Mass General Hospital

Harvard Medical School

Psychiatric Disorders During Pregnancy

General:

Nonacs R, Cohen LS. Depression during pregnancy: diagnosis and treatment options. J Clin Psychiatry. 2002;63 Suppl 7:24-30.

Koren G, Goh Y, Klieger C. Folic Acid. Motherisk Update November 2008.

Drugs, Pregnancy and Lactation: Reprinted with permission from Ob. Gyn. News

© International Medical News Group, an Elsevier company

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Course of Depression During Pregnancy:

Altshuler L, Cohen L, Moline M, et al: Expert consensus guideline series: Treatment of depression in women. Postgrad Med Special Report:1-116, 2001.

Altshuler LL, Hendrick V, Cohen LS. Course of mood and anxiety disorders during pregnancy and the postpartum period. J Clin Psychiatry 1998; 59[suppl 2]: 29-33.

Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC, Suri R, Burt VK, Hendrick V, Reminick AM, Loughead A, Vitonis AF, Stowe ZN. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA 295(5):499-507, 2006.

Evans J, Heron J, Francomb H, et al: Cohort study of depressed mood during pregnancy and after childbirth. Br Med J 323(7307):257-260, 2001.

O’Hara MW: Social support, life events, and depression during pregnancy and the pueperium. Arch Gen Psychiatry 43:569-573, 1986.

Effects of Untreated Maternal Depression and Pregnancy:

Altshuler LL, Cohen LS, Moline ML, Kahn DA, Carpenter D, Docherty JP. The Expert Consensus Panel for Depression in Women. The Expert Consensus Guideline Series. Treatment of depression in women. Postgraduate Medicine 2001 March;(Spec No):1-107.

Bonari L, Pinto N, Ahn E, Einarson A, Steiner M, Koren G. Perinatal Risks of Untreated Depression during Pregnancy. Can J Psychiatry, Vol 49, No 11, November 2004.

Chung TK, et al. Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosomatic Medicine 2001.

Dayan J, et al. Prenatal depression, prenatal anxiety, and spontaneous preterm birth: A prospective cohort study among women with early and regular care. Psychosomatic Medicine 2006.

Hoffman H, Hatch M. Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women. Health Psychology 2000.

Kurki T, et al. Depression and anxiety in early pregnancy and risk for preeclampsia. Obstetrics and Gynecology 2000.

Orr ST. Maternal prenatal depressive symptoms and spontaneous preterm births among African-American women in Baltimore, Maryland. Am J Epidemiol 2002.

Rondo PHC, et al. Maternal psychological stress and distress as predictors of low birth weight, prematurity, and intrauterine growth retardation. Eur J Clin Nutrition 2003.

Nonpharmacologic Intervention During Pregnancy

Oren DA, Wisner KL, Spinelli M, Epperson CN, Peindl KS, Terman JS, Terman M. An open trial of morning light therapy for treatment of antepartum depression. Am J Psychiatry 2002 Apr;159(4):666-9.

Editor’s Comments on above article

Spinelli MG, Endicott J. Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. Am J Psychiatry 2003 Mar;160(3):555-62.

Spinelli MG. Interpersonal psychotherapy for depressed antepartum women: a pilot study. Am J Psychiatry. 1997 Jul;154(7):1028-30.

Leiknes, K. A., Cooke, M. J., Jarosch-von Schweder, L., Harboe, I., & Høie, B. (2013). Electroconvulsive therapy during pregnancy: a systematic review of case studiesArchives of women’s mental health, 1-39.

Antidepressant Use During Pregnancy

General

Einarson TR, Einarson A: Newer antidepressants in pregnancy and rates of major malformations: A meta-analysis of prospective comparative studies. Pharmacoepidemiol Drug Saf 14(12):823-827, 2005.

Hallberg P, Sjoblom V. The use of selective serotonin reuptake inhibitors during pregnancy and breastfeeding: a review and clinical aspects. Journal of Clinical Psychopharmacology 2005; 25 (1): 59-73.

Lamberg L. Risks and Benefits Key to Psychotropic Drug Use during Pregnancy and Postpartum Period. JAMA 2005 Oct;294(13):1604-8.

Drugs, Pregnancy and Lactation: Antidepressants in Pregnancy
By Elizabeth Mechcatie, Senior Writer Ob. Gyn. News. Reprinted with Permission from Ob. Gyn. News (www.eobgynnews.com) (May 1, 2000, Internation al Medical News Group, a division of W. B. Saunders Co.)

