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Wiggs KK, Sujan AC, Rickert ME, Quinn PD, Larsson H, Lichtenstein P, D'Onofrio BM, Oberg AS. Maternal Serotonergic Antidepressant Use in Pregnancy and Risk of Seizures in Children. Neurology 2022; 98:e2329-e2336. [PMID: 35545445 PMCID: PMC9202527 DOI: 10.1212/wnl.0000000000200516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To evaluate whether children born to women who use serotonergic antidepressants during pregnancy have higher risk of neonatal seizures and epilepsy. METHODS We used Swedish register-based data to examine associations between maternal reported use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) in pregnancy and diagnosis of neonatal seizures or epilepsy in >1.2 million children. To account for systematic differences between exposed and unexposed children, we adjusted for a wide range of measured confounders. After first evaluating the role of maternal indication for SSRI/SNRI use (i.e., depression or anxiety) and parental epilepsy, we adjusted for remaining parental background factors (e.g., age, comorbidities, education, and family socioeconomic indices) and pregnancy-specific characteristics (e.g., maternal use of other psychotropic medications and tobacco smoking in early pregnancy). RESULTS Compared with all other children, children of women who reported use of SSRI/SNRI in pregnancy had an elevated risk of neonatal seizures and epilepsy (risk ratio [RR] 1.41, 95% CI 1.03-1.94; hazard ratio [HR] 1.21, 95% CI 1.03-1.43, respectively). The estimates of association were attenuated by adjustment for maternal indications for SSRI/SNRI use (RR 1.30, 95% CI 0.94-1.80; HR 1.13, 95% CI 0.95-1.33), but not by additional adjustment for parental history of epilepsy. Full adjustment for all measured parental and pregnancy-specific factors resulted in substantial attenuation of the remaining associations (RR 1.10, 95% CI 0.79-1.53; HR 0.96, 95% CI 0.81-1.14). DISCUSSION We found no support for the concern that maternal SSRI/SNRI use in pregnancy increases children's risk for neonatal seizures or epilepsy. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that exposure to SSRIs/SNRIs in the first trimester of pregnancy is not associated with an increased incidence of neonatal seizures/epilepsy.
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Affiliation(s)
- Kelsey Kathleen Wiggs
- From the Department of Psychological & Brain Sciences (K.K.W., M.E.R., B.M.D.) and Department of Applied Health Science, School of Public Health (P.D.Q.), Indiana University, Bloomington; Kaiser Permanente Northern California Division of Research (A.C.S.), Oakland; Department of Medical Epidemiology and Biostatistics (H.L., P.L., B.M.D., A.S.O.), Karolinska Institutet, Stockholm; School of Medical Sciences (H.L.), Örebro University, Sweden; and Department of Epidemiology (A.S.O.), T.H. Chan School of Public Health, Harvard, Boston, MA.
| | - Ayehsa C Sujan
- From the Department of Psychological & Brain Sciences (K.K.W., M.E.R., B.M.D.) and Department of Applied Health Science, School of Public Health (P.D.Q.), Indiana University, Bloomington; Kaiser Permanente Northern California Division of Research (A.C.S.), Oakland; Department of Medical Epidemiology and Biostatistics (H.L., P.L., B.M.D., A.S.O.), Karolinska Institutet, Stockholm; School of Medical Sciences (H.L.), Örebro University, Sweden; and Department of Epidemiology (A.S.O.), T.H. Chan School of Public Health, Harvard, Boston, MA
| | - Martin E Rickert
- From the Department of Psychological & Brain Sciences (K.K.W., M.E.R., B.M.D.) and Department of Applied Health Science, School of Public Health (P.D.Q.), Indiana University, Bloomington; Kaiser Permanente Northern California Division of Research (A.C.S.), Oakland; Department of Medical Epidemiology and Biostatistics (H.L., P.L., B.M.D., A.S.O.), Karolinska Institutet, Stockholm; School of Medical Sciences (H.L.), Örebro University, Sweden; and Department of Epidemiology (A.S.O.), T.H. Chan School of Public Health, Harvard, Boston, MA
| | - Patrick D Quinn
- From the Department of Psychological & Brain Sciences (K.K.W., M.E.R., B.M.D.) and Department of Applied Health Science, School of Public Health (P.D.Q.), Indiana University, Bloomington; Kaiser Permanente Northern California Division of Research (A.C.S.), Oakland; Department of Medical Epidemiology and Biostatistics (H.L., P.L., B.M.D., A.S.O.), Karolinska Institutet, Stockholm; School of Medical Sciences (H.L.), Örebro University, Sweden; and Department of Epidemiology (A.S.O.), T.H. Chan School of Public Health, Harvard, Boston, MA
| | - Henrik Larsson
- From the Department of Psychological & Brain Sciences (K.K.W., M.E.R., B.M.D.) and Department of Applied Health Science, School of Public Health (P.D.Q.), Indiana University, Bloomington; Kaiser Permanente Northern California Division of Research (A.C.S.), Oakland; Department of Medical Epidemiology and Biostatistics (H.L., P.L., B.M.D., A.S.O.), Karolinska Institutet, Stockholm; School of Medical Sciences (H.L.), Örebro University, Sweden; and Department of Epidemiology (A.S.O.), T.H. Chan School of Public Health, Harvard, Boston, MA
| | - Paul Lichtenstein
- From the Department of Psychological & Brain Sciences (K.K.W., M.E.R., B.M.D.) and Department of Applied Health Science, School of Public Health (P.D.Q.), Indiana University, Bloomington; Kaiser Permanente Northern California Division of Research (A.C.S.), Oakland; Department of Medical Epidemiology and Biostatistics (H.L., P.L., B.M.D., A.S.O.), Karolinska Institutet, Stockholm; School of Medical Sciences (H.L.), Örebro University, Sweden; and Department of Epidemiology (A.S.O.), T.H. Chan School of Public Health, Harvard, Boston, MA
| | - Brian M D'Onofrio
- From the Department of Psychological & Brain Sciences (K.K.W., M.E.R., B.M.D.) and Department of Applied Health Science, School of Public Health (P.D.Q.), Indiana University, Bloomington; Kaiser Permanente Northern California Division of Research (A.C.S.), Oakland; Department of Medical Epidemiology and Biostatistics (H.L., P.L., B.M.D., A.S.O.), Karolinska Institutet, Stockholm; School of Medical Sciences (H.L.), Örebro University, Sweden; and Department of Epidemiology (A.S.O.), T.H. Chan School of Public Health, Harvard, Boston, MA
| | - A Sara Oberg
- From the Department of Psychological & Brain Sciences (K.K.W., M.E.R., B.M.D.) and Department of Applied Health Science, School of Public Health (P.D.Q.), Indiana University, Bloomington; Kaiser Permanente Northern California Division of Research (A.C.S.), Oakland; Department of Medical Epidemiology and Biostatistics (H.L., P.L., B.M.D., A.S.O.), Karolinska Institutet, Stockholm; School of Medical Sciences (H.L.), Örebro University, Sweden; and Department of Epidemiology (A.S.O.), T.H. Chan School of Public Health, Harvard, Boston, MA
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Sun Y, Dreier JW, Wu C, Ehrenstein V, Christensen J. Importance of Reporting Complete Procedures of Identifying Patients from the Danish National Patient Registry: The Case of Neonatal Jaundice and Epilepsy. Clin Epidemiol 2022; 14:445-452. [PMID: 35418783 PMCID: PMC8995155 DOI: 10.2147/clep.s353215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The Danish National Patient Registry (DNPR) is a valuable resource for medical and epidemiological Research. However, not all research articles fully described procedures they used to identify events. In this study, we compared two approaches in identifying persons with a disease diagnosis using neonatal jaundice and epilepsy as examples. Methods A cohort of singletons born alive between the 1st January 1997 and the 30th November 2016 in Denmark was used for this purpose. Diagnostic information for a hospital contact in the registry included a primary diagnosis, secondary diagnoses, referral diagnoses, and additional information to a diagnosis (associated diagnoses), if any. Approach 1 identified patients of interest by considering all diagnostic information with exclusion of referral diagnoses only. Approach 2 identified patients of interest by additionally excluding diagnoses from a hospital contact that were coded with Z00 – Z99 of ICD-10 (for health service on examination and reproduction, etc.) as the main reason of the hospital contact. We presented the proportion of people with a diagnosis of neonatal jaundice and epilepsy by the two approaches and explored the potential explanations for the difference. Results For the example of neonatal jaundice, the study population included N=1,186,683 persons. The proportion of children with a diagnosis of neonatal jaundice was 5.5% (n=66,736) by approach 1 and 3.9% (n=45,928) by approach 2. For the example of epilepsy, the study population included N=1,183,273 persons. The proportion of children with a diagnosis of epilepsy were 1.2% (n=14,604) by approach 1 and 0.9% (n=10,441) by approach 2. Discussion This study demonstrated that the two approaches identified different proportion of persons with a diagnosis of neonatal jaundice and epilepsy. We advocated researchers report complete procedures of identifying patients for making research findings reproducible and comparable. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/nYwWUUkmFBs
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Affiliation(s)
- Yuelian Sun
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Correspondence: Yuelian Sun, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark, Email
| | - Julie Werenberg Dreier
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Chunsen Wu
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob Christensen
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Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Leung MTY, Wong KH, Ho PWH, Ip P, Wei L, Wong ICK, Man KKC. Gestational exposure to antidepressants and risk of seizure in offspring: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 131:345-359. [PMID: 34571118 DOI: 10.1016/j.neubiorev.2021.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
In spite of the preliminary evidence suggesting a link between gestational use of antidepressant and neurodevelopmental disorders in their offspring, the association between maternal use of antidepressants during pregnancy and the risk of neurologically-related adverse outcomes such as neonatal seizure is still unclear. This study summarises the available evidence on the association between gestational exposure to any antidepressants and the risk of seizure in neonates and children. We found that gestational antidepressant exposure is associated with a 2.3-fold higher incidence of seizure in offspring. Although a causal relationship cannot be confirmed in view of other potential confounders, our findings warrant future research on related clinical aspects, and possibly more careful monitoring of foetal neurodevelopment in pregnant women taking antidepressants during pregnancy. However, this does not suggest the abrupt withdrawal of antidepressants during pregnancy for all cases at risk of seizure in offspring as this must be balanced with the risk of negative consequences caused by untreated maternal depression, and decision-making should be individualised for each patient.
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Affiliation(s)
- Miriam T Y Leung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Kirstie H Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong; Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Phoebe W H Ho
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong; Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong; Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.
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Abstract
INTRODUCTION The POMME (PrescriptiOn Médicaments Mères Enfants) cohort has been implemented for the evaluation of the long-term consequences of medicine prenatal exposure. It holds anonymous medical information as well as information on medicine and healthcare reimbursement to the children, from the first day of intra-uterine life until childhood. OBJECTIVE This article provides a description of the cohort regarding its structure and content and presents an outlook of the studies that could be performed with this new data source. METHODS Data sources include (1) the French Health Insurance Database (medicines and medical care prescriptions and reimbursements to children and mothers during pregnancy) and (2) the Mother and Child Protection Centre Database (child health certificates at birth, 9 months of age and 24 months of age). Children born in Haute-Garonne (south-west France), over a period of 1 year (from 1 July to 30 June), are registered in POMME every 5 years. The cohort began on 1 July, 2010. RESULTS To date, 8372 children have been recorded in POMME. They have reached 7 years of age now. Among them, 4249 (50.8%) are boys, 286 (3.4%) were from multiple pregnancies and 519 (6.2%) were born prematurely. They were prenatally exposed to 9.8 ± 6.1 medications. After birth, drug exposure was greatest in children aged 0-2 years. Children were mostly exposed to paracetamol, anti-infective agents and respiratory system drugs; 908 (10.8%) children presented with at least two signs of psychomotor development disorders. CONCLUSIONS POMME provides an observatory study on drug exposure and medical care use in children. This innovative cohort would make it possible to assess the risk of the long-term consequences of prenatal medicine exposure.
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Antidepressant use in pregnancy: are we closer to consensus? Arch Womens Ment Health 2019; 22:189-197. [PMID: 30128847 DOI: 10.1007/s00737-018-0906-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 08/10/2018] [Indexed: 01/01/2023]
Abstract
We specify and summarize significant data from recent large studies in a tool with which to aim at consensus on the question of whether and how serotonin-reuptake antidepressants should be used in pregnancy, on the basis that concern for the mental health of the mother should not vie for primacy with concern for the short-, medium-, and long-term health of the child, but must be best served together. Side effects are small but significant over the majority of 11 categories, perinatal and into adolescence. In clinical practice, alternatives for serotonin-reuptake medication in pregnancy should be more actively pursued.
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Fatima Z, Zahra A, Ghouse M, Wang X, Yuan Z. Maternal SSRIs experience and risk of ASD in offspring: a review. Toxicol Res (Camb) 2018; 7:1020-1028. [PMID: 30510676 PMCID: PMC6220718 DOI: 10.1039/c8tx00102b] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/09/2018] [Indexed: 12/20/2022] Open
Abstract
Antidepressants are extensively used during pregnancy and associated with severe outcomes, including innate malformations, prematurity, and low birth weight, etc. A recent study suggested that prenatal exposure to antidepressants may impair child neurodevelopment process. Thus, the aim of this review is to investigate the potential association between prenatal use of selective 5-HT reuptake inhibitors (SSRIs) and the risk of autism spectrum disorders (ASDs). Twelve studies related to the linkage between SSRI exposure during pregnancy and ASD in children were explored and compiled. However, there is a knowledge gap concerning the potential link between gestational exposure to antidepressants and the risk of ASDs. Despite such limitations, the available data show that some signal exists and signifies that antenatal exposure to SSRIs may increase the risk of ASDs. Thus, there is a vital need for further, large and well-designed research to definitively evaluate the existence and the magnitude of this severe risk.
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Affiliation(s)
- Zainab Fatima
- National Reference Laboratory of Veterinary Drug Residues and MAO Key Laboratory for Detection of Veterinary Drug Residues , Huazhong Agricultural University (HZAU) , Wuhan , China . ; ; ; Fax: +86-27-87672232 ; Tel: +86-27-87287186 ; Tel: +86-27-87287186
| | - Aqeela Zahra
- School of Life Sciences , South China Normal University , China
- School of Psychology and Brain Science Institute , South China Normal University , Guangzhou , 510631
| | - Maria Ghouse
- School of Life Sciences , South China Normal University , China
| | - Xu Wang
- National Reference Laboratory of Veterinary Drug Residues and MAO Key Laboratory for Detection of Veterinary Drug Residues , Huazhong Agricultural University (HZAU) , Wuhan , China . ; ; ; Fax: +86-27-87672232 ; Tel: +86-27-87287186 ; Tel: +86-27-87287186
| | - Zonghui Yuan
- National Reference Laboratory of Veterinary Drug Residues and MAO Key Laboratory for Detection of Veterinary Drug Residues , Huazhong Agricultural University (HZAU) , Wuhan , China . ; ; ; Fax: +86-27-87672232 ; Tel: +86-27-87287186 ; Tel: +86-27-87287186
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products , Wuhan , China
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Dassi Tchoupa Revegue MH, Marin B, Ibinga E, Boumediene F, Preux PM, Ngoungou EB. Meta-analysis of perinatal factors associated with epilepsy in tropical countries. Epilepsy Res 2018; 146:54-62. [DOI: 10.1016/j.eplepsyres.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/27/2018] [Accepted: 07/14/2018] [Indexed: 12/18/2022]
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Dreier JW, Petersen L, Pedersen CB, Christensen J. Parental age and risk of epilepsy: A nationwide register-based study. Epilepsia 2018; 59:1334-1343. [PMID: 29897612 DOI: 10.1111/epi.14453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aims to examine the association between maternal age, paternal age, and parental age difference at the time of birth and the risk of epilepsy in the offspring. METHODS We carried out a prospective population-based register study of all singletons born in Denmark between 1981 and 2012. Cox regression was used to estimate hazard ratios (HRs) of epilepsy and their corresponding 95% confidence intervals (CIs), adjusted for relevant confounders. RESULTS We followed 1 587 897 individuals for a total of ~25 million person-years and identified 21 797 persons with epilepsy during the study period. An excess risk of epilepsy was found in individuals born to mothers younger than 20 years (HR = 1.17, 95% CI = 1.07-1.29) and born to parental couples where paternal age exceeded maternal age by at least 5 years. The risk of epilepsy increased with increasing parental age gap and was highest when the father was ≥15 years older than the mother (adjusted HR = 1.28, 95% CI = 1.16-1.41). In contrast to maternal age, we found that paternal age did not independently contribute to offspring epilepsy risk, once we accounted for the parental age difference (P = .1418). The observed associations with maternal age and parental age gap were invariant to epilepsy subtypes, but were modified by age of epilepsy onset, with the effect being most pronounced in the first 10 years of the child's life. SIGNIFICANCE Maternal age and parental age gap, but not paternal age, were associated with the offspring's risk of epilepsy. Our results do not support the hypothesis that de novo mutations associated with advanced paternal age increase the risk of epilepsy in the offspring.
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Affiliation(s)
- Julie W Dreier
- National Center for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Liselotte Petersen
- National Center for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Carsten B Pedersen
- National Center for Register-Based Research, Aarhus University, Aarhus, Denmark.,Center for Integrated Register-Based Research, Aarhus, Denmark
| | - Jakob Christensen
- National Center for Register-Based Research, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Mao Y, Ahrenfeldt LJ, Christensen K, Wu C, Christensen J, Olsen J, Sun Y. Risk of epilepsy in opposite-sex and same-sex twins: a twin cohort study. Biol Sex Differ 2018; 9:21. [PMID: 29866174 PMCID: PMC5987428 DOI: 10.1186/s13293-018-0179-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/14/2018] [Indexed: 02/08/2023] Open
Abstract
Background There is a complex interaction between female and male sex hormones and the risk of epilepsy. Whether prenatal exposure to higher levels of sex hormones affects the development of epilepsy in childhood or later in life is not well known. The sex hormone environment of fetuses may be affected by the sex of the co-twin. We estimated the risk of epilepsy for twins with an opposite-sex (OS) co-twin compared with twins with a same-sex (SS) co-twin. Methods From the Danish Twin Registry, we identified OS female twins (n = 11,078), SS female twins (n = 19,186), OS male twins (n = 11,080), and SS male twins (n = 20,207) born between 1977 and 2009. The SS twins include monozygotic twins, dizygotic twins, and twins with unknown zygosity. These children were followed up from day 29 after birth until diagnosis of epilepsy, death, emigration, or end of follow-up (31 December 2011) whichever came first. Information on diagnosis of epilepsy was obtained from the Danish National Patient Registry. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for epilepsy in the OS twins using a Cox proportional hazards regression model compared with the SS twins. To account for the correlation of twins from the same mother when estimating standard errors, we used the cluster option in Stata. Results We identified 152 OS female twins, 282 SS female twins, 162 OS male twins, and 335 SS male twins diagnosed with epilepsy corresponding to an incidence rate of 9.9 and 9.7 per 10,000 person years for the OS and SS female twins, and 10.6 and 10.9 per 10,000 person years for the OS and SS male twins, respectively. We found a similar risk of epilepsy among the OS and SS female twins [HR = 1.01; 95% CI 0.83–1.24] as well as among the OS and SS male twins [HR = 0.94; 95% CI 0.78–1.14] Conclusions In this population-based study of Danish twins, we did not find difference in the risk of epilepsy between twins with an OS co-twin and twins with a SS co-twin. This applied to both female and male twins. The study therefore does not support the hypothesis that subtle hormone difference in fetal life due to co-twin may play a role in the development of epilepsy later in life.
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Affiliation(s)
- Yanyan Mao
- School of Public Health, Fudan University, Shanghai, China.,Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China
| | - Linda Juel Ahrenfeldt
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Chunsen Wu
- Research Unit of Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Jakob Christensen
- Department of Neurology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Institute for Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), California, LA, USA
| | - Yuelian Sun
- Department of Clinical Epidemiology, Institute for Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark.
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Zabegalov KN, Kolesnikova TO, Khatsko SL, Volgin AD, Yakovlev OA, Amstislavskaya TG, Alekseeva PA, Meshalkina DA, Friend AJ, Bao W, Demin KA, Gainetdinov RR, Kalueff AV. Understanding antidepressant discontinuation syndrome (ADS) through preclinical experimental models. Eur J Pharmacol 2018; 829:129-140. [DOI: 10.1016/j.ejphar.2018.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 12/14/2022]
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Pedersen LH. The risks associated with prenatal antidepressant exposure: time for a precision medicine approach. Expert Opin Drug Saf 2017. [PMID: 28621560 DOI: 10.1080/14740338.2017.1341872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The prevalence of depression in pregnancy is over 10% and a significant proportion of pregnant women use antidepressant medication. The safety of antidepressants in pregnancy is controversial, partly due to methodological challenges. The conflicting results in the literature may, however, also be due to differences in risks between the study populations related to variations in e.g. degree of depression, type of antidepressant, and lifestyle. Areas covered: The literature on the safety of antidepressants in pregnancy is vast and thousands of papers have been published mainly in the last decades. This paper summarizes the evidence on important outcomes, including malformations, obstetric and neonatal outcomes, and long-term effects. It further describes results indicating that genetic variations in e.g. metabolism need to be taken into account. Expert opinion: Use of antidepressants during pregnancy must balance between the risks related to the underlying disease and the risks of antidepressant use. This balance needs to include information on a number of factors, including degree of depression and life-style. More data are required on how to include genetic information in the counseling. Overall, emerging evidence points to the need for a precision medicine approach to the treatment of pregnant women with depression.
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Affiliation(s)
- Lars Henning Pedersen
- a Department of Obstetrics and Gynecology, Institute of Clinical Medicine , Aarhus University & Aarhus University Hospital , Aarhus , Denmark
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