Tehotenstvo a popôrodné obdobie sa spája s náročnými fyzickými a psychickými zmenami, ktoré neraz vedú k rozvoju psychických porúch. Depresia je diagnostikovaná u viac ako jednej zo šiestich žien po pôrode. Prevalencia popôrodnej depresie však môže byť oveľa vyššia, pretože mnohé prípady ochorenia ostávajú nediagnostikované. V prípade ťažkých foriem depresie sa pacientka nastavuje na farmakologickú liečbu, pričom najčastejšie sa u tejto diagnózy využíva sertralín. Novým liečivom používaným v terapii popôrodnej depresie je brexanolón, ktorý bol registrovaný FDA v roku 2019. Jeho výhodou oproti konvenčnej liečbe je rýchly nástup účinku. Štruktúra brexanolónu predstavuje neuroaktívny steroid – allopregnanolón, ktorý pôsobí agonisticky na δ-podjednotku GABA-A receptora a zlepšuje symptómy popôrodnej depresie. Okrem registrovaného brexanolónu sa v 3. fáze klinického skúšania nachádza aj ďalšie steroidné liečivo zuranolón v perorálnej liekovej forme. Iný syntetický analóg neuroaktívneho allopregnanolónu, známy ako ganaxolón, v druhej fáze klinického skúšania nepreukázal výrazné zlepšenie depresívnych symptómov oproti placebu. Napriek tomu má veľký terapeutický potenciál v liečbe rôznych typov epilepsie.

Pregnancy and postpartum period are associated with demanding physical and psychological changes that often lead to the development of psychological disorders. Depression is diagnosed in more than one in six women after childbirth. However, the prevalence of postpartum depression can be much higher because many cases are undiagnosed. In the case of severe depression, the patient is switched to pharmacological treatment, with sertraline being the most commonly used for this diagnosis. A new drug used in the treatment of postpartum depression is brexanolone, which was registered by FDA in 2019. The advantage over conventional therapy is its rapid onset of action. The structure represents the neuroactive steroid – allopregnanolone, which acts as an agonist on the δ-subunit of the GABA receptor and improves the symptoms of postpartum depression. In addition to the registered brexanolone, another steroidal drug, zuranolone, is available in the third phase of the clinical trial. The steroid structure was chemically altered to improve bioavailability and create an oral dosage form. Another synthetic analogue of neuroactive allopregnanolone, known as ganaxolone, did not show a significant reduction in depressive symptoms in the second phase of the clinical trial compared to placebo. Nevertheless, it has great therapeutic potential in the treatment of various types of epilepsy.

• Klíčová slova
• brexanolón, zuranolón, ganaxolón,
• MeSH
• lidé MeSH
• neurosteroidy * farmakologie   terapeutické užití   MeSH
• poporodní deprese * etiologie   farmakoterapie   psychologie   MeSH
• poporodní období psychologie   MeSH
• pregnanolon analogy a deriváty   antagonisté a inhibitory   terapeutické užití   MeSH
• pregnany aplikace a dávkování   terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH

Aim: The aim of our study was to examine the impact of partner support and perceived stress on the level of depressive symptoms in the postpartum period. Design: Cross-sectional observational study. Methods: A total of 206 women were included in the study. The mean age of respondents was 30.9 years (SD = 4.8; range: 20-44 years.). The Edinburgh Postnatal Depression Scale, Postpartum Partner Support Scale, and Perceived Stress Scale were used to measure the main observed variables. The questionnaire was supplemented with socio-demographic, health-related, and obstetric data. Results: The linear regression model showed that significant predictors of postpartum depression were: lack of support person during labor [β = -0.105; 95% CI = (-0.754; -0.030)]; lower education [β = -0.139; 95% CI = (-2.256; -0.407)]; lower partner support [β = -0.154; 95% CI = (-0.115; -0.025)]; and higher perceived stress [β = 0.755; 95% CI = (0.470; 0.615)]. Perceived stress was deemed to be the most significant predictor of increased depressive symptoms. Conclusion: Identifying mothers who perceive low support from their partner, or who experience high levels of stress and depression, and, subsequently, offering effective psychological support is important in helping to maintain the psychological and mental wellbeing of mothers.

• MeSH
• dospělí MeSH
• lidé MeSH
• manželé MeSH
• mladý dospělý MeSH
• poporodní deprese * etiologie   psychologie   MeSH
• poporodní období psychologie   MeSH
• průzkumy a dotazníky MeSH
• psychický stres MeSH
• sociální opora MeSH
• těhotné ženy psychologie   MeSH
• zdraví matek MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• hodnotící studie MeSH
• práce podpořená grantem MeSH

Cíl: Zhodnotit přesnost Edinburské škály poporodní deprese (EPDS) ve screeningu těžké deprese a jiných duševních poruch u žen v šestinedělí. Soubor a metodika: U 243 žen jsme administrovali EPDS k hodnocení depresivních příznaků a Mini-mezinárodní neuropsychiatrické interview k určení psychiatrických diagnóz. Určili jsme frekvenci výskytu sledovaných psychických poruch v souboru a vyhodnotili jsme senzitivitu, specificitu a další diagnostické proměnné pro přítomnost těžké deprese a jiných duševních poruch pro různé prahové skóry v EPDS. Výsledky: Těžká depresivní porucha se vyskytovala u 2,5 % (95% IS 1,1–5,3 %) žen. Jakákoli sledovaná duševní porucha pak u 13,6 % (95% IS 9,8–18,5 %) žen. Nejlepšího poměru senzitivity a specificity pro záchyt těžké depresivní poruchy dosahoval prahový skór EPDS ≥ 11; senzitivita: 83 % (95% IS 35–99 %); specificita: 79 % (95% IS 74–84 %). EPDS skór ≥ 11 pak dosahoval senzitivitu 76 % (95% IS 58–89 %) a specificitu 82 % (95% IS 76–87 %) pro záchyt jakékoli sledované duševní poruchy. Závěr: Česká verze EPDS má dobrou vnitřní konzistenci a EPDS skóre ≥ 11 dosahuje nejlepší kombinace hodnot senzitivity a specificity pro detekci těžké depresivní poruchy. Screening pomocí EPDS u žen na konci šestinedělí může odhalit i jiné psychické poruchy než pouze těžké deprese.

Objective: To assess the accuracy of the Edinburgh Postnatal Depression Scale (EPDS) in screening for severe depression and other mental disorders in women at the end of puerperium. Materials and methods: We administered the Czech version of the EPDS to assess depressive symptoms and the Mini International Neuropsychiatric Interview to determine psychiatric diagnoses in 243 women at the end of their puerperium. Then, we determined the frequencies of severe depressive disorder and other psychiatric disorders in our cohort. Furthermore, we assessed the sensitivity, specificity, positive predictive value, negative predictive value, and other diagnostic variables for the presence of severe depression and other psychiatric disorders for different threshold scores on EPDS. We evaluated the detection potential of EPDS for detecting monitored mental disorders by using the receiver operating characteristic curve analysis and determining the area under the curve. Results: Severe depressive disorder was present in 2.5% (95% CI: 1.1–5.3%) of women. Any monitored mental disorder was present in 13.6% (95% CI: 9.8–18.5%). The best sensitivity/specificity ratio for detecting major depressive disorder was found for the EPDS threshold score ≥ 11; sensitivity was 83% (95% CI: 35–99%) and specificity was 79% (95% CI: 74–84%). The EPDS ≥ 11 then achieved a sensitivity of 76% (95% CI: 58–89%) and specificity of 82% (95% CI: 76–87%) for the detection of any mental disorder of interest. Conclusion: Our results showed that the Czech version of EPDS has good internal consistency, and the EPDS score ≥ 11 achieves the best combination of sensitivity and specificity values for detecting major depressive disorder. Screening with EPDS in women at the end of puerperium can detect psychiatric disorders other than severe major depression.

