin D insufficiency. Past research found that 25 percent of American women experience clinical depression at some point in their lives, compared to 16 percent of men, for example.

OSU researchers recruited 185 college students, all women ages 18-25, to participate in the study at different times during the school year. Vitamin D levels were measured from blood samples and participants completed a depression symptom survey each week for five weeks.

Many women in the study had vitamin D levels considered insufficient for good health, and the rates were much higher among women of color, with 61 percent of women of color recording insufficient levels, compared to 35 percent of other women. In addition, more than a third of the participants reported clinically significant depressive symptoms each week over the course of the study.

"It may surprise people that so many apparently healthy young women are experiencing these health risks," Kerr said.

As expected, the women's vitamin D levels depended on the time of year, with levels dropping during the fall, at their lowest in winter, and rising in the spring. Depression did not show as a clear pattern, prompting Kerr to conclude that links between vitamin D deficiency and seasonal depression should be studied in larger groups of at-risk individuals.

Researchers say the study does not conclusively show that low vitamin D levels cause depression. A clinical trial examining whether vitamin D supplements might help prevent or relieve depression is the logical next step to understanding the link between the two, Kerr said.

OSU researchers already have begun a follow-up study on vitamin D deficiency in women of color. In the meantime, researchers encourage those at risk of vitamin D deficiency to speak with their doctor about taking a supplement.

"Vitamin D supplements are inexpensive and readily available." Kerr said. "They certainly shouldn't be considered as alternatives to the treatments known to be effective for depression, but they are good for overall health."

http://www.sciencedaily.com/releases/2015/03/150318145501.htm

Longer duration of breastfeeding linked with higher adult IQ and earning ability

March 17, 2015

Science Daily/The Lancet

Longer duration of breastfeeding is linked with increased intelligence in adulthood, longer schooling, and higher adult earnings, a study following a group of almost 3,500 newborns for 30 years.

"The effect of breastfeeding on brain development and child intelligence is well established, but whether these effects persist into adulthood is less clear," explains lead author Dr Bernardo Lessa Horta from the Federal University of Pelotas in Brazil.

"Our study provides the first evidence that prolonged breastfeeding not only increases intelligence until at least the age of 30 years but also has an impact both at an individual and societal level by improving educational attainment and earning ability. What is unique about this study is the fact that, in the population we studied, breastfeeding was not more common among highly educated, high-income women, but was evenly distributed by social class. Previous studies from developed countries have been criticized for failing to disentangle the effect of breastfeeding from that of socioeconomic advantage, but our work addresses this issue for the first time."

Horta and colleagues analysed data from a prospective study of nearly 6000 infants born in Pelotas, Brazil in 1982. Information on breastfeeding was collected in early childhood. Participants were given an IQ test (Wechsler Adult Intelligence Scale, 3rd version) at the average age of 30 years old and information on educational achievement and income was also collected.

Information on IQ and breastfeeding was available for just over half (3493) participants. The researchers divided these subjects into five groups based on the length of time they were breastfed as infants, controlling for 10 social and biological variables that might contribute to the IQ increase including family income at birth, parental schooling, genomic ancestry, maternal smoking during pregnancy, maternal age, birthweight, and delivery type.

While the study showed increased adult intelligence, longer schooling, and higher adult earnings at all duration levels of breastfeeding, the longer a child was breastfed for (up to 12 months), the greater the magnitude of the benefits. For example, an infant who had been breastfed for at least a year gained a full four IQ points (about a third of a standard deviation above the average), had 0.9 years more schooling (about a quarter of a standard deviation above the average), and a higher income of 341 reais per month (equivalent to about one third of the average income level) at the age of 30 years, compared to those breastfed for less than one month.

According to Dr Horta, "The likely mechanism underlying the beneficial effects of breast milk on intelligence is the presence of long-chain saturated fatty acids (DHAs) found in breast milk, which are essential for brain development. Our finding that predominant breastfeeding is positively related to IQ in adulthood also suggests that the amount of milk consumed plays a role."

