Reduced birth length and weight, microcephaly, and characteristic facial deformities (smooth philtrum and thin vermillion border) are associated with alcohol exposure during the second half of the first trimester and are dose-related. In this prospective study including 992 subjects, there was no evidence of a threshold, indicating that women should be advised to abstain from alcohol consumption from conception throughout pregnancy.
We want to thank those of you who have continued to subscribe to our blog and who have visited our website. Some have written noting particular interest in the research conducted at the MGH Center for Women's Mental Health, including the National Pregnancy Registry for Atypical Antipsychotics.
Topiramate (marketed as a Topamax), in addition to its use for the treatment of epilepsy, is now being prescribed to reproductive aged women for a broad spectrum of indications, including migraine headaches, weight control, and mood stabilization. Limited information is available on its reproductive safety; however, the preliminary data we do have raises some concerns regarding the use of topiramate in pregnancy.
A few weeks after the FDA called into question the association between SSRI exposure and persistent pulmonary hypertension of the newborn or PPHN, BMJ published another article supporting an increased risk of PPHN among infants exposed to SSRIs in utero.
In 2006, Chambers and colleagues published an article in the New England Journal of Medicine linking SSRI use during late pregnancy to an increased risk of persistent pulmonary hypertension in the newborn (PPHN). Based on these findings, the “Usage in Pregnancy” section on the labels for SRRI antidepressants was updated to include the following warning: “Infants exposed to SSRIs in late pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn (PPHN).”
Both citalopram and escitalopram are antidepressants belonging to the SSRI class. While escitalopram (marketed in the U.S. as Lexapro) contains only the S-stereoisomer (or enantiomer) of the drug citalopram, Celexa or generic citalopram is a racemic mixture of the S-citalopram and its mirror image, R-citalopram, which is less effective as an antidepressant.
It is estimated that up to 95% of women experience some type of sleep disturbance during pregnancy. While for many women the insomnia is relatively benign and may respond to simple interventions, other women experience more severe insomnia which has a significant impact on their quality of life and ability to function. Various non-benzodiazepine hypnotic agents, specifically zalepion (Sonata), eszopiclone (Lunesta), and zolpidem (Ambien), are commonly used for the short-term treatment of insomnia; however, information regarding the reproductive safety of these sleep aids has been sparse.
In a recent study by Gerardin and colleagues, the authors note that more research has been done to demonstrate the consequences of postpartum depression than depression during pregnancy (also called antenatal or prenatal depression). Infants born to mothers with depression during pregnancy have been demonstrated to have lower scores on motor behavior and more crying and irritability. Few studies, however, have assessed the longer-term effects of antenatal depression.
May 2011, ObGyn News, Lee S. Cohen, MD
Women face difficult choices when deciding whether or not to continue psychiatric medications during pregnancy. This choice can be especially difficult for women taking newer medications which lack adequate reproductive safety data.
