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Chi LH, Burrows AD, Anderson RL. Can preclinical drug development help to predict adverse events in clinical trials? Drug Discov Today 2021; 27:257-268. [PMID: 34469805 DOI: 10.1016/j.drudis.2021.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/03/2021] [Accepted: 08/24/2021] [Indexed: 12/23/2022]
Abstract
The development of novel therapeutics is associated with high rates of attrition, with unexpected adverse events being a major cause of failure. Serious adverse events have led to organ failure, cancer development and deaths that were not expected outcomes in clinical trials. These life-threatening events were not identified during therapeutic development due to the lack of preclinical safety tests that faithfully represented human physiology. We highlight the successful application of several novel technologies, including high-throughput screening, organs-on-chips, microbiome-containing drug-testing platforms and humanised mouse models, for mechanistic studies and prediction of toxicity. We propose the incorporation of similar preclinical tests into future drug development to reduce the likelihood of hazardous therapeutics entering later-stage clinical trials.
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Affiliation(s)
- Lap Hing Chi
- Translational Breast Cancer Program, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia; School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia
| | - Allan D Burrows
- Translational Breast Cancer Program, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia; School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia
| | - Robin L Anderson
- Translational Breast Cancer Program, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia; School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.
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2
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Guo Y, Lee H, Jeong H. Gut microbiota in reductive drug metabolism. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2020; 171:61-93. [PMID: 32475528 DOI: 10.1016/bs.pmbts.2020.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gut bacteria are predominant microorganisms in the gut microbiota and have been recognized to mediate a variety of biotransformations of xenobiotic compounds in the gut. This review is focused on one of the gut bacterial xenobiotic metabolisms, reduction. Xenobiotics undergo different types of reductive metabolisms depending on chemically distinct groups: azo (-NN-), nitro (-NO2), alkene (-CC-), ketone (-CO), N-oxide (-NO), and sulfoxide (-SO). In this review, we have provided select examples of drugs in six chemically distinct groups that are known or suspected to be subjected to the reduction by gut bacteria. For some drugs, responsible enzymes in specific gut bacteria have been identified and characterized, but for many drugs, only circumstantial evidence is available that indicates gut bacteria-mediated reductive metabolism. The physiological roles of even known gut bacterial enzymes have not been well defined.
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Affiliation(s)
- Yukuang Guo
- Department of Pharmaceutical Sciences, Center for Biomolecular Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Hyunwoo Lee
- Department of Pharmaceutical Sciences, Center for Biomolecular Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States.
| | - Hyunyoung Jeong
- Department of Pharmaceutical Sciences, Center for Biomolecular Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States.
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Zhong QY, Gelaye B, Karlson EW, Avillach P, Smoller JW, Cai T, Williams MA. Associations of antepartum suicidal behaviour with adverse infant and obstetric outcomes. Paediatr Perinat Epidemiol 2019; 33:137-144. [PMID: 30790331 DOI: 10.1111/ppe.12535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/02/2018] [Accepted: 12/05/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Relatively little is known about antepartum suicidal behaviour and pregnancy outcomes. We examined associations of antepartum suicidal behaviour, alone and in combination with psychiatric disorders, with adverse infant and obstetric outcomes. METHODS We included 188 925 singleton livebirths from a retrospective cohort (1996-2016). Suicidal behaviour, psychiatric disorders, and outcomes were derived from electronic medical records. We performed multivariable logistic regressions with generalised estimating equations to estimate adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). RESULTS The prevalence of antepartum suicidal behaviour was 152.44 per 100 000 singleton livebirths. Nearly two-thirds (64.24%) of women with suicidal behaviour also had psychiatric disorders. Compared to women without psychiatric disorders and suicidal behaviour, women with psychiatric disorders alone had 1.3-fold to 1.4-fold increased odds of delivering low birthweight or preterm infants and 1.2-fold increased odds of experiencing obstetric complications. Women with suicidal behaviour alone had increased odds of preterm labour (aOR 2.05, 95% CI 1.16, 3.62). Women with both suicidal behaviour and psychiatric disorders had > twofold increased odds of delivering low birthweight (aOR 2.52, 95% CI 1.40, 4.54), preterm birth (aOR 2.44, 95% CI 1.63, 3.66), and low birthweight/preterm birth (aOR 2.30, 95% CI 1.54, 3.44) infants; the odds of preterm labour (aOR 1.62, 95% CI 1.06, 2.47), placental abruption (aOR 2.33, 95% CI 1.20, 4.51), preterm rupture of membranes (aOR 1.63, 95% CI 1.08, 2.46), and postpartum haemorrhage (aOR 1.93, 95%CI 1.09, 3.40) were elevated. CONCLUSIONS Antepartum suicidal behaviour, when co-occurring with psychiatric disorders, is associated with increased odds of adverse infant and obstetric outcomes. Future studies are warranted to understand the causal roles of suicidal behaviour and psychiatric disorders in pregnancy.
