Opioid use in pregnant women is a significant public health concern.  A recent study observed that one out of five pregnant women (21.6%) filled a prescription for an opioid and 2.5% received a chronic opioid prescription for greater than 30 days.  It is estimated that the number of pregnant women diagnosed with an opioid use disorder (OUD) has more than quadrupled over a 15-year period ending in 2014, increasing from 1.5 to 6.5 per 1000 deliveries per year.  While we have considerable information regarding neonatal opioid withdrawal symptoms, we have limited data regarding the long-term effects of prenatal opioid exposure.

Several articles this week look at the impact of prenatal opioid exposure (POE) on children’s development.  In a meta-analysis, Yeoh and colleagues looked at cognitive development in a total of 1455 children with POE and motor development in 688 children with POE.  Scores on cognitive tests were lower for children with POE at all time points assessed; however, this finding was not statistically significant for those aged 7 to 18 years. Motor scores were lower in children with POE compared to non-exposed children.  Similarly, Lee and colleagues observed low rates of school readiness in children born to opioid-dependent mothers.

Given the emerging data that prenatal opioid exposure many have adverse effects on the developing fetal brain, Caritis and colleagues urge us to consider a new paradigm of care for pregnant women, one that includes increasing access to medication-assisted treatment but also the consideration of medically supervised opioid withdrawal for some women. 

For more detailed descriptions of many of these topics, you can read the CWMH NEWSLETTER which comes out every Thursday.  You can sign up for our newsletter HERE.


Ruta Nonacs, MD PhD


No articles this week



Maternal Mental Health in Assisted and Natural Conception: A Prospective Cohort Study.

Furmli H, Seeto RA, Hewko SL, Dalfen A, Jones CA, Murphy KE, Bocking A.  J Obstet Gynaecol Can. 2019 Jul 25. 

Women who conceived using ART reported decreased rates of depressive symptoms, perceived stress, and generalized anxiety during the second trimester of pregnancy compared with women who had spontaneously conceived pregnancies, and both groups experienced similar mental health status earlier in gestation and in the postpartum period.



Measuring and conceptualizing PTSD following childbirth: Validation of the City Birth Trauma Scale.

Naki? Radoš S, Matijaš M, Kuhar L, An?elinovi? M, Ayers S.  Psychol Trauma. 2019 Aug 1.

City Birth Trauma Scale is a recently developed scale specifically designed for evaluation of posttraumatic stress disorder (PTSD) following childbirth based on the DSM-5 criteria.



Relation of in-utero exposure to antiepileptic drugs to pregnancy duration and size at birth.

Margulis AV, Hernandez-Diaz S, McElrath T, Rothman KJ, Plana E, Almqvist C, D’Onofrio BM, Oberg AS.  PLoS One. 2019 Aug 5.  Free Article

Relative to lamotrigine, valproic acid and carbamazepine were associated with smaller head circumference.


The impact of obesity on pregnancy outcomes among women with psychiatric disorders: Results from a prospective pregnancy registry.

Freeman MP, Goez-Mogollon L, Sosinsky AZ, Church TR, McElheny SA, Viguera AC, Cohen LS.  J Psychosom Res. 2019 Aug.

Women with obesity were at higher risk for gestational diabetes (p?=?0.011; OR:3.23; 95% CI:1.30,7.98), as were women in the overweight BMI category (p?=?0.003; OR:3.77; 95% CI:1.58,9.00). Among women with obesity, there was a tendency for a higher C-section rate (p?=?0.07) compared to women in the normal-weight BMI category. Other outcomes were not significantly different among groups.


Psychopharmacological prescribing practices in pregnancy for women with severe mental illness: A multicentre study.

Galbally M, Frayne J, Watson SJ, Snellen M.  Eur Neuropsychopharmacol. 2019 Jan;29(1):57-65. 


Perinatal exposure to venlafaxine leads to lower anxiety and depression-like behavior in the adult rat offspring.

Bogi E, Belovicová K, Ujhazy E, Mach M, Koprdova R, Zilava L, Garafová A, Jezova D, Dubovicky M.  Behav Pharmacol. 2018 Aug;29(5):445-452. 

In this study carried out in rats, the animals exposed through their mothers to venlafaxine, particularly at the lowest and middle doses, were less anxious and less depressive in several relevant behavioral tests. At clinically relevant doses, venlafaxine did not alter circulating levels of corticosterone and aldosterone in the adult offspring. In general, the consequences of venlafaxine were dose dependent and more apparent in females. Together, these results suggest that prenatal and early postnatal exposure to venlafaxine may affect functional development of the brain, though not necessarily in a negative way.