Writing in a linked Comment, Dr Erik Mortensen from the University of Copenhagen in Denmark says, "With age, the effects of early developmental factors might either be diluted, because of the effects of later environmental factors, or be enhanced, because cognitive ability affects educational attainment and occupational achievements...By contrast, Victora and colleagues' study suggests that the effects of breastfeeding on cognitive development persist into adulthood, and this has important public health implications...However, these findings need to be corroborated by future studies designed to focus on long-term effects and important life outcomes associated with breastfeeding."

http://www.sciencedaily.com/releases/2015/03/150317195937.htm

Stress may partly explain worse heart attack recovery in young and middle-aged women

February 9, 2015

Science Daily/American Heart Association

Stress is associated with worse recovery after heart attack among young and middle-age patients. Women patients perceive greater psychological stress than men. Greater stress among women partially explained their worse recovery.

Although 35,000 women under age 65 experience heart attack each year in the United States, there's limited data on psychosocial characteristics and recovery outcomes of young and middle-aged women.

"Our study found a significantly higher level of mental stress in women 18-55 years old with heart attack compared to their male counterparts," said Xiao Xu, Ph.D., lead author of the study and assistant professor of obstetrics, gynecology and reproductive sciences at Yale University in New Haven, Connecticut.

Previous research suggests that mental stress may reduce blood flow and promote plaque forming in the arteries. Stress is also associated with behaviors that may adversely affect health outcomes such as treatment noncompliance.

Researchers analyzed data collected from 2,397 female and 1,175 male heart attack survivors 18-55 years old in the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, a prospective observational study of young and middle-aged adult heart attack patients in the United States, Spain and Australia. During their initial hospital stay for heart attack, researchers measured patients' perceived stress using a 14-item scale that gauged their lives as being uncontrollable and overloaded over the past month.

The study showed:

• Women had worse recovery one month after heart attack on multiple outcome measures such as chest-pain-related physical function and quality of life as well as overall health.
• Women had a significantly higher level of mental stress.
• Greater stress among women partially explained their worse recovery.
• Women were more likely to be concerned about family issues while men were more likely to be worried about financial matters:
• Family conflict during the past year was reported by about 33 percent of women versus 20 percent of men.
• A major personal injury or illness was reported by 22.4 percent of women versus 16.6 percent of men.
• Death or major illness of a close family member was reported by 36.6 percent of women versus 27.8 percent of men.
• A loss of crop or business failure as heavy stressors was identified more by men (7.4 percent) compared to 3.5 percent of women.

The study's results add to the growing literature on younger heart attack patients and the need to identify and understand how stress and other psychosocial issues affect recovery.

"We need to think more broadly about our patients," said Harlan Krumholz, M.D., S.M., the study's senior author and director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital and a professor in Yale's School of Medicine and Public Health. "We have to consider their state of mind and the experiences of their lives."

http://www.sciencedaily.com/releases/2015/02/150209171305.htm

Parenting and depression study: Fathers are at risk, too

February 5, 2015

Science Daily/Brigham Young University

A national study of parents found that parents with multiple parenting roles -- such as those in blended families -- are at higher risk of depression. Specifically, parents with three roles were 57 percent more likely to be depressed than those with just a single parenting role.

Scholars at Brigham Young University and Princeton conducted research that gives a better look at how various types of parents experience stress. One finding of the study is that some stepfathers -- those with multiple family roles -- experience the highest stress levels.

"If you say parenting and depression, the first thing people think of is post-partum moms," said Kevin Shafer, a professor of social work at BYU. "But both moms and dads experience stress and certain kinds of parenting roles can be very, very stressful."

Shafer and Princeton's Garrett Pace analyzed data from more than 6,000 parents around the country. The main finding of the study is that depression risk increases for both men and women when the number of parenting roles they hold increases.

Parents in a "yours, mine and ours" family hold three parenting roles: one each for the two families that blended, and a third when a child is born into the blended family. The study found parents with three roles were 57 percent more likely to be depressed than those with just a single parenting role.

Shafer said that there's inherently bumpiness that comes with the process of blending two different families.

"There are norms that govern parenting, but there aren't norms for being a stepparent," Shafer said. "Am I supposed to be an actual parent, a friend, or something like a cool uncle?"

The risk is even higher for fathers in such blended families when a father has biological children who don't live with him. Shafer says that's driven partially by feelings of guilt for spending more time with his new children than his older children. The dynamic also shifts when a new baby comes along.

"The stress doesn't come from a bad place," Shafer said. "It actually comes from a really good place. They want to be a good parent, they want to be a good stepparent, and they want to be a good new parent."

