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Peripartum depression (PPD) affects similar to 12-25% of pregnant and postpartum women worldwide, yet routine screening often fails to capture real-time symptom changes. Digital phenotyping (DP), using data from digital devices such as text entries, sleep tracking, physical activity, social media behavior, and ecological momentary assessments, has been proposed as a complementary approach to support the prediction and early identification for PPD. This systematic review (PROSPERO: CRD42023461325) examined 14 studies published between 2014 and March 2025 that explored passive and active DP data across the antenatal and postnatal periods. Most studies employed observational designs and used the Edinburgh Postnatal Depression Scale as the primary outcome. Passive DP data related to sleep and circadian rhythms were frequently associated with depressive symptoms, whereas findings for physical activity were inconsistent. Active DP data, including language features from text entries, mood logs, semi-random ecological momentary assessments, and social media behavior, were often reported as informative, particularly when combined with personal history or self-reported measures. However, considerable variation across study designs, data sources, analytical approaches, and validation strategies limits direct comparison of findings and prevents causal interpretation. Overall, the evidence remains largely exploratory, and findings should be interpreted cautiously pending more rigorous validation.

Change in cohabitation status could influence the economic security and well-being of parents and their children. However, literature concerning the association between the duration of perinatal depression (PND) exposure and change in parental cohabitation status is limited. Therefore, this study aimed to assess whether the presence and persistence of maternal PND symptoms are associated with changes in parental cohabitation status up to six years postpartum. Using data from 4,344 persons in the Swedish BASIC and U-BIRTH cohort studies, maternal depressive symptoms were assessed at three time points (during pregnancy, 6 weeks, and 6 months postpartum) using the Edinburgh Postnatal Depression Scale. Cohabitation status was measured at 6 weeks and 6 years postpartum. Logistic regressions estimated odds ratios (ORs) for non-cohabitation associated with the number of PND-positive time points. Mothers with positive screenings at more than one time point for depressive symptoms had higher odds of not cohabiting at both 6 weeks and 6 years postpartum. At 6 years, mothers with depressive symptoms at all three time points had over four times the odds of not cohabiting (OR 4.1, 95% CI 1.7-9.5). However, most associations lost significance after full adjustment for sociodemographic and psychosocial factors, except the association between prolonged PND (3 positive screenings) and non-cohabitation at six years postpartum. Prolonged PND symptoms may increase the risk of long-term parental separation. Although confounding factors reduce the strength of this association, findings underscore the need for extended mental health monitoring and support for perinatal persons.

Background:

Evidence of the relationship between breastfeeding and maternal mental health is mixed and complex, with some studies suggesting breastfeeding may lower the risk for postpartum depressive symptoms, while others report no clear or consistent effects. Given these inconsistencies, we aim to assess the association between the timing of initiation of breastfeeding and postpartum depressive symptoms 90 days after birth in Nepal.

Methodology:

This longitudinal multi-centric cohort study included 898 mother-infant pairs in 9 district hospitals of Nepal. Data was collected on timing of initiation of breastfeeding, sociodemographic variables and depressive symptoms assessed through the Edinburg Postnatal Depression Scale. A Directed Acyclic Graph was constructed and multiple logistic regression, generalized mixed linear regression model and Generalized Estimating Equations (GEE) were used to assess the association of timing of breastfeeding with postpartum depressive symptoms.

Principal results:

At the 90th day postpartum, 31.4% of women reported depressive symptoms. Compared to women who had immediate breastfeeding, those who had no immediate breastfeeding had 3.47 higher odds of depressive symptoms (cOR: 3.47; 95% CI; 2.40, 5.01). After adjusting for confounding and mediating factors, the odds of depressive symptoms were 2.81 times higher among women who did not immediately breastfeed (aOR, 2.81; 95% CI; 1.76, 4.50). Using GEE modeling, there was a positive association between delayed breastfeeding and postpartum depression at 7 days (β coefficient, 0.583, p = 0.001) and at 45 days (β coefficient, 0.551, p = 0.003). Using the generalized linear mixed model, the prediction to postpartum depression score increased with delay in breastfeeding.

