British doctors reveal ‘extremely important’ research that could help tens of thousands of women at risk
British doctors have identified the first advance blood test for postnatal depression, it was reported on Monday.
The development could see pregnant women have a £10 screening test that would allow those found to be at risk to receive treatment before they give birth. Professor Dimitris Grammatopoulos, who led the research at University Hospitals Coventry and Warwickshire NHS Trust, described the research as being “extremely important”.
He told Sky News: “There is evidence that if you can identify women at risk early you could treat early or introduce measures to prevent or stop the process of the disease.”
According to the news channel, a study of 200 pregnant women, published in the Journal of Psychiatric Research, found two molecular “signatures” in the genes that increased the risk of postnatal depression by up to five times. One in seven new mothers suffer from depression.
Researchers believe that changes in oestrogen levels make pregnant women more sensitive to the stress hormone cortisol, and those with the genetic variations are unable to correct the hormonal imbalance after giving birth.
Prof Grammatopoulos has claimed he could test women for the genetic changes for £30-£40, but the cost could be reduced to £10 if the screening system is automated.
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The specialist Mother and Baby Unit at the Bethlem Royal Hospital has been recognised as providing an example of “best practice” in caring for women suffering with severe mental illness during pregnancy or post-birth.
An NSPCC report released last week suggests the wellbeing of more than one in 10 newborn babies in England could be improved if all new mothers with mental illness had equal access to good services.
The report states there is evidence to show that the work carried out at the Channi Kumar Mother and Baby Unit, part of the South London and Maudsley NHS Foundation Trust, leads to significant improvements in mental state in approximately three quarters of women, in the sensitivity of mothers with schizophrenia and postpartum psychosis when interacting with their babies and major improvements in the interaction of the babies of mothers with schizophrenia, psychosis and depression.
The 13-bed unit was set up for women who develop or have a relapse of serious mental illness during pregnancy or following the birth of their baby. The unit offers a wide range of treatment, therapy and care which is not offered on the same scale in any other unit in the UK.
One unique factor is the work of a developmental psychologist who works closely with the mothers and infants.
Dr Susan Pawlby works clinically as a developmental psychologist at the unit and academically at the King’s College London’s Institute of Psychiatry.
She said: “I think our unit stands out because we have a developmental psychologist to work with nursery nurses and nurses on the ward and most other units do not have that.
“It means we can give mothers and infants more support in forming and maintaining this early and most fundamental relationship. We have developed video feedback interventions so that mothers can see how their babies respond to them. Together we watch video clips of play sessions, talk about the communication between the mother and her baby in order to help mothers develop their relationship with their baby.
“We systematically evaluate this intervention and see how effective it is. Our work is to encourage mothers to respond to their babies’ cues, so that mothers become more sensitive and babies more co-operative in their interaction with one another. I am delighted our work has been recognised by the NSPCC.”
Alongside this support, the Mother and Baby Unit also treats mothers with medication where needed. The unit also offers various forms of therapy (psychological, art psychotherapy, cognitive behavioural therapy and cognitive analytical therapy), life skills, health skills, leisure activities, baby massage and dance therapy.
Following the release of the report the NSPCC is calling on health ministers to lead a drive to address major gaps in access to mental health services for pregnant and new mums.
Mental health problems including depression, anxiety, postpartum psychosis, obsessive compulsive disorders, eating disorders , schizophrenia, post-traumatic stress disorderand personality disorder can begin or escalate when a woman is pregnant or in her infant’s first year. They can have a damaging effect on family life, and in the worst cases, impact on babies’ health and welfare.
Evidence shows that the vast majority of these illnesses are preventable and treatable, and with the right support, the negative effects on families can be avoided.
Sally Hogg, author of the NSPCC report, said: “The Mother and Baby Unit at Royal Bethlem Hospital provides excellent support for mothers suffering from perinatal mental illnesses and their babies. They do fantastic work to help mums to care for and bond with their babies, which helps ensure these children have the best possible start in life.
“It is crucial that more units like this are made available across the country for all families who need them, as without access to specialist units such as this some mothers don’t get the right help and can be separated from their babies, which is traumatic for the whole family.”
For more information on the NSPCC report:
Read Susan’s story here
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The risk posed by some popular antidepressants in early pregnancy is not worth taking for women with mild to moderate depression, an expert has warned.
Professor Stephen Pilling says evidence suggests SSRIs can double the risk of a child being born with a heart defect.
The drugs have been used by up to one in six women of child-bearing age.
A manufacturer contacted by the BBC denies any link to major foetal malformations.
Panorama has spoken to eight mothers who had babies born with serious heart defects after taking a commonly used SSRI (selective serotonin reuptake inhibitors) antidepressant while pregnant. Currently, prescription guidelines for doctors only warn specifically against taking the SSRI, paroxetine, in early pregnancy.
But Prof Pilling, expert adviser to the National Institute for Health and Care Excellence (NICE), says that advice is about to be updated.
“The available evidence suggests that there is a risk associated with the SSRIs. We make a quite a lot of effort really to discourage women from smoking or drinking even small amounts of alcohol in pregnancy, and yet we’re perhaps not yet saying the same about antidepressant medication, which is going to be carrying similar – if not greater – risks,” he said.
When Anna Wilson, from Ayrshire, had her 20-week scan, doctors realised her son had a serious heart problem and would need immediate heart surgery when he was born.
“He’s got a lot of suffering ahead of him before anything else,” his mother said. “We know that’s a certainty and that’s pretty awful.”
Four years before she became pregnant, Mrs Wilson was prescribed the drug Citalopram by her GP because she was suffering from anxiety.
Her doctor told her it was fine to continue using the drug when trying for a baby. But after David was born she asked what might have caused his heart condition.
“We did meet with a cardiologist at one of the scan appointments, and he explained that as far as he knew there were no environmental factors and it wasn’t because of anything we as parents had done. It was just one of those things – couldn’t be prevented,” she said.
Prof Pilling says the guidance will now be re-written to take in to account evidence that the SSRI antidepressants, as a group, are linked to heart defects.
He says the risk of any baby being born with a heart defect is around two in 100; but the evidence suggests if the mother took an SSRI in early pregnancy that risk increases to around four in 100.
“You’ve got double the risk. And for women who are mild to moderately depressed, I don’t think that those risks, in most cases, are really worth taking” he said.
“It’s not just when a woman who’s pregnant is sitting in front of you. I think it needs to be thought about with a woman who could get pregnant. And, that’s the large majority of women aged between 15 and 45.”
Mrs Wilson will never know for sure what caused David’s heart defect, but said if she had known there was even a very small risk associated with the drug she would have stopped taking it.
“If David’s condition was preventable, and it wasn’t prevented, that’s really, really awful.
“If somebody had given me the choice in pregnancy and said ‘there’s a risk of this’, I would have stopped taking those tablets in a flash.”
Lundbeck, the manufacturer of Citalopram, says a recent review of scientific literature concluded that the drug “does not appear to be associated with an increased risk of major foetal malformations”.
“The decision not to prescribe anti-depressants to a woman who is depressed… may generate greater risks to the woman and her foetus than the risks of exposure to the medication.”
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While it notes that there are good examples of mother and baby units that are providing families with expert care and support, the report says that in huge areas of the country, women have no access to a unit.
In these areas some mothers do not get the right help and can be separated from their babies, it adds.
The NSPCC is calling for a step change so that the mental health of mothers and babies is given the same importance as physical health.
It is also calling on the DH to lead work to fill gaps in services, which could in turn save the lives of mothers and babies.
Peter Wanless, chief executive officer of the NSPCC, said: ‘This report clearly shows that with the right services, it is possible to prevent the harm caused by maternal mental illness. But opportunities to help many more families are being missed.
He added: ‘Pregnancy and the first months of a child’s life are critical for their future wellbeing and parents naturally play a vital role.
‘If the government is serious about giving every child the best start in life it must take action to fill the gaps in services.’
Louise Silverton, director for midwifery at the RCM, said: ‘There is a real and pressing need to detect and improve the care for pregnant women with mental health problems, throughout their pregnancy and after the birth in particular.
‘However, this is going to be very difficult to do without the right number of midwives to cope with the rising demand on maternity services, and the right specialist help for these women.’
She added: ‘The government has said that this is a high priority area and we need to see that commitment turn into better services for women.’
Previous research by the NSPCC has shown that over 120,000 under ones are living with a parent who has a mental health problem.
The charity is running a range of services in locations across the UK to support new mothers. Please click here for further information.
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