• Klíčová slova
• Edinburská škála postnatální deprese,
• MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• plošný screening metody   MeSH
• poporodní deprese * diagnóza   psychologie   MeSH
• poporodní období MeSH
• psychiatrické posuzovací škály MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH

The study objectives were to (1) identify risk factors related to stress urinary incontinence (SUI) and postnatal depression (PD) after birth, and (2) investigate both possible directions of association between SUI and PD in population-based sample of Czech mothers. 3,701 nulliparous and multiparous women completed the self-reported questionnaires at 6 weeks and 6 months after birth and were included into the analyses of this prospective cohort study. Unadjusted and adjusted logistic regressions examined relationship between SUI a PD accounting for range of other risk factors. During the first 6 months after birth, 650 mothers (17.6%) developed SUI and 641 (17.3%) displayed signs of PD. The mode of delivery, parity and higher BMI were associated with SUI. The rate of PD symptoms was higher in mothers with positive history of prenatal depression, and in divorced or widowed mothers. Both conditions were associated with worse self-reported health, back pain and stop-smoker status. Initially, SUI at 6 weeks was slightly, but significantly associated with onset of PD at 6 months (OR 1.51, 95% CI 1.02-2.23) while PD at 6 weeks was not significantly related to new cases of SUI at 6 months (OR 1.48, 95% CI 0.91-2.39). After full adjustment these OR reduced to 1.41 and 1.38 (both non-significant), respectively. SUI and PD are common conditions in women postpartum that share some risk factors. Our study suggests that both directions of their relationship are possible although a larger study is needed to confirm our findings.

• MeSH
• bolesti zad epidemiologie   MeSH
• bývalí kuřáci psychologie   statistika a číselné údaje   MeSH
• dospělí MeSH
• kvalita života * MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• poporodní deprese komplikace   epidemiologie   psychologie   MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• socioekonomické faktory MeSH
• stresová inkontinence moči epidemiologie   etiologie   psychologie   MeSH
• těhotenství MeSH
• vdovský stav psychologie   statistika a číselné údaje   MeSH
• věk matky MeSH
• zdravotní stav MeSH
• zpráva o sobě statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

Postpartum depression (PPD) affects up to 19% of all mothers, with detrimental effects on both mother and child. The antidepressant and anxiolytic effects of plasma oxytocin are well-documented, but it is still disputable whether synthetic oxytocin (synOT) may protect women against postpartum mood alterations. The current study examined the association between synOT intrapartum and maternal mood postpartum using a prospective design. Two hundred sixty women were screened for depressive symptoms in the last trimester of pregnancy and then again 6 weeks and 9 months postpartum using the Edinburgh Postnatal Depression Scale. They also completed Maternity Blues Questionnaire in the first postpartum week. The data concerning the intrapartum interventions and health status of the newborn were extracted from the medical records. Cox proportional hazards regression adjusted for a history of depression, mode of delivery, and childbirth experience showed that synOT predicted a significantly lower risk of PPD (HR = 0.65, 95% CI 0.45-0.95, p = 0.025). The risk factors for PPD included a history of depression (HR = 3.20, 95% CI 2.33-4.40, p < 0.001) and negative childbirth experience (HR = 1.39, 95% CI 1.01-1.90, p = 0.040). Logistic regression adjusted for the same covariates found no significant effect of synOT on maternity blues (OR = 0.64, 95% CI 0.31-1.32, p = 0.23). While synOT administered intrapartum does not affect maternal mood immediately, it may come to effect some weeks after childbirth to protect mothers from developing PPD symptoms.

• MeSH
• dospělí MeSH
• lidé MeSH
• longitudinální studie MeSH
• matky psychologie   MeSH
• oxytocin aplikace a dávkování   krev   MeSH
• poporodní deprese krev   diagnóza   epidemiologie   psychologie   MeSH
• poporodní období MeSH
• proporcionální rizikové modely MeSH
• prospektivní studie MeSH
• psychiatrické posuzovací škály MeSH
• rizikové faktory MeSH
• těhotenství MeSH
• uterotonika aplikace a dávkování   krev   MeSH
• vedení porodu psychologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH

BACKGROUND: Previous studies of relations between parenting self-concepts, parental adjustment and child temperament have been ambiguous regarding the direction of influence; and have rarely followed families from pregnancy through the first year of life. The current study examines change and stability in maternal depressive symptoms, parenting competences and child temperament through the perinatal period until nine months postpartum. METHODS: Czech mothers (N = 282) participated at three time points: the third trimester of pregnancy (Time 1), six weeks (Time 2) and nine months postpartum (Time 3). Questionnaire data concerned depressive symptoms (T1, T2, T3), maternal parenting self-esteem (T1, T2) and sense of competence (T3), and child temperament (T2, T3). A path model was used to examine concurrent and longitudinal relations between these variables. RESULTS: The analyses indicated longitudinal stability of all constructs, as well as concurrent relations between them. Longitudinal relations supported child-to-parent, rather than parent-to-child, effects: child difficult temperament predicted decreases in perceived maternal parenting competences, but maternal variables did not predict change in infant temperament. In addition, we observed weak mutual relations between maternal depression levels and parenting competences, such that maternal depression diminished perceived parenting competences that in turn contributed to higher levels of depression. CONCLUSION: Mothers' confidence in their ability to parent is influenced by their experience with a difficult infant and by their depressive symptoms during the child's first year of life. Depressive symptoms are, in turn, aggravated by mothers' low perceived competences in the parenting role.

