Neonatal outcomes in pregnant women with untreated and treated panic disorder

Pharmacotherapy of Chronic Neuropsychiatric Conditions During Pregnancy

Many pregnant persons will experience neuropsychiatric conditions during pregnancy, including migraine, attention deficit disorder, depression, and anxiety. Treatment of each of these conditions requires shared decision-making among the individual, family, and health care team. Although medications may include risk, the benefits often outweigh the potential fetal risks. In this article, we review pharmacologic treatment options for each of these conditions and appropriate use in pregnancy to maintain the stability of conditions and to optimize maternal and fetal outcomes.

Panic disorder during pregnancy: A scoping review

Background

Panic Disorder is a serious anxiety disorder, and one of the severe mental problems that impacts mothers' mental health and fetal health as well.

Aim

The current scoping review aims to provide a wide overview of the literature regarding panic disorder during pregnancy.

Methods

Twenty-five eligible articles were selected for full review from SAGE, CINAHL, PubMed, Medline, Research Gate, Science Direct, and Google Scholar literature searches. This review followed the framework suggested by Arksey and O'Malley for a scoping review.

Results

Content analysis of the studies was done, and five categories have been identified: Panic disorder course during pregnancy; prevalence of panic disorder during pregnancy; factors associated with pregnancy panic disorder; impact of panic disorder during pregnancy; and treatment of panic disorder during pregnancy.

Conclusion

A significant gap in the literature, and inconsistent and mixed findings regarding prevalence, impact, associated factors, and treatment of PD during pregnancy exist. This scoping review revealed that more studies need to be conducted to further understand and examine PD during pregnancy.

In utero exposure to antipsychotic medication and psychiatric outcomes in the offspring

Information on neurodevelopmental effects of antenatal exposure to antipsychotics is limited to 10 studies, all examining children up to 5 years of age or less. The paper aimed to investigate the association between in utero exposure to antipsychotics and psychiatric outcomes in children using Danish nationwide registers. In total, 9011 liveborn singletons born 1998-2015 in Denmark whose mothers took antipsychotic medication before pregnancy were identified. Children whose mothers continued to take antipsychotics during pregnancy were compared with children of mothers who discontinued antipsychotics before pregnancy. As a negative control, paternal antipsychotic use in the same window was investigated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression for the primary outcome of psychiatric disorders, as well for subcategories of psychiatric disorders. In total, 9.9% of children in the discontinuation group and 11.0% of children in the continuation group received a psychiatric disorder diagnosis during follow-up. The adjusted HR for psychiatric disorders among offspring in the continuation group compared to the discontinuation group was 1.10 (95% CI 0.93-1.30). For antipsychotic use in the fathers, the HR was 1.05 (95% CI 0.89-1.24). The study does not provide evidence of increased risk of psychiatric disorders among children of women who continue antipsychotic treatment during pregnancy. This was observed after accounting for the underlying risk conferred by maternal psychiatric disorders. This suggests women who need to continue antipsychotic medications during pregnancy can do so without adverse psychiatric outcomes for offspring.

Postpartum onset of panic disorder: A metaphor analysis

Prevalence rates of postpartum panic disorder range from 0.5% to 2.9%. New mothers may not know the medical terminology to describe what they are experiencing. Metaphors can provide women with a different voice to help provide a basis for shared understanding with clinicians. The purpose of this secondary qualitative data analysis was to examine the metaphors used by women to describe their panic disorder after birth. Metaphor Identification Procedure was used to analyze the primary dataset. The process revealed the following eight metaphors: caged animal, Coke in my veins, bone-tired, imposter, escape artist, magnifying glass, detective, and hermit.

Antenatal Antidepressant Prescription Associated With Reduced Fetal Femur Length but Not Estimated Fetal Weight: A Retrospective Ultrasonographic Study

PURPOSE/BACKGROUND

Antidepressants are among the most frequently prescribed medications during pregnancy and may affect fetal weight. Associations between antenatal antidepressant use and ultrasonographic measures of fetal development have rarely been examined. We hypothesized that the prescription of an antenatal antidepressant would be associated with lower estimated fetal weight (EFW).

METHODS/PROCEDURES

A retrospective analysis of routine ultrasonographic data extracted from electronic medical records was performed on a cohort of pregnant women with psychiatric diagnoses and grouped according to the presence of an antenatal antidepressant prescription (n = 32 antidepressant-prescribed and n = 44 antidepressant prescription-free). After stratifying for gestational age, comparisons included 13 ultrasonographic parameters, frequency of oligohydramnios and polyhydramnios and growth deceleration, and maternal serum protein markers assessed per routine care, including α-fetoprotein, free β-human chorionic gonadotropin, and unconjugated estriol levels, using t tests, nonparametric and Fisher tests, and effect sizes (ESs) were computed.

FINDINGS/RESULTS

No statistically significant EFW differences between groups at any time point were detected (P > 0.05). Antenatal antidepressant prescription was associated with lower femur length at weeks 33 to 40 (P = 0.046, ES = 0.75) and greater left ventricular diameter at weeks 25 to 32 (P = 0.04, ES = 1.18). No differences for frequency of oligohydramnios or polyhydramnios or growth deceleration were observed (P > 0.05). We did not detect group differences for maternal proteins (P > 0.05).

IMPLICATIONS/CONCLUSIONS

Our evidence suggested a lack of association between antenatal antidepressant prescription and lower EFW but indicated an association with lower femur length and greater left ventricular diameter in mid-late gestation. Future research should examine the clinical implications of these findings.

Prevalence, onset and course of anxiety disorders during pregnancy: A systematic review and meta analysis

BACKGROUND

Anxiety disorders during pregnancy are associated with various adverse outcomes. Previous reviews of anxiety disorders during pregnancy have methodological limitations and were conducted without a meta-analysis. The present study is a systematic review and meta-analysis of the published research on the prevalence, onset and course of all anxiety disorders during pregnancy plus obsessive-compulsive disorder (OCD) and posttraumatic stress disorder.

METHODS

A comprehensive literature search was performed on a wide range of databases. A random effects model was used for the meta-analysis.

RESULTS

Thirty-six studies were included. Prevalence rates of anxiety disorders during pregnancy varied considerably. The pooled prevalence rate of each disorder during pregnancy was 3%, except for specific phobia, where it was 6%. Between 13% and 39% of pregnant OCD women had the onset of OCD during pregnancy, and this occurred mainly in the 2nd trimester. The onset of panic disorder (PD) was more common in the 1st and 2nd trimesters of pregnancy.

LIMITATIONS

Different designs of the included studies, as well as different assessment tools and assessment times during pregnancy and the paucity of studies of the onset and course, preclude definitive conclusions.

CONCLUSIONS

Anxiety disorders are common during pregnancy. Unlike prevalence rates of other anxiety disorders during pregnancy, prevalence rates of PD and OCD during pregnancy were higher than their lifetime prevalence rates in women in the general population. The onset of OCD during pregnancy is not rare and the course of PD and OCD during pregnancy is highly variable. These findings suggest that pregnancy may be a specific risk factor for the occurrence and/or exacerbation of PD and OCD and underscore the importance of their early diagnosis and management.