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Affiliation(s)
- Qiu-Yue Zhong
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Elizabeth W Karlson
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul Avillach
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Children's Hospital Informatics Program, Boston Children's Hospital, Boston, Massachusetts.,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Jordan W Smoller
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Tianxi Cai
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Zhong QY, Gelaye B, Smoller JW, Avillach P, Cai T, Williams MA. Adverse obstetric outcomes during delivery hospitalizations complicated by suicidal behavior among US pregnant women. PLoS One 2018; 13:e0192943. [PMID: 29447245 PMCID: PMC5814027 DOI: 10.1371/journal.pone.0192943] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 01/16/2018] [Indexed: 11/19/2022] Open
Abstract
Objective The effects of suicidal behavior on obstetric outcomes remain dangerously unquantified. We sought to report on the risk of adverse obstetric outcomes for US women with suicidal behavior at the time of delivery. Methods We performed a cross-sectional analysis of delivery hospitalizations from 2007–2012 National (Nationwide) Inpatient Sample. From the same hospitalization record, International Classification of Diseases codes were used to identify suicidal behavior and adverse obstetric outcomes. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were obtained using logistic regression. Results Of the 23,507,597 delivery hospitalizations, 2,180 were complicated by suicidal behavior. Women with suicidal behavior were at a heightened risk for outcomes including antepartum hemorrhage (aOR = 2.34; 95% CI: 1.47–3.74), placental abruption (aOR = 2.07; 95% CI: 1.17–3.66), postpartum hemorrhage (aOR = 2.33; 95% CI: 1.61–3.37), premature delivery (aOR = 3.08; 95% CI: 2.43–3.90), stillbirth (aOR = 10.73; 95% CI: 7.41–15.56), poor fetal growth (aOR = 1.70; 95% CI: 1.10–2.62), and fetal anomalies (aOR = 3.72; 95% CI: 2.57–5.40). No significant association was observed for maternal suicidal behavior with cesarean delivery, induction of labor, premature rupture of membranes, excessive fetal growth, and fetal distress. The mean length of stay was longer for women with suicidal behavior. Conclusion During delivery hospitalization, women with suicidal behavior are at increased risk for many adverse obstetric outcomes, highlighting the importance of screening for and providing appropriate clinical care for women with suicidal behavior during pregnancy.
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Affiliation(s)
- Qiu-Yue Zhong
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jordan W. Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Paul Avillach
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
- Children’s Hospital Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Tianxi Cai
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Gelaye B, Kajeepeta S, Williams MA. Suicidal ideation in pregnancy: an epidemiologic review. Arch Womens Ment Health 2016; 19:741-51. [PMID: 27324912 PMCID: PMC5023474 DOI: 10.1007/s00737-016-0646-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
Suicidal behaviors are the leading causes of injury and death worldwide, and are leading causes of maternal deaths in some countries. One of the strongest risk factors, suicidal ideation, is considered a harbinger and distal predictor of later suicide attempt and completion, and also presents an opportunity for interventions prior to physical self-harm. The purpose of this systematic epidemiologic review is to synthesize available research on antepartum suicidal ideation. Original publications were identified through searches of the electronic databases using the search terms pregnancy, pregnant women, suicidal ideation, and pregnan* and suicid* as root searches. We also reviewed references of published articles. We identified a total of 2626 articles through the electronic database search. After irrelevant and redundant articles were excluded, 57 articles were selected. The selected articles were original articles that focused on pregnancy and suicidal ideation. Of the 57 included articles, 20 reported prevalence, 26 reported risk factors, 21 reported consequences of antepartum suicidal ideation, and 5 reported on screening measures. Available evidence indicates that pregnant women are more likely than the general population to endorse suicidal ideation. Additionally, a number of risk factors for antepartum suicidal ideation were identified including intimate partner violence, <12-year education, and major depressive disorder. There is a need for enhanced screening for antepartum suicidal ideation. The few screening instruments that exist are limited as they were primarily developed to measure antepartum and postpartum depression. Given a substantial proportion of women with suicidal ideation that does not meet clinical thresholds of depression and given the stress-diathesis model that shows susceptibility to suicidal behavior independent of depressive disorders, innovative approaches to improve screening and detection of antepartum suicidal ideation are urgently needed.