Longitudinal assessment of symptoms of postpartum mood disorder in women with and without a history of depression.

Pataky EA, Ehlert U.  Arch Womens Ment Health. 2019 Jul 26. 

Women with a history of depression were twice more likely to show peripartum depressive symptoms than women without a history of depression. A history of symptoms of PMS/PMDD prior to the current pregnancy was associated with increased odds of peripartum depressive symptoms (p values <?.05). 


Postpartum depression screening in the first year: A cross-sectional provider analysis in Oregon.

Docherty A, Najjar R, Combs S, Woolley R, Stoyles S.

J Am Assoc Nurse Pract. 2019 Jul 31.

Of the 55 respondents, 29% followed the AAP recommendations and screened at well-child visits; the most common screening barriers were limited knowledge and/or availability of referral services. Physicians were more likely to meet any recommended guidelines than nurse practitioners (NPs).


Transdermal estradiol for postpartum depression: results from a pilot randomized, double-blind, placebo-controlled study.

Li HJ, Martinez PE, Li X, Schenkel LA, Nieman LK, Rubinow DR, Schmidt PJ.  Arch Womens Ment Health. 2019 Aug 1. d

Researchers were unable to demonstrate a significant therapeutic benefit of transdermal estradiol compared with placebo in PPD; however, the study was limited by under-recruitment and loss to follow-up.


The effect of perceived social support during early pregnancy on depressive symptoms at 6 weeks postpartum: a prospective study.

Gan Y, Xiong R, Song J, Xiong X, Yu F, Gao W, Hu H, Zhang J, Tian Y, Gu X, Zhang J, Chen D.  BMC Psychiatry. 2019 Jul 29;19(1):232. Free Article

Low perceived social support early in pregnancy was associated with an increased risk of postpartum depressive symptoms.  Thus, it is possible that interventions to increase supports may decrease risk for PPD.



No articles this week



Health and Neurodevelopment of Children Born to Opioid-Dependent Mothers at School Entry.

Lee SJ, Pritchard VE, Austin NC, Henderson JMT, Woodward LJ.  J Dev Behav Pediatr. 2019 Aug 1.

Children born to opioid-dependent mothers are at high risk of impaired school readiness, with multiple domain problems being common. Impaired school readiness was associated with greater maternal prenatal substance use, higher social risk, male sex, and lower-quality caregiving environments.


Opioids Affect the Fetal Brain: Reframing the Detoxification Debate.

Caritis SN, Panigrahy A.  Am J Obstet Gynecol 2019.

In light of the recent data on medically supervised withdrawal and the emerging evidence suggesting adverse effects of opioids on the developing fetal brain, a new paradigm of care is needed that includes the preferred option of medication-assisted treatment but also the option of medically supervised opioid withdrawal for a select group of women. 


Cognitive and Motor Outcomes of Children With Prenatal Opioid Exposure: A Systematic Review and Meta-analysis.

Yeoh SL, Eastwood J, Wright IM, Morton R, Melhuish E, Ward M, Oei JL.  JAMA Netw Open. 2019 Jul 3. Free Article

Prenatal opioid exposure appeared to be negatively associated with neurocognitive and physical development from age 6 months, and this association persisted until adolescence. 


Association between prenatal opioid exposure, neonatal opioid withdrawal syndrome, and neurodevelopmental and behavioral outcomes at 5-8 months of age.

Bakhireva LN, Holbrook BD, Shrestha S, Leyva Y, Ashley M, Cano S, Lowe J, Stephen JM, Leeman L.  Early Hum Dev. 2019 Jan;128:69-76.

There was little to no effect of MAT and pharmacological treatment of neonatal opioid withdrawal symptoms on infant neurodevelopmental and behavioral outcomes at 5-8?months of age.


Trans-generational stress regulation: Mother-infant cortisol and maternal mental health across the perinatal period.

Galbally M, van Rossum EFC, Watson SJ, de Kloet ER, Lewis AJ.  Psychoneuroendocrinology. 2019 Jul 29;1

Anxiety, stress and antidepressant use were not associated with maternal HCC. Independently, higher maternal 3rd trimester maternal depressive and anxiety symptoms were associated with lower infant cortisol response at 12 months of age. A higher number of postpartum stressful events was associated with lower infant cortisol response. Lower infant stress reactivity was associated with higher externalizing symptoms at 12 months of age. 



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No articles this week



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