While the human brain continues develop throughout the first twenty or so years of life, the most vulnerable periods of brain development occur during pregnancy and the first 2 to 3 years of the child’s [...]
Two recent epidemiologic studies have demonstrated an association between prenatal exposure to selective serotonin reuptake inhibitor antidepressants (SSRIs) with autism spectrum disorders (ASD; Croen et al 2011, Rai et al, 2013). One important imitation of these two studies is that parental psychiatric disorder in itself is associated with an increased risk of ASD in the offspring, and these studies could not distinguish between the effects of drug exposure and the consequences of the underlying maternal psychiatric illness. Two new studies shed light on the association between prenatal antidepressant exposure and risk of autism spectrum disorder in the offspring.
In a recent editorial in The Annals of Internal Medicine entitled “Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements,” authors make a case that multivitamins are not a good value (Dec 17, 2013 issue). This editorial was based on new research that demonstrated that there was no association between multivitamin use and rates of mortality, cognitive decline and recurrent cardiovascular events in three different studies. The assertion that multivitamins are not worth the money was widely reported in the media.
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.
There have long been concerns regarding the use of the anticonvulsant valproate (Depakote, VPA) during pregnancy. First trimester use of valproate has been associated with a 3-5% risk of neural tube defects, as well as an increased risk of other malformations affecting the heart and other organ systems. Multiple reports have also indicated that in utero exposure to valproate may also negatively affect cognitive development.
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.
While we have data on the use of lithium use during pregnancy with regard to risk for congenital malformations, there is much less information on the long-term effects of lithium on neurodevelopment. A recent study from the Perinatal Center of the Leiden University Medical Center provides some reassuring data on the long-term effects of lithium exposure.