• MeSH
• deprese * psychologie   MeSH
• dospělí MeSH
• kojenec MeSH
• lidé MeSH
• matky MeSH
• mladiství MeSH
• mladý dospělý MeSH
• poporodní deprese * psychologie   MeSH
• rodičovství * MeSH
• sebepojetí MeSH
• těhotenství MeSH
• temperament * MeSH
• vztahy mezi matkou a dítětem * MeSH
• Check Tag
• dospělí MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Pôrod môže byť pre niektoré ženy mimoriadne stresujúca udalosť, pripomínajúca prežitú popôrodnú traumu, spĺňajúcu diagnostické kritéria posttraumatickej stresovej poruchy (PTSD: Posttraumatic stress disorder). Cieľom štúdie práce bolo zistiť u žien po pôrode riziko PTSD a jeho súvislosti. Použili sme kvantitatívnu metódu – dotazník, doplnený škálou zameranou na zistenie príznakov PTSD. Štúdie sa zúčastnilo 225 žien (priemerný vek 29,64 ± 7,34 rokov; priemerná doba od pôrodu 2,74 ± 6,28 rokov), pričom zaraďovacím kritériom bola negatívna pôrodná skúsenosť z pôrodu. Na spracovanie získaných údajov z dotazníka sme použili deskriptívnu štatistiku. Riziko PTSD v súvislosti s pôrodom sa celkovo prejavilo u 3,56 % žien. Najčastejšími príznakmi PTSD po pôrode boli strach z opakovania sa negatívneho pôrodu (16,93 %), nepripomínanie si pôrodu (11,36 %) a pocit zdesenia pri spomienke na pôrod (10,91 %). Negatívna pôrodná skúsenosť u žien súvisela najčastejšie s komplikovaným pôrodom (25,37 %), so zlým prístupom zdravotníckych profesionálov (18,56 %) a s veľkou bolesťou (13,98 %). Výsledky poukazujú na skutočnosť, že negatívna skúsenosť z pôrodu a popôrodná trauma u žien súvisí s vplyvom negatívnych faktorov, ktoré môže pôrodná asistentka minimalizovať a svojim profesionálnym, individuálnym a empatickým prístupom im predchádzať.

Childbirth could be exceptionally stressful event, resembling experienced birth trauma, meeting the diagnostic criteria of post-traumatic stress disorder (PTSD). The aim of the study was to find out risk PTSD after childbirth and its context. The questionnaire- quantitative explorative method has been used and supplemented with the scale focused on finding PTSD symptoms. The study consisted of 225 women (mean age of 29,64 ± 7,34 years; mean period after childbirth of 2,74 ± 6,28 rokov) and the inclusion criteria was a negative birth experience. We have used a descriptive statistic to process gathered data from a questionnaire. The PTSD risk in relation to the parturition has been proved overall by 3,56% of women. The most frequent PTSD symptoms after the birth were fear from repeating the negative childbirth (16,93 %), not resembling a childbirth (11,36 %) and a feeling of panic while recalling the childbirth (10,91 %). Negative birth experience of women was mostly related to a complicated childbirth (25,37 %), to bad attitude of health care professionals (18,56 %) and to severe pain (13,98 %). The results pointed out facts that negative birth experience and birth trauma of women is related to the influence of negative factors, that could be minimized and prevented by a professional, individual, and empathetic attitude of a midwifery.