Two trends underscore the importance of these findings. The first is that men are less likely to seek professional counseling when they need it. The second is that blended families are becoming more common, so more parents feel the burden of holding multiple roles.

As a social worker, Shafer hopes these findings will help more parents seek help they need. Mental health professionals should also recognize that depression can manifest in a variety of ways.

"We hope clinicians recognize that parents aren't just a homogeneous group," Shafer said. "Parents show symptoms of depression in different ways than non-parents do."

The new study is published in the journal Social Work. This study follows a 2013 paper by Shafer that the The New York Times highlighted in a post called "What Makes a Successful Stepfather."

Pace collaborated with Shafer while a student in BYU's Master of Social Work program. He graduated in in 2013 and now works at Princeton's Center for Research on Child Wellbeing.

http://www.sciencedaily.com/releases/2015/02/150205095229.htm

Mother's stress hormone levels may affect fetal growth and long term health of child

January 26, 2015

Science Daily/University of Cambridge

Increased levels of stress hormones can lead pregnant mice to overeat, but affect growth of the fetus and, potentially, the long term health of the offspring, according to a new study.

The foetuses of the mice with raised levels of the stress hormone tended to be smaller, despite the mother overeating, suggesting that a mother's stress levels may affect her child's growth.

In the Journal of Physiology, researchers at the Department of Physiology, Development and Neuroscience at the University of Cambridge examine whether levels of the stress hormones known as glucocorticoids can influence the supply of glucose from mother to foetus. Glucocorticoids are important in regulating metabolism in adults as well as in the foetus. Levels of the hormone are raised by stress related to the physical or social environment, disease or pregnancy.

Pregnant mice received the natural glucocorticoid corticosterone at different times during pregnancy via their drinking water, either from days 11 to 16, days 14-19, or not at all; pregnancy in mice lasts 21 days and the days on which corticosterone was given corresponds to different developmental phases of the placenta. This treatment was designed to produce glucocorticoid levels in the mother similar to those seen in stressful conditions. The animals were either allowed to eat freely or their food intake limited to that of normal, untreated mice. The researchers then measured the amount of glucose crossing the placenta, the organ that supplies all of the substances required for foetal growth, in a specific period of time.

The researchers found that when corticosterone was given later in pregnancy and the mice allowed to eat freely, the mother ate more but her placenta was less able to transport glucose to the foetus, leading to a decrease in the size of the foetus. This effect was not seen when the hormone was administered earlier in pregnancy or when the diet was restricted. They believe this may be because, under stress and with an unlimited diet, the activity of certain genes in the placenta was modified, including that of the gene Redd1. This gene is believed to signal availability of other substances, like oxygen, and to interact with intracellular pathways regulating growth and nutrient uptake in other tissues of the body. The team believe that future studies may prove this molecule is important in the placenta in linking environmental effects to the nutrition of the foetus.

Together with previous work, the findings show that maternal glucocorticoids regulate foetal nutrition by acting on the placenta. The researchers believe that glucocorticoid levels in pregnant women may therefore determine the specific combination of nutrients received by the foetus and influence the long term metabolic health of their children as a result.

Dr Owen Vaughan from the University of Cambridge says: "The foetuses of the mice with raised levels of the stress hormone tended to be smaller, despite the mother overeating, suggesting that a mother's stress levels may affect her child's growth. We showed that this is likely to be because the stress hormone reduced the ability of the placenta to pass essential nutrients to the foetus."

The researchers believe this study may have implications for women stressed during pregnancy or treated clinically with glucocorticoids, if the mechanisms are similar in humans, though it is unclear yet the extent to which changes in the ability of the placenta to transport nutrients to the foetus exacerbate or protect the child from the potential adverse effects of glucocorticoid overexposure during pregnancy. Nor is it clear whether maternal diet influences the outcome of glucocorticoid overexposure during human pregnancy.

Professor Abby Fowden, who led the research, adds: "It may be that by changing her diet, a mother can counter the effects of stress hormones on the human placenta. In other words, a mother's 'hormonal profile' may dictate the most appropriate diet for a successful outcome of pregnancy. We need more research in this area before we can start giving such advice, however."

http://www.sciencedaily.com/releases/2015/01/150126095717.htm

Stress during pregnancy related to infant gut microbiota

January 26, 2015

Science Daily/Radboud University

Women who experience stress during pregnancy are likely to have babies with a poor mix of intestinal microbiota and with a higher incidence of intestinal problems and allergic reactions. This could be related to psychological and physical problems as the child develops.

