Journal Article Annotations
2021, 3rd Quarter
Annotations by Mary Burke, MD and Liliya Gershengoren, MD, MPH
Results from this meta-analysis demonstrate an association between PMDD and suicidality. Women with PMDD are at higher risk of suicide attempts and ideation by almost seven- and fourfold, respectively. Furthermore, PMS and premenstrual symptoms are risk factors for suicidal ideation but not suicide attempts.
Strength and weaknesses:
There is a paucity of research on PMDD and suicidality. This meta-analysis attempts to quantitatively confirm results of prior studies describing an association of PMDD with suicidal thoughts, ideation, plans, and attempts. The limitation of this study includes its inclusion of studies written in English and Spanish only. In addition, most studies described a cross-sectional design that limits the ability to draw causal relationships between PMDD, PMS, and suicidality.
C-L psychiatrists working in OB/GYN or general hospital settings often encounter patients with suicidal ideation or a recent suicide attempt. Increased awareness of premenstrual disturbances in these patients will further help to tailor treatment from a multidisciplinary perspective.
Compared to White and Hispanic women, non-Hispanic Black women were more likely to have major post-operative consequences of surgeries that occur during pregnancy. Cholecystectomy and appendicitis were the most common surgeries. Among major complications, Black women had higher rates of transfusion and experienced longer surgeries. The adjusted RR was significant higher overall (1.41), among healthier subjects (1.64 among women with American Society of Anesthesiology (ASA) risk classification I-II), and in score-matched control analyses (1.50). Black women were more likely to be rated in ASA class III, indicating the presence of severe, systemic disease (18%), compared to White and Hispanic pregnant women (12%, 9% respectively). Overall, Hispanic women had better surgical outcomes.
Strength and weaknesses:
This was a large (3,093 subjects) longitudinal prospective study of a national database. Researchers had access to multiple sources of information for their analyses that included premorbid conditions, Current Procedural Terminology codes and surgical specialty, operative time, type of anesthesia, work relative value units, and case urgency. Composite scores of adverse outcomes were derived using a previously validated tool. Tables of data were easy to read. There were no reported conflicts of interest. Weaknesses included the authors’ inability to examine outcomes among other ethnic groups (Asian, Native American) due to the limits of the database or study disaggregated information.
Surgical complications of pregnancy impact the health of the developing fetus, the overall health of the pregnancy, and the mental well-being of the expectant mothers. This study bolsters prior research demonstrating significant health disparities in this country, in particular between non-Hispanic Black and White women. While the authors do not make causal conclusions, they set this study squarely in the context of ongoing investigations of serious health disparities in the US. They deepen the discussion of systemic bias in the US health system, with information that can generate better health care for Black women, as well as preparation for higher likelihood of adversity during pregnancy for Black women in the US.
The investigators found that pregnancy does not suppress the immune response to the SARS-CoV-2 virus: maternal IgG was present in 100% of maternal blood samples after infection. However, there is a low transplacental passage of maternal neutralizing antibodies to the spike receptor protein (the mechanism of immunity relevant to vaccinations). Only 25% of cord blood samples had such antibodies. Time from maternal infection to delivery did not affect potency of neutralizing antibodies.
Strength and weaknesses:
This was a methodical, prospective study of maternal and cord blood samples, and infection was confirmed by PCR testing. COVID-19 remains a public health crisis, and its impact on pregnancy and fetal development remains of major importance for all involved in women’s health care. The patient population was predominantly African American, a demographic group that has been hit especially hard by the pandemic and that has traditionally been under-represented in medical literature. The findings were cleanly presented and easy to follow. The article also reviews information about the SARS-CoV-2 virus that has been elucidated in the past 18 months, including viral replication patterns and what we understand about immune response.
C-L psychiatrists working in obstetrical and perinatal services should be familiar with the impact of the SARS-CoV-2 virus on their patients. In particular, psychiatrists should continue to recommend vaccination and thoughtful decisions regarding avoidable exposure risk. Further research is needed on fetal outcomes of maternal SARS-CoV-2 infection.