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Introduction: Egg donation is an increasingly common fertility treatment. Around 5.4% of women residing in Spain, between 18-55 years old undergo fertility treatment. This percentage increases with age, being higher (8.8%) between the ages of 40-44 years old. The implication in women who submit a fertility treatment with past history of psychiatric illness remains unknown. Objectives: To conduct a literature review about mother-infant bonding in mothers with past history of mental health disorder. Methods: Literature review about mother-baby bonding in mothers with mental illness. Present a case report with therapeutic interventions and follow-up outcomes. Results: One study shows less optimal interaction quality in mothers-infants from egg-donation families than IFV families. There is no literature focused on women with past history of psychiatric illness. We present the case of a 39 year old woman admitted in Mother- Baby Day Hospital with history of Generalized Anxiety Disorder and hypochondriasis under treatment with antidepressants, who undergo an egg donation treatment. During pregnancy presents depressive symptomatology as well as increasing levels of anxiety-hypochondriasis. In postpartum this symptomatology exacerbates due to difficulties in bonding without feeling the baby like her own child, causing severe involvement in maternal care. Weperform a psychotherapeutic intervention focusing in mother-baby bonding and optimizing psychopharmacological treatment. Conclusions: There is limited literature which assesses interaction quality in mothers-infants from egg-donation families. As we know, there is no literature evaluating relationship between egg donation babies and mothers with mental health disorders. Further investigation is needed in this area due to relevant implications for both mother and child. [ABSTRACT FROM AUTHOR]

Introduction: Aripiprazole is a second generation antipsychotic, frequently use in women with psychotic or affective disorders that can appear or relapse during postpartum period. However, very little is known about the effect of aripiprazole in breastfeeding. Objectives: - Perform a literature search on case reports published about the use of aripiprazole and lactation. - Report a case of hypoprolactinemia and consequently hypogalactorrhea after aripipirazole initiation in postpartum woman. Methods: A systematic search of the literature (case reports) published, was carried out in the database MEDLINE (PubMed) between 2000 and 2018. We describe a case of unexpected hypogalactorrhea in a postpartum woman due to aripiprazole. Results: Four case reports have been published regarding maternal use of aripiprazole during breastfeeding; two of them described failure of lactation associated to aripiprazole treatment. We describe a case of a 41 years old postpartum woman, who after urgent caesarean section for preeclampsia and admission to ICU, presents anxiety, depressive symptoms, hypocondriform thoughts and checking compulsions, which interfered with bonding. She was treated with sertraline 200mg/d maintaining breastfeeding. Two months later Aripiprazole 5mg/d was added, with adequate tolerance. However, 2-3 days later the patient reported decreased milk production. Prolactin levels decreased from a previous 30,18 ng/ml to 5,02 ng/ml. Milk production normalized in less than a week after stopping aripiprazole. Conclusions: Both published cases and the present case suggest aripiprazole may possible cause hypoprolactinemia and therefore a milk production decrease in lactating women. This factor should be considered when starting aripiprazole in nursing mothers. [ABSTRACT FROM AUTHOR]