Stress during pregnancy is often linked to physical and psychological problems in the child. But why is this? Could the infant's gut microbiota be an underlying mechanism? An initial study of the correlation in humans has shown that babies born to mothers who experience stress have a poorer mix of intestinal microbiota.

For the purposes of this study, the stress and anxiety levels of pregnant women were measured by means of questionnaires and testing the levels of the hormone cortisol in saliva. In addition, faeces samples from 56 babies were tested from 7 days until 4 months after birth. A correlation was found between the mothers who reported high stress levels and presented high cortisol levels and the variety of microbiota in the babies' guts, even when the analyses took breastfeeding and postnatal stress into account.

Different mix of bacteria

Mothers who reported high stress levels and presented high cortisol readings had babies with more Proteobacteria and fewer lactic acid bacteria and Actinobacteria in their microbiota. This represents a poor mix of microbiota, which was also reflected in the relationship between the presence of these microbiota and a higher incidence of intestinal problems and allergic reactions among the babies in this research group.

Mechanism

'We think that our results point towards a possible mechanism for health problems in children of mothers who experience stress during pregnancy. Giving other bacteria would probably benefit these children's development,' says Carolina de Weerth, professor of developmental psychology in the Behavioural Science Institute of Radboud University Nijmegen, and corresponding author of the article that is in press in Psychoneuroendocrinology.

http://www.sciencedaily.com/releases/2015/01/150126095425.htm

Black women working night shifts have an increased risk of developing diabetes

January 11, 2015

Science Daily/Diabetologia

Those who work night shifts are significantly more likely to develop diabetes than those who have never worked night shifts, with more years working the night shift resulting in a higher risk. These are the results from a large ongoing study into the health of African-American women. Furthermore, the increased risk of diabetes seen in shift workers was more pronounced in younger women than older women, researchers say.

Some previous studies have investigated the link between night shift work and diabetes, with the Nurses' Health Study (NHS) (of mostly white nurses in the USA), showing a link, and another study in Sweden showing a link. However, body-mass index (BMI) accounted for most of this association in the NHS, and all of that found in the Swedish study. However, given the increased prevalence of diabetes in black women in the USA (12.6%) versus white women (4.5%), the authors decided that this potential association should be further investigated in a population of black women.

n the Black Women's Health Study (BWHS), 28,041 participants free of diabetes provided information in 2005 about having worked the night shift. The women were followed for incident diabetes during the next 8 years. Thirty-seven percent of the women reported having worked the night shift, with 5% having worked that shift for at least 10 years. During the 8 years of follow-up, there were 1,786 incident diabetes cases.

Relative to never having worked the night shift, the increased risk of developing diabetes was 17% for 1-2 years night shift work; 23% for 3-9 years, and 42% for 10 or more years. After adjustment for BMI and lifestyle factors such as diet and smoking status, the association between increasing years of night shift work and increasing diabetes risk remained statistically significant, with a 23% increase in those who had worked night shifts for 10 years or more versus those who never had worked the night shift.

When black women having ever worked the night shift (any duration) were compared to those who had never worked it, they were found to be at a 22% increased risk of developing diabetes. After adjustment for BMI and lifestyle factors, this increased risk became 12%.

The authors also found that the association was stronger in younger women than in older women. Working night shifts for 10 or more years relative to never working the night shift was associated with a 39% higher risk of diabetes among women aged less than 50 years compared with 17% higher risk in women aged 50 years or over.

The authors explain: "Even though lifestyle factors and BMI explained a major part of the association of shift work with incident diabetes, women with a long duration of shift work had an increased risk of diabetes after control for those factors, suggesting the presence of additional causal pathways. Shift work is associated with disrupted circadian rhythms and reduced total duration of sleep. Similar to the effects of jet lag, which are short term, shift workers experience fatigue, sleepiness during scheduled awake periods and poor sleep during scheduled sleep periods. These alterations in the normal sleep-wake cycle have profound effects on metabolism... Even after many years of night-shift work, circadian rhythms do not fully adjust to the shifted sleep-wake cycle. The metabolic effects of long-term shift work likely underlie a part of the association with diabetes that we and others describe and that strengthens with years of exposure to sleep disruption."

