While much attention has focused on the impact of maternal psychiatric illness on the well-being of the child, less is known about the impact of psychiatric illness in the father. A large population-based study from Norway examines the association between symptoms of psychological distress in expectant fathers and socioemotional and behavioral outcomes in their children at 36 months of age.
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.  Â
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.
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.
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.
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.
Most studies have shown that women experience an improvement or remission in eating disorders during pregnancy; however, studies assessing how eating disorders may affect pregnancy outcomes have yielded conflicting results. While some studies have demonstrated no negative effects, others have demonstrated higher miscarriage rates among women with bulimia nervosa. In addition, women with histories of eating disorders have been shown to be significantly more likely to experience preterm delivery and to give birth to babies small for gestational age.