Introduction: The Obsessive Compulsive Disorder (OCD) affects 1.2% of the general population; nevertheless the evidence suggests that postnatal OCD reaches a frequency of 4-9%. Objectives: - Perform a literature search about the psychotherapeutic and psychopharmacological intervention in the treatment of postpartum OCD. - Report a case about OCD clinical management. Methods: - A narrative review of the literature published, was carried out in the database MEDLINE (PubMed) between 2013 and 2018. -We describe psychotherapeutic intervention in a case of OCD in a postpartum woman. Results: A 47-year-old woman with a history of OCD, in treatment with fluoxetine 40mg/d, admitted to the Obstetrics Unit for severe pre-eclampsia and intrauterine growth restriction. They request psychiatric assessment due to exacerbation contamination obsessive ideas; as well as bizarre ideas consistent in pain transmission to the baby through breathing, which avoids physical contact with her baby. It is diagnosed as an OCD puerperal decompensation with severe involvement in maternal care. The fluoxetine dose is increased to 60mg/d and it is established risperidone 0.5mg/night. Likewise, a coordinated intervention is carried out by the Perinatal Mental Health Unit and Neonatology being able to optimize psychopharmacological treatment and focusing psychotherapeutic intervention on baby exposure at the Neonatal ICU and later at Mother-Baby Day Hospital. Conclusions: The literature shows that certain aspects of the postpartum period should be considered in therapeutic decisions such as psychopharmacological treatment, breastfeeding or the involvement of affective-behavioral symptoms in the baby interaction and the consequent bond establishment. Specific and specialized intervention programs are necessary for severe perinatal OCD. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that a 30-50 % lithium dose reduction or lithium discontinuation 24-48 h before delivery could minimize neonatal complications. We investigated the maternal lithemia changes around delivery after a brief discontinuation, the placental transfer of lithium at delivery, and the association between neonatal lithemia at delivery and acute neonatal outcomes., Methods: A retrospective observational cohort study was conducted in a teaching hospital (November/2006-December/2018). Data was extracted from the medical records. We included psychopathologically stable women, with a singleton pregnancy, treated with lithium in late pregnancy, with at least one maternal and neonatal lithemia at delivery. Lithium was discontinued 12 h before a scheduled caesarean section or induction, or at admission day to hospital birth; and restarted 6-12 h post., Results: Sixty-six mother-infant pairs were included, and 226 maternal and 66 neonatal lithemias were obtained. We found slight maternal lithemia fluctuations close to 0.20 mEq/L, and early postpartum relapse of 6 %. The mean (SD) umbilical cord/mother intrapartum lithemia ratio was 1.10 (0.17). Fifty-six percent of neonates presented transient acute complications. Neonatal hypotonia was the most frequent outcome (N = 15). Mean lithemia were 0.178 mEq/L higher in those with hypotonia than in those without (p = 0.028)., Limitations: It is a retrospective cohort of a moderate sample size of healthy uncomplicated pregnancies and results cannot be generalized to all pregnant treated with lithium., Conclusions: Lithium transfers completely across the placenta. A brief predelivery lithium discontinuation was associated with slight maternal lithemia fluctuations. Neonates exposed intrautero to lithium present frequent but transient acute effects., Competing Interests: Declaration of competing interest EV has received grants and served as a consultant, advisor or CME speaker for the following entities: AB-Biotics, Abbott, Allergan, Angelini, AstraZeneca, Biogen, Biohaven, Bristol-Myers Squibb, Celon, Compass, Dainippon Sumitomo Pharma, Farmindustria, Ferrer, Forest Research Institute, Gedeon Richter, Glaxo-Smith-Kline, HMNC, Idorsia, Janssen, Lundbeck, Medincell, Merck, Novartis, Orion, Otsuka, Pfizer, Roche, SAGE, Sanofi-Aventis, Servier, Shire, Sunovion, Takeda, Viatris, the Brain and Behaviour Foundation, the Spanish Ministry of Science and Innovation (CIBERSAM), the EU Horizon 2020 and the Stanley Medical Research Institute. Other authors declare no financial interests or potential conflicts of interest regarding the authorship and publication of this article., (Copyright © 2024. Published by Elsevier B.V.)

The aim of the present study was to validate the Spanish Postpartum Bonding Questionnaire (PBQ) against external criteria of bonding disorder, as well as to establish its test-retest reliability. One hundred fifty-six postpartum women consecutively recruited from a perinatal mental health outpatient unit completed the PBQ at 4-6 weeks postpartum. Four weeks later, all mothers completed again the PBQ and were interviewed using the Birmingham Interview for Maternal Mental Health to establish the presence of a bonding disorder. Receiver operating characteristic curve analysis revealed an area under the curve (AUC) value for the PBQ total score of 0.93, 95% CI [0.88, 0.98], with the optimal cut-off of 13 for detecting bonding disorders (sensitivity: 92%, specificity: 87%). Optimal cut-off scores for each scale were also obtained. The test-retest reliability coefficients were moderate to good. Our data confirm the validity of PBQ for detecting bonding disorders in Spanish population.

