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    <recommendedItem id="20100101_19_412"
                     title="Depression During Pregnancy Linked to Kids&apos; Behavior Problems (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/Psychiatry/Depression/tb/18321?impressionId=1265799636256"
                     
      &lt;p&gt;Children born to mothers who were depressed during pregnancy were more than twice as likely to display antisocial behavior by age 16 as children whose mothers had not been depressed, researchers found.&lt;/p&gt;
&lt;p&gt;Of 120 mothers from South London who were followed from pregnancy through their children&apos;s teen years, 31% had depression during pregnancy, according to Dale Hay, PhD, of Cardiff University in Wales, and colleagues.&lt;/p&gt;
&lt;p&gt;Children born to these women were significantly more likely to display antisocial behavior (OR 2.46, 95% CI 1.10 to 5.48) and commit violent acts (OR 4.36, 95% CI 1.54 to 12.41) before age 16, the researchers reported in the January/February issue of &lt;em&gt;Child Development&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The associations were magnified in women who also had a history of behavior problems when they were children.&lt;/p&gt;
&lt;p&gt;&quot;A focus on mothers&apos; history of conduct problems and depression during pregnancy, as opposed to broader measures of the social environment, would hold promise for more targeted early interventions to prevent the development of serious antisocial behavior,&quot; Hay&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;Previous studies have linked mothers&apos; mental health problems in pregnancy with disruptive behaviors in their children, but it&apos;s unclear what explains the relationship, according to the researchers.&lt;/p&gt;
&lt;p&gt;To explore the issue, they turned to the South London Child Development Study, which prospectively followed 120 pregnant women and their children into the teenage years.&lt;/p&gt;
&lt;p&gt;All families came from a relatively disadvantaged urban area. These families were more likely to belong to the working class and to be from ethnic minority groups than the general U.K. population.&lt;/p&gt;
&lt;p&gt;One-third of the children had been arrested or diagnosed with a conduct disorder by age 16. Of these 88.9% had been arrested and 45% had committed violent acts, including theft from a person, violent disorder, fighting, carrying a weapon, and assault.&lt;/p&gt;
&lt;p&gt;The association between maternal depression during pregnancy and risk of antisocial behavior remained relatively constant in analyses controlling for family environment, a child&apos;s exposure to maternal depression after birth, mothers&apos; substance use during pregnancy, and parental antisocial behavior.&lt;/p&gt;
&lt;p&gt;None of the factors fully explained the relationship. Neither did the arrest history of the biological father.&lt;/p&gt;
&lt;p&gt;But, the researchers wrote in the paper, &quot;it would be unwise to conclude that paternal risk factors are unimportant, given that we did not have more detailed information about the father&apos;s own history of conduct disorders.&quot;&lt;/p&gt;
&lt;p&gt;They explored several potential mechanisms for the link between maternal depression and a child&apos;s behavior problems: &lt;ul&gt; &lt;li&gt;Direct effects on the fetus from biological correlates of the mothers&apos; depressive symptoms&lt;/li&gt; &lt;li&gt;Depression in pregnancy as a sign of environmental adversity&lt;/li&gt; &lt;li&gt;Re-exposure to maternal depression after birth&lt;/li&gt; &lt;li&gt;Indirect effects of depression on the developing fetus driven by mothers&apos; smoking, drinking, and drug taking during pregnancy &lt;/li&gt; &lt;li&gt;A genetic explanation whereby women who experience depression in pregnancy may also have a greater genetic risk for antisocial behavior, which they pass on to their offspring &lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Hay and her colleagues noted that these explanations are not necessarily mutually exclusive.&lt;/p&gt;
&lt;p&gt;They also acknowledged some limitations of the study, including the lack of information about fetal growth and neuroendocrine measures on the mother and child and the relatively small sample size.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The SLCDS has been funded by U.K. project grants from the Medical Research Council, by the Psychiatric Research Trust, and by the South West G.P. Trust. The current analysis was partially supported by an Economic and Social Research Council studentship to one of Hay&apos;s co-authors and by a Medical Research Council U.K. Program Grant.&lt;/p&gt;&lt;p&gt;The authors did not report any conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_299"
                     title="Teen Pregnancies, Births, and Abortions Increase"
                     score="0.003"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/18162?impressionId=1265799636256"
                     
      &lt;p&gt;After a decade of decline, the rate of teenage pregnancies increased by 3% in 2006 as 750,000 women younger than 20 became pregnant, according to a report released by the Guttmacher Institute.&lt;/p&gt;
&lt;p&gt;And as pregnancies increased, so did births  --  41.9 births per 1,000 U.S. teenage girls, which was 4% higher than in 2005  --  and abortions, which increased by 1% from 2005 to 2006.&lt;/p&gt;
&lt;p&gt;In a prepared statement, Planned Parenthood blamed abstinence-only sex education programs for the uptick.&lt;/p&gt;
&lt;p&gt;&quot;It is a tragedy that after a decade of progress in reducing the rate of teenage pregnancy we are witnessing a substantial increase in the number of teens who are getting pregnant,&quot; Planned Parenthood said.&lt;/p&gt;
&lt;p&gt;In a statement released last May in conjunction with the &quot;National Day to Prevent Teen Pregnancy&quot; the American College of Obstetricians and Gynecologists (ACOG), agreed that comprehensive sex education was likely to be more effective than abstinence-only programs.&lt;/p&gt;
&lt;p&gt;&quot;Abstinence works for some teens, but the idea that most teens will wait to have sex indefinitely is rigid and impractical,&quot; said Richard S. Guido, MD, chair of the ACOG&apos;s Committee on Adolescent Health Care.&lt;/p&gt;
&lt;p&gt;But the Guttmacher report suggested that the reasons for increase may be more complex, including &quot;shifts in the racial and ethnic composition of the population, increases in poverty, the growth of abstinence-only sex education programs at the expense of comprehensive programs, and changes in public perception and attitudes toward both teenage and unintended pregnancy.&quot;&lt;/p&gt;
&lt;p&gt;Among black teenagers the pregnancy rate was 126.3 per 1,000 versus 44 per 1,000 non-Hispanic white teenagers.&lt;/p&gt;
&lt;p&gt;A breakdown by state revealed that New Mexico had the highest teenage pregnancy rate, followed by Nevada, Arizona, Texas, and Mississippi.&lt;/p&gt;
&lt;p&gt;Conversely, the lowest teenage pregnancy rate was in New Hampshire  --  33 pregnancies per 1,000  --  followed by Vermont, Maine, Minnesota, and North Dakota.&lt;/p&gt;
&lt;p&gt;Texas had the highest rate of births to teenage mothers  --  62 per 1,000  --  and New York had the highest rate of abortions among teenagers, 41 per 1,000.&lt;/p&gt;
&lt;p&gt;The report was based on data from the National Center for Health Statistics of the U.S. Department of Health and Human Services (number of births), the Guttmacher Institute (total number of abortions), the U.S. Centers for Disease Control and Prevention (age and race/ethnicity distribution of women obtaining abortions), and the Population Estimates Program of the U.S. Bureau of the Census in collaboration with NCHS (population estimates).&lt;/p&gt;
&lt;p&gt;Among other findings in the report: &lt;ul&gt; &lt;li&gt;The pregnancy rate was 71.5 pregnancies per 1,000 girls ages 15-19 and pregnancies occurred among 7% of females in this age group.&lt;/li&gt; &lt;li&gt;Although teenage abortions increased by 1% from 2005 to 2006, the overall teenage abortion rate declined by about a third over the two decades from 1986 to 2006.&lt;/li&gt; &lt;li&gt;The increase in teen pregnancies and births to teenage mothers was observed across all racial and ethnic groups.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The authors said that additional research was needed to determine if the disparities in rates by both race and region carry over to adult women.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The report was prepared by Kathryn Kost, Stanley Henshaw, and Liz Carlin of the Guttmacher Institute.&lt;/p&gt;&lt;p&gt;Lawrence Finer, Rebecca Wind, Susheela Singh, and Laura Lindberg provided comments on early drafts.&lt;/p&gt;&lt;p&gt;The report was funded by grants from the Brush Foundation, The California Wellness Foundation (TCWF) and the Annie E. Casey Foundation. The Guttmacher Institute also gratefully acknowledges the general support it receives from individuals and foundations, including major grants from The William and Flora Hewlett Foundation, The David and Lucile Packard Foundation, and the Ford Foundation, which undergirds all of the Institute&apos;s work.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_243"
                     title="Depression More than a Postpartum Concern (CME/CE)"
                     score="-0.001"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/18097?impressionId=1265799636256"
                     