They add: "The precise mechanisms by which these changes occur are still unclear. In animal models, circadian disruption in susceptible rats led to more rapid loss of beta cell function and increased beta cell death, resulting in decreased beta cell mass, decreased glucose-stimulated insulin secretion and accelerated development of diabetes."

They conclude: "In summary, we found that African-American women undergoing long-duration night-shift work had a higher risk of incident diabetes. The fact that the association remained, though reduced, after adjustment for lifestyle factors and BMI suggests that additional pathways such as disruption of the circadian system may be playing a role. In view of the high prevalence of shift work among workers in the USA -- 35% among non-Hispanic blacks and 28% in non-Hispanic whites -- an increased diabetes risk among this group has important public health implications. There is a need for continued research into facilitating circadian adaptation to shift work and consideration of avoiding shift work in favour of other work arrangements when possible."

http://www.sciencedaily.com/releases/2015/01/150111195429.htm

PTSD doubles diabetes risk in women

January 7, 2015

Science Daily/Columbia University's Mailman School of Public Health

Women with post-traumatic stress disorder are nearly twice as likely to develop type 2 diabetes compared with women who don't have PTSD, according to new research. The longitudinal cohort study provides the strongest evidence to date of a causal relationship between PTSD and type 2 diabetes.

The longitudinal cohort study provides the strongest evidence to date of a causal relationship between PTSD and type 2 diabetes. Results are published online in the journal JAMA Psychiatry.

The researchers analyzed survey data collected between 1989 and 2011 from 49,739 women enrolled in the Nurses Health Study II and found a dose-response relationship: the greater the number and severity of PTSD symptoms, the greater a woman's risk of type 2 diabetes. Four percent of the nurses reported the highest number of PTSD symptoms. By age 60, nearly 12 percent of women with the highest number of PTSD symptoms had developed type 2 diabetes, whereas fewer than 7 percent of women with no trauma exposure had diabetes.

Antidepressant use and elevated body mass index accounted for nearly half of the increased risk of type 2 diabetes, or 34 and 14 percent, respectively. On the other hand, smoking, diet quality, alcohol intake, and physical activity did not explain the association.

One in nine women will have PTSD at sometime over the course of her lifetime--twice the rate of men. Women are also more likely to experience extreme traumatic events like rape that carry a high risk for the disorder.

"Not only is PTSD devastating to mental health, but it affects physical health too, raising risk for cardiovascular disease, diabetes, and obesity," said senior author Karestan C. Koenen, PhD, professor in the Department of Epidemiology at the Mailman School.

"Women with PTSD and the health professionals who care for them should be aware that these women are at greater risk for diabetes," said first author Andrea L. Roberts, PhD, research associate in the Department of Social and Behavioral Sciences at Harvard School of Public Health. "As fewer than half of Americans with PTSD receive treatment, our study adds urgency to the effort to improve access to mental health care to address factors that contribute to diabetes and other chronic diseases."

To assess type 2 diabetes, the researchers used a validated survey method that first asked women whether they had been diagnosed by a doctor, then confirmed diagnosis with information about test results, symptoms, and medications. PTSD was assessed using the Short Screening Scale. The nurses reported a range of trauma, including sexual assault, domestic violence, car accidents, and unexpected death of a loved one.

The study builds on past findings by the researchers, including a 2013 study that reported a link between PTSD and obesity. Other research has shown a link between mental health issues like anxiety, social phobia, and agoraphobia and type 2 diabetes.

Further research is needed to identify the biochemical and possible additional behavioral changes, such as sleep disturbance, that mediate the relationship between PTSD and type 2 diabetes.

http://www.sciencedaily.com/releases/2015/01/150107122906.htm

Early exposure to antidepressants affects adult anxiety, serotonin transmission

December 19, 2014

Science Daily/University of California - Los Angeles Health Sciences

http://images.sciencedaily.com/2014/12/141219160606-large.jpg

Early developmental exposure to two different antidepressants, Prozac and Lexapro, has been studied by researchers in a mouse model that mimics human third trimester medication exposure. They found that, although these serotonin-selective reuptake inhibiting antidepressants were thought to work the same way, they did not produce the same long-term changes in anxiety behavior in the adult mice.

About 15 percent of women in the United States suffer from anxiety disorders and depression during their pregnancies, and many are prescribed antidepressants. However little is known about how early exposure to these medications might affect their offspring as they mature into adults.

