Happy Fourth of July!  This week there are several articles on the use of antipsychotics during pregnancy (Tosato et al and Park et al). The highlight of this week is an article from Man and colleagues which did not show an association between prenatal antidepressant exposure and risk for ADHD in children.  

A Systematized Review of Atypical Antipsychotics in Pregnant Women: Balancing Between Risks of Untreated Illness and Risks of Drug-Related Adverse Effects.

Tosato S, Albert U, Tomassi S, Iasevoli F, Carmassi C, Ferrari S, Nanni MG, Nivoli A, Volpe U, Atti AR, Fiorillo A.  J Clin Psychiatry. 2017 May;78(5):e477-e489.

Abrupt discontinuation of antipsychotics in mothers with bipolar disorder or schizophrenia led to a high risk of relapses during pregnancy. Both bipolar disorder and schizophrenia were linked to a slightly increased risk of obstetric complications for mothers and newborn, although data on drug exposure during pregnancy were not given in the majority of studies.

Antipsychotic Medication Use Among Publicly Insured Pregnant Women in the United States.

Park Y, Huybrechts KF, Cohen JM, Bateman BT, Desai RJ, Patorno E, Mogun H, Cohen LS, Hernandez-Diaz S.  Psychiatr Serv. 2017 Jun 15.

The use of second-generation antipsychotics during pregnancy increased threefold, from 0.4% to 1.3%, from 2001 to 2010, while the use of first-generation antipsychotics remained stable at around .1%. Quetiapine and aripiprazole were the most commonly prescribed agents.

Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial.

Forsell E, Bendix M, Holländare F, Szymanska von Schultz B, Nasiell J, Blomdahl-Wetterholm M, Eriksson C, Kvarned S, Lindau van der Linden J, Söderberg E, Jokinen J, Wide K, Kaldo V.

J Affect Disord. 2017 Jun 13;221:56-64.

Women with depression during pregnancy who received internet-delivered CBT had significantly lower levels of depressive symptoms post treatment (p < 0.001, Hedges g =1.21) and were more likely to be responders (i.e. achieve a statistically reliable improvement) than women receiving treatment as usual.  

Prenatal antidepressant use and risk of attention-deficit/hyperactivity disorder in offspring: population based cohort study.

Man KKC, Chan EW, Ip P, Coghill D, Simonoff E, Chan PKL, Lau WCY, Schuemie MJ, Sturkenboom MCJM, Wong ICK.  BMJ. 2017 May 31;357:j2350.  Free Article

Children with mothers with psychiatric disorders had higher risk for ADHD, even if mothers had never used antidepressants (HR = 1.84; 95% CI, 1.54-2.18; P < .01).  Sibling matched analysis did not indicate a significant difference in ADHD risk between siblings exposed to antidepressants vs. those not exposed during gestation (HR = 0.54; 95% CI, 0.17-1.74).

Depression and Anxiety in the Postpartum Period and Risk of Bipolar Disorder: A Danish Nationwide Register-Based Cohort Study.

Liu X, Agerbo E, Li J, Meltzer-Brody S, Bergink V, Munk-Olsen T.  J Clin Psychiatry. 2017 May;78(5):e469-e476.   Free Article

Socioeconomic disadvantage, gestational immune activity, and neurodevelopment in early childhood.

Gilman SE, Hornig M, Ghassabian A, Hahn J, Cherkerzian S, Albert PS, Buka SL, Goldstein JM.  Proc Natl Acad Sci U S A. 2017 Jun 27;114(26):6728-6733.

Median concentrations of IL-8 were lower in the most disadvantaged pregnancies.  Offspring of these pregnancies had significantly higher risk of neurologic abnormalities at 4 months [odds ratio (OR) = 4.61] and 1 year (OR = 2.05). This higher risk was partially related to alterations in maternal immune activity, specifically lower maternal IL-8 levels, which also predicted higher risks of neurologic abnormalities at 4 months (OR = 7.67) and 1 year (OR = 2.92).

Mutual regulation between infant facial affect and maternal touch in depressed and nondepressed dyads.

Egmose I, Cordes K, Smith-Nielsen J, Væver MS, Køppe S.  Infant Behav Dev. 2017 Jun 10.

Mothers use specific touch types to regulate infants’ negative and positive affects; infants are more likely to initiate positive affect during periods with playful touch, and more likely to terminate negative affect during periods with caregiving touch.

What Is Being Measured? A Comparison of Two Depressive Symptom Severity Instruments with a Depression Diagnosis in Low-Income High-Risk Mothers.

Yang J, Martinez M, Schwartz TA, Beeber L.  J Womens Health (Larchmt). 2017 Jun;26(6):683-691.

The CES-D had better screening sensitivity and specificity than the Hamilton Depression Rating Scale. This study suggests that the Hamilton may underdiagnose cases of major depressive episodes (MDE)  among black and low-income mothers compared to the CES-D.

Antenatal depressive symptoms and subjective birth experience in association with postpartum depressive symptoms and acute stress reaction in mothers and fathers: A longitudinal path analysis.

Gürber S, Baumeler L, Grob A, Surbek D, Stadlmayr W.  Eur J Obstet Gynecol Reprod Biol. 2017 May 30;215:68-74.

Depressive symptoms during pregnancy and a negative subjective birth experience were independently predictive of postpartum depression and acute stress reaction after childbirth in mothers and fathers.

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