Amanda M. Koire

BACKGROUND Postpartum anxiety (PPA) is a common condition that can have significant negative implications for the wellbeing of mothers and babies. Compared to postpartum depression (PPD), PPA has been understudied and is much less frequently screened for. Moreover, there is a deficit of trained therapists and perinatal mental health care which limits the available treatment for PPA. Mobile app delivery of therapeutic interventions has shown high potential for treating mood and anxiety disorders; however the digital interventions for perinatal mental health are often low in quality and focused on PPD. OBJECTIVE This pilot study assessed the feasibility and acceptability of momLamp, a mobile app-based intervention for PPA. METHODS Over 8 weeks, 10 postpartum women with a score of ≥ 26 on the Perinatal Anxiety Screening Scale (PASS) were prompted to complete a daily module incorporating evidence-based CBT and ACT-driven psychoeducation, tools, and skill building. Participants completed the Edinburgh Postnatal Depression Scale (EPDS) at the beginning and end of the study and the PASS weekly. Feasibility was measured by analyzing participants’ app engagement while acceptability was determined via descriptive analysis of participants’ responses to an end-of-study survey. Exploratory analyses of anxiety and depression scores were conducted using paired sample t-tests. RESULTS On average, participants completed 44.9 out of 56 possible modules (SD = 11.79) with at least 6 out of 10 participants completing 5 or more of their assigned modules in any given week. 9 out of 10 participants described the app as either “very helpful” or “somewhat helpful” and 10 out of 10 participants reported that using the app felt more positive than negative. All participants agreed that learning about PPA made them feel better about their own anxiety and would recommend the app as is or with minor tweaks. The average baseline PASS score was 52.2 (SD = 19.1, range 32-93), and the average post-intervention PASS score was 32.3 (SD = 13.70, range 16-55). This represents a decrease in the severity of anxiety from severe to mild or moderate. After removing outliers, the mean difference between pre- and post-intervention PASS scores was –17.75 (dz = -1.98, p = 0.002). The mean difference between pre- and post-intervention EPDS scores did not significantly decrease (dz = -0.63, p = 0.12). CONCLUSIONS This pilot study found that the participants were highly engaged with the app, found it helpful, and would recommend it. Anxiety scores decreased over the course of this single-arm pilot. These preliminary results indicate that momLamp could serve as a useful additional intervention for PPA. Future research should focus on a larger study with a control group to confirm and quantify the efficacy of the intervention. CLINICALTRIAL N/A

Figure S3 shows MYC-induced apoptosis and cell death in early and late timepoints, ectopic expression of BCL2 and its impact on MYC-induced RNA decay, gene expression changes upon DIS3L knockdown in MYC-hyperactivated conditions, and expression of exosome components upon MYC-induction.

Figure S4 shows DIS3L mutation in human tumors, evolutionary action score of tumor-derived mutation in DIS3L, genomic alteration of MYC and DIS3L in human breast cancer, expression of DIS3L mRNA in human breast tumors, and expression of genes in ribonucleotide catabolism and synthesis upon DIS3L knockdown.

Table S1 is the list of candidate facilitator genes of MYC-induced cell death. Table lists the candidate facilitators of MYC-induced cell death discovered through the MYC-specific loss of function genetic screen.

Table S4 shows predictions of hypothetical purine nucleotide flux.

Figure S1 shows PCA of human breast tumors, hallmark MYC signature score for human breast tumors, expression of MYC-target NECTIN4, schematic for purine ribonucleotide catabolism, concentrations of nucleotides in physiological conditions, prediction of hypothetical purine nucleotide flux, MYC-induced cell death in MYC-ER HMECs, and candidate facilitators of MYC-induced cell death.

Figure S5 shows expression of MCL1 upon DIS3L knockdown, effect of XDH inhibition on MYC-induced cell death, effect of xanthosine on TNBC apoptosis, ROS and MYC-induced cell death, MYC-induced cell death upon HPRT1 knockdown, and expression of HPRT1 upon knockdown, and effect of DIS3L knockdown on TNBC xenografts.

Figure S2 shows MYC-induced cell death in MYC-ER HMECs with DIS3L, EXOSC2, EXOSC8 and DIS3 knockdown, expression of DIS3L, EXOSC2, EXOSC8 and DIS3 upon knockdown, and MYC-induced EU incorporation in MYC-hyperactivated conditions.

Figure S6 shows 6-mercaptopurine dose curve in various cell lines, effect of 6-mercaptopurine on purine catabolite abundance in TNBC cells, effect of XDH knockdown on 6-mercaptopurine induced cell death, and 6-mercaptopurine- induced effect on cell viability upon purine nucleotide supplementation.