Cindy-Lee Dennis

Importance: Maternal attention-deficit disorder with or without hyperactivity (ADHD) is an established risk factor for adverse perinatal outcomes that remains understudied to breastfeeding. Objective: To estimate the effect of maternal ADHD on 6-month exclusive breastfeeding. Design: A prospective longitudinal community-based cohort study. Setting: Canada, 2014-2020. Participants: We included 3217 English-literate mother-father dyads with internet or telephone access, comprising women with singleton birth within 3 weeks postpartum (study baseline) and were cohabiting with the biological father. Women with major psychiatric conditions or suicidality were excluded. All participants provided informed consent at recruitment. Data were collected online through self-report questionnaires. Exposure: Maternal ADHD was measured at baseline using the Adult ADHD Self-Report Scale (sum of scores ≥14). Main Outcomes and Measures: We defined 6-month exclusive breastfeeding based on maternal reported infant feeding, assessed at 3 and 6 months. Maternal childhood adversity (Adverse Childhood Experiences International Questionnaire, ACE-IQ; sum score) was included as a confounder. The average treatment effect on the treated (ATT) was estimated using linear probability models. We calculated 95% percentile bootstrap CI. Missing data were handled using multiple imputation by chained equations with 10 iterations. Results: Complete-case analyses included 2071/3217 mother-father dyads, most of which were Canadian-born (79%). Childhood adversity, mental health conditions, and substance use were higher among mothers who screened positive for ADHD (4%) than among those who did not: the median number of ACE was 5 IQR 4-6; 38% self-reported prenatal depression, 13% smoked cigarettes and 19% drank alcohol during pregnancy; 11% of infants used the neonatal intensive care unit. Notably, though 90% of mothers with ADHD intended to breastfeed exclusively only 28% breastfed exclusively for 6 months. Among families with maternal ADHD, the effect of maternal ADHD on 6-month exclusive breastfeeding was ATT −0.105, 95% CI −0.209 to −0.003 in the model adjusted for maternal ACE and paternal ADHD. With multiple imputation: ATT −0.109, 95% CI −0.213 to −0.004. Conclusions and Relevance: Mothers with ADHD intend to breastfeed their infants exclusively, but additional challenges shorten the duration of exclusive breastfeeding, indicating a need for interventions tailored to neurodevelopmental differences. KEY POINTS: Question: Does maternal ADHD influence exclusive breastfeeding duration? Findings: In this community-based cohort study of 3217 mother-father dyads in Canada, most mothers with ADHD intended to breastfeed exclusively, but few actually maintained it for 6 months. Maternal ADHD predicted lower probability of exclusive breastfeeding until 6 months among families with maternal ADHD. Meaning: To equitably promote maternal and infant well-being, early detection and support for breastfeeding challenges are needed for mothers with ADHD.

Introduction: Bipolar disorder (BD) is a chronic mental health condition characterized by extreme mood swings, which significantly affects both the individual and their family system. Given the psychosocial impact of BD on families, family interventions (FI) have emerged as a promising approach to improve treatment outcomes. This review explores the effectiveness of FI in managing BD, focusing on various intervention types, their outcomes, and clinical implications. Methods: This review followed PRISMA guidelines and registered with PROSPERO (registration number: CRD42023410879). We included studies involving adults diagnosed with BD and their family members, focusing on family‐based interventions. Studies were identified through systematic searches in five bibliographic databases and managed using Covidence 2.0. Data extraction and synthesis included primary and secondary outcomes related to clinical, behavioral, and lifestyle measures. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool for quasi‐experimental studies. Results: Family‐focused interventions were found to reduce relapse rates, enhance medication adherence, and improve family communication. Psychoeducational interventions also demonstrated a significant reduction in symptom severity and hospitalization rates. However, findings regarding the long‐term sustainability of these outcomes were mixed, and some interventions showed limited generalizability across diverse family structures and cultural contexts. Conclusion: FIs are critical in treating BD by improving both clinical and relational outcomes. However, the heterogeneity of family structures and cultural factors calls for more tailored approaches to ensure long‐term efficacy. Future research should focus on developing culturally sensitive interventions and exploring the mechanisms by which family dynamics influence treatment adherence and recovery in BD.

