• pregnancy outcomes

    FDA Announces Approval of a New (Old) Medication for Nausea and Vomiting in Pregnancy

    The combination of doxylamine succinate and pyridoxine hydrochloride (vitamin B6), to be marketed as Diclegis, has been approved by the FDA for the treatment of nausea and vomiting in pregnancy. A similar combination was previously sold under the name Bendectin but was pulled from the market in 1983 because there were concerns regarding its reproductive safety.  (Bendectin originally contained dicyclomine which was later removed due to lack of efficacy.)

    Exposure to Valproic Acid and Increased Risk of Autism Spectrum Disorders

    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.

    Antidepressants and Pregnancy: A Meta-Analysis Puts the Risks into a Larger Context

    While some studies have shown an association between in utero exposure to antidepressants and various pregnancy outcomes, including preterm delivery, low birth weight, and lower Apgar scores, these outcomes have also been linked to untreated maternal depression. Thus, it has been difficult to determine if there is a causal relationship between antidepressant exposure and negative pregnancy outcomes or whether maternal depression is itself responsible for these negative outcomes.

    Binge Drinking Common among Women of Reproductive Age

    The CDC recently analyzed data from the 2011 Behavioral Risk Factor Surveillance System (BRFSS) to determine the prevalence, frequency, and intensity of binge drinking among adult women.  Data from the 2011 national Youth Risk Behavior Survey (YRBS) was used to assess current alcohol use and binge drinking among high school girls.

    What’s Worse for Pregnancy: Bipolar Disorder or the Medications Used to Treat It?

    In studies of pregnant women with unipolar depression, it has been shown that untreated psychiatric illness in the mother may have a negative impact on pregnancy outcomes, influencing the length of gestation and birthweight.  There is far less data on pregnancy outcomes in women with bipolar disorder.  A recent Swedish study analyzes pregnancy outcomes in treated and untreated women with bipolar disorder and attempts to distinguish between the effects of medication versus the effects of untreated psychiatric illness in the mother.

    Screening of Intimate Partner Violence Recommended for All Women of Reproductive Age

    This is a topic we do not typically cover on our site, but it is clearly an important one.  The U.S. Preventive Services Task Force (USPSTF) has updated its recommendations on screening for family and intimate partner violence (IPV). These guidelines, published in the Annals of Internal Medicine, recommend that all women of reproductive age be screened for intimate partner violence.  The review provides some information on which screening instruments to use and reviews interventions to reduce the risk of IPV.

    Dr. Lee Cohen in Ob-Gyn News: Using SSRIs in 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.

    SSRIs and Pregnancy: Putting the Risks and Benefits into Perspective

    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.

    Duloxetine and Pregnancy: Preliminary Data

    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.

    Yet Another Study Investigating SSRIs and Their Impact on Neonatal Outcomes

    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).

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