Conclusions:

This study highlights that the delayed initiation of breastfeeding is associated with higher odds of symptoms for postpartum depression among various groups of women, especially among women from disadvantageous groups and women with no education in Nepal. Improving support to women for early initiation of breastfeeding could help reduce postpartum depression.

Background: Parental prenatal mood and anxiety disorders (PMADs) are linked to child neurodevelopmental disorders (NDDs), but evaluations of the magnitude and mechanisms of this association are limited. This study estimates the strength of the association and whether it is impacted by genetic and environmental factors.

Methods: A systematic search of PubMed, CENTRAL, PsycINFO, OVID, and Google Scholar was performed for articles published from January 1988 to September 2025. Of 2,420 articles screened, 74 met the inclusion criteria. Meta-analyses were conducted on 21 studies, and 53 were included in the narrative synthesis. We conducted random-effects meta-analyses, along with tests for heterogeneity (I²) and publication bias (Egger's test). The review followed PRISMA and MOOSE guidelines.

Results: Maternal PMADs were associated with a significantly increased risk of attention-deficit/hyperactivity disorder (ADHD; odds ratio [OR] 1.91, 95% confidence interval [CI] 1.45-2.52) and autism spectrum disorder (ASD; OR 1.75, 95% CI 1.43-2.14) in children. Paternal PMADs were also associated with the risk of NDDs, with combined odds for ASD and ADHD (OR = 1.23, 95% CI 1.14-1.33). Several studies suggested that the link between parental PMADs and offspring NDDs might be impacted by both genetic and environmental factors, including the impact of ongoing parental depression on child behavior.

Conclusions: Parental PMADs are associated with increased risk of NDDs in children. These findings likely reflect a combination of inherited liability and environmental processes; clarifying mechanisms will require genetically informed designs. Regardless of mechanism, offering optional, family-centered developmental support may help promote child well-being in families where a parent is experiencing PMADs.

Background

Peripartum depression (PPD) is one of the most common pregnancy complications; nevertheless, it often goes underdiagnosed. Pinpointing important correlates is crucial for early risk identification and pathophysiology understanding. We aimed to investigate the association between self-reported mood swings during oral contraceptive (OC) use and peripartum depressive symptoms (PPDS).

Methods

We used data from the Swedish longitudinal cohort study Mom2B. 3829 women who had reported previous usage of OCs were included. Self-reported mood swings during OC use were assessed through a single question, and PPDS were evaluated using established cut-offs of the Edinburgh Postnatal Depression Scale (EPDS).

Results

Self-reported mood swings during OC use were associated with PPDS at gestational weeks 12-22 (OR = 1.30, 95% CI, 1.01-1.66), 24-34 (OR = 1.37, 95% CI, 1.10-1.71) and 36-42 (OR = 1.39, 95% CI, 1.05-1.82) as well as at postpartum weeks 6-13 (OR = 1.46, 95% CI, 1.12-1.92) and 24-35 (OR = 2.07, 95% CI, 1.43-2.99). Interestingly, self-reported mood swings during OC use were associated with higher odds for newly developed PPDS in early postpartum (OR for weeks 6-13 = 1.92, 95% CI: 1.19-3.08).

Conclusions

Women with self-reported mood swings during OC use have higher risk of experiencing depressive symptoms across the peripartum period and twice the risk of newly developed PPDS during the early postpartum, adding to current evidence of a hormonal sensitive subgroup of women and the opportunity to use this simple question in future predictive efforts.

Purpose: The COVID-19 pandemic posed substantial challenges to cancer care, raising concerns about the safety of ongoing endocrine therapy in women with breast cancer. However, real-world evidence on the association between endocrine therapy and COVID-19 outcomes in population-based cohorts remains limited.

Methods: A nationwide, register-based matched cohort study was conducted in Sweden, including women aged ≥55 years who received endocrine therapy for breast cancer during 2020. A total of 31,678 women were included: 8,879 treated with tamoxifen, 21,384 with aromatase inhibitors, and 1,415 with sequential therapy. Exposed women were matched 1:1 by age and region to population controls without breast cancer or estrogen-modulating therapy. Stage-stratified analyses were performed for early-stage and locally advanced breast cancer. Outcomes included COVID-19-related mortality (primary outcome), all-cause mortality, intensive care unit admission, COVID-19-related hospitalization, and laboratory-confirmed SARS-CoV-2 infection.