Yaris F, Kadioglu M, Kesim M, Ulku C, Yaris E, Kalyoncu NI, Unsal M. Newer antidepressants in pregnancy: prospective outcome of a case series. Reproductive Toxicology 2004(19)235–238.

Neonatal Outcome Studies:

Alwan S, Reefhuis J, Rasmussen S, Olney RS, Friedman, JM. Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of defects. N Engl J Med 2007; 356:2684-92.

Boyles S. Taking SSRIs in Pregnancy Affects Infant Restlessness: Rigidity Commonly Seen, but Problems Seem to Fade Quickly. (WebMD comments on above article.)

Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL, Mitchell AA. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med 2006; 354(6):579-87.

Chun-Fai-Chan B, Koren G, Fayez I, et al: Pregnancy outcome of women exposed to bupropion during pregnancy: A prospective comparative study. Am J Obstet Gynecol 192(3):932-936, 2005.

Cohen LS, Heller VL, Bailey JW, Grush L, Ablon JS, Bouffard SM. Birth outcomes following prenatal exposure to fluoxetine. Biol Psychiatry. 2000;48:996-1000. (Fluoxetine (Prozac))

Cole JA, Modell JG, Haight BR, et al: Bupropion in pregnancy and the prevalence of congenital malformations. Pharmacoepidemiol Drug Saf, 2006.

Costei AM, Kozer E, Ho T, Ito S, Koren G. Perinatal outcome following third trimester exposure to paroxetine. Arch Pediatr Adolesc Med. 2003 Jun;157(6):601. (Paroxetine)

Einarson A, Bonari L, Voyer-Lavigne S, Addis A, Matsui D, Johnson Y, Koren G. A multicentre prospective controlled study to determine the safety of trazodone and nefazodone use during pregnancy. Can J Psychiatry. 2003 Mar;48(2):106-10. (Nefazodone (Serzone) and Trazodone (Desyryl))

Editor’s comments on above article

Einarson A, Fatoye B, Sarkar M, Lavigne SV, Brochu J, Chambers C, Mastroiacovo P, Addis A, Matsui D, Schuler L, Einarson TR, Koren G. Pregnancy outcome following gestational exposure to venlafaxine: a multicenter prospective controlled study. Am J Psychiatry 2001 Oct;158(10):1728-30. (Venlafaxine (Effexor))

Ferreira E, Carceller AM, Agogue C, Martin BZ, St-Andre M, Francoeur D, Berard A. Effects of selective serotonin reuptake inhibitors and venlafaxine during pregnancy in term and preterm neonates. Pediatrics. 2007; 119(1): 52-9.

GlaxoSmithKline. New safety information regarding paroxetine: Second large study shows and increased risk of cardiac defects, over other antidepressants, following first trimester exposure to paroxetine. 2005. Available by clicking here. Accessed June 15, 2006.

GlaxoSmithKline. Updated preliminary report on bupropion and other antidepressants, including paroxetine, in pregnancy and the occurrence of cardiovascular and major congenital malformation. 2005. Available at http://www.gsk.com/media/paroxetine/ingenix_study.pdf. Accessed 2007.

Källén B, Otterblad OP: Maternal use of selective serotonin reuptake inhibitors in early pregnancy and infant congenital malformations. Birth Defects Research Part A: Clinical and Molecular Teratology 79:301-308, 2007.

Koren G, Matsui D, Einarson A, Knoppert D, Steiner M. Is maternal use of selective serotonin reuptake inhibitors in the third trimester of pregnancy harmful to neonates? CMAJ 2005 May 24;172(11):1457-1459.

Kulin NA, Pastuszak A, Sage SR, Schick-Boschetto B, Spivey G, Feldkamp M, Ormond K, Matsui D, Stein-Schechman AK, Cook L, Brochu J, Rieder M, Koren G. Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA 1998 Feb 25;279(8):609-10. (Fluvoxamine, Paroxetine, Sertraline)

Laine K, Heikkinen T, Ekblad U, Kero P. Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations. Arch Gen Psychiatry. 2003 Jul;60(7):720-6.

Levinson-Castiel R, Merlob P, Linder N, Sirota L, Klinger G. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med 2006; 160:173-76.

