Duloxetine (sold in the United Sates under the brand name of Cymbalta) is a serotonin-norepinephrine reuptake inhibitor (SNRI) effective for major depressive disorder and generalized anxiety disorder (GAD). Although used fairly commonly in women of child-bearing age, information regarding its reproductive safety has been lacking.
Over the last few years, we have reported on several studies which have suggested an increased risk of certain types of cardiovascular malformations among children exposed to selective serotonin reuptake inhibitors (SSRIs) during pregnancy. The first reports suggested a link between cardiac septal defects and exposure to paroxetine; subsequent studies have also shown elevated risks with the other SSRIIs.
While data accumulated over the last 30 years suggest that certain antidepressants may be used with relative safety during pregnancy, our knowledge regarding the risks of prenatal exposure to psychotropic medications is incomplete. Because neuronal migration and differentiation occur throughout pregnancy and into the early years of life, development of the central nervous system (CNS) remains particularly vulnerable throughout pregnancy.
Several studies have shown that vitamin D deficiency is associated with depression. A recent study has assessed the relationship between vitamin D levels and risk for antenatal depression in a cohort of African-American women. Vitamin D deficiency is more common among African-American women than in Caucasians. The active form of vitamin D is produced as a byproduct of natural sun exposure. Because women with darker skin have more melanin, which blocks the sun’s rays and affects the skin’s ability to produce the active form of vitamin D, they typically have lower vitamin D levels.
