Most women have some nausea or vomiting, or "morning sickness", during the first trimester of pregnancy. Some women, however, have a more severe and persistent pattern of nausea and vomiting called hyperemesis gravidarum (HG). A new study demonstrates, not so surprisingly, that depression is more common in women suffering from HG.
While there has been a great deal of attention paid to the risks of exposure to antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs), during pregnancy, there has been comparatively little information on the risk of stillbirth and infant mortality in this population. In a recent population-based cohort study utilizing data from all Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden), researchers assessed the risk of stillbirth and infant mortality associated with the use of SSRIs during pregnancy.
Over the last decade, attention in the medical literature has gathered logarithmically to focus on potentially efficacious treatments for perinatal depression. Studies of relevant databases, editorials, and various reviews have addressed the reproductive safety concerns of antidepressant treatments, particularly selective serotonin reuptake inhibitors (SSRIs) on one hand, and the impact of untreated maternal psychiatric illness on fetal and maternal well-being on the other.
Prozac hit the market in 1988, the first selective serotonin reuptake inhibitor (SSRI) antidepressant approved by the FDA for the treatment of depression. Because it was safer and more tolerable than the antidepressants that preceded it, Prozac was soon the most commonly prescribed antidepressant in the United States.
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.
In 2009, the Australian government launched the National Perinatal Depression Initiative (NPDI) in order “to improve the prevention and early detection of antenatal and postnatal depression and to provide better support and treatment for expectant and new mothers experiencing depression.” Its scope is very much like the MOTHERS Act, which became law in the United States in 2010. Both initiatives seek to increase public awareness of perinatal depression, to provide support and treatment for pregnant and postpartum women with depression, to fund research in this area, and to implement training of health care professionals.
In a recent retrospective cohort study, data collected from linked records from the Women's and Children's Health Network in South Australia were used to investigate neonatal outcomes in children exposed prenatally to selective serotonin reuptake inhibitors (SSRIs). Women were included in this study if they gave birth to a singleton, live-born infant between September 2000 and December 2008 (n = 33,965).
Over the past few years, there have been a large number of studies which have relied on large administrative databases to generate information on the reproductive safety of various medications. One of the strengths of this type of approach is that it provides an opportunity to observe outcomes in a large number of subjects; however, there are certain, very important limitations. A recent study published in the American Journal of Obstetrics and Gynecology helps to understand some of the challenges in interpreting the data generated from these studies.
Some, but not all, studies have indicated that depression during pregnancy increases the risk of preterm birth. A recent study published in the American Journal of Obstetrics and Gynecology is one of the largest to address this question.
We have recently written about the link between vitamin D and depression. While several studies have indicated that low vitamin D levels may be associated with depression, we lack randomized, controlled trials assessing the benefits of vitamin D supplements for the treatment (or prevention) of depression. A recent report from the Women's Health Initiative Calcium and Vitamin D Trial included 36,282 women (50 to 80 years of age) who were randomized to receive 400 IU vitamin D (with 1000 mg calcium) or to placebo.
