There a few new articles on the impact of antidepressant use during pregnancy.  Viktorin and colleagues demonstrated no increase in risk for intellectual disability in children with prenatal exposure to antidepressants.  Rai and colleagues demonstrated a small increase in risk of autism (without intellectual disability) in children exposed prenatally to antidepressants. We will be covering those two papers in greater detail next week.  

Ruta Nonacs, MD PhD

Association of Antidepressant Medication Use During Pregnancy With Intellectual Disability in Offspring.

Viktorin A, Uher R, Kolevzon A, Reichenberg A, Levine SZ, Sandin S.  JAMA Psychiatry. 2017 Jul 12.

This study compared mothers who used antidepressants during pregnancy with mothers who had at least one diagnosis of depression or anxiety before childbirth but did not use antidepressants during pregnancy. The unadjusted relative risk (RR) of intellectual disability was increased in offspring born to mothers treated with antidepressants during pregnancy; however, after adjustment for confounding factors, this study did not find evidence of an association between intellectual disability and maternal antidepressant medication use during pregnancy.

Antidepressants during pregnancy and autism in offspring: population based cohort study.

Rai D, Lee BK, Dalman C, Newschaffer C, Lewis G, Magnusson C.  BMJ. 2017 Jul 19;358:j2811.

Of the 3342 children exposed to antidepressants during pregnancy, 4.1% (n=136) had a diagnosis of autism compared with a 2.9% prevalence (n=353) in 12?325 children not exposed to antidepressants whose mothers had a history of a psychiatric disorder (adjusted odds ratio 1.45, 95% confidence interval 1.13 to 1.85). Propensity score analysis led to similar results.

Variations in Neurodevelopmental Outcomes in Children with Prenatal SSRI Antidepressant Exposure.

Rotem-Kohavi N, Oberlander TF.  Birth Defects Res. 2017 Jul 17;109(12):909-923.

Review of developmental outcomes.

Treatment of premenstrual dysphoric disorder with the GABAA receptor modulating steroid antagonist Sepranolone (UC1010)-A randomized controlled trial.

Bixo M, Ekberg K, Poromaa IS, Hirschberg AL, Jonasson AF, Andréen L, Timby E, Wulff M, Ehrenborg A, Bäckström T.  Psychoneuroendocrinology. 2017 Jun;80:46-55.   Free Article

Inhibition of allopregnanolone by treatment with the GABA-A modulating steroid antagonist UC1010 may be a potential treatment for PMDD. The effect size was comparable to that of SSRIs and drospirenone containing oral contraceptives.

Depression Trajectories of Antenatally Depressed and Nondepressed Young Mothers: Implications for Child Socioemotional Development.

Raskin M, Easterbrooks MA, Lamoreau RS, Kotake C, Goldberg J.  Womens Health Issues. 2016 May-Jun;26(3):344-50.

Women with prenatal depression reported more child behavioral problems than non-depressed women.

Conception by means of in vitro fertilization is not associated with maternal depressive symptoms during pregnancy or postpartum.

Gambadauro P, Iliadis S, Bränn E, Skalkidou A.  Fertil Steril. 2017 Jun 23.

The prevalence of depressive symptoms and the EPDS scores during pregnancy and postpartum were similar between women conceiving spontaneously or through IVF (n=167).

Placental passage of antiepileptic drugs at delivery and neonatal outcomes.

Bank AM, Stowe ZN, Newport DJ, Ritchie JC, Pennell PB.  Epilepsia. 2017 May;58(5):e82-e86.

Mean umbilical-to-maternal ratios for free concentrations ranged from 0.86 for valproic acid to 1.42 for carbamazepine, indicating complete placental passage. Neither umbilical cord concentrations nor umbilical-to-maternal ratios were associated with adverse neonatal outcomes.

Antenatal and postnatal depression in women with obesity: a systematic review.

Steinig J, Nagl M, Linde K, Zietlow G, Kersting A.  Arch Womens Ment Health. 2017 Aug;20(4):569-585.

Of 13 studies examining pre-pregnancy obesity and antenatal depression, 9 found a higher risk or higher levels of antenatal depression among women with obesity relative to normal weight, while 4 studies found no association.

Rating scale item assessment of self-harm in postpartum women: a cross-sectional analysis.

Coker JL, Tripathi SP, Knight BT, Pennell PB, Magann EF, Newport DJ, Stowe ZN.  Arch Womens Ment Health. 2017 Jun 30.

Up to 22.3% of postpartum women admitted SI on rating scales, despite the majority (79%) receiving active pharmacological treatment for psychiatric illness. Postpartum women admitting self-harm/SI were more likely to meet criteria for current major depressive episode (MDE), less than college education, an unplanned pregnancy, a history of past suicide attempt, and a higher score on the Childhood Trauma Questionnaire. In women with a history of neuropsychiatric illness, over 20% admitted SI during the postpartum period despite ongoing psychiatric treatment. Patient-rated depression scales are more sensitive screening tools than a clinician-rated depression scale for +SI in the postpartum period.

NICU-based Interventions To Reduce Maternal Depressive and Anxiety Symptoms: A Meta-analysis.

Mendelson T, Cluxton-Keller F, Vullo GC, Tandon SD, Noazin S.  Pediatrics. 2017 Mar;139(3).

According to this meta-analysis of NICU-based interventions, combined intervention effects significantly reduced maternal depressive but not anxiety symptoms. The evidence is strongest for cognitive behavioral therapy interventions on maternal depressive symptoms.

Factors associated with post-traumatic stress symptoms (PTSS) 4-6 weeks and 6 months after birth: A longitudinal population-based study.

Dikmen-Yildiz P, Ayers S, Phillips L.  J Affect Disord. 2017 Oct 15;221:238-245.

In a sample of 950 postpartum women in Turkey, ost-traumatic stress symptoms (PTSS) at six months postpartum were associated with anxiety and PTSS during pregnancy, complications during birth, satisfaction with health professionals, fear of childbirth, traumatic events after birth, and social support. PTSS was highly comorbid with depression and anxiety at all-time points. The most robust predictor of PTSS at 6-months postpartum was PTSS at 4-6 weeks postpartum.

Racial Differences in the Association Between Maternal Antenatal Depression and Preterm Birth Risk: A Prospective Cohort Study.

Ncube CN, Enquobahrie DA, Gavin AR.  J Womens Health (Larchmt). 2017 Jun 16.

Mood symptoms in pregnant and postpartum women with bipolar disorder: a naturalistic study.  

Driscoll KE, Sit DKY, Moses-Kolko EL, Pinheiro E, Yang A, Ciolino JD, Eng HF, Luther JF, Clark CT, Wisniewski SR, Wisner KL.  Bipolar Disord. 2017 Jun 30.

Mild residual depressive symptoms were present in both treated and untreated women with bipolar disorder.

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