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Tanguay N, Abdelouahab N, Simard MN, Séguin JR, Marc I, Herba CM, MacLeod AAN, Courtemanche Y, Fraser WD, Muckle G. Antidepressants use during pregnancy and child psychomotor, cognitive and language development at 2 years of age-Results from the 3D Cohort Study. Front Pharmacol 2023; 14:1252251. [PMID: 38035027 PMCID: PMC10687276 DOI: 10.3389/fphar.2023.1252251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction: Approximately 5.5% of pregnant women take antidepressants. Studies on prenatal exposure to antidepressants reported no association with child cognition, and inconsistent results with motor function and language development. A limitation has been the failure to adjust for prenatal maternal distress. Objectives: Assess the associations between prenatal exposure to antidepressants and child development at age two, while adjusting for maternal depressive symptoms and stress during pregnancy. Explore indirect effects through birth complications and consider sex-specific associations. Methods: This is an ancillary study of the 3D (Design Develop, Discover) Study initiated during pregnancy. Data on antidepressants were collected through medication logs spanning the entire pregnancy. Depressive symptoms and stress were assessed during pregnancy by self-reported questionnaires, motor and cognitive development with the Bayley Scales of Infant and Toddler Development (BSID-III), and language development with the MacArthur Communicative Development Inventories at age 2. Multiple linear regressions were used to assess the associations between exposure and developmental outcomes. Mediation models were used to assess indirect effects. Interaction terms were introduced to assess sex-specific associations. Results: 1,489 mother-child dyads were included, of whom 61 (4.1%) reported prenatal antidepressant use. Prenatal exposure was negatively associated with motor development (B = -0.91, 95% CI -1.73, -0.09 for fine motor, B = -0.89, 95% CI -1.81, 0.02 for gross motor), but not with cognitive (B = -0.53, 95% CI -1.82, 0.72) and language (B = 4.13, 95% CI -3.72, 11.89) development. Adjusting for maternal prenatal distress only slightly modified these associations. No indirect effect or differential effect according to child sex were found. Conclusion: This study supports evidence of a negative association between prenatal exposure to antidepressants and motor development at age two, after adjusting for maternal distress, but the effect size remains very small, with about only one BSID-III point lower in average.
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Affiliation(s)
- Noémie Tanguay
- École de psychologie, Université Laval, Québec, QC, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Marie-Noelle Simard
- Centre de Recherche du CHU Sainte-Justine, Montréal, QC, Canada
- École de réadaptation, Université de Montréal, Montréal, QC, Canada
| | - Jean R. Séguin
- Centre de Recherche du CHU Sainte-Justine, Montréal, QC, Canada
- Département de psychiatrie et d’addictologieUniversité du Québec à Montréal, Montréal, QC, Canada
| | - Isabelle Marc
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Département de pédiatrie, Université Laval, Québec, QC, Canada
| | - Catherine M. Herba
- Centre de Recherche du CHU Sainte-Justine, Montréal, QC, Canada
- Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Andrea A. N. MacLeod
- Department of Communication Sciences, University of Alberta, Edmonton, AB, Canada
| | | | | | - Gina Muckle
- École de psychologie, Université Laval, Québec, QC, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
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Babineau V, McCormack CA, Feng T, Lee S, Berry O, Knight BT, Newport JD, Stowe ZN, Monk C. Pregnant women with bipolar disorder who have a history of childhood maltreatment: Intergenerational effects of trauma on fetal neurodevelopment and birth outcomes. Bipolar Disord 2022; 24:671-682. [PMID: 35319806 DOI: 10.1111/bdi.13207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/24/2022] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Intergenerational transmission of trauma occurs when the effects of childhood maltreatment (CM) influence the next generation's development and health; prenatal programming via maternal mood symptoms is a potential pathway. CM is a risk factor for bipolar disorder which is present in 1.8% of pregnant women. Mood symptoms are likely to increase during pregnancy, particularly for those with a history of CM. We examined whether there was evidence for intergenerational transmission of trauma in utero in this population, and whether maternal mood was a transmission pathway. METHODS CM and maternal mood were self-reported by N = 82 pregnant women in treatment for bipolar disorder. Fetal heart rate variability (FHRV) was measured at 24, 30, and 36 weeks' gestation. Gestational age at birth and birth weight were obtained from medical charts. RESULTS A cluster analysis yielded two groups, Symptom+ (18.29%) and Euthymic (81.71%), who differed on severe mood symptoms (p < 0.001) but not on medication use. The Symptom+ group had more CM exposures (p < 0.001), a trend of lower FHRV (p = 0.077), and greater birth complications (33.3% vs. 6.07% born preterm p < 0.01). Maternal prenatal mood mediated the association between maternal CM and birth weight in both sexes and at trend level for gestational age at birth in females. CONCLUSIONS This is the first study to identify intergenerational effects of maternal CM prior to postnatal influences in a sample of pregnant women with bipolar disorder. These findings underscore the potential enduring impact of CM for women with severe psychiatric illness and their children.
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Affiliation(s)
- Vanessa Babineau
- Department of Obstetrics and Gynecology, Columbia University, New York, USA
| | | | - Tianshu Feng
- Research Foundation of Mental Hygiene, Columbia University, New York, USA
| | - Seonjoo Lee
- Departments of Psychiatry and Biostatistics, Columbia University, New York, USA.,Department of Mental Health Data Science, New York State Psychiatric Institute, New York, USA
| | - Obianuju Berry
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, USA
| | - Bettina T Knight
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jeffrey D Newport
- Departments of Psychiatry & Behavioral Sciences and Obstetrics and Gynecology, University of Texas at Austin, Austin, USA
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin-Madison, Madison, USA
| | - Catherine Monk
- Departments of Obstetrics and Gynecology and Psychiatry, Columbia University, New York, USA
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Pingeton BC, Goodman SH, Monk C. Prenatal origins of temperament: Fetal cardiac development & infant surgency, negative affectivity, and regulation/orienting. Infant Behav Dev 2021; 65:101643. [PMID: 34479091 DOI: 10.1016/j.infbeh.2021.101643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Temperament, i.e. individual differences in reactivity and self-regulation, emerges early in infancy; might temperament originate during fetal development? Mixed findings and methodological issues in the literature examining this consideration limit our understanding of the continuity between these fetal indices and infant temperament. The primary aims of the current study were to improve on published studies by (a) using standardized and well-accepted fetal cardiac (actocardiograph) and infant temperament measures (the Infant Behavior Questionnaire-Revised; IBQ-R) (b) expanding fetal assessments to include coupling (the cross correlation of heart rate with movement), and (c) examining a diverse sample to determine if findings of associations between fetal neurobehavior and infant temperament generalize beyond cohorts that are demographically well-resourced and predominantly white. Building on theory and empirical findings, we hypothesized that (1) FHR would be positively associated with Surgency and Negative Affectivity, (2) FHRV would be positively associated with Surgency, and Regulation/Orienting and inversely associated with Negative Affectivity, and (3) fetal coupling would be positively associated with Regulation/Orienting and Surgency and inversely associated with Negative Affectivity. We collected 20 min of fetal data (m gestational age = 34.42 weeks) and mothers completed the IBQ-R (n = 90 women; 60 % non-Caucasian race; 63 % Latina ethnicity). We found that FHR was positively associated with Negative Affectivity but not associated with Surgency (or Regulation/Orienting). FHRV was inversely associated with Surgency but not associated with Negative Affectivity or Regulation/Orienting. Coupling was positively associated with Regulation/Orienting and Surgency but not associated with Negative Affectivity. Our findings, from a more diverse sample and with established measures, provide further evidence that individual differences in reactivity and regulation can be identified in the in-utero period and show theory-based continuity to specific infant temperament constructs.
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Affiliation(s)
- B C Pingeton
- Department of Psychology, Emory University, United States.
| | - S H Goodman
- Department of Psychology, Emory University, United States
| | - C Monk
- Department of Obstetrics and Gynecology and Psychiatry, Columbia University Irving Medical Center, United States; New York State Psychiatric Institute, United States
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Trumpff C, Sturm G, Picard M, Foss S, Lee S, Feng T, Cardenas A, McCormack C, Champagne FA, Monk C. Added sugar intake during pregnancy: Fetal behavior, birth outcomes, and placental DNA methylation. Dev Psychobiol 2021; 63:878-889. [PMID: 33415750 DOI: 10.1002/dev.22088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 11/23/2020] [Accepted: 12/20/2020] [Indexed: 12/11/2022]
Abstract
Pregnancy is a critical time for the effects of environmental factors on children's development. The effect of added sugar intake on fetal development and pregnancy outcomes remains understudied despite increasing dietary intake in the United States. This study investigated the effect of added sugar on fetal programming by examining the association between maternal added sugar consumption, fetal movement, birth outcomes, and placental DNA methylation. Further, primary human fibroblasts were cultured under normal or high glucose conditions to assess the effect of high glucose exposure on cells' DNA methylation. We found that higher added sugar intake across pregnancy was associated with reduced 3rd-trimester fetal movement (p < .05) and shorter gestation (p < .01). Our sample size was not powered to detect the alteration of individual placental CpG with genome-wide significance. However, a secondary analysis suggested that added sugar consumption was associated with differential methylation of functionally related gene families across pregnancy. Consistent with this, high glucose exposure in primary cultured human fibroblasts altered the methylation of 17% of all CpGs, providing converging evidence for an effect of sugar on DNA methylation. Our results suggest that diets high in added sugar during pregnancy may have implications for offspring health via prenatal programming effects measurable before birth.
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Affiliation(s)
- Caroline Trumpff
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA
| | - Gabriel Sturm
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA
| | - Martin Picard
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA.,Department of Neurology, Columbia Translational Neuroscience Initiative, Columbia University Medical Center, New York, NY, USA
| | - Sophie Foss
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA
| | - Seonjoo Lee
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA.,Research Foundation for Mental Hygiene Inc, New York, NY, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Tianshu Feng
- Research Foundation for Mental Hygiene Inc, New York, NY, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Andrès Cardenas
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Clare McCormack
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA
| | - Frances A Champagne
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Catherine Monk
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA.,Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA
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Campbell KSJ, Collier AC, Irvine MA, Brain U, Rurak DW, Oberlander TF, Lim KI. Maternal Serotonin Reuptake Inhibitor Antidepressants Have Acute Effects on Fetal Heart Rate Variability in Late Gestation. Front Psychiatry 2021; 12:680177. [PMID: 34483982 PMCID: PMC8415315 DOI: 10.3389/fpsyt.2021.680177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/14/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants increases risk for adverse neurodevelopmental outcomes, yet little is known about whether effects are present before birth. In relation to maternal SRI pharmacokinetics, this study investigated chronic and acute effects of prenatal SRI exposure on third-trimester fetal heart rate variability (HRV), while evaluating confounding effects of maternal depressed mood. Methods: At 36-weeks' gestation, cardiotocograph measures of fetal HR and HRV were obtained from 148 pregnant women [four groups: SRI-Depressed (n = 31), SRI-Non-Depressed (n = 18), Depressed (unmedicated; n = 42), and Control (n = 57)] before, and ~5-h after, typical SRI dose. Maternal plasma drug concentrations were quantified at baseline (pre-dose) and four time-points post-dose. Mixed effects modeling investigated group differences between baseline/pre-dose and post-dose fetal HR outcomes. Post hoc analyses investigated sex differences and dose-dependent SRI effects. Results: Maternal SRI plasma concentrations were lowest during the baseline/pre-dose fetal assessment (trough) and increased to a peak at the post-dose assessment; concentration-time curves varied widely between individuals. No group differences in fetal HR or HRV were observed at baseline/pre-dose; however, following maternal SRI dose, short-term HRV decreased in both SRI-exposed fetal groups. In the SRI-Depressed group, these post-dose decreases were displayed by male fetuses, but not females. Further, episodes of high HRV decreased post-dose relative to baseline, but only among SRI-Non-Depressed group fetuses. Higher maternal SRI doses also predicted a greater number of fetal HR decelerations. Fetuses exposed to unmedicated maternal depressed mood did not differ from Controls. Conclusions: Prenatal SRI exposure had acute post-dose effects on fetal HRV in late gestation, which differed depending on maternal mood response to SRI pharmacotherapy. Importantly, fetal SRI effects were sex-specific among mothers with persistent depressive symptoms, as only male fetuses displayed acute HRV decreases. At trough (pre-dose), chronic fetal SRI effects were not identified; however, concurrent changes in maternal SRI plasma levels suggest that fetal drug exposure is inconsistent. Acute SRI-related changes in fetal HRV may reflect a pharmacologic mechanism, a transient impairment in autonomic functioning, or an early adaption to altered serotonergic signaling, which may differ between males and females. Replication is needed to determine significance with postnatal development.
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Affiliation(s)
- Kayleigh S J Campbell
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Abby C Collier
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Irvine
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Ursula Brain
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Dan W Rurak
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Tim F Oberlander
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kenneth I Lim
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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Hjorth S, Bromley R, Ystrom E, Lupattelli A, Spigset O, Nordeng H. Use and validity of child neurodevelopment outcome measures in studies on prenatal exposure to psychotropic and analgesic medications - A systematic review. PLoS One 2019; 14:e0219778. [PMID: 31295318 PMCID: PMC6622545 DOI: 10.1371/journal.pone.0219778] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 07/01/2019] [Indexed: 02/07/2023] Open
Abstract
In recent years there has been increased attention to child neurodevelopment in studies on medication safety in pregnancy. Neurodevelopment is a multifactorial outcome that can be assessed by various assessors, using different measures. This has given rise to a debate on the validity of various measures of neurodevelopment. The aim of this review was twofold. Firstly we aimed to give an overview of studies on child neurodevelopment after prenatal exposure to central nervous system acting medications using psychotropics and analgesics as examples, giving special focus on the use and validity of outcome measures. Secondly, we aimed to give guidance on how to conduct and interpret medication safety studies with neurodevelopment outcomes. We conducted a systematic review in the MEDLINE, Embase, PsycINFO, Web of Science, Scopus, and Cochrane databases from inception to April 2019, including controlled studies on prenatal exposure to psychotropics or analgesics and child neurodevelopment, measured with standardised psychometric instruments or by diagnosis of neurodevelopmental disorder. The review management tool Covidence was used for data-extraction. Outcomes were grouped as motor skills, cognition, behaviour, emotionality, or "other". We identified 110 eligible papers (psychotropics, 82 papers, analgesics, 29 papers). A variety of neurodevelopmental outcome measures were used, including 27 different psychometric instruments administered by health care professionals, 15 different instruments completed by parents, and 13 different diagnostic categories. In 23 papers, no comments were made on the validity of the outcome measure. In conclusion, establishing neurodevelopmental safety includes assessing a wide variety of outcomes important for the child's daily functioning including motor skills, cognition, behaviour, and emotionality, with valid and reliable measures from infancy through to adolescence. Consensus is needed in the scientific community on how neurodevelopment should be assessed in medication safety in pregnancy studies. Review registration number: CRD42018086101 in the PROSPERO database.
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Affiliation(s)
- Sarah Hjorth
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Rebecca Bromley
- Division of Evolution and Genomic Science, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, England
- Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England
| | - Eivind Ystrom
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Olav Spigset
- Department of Clinical Pharmacology, St. Olav's University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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