The answer to that question is vital, as 5 percent of all babies born in the U.S. -- more than 200,000 a year -- are exposed to antidepressants during gestation via transmission from their mothers.

Now, a UCLA team has studied early developmental exposure to two different antidepressants, Prozac and Lexapro, in a mouse model that mimics human third trimester medication exposure. They found that, although these serotonin-selective reuptake inhibiting antidepressants (SSRIs) were thought to work the same way, they did not produce the same long-term changes in anxiety behavior in the adult mice.

"This was quite surprising, since these medications belong to the same drug class and are believed to work by the same mechanism. The implications of these findings are that with additional investigation, it may be possible to identify specific antidepressants that are safer for pregnant women," Andrews said. "It's important to recognize that major depressive disorders and anxiety disorders are serious medical conditions that often require therapeutic intervention. Prescribing the safest medication for mother and child is paramount."

Genetic reductions in serotonin transporters are thought to be a risk factor, particularly when combined with stressful life experiences, for developing anxiety and mood disorders. And in fact, the genetically engineered mice Andrews studied showed more anxiety as adults.

"It might be possible that when mothers are treated for depression or anxiety during pregnancy that certain SSRIs may promote resilience to developing these disorders in children later in life," Andrews said. "However, it will take much more research for us to understand whether this is true and whether certain SSRIs may be better at promoting these effects."

Going forward, Andrews and her team plan to investigate the effects of early exposure to antidepressants on the architectures of serotonin neurons. Based on the current findings, they suspect that early exposure to Lexapro may alter the way serotonin neurons innervate brain regions involved in mood and anxiety behavior. They also plan to investigate other SSRIs such as Paxil and Zoloft.

"Current antidepressant therapies are ineffective in treating anxiety and depression in large numbers of patients, and advances in predicting individual responses are hindered by difficulties associated with characterizing complex influences of genetic and environmental factors on serotonergic transmission in humans," the study states. "Highly controlled animal models, such as those studied here, represent avenues by which to identify factors potentially influencing behavioral domains associated with emotion-related disorders."

http://www.sciencedaily.com/releases/2014/12/141219160606.htm

Helping parents understand infant sleep patterns

December 19, 2014

Science Daily/Penn State

Most parents are not surprised by the irregularity of a newborn infant's sleep patterns, but by six months or so many parents wonder if something is wrong with their baby or their sleeping arrangements if the baby is not sleeping through the night. Health-care providers, specifically nurse practitioners, can help parents understand what 'normal' sleep patterns are for their child, according to researchers.

"Nurse practitioners are at the frontline of healthcare," said Robin Yaure, senior instructor of human development and family studies, Penn State Mont Alto. "They are in an ideal position to help parents understand infant sleep pattern norms. Thus, nurse practitioners can help parents understand that 'sleeping through the night' is not entirely likely in young infants and that infants' sleep patterns change during the first few years of life."

According to the researchers, there are four common areas of concern for both parents and practitioners: what constitutes "normal" infant sleep and waking patterns, whether nightwakings are a problem or not, is a parent's presence disruptive when an infant is falling asleep, and whether sleep training is safe and healthy for infants. Sleep training is one way to establish a sleep routine for a child, although the methods used may not be appealing to parents or in the best interests of the child, the researchers said.

Yaure and colleagues reviewed current research on infant sleep, focusing on the above four areas of concern, and specifically infant safety and the well being of both infant and mother during nighttime care. The researchers suggest how to best integrate parents' preferences for care and best practice information, and include conversation points for nurse practitioners recently online in the Journal of the American Association of Nurse Practitioners.

Infants' sleep patterns vary for at least the first three years of life. There are many reasons for this, including changes in infant health and mobility and the development of separation anxiety.

"Sharing this basic information with parents is one way of assuring parents that infants' waking does not necessarily mean that the parents are doing something wrong," the researchers wrote.

Parent presence at bedtime, sleep training and infant self-settling are frequently debated topics about which parents might look to healthcare professionals for advice. Yaure and colleagues again point to sharing information with parents -- for example, recent research suggests that the presence of parents at bedtime, specifically during the transition to sleep, may not trigger nightwakings as previously thought.

