The first two articles look at the risk of autism spectrum disorders (ASD) in children exposed to SSRIs during pregnancy.  We will review these studies in greater detail next week. They both indicate that the use of antidepressants during pregnancy does not increase risk for ASD; however, the studies suggest that the risk of ASD is greater in mothers with more severe depression.  Also on the list is the largest meta-analysis to date looking at exposure to SSRIs during pregnancy and risk for congenital malformations (Gao et al, 2019).

Ruta Nonacs, MD PhD

Association between antidepressant use during pregnancy and autism spectrum disorder in children: a retrospective cohort study based on Japanese claims data.

Yamamoto-Sasaki M, Yoshida S, Takeuchi M, Tanaka-Mizuno S, Ogawa Y, Furukawa TA, Kawakami K.  Matern Health Neonatol Perinatol. 2019 Jan 10;5:1.

After adjusting for potential confounders, researchers found no significant association between antidepressant use during pregnancy and ASD in children in Japan.

Maternal depression and antidepressant use during pregnancy and the risk of autism spectrum disorder in offspring.

Hagberg KW, Robijn AL, Jick S.  Clin Epidemiol. 2018 Nov 1;10:1599-1612.  Free Article

Women with depression during pregnancy have an increased risk of having a child with ASD, regardless of antidepressant use.  The risk of ASD in offspring increases with increasing severity of depression in the mother, not with the use of antidepressant.

Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births.

Gao SY, Wu QJ, Sun C, Zhang TN, Shen ZQ, Liu CX, Gong TT, Xu X, Ji C, Huang DH, Chang Q, Zhao YH. BMC Med. 2018 Nov 12;16(1):205.  Free Article

The evidence suggests a generally small risk of congenital malformations and argues against a substantial teratogenic effect of SSRIs.

Trajectories of maternal depressive and anxiety symptoms from pregnancy to five years postpartum and their prenatal predictors.

Ahmed A, Bowen A, Feng CX, Muhajarine N.

BMC Pregnancy Childbirth. 2019 Jan 14;19(1):26.    Free Article

In a substantial portion of women, anxiety and depressive symptoms persisted over the five years after the birth of a child.  

Efficacy of Regular Exercise During Pregnancy on the Prevention of Postpartum Depression: The PAMELA Randomized Clinical Trial.

Coll CVN, Domingues MR, Stein A, da Silva BGC, Bassani DG, Hartwig FP, da Silva ICM, da Silveira MF, da Silva SG, Bertoldi AD.  JAMA Netw Open. 2019 Jan 4;2(1).

Moderate-intensity exercise during pregnancy did not lead to significant reductions in postpartum depression. However, noncompliance to the intervention protocol was substantial and may have led to underestimations of the possible benefits of exercise.

Offspring outcomes after prenatal interventions for common mental disorders: a meta-analysis.

Brouwer ME, Williams AD, van Grinsven SE, Cuijpers P, Lambregtse-van den Berg MP, Burger H, Bockting CLH.  BMC Med. 2018 Nov 15;16(1):208. Free Article

Non-pharmacological interventions had no significant effect on birth outcomes, although this outcome should be considered with caution due to the possibility of biases. No randomized controlled trial examined the effects of prenatal pharmacological treatments as compared to treatment as usual for common mental disorders on offspring outcomes.

Depression precedes, but does not follow, gestational diabetes.

Clark CE, Rasgon NL, Reed DE 2nd, Robakis TK.  Acta Psychiatr Scand. 2018 Dec 18.

Past episodes of depression increase risk for the most severe form of gestational diabetes; however, gestational diabetes does not contribute significantly to risk for postpartum depression.

Pregnancy outcomes following maternal venlafaxine use; a prospective observational comparative cohort study.

Richardson JL, Martin F, Dunstan H, Greenall A, Stephens S, Yates LM, Thomas SHL.  Reprod Toxicol. 2019 Jan 10.

In this productive study of  281 venlafaxine exposed pregnancies matched to antidepressant unexposed (n?=?1,405) and SSRI exposed (n?=?843) comparator groups, exposure to venlafaxine was not associated with increased risk of spontaneous abortion.

Pre-conception self-harm, maternal mental health and mother-infant bonding problems: a 20-year prospective cohort study.

Borschmann R, Molyneaux E, Spry E, Moran P, Howard LM, Macdonald JA, Brown SJ, Moreno-Betancur M, Olsson CA, Patton GC.  Psychol Med. 2018 Dec 18:1-9.

Self-harm during young adulthood may be an indicator of future vulnerability to perinatal mental health and mother-infant bonding problems.

Risk factors for delayed social-emotional development and behavior problems at age two: Results from the All Our Babies/Families (AOB/F) cohort.

McDonald SW, Kehler HL, Tough SC.

Health Sci Rep. 2018 Aug 28;1(10).  Free Article

Multiple factors were associated delayed social-emotional development in children, including maternal depression at 2 years postpartum (OR 2.46, 95% CI 1.63, 3.72) and lower parenting self-efficacy at 2 years postpartum (OR 2.76, 95% CI 1.51, 5.06).  Risk factors for behavior problems included lower maternal optimism during pregnancy (OR 2.02, 95% CI 1.36, 2.99), maternal depression at 2 years postpartum (OR 2.19, 95% CI 1.46, 3.27), and difficulty balancing responsibilities at 2 years postpartum (OR 2.32 95% CI 1.55, 3.47).

The prevalence and risk factors for postpartum depression symptoms of fathers at one and 6 months postpartum: birth cohort study of an adjunct study of the Japan Environment & Children’s Study.

Nishigori H, Obara T, Nishigori T, Metoki H, Mizuno S, Ishikuro M, Sakurai K, Hamada H, Watanabe Z, Hoshiai T, Arima T, Nakai K, Kuriyama S, Yaegashi N; Miyagi Regional Center of Japan Environment & Children’s Study Group.  J Matern Fetal Neonatal Med. 2018 Dec 18:1-131.

The prevalence of paternal postpartum depression symptoms were 11.2 and 12.0% at one and 6 months postpartum. Paternal postpartum depression symptoms at 1 month postpartum was associated with history of mental health disorders, psychological distress during pregnancy, low income, and infant illness under medical treatment.

Postpartum Outcomes and Formal Mindfulness Practice in Mindfulness-Based Cognitive Therapy for Perinatal Women.

Luberto CM, Park ER, Goodman JH.  Mindfulness (N Y). 2018 Jun;9(3):850-859.

Maternal circadian cortisol mediates the link between prenatal distress and breastfeeding.

Bublitz MH, Bourjeily G, Bilodeau C, Stroud LR.  Stress. 2019 Jan 10:1-7.

Participants who reported lower socioeconomic status in pregnancy were less likely to breastfeed, and lower maternal cortisol awakening responses mediated this association.

Annual Research Review: Maternal antidepressant use during pregnancy and offspring neurodevelopmental problems – a critical review and recommendations for future research.

Sujan AC, Öberg AS, Quinn PD, D’Onofrio BM.  J Child Psychol Psychiatry. 2018 Dec 5.

ACOG Committee Opinion No. 757: Screening for Perinatal Depression.  Obstet Gynecol. 2018 Nov;132(5):e208-e212.

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