Results: COVID-19-related mortality did not differ between women receiving endocrine therapy and their matched population controls. Intensive care unit admission risk were comparable across groups.Tamoxifen was associated with lower all-cause mortality in early-stage breast cancer, whereas aromatase inhibitors were linked to higher all-cause mortality and increased COVID-19-related hospitalization in locally advanced disease. A modestly increased risk of SARS-CoV-2 infection was observed among tamoxifen users.

Conclusion: In this nationwide Swedish cohort, adjuvant endocrine therapy was not associated with increased COVID-19-specific mortality. These findings support the continued use of adjuvant endocrine therapy in women with breast cancer without added COVID-19 mortality risk and highlight stage-specific differences in outcomes, reinforcing the safety of endocrine therapy during pandemic conditions.

Objective: To assess the association between postpartum depression (PPD) and miscarriage history and the role of moderators.

Methods: We identified observational studies of PPD rates in women with vs. without miscarriage history in Embase and Medline in July 2023 and updated in October 2024. Study quality was evaluated using the Newcastle-Ottawa Scale. The primary outcome was the odds ratio (OR, 95 % confidence intervals [95 %CI]) of PPD in women with vs. without miscarriage history. Meta-regression analyses included the effects of age, marital status, history of depression/anxiety and parity; subgroup analyses were based on PPD assessment methods and timepoint, cohorts from low-/middle-vs. high-income countries and cohorts with single vs. multiple miscarriages. We performed sensitivity analyses excluding poor-quality, cross-sectional studies and sequentially each study. Results: Seventeen and two studies were rated as poor- and fair-quality, respectively. In 19 studies (n = 111,772), women with miscarriage history were at higher PPD risk compared to women without miscarriage (OR = 1.62, 95 % CI = 1.26 to 2.07, p < 0.001), with substantial heterogeneity (I2 = 99.8 %). We detected some asymmetry in the funnel plot. The Egger's test was positive (p = 0.04). The OR using the trim-and-fill method was 0.98 (95 % CI = 0.70 to 1.37, p = 0.91). Higher miscarriage-related PPD ORs were estimated in low-/middle-vs. high-income countries (OR = 2.09, 95 %CI = 1.47 to 2.95, k = 10, n = 5,665, vs. 1.23, 95 %CI = 0.96 to 1.58, k = 9, n = 106,107, p = 0.02). After excluding low-quality studies the PPD OR dropped (1.15, 95 %CI = 0.50 to 2.64, k = 2, n = 2,911, p = 0.75).

Conclusions: Women with miscarriage history had higher PPD risk, although small study effects and low study quality may have led to an overestimation.

INTRODUCTION: Labour epidural analgesia is the most effective method for intrapartum pain relief and is associated with improved maternal outcomes. However, concerns have been raised regarding potential associations between labour epidural analgesia and adverse psycho-emotional outcomes in children. Evidence from large epidemiological studies is inconsistent and potential biological mechanisms remain unclear. Maternal immune activation during pregnancy may play a role. We aimed to investigate behavioural and psycho-emotional outcomes in children of mothers who received epidural analgesia during labour, accounting for perinatal mental health, sociodemographic characteristics and cytokine profiles.

METHODS: Singleton vaginal births from the Biology, Affect, Stress, Imaging and Cognition study were included. Child behavioural outcomes were assessed by Child Behavioural Checklist scores at 18 months, 6 years and 11 years postpartum in the U-BIRTH follow-up cohort, with higher scores indicating more behavioural difficulties. The main exposure was maternal use of labour epidural analgesia. Maternal data were collected from questionnaires and medical records.

RESULTS: Among 1962 mother-child dyads, 726 (37%) received labour epidural analgesia. Younger maternal age; lower resilience; inflammatory diseases; primiparity; antenatal depression; fear of childbirth; and longer duration of labour were associated with higher Child Behavioural Checklist scores at 18 months postpartum. In crude analysis, labour epidural analgesia correlated with higher Child Behavioural Checklist scores at 18 months postpartum; however, this association was not significant after adjusting for confounders. Among those with lower expression of TNFSF14 and CXCL6 cytokines, labour epidural analgesia use was associated with higher Child Behavioural Checklist scores.

DISCUSSION: Use of epidural analgesia during labour was not found to be independently associated with adverse child behavioural outcomes. Variations in maternal cytokine profiles among those choosing labour epidural analgesia or not may influence susceptibility to early behavioural differences. Replication in larger cohorts and further exploration of additional immune biomarker dynamics during pregnancy are warranted.

If left untreated, peripartum depression (PPD) can significantly disrupt mother-infant interactions and is associated with long-term negative consequences for child development. The aim of this article was to systematically review studies examining the underlying neural and physiological markers associated with socioemotional and cognitive development in infants and children exposed to maternal PPD. A literature search was conducted in PubMed, MEDLINE, PsycINFO, Web of Science, Scopus, Embase, and Cochrane databases, covering studies from their inception until July 2024. Six studies were included in this review. Two studies assessed PPD symptoms during pregnancy, two during the postpartum period, and two during both pregnancy and the postpartum period. The findings suggest that the developmental outcomes of the offspring of depressed mothers during the perinatal period may be underpinned by specific correlates of brain activity and psychophysiological functioning-specifically, greater right frontal EEG asymmetry, heightened activation of the amygdala and other paralimbic structures, lower vagal tone, and increased N2 latencies. This review highlights the need for further research in this area.

IMPORTANCE: Paternal psychiatric disorders during the perinatal period can affect the health of the entire family; however, these conditions have often been underrecognized, and little is known about their incidence and timing of onset.

OBJECTIVE: To investigate incidence patterns of new-onset diagnosed psychiatric disorders among men in Sweden before, during, and after a partner's pregnancy.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used linked national register data for all fathers of children born in Sweden between January 1, 2003, and December 31, 2021, with follow-up from 1 year before to 1 year after pregnancy. Data were analyzed from October 1, 2024, to March 31, 2025.

EXPOSURES: The time during pregnancy and 1 year after childbirth (post partum) were considered the risk periods, while 1 year before pregnancy (before conception) was used as the reference period.

MAIN OUTCOMES AND MEASURES: Annual and weekly incidence rates (IRs) of clinical diagnoses of any psychiatric disorder and 9 type-specific disorders were calculated and standardized by age and calendar year. Adjusted Poisson regression analysis was used to further estimate incidence rate ratios (IRRs) of psychiatric disorders during and after pregnancy compared with before conception.

RESULTS: This study included 1 915 722 births from 1 096 198 fathers (mean [SD] age at childbirth, 33.8 [6.2] years) in Sweden. IRs of any diagnosed psychiatric disorder were lower during pregnancy (eg, pregnancy week 1: IR, 5.50 [95% CI, 4.69-6.31] per 1000 person-years) and the early postpartum period (eg, postpartum week 1: IR, 5.19 [95% CI, 4.41-5.97] per 1000 person-years) than in the corresponding preconception weeks (eg, preconception week 1: IR, 7.00 [95% CI, 5.97-8.04] per 1000 person-years); they returned to comparable rates later post partum. This pattern was also observed for IRRs of anxiety, alcohol use, and drug use (ie, the use of nonalcohol, nontobacco psychoactive drugs) disorders. IRRs of depression (eg, postpartum weeks 45-49: IRR, 1.30 [95% CI, 1.12-1.52]) and stress-related disorders (eg, postpartum weeks 45-49: IRR, 1.36 [95% CI, 1.15-1.61]), however, showed a notable 30% increase toward the end of the first postpartum year. In contrast, IRRs of diagnosis of tobacco use disorder, attention-deficit/hyperactivity disorder, bipolar disorder, or psychosis remained relatively stable before, during, and after pregnancy.

CONCLUSIONS AND RELEVANCE: In this nationwide cohort study, fathers in Sweden were less likely to be diagnosed with a psychiatric disorder during a partner's pregnancy and early post partum than before conception, but IRs returned to comparable levels thereafter. These incidence patterns may reflect transient protection and delayed detection during the transition to fatherhood and support the need for paternal mental health surveillance, particularly for increased depression and stress-related disorders in the late postpartum period.