New and expecting dads get depression too

A New Zealand study published in JAMA Psychiatry has found that expectant fathers were at risk of developing depression if they felt stressed or were in poor health. Elevated depression symptoms following their child’s birth were linked to social and relationship problems. The researchers from the University of Auckland investigated depression symptoms in more than 3500 New Zealand men during the perinatal period – the third trimester of their partner’s pregnancy and again 9 months after their child’s birth. During that time, 217 of the men in the study (6.2%) experienced symptoms of depression compared with 3306 who did not have elevated depression symptoms. Around one in 23 men reported symptoms of postnatal depression, while antenatal depression only affected 2.3%. Elevated antenatal depression symptoms for men were associated with perceived stress and poorer health, while elevated postnatal depression symptoms in fathers were associated with perceived stress in pregnancy, no longer being in a relationship with the mother, having poorer health, being unemployed and having a history of depression, according to the article. By comparison, more mothers suffered depression symptoms before than after the birth of their children. One in six of the mothers interviewed in the Growing Up in New Zealand study cohort reported significant depressive symptoms at either the antenatal interview or when their children were 9 months old. One in eight experienced antenatal depression symptoms, with one in 12 experiencing symptoms postnatally, although these were not always the same mothers. One in four women who had antenatal depression also experienced postnatal depression, and more than one in three with postnatal depression had experienced antenatal depression. “Given that paternal depression can have direct or indirect effects on children, it is important to recognize and treat symptoms among fathers early,” the authors concluded.

Malaria vaccination trial reports 100% protection

A German trial, published in Nature, of a malaria vaccine, delivered by venous inoculation, has achieved up to 100% protection against infection (by the same strain used in the vaccine), for at least 10 weeks after the last dose, in a small group of patients. The trial tested the safety of the vaccine in 35 human participants and found no severe side effects to the treatment. Some of the highest levels of protection against malaria reported to date have been achieved with vaccination strategies that use either infectious or attenuated Plasmodium falciparum sporozites (PfSPZ) – cells from the malaria-causing parasite – to elicit an immune response. Previous efforts have used mosquitoes to deliver live PfSPZ, but the German researchers investigated direct venous inoculation of infectious PfSPZ, which is a more practical mode of delivery in clinical settings. Healthy volunteers were given varying doses of the vaccine alongside chloroquine, an antimalarial drug, and were then infected with the same strain of malaria used in the vaccine. When delivered in three doses at 4-week intervals, the lower doses only protected some of the participants against infection, but the highest dose achieved 100% protection (in nine participants) for at least 10 weeks after the last dose. The same high dose delivered at a shorter time period (three doses at 5-day intervals) protected five out of eight individuals (63%). The authors stated that further optimisation of the treatment was needed before it could be determined whether the approach would be suitable for the development of a vaccination program to prevent malaria. They proposed that their next clinical trials would assess how effective their vaccine could be in more diverse populations, whether it worked for different forms of malaria exposure and in different strains of the disease, and what the duration of protection might be.

Brain growth may predict autism in high-risk babies

Researchers from the University of North Carolina have found an association between increased growth in brain volume compared with typically developing infants during the first year of life and the ability to predict whether a child at high risk of developing autism spectrum disorder is likely to receive a diagnosis of the disorder at age 2. Enlarged brain volume has previously been observed in children with autism, but the development of these changes and their relation to the behavioural symptoms of the disorder remain unclear. The researchers conducted a prospective study of 106 infants who had an older sibling with a clinical autism diagnosis (high risk) and 42 infants with no immediate family history of autism (low risk). Analysing neuroimaging data obtained between 6 and 24 months of age, the authors found an increased growth rate of cortical surface area in the high risk infants that were later diagnosed with autism compared with the low risk infants and high risk infants not diagnosed later with autism in the first year of life. Increased surface-area growth was linked to the total brain overgrowth observed in the high risk infants’ second year of life. They also found that these changes in brain volume were associated with the social deficits that emerge in the second year. Finally, the authors employed a machine-learning algorithm that could predict, with good accuracy, which children in the high risk group would eventually be diagnosed with autism at 24 months of age. The authors noted that it remained unknown whether these brain changes are specific to autism or might overlap with other neurodevelopmental disorders. The study was published in Nature.

Gestational diabetes and increased risk of poor outcomes

French research, published in Diabetologia, has shown an increased risk of adverse outcomes in babies born to mothers with gestational diabetes (GDM), when compared with mothers who do not have diabetes, although the risks of adverse outcomes were much lower with GDM than with pre-gestational diabetes. All 796 346 deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database and the national health insurance system. The diabetic status of mothers was determined by the use of diabetes drugs or insulin to lower blood sugar, and by hospital diagnosis. Outcomes were analysed according to the type of diabetes and, in the gestational diabetes group, whether or not diabetes was insulin-treated. The cohort of 796 346 deliveries included 57 629 (7.24%) mothers with GDM. Data linking the mother to the child were available for 705 198 deliveries (88% of the total). The risks of adverse outcomes were two to four times higher for babies of mothers with type 2 diabetes before pregnancy (pre-gestational diabetes) than for those with GDM. The authors then adjusted their data, limiting the analysis to deliveries after 28 weeks to ensure all women diagnosed with GDM were included (since diagnosis of GDM in most cases takes place at or after 28 weeks). Following adjustment, the increased risks of various complications for mothers with GDM versus mothers without diabetes were: pre-term birth 30%, Caesarean section 40%, pre-eclampsia or eclampsia 70%, babies born significantly larger than average size (macrosomia) 80%, respiratory distress 10%, birth trauma 30% and cardiac malformations 30%. While these increased risks combine women with both insulin- and diet-treated GDM, most of the increased risk is found in women with insulin-treated GDM. This is because the diabetes is more serious and blood sugar more difficult to control in women who need insulin treatment, resulting in a higher risk of complications than in those women treated with diet only. The authors concluded that GDM is associated with a moderately increased risk of adverse perinatal outcomes, which is higher in insulin-treated GDM than in non-insulin treated GDM for most outcomes.

 

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