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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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Halvorsen A, Hesel B, Østergaard SD, Danielsen AA. In utero exposure to selective serotonin reuptake inhibitors and development of mental disorders: a systematic review and meta-analysis. Acta Psychiatr Scand 2019; 139:493-507. [PMID: 30937904 DOI: 10.1111/acps.13030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Several studies have investigated whether in utero exposure to selective serotonin reuptake inhibitors (SSRIs) is associated with increased risk of developing mental or behavioural disorders. The aim of this study was to perform a systematic review and meta-analysis based on this literature. METHODS A systematic search of eligible literature in PubMed, EMBASE, and PsycINFO and subsequent meta-analysis was conducted in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. RESULTS A total of 20 studies were included in the review, and results from 18 of these were meta-analyzed. We found a statistically significant positive association between in utero exposure to SSRIs and mental or behavioural disorders such as autism spectrum disorder (hazard ratio (HR) = 1.27; 95% confidence interval (CI) = 1.10-1.47), attention-deficit/hyperactivity disorder (HR = 1.33; 95% CI = 1.06-1.66) and mental retardation (HR = 1.41; 95% CI = 1.03-1.91). Confounding by indication was identified in five of seven studies investigating this aspect. CONCLUSION Exposure to SSRIs in utero is associated with increased risk of developing mental or behavioural disorders. However, these associations do not necessarily reflect a causal relationship since the results included in this meta-analysis are likely affected by residual confounding by indication, which is likely to account for some (or all) of the positive association.
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Affiliation(s)
- A Halvorsen
- Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - B Hesel
- Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - S D Østergaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - A A Danielsen
- Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Abstract
Purpose of review Antipsychotics are frequently prescribed to women of childbearing age and are increasingly prescribed during pregnancy. A small, but growing, body of research on implications for pregnancy and infant outcomes is available to inform the risks and benefits of in utero exposure to antipsychotics. This review examines the existing published research on the use of common typical and atypical antipsychotics in pregnancy and the implications for pregnancy and infant outcomes. Recent findings The majority of studies do not show associations with major malformations and antipsychotic use in pregnancy, with the possible exception of risperidone. There is concern that atypical antipsychotics may be associated with gestational diabetes. Metabolic changes during pregnancy may necessitate dose adjustments. Summary In general, it is recommended that women who need to take an antipsychotic during pregnancy continue the antipsychotic that has been most effective for symptom remission. Further study on risperidone is needed to better understand its association with malformations and it is not considered a first-line agent for use during pregnancy.
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Affiliation(s)
- Hannah K Betcher
- Department of Psychiatry, Northwestern University Feinberg School of Medicine 676 N. St. Clair St. Ste 1000, Chicago, IL 60611, USA.,Mayo Clinic, Rochester, MN, USA
| | - Catalina Montiel
- Department of Psychiatry, Northwestern University Feinberg School of Medicine 676 N. St. Clair St. Ste 1000, Chicago, IL 60611, USA
| | - Crystal T Clark
- Department of Psychiatry, Northwestern University Feinberg School of Medicine 676 N. St. Clair St. Ste 1000, Chicago, IL 60611, USA.,Department of Obstetrics and Gynecology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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Denton LK, Creeley CE, Stavola B, Hall K, Foltz BD. An analysis of online pregnancy message boards: Mother-to-mother advice on medication use. Women Birth 2018; 33:e48-e58. [PMID: 30545755 DOI: 10.1016/j.wombi.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 12/13/2022]
Abstract
PROBLEM AND BACKGROUND Psychotropic medication use is increasingly common among pregnant women. Many women solicit information from other mothers about the safety of these medications for use during pregnancy, yet little is known about the specific advice they receive. AIM The purpose of the current study was to examine the type of feedback women receive on a popular internet message board about psychotropic medication use during pregnancy. METHODS A modified Consensual Qualitative Research approach was used to analyze 1728 comments posted by Babycenter.com users about the safety of the use of six common psychotropic medications during pregnancy. Researchers analyzed the comments for overall themes and core ideas. FINDINGS Results found that comments were comprised of six themes: (1) Personal Anecdotes, (2) Suggesting Alternative Solutions, (3) Directives, (4) Judgement, (5) Social Support, (6) Skepticism & Mistrust, and (7) Risks vs. Benefits. While many comments conveyed emotional support, or encouraged women to seek professional advice, others contained inaccurate and/or contradictory information, or harsh criticism. CONCLUSION Given that the decision about the use of medication during pregnancy has implications for the health of the mother and fetus, it is important for care providers to be aware of what feedback women may receive from this source. Providers should address questions and concerns that women have about safety of these medications and recognize how the social context of the internet impacts the emotional health of pregnant women faced with these decisions.
