Wouldn’t it be nice if we could identify women who were at risk for postpartum depression (PPD)? Maybe if we could do that, we could actually prevent the depression from occurring. Or at least, we could intervene in some way so that the depression would not significantly affect the mother and her family.
3,4-methylenedioxymethamphetamine (MDMA) or “Ecstasy” is one of the most widely used illicit recreational drugs among young adults. This report indicates that infants exposed to Ecstasy ad other recreational drugs may have delays in their motor development.
In this essay published in the Journal of the American Medical Association, Dr. Helen Kim (an alumna of the CWMH) discusses the challenges of treating women with severe psychiatric illness during pregnancy:
Antenatal exposure to Wellbutrin (bupropion) does not appear to be associated with an increased risk of malformations in the exposed infant; however, it is not known if exposure to Wellbutrin during pregnancy has any effect on the child’s neurobehavioral development. In a study from Figueroa and colleagues published in 2010, insurance claims data from 38,704 children and their families were analyzed, using information obtained from the beginning of pregnancy until age 5. Outcomes were assessed in mothers taking selective serotonin reuptake inhibitors (SSRIs) or Wellbutrin before, during or after the pregnancy. This study sought to determine the risk of ADHD in exposed infants. Children up to the age of 5 were identified as having ADHD if they had an outpatient or inpatient claim with a primary or secondary diagnosis of ADHD or a prescription claim for stimulants.
While a handful of studies have assessed the risk for congenital malformations in infants exposed to antipsychotic agents, there is even less information regarding neonatal outcome in this population. In 1992, it was first reported that infants exposed to first-generation antipsychotic medications exhibited increased muscle tone, tremulousness, and poor motor functioning when assessed within a few days of delivery.
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).”