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Affiliation(s)
- Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, K505F, Boston, MA, 02115, USA.
| | - Sandhya Kajeepeta
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
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Larsen ER, Damkier P, Pedersen LH, Fenger-Gron J, Mikkelsen RL, Nielsen RE, Linde VJ, Knudsen HED, Skaarup L, Videbech P. Use of psychotropic drugs during pregnancy and breast-feeding. Acta Psychiatr Scand Suppl 2016:1-28. [PMID: 26344706 DOI: 10.1111/acps.12479] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To write clinical guidelines for the use of psychotropic drugs during pregnancy and breast-feeding for daily practice in psychiatry, obstetrics and paediatrics. METHOD As we wanted a guideline with a high degree of consensus among health professionals treating pregnant women with a psychiatric disease, we asked the Danish Psychiatric Society, the Danish Society of Obstetrics and Gynecology, the Danish Paediatric Society and the Danish Society of Clinical Pharmacology to appoint members for the working group. A comprehensive review of the literature was hereafter conducted. RESULTS Sertraline and citalopram are first-line treatment among selective serotonin reuptake inhibitor for depression. It is recommended to use lithium for bipolar disorders if an overall assessment finds an indication for mood-stabilizing treatment during pregnancy. Lamotrigine can be used. Valproate and carbamazepin are contraindicated. Olanzapine, risperidone, quetiapine and clozapine can be used for bipolar disorders and schizophrenia. CONCLUSION It is important that health professionals treating fertile women with a psychiatric disease discuss whether psychotropic drugs are needed during pregnancy and how it has to be administered.
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Affiliation(s)
- E. R. Larsen
- Department of Affective Disorders; Aarhus University Hospital; Risskov Denmark
| | - P. Damkier
- Department of Clinical Biochemistry and Pharmacology; Odense University Hospital; Odense Denmark
| | - L. H. Pedersen
- Department of Clinical Medicine - Gynecological/Obstetric Ward Y; Aarhus University Hospital; Skejby Denmark
| | | | - R. L. Mikkelsen
- Psychiatry in the Capital Region of Denmark; Psychiatric Centre Copenhagen; Section 6211; Rigshospitalet; Copenhagen Denmark
| | - R. E. Nielsen
- Psychiatry; Aalborg University Hospital; Aalborg Denmark
| | - V. J. Linde
- Psychiatry in the Capital Region of Denmark; Psychiatric Centre Copenhagen; Affective Ward 6203; Rigshospitalet; Copenhagen Denmark
| | - H. E. D. Knudsen
- District Psychiatry Center; Psychiatric Center; Hvidovre Denmark
| | - L. Skaarup
- Department of Affective Disorders; Aarhus University Hospital; Risskov Denmark
| | - P. Videbech
- Department of Affective Disorders; Aarhus University Hospital; Risskov Denmark
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Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: a systematic review. Eur Child Adolesc Psychiatry 2014; 23:973-92. [PMID: 24863148 DOI: 10.1007/s00787-014-0558-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 05/02/2014] [Indexed: 12/17/2022]
Abstract
Antidepressant and anxiolytic medications are widely prescribed and used by pregnant women for acute and maintenance therapy. These drugs are able to pass the placental barrier, and may potentially influence fetal and brain development. It is possible that exposure to prenatal antidepressants or anxiolytic medication may disturb neurotransmitter systems in the brain and have long-lasting consequences on neurodevelopment in the offspring. As all medication during pregnancy may pose a certain risk to the developing fetus, the potential benefits of the medication must be weighed against the risks for both mother and her unborn child. Therefore, information to guide patients and physicians to make a well-balanced decision for the appropriate treatment during pregnancy is needed. In this systematic review, an overview of maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes is provided. Some studies indicate a relation between prenatal exposure to antidepressants and adverse neurodevelopmental outcomes such as delayed motor development/motor control, social difficulties, internalizing problems and autism, but cannot rule out confounding by indication. Overall, the results of the observational studies have been inconsistent, which makes translation of the findings into clinical recommendations difficult. More well-designed observational studies and also randomized controlled trials (e.g., maintenance treatment vs. cessation) are needed to move forward and provide a comprehensive evaluation of the risks and benefits of antidepressant and anxiolytic use during pregnancy.