Louik C, Lin AE, Werler MM, et al: First-trimester use of selective serotonin reuptake inhibitors and the risk of birth defects. N Engl J Med 356(26):2675-2683, 2007.

Moses-Kolko EL, Bogen D, Perel J, et al: Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: Literature review and implications for clinical applications. JAMA 293(19):2372-2383, 2005.

Pastuszak A, Schick-Boschetto B, Zuber C, et al: Pregnancy outcome following first-trimester exposure to fluoxetine (prozac). JAMA 269(17):2246-2248, 1993.

Pearson KH, Nonacs RM, Viguera AC, Heller VL, Petrillo LF, Brandes M, Hennen J, Cohen LS. Birth outcomes following prenatal exposure to antidepressants. J Clin Psychiatry. 2007 Aug 68(8): 1284-9.

Suri R, Altshuler L, Hendrick V, et al: The impact of depression and fluoxetine treatment on obstetrical outcome. Arch Women Ment Health 7(3):193-200, 2004.

Wogelius P, Norgaard M, Gislum M, et al: Maternal use of selective serotonin reuptake inhibitors and risk of congenital malformations. Epidemiology 17(6):701-704, 2006.

Zeskind P, Stephens L: Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehavior. Pediatrics 113(2):368-375, 2004.

Neurodevelopmental Outcome of Children Exposed to Antidepressants in Utero:

Casper RC, Fleisher BE, Lee-Ancajas JC, Gilles A, Gaylor E, DeBattista A, Hoyme HE.  Follow-up of children of depressed mothers exposed or not exposed to antidepressant drugs during pregnancy. J Pediatr. 2003 Apr;142(4):402-8.

Misri S, Reebye P, Kendrick K, et al: Internalizing behaviors in 4-year-old children exposed in utero to psychotropic medications. Am J Psychiatry 163(6):1026-1032, 2006.

Nulman I, Rovet J, Stewart D, et al: Neurodevelopment of children exposed in utero to antidepressant drugs. N Engl J Med 336:258-262, 1997.

Nulman I, Rovet J, Stewart DE, et al: Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: A prospective, controlled study. Am J Psychiatry 159(11):1889-1895, 2002.

Bipolar Disorder and Pregnancy

Baethge C, Tondo L, Bratti IM, Bschor T, Bauer M, Viguera AC, Baldessarini RJ. Prophylaxis latency and outcome in bipolar disorders. Canadian Journal of Psychiatry – Revue Canadienne de Psychiatrie. 48(7):449-57, 2003 Aug

Cohen LS, Friedman JM, et al. A reevaluation of risk of in utero exposure to lithium. JAMA 1994; 271: 146-150.

Cunnington M, Tennis P: Lamotrigine and the risk of malformations in pregnancy. Neurology 64(6):955-960, 2005.

Ernst CL, Goldberg JF. The reproductive safety profile of mood stabilizers, atypical antipsychotics, and broad-spectrum psychotropics. J Clin Psychiatry 2002;63 Suppl 4:42-55.

Holmes LB, Baldwin EJ, Smith CR, Habecker E, Glassman L, Wong SL, Wyszynski DF. Increased frequency of isolated cleft palate in infants exposed to lamotrigine during pregnancy. Neurology. 2008 May 27;70(22 Pt 2):2152-8. Epub 2008 Apr 30.

Holmes LB, Wyszynski DF, Baldwin EJ, et al: Increased risk for non-syndromic cleft palate among infants exposed to lamotrigine during pregnancy, in 46th Annual Meeting of the Teratology Society. Tucson, AZ, June 2006.

Shor S, Koren G, Nulman I. Teratogenicity of lamotrigine.  Motherisk Update, June 2007.

Tennis P, Eldridge RR. International Lamotrigine Pregnancy Registry Scientific Advisory Committee. Preliminary results on pregnancy outcomes in women using lamotrigine. Epilepsia 2002 Oct;43(10):1161-7.

Viguera AC, Cohen LS, Bouffard S, Whitfield TH, Baldessarini RJ. Reproductive decisions by women with bipolar disorder after prepregnancy psychiatric consultation. Am J Psychiatry 2002; 159:2102–2104.

Wyszynski D, Nambisan M, Surve T, et al: Increased rate of major malformations in offspring exposed to valproate during pregnancy. Neurology 64(6):291-295, 2005.

