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
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.
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.
Rotem-Kohavi N, Oberlander TF. Birth Defects Res. 2017 Jul 17;109(12):909-923.
Review of developmental outcomes.
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.
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.
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).
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.
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.
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.
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.
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.
Ncube CN, Enquobahrie DA, Gavin AR. J Womens Health (Larchmt). 2017 Jun 16.
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.