Purpose: Women who take lithium during pregnancy and continue after delivery may choose to breastfeed, formula feed, or mix these options. The aim of the study was to evaluate the neonatal lithium serum concentrations based on these three feeding trajectories. Methods: We followed 24 women with bipolar disorder treated with lithium monotherapy during late pregnancy and postpartum (8 per trajectory). Lithium serum concentrations were determined by an AVL 9180 electrolyte analyser with a 0.10 mEq/L detection limit and a 0.20 mEq/L limit of quantification (LoQ). Results: There was complete lithium placental passage at delivery, with a mean ratio of lithium concentration in the umbilical cord to maternal serum of 1.12 ± 0.17. The median times to LoQ were 6-8, 7-8, and 53-60 days for formula, mixed, and exclusive breastfeeding respectively. The generalized log-rank testing indicated that the median times to LoQ differ according to feeding trajectory ( p = 0.037). According to the multivariate analysis-adjusted lithium serum concentrations at birth, times to LoQ are, on average, longer under exclusive breastfeeding (formula, p = 0.015; mixed, p = 0.012). No lithium accumulation was observed in infants under either exclusive or mixed breastfeeding. During the lactation follow-up, there was no acute growth or developmental delays in any neonate or infant. Indeed, lithium concentrations in the three trajectories declined in all cases. However, the time needed to reach the LoQ was much longer for those breastfeeding exclusively. Conclusions: In breastfeed infant no sustained accumulation of lithium and no adverse effects on development or growth were observed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Imaz, Langohr, Torra, Soy, García-Esteve and Martin-Santos.)

Our aim was to assess personality traits associated with substance use during pregnancy in a population-based, multicentre study of 1804 pregnant women. On day 2-3 postpartum, participants completed a semi-structured interview, including self-reported drug use (alcohol, tobacco, caffeine, cannabis, cocaine, opioids) during pregnancy, and socio-demographic, reproductive and obstetric variables, personal and family psychiatric history, social support, and the Eysenck personality questionnaire, short version (EPQ-RS). Logistic regression models were conducted. Fifty per cent of women reported substance use during pregnancy: 40% caffeine, 21% tobacco, 3.5% alcohol, and 0.3 % cannabis. Mean T-scores (SD) for personality dimensions were 51.1 (9.6) for extraversion, 48 (8.9) for psychoticism, and 43.6 (8.5) for neuroticism. Extroversion (p = .029) and psychoticism (p = .009) were identified as risk factors after adjustment by age, level of education, employment status during pregnancy, low social support, and previous psychiatric history. For each increment of 10 units in their scores, the odds of substance use increased by 12% and 16% respectively. Low education, being on leave during pregnancy, and previous psychiatric history were independent factors (p < .05) associated with substance use during pregnancy. Primiparity was a protective factor (p = .001). The final models showed a good fit (p = .26). The screening of substance use during pregnancy should include personality dimensions apart from psychosocial variables and history of psychiatric disorders. It is important to identify the associated risk factors for substance use during pregnancy to prevent and improve foetal/neonatal and maternal health during perinatal period.