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Meltzer-Brody S, Stuebe A. The long-term psychiatric and medical prognosis of perinatal mental illness. Best Pract Res Clin Obstet Gynaecol 2013; 28:49-60. [PMID: 24063973 DOI: 10.1016/j.bpobgyn.2013.08.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 06/29/2013] [Accepted: 08/13/2013] [Indexed: 11/30/2022]
Abstract
The perinatal period provides an important window into a woman's long-term health. Perinatal mental illness is a common condition conferring potential serious long-term psychiatric and medical consequences for the mother and family. It is known that childbirth acts as a powerful trigger for depressive episodes in some women, and that women with histories of a mood disorder are particularly vulnerable. Some evidence links perinatal mental illness with obstetrical complications and reduced lactation initiation and duration. Therefore, perinatal mental illness may be a marker for long-term risk, and may contribute directly to subsequent cardiometabolic disease through both neuroendocrine mechanisms and the effects of mental illness on health behaviours. In clinical practice, these associations underscore the importance of screening and treating women with perinatal mental illness to ensure best possible long-term outcomes. Early screening and treatment may both mitigate the primary disease process and reduce the risk of comorbid medical conditions.
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Affiliation(s)
| | - Alison Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, NC, USA
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Bellantuono C, Tofani S, Di Sciascio G, Santone G. Benzodiazepine exposure in pregnancy and risk of major malformations: a critical overview. Gen Hosp Psychiatry 2013; 35:3-8. [PMID: 23044244 DOI: 10.1016/j.genhosppsych.2012.09.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 08/30/2012] [Accepted: 09/01/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Benzodiazepines (BDZs) safety profiles in pregnancy suggest that the risk of major malformations (MMs) cannot be considered simply as a "class effect". The aim of this paper was to review and update the available literature on the risks of MMs in women exposed to BDZs in the first trimester of pregnancy. METHODS PubMed was searched for English-language articles, from January 2001 to November 2011, introducing as keywords "teratogens", " major malformation", "foetus", "infant", "newborn", "pregnancy", in conjunction with "benzodiazepines" as a keyword or BDZ generic name as text words. RESULTS Twelve studies were selected for the review. BDZ exposure during the first trimester of pregnancy seems not to be associated with an increasing risk of congenital MMs. Diazepam and chlordiazepoxide should be considered drugs of first choice. CONCLUSIONS Data published in the last 10 years did not indicate an absolute contraindication in prescribing BDZs during the first gestational trimester. In any case, studies analyzed suffer from a number of methodological limitations such as lack of careful report of BDZ patterns of use in pregnancy, possible influences of recall bias, lack of controlling for confounding factors and lack of data concerning possible MMs in aborted fetuses.
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Affiliation(s)
- Cesario Bellantuono
- Psychiatric Unit, United Hospitals of Ancona and Department of Experimental and Clinical Medicine at the Polytechnic University of Marche, Ancona, Italy
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIMITTEL IN SCHWANGERSCHAFT UND STILLZEIT 2012. [PMCID: PMC7271212 DOI: 10.1016/b978-3-437-21203-1.10002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Background: Epidemiological research has demonstrated that suicidal ideation is a relatively frequent complication of pregnancy in both developed and developing countries. Hence, the aims of this study are: to assess whether or not pregnancy may be considered a period highly susceptible to suicidal acts; to recognize potential contributing factors to suicidal behaviors; to describe the repercussions of suicide attempts on maternal, fetal, and neonatal outcome; to identify a typical profile of women at high risk of suicide during pregnancy. Methods: Medical literature information published in any language since 1950 was identified using MEDLINE/PubMed, Scopus, and Google Scholar databases. Search terms were: "pregnancy", (antenatal) "depression", "suicide". Searches were last updated on 28 September 2010. Forty-six articles assessing the suicidal risk during pregnancy and obstetrical outcome of pregnancies complicated by suicide attempts were analyzed, without methodological limitations. Results: Worldwide, frequency of suicidal attempts and the rate of death by suicidal acts are low. Although this clinical event is rare, the consequences of a suicidal attempt are medically and psychologically devastating for the mother-infant pair. We also found that common behaviors exist in women at high risk for suicide during pregnancy. Review data indeed suggest that a characteristic profile can prenatally identify those at highest risk for gestational suicide attempts. Conclusions: Social and health organizations should make all possible efforts to identify women at high suicidal risk, in order to establish specific programs to prevent this tragic event. The available data informs health policy makers with a typical profile to screen women at high risk of suicide during pregnancy. Those women who have a current or past history of psychiatric disorders, are young, unmarried, unemployed, have incurred an unplanned pregnancy (eventually terminated with an induced abortion), are addicted to illicit drugs and/or alcohol, lack effective psychosocial support, have suffered from episodes of sexual or physical violence are particularly vulnerable.
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Hall GC. Commentary on ‘validity of the codes of suicidality in the THIN database’ by Aranaet al. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.2056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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