Background: Postpartum depressive symptoms can vary substantially and probably reflect distinct subtypes. Understanding specific symptom patterns may help identify those at risk for later psychiatric care. Aims: We aimed to identify subtypes of postpartum depressive symptoms and examine their associations with subsequent psychiatric care. Method: We conducted a cohort study using Danish nationwide health registers linked to population-based Edinburgh Postnatal Depression Scale (EPDS) scores from 2015 to 2021. Latent class analysis of EPDS responses identified subtypes among women with clinically relevant symptoms (EPDS ≥11), using a maternal background population as a reference group (EPDS <11). The outcome was psychiatric hospital contacts or redeemed psychotropic prescriptions within 1 year postpartum. We estimated standardised cumulative incidence rates and risk ratios using spline-based, time-to-event models. Results: Among 162 079 women, 11 847 (7.3%) had clinically relevant symptoms (EPDS ≥11). Five subtypes were identified: Mild-depressive (23%), Moderate-anxious (17%), Moderate-depressive (18%), Moderate-overwhelmed (31%) and Severe-depressive (11%). At 1 year, the standardised cumulative incidence of psychiatric care was 69.6 (95% CI, 61.4–79.0) per 1000 persons in the Mild-depressive subtype. Compared with this group, the adjusted risk ratio was 0.33 (95% CI, 0.28–0.38) in the background maternal population, between 1.11 (95% CI, 0.93–1.32) and 1.25 (95% CI, 1.06–1.48) across moderate subtypes and 2.37 (95% CI, 1.99–2.82) for the Severe-depressive subtype. Conclusions: Distinct subtypes of postpartum depressive symptoms were associated with varying risks of subsequent psychiatric care, depending on both symptom severity and symptom type. These findings underscore the importance of systematic screening and tailored follow-up, even for women with mild to moderate symptoms.

Purpose: There is some evidence that children exposed to the COVID-19 pandemic experienced more neurodevelopmental difficulties than children before the pandemic, as well as evidence that women with young children experienced more mental health challenges during this period compared to pre-pandemic. However, it is unclear whether increased maternal mental health challenges acted as a mechanism linking pandemic exposure to children’s neurodevelopment difficulties. Methods: As part of the Ontario Birth Study, women ( N = 862) reported their internalizing (i.e., depression and anxiety) symptoms using the Patient Health Questionnaire-4 (PHQ-4) at three timepoints (prenatally and 8 and 24 months postnatally). Child neurodevelopment was assessed at 24 months using the Ages and Stages Questionnaire-3 (ASQ-3). Analyses included a combination of regression and path analyses with adjustment for covariates. Results: Women exposed to the pandemic prenatally and at 8 and 24 months postnatally reported more concurrent internalizing difficulties than those not exposed; however, women exposed both pre- and postnatally did not differ from those only exposed postnatally. Higher prenatal maternal internalizing symptoms were associated with lower child gross motor skills at 24 months. Higher maternal internalizing symptoms at 8 and 24 months were marginally ( p < 0.1) associated with lower child personal-social and gross motor skills, respectively, at 24 months. The association between prenatal pandemic exposure and lower gross motor skills was marginally mediated by the presence of prenatal maternal internalizing symptoms. Conclusion: Mothers and young children may have been particularly vulnerable to pandemic stress. Maternal internalizing symptoms, especially during pregnancy, may serve as a pathway linking pandemic exposure with child neurodevelopment and may represent a malleable target for intervention.

Birth weight is an important determinant of infant growth and development associated with neonatal morbidity (e.g., respiratory distress, hypoglycemia) and mortality, as well as long-term health risks such as developmental delays and chronic conditions (e.g., asthma, type 2 diabetes) in later life. These adverse health outcomes are particularly concerning when infants are born small or large for their gestational age. A potential strategy to improve optimal birth weight is preconception care, with consistent evidence demonstrating a relationship between maternal preconception health and infant birth weight. However, little attention has been given to the influence of paternal preconception health on pregnancy outcomes. This scoping review aimed to capture the existing literature and highlight evidence gaps regarding associations between paternal preconception health and infant birth weight. We followed the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. The review considered studies that included men in the preconception period who identified as the parent of a child for whom infant birth weight outcomes were reported. Medline, PsycINFO, Embase, Scopus and CINAHL databases were searched to June 30, 2024. Two independent reviewers screened the titles/abstracts and full-text articles. Data extraction was performed independently by two researchers using a standardized form in Covidence. The data were synthesized narratively according to the paternal preconception health factors identified within the included studies (e.g., physical well-being, health behaviors, substance use, environmental exposures, mental health, and treatment effects). From 7,690 citations, 57 published studies were included in the review. Most studies were conducted in China (n = 18, 31.6%) or the United States (US) (n = 17, 29.8%) and used a cohort design (n = 54, 94.7%). Our review identified growing evidence that specific paternal preconception factors, such as physical well-being (e.g., BMI, physical health), certain medications (e.g., recreational drugs, sulfonylureas, diazepam), and environmental chemical exposure, may adversely influence infant birth weight. There are mixed findings related to other paternal health factors, including some health behaviors (e.g., nutrition, sleep, physical activity), substance use, and mental health. Consideration should be given to expanding preconception counseling and public health initiatives to include fathers, to improve paternal health and potentially reduce risks to offspring (e.g., birth weight). We also identified key areas where further research is required to advance knowledge in this field.