      Screening women for depression during and after pregnancy should be strongly considered, according to new Ob/Gyn guidelines.&lt;br&gt;
&lt;br&gt;However, the American College of Obstetricians and Gynecologists found that there isn&apos;t enough data to support a firm recommendation for universal screening.&lt;br&gt;
&lt;br&gt;What screening tools to use, who should do the screening, and how often were also left up to the physician&apos;s discretion in the ACOG committee&apos;s opinion, published in the February &lt;em&gt;Obstetrics &amp;amp; Gynecology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The guidelines are not meant to downplay the importance of screening, cautioned ACOG president Gerald F. Joseph, Jr., MD, of Ochsner Clinic Foundation in New Orleans.&lt;br&gt;
&lt;br&gt;&quot;Perinatal depression, postpartum depression, have the potential to be devastating  --  not only for the patient, but for her offspring both during the pregnancy and after the pregnancy,&quot; he said in an interview.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Infants of depressed mothers, for example, may be set back in their psychologic, cognitive, neurologic, and motor development, the committee wrote.&lt;/p&gt;
&lt;p&gt;Treating the mother&apos;s depression can actually resolve a child&apos;s mental and behavioral disorders, they added.&lt;/p&gt;
&lt;p&gt;The perinatal period is an ideal time to screen because of the mother&apos;s consistent contact with healthcare providers and opportunity to intervene, according to the committee opinion.&lt;/p&gt;
&lt;p&gt;However, all ACOG guidelines are evidence-based, and there simply wasn&apos;t enough evidence for this one, Joseph explained.&lt;/p&gt;
&lt;p&gt;&quot;Unfortunately, although I personally and many, many of our fellows feel that screening in the pregnant patient during and certainly after is extremely important,&quot; he told &lt;em&gt;MedPage Today&lt;/em&gt;, &quot;there&apos;s not a big girth of information that would allow us to publish evidence-based guidelines that say it absolutely should be done.&quot;&lt;/p&gt;
&lt;p&gt;One thorny issue is who should do the screening.&lt;/p&gt;
&lt;p&gt;Traditionally, Ob/Gyns see women four to six weeks after delivery for a check-up, but this may be too late, Joseph noted.&lt;/p&gt;
&lt;p&gt;Postpartum depression often shows up in the first week or two. &quot;It may be either gone or something untoward may have happened by six weeks,&quot; Joseph told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;A visit to the pediatrician, though, typically happens for healthy infants at two weeks of age, so many &lt;a href=&quot;http://www.medpagetoday.com/OBGYN/Pregnancy/6813&quot; mce_href=&quot;http://www.medpagetoday.com/OBGYN/Pregnancy/6813&quot; target=&quot;_blank&quot;&gt;pediatricians screen then&lt;/a&gt;.&lt;/p&gt;
&lt;p&gt;&quot;We&apos;re kind of hamstrung, telling physicians when absolutely the best time to screen is, because we don&apos;t know that,&quot; he said in the interview.&lt;/p&gt;
&lt;p&gt;Joseph suggested screening at least once during the pregnancy and once postpartum.&lt;/p&gt;
&lt;p&gt;&quot;I&apos;m sure that a lot of physicians probably feel that just being with patients and interviewing them may be a &apos;screen,&apos;&quot; he said, &quot;but I personally feel there should be a formal screening of patients.&quot;&lt;/p&gt;
&lt;p&gt;There are multiple depression screening tools that typically take under 10 minutes and have a specificity ranging from 77% to 100%, according to the guidelines.&lt;/p&gt;
&lt;p&gt;One of the most validated is the Edinburgh Postnatal Depression Scale, Joseph noted.&lt;/p&gt;
&lt;p&gt;Whatever a physician chooses to use, each medical practice should have a referral process in place for women who screen positive and require further evaluation and possible treatment, the writing committee emphasized.&lt;/p&gt;
&lt;p&gt;Another challenge with screening in the Ob/Gyn office is insurance coverage for mental health services.&lt;/p&gt;
&lt;p&gt;Many payers require that evaluation and management be done only by a psychiatrist or psychologist, and will crosscheck the provider&apos;s specialty, the guidelines warned.&lt;/p&gt;
&lt;p&gt;Medical practices should check ahead of time with all payers before billing for depression screening, the committee opinion recommended.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The ACOG committee that wrote the opinion provided no information on conflicts of interest. Joseph reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_84"
                     title="Pregnant Women Who Suspend Antidepressants Risk Relapse"
                     score="-0.005"
                     href="