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Affiliation(s)
- Lisa K Denton
- Department of Psychology, State University of New York at Fredonia, W357 Thompson Hall, Fredonia NY 14063, United States.
| | - Catherine E Creeley
- Department of Psychology, State University of New York at Fredonia, W357 Thompson Hall, Fredonia NY 14063, United States
| | - Brianna Stavola
- Department of Sociocultural and Justice Sciences, State University of New York at Fredonia, W363 Thompson Hall, Fredonia NY 14063, United States
| | - Kara Hall
- Department of Psychology, State University of New York at Fredonia, W357 Thompson Hall, Fredonia NY 14063, United States
| | - Brad D Foltz
- Department of Athletics, Georgetown University, 37th Street Northwest, Washington, DC 20007, United States
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Wang H, Li JT, Zhang Y, Liu R, Wang XD, Si TM, Su YA. Prenatal Exposure to Antipsychotics Disrupts the Plasticity of Dentate Neurons and Memory in Adult Male Mice. Int J Neuropsychopharmacol 2018; 22:71-82. [PMID: 30169628 PMCID: PMC6313132 DOI: 10.1093/ijnp/pyy073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 08/20/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND With the growing use of second-generation antipsychotics for the treatment of a spectrum of psychiatric illnesses in pregnancy, concerns have been raised about the long-term impact of these medications on offspring neurodevelopment. However, preclinical and clinical evidence on the lasting effects of prenatal antipsychotic exposure is still sparse. METHODS Risperidone, a widely used second-generation antipsychotic, and haloperidol, a representative first-generation antipsychotic, were administered to pregnant C57BL/6N mice from embryonic day 6 to 16. Behavioral tests, immunohistochemical staining, Golgi-Cox technique, and western blot were used to determine the effects of prenatal antipsychotic exposure on the plasticity of the dentate gyrus and related behavior in adult male mice. RESULTS Both prenatal haloperidol- and risperidone-exposed mice showed recognition memory deficits but had no anxiety-related behavior. In addition, both prenatal haloperidol and risperidone exposure impaired the proliferation and maturation of adult-born dentate granule cells. We found that haloperidol exposure decreased dendritic length of dentate granule cells, while risperidone had no effect. However, both drugs inhibited dendrite branching in granule cells. Haloperidol exposure also significantly reduced total spine density in the middle dendritic segment of dentate gyrus. Prenatally risperidone-exposed mice only displayed a loss in thin and mushroom spines of infrapyramidal blade of dentate gyrus. Collectively, prenatal haloperidol exposure exerted more robust negative effects than risperidone. CONCLUSION These data provide evidence for the long-term programming effects of early-life exposure to antipsychotics on hippocampal plasticity and behavior.
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Affiliation(s)
- Han Wang
- Peking University Sixth Hospital & Peking University Institute of Mental Health & Key Laboratory of Mental Health, Ministry of Health, (Peking University) & National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ji-Tao Li
- Peking University Sixth Hospital & Peking University Institute of Mental Health & Key Laboratory of Mental Health, Ministry of Health, (Peking University) & National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yue Zhang
- Peking University Sixth Hospital & Peking University Institute of Mental Health & Key Laboratory of Mental Health, Ministry of Health, (Peking University) & National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Rui Liu
- Peking University Sixth Hospital & Peking University Institute of Mental Health & Key Laboratory of Mental Health, Ministry of Health, (Peking University) & National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiao-Dong Wang
- Department of Neurobiology, Key Laboratory of Medical Neurobiology of Ministry of Health of China,Zhejiang Province Key Laboratory of Neurobiology, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian-Mei Si
- Peking University Sixth Hospital & Peking University Institute of Mental Health & Key Laboratory of Mental Health, Ministry of Health, (Peking University) & National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China,Correspondence: Yun-Ai Su, PhD, MD () and Tian-Mei Si (), Peking University Sixth Hospital & Peking University Institute of Mental Health & Key Laboratory of Mental Health, Ministry of Health (Peking University), and National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China