Depression and anxiety affect about one in five women during pregnancy or after birth, yet many are never identified early enough to receive support. Because some women may hesitate to report symptoms directly, clinicians are encouraged to assess overall well‑being instead of mental health symptoms only. We examined whether a well‑being screening tool—the WHO‑5—can reliably identify women with probable postpartum depression or anxiety compared with two validated symptom‑based tools: the Edinburgh Postnatal Depression Scale (EPDS) and the Generalized Anxiety Disorder Scale (GAD‑7). We used data from a trial of 510 women in Quebec who reported significant depressive symptoms during pregnancy. At three months postpartum, 16% screened positive for depression on the EPDS and 22% for anxiety on the GAD‑7. We compared WHO‑5 scores with each tool and estimated how often the WHO‑5 incorrectly classified women as having probable depression or anxiety. False‑positive rates were high: 64–70% for depression and 63–69% for anxiety. Thus, the WHO‑5 does not reliably identify postpartum depression or anxiety and might substantially overrate women as needing follow‑up assessment. Symptom‑based perinatal‑validated toolssuch as the EPDS and GAD‑7 remain more accurate for early detection in postpartum care.(Comprehensive lay and technical summaries are available in the full‑text)

Temporal alterations in the host lipidome and gut microbiome, and their dynamic interactions, in the progression of antenatal depression remain poorly understood. Here, we characterized the maternal lipidome and gut microbiome in 1086 Chinese pregnant women from the Tongji-Huaxi-Shuangliu Birth Cohort using 2954 serum and 2812 fecal samples collected longitudinally across early, mid, and late pregnancy. Our analyses identified 95 host lipids, and seven gut microbial genera associated with antenatal depression. Period-specific and longitudinal analyses indicated that lysophosphatidylethanolamines (LPEs) exhibited concordant associations with antenatal depression. In addition, temporal analyses suggested that decreases in the abundances of gut microbial genera [Ruminococcus]_gnavus_group and Enterococcus preceded the onset of antenatal depression and demonstrated extensive associations with LPEs and acylcarnitines (CARs). Integrative analyses revealed bidirectional concurrent and temporal crosstalk between microbiota-lipid axis and antenatal depression, with LPEs and medium- and long-chain CARs constituting key molecules of this axis. Collectively, this study offers valuable insights into the interplay between host lipidome and gut microbiome in the development of antenatal depression, laying a foundation for future investigations into the microbiota-lipid axis during pregnancy.

While paternal environmental exposures and lifestyle factors can influence sperm epigenetic states and affect fetal development, this area of research remains relatively underexplored. This comprehensive scoping review aimed to identify, compile, and analyze the literature on paternal preconception health and its impact on fetal development, specifically related to congenital birth defects (CBDs) and head circumference. We conducted a scoping review following the Joanna Briggs Institute methodology and a published protocol. Five databases were searched for articles that included men in the preconception period and outcomes for CBDs and head circumference. Studies were published in English up to July 16, 2025. Two independent reviewers screened titles and abstracts and extracted data from eligible studies using Covidence. Forty-eight studies were included in the review. We identified several paternal factors associated with CBDs, including paternal physical health (metabolic syndrome, viral infections, cancer), smoking and alcohol use, and environmental exposures (solvents, metals, pesticides). Most medications were not associated with increased risks; however, metformin and diazepam were identified as potential risk factors for increased CBD risk. The limited studies on head circumference also suggest a potential relationship; however, the findings are not widely applicable due to the small number of included studies. We also identified important knowledge gaps and methodological limitations that require further research to advance this field. Our findings indicate that paternal preconception health and exposures—particularly paternal health, substance use, environmental factors, and certain medications—significantly influence offspring health outcomes, including congenital defects and infant head circumference. These findings highlight the need to expand preconception counselling and preventive strategies to explicitly include fathers, with targeted efforts to improve paternal health, eliminate tobacco and alcohol use, and reduce occupational and environmental exposures. Incorporating paternal health into preconception frameworks is essential to understanding mechanistic pathways, decreasing congenital risks, and developing precision strategies for improving reproductive and neonatal outcomes.