• MeSH
• poporodní deprese klasifikace   komplikace   ošetřování   prevence a kontrola   psychologie   MeSH
• poporodní období psychologie   MeSH
• porod psychologie   MeSH
• průzkumy a dotazníky MeSH

• NLK Publikační typ
• studie

• MeSH
• indukovaný potrat psychologie   MeSH
• komplikace těhotenství * psychologie   MeSH
• lidé MeSH
• narození mrtvého plodu psychologie   MeSH
• poporodní deprese psychologie   MeSH
• samovolný potrat psychologie   MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH

Objectives The role of perceived discrimination in postpartum depression is largely unknown. We investigate whether perceived discrimination reported in pregnancy contributes to postpartum depression, and whether its impact varies by education level. Methods Prospective data are a part of European Longitudinal Study of Pregnancy and Childhood, the Czech Republic. Surveys were collected in mid-pregnancy and at 6 months after delivery. Depression was measured using Edinburgh Postnatal Depression Scale. Generalized linear models were estimated to test the effects of perceived discrimination on postpartum depression. Results Multivariate models revealed that among women with low education, discrimination in pregnancy was prospectively associated with 2.43 times higher odds of postpartum depression (p < .01), after adjusting for antenatal depression, history of earlier depression, and socio-demographic background. In contrast, perceived discrimination was not linked to postpartum depression among women with high education. Conclusions Perceived discrimination is a risk factor for postpartum depression among women with low education. Screening for discrimination and socio-economic disadvantage during pregnancy could benefit women who are at risk for mental health problems.

• MeSH
• deprese diagnóza   psychologie   MeSH
• diskriminace (psychologie) * MeSH
• dospělí MeSH
• komplikace těhotenství psychologie   MeSH
• lidé MeSH
• percepce * MeSH
• poporodní deprese diagnóza   psychologie   MeSH
• poporodní období MeSH
• prospektivní studie MeSH
• průzkumy a dotazníky MeSH
• psychiatrické posuzovací škály MeSH
• rizikové faktory MeSH
• socioekonomické faktory MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: In the postpartum period, certain groups of women are at a higher risk for developing depressive episodes. Several studies have described risk factors for developing postpartum depression (PPD). However, these studies have used limited numbers of participants, and therefore the estimated prevalence of PPD varies greatly. METHODS: The objective of this study is to identify the main risk factors for developing PPD by using data collected via the Czech version of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC). This database provides a representative sample (n = 7589) observed prospectively and a large amount of data on depressive symptoms and on biological, socioeconomic, and environmental factors. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for incidence of PPD. The affective pathology was examined at three time points: before delivery, 6 weeks after delivery, and 6 months after delivery. RESULTS: The prevalence of depressive symptoms before delivery was 12.8%, 6 weeks after delivery 11.8%, and 6 months after delivery 10.1%. The prevalence rates are based on women who completed questionnaires at all three time-points (N = 3233). At all three time points, the main risk factors for developing PPD identified as significant by both univariate and multivariate analysis were personal history of depressive episodes and mothers experiencing psychosocial stressors. Other risk factors occurring in both types of analysis were: family history of depression from expectant mother's paternal side (prenatal), mothers living without partners (6 weeks postpartum) and feelings of unhappiness about being pregnant (6 months postpartum). Several protective factors were also observed: male child gender (prenatal), primiparous mothers (6 months postpartum), and secondary education (prenatal, only by multivariate analysis). Significant risk factors found solely by univariate analysis were family history of depression in both parents of the expectant mother (prenatal and 6 weeks postpartum), family history of depression from subject's maternal side (6 months postpartum), unintentional pregnancy (prenatal and 6 weeks postpartum), feelings of unhappiness about being pregnant (prenatal and 6 weeks postpartum), primary education (prenatal and 6 weeks postpartum), mothers who opted not to breastfeed (6 months postpartum) and mothers living without partners (prenatal and 6 months postpartum). Family savings were identified as protective factor (prenatal and 6 months postpartum). CONCLUSIONS: We identified significant predictors of PPD. These predictors can be easily detected in clinical practice, and systematic screening can lead to identifying potentially at risk mothers. Since the risk is linked with experience of psychosocial stressors it seems that they might benefit from increased psychosocial support to prevent affective pathology.

• MeSH
• dospělí MeSH
• lidé MeSH
• longitudinální studie MeSH
• ochranné faktory MeSH
• poporodní deprese diagnóza   epidemiologie   psychologie   MeSH
• prospektivní studie MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• socioekonomické faktory * MeSH
• těhotenství MeSH
• vedení porodu psychologie   MeSH
• zdravotnické přehledy MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH