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Dupuis M, Weir KR, Vidonscky Lüthold R, Panchaud A, Baggio S. Social determinants of antidepressant continuation during pregnancy in the USA: findings from the ABCD cohort study. Arch Womens Ment Health 2024:10.1007/s00737-024-01470-0. [PMID: 38740587 DOI: 10.1007/s00737-024-01470-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/08/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Patients and healthcare professionals overestimate the risks of using antidepressants during pregnancy. According to current literature, approximately half of people stop taking an anti-depressant medication when they become pregnant. Discontinuing antidepressants during pregnancy increases risks of postnatal relapses. Factors like socioeconomic status, education, and planned pregnancies play a role in the decision to continue antidepressant medication, which can worsen disparities in maternal and child health. Our aim was to identify the sociodemographic factors associated with antidepressant continuation after awareness of pregnancy. METHODS We used representative data from the Adolescent Brain Cognitive Development (ABCD) study that captures maternal medication during pregnancy. We identified women who used antidepressants before awareness of their pregnancy. We calculated crude and adjusted associations between sociodemographic factors and continuation of antidepressant medication during pregnancy. Our model included age, education, ethnicity, first language, household income, living with a partner, having planned the pregnancy, pregnancy duration and smoking during pregnancy. RESULTS In total, 199 women continued antidepressants and 100 discontinued. The logistic regressions resulted in only one significant factor: first language. Native English speakers were more likely to continue medication than other mothers (adjusted OR = 14.94, 95% CI = [2.40; 291.45], p = .015). CONCLUSIONS Language differences were associated with continuation of antidepressants. Non-native English speakers were more likely to discontinue antidepressants, which may lead to health inequities. This finding should be taken into account to reinforce information about the limited risks of antidepressants among people with non-English speaking backgrounds in the USA.
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Affiliation(s)
- Marc Dupuis
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland.
- Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland.
| | - Kristie Rebecca Weir
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Renata Vidonscky Lüthold
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland
- Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland
| | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
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Hecht LM, Braciszewski JM, Miller-Matero LR, Ahmedani BK, Kerver JM, Loree AM. Adequacy of prenatal care utilisation and gestational weight gain among women with depression. J Reprod Infant Psychol 2024; 42:222-233. [PMID: 35582731 DOI: 10.1080/02646838.2022.2075544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Depression is common during pregnancy, can elevate risk for excessive or inadequate gestational weight gain (GWG), and is associated with both underutilisation and overutilisation of prenatal care. Whether GWG is associated with adequacy of prenatal care among women with and without depression in the United States is unknown. This study evaluated whether adequacy of prenatal care differed by depression status and GWG. METHODS Data from the Pregnancy Risk Assessment Monitoring System from 1,379,870 women who were pregnant with a singleton and delivered at 37-42 weeks gestation during 2016 to 2018 were included. Depression was self-reported. The Kotelchuck index was used to evaluate adequacy of prenatal care. Maternal weight gain was compared to GWG guidelines. RESULTS Approximately 13.1% of the sample experienced depression during pregnancy. Although those with depression had increased odds of both inadequate and above adequate levels of prenatal care, this association was no longer significant after accounting for demographics, medical comorbidities, and socioeconomic factors. Individuals with inadequate levels of prenatal care with a normal pre-pregnancy body mass index gained less weight during pregnancy. CONCLUSIONS The association between depression and prenatal care utilisation seems driven by demographic, medical comorbidity, and socioeconomic variables. Weight outcomes were associated with inadequate prenatal care utilisation.
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Affiliation(s)
- Leah M Hecht
- Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI, USA
| | - Jordan M Braciszewski
- Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI, USA
- Henry Ford Health System, Behavioral Health, Detroit, MI, USA
| | - Lisa R Miller-Matero
- Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI, USA
- Henry Ford Health System, Behavioral Health, Detroit, MI, USA
| | - Brian K Ahmedani
- Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI, USA
- Henry Ford Health System, Behavioral Health, Detroit, MI, USA
| | - Jean M Kerver
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Amy M Loree
- Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI, USA
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Mestermann S, Fasching PA, Beckmann MW, Gerlach J, Kratz O, Moll GH, Kornhuber J, Eichler A. The Benefit of a Retrospective Pregnancy Anamnesis in Child and Adolescent Psychiatry: The Reliability of Maternal Self-Report during Childhood Development. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050866. [PMID: 37238414 DOI: 10.3390/children10050866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
Pregnancy anamnesis is a crucial part of child and adolescent psychiatry diagnostics. In previous works, the reliability of retrospective maternal self-report on perinatal characteristics was heterogeneous. This prospective longitudinal study aimed to evaluate women's recall of prenatal events in a within-subject design. A sample of 241 women gave a self-report on prenatal alcohol, smoking, partnership quality, pregnancy satisfaction, and obstetric complications during the 3rd trimester (t0), childhood (t1, 6-10 y), and adolescence (t2, 12-14 y). The intra-individual agreement was examined. The t0-t1-(t2) agreement was poor to substantial; this was highest for smoking and worst for obstetric complications, followed by alcohol (Fleiss' κ = 0.719 to -0.051). There were significant t0-t1-(t2) differences for all pregnancy variables (p < 0.017), except for 3rd trimester satisfaction (p = 0.256). For alcohol (t0 25.8%, t1 17.4%, t2 41.0%) and smoking (t0 11.9%, t1 16.4%, t2 22.6%), the highest self-reported rates were found during adolescence. During childhood, fewer obstetric complications (t0 84.9%, t1 42.2%) and worse partnerships were reported (t0 M = 8.86, t1 M = 7.89). Thought to be due to social stigmata and memory effects, pregnancy self-reports cannot be precisely reproduced. Creating a respectful and trusting atmosphere is essential for mothers to give honest self-reports that are in the best interest of their children.
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Affiliation(s)
- Stefan Mestermann
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Peter A Fasching
- Department of Obstetrics and Gynaecology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynaecology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Jennifer Gerlach
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Gunther H Moll
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
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4
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Rolan EP, Robertson O, Nonkovic N, Marceau K. Reliability of prospective and retrospective maternal reports of prenatal experiences. BMC Pregnancy Childbirth 2022; 22:968. [PMID: 36575374 PMCID: PMC9793511 DOI: 10.1186/s12884-022-05286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 12/06/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Extant perinatal research utilizes retrospective reports on the prenatal environment, but there are limited data on the validity of retrospective data compared with prospective data. The current study examined the reliability of birth mothers' memory of prenatal stress and distress and perinatal risks at 6-months postpartum with maternal reports gathered across each trimester of pregnancy and explored whether recall varied with maternal socioeconomic status. METHODS Surveys were collected from 34 pregnant women (M age = 29.14, SD = 5.06 years, 83% non-Hispanic White) on stress, distress, and pregnancy complications at 12(T1), 26(T2), and 38(T3) weeks of pregnancy, and at 6-month post-partum asking the same questions but specifically about the pregnancy. Cohen's kappa and Pearson's correlations were used to investigate maternal recall at post-partum with prospective reports at T1, T2, T3 and an average score of T1, T2, and T3. Correlations were also examined separately for those with high and relatively lower socioeconomic status. RESULTS Birth mothers' recall was generally reliable. Retrospective reports were most strongly related to prospective reports in T1 for perceived stress, T1 and T3 for anxiety symptoms and exposure to toxins, but T3 for depressive symptoms. Recall of pregnancy complications best reflected the average score across trimesters (rather than specific trimesters). Women with higher socioeconomic status better recalled prenatal (di)stress, but women with relatively lower socioeconomic status better recalled exposure to toxins. CONCLUSION This study provides support for utilizing retrospective reports of maternal prenatal experiences at 6-months post-partum, with implications for interpretation of specific recalled phenotypes.
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Affiliation(s)
- Emily P. Rolan
- grid.17088.360000 0001 2150 1785Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI USA
| | - Olivia Robertson
- grid.169077.e0000 0004 1937 2197Department of Human Development and Family Science, Purdue University, 1202 W. State Street, West Lafayette, IN USA
| | - Nikolina Nonkovic
- grid.169077.e0000 0004 1937 2197Department of Human Development and Family Science, Purdue University, 1202 W. State Street, West Lafayette, IN USA
| | - Kristine Marceau
- grid.169077.e0000 0004 1937 2197Department of Human Development and Family Science, Purdue University, 1202 W. State Street, West Lafayette, IN USA
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Simeone RM, Reefhuis J, Jamieson DJ, Drews-Botsch CD, Lash TL, Fisher SC, Howley MM, Evans S, Howards PP. Delayed entry into prenatal care among women with pre-pregnancy health conditions, National Birth Defects Prevention Study, 1997-2011. Prev Med 2022; 164:107272. [PMID: 36152821 PMCID: PMC10392703 DOI: 10.1016/j.ypmed.2022.107272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 09/18/2022] [Indexed: 10/31/2022]
Abstract
First trimester entry into prenatal care is recommended for all women, and especially women with pre-pregnancy conditions. Our objective was to determine whether women with pre-pregnancy conditions were at lower risk of entry after the first trimester (delayed entry) into prenatal care than women without a pre-pregnancy health condition. We used data from 10,890 participants in the National Birth Defects Prevention Study who delivered liveborn infants without birth defects. Women reported pre-pregnancy conditions and timing of entry into prenatal care during a computer-assisted telephone interview. Multivariable logistic regression analyses were conducted to evaluate whether having a pre-pregnancy condition was associated with delayed entry into prenatal care compared to women without pre-pregnancy conditions. Approximately 13% of women reported delayed entry into prenatal care, and 18% of women reported a pre-pregnancy condition. Delayed entry into prenatal care was not associated with pre-pregnancy cardiometabolic or neurologic conditions. Women with thyroid conditions were less likely to report delayed entry into prenatal care (prevalence odds ratio (OR), 95% confidence interval (CI): 0.55 [0.32, 0.94]), but women with hematologic and respiratory conditions were more likely to report delayed entry into prenatal care (OR: 1.95 [1.00, 3.82] and 1.27 [0.95, 1.72], respectively), compared to those without any chronic conditions. Future research investigating the success of early prenatal care among women with thyroid conditions could identify ways to reduce delayed prenatal care among women with other pre-pregnancy conditions.
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Affiliation(s)
- Regina M Simeone
- Centers for Disease Control and Prevention, Atlanta, GA, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - Jennita Reefhuis
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Carolyn D Drews-Botsch
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Sarah C Fisher
- Birth Defects Registry, New York State Department of Health, Albany, NY, United States
| | - Meredith M Howley
- Birth Defects Registry, New York State Department of Health, Albany, NY, United States
| | - Shannon Evans
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Kroner BL, Hankins JS, Pugh N, Kutlar A, King AA, Shah NR, Kanter J, Glassberg J, Treadwell M, Gordeuk VR. Pregnancy outcomes with hydroxyurea use in women with sickle cell disease. Am J Hematol 2022; 97:603-612. [PMID: 35142007 PMCID: PMC8986611 DOI: 10.1002/ajh.26495] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 11/07/2022]
Abstract
Hydroxyurea reduces pain crises, acute chest syndrome, and blood transfusions in sickle cell disease (SCD), but potential detrimental effects on fertility and birth outcomes impede its use. Data on the effects of hydroxyurea taken for SCD during conception and pregnancy are scarce. The Sickle Cell Disease Implementation Consortium collected self-reported pregnancy history, corresponding hydroxyurea use, and pregnancy outcomes in women with SCD in the clinical setting. Among 1285 women 18-45 years of age, 737 (57.4%) reported 1788 pregnancies (1079 live births, 394 miscarriages, 40 stillbirths, 207 abortions, 48 current pregnancies, and 20 missing outcomes) of which 241 (15.9%) live births, miscarriages or stillbirths were conceived while on hydroxyurea. In univariate analyses, pregnancy number more than three, severe sickle genotype, history of stillbirth or miscarriage, and chronic kidney disease at enrollment were covariates significantly associated with a pregnancy ending in miscarriage or stillbirth. After adjustment for covariates and additional SCD severity markers in multivariate analyses, hydroxyurea use during conception and pregnancy, but not during conception only, was associated with an increase in the odds ratio (OR) of miscarriage or stillbirth (OR 2.21, 95% confidence interval [CI] 1.40-3.47). In analyses of live birth outcomes, hydroxyurea use during conception and pregnancy was associated with birth weight < 5.5 pounds in full-term infants (OR 2.98, 95% CI 1.09-7.38) but not with prematurity or serious medical problems at birth. These findings suggest that hydroxyurea use may be safe up to the time of conception, but that clinicians should continue to advise caution regarding use during pregnancy.
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Affiliation(s)
- Barbara L. Kroner
- Division of Biostatistics and Epidemiology RTI International Research Triangle Park North Carolina USA
| | - Jane S. Hankins
- Department of Hematology St. Jude Children's Research Hospital Memphis Tennessee USA
| | - Norma Pugh
- Division of Biostatistics and Epidemiology RTI International Research Triangle Park North Carolina USA
| | | | - Allison A. King
- Division of Hematology and Oncology Washington University School of Medicine St. Louis Missouri USA
| | - Nirmish R. Shah
- Pediatric Hematology/Oncology Duke University Durham North Carolina USA
| | - Julie Kanter
- Department of Medicine University of Alabama Birmingham Alabama USA
| | - Jeffrey Glassberg
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Marsha Treadwell
- Department of Hematology/Oncology UCSF Benioff Children's Hospital Oakland Oakland California USA
| | - Victor R. Gordeuk
- Department of Medicine University of Illinois at Chicago Chicago Illinois USA
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7
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Moreau AL, Voss M, Hansen I, Paul SE, Barch DM, Rogers CE, Bogdan R. Prenatal Selective Serotonin Reuptake Inhibitor Exposure, Depression and Brain Morphology in Middle Childhood: Results from the ABCD Study. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022; 3:243-254. [PMID: 37124359 PMCID: PMC10140451 DOI: 10.1016/j.bpsgos.2022.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/14/2021] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background Prenatal selective serotonin reuptake inhibitor (SSRI) exposure has been inconsistently linked to depression, and little is known about neural correlates. We examined whether prenatal SSRI exposure is associated with depressive symptoms and brain structure during middle childhood. Methods Prenatal SSRI exposure (retrospective caregiver report), depressive symptoms (caregiver-reported Child Behavior Checklist), and brain structure (magnetic resonance imaging-derived subcortical volume; cortical thickness and surface area) were assessed in children (analytic ns = 5420-7528; 235 with prenatal SSRI exposure; 9-10 years of age) who completed the baseline Adolescent Brain Cognitive Development Study session. Linear mixed-effects models nested data. Covariates included familial, pregnancy, and child variables. Matrix spectral decomposition adjusted for multiple testing. Results Prenatal SSRI exposure was not independently associated with depression after accounting for recent maternal depressive symptoms. Prenatal SSRI exposure was associated with greater left superior parietal surface area (b = 145.3 mm2, p = .00038) and lateral occipital cortical thickness (b = 0.0272 mm, p = .0000079); neither was associated with child depressive symptoms. Child depression was associated with smaller global brain structure. Conclusions Our findings, combined with adverse outcomes of exposure to maternal depression and the utility of SSRIs for treating depression, suggest that risk for depression during middle childhood should not discourage SSRI use during pregnancy. Associations between prenatal SSRI exposure and brain structure were small in magnitude and not associated with depression. It will be important for future work to examine associations between prenatal SSRI exposure and depression through young adulthood, when risk for depression increases.
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Affiliation(s)
- Allison L. Moreau
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
- Allison Moreau, M.A.
| | - Michaela Voss
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Isabella Hansen
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Sarah E. Paul
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Deanna M. Barch
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Cynthia E. Rogers
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Ryan Bogdan
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
- Address correspondence to Ryan Bogdan, Ph.D.
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8
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Mountain RV, Zhu Y, Pickett OR, Lussier AA, Goldstein JM, Roffman JL, Bidlack FB, Dunn EC. Association of Maternal Stress and Social Support During Pregnancy With Growth Marks in Children's Primary Tooth Enamel. JAMA Netw Open 2021; 4:e2129129. [PMID: 34751761 PMCID: PMC8579236 DOI: 10.1001/jamanetworkopen.2021.29129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Exposure to maternal psychosocial stressors during the prenatal and perinatal periods can have major long-term mental health consequences for children. However, valid and inexpensive biomarkers are currently unavailable to identify children who have been exposed to psychosocial stress and the buffers of stress exposure. OBJECTIVE To assess whether a growth mark in tooth enamel, the neonatal line, is associated with exposure to prenatal and perinatal maternal psychosocial factors. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study used exfoliated primary canine teeth and epidemiological survey data from 70 children enrolled in the Avon Longitudinal Study of Parents and Children, a birth cohort based in Bristol, England. Exfoliated teeth were collected from children at 5 to 7 years of age. Data were collected from January 1, 1991, to December 31, 1998, and were analyzed from January 1, 2019, to August 10, 2021. EXPOSURES Four types of prenatal and perinatal maternal psychosocial factors were studied: stressful life events, psychopathological history, neighborhood disadvantage, and social support. Data were collected from mailed-in questionnaires completed during and shortly after pregnancy. MAIN OUTCOMES AND MEASURES Neonatal line width measured within 3 portions of the tooth crown (the cuspal, middle, and innermost third) in exfoliated primary canines. RESULTS A total of 70 children (34 of 70 [48.7%] male; 63 of 67 [94.0%] White) were studied. Most children were born full term (57 [83.8%]) and to mothers of typical child-bearing age (60 [88.2%]). Neonatal lines were wider in the canines of children born to mothers who self-reported severe lifetime depression (β = 3.35; 95% CI, 1.48-5.23; P = .001), any lifetime psychiatric problems (β = 2.66; 95% CI, 0.92-4.41; P = .003), or elevated anxiety or depressive symptoms at 32 weeks' gestation (β = 2.29; 95% CI, 0.38-4.20; P = .02). By contrast, neonatal lines were narrower in children born to mothers who self-reported high social support shortly after birth (β = -2.04; 95% CI, -3.70 to -0.38; P = .02). The magnitude of these associations was large, up to 1.2 SD unit differences, and persisted after adjusting for other risk factors. CONCLUSIONS AND RELEVANCE In this cohort study, neonatal line width was associated with exposure to maternal perinatal psychosocial factors. Replication and validation of these findings can further evaluate teeth as possible new biomarkers.
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Affiliation(s)
- Rebecca V. Mountain
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Yiwen Zhu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Olivia R. Pickett
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
| | - Alexandre A. Lussier
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jill M. Goldstein
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston
- Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Boston
| | - Joshua L. Roffman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Felicitas B. Bidlack
- Forsyth Institute, Cambridge, Massachusetts
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Erin C. Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston
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9
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Orbach-Zinger S, Eidelman LA, Livne MY, Matkovski O, Mangoubi E, Borovich A, Wazwaz SA, Ioscovich A, Zekry ZHB, Ariche K, Weiniger CF. Long-term psychological and physical outcomes of women after postdural puncture headache: A retrospective, cohort study. Eur J Anaesthesiol 2021; 38:130-137. [PMID: 32858584 DOI: 10.1097/eja.0000000000001297] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postdural puncture headache after accidental dural puncture during labour may lead to chronic sequalae. OBJECTIVES We aimed to measure the incidence of postpartum depression, posttraumatic stress disorder, chronic headache, backache and breastfeeding rates after a postdural puncture headache. DESIGN A retrospective, case-matched cohort study. SETTING A review of documented cases of dural puncture and matched case controls occurring at Rabin Medical Center and Shamir Medical Center from 01 January 2012 to 30 September 2018. PATIENTS The study cohort consisted of women with a documented postdural puncture headache and the controls were women with uneventful labour epidurals in the same 24-h period. Women were interviewed by telephone. PRIMARY OUTCOMES MEASURE The primary outcome measure was the incidence of postpartum depression after a postdural puncture headache. RESULTS Women with postdural puncture headache (n = 132) and controls (n = 276) had similar demographic data. The incidence of postpartum depression was 67/128 (52.3%) versus 31/276 (11.2%) for controls, P < 0.0001, 95% confidence intervals of the difference 31.5 to 50.2. Posttraumatic stress disorder was more frequent among women with postdural puncture headache, 17/132 (12.8%) versus controls 1/276 (0.4%), P < 0.0001, 95% confidence intervals of the difference 7.6 to 19.5. Women with postdural puncture headache breastfed less, 74/126 (54.5%) versus controls 212/276 (76.8%), P < 0.0001, 95% confidence intervals of the difference 33.1 to 55.2. Current headache and backache were significantly more frequent among women with postdural puncture headache [current headache 42/129 (32.6%) versus controls 42/276 (15.2%) P < 0.00001, 95% confidence intervals 0.085 to 0.266; current backache 58/129 (43.9%) versus controls 58/275 (21%) P < 0.0001, 95% confidence intervals 14.1 to 33.5]. CONCLUSION We report an increased incidence of postpartum depression, posttraumatic stress disorder, chronic headache and backache and decreased breastfeeding following a postdural puncture headache. Our findings emphasise the need for postpartum follow-up for women with postdural puncture headache. TRIAL REGISTRY NUMBER Clinical trial registry number: NCT03550586.
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Affiliation(s)
- Sharon Orbach-Zinger
- From the Department of Anesthesia, Rabin Medical Centre and Sackler Faculty of Medicine, Tel Aviv University (SOZ, LAE, MYL, EM, SW), the Department of Anesthesia, Assaf Harofeh Medical Centre, Shamir Medical Centre (OM, ZHBZ), