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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The perceptive physician can anticipate and prevent eclampsia. If possible, he should try to prolong preeclamptic pregnancies to the 37th week to avoid neonatal deaths from complications and prematurity. In some cases, preeclampsia strikes and progresses rapidly before the 30th week, however, and, in order to save the mother, the pregnancy must be terminated. If the preeclamptic woman deteriorates to the point where severe headache, epigastric pain, vomiting, and hyperreflexia exist, eclampsia is imminent. If she becomes eclamptic, clinicians must immediately begin to manage the convulsions with a sedative. Diazepam has proved successful which accounts for its widespread use in Great Britain and developing countries. Large doses given over a long period of time, however, adversely affect the newborn, e.g. respiratory depression. Another popular sedative is magnesium sulphate (in use for 50 years). Dangers of overdose can be avoided by testing the patella reflex every hour when magnesium sulphate is being administered intravenously: the reflex becomes null before serious toxic effects occur. If the systolic blood pressure exceeds 170mmHg, antihypertensives should also be given selectively to prevent cerebral hemorrhage. The preferred antihypertensive must act rapidly and predictably, with a wide margin of safety between the therapeutic and toxic dose. Hydralazine hydrochloride meets these requirements. Fluid and acid-base balances must be controlled to treat hypovolemia, oliguria, and acidosis. The longer delivery is delayed, the worse the outlook for mother and infant. Regardless of the type of delivery, clinicians must avoid hemorrhage and operative shock because eclamptics cannot tolerate blood loss. It is imperative that clinicians do not become so involved in saving the patient that they overtreat her, e.g., mixing antihypertensives.
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PMID:Eclampsia. 675 54

In a two-point longitudinal study we compared preterm and fullterm infants with respect to certain behaviour patterns known as "infant temperament". Interdependencies between depression and childrearing attitudes of the mothers and temperamental characteristics of infants are analysed. Investigations took place after birth and four months (corrected age) later and comprised, among other questionnaires, a new German temperament assessment scale as well as clinical data. Our results show that, independent of their depression and childrearing attitudes, mothers of preterm infants describe their babies as showing much less positive emotions and having far more problems in being soothed. In both groups the baby's positive reactions and soothability was related to the extent of its mother's motivation to stimulate the baby and care for it. However, showing many negative emotions cannot sufficiently be explained by prematurity and certain mother characteristics at time of birth.
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PMID:[Behavioral markers of premature infants--a study of "temperament in early childhood"]. 779 82

In summary, emotion dysregulation can develop from brief or more prolonged separations from the mother as well as from the more disturbing effects of her emotional unavailability, such as occurs when she is depressed. Harmonious interaction with the mother or the primary caregiver (attunement) of the mother's physical unavailability were seen in studies of separations from the mother due to her hospitalization or to her conference trips. These separations affected the infants' play behaviors and sleep patterns. Comparisons between hospitalizations and conference trips, however, suggested that the infants' behaviors were more negatively affected by the hospitalizations than the conference trips. This probably related to these being hospitalizations for the birth of another baby--the infants no longer had the special, exclusive relationship with their mothers after the arrival of the new sibling. This finding highlights the critical importance of emotional availability. The mother had returned from the hospital, but, while she was no longer physically unavailable, she was now emotionally unavailable. Emotional unavailability was investigated in an acute form by comparing two laboratory situations, the still face paradigm and the momentary leave taking. The still face had more negative effects on the infants' interaction behaviors than the physical separation. The most extreme form of emotional unavailability, mother's depression, had the most negative effects. The disorganization or emotion dysregulation in this case is more prolonged. Changes in physiology (heart rate, vagal tone, and cortisol levels), in play behavior, affect, activity level, and sleep organization as well as other regulating functions such as eating and toileting, and even in the immune system persist for the duration of the mother's depression. My colleagues and I have suggested that these changes occur because the infant is being chronically deprived of an important external regulator of stimulation (the mother) and thus fails to develop emotion regulation or organized behavioral and physiological rhythms. Finally, individual differences were discussed, including those related to maturity (e.g., prematurity) and temperament/personality (e.g., uninhibited/inhibited or externalizing/internalizing) and those deriving from degree of mother-infant mismatch, such as dissimilar temperaments. Further investigations are needed to determine how long the effects of such early dysregulation endure, how they affect the infant's long-term development, how their effect differs across individuals and across development, and whether they can be modified by early intervention. Eventually, with increasing age, developing skills, and diversity of experience, infants develop individualized regulatory styles. That process, and how it is affected by the mother's physical and emotional unavailability, also requires further investigation.
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PMID:The effects of mother's physical and emotional unavailability on emotion regulation. 798 62

This study was made in a neonatal intensive care unit in a school hospital at Porto Alegre/RS, trying to identify the reactions of nuliparous mothers about prematurity. Ten (10) interviews with mothers of premature infants was made. The most commonly reactions were: fear, guilty, anxiety, negation, angry and depression. The mother's feeling about the team, are also observed, and classified in: positive (tranquility, safety, trust, regardless) and negative (doubt, indifference, guilty, envy and fear). A plane of nursing care was made to mothers of premature infants in neonatal intensive care unit (NICU), with the objective of humanization and improving the assistance.
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PMID:[Perceptions of nulliparous women about prematurity]. 927 93

The etiology of increased rates of cerebral palsy (CP) in twins is unclear, but likely is associated with growth retardation, which occurs more often in twins. Asymmetric growth restriction, a form of growth retardation, has been found associated with increased rates of perinatal morbidity in infants with normal centile birthweights, and occurs more often in twins. Data from 55,457 infants were evaluated. Associations between twinning, CP, and neonatal mortality were evaluated. Influences of confounding factors, such as prematurity, perinatal depression, and asymmetric growth were assessed. Although twinning was a significant univariate correlate of both CP and neonatal mortality, low weight/length ratio (a marker of asymmetric growth) was a better correlate of both outcomes, and twinning was not significantly associated with either outcome after logistic adjustment for factors such as prematurity, perinatal depression, and low weight/length ratio. Low weight/length ratio occurred more often in twins of advancing gestational age, supporting a hypothesis of competition for nutritional resources as the cause for increased rates of low weight/length ratio in twins as compared with singletons. Asymmetric growth restriction is an important correlate of neonatal morbidity in twins, and should be considered when these factors are assessed in infants from multiple gestations.
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PMID:Low weight/length ratio to assess risk of cerebral palsy and perinatal mortality in twins. 956 18

The delivery room management of meconium-stained amniotic fluid remains controversial. We attempted to determine if intubation of the low-risk newborn with thin meconium affects the incidence of respiratory symptoms. Exclusion criterion included moderate or thick meconium, fetal distress, neonatal depression, or prematurity. Eligible infants were randomized to either an intubation (group I) or to a nonintubation group (group II). The outcome was the presence of respiratory symptoms. Patients were studied from May 1994 to June 1997. There were 8967 births during this period: 7.9% (708/8967) were delivered through meconium. Thin meconium was noted in 50.3% (356/708) of all births. 24/356 infants with thin meconium were excluded for medical criterion. One hundred sixty-three infants were medically eligible but could not be randomized due to lack of consent, late arrival of the team, or obstetrician request. These were placed into intubation (group I B) and nonintubation (group II B) groups. Seventy-seven infants were randomized into group I and 92 infants into group II. From the intubation groups I and I B, one required supplemental oxygen and was weaned to room air in 7 hr. From the nonintubation groups II and II B, two infants required oxygen, weaning to room air in 11 and 46 hr. Comparing birth weight, gestational age, sex, mode of delivery and 5-min Apgar, there were no significant differences. However, the intubation groups had significantly lower 1-min Apgar scores. There was no airway morbidity reported in the intubation groups. In the infant with thin meconium and an otherwise low-risk pregnancy, we were unable to demonstrate a difference in respiratory symptoms with intubation and intratracheal suctioning.
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PMID:The need for delivery room intubation of thin meconium in the low-risk newborn: a clinical trial. 1033 94

To determine which factors from a range of demographic, perinatal, psychosocial, and hormonal factors were related to postpartum depression, a sample of 81 women between 2 weeks and 6 months postpartum was divided into a depressed group (n = 22) and a nondepressed group (n = 59) by means of the Beck Depression Inventory as the main measure and the Visual Analogue Scale as an additional measure. A demographic questionnaire, a social support questionnaire, and a marital satisfaction questionnaire were completed by each subject. A depression incidence rate of 27.2% was found. There were significant differences between the depressed group and the nondepressed group in the area of social support, marital satisfaction, and premenstrual tension. No significant differences were found in age, parity, previous depressive episodes, cesarean births, or prematurity. It was concluded that psychosocial and hormonal factors played a more important role in postpartum depression than demographic and perinatal factors. (author's)
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PMID:Factors related to postpartum depression. 1228 88

Adolescent pregnancy increases the risk of pregnancy complications, low birth weight (LBW), and infant mortality. Complications include urinary tract infections, acute pyelonephritis, and preeclampsia. Full eclampsia is often fatal, thus preeclamptic women are delivered immediately. LBW (below 2500 g) is caused by prematurity and intrauterine growth retardation, both of which factors are associated with adolescence. In 1989, approximately 7% of all live births in the US were LBW (5.7% White and 13.5% Black). A large sample of births in 1975-78 found increased risk of neonatal mortality for the infants of adolescents, possibly owing to higher rates of LBW. In 1991, a random sample of 389 adolescent mothers who had given birth in 1983 indicated a 54% rate of depression, and even higher rates existed among those with 2 or more pregnancies. Additional risk factors include socioeconomic circumstances (poor housing, nutrition, and cultural deprivation). In a 1991 study of adolescent mothers, 80% of Blacks and 57% of Whites lived in female-headed households. Of the total, 1% of Blacks and 25% of Whites were married and living together. 45% of Whites and 58% of Blacks lived in poverty. Only 44% of these women used prenatal care in the 1st trimester, and 11% had no regular source of health care at 15-18 months after childbirth. A 1989 study of 253 pregnant women aged 19 or younger showed that 52.2% admitted drinking alcohol, 31.6% admitted using marijuana, and 13.8% admitted using cocaine during pregnancy. Nutritional problems included skipping meals and eating junk food, as well as not getting enough food, although they were entitled to government food stamps. Immaturity and lack of knowledge also contributed to poor health. Prenatal clinics, school-based clinics, and hospitals have to encourage prenatal care (e.g., the Johns Hopkins University comprehensive maternity-care program for adolescents), treat depression, assess their concrete needs regarding services and eligibility, and recognize that adolescents have cognitive and emotional limitations.
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PMID:Health effects of adolescent pregnancy: implications for social workers. 1231 42

Schizophrenia is a multifactorial disease with complex interactions between a genetic liability, possible perinatal complications and exposure to later environmental risk factors in childhood. Maternal influenza infection, wartime-famine-related denutrition and maternal depression or exposure to repeated stress in pregnancy may have a deleterious effect on brain development and neuronal migration. Obstetrical complications which are significantly associated with schizophrenia are bleeding, diabetes, prematurity, fetal growth retardation, Rhesus incompatibility, preeclampsia and congenital malformations. Subjects with onset of schizophrenia before age 22 had more often a history of acute fetal distress (abnormal presentation at birth and complicated cesarean delivery). Obstetrical complications may have a direct negative impact on fetal brain development or may be on the causal pathway between prepartum maternal depression or psychosis, exposure to stress and impaired relation between mother and child consecutive to postnatal depression.
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PMID:[Obstetrical complications and further schizophrenia of the infant: a new medicolegal threat to the obstetrician?]. 1506 96

Association between prematurity/low birthweight and adolescent depressive disorder studied using a case-control design within a prospective cohort study of 2032 adolescents. Odds for depressive disorder were 11-fold (95% CI 2-62) higher for the premature/low-birthweight participants after regression adjustment for major confounding factors. For premature/low-birthweight females, cumulative rates of depressive disorder over 30 months were 15.2% (95% CI 11.1-20.5) v. 1.8% (95% CI 1.6-2.1) in those with normal deliveries. Physiological adaptations in utero before full term may be implicated causally in some cases of depression in adolescence.
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PMID:Prematurity at birth and adolescent depressive disorder. 2951 Jul 66


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