The researchers also point out that recent research on the nonresponsiveness of mothers during nighttime care can raise stress for both mom and baby. Elevated stress increases cortisol in the body, which may hurt the baby in the long run. Increased cortisol levels are associated with depression, aggression and attention problems, among other issues, in children and adults.

"I worry about parents who feel like they can't trust their own instincts," said Yaure. "Different parents have different goals and ideas for parenting, and we want parents to figure out how to incorporate best practices into their belief system. We have to be culturally aware and sensitive to different families and beliefs."

By encouraging nurse practitioners to talk about current knowledge on infant nightwakings and parental presence, among other things, Yaure hopes that parents will become more comfortable and confident with their nighttime care choices.

http://www.sciencedaily.com/releases/2014/12/141219104146.htm

Fine particulate air pollution linked with increased autism risk

December 18, 2014

Science Daily/Harvard School of Public Health

Women exposed to high levels of fine particulate matter specifically during pregnancy -- particularly during the third trimester -- may face up to twice the risk of having a child with autism than mothers living in areas with low particulate matter, according to a study. The greater the exposure, the greater the risk, researchers found. It was the first US-wide study exploring the link between airborne particulate matter and autism.

"Our data add additional important support to the hypothesis that maternal exposure to air pollution contributes to the risk of autism spectrum disorders," said Marc Weisskopf, associate professor of environmental and occupational epidemiology and senior author of the study. "The specificity of our findings for the pregnancy period, and third trimester in particular, rules out many other possible explanations for these findings."

The researchers explored the association between autism and exposure to PM2.5 before, during, and after pregnancy. They also calculated exposure to PM2.5 during each pregnancy trimester.

Exposure to PM2.5 was significantly associated with autism during pregnancy, but not before or after, the study found. And during the pregnancy, the third trimester specifically was significantly associated with an increased risk. Little association was found between air pollution from larger-sized particles (PM10-2.5) and autism.

"The evidence base for a role for maternal exposure to air pollution increasing the risk of autism spectrum disorders is becoming quite strong," said Weisskopf. "This not only gives us important insight as we continue to pursue the origins of autism spectrum disorders, but as a modifiable exposure, opens the door to thinking about possible preventative measures."

http://www.sciencedaily.com/releases/2014/12/141218081334.htm

Women's age at first menstrual cycle linked to heart disease risk

December 15, 2014

Science Daily/American Heart Association

The risk of heart disease, stroke and high blood pressure was significantly higher when menstruation began at age 10 or younger, or age 17 or older. First menstrual cycle at the age of 13 posed the lowest risk of heart disease, stroke and high blood pressure.

Researchers analyzed data collected from 1.3 million women aged 50 to 64 years old, who were mostly white. After over a decade of observation, those women who had their first menstrual cycle at the age of 13 had the least risk of developing heart disease, stroke, and high blood pressure.

Compared to women who had their first menstrual cycle at age 13, women with their first menstrual cycle at age 10 or younger, or age 17 or older, had up to:

• ·      27 percent more hospitalizations or deaths due to heart disease;
• ·      16 percent more hospitalizations or deaths from stroke; and
• ·      20 percent more hospitalizations with high blood pressure, or deaths due to its complications.

"The size of our study, the wide range of ages considered, and the vascular diseases being examined made it unique and informative," said Dexter Canoy, M.D, Ph.D., study lead author and cardiovascular epidemiologist at the Cancer Epidemiology Unit, Nuffield Department of Population Health at the University of Oxford in the U.K.

"Childhood obesity, widespread in many industrialized countries, is linked particularly to early age at which the first menstrual cycle occurs. Public health strategies to tackle childhood obesity may possibly prevent the lowering of the average age of first menstrual cycle, which may in turn reduce their risk of developing heart disease over the long term."

The effect of age of the first occurrence of menstruation on heart disease was consistently found among lean, over-weight, and obese women, among never, past or current smokers, and among women in lower, middle, or higher socioeconomic groups.

For the majority of these women, however, their additional risk of developing a vascular disease was small. Of the million women, only four percent of them had their first menstrual cycle occurring at age 10 or younger, and only one percent at age 17 or older.

http://www.sciencedaily.com/releases/2014/12/141215185203.htm

Prenatal exposure to common household chemicals linked with substantial drop in child IQ

December 10, 2014

Science Daily/Columbia University's Mailman School of Public Health

Children exposed during pregnancy to elevated levels of two common chemicals found in the home -- di-n-butyl phthalate and di-isobutyl phthalate -- had an IQ score, on average, more than six points lower than children exposed at lower levels, according to researchers.

The study is the first to report a link between prenatal exposure to phthalates and IQ in school-age children. While avoiding all phthalates in the United States is for now impossible, the researchers recommend that pregnant women take steps to limit exposure by not microwaving food in plastics, avoiding scented products as much as possible, including air fresheners, and dryer sheets, and not using recyclable plastics labeled as 3, 6, or 7.

DnBP and DiBP are found in a wide variety of consumer products, from dryer sheets to vinyl fabrics to personal care products like lipstick, hairspray, and nail polish, even some soaps.

Since 2009, several phthalates have been banned from children's toys and other childcare articles in the United States. However, no steps have been taken to protect the developing fetus by alerting pregnant women to potential exposures. In the U.S., phthalates are rarely listed as ingredients on products in which they are used.

The range of phthalate metabolite exposures measured in the mothers was not unusual: it was within what the Centers for Disease Control and Prevention observed in a national sample.

"Pregnant women across the United States are exposed to phthalates almost daily, many at levels similar to those that we found were associated with substantial reductions in the IQ of children," says lead author Pam Factor-Litvak, PhD, associate professor of Epidemiology at the Mailman School.

"The magnitude of these IQ differences is troubling," says senior author Robin Whyatt, DrPH, Professor of Environmental Health Sciences and deputy director of the Columbia Center for Children's Environmental Health at the Mailman School. "A six- or seven-point decline in IQ may have substantial consequences for academic achievement and occupational potential."

"While there has been some regulation to ban phthalates from toys of young children," adds Dr. Factor-Litvak, "there is no legislation governing exposure during pregnancy, which is likely the most sensitive period for brain development. Indeed, phthalates are not required to be on product labeling."

While avoiding all phthalates in the United States is for now impossible, the researchers recommend that pregnant women take steps to limit exposure by not microwaving food in plastics, avoiding scented products as much as possible, including air fresheners, and dryer sheets, and not using recyclable plastics labeled as 3, 6, or 7.

The findings build on earlier, similar observations by the researchers of associations between prenatal exposure to DnBP and DiBP and children's cognitive and motor development and behavior at age 3. This September, they reported a link between prenatal exposure to phthalates and risk for childhood asthma.

It's not known how phthalates affect child health. However, numerous studies show that they disrupt the actions of hormones, including testosterone and thyroid hormone. Inflammation and oxidative stress may also play a role.

http://www.sciencedaily.com/releases/2014/12/141210140823.htm

Mindfulness techniques can help protect pregnant women against depression

November 19, 2014

Science Daily/University of Colorado at Boulder

Pregnant women with histories of major depression are about 40 percent less likely to relapse into depression if they practice mindfulness techniques -- such as meditation, breathing exercises and yoga -- along with cognitive therapy, according to a new study.

About 30 percent of women who have struggled with depression in the past relapse during pregnancy, according to past research. In the new study, published in the journal Archives of Women's Mental Health, the research team found that pregnant women with histories of depression who participated in Mindfulness Based Cognitive Therapy had a relapse rate of just 18 percent.

"It's important for pregnant women who are at high risk of depression to have options for treatment and prevention," said Sona Dimidjian, an associate professor in CU-Boulder's Department of Psychology and Neuroscience and lead author of the study. "For some women, antidepressant medication is truly a lifesaver, but others want a non-pharmacological intervention. This program focuses on teaching women skills and practices that are designed to help them stay well and care for themselves and their babies during this important time of life."

Mindfulness Based Cognitive Therapy--which combines mindfulness practice with more traditional cognitive behavioral therapy--has been shown to be effective at preventing recurrent episodes of depression in the general population. But few studies of any kind have looked at the effect of mindfulness or cognitive behavioral therapies among pregnant women.

A high percentage of the women who began the courses--86 percent--completed the study, a sign that the women found the sessions valuable, Dimidjian said. The researchers also were struck by the number of pregnant women who expressed interest in participating in a mindfulness program, even though they didn't meet the criteria to participate in this study.

"I was surprised by the level of interest, even among women who didn't have a history of depression," Dimidjian said. "Pregnant women know that the experience of having a child is going to change their lives, and they want to be ready."

http://www.sciencedaily.com/releases/2014/11/141119125430.htm