| | - Yun-Ai Su
- Peking University Sixth Hospital & Peking University Institute of Mental Health & Key Laboratory of Mental Health, Ministry of Health, (Peking University) & National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China,Correspondence: Yun-Ai Su, PhD, MD () and Tian-Mei Si (), Peking University Sixth Hospital & Peking University Institute of Mental Health & Key Laboratory of Mental Health, Ministry of Health (Peking University), and National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China
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Bénard-Laribière A, Pambrun E, Sutter-Dallay AL, Gautier S, Hurault-Delarue C, Damase-Michel C, Lacroix I, Bégaud B, Pariente A. Patterns of antidepressant use during pregnancy: a nationwide population-based cohort study. Br J Clin Pharmacol 2018; 84:1764-1775. [PMID: 29665098 DOI: 10.1111/bcp.13608] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 12/24/2022] Open
Abstract
AIMS We explored the patterns of antidepressant use during pregnancy. METHODS A cohort of women who started a pregnancy in 2014 was identified using data from the French reimbursement healthcare system (covering approximately 99% of the population). Antidepressant usage (initiated before or during pregnancy) was assessed. Explored changes in antidepressant treatment were: associations, switches, discontinuation and resumption of antidepressants during pregnancy. RESULTS The cohort included 766 508 pregnancies (755 519 women). Antidepressant use during pregnancy was 25.7 per 1000 [95% CI: 25.3-26.0]. New use concerned 3.9 per 1000 [95% CI: 3.7-4.0]; the most initiated class during pregnancy was selective serotonin reuptake inhibitors (SSRIs), while the most prescribed individual drug in second and third trimesters was amitriptyline, a tricyclic. Most changes were observed before pregnancy and during the first trimester: 63% of ongoing treatments in the year before pregnancy were discontinued before conception; 68% of treatments maintained after conception were discontinued during the first trimester; switches or antidepressant associations mostly occurred during the periconceptional period or during the first trimester. Regardless of initial antidepressant, switches to sertraline were the most frequent. Associations mainly consisted of a prescription of tri-/tetracyclic or mirtazapine/mianserin in addition to an SSRI. Discontinuation during pregnancy led to treatment resumption in 22% of pregnancies. CONCLUSIONS These results suggest that pregnancy was planned or the treatment especially adapted in accordance with existing recommendations in a large proportion of women under antidepressants or in whom such treatments have been initiated after starting a pregnancy.
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Affiliation(s)
- Anne Bénard-Laribière
- team PHARMACOEPIDEMIOLOGY, Univ. Bordeaux, Inserm UMR 1219, Bordeaux Population Health Research Center, F-33000, Bordeaux, France
| | - Elodie Pambrun
- team PHARMACOEPIDEMIOLOGY, Univ. Bordeaux, Inserm UMR 1219, Bordeaux Population Health Research Center, F-33000, Bordeaux, France
| | - Anne-Laure Sutter-Dallay
- team PHARMACOEPIDEMIOLOGY, Univ. Bordeaux, Inserm UMR 1219, Bordeaux Population Health Research Center, F-33000, Bordeaux, France.,Charles Perrens Hospital, F-33000, Bordeaux, France
| | - Sophie Gautier
- Clinical Pharmacology Department, U 1171 University Hospital of Lille, University of Lille, F-59000, Lille, France
| | - Caroline Hurault-Delarue
- Clinical Pharmacology Department, Inserm UMR 1027, CIC Inserm 1436, Faculty of Medicine, University Hospital of Toulouse, F-31000, Toulouse, France
| | - Christine Damase-Michel
- Clinical Pharmacology Department, Inserm UMR 1027, CIC Inserm 1436, Faculty of Medicine, University Hospital of Toulouse, F-31000, Toulouse, France
| | - Isabelle Lacroix
- Clinical Pharmacology Department, Inserm UMR 1027, CIC Inserm 1436, Faculty of Medicine, University Hospital of Toulouse, F-31000, Toulouse, France
| | - Bernard Bégaud
- team PHARMACOEPIDEMIOLOGY, Univ. Bordeaux, Inserm UMR 1219, Bordeaux Population Health Research Center, F-33000, Bordeaux, France.,Clinical Pharmacology, University Hospital of Bordeaux, F-33000, Bordeaux, France
| | - Antoine Pariente
- team PHARMACOEPIDEMIOLOGY, Univ. Bordeaux, Inserm UMR 1219, Bordeaux Population Health Research Center, F-33000, Bordeaux, France.,Clinical Pharmacology, University Hospital of Bordeaux, F-33000, Bordeaux, France
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