Medscape Psychiatry Expert Interview with Dr. Adele Viguera: Women and Bipolar Disorder: Special Considerations

Viguera AC, Cohen LS, Baldessarini RJ, Nonacs R. Managing bipolar disorder during pregnancy: weighing the risks and benefits. Can J Psychiatry 2002 Jun;47(5):426-36.

Drugs, Pregnancy and Lactation: Update on Bipolar Disorder
Reprinted with permission from Ob.Gyn. News (www.eobgynnews.com) (June 1, 2002, International Medical News Group, a division of W.B. Saunders Co.)

Drugs, Pregnancy and Lactation: Antipsychotics in Pregnancy
By Elizabeth Mechcatie, Senior Writer Ob. Gyn. News
Reprinted with Permission from Ob. Gyn. News (www.obgynnews.com) (July 1, 2000, International Medical News Group, a division of W. B. Saunders Co.)

Viguera AC, Nonacs R, Cohen LS, Tondo L, Murray A, Baldessarni RJ. Risk of Recurrence of Bipolar Disorder in Pregnant and Nonpregnant Women After Discontinuing Lithium Maintenance. Am J Psychiatry Feb 2000; 157: 179-184.

Anxiety Disorders and Pregnancy:

Dolovich LR, Antonio A, et al. Benzodiazepine use in pregnancy and major malformations of oral cleft: Meta-analysis of cohort and case-control studies. Br Med J 1998; 317: 839-843.

Cohen LS, Sichel DA, Faraone SV, et al: Course of panic disorder during pregnancy and the puerperium: A preliminary study. Biol Psychiatry 1996; 39: 950-954.

Glover V. O’Connor TG. Effects of antenatal stress and anxiety: Implications for development and psychiatry. British Journal of Psychiatry. 180:389-91, 2002.

Psychotic Disorders and Pregnancy:

Coppola D, Russo LJ, Kwarta RF, et al: Evaluating the postmarketing experience of risperidone use during pregnancy: Pregnancy and neonatal outcomes. Drug Safety 30(3):247-264, 2007.

Gentile, S. Clinical Utilization of Atypical Antipsychotics in Pregnancy and Lactation. Annals of Psychiatry, 2004. 38:1265-1271. antipsychotic administration during late pregnancy: Placental passage and obstetrical outcomes. Am J Psychiatry 2007 Aug; 164(8):1214-20.

McKenna K, Koren G, Tetelbaum M, et al: Pregnancy outcome of women using atypical antipsychotic drugs: A prospective comparative study. J Clin Psychiatry 66(4):444-449, 2005.

Newport DJ, Calamaras MR, DeVane CL, Donovan J, Beach AJ, Winn S, Knight BT, Gibson BB, Viguera AC, Owens MJ, Nemeroff CB, Stowe ZN. Atypical antipsychotic administration during late pregnancy: placental passage and obstetrical outcomes. Am J Psychiatry. 2007 Aug;164(8):1214-20.

Eating Disorders and Pregnancy

Blais MA, et al. Pregnancy: outcome and impact on symptomatology in a cohort of eating-disordered women. Int J Eat Disord 2000; 27:140-9.

Kouba S, et al. Pregnancy and neonatal outcomes in women with eating disorders. Obstet Gynecol 2005; 105:255-260.

Larrson, G, Andersson-Ellstron A. Experiences of pregnancy-related body shape changes and of breast-feeding in women with a history of eating disorders. Eur Eat Disord Rev 2003; 11:116-24.

Micali N, et al. Eating disorders symptoms in pregnancy: a longitudinal study of women with recent and past eating disorders and obesity. J Psychosom Res 2007; 63:297-303.

Micali N, et al. Risk of major adverse perinatal outcomes in women with eating disorders, Br J Psychiatry 2007; 190:255-9.

Morgan JF, et al. Risk of postnatal depression miscarriage and preterm birth in bulimia nervosa: retrospective controlled study. Psychosom Med 2006;68:487-92.

Mazzeo SE, et al. Associations among postpartum depression, eating disorders and perfectionism in a population-based sample of adult women. Int J Eat Disord 2006; 39:202-11.

Rocco PL, et al. Effects of pregnancy on eating attitudes and disorders: a prospective study. J Psychosom Res 2005; 59:175-9.

Stein A, et al. An observational study of mothers with eating disorders and their infants. J Child Psychol Psychiatry 1994;35:733-48.

Ward V. Pregnancy Plus: Eating disorders in pregnancy. BMJ 2008; 336:93-96.