SSRIs and PPHN: Are We Any Closer to Calculating the Risk?
The PPHN story has been a bit of a rollercoaster. Just to review…
Cognitive Development in Children Exposed to Levetiracetam (Keppra)
An increasing number of reproductive age women now take newer anticonvulsants for the treatment of mood and anxiety disorders; however, information regarding the reproductive safety of these medications is limited. A recent study has evaluated the cognitive and language development of children born to women with epilepsy exposed in utero to levetiracetam (LEV, Keppra) or sodium valproate (VPA, Depakote), as compared to control children born to women without epilepsy not taking medication during pregnancy.
Do SSRIs Increase the Risk of Postpartum Hemorrhage? Maybe, But Not By Much
Selective serotonin reuptake inhibitor (SSRI) antidepressants may affect platelet aggregation and thus may increase the risk of bleeding. Several studies have sought to determine if exposure to SSRI antidepressants in late pregnancy is associated with an increased risk of postpartum hemorrhage.
Postpartum Depression and Bonding Difficulties: Different but Interrelated Problems
A mother’s emotional relationship with her baby begins during her pregnancy. The mother’s feelings about her baby, described as bonding, typically grow and intensify after the baby’s birth and become the foundation of the mother’s relationship with her child.
Levetiracetam (Keppra) and Pregnancy
While it is well-established that several of the older anticonvulsants, including valproate (Depakote), carry a significant teratogenic risk, less is known about the reproductive safety of the newer antiepileptic drugs (AEDs). A new report from the U.K. and Ireland Epilepsy and Pregnancy Registers suggests that the risk of malformations associated with levetiracetam (LVT, Keppra) use during pregnancy is low.
Prenatal Exposure to Antiepileptic Drugs Associated with Worse Developmental Outcomes
We have previously written about studies which indicate that prenatal exposure to antiepileptic drugs (AEDs), particularly valproic acid, may adversely affect the developing fetus. Numerous studies have documented long-term effects of antiepileptic exposure on cognitive functioning: prenatal exposure to AEDs has been associated with lower IQs, as well as lower scores on tests of executive functioning, memory, verbal and nonverbal abilities, in children at 6 yeas of age (Meador KJ et al, 2012). These deficits were the most prominent in children exposed to valproic acid.
Eating Disorders and Their Impact on Pregnancy Outcomes
Eating disorders are relatively common among women of reproductive age, yet the literature on the effects of maternal eating disorders (ED) on pregnancy outcomes is relatively sparse. There has been concern that eating disorders may negatively affect gestational weight gain. Previous studies have demonstrated an association between maternal anorexia nervosa (AN) (both active and past) and lower infant birthweight (as compared to women with no history of ED); however, calculations of the magnitude of this effect have been inconsistent.
More Data on the Use of Atypical Antipsychotics During Pregnancy
Despite the use of the newer “atypical” antipsychotic agents to treat a spectrum of psychiatric disorders, including schizophrenia, bipolar disorder, major depression, PTSD and other anxiety disorders, three is relatively little data on the reproductive safety of these newer atypical agents.
Prenatal Exposure to Antidepressants and Risk of Autism
It is estimated that autism spectrum disorders (ASD) affect about 1% to 2% of children. Research carried out in twins and families indicate that ASD is highly heritable; however, it is generally believed that while genetic factors play an important role, there is an interplay between genetic and environmental factors in the etiology of this disorder. Various environmental exposures have been implicated, including vaccinations, mercury, air pollution, insecticides, and infection.
Valproic Acid and Pregnancy: FDA Issues Warning
There have been multiple recent reports indicating that the use of valproate during pregnancy may be associated with lower IQ, cognitive problems, and developmental delays in exposed children. This has prompted the FDA to issue a warning regarding the use of valproate-containing drugs, including Depakote and Depakene, during pregnancy: