In a large study from France (Blotière et al, 2019), researchers demonstrated that exposure to monotherapy with valproic acid was associated with 8 specific types of major congenital malformations (e.g., spina bifida, OR 19.4), and exposure to topiramate was associated with an increased risk of cleft lip (OR 6.8). No significant associations were found for lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, and gabapentin.

Two studies look at the accuracy of various screening instruments for the identification of substance use in women during pregnancy (Ondersma et al, 2019; Colman-Cowger et al, 2019).  It turns out that there is considerable variation in how these screening tools perform.  

Can ketamine be used to prevent postpartum depression? Ma and colleagues (2019) report on the use of ketamine in this setting.  More on this next week.  


Ruta Nonacs, MD PhD


Impact of antidepressant use, discontinuation, and dosage modificationon maternal depression during pregnancy.

Bérard A, Sheehy O, Zhao JP, Chambers C, Roth M, Bozzo P, Johnson D, Kao K, Lavigne S, Wolfe L, Quinn D, Dieter K; MotherToBaby Collaborative Research Committee.  Eur Neuropsychopharmacol. 2019 Jun 24. 

Adjusting for potential confounders including maternal depression/anxiety before pregnancy, women who discontinued of antidepressant were 5.95 times as likely to have depression than non-users(95%CI: 1.54-23.02), and continued users without dosage modification were 4.59 times (95%CI: 1.44-14.64) more likely to have depression in the second-half of pregnancy. Those with dosage modifications were at a similar risk of depression during pregnancy as non-users (adjusted odds ratio 0.58, 95%CI: 0.06-5.52). 


Outcomes of Implementing Routine Screening and Referrals for PerinatalMood Disorders in an Integrated Multi-site Pediatric and Obstetric Setting.

Puryear LJ, Nong YH, Correa NP, Cox K, Greeley CS.  Matern Child Health J. 2019 Jun 20. 

Of referred women 2172 (55.8%) completed an appointment with a mental health provider within 60 days of referral. Rates of completed appointments varied by the level of integration of the mental health provider and referring physician.


Systematic review of the association between dietary patterns and perinatal anxiety and depression.

Silva DFO, Cobucci RN, Gonçalves AK, Lima SCVC.  BMC Pregnancy Childbirth. 2019 Jun 24;19(1):212. Free Article

There is no definitive evidence about the relationship between Western dietary patterns and perinatal anxiety and depression.


Anxiety among women experiencing medically complicated pregnancy: A systematic review and meta-analysis.

Abrar A, Fairbrother N, Smith AP, Skoll A, Albert AYK.  Birth. 2019 Jun 21.

Based on the five studies which met our inclusion criteria, findings provide evidence of higher levels of anxiety symptoms among pregnant women experiencing a medically complicated versus a medically uncomplicated pregnancy. 


Risks of 23 specific malformations associated with prenatal exposure to 10 antiepileptic drugs.

Blotière PO, Raguideau F, Weill A, Elefant E, Perthus I, Goulet V, Rouget F, Zureik M, Coste J, Dray-Spira R.  Neurology. 2019 Jun 12.

Exposure to valproic acid was associated with 8 specific types of MCMs (e.g., spina bifida, OR 19.4, 95% CI 8.6-43.5), and exposure to topiramate was associated with an increased risk of cleft lip (6.8, 95% CI 1.4-20.0). No significant associations were found for lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, and gabapentin.


Behavioral problems in children of mothers with epilepsy prenatally exposed to valproate, carbamazepine, lamotrigine, or levetiracetam monotherapy.

Huber-Mollema Y, Oort FJ, Lindhout D, Rodenburg R.  Epilepsia. 2019 Jun;60(6):1069-1082. 

Compared to population norms, a high proportion of children of mothers with epilepsy exposed prenatally to monotherapy with four common AEDs had clinical behavioral problems reported by parents. 


Prophylactic use of ketamine reduces postpartum depression in Chinesewomen undergoing cesarean section.

Ma JH, Wang SY, Yu HY, Li DY, Luo SC, Zheng SS, Wan LF, Duan KM.  Psychiatry Res. 2019 Mar 16. 


Methylation analysis for postpartum depression: a case control study.

Nakamura Y, Nakatochi M, Kunimoto S, Okada T, Aleksic B, Toyama M, Shiino T, Morikawa M, Yamauchi A, Yoshimi A, Furukawa-Hibi Y, Nagai T, Ohara M, Kubota C, Yamada K, Ando M, Ozaki N.  BMC Psychiatry. 2019 Jun 20;19(1):190. Free Article

Implications of the clinical gestational diagnosis of ZIKV infection in the manifestation of symptoms of postpartum depression: a case-control study.

Moraes EV, Toledo OR, David FL, Godoi BN, Monteiro KA, Deluqui TC, Teixeira TW, Carvalho AL, Avelino MM.  BMC Psychiatry. 2019 Jun 26;19(1):199. Free Article

Clinical diagnosis of Zika virus during pregnancy was associated with a 20-fold increase in risk of severe PPD symptoms.  


The interaction between estradiol change and the serotonin transporter gene (5-HTTLPR) polymorphism is associated with postpartum depressive symptoms.

Hu J, Zhou B, Li Y, Deng Y, He Q, Ye J, Ning Y.  Psychiatr Genet. 2019 Aug;29(4):97-102.


The First Food and Drug Administration-Indicated Drug for PostpartumDepression-Brexanolone.

Wisner KL, Stika CS, Ciolino JD.  JAMA Psychiatry. 2019 Jun 26. 


Association between Stillbirth at or after 23 weeks gestation and Acute Psychiatric Illness within One Year of Delivery.

Lewkowitz AK, Rosenbloom JI, Keller M, López JD, Macones GA, Olsen MA, Cahill AG.  Am J Obstet Gynecol. 2019 Jun 18. 

Within one year of hospital discharge after stillbirth, 4.0% (n=331) of women had an ED encounter or inpatient admission coded for psychiatric morbidity: the risk was nearly 2.5 times higher compared to livebirth. Women also had higher risk of having an ED encounter or inpatient admission coded for drug or alcohol use or dependence in the year following delivery of stillbirth versus livebirth (aOR 2.41). 


Universal Early Home Visiting: A Strategy for Reaching All PostpartumWomen.

Handler A, Zimmermann K, Dominik B, Garland CE.  Matern Child Health J. 2019 Jun 24.


Accuracy of five self-report screening instruments for substance use in pregnancy.

Ondersma SJ, Chang G, Blake-Lamb T, Gilstad-Hayden K, Orav J, Beatty JR, Goyert GL, Yonkers KA.  Addiction. 2019 Jun 19. 

Of five screening instruments for substance use in pregnancy tested (Substance Use Risk Profile-Pregnancy (SURP-P), CRAFFT, 5Ps, Wayne Indirect Drug Use Screener (WIDUS) and the National Institute on Drug Abuse (Quick Screen), none showed both high sensitivity and high specificity, and area under the curve was low for nearly all measures.


Accuracy of Three Screening Tools for Prenatal Substance Use.

Coleman-Cowger VH, Oga EA, Peters EN, Trocin KE, Koszowski B, Mark K.  Obstet Gynecol. 2019 May;133(5):952-961. Free Article

The SURP-P and 4P’s Plus had high sensitivity and negative predictive values, making them more ideal screening tests than the NIDA Quick Screen-ASSIST. 


Children’s appraisals of maternal depression and responses to emotional faces in early-adolescence: An Event Related Potential (ERP) study.

Connell AM, Danzo S, Magee K, Uhlman R.  J Affect Disord. 2019 May 1;250:241-248.