Postpartum depression (PPD) is a common mood disorder that occurs after delivery with a prevalence of approximately 10%. Recent reports have related placental corticotropin-releasing hormone (pCRH) to postpartum depressive symptoms. The aim of this study was to determine whether pCRH, ACTH, and cortisol (measured 48 h after delivery) and glucocorticoid and mineralocorticoid receptor genotypes (NR3C1 and NR3C2) and their interaction are associated with PPD. A longitudinal 32-week prospective study of five hundred twenty-five Caucasian depression-free women that were recruited from obstetric units at two Spanish general hospitals immediately after delivery. Of the women included in the sample, forty-two (8%) developed PPD. A strong association between PPD and the interaction between the pCRH and NR3C2 rs2070951 genotype was observed. The mean level of pCRH in rs2070951GG carriers with PPD was 56% higher than the mean in the CG and CC genotype groups (P < 0.00005). Carriers of the rs2070951GG genotype with high levels of pCRH had a higher risk of developing PPD (OR = 1.020, 95% CI 1.007-1.034, P = 0.002). This association remained even after controlling for variables such as neuroticism, obstetric complications and the number of stressful life events during pregnancy. There is an important interaction between pCRH 48 h postpartum and the NR3C2 rs2070951GG genotype. This interaction moderately associates with the presence of PPD. These results may open a new line of research and, if confirmed in other settings, will help to identify better risk predictors and the treatment for PPD.

Introduction: The Edinburgh Postnatal Depression Scale (EPDS) is considered the gold standard in screening for postpartum depression. Although the Spanish version has been widely used, its factorial structure has not yet been studied ., Methods: A total of 1,204 women completed the EPDS 32 weeks after delivery. To avoid multiple testing, we split the sample into two halves, randomly drawing two subsamples of 602 participants each. We conducted exploratory factor analysis (EFA), followed by an oblimin rotation with the first sub-sample. Confirmatory factor analysis (CFA) was conducted using a Weighted Least Squares Means and Variance (WLSMV) estimation of the data. We explored different solutions between two and four factors. We compared the factors between two groups with depression and non-depression (evaluated with the Diagnostic Interview for Genetic Studies (DIGS) for the DSM-IV)., Results: The EFA indicated a three-factor model consisting of anxiety, depression and anhedonia. The results of the CFA confirmed the three-factor model (&#967;2=99.203, p<0.001; RMSEA=0.06, 90% CI=0.04/0.07, CFI=0.87 and TLI=0.82). Women with depression in the first 32 weeks obtained higher scores for anxiety, depression and anhedonia dimensions (p<0.001)., Conclusions: This is the first study of confirmatory analysis with the Spanish version of EPDS in a large sample of women without psychiatric care during pregnancy. A three-factor model consisting of anxiety, depression and anhedonia was used. Women with depression had a higher score in the three dimensions of the EPDS.

This study aims to examine the prevalence and characteristics of physical, emotional and sexual childhood abuse. It also examines whether other non-abuse types of childhood adversities related to maladaptive family functioning and separations during childhood can be used as markers for the presence of childhood abuse. Participants (N = 237) were women at 2-3 days after delivery that completed the Spanish-validated version of the Early Trauma Inventory Self Report (ETI-SR; Bremner, Bolus, & Mayer, 2007; Plaza et al., 2011), designed to assess the presence of childhood adversities. Results show that 29% of the women had experienced some type of childhood abuse, and 10% more than one type. Logistic regression analyses indicate that childhood parental death is a risk marker for childhood emotional abuse (OR: 3.77; 95% CI: 1.327-10.755; p <.013), childhood parental substance abuse is a risk marker for childhood sexual (OR: 3.72; 95% CI: 1.480-9.303; p < .005) and physical abuse (OR: 2.610; 95% CI: 1.000-6.812; p < .05) and that childhood family mental illness is a risk marker for childhood emotional (OR: 2.95; 95% CI: 1.175-7.441; p < .021) and sexual abuse (OR: 2.55; 95% CI: 1.168-5.580; p < .019). The high prevalence of childhood abuse indicates a need for assessment during the perinatal period. Screening for childhood family mental illness, parental substance abuse, and parental death - all identified risk factors for reporting childhood abuse - can help to identify women that should be assessed specifically regarding abuse.

Purpose: To carry out a systematic review of the association between maternal and school-age children depression and covariate factors., Design and Methods: The key words maternal depression, depressed children, and school-age key words were searched in Medline, Lilacs, Scielo, IndexPsi, and PsycInfo (2004-2010). Clinical and community cross-sectional and longitudinal studies were included. A qualitative checklist was used., Findings: Thirty studies were included (21.926 dyads). The results supported the association, showing several modulators: family environment, marital adjustment, social support, depression symptoms, and children-related variables. Limitations were nonrandom samples, single informants, and nondepression diagnosis., Practice Implications:   Identifying mothers with depression may be useful for prevention and early detection of school-age children's depression., (© 2011 Wiley Periodicals, Inc.)

Background: Although perfectionism from a multidimensional perspective has generally been associated with depressive illness, there are not many studies on its role in major depression in the postnatal period. The aim of the present study was to explore the relationship between perfectionism dimensions using the Frost Multidimensional Perfectionism Scale (FMPS) and major postpartum depression., Methods: One-hundred-twenty-two women with major postpartum depression (SCID-I; DSM-IV) and 115 healthy postpartum women were evaluated using the FMPS, an instrument for the assessment of six perfectionism dimensions: concern over mistakes, personal standards, parental expectations, parental criticism, doubt about actions and organisation. Other variables were also considered: neuroticism, psychiatric history, social support, life events and genotype combinations according to serotonin transporter expression (5-HTTLPR and Stin2 VNTR polymorphisms)., Results: The prevalence of high-perfectionism was higher in major postpartum depression group than in control group (34% vs. 11%; p<0.001). Multivariate models confirmed high-perfectionism as an independent factor associated with major postpartum depression. Specifically, the high-concern over mistakes dimension increased over four-fold the odds of major depression in postpartum period. (OR=4.14; 95% CI=1.24-13.81) Neuroticism, personal psychiatric history and 5-HTT low-expressing genotypes at one of the loci were also identified as independent factors., Conclusions: High-perfectionism, and particularly high-concern over mistakes is a personality dimension associated with major postpartum depression. The inclusion of perfectionism assessment, together with others factors, may be considered in order to improve the detection of women at risk of postpartum depression, in whom early intervention may be of benefit., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Context: Iron deficiency is the most common nutritional problem experienced by childbearing women, and postpartum depression (PPD) is the most common psychiatric disorder seen during the first year after delivery. The possible link between iron deficiency and PPD is not clear., Objective: To evaluate whether iron status 48 h after delivery was associated with PPD. Our hypothesis was that iron deficiency would be associated with PPD., Design: This was a prospective cohort study of depression-free women studied in the postpartum period., Setting: Women who give birth at obstetric units in several general hospitals in Spain., Participants: A subsample of 729 women was included in the present study after exclusion of women with high C-reactive protein (CRP) and other diseases known to interfere with iron metabolism., Main Outcome Measures: We evaluated depressive symptoms at 48 h, 8 weeks and 32 weeks postpartum and used a diagnostic interview to confirm the diagnosis of major depression. A blood sample obtained 48 h after delivery was used to measure the following iron storage parameters: ferritin, transferrin (Tf), free iron and transferrin saturation (TfS) and the inflammatory marker CCRP., Results: Overall, the women in the study had low iron concentrations (8.8 ± 6.9 μmol/L) and low TfS (12.6 ± 9.6%) but normal ferritin and Tf concentrations. A total of 65 women (9%) developed PPD during the 32 week postpartum period; these women also had a lower ferritin concentration (15.4 ± 12.7 μg/L vs. 21.6 ± 13.5 μg/L, P = 0.002). A strong association between ferritin and PPD was observed (odds ratio = 3.73, 95% CI: 1.84-7.56; P = 0.0001 for ferritin cutoff value of 7.26 μg/L). In our study, ferritin concentrations have a high specificity but low sensitivity in predicting PPD., Conclusions: These findings support the role of iron in the etiology of PPD and the use of ferritin as a marker of iron deficiency in the postpartum period. We believe that this topic deserves further investigation., (Copyright © 2010 Elsevier B.V. All rights reserved.)

The Vulnerable Personality Style Questionnaire (VPSQ) is a nine-item self-report scale developed to asses personality traits which increase the risk of postpartum depression. The aim of the present study was to examine the psychometric properties of the Spanish version of the VPSQ in a sample of postpartum women. A cohort of 309 postpartum women was followed up for 32 weeks after delivery. All women were assessed with the Spanish version of the VPSQ, the Eysenck Personality Questionnaire-R Short Scale, the Frost Multidimensional Perfectionism Scale and the harm avoidance dimension of the Temperament and Character Inventory at 2-3 days postpartum. Depressive symptoms were evaluated at 8 and 32 weeks after delivery by the Edinburgh Postnatal Depression Scale, and a diagnostic interview was used to confirm the presence of major depression disorder. Factor analysis results revealed the unidimensionality of the Spanish version of the VPSQ. Cronbach's alpha coefficient for the VPSQ total score was 0.63. The test-retest reliability indicated a good temporal stability (ICC = 0.88; 95% confidence interval (CI) = 0.82-0.91). A moderate association between the VPSQ and other personality measures provided evidence for its construct validity. Logistic regression analyses showed that women with higher scores on the VPSQ had a higher risk of developing depressive symptoms (OR = 1.20; 95% CI = 1.11-1.29) and major depression (OR = 1.16; 95% CI = 1.07-1.26) throughout the 32 weeks after delivery. Overall, our results suggest adequate psychometric properties of the Spanish version of the VPSQ and its usefulness in identifying women with a personality style that increases the risk of developing postpartum depression.

This instrumental study was designed to analyze the psychometric properties of the Spanish version of the Frost Multidimensional Perfectionism Scale (FMPS). The total sample was made up of 582 female college students, with a mean age of 21.68 (SD= 4.45). The results of confirmatory factor analysis identified the six-factor solution proposed by the original authors as the best factor structure, with acceptable fit indices. Cronbach's alpha coefficient was .93 for the FMPS total score and ranged from .74 to .91 for the subscales. Test-retest reliability suggested a good temporal stability of the FMPS total score [ICC= .89 (95% CI= .80-.94)] and its subscales. Results showed moderate to high associations between the Spanish version of the FMPS and other measures of perfectionism. The Spanish version of FMPS has shown satisfactory psychometric properties to be used in women. Future research should replicate these findings in broader samples, in clinical populations, and use longitudinal designs to determine whether perfectionism is a risk factor for psychopathology in women.

The post-partum period is a time of extreme vulnerability for a whole spectrum of psychiatric disorders. Delivery may be considered an important risk factor in genetically susceptible women. Five hundred and eight SNPs in 44 genes at candidate pathways putatively related to mood changes after delivery were genotyped in a multicenter cohort of 1804 women from Spain. Participants completed two scales at 2-3 days, 8 weeks, and 32 weeks post-partum, the Edinburgh Post-partum Depression Scale (EPDS) and the Spielberger State-Trait Anxiety Inventory (STAI). Those women who scored 9 or more on EPDS were evaluated for major depression using the Diagnostic Interview for Genetics Studies (DIGS) adapted for post-partum depression. Association with major depression was assessed using likelihood ratio tests under a codominant genotype model. Association with scale scores was tested using linear mixed models to take into account repeated measures over time. Two intronic SNPs, one at the serotonin transporter gene (SLC6A4) and another at dopa decarboxylase (DDC), were significantly associated to STAI anxiety scores after multiple testing correction (nominal P=0.0000513 and 0.000097, respectively). In addition, post hoc analysis at the unphased haplotype level using nominal significant SNPs revealed an association with a combination of three SNPs at protein kinase C, beta (PRKCB) with major depression, significant after multiple testing correction (nominal global P=0.0001596). In conclusion, we detected a role of SLC6A4 in mood changes after stressful events, and revealed new putative associations involving DDC and PRKCB. Therefore, these genes deserve further investigation to confirm these results., (2009 Elsevier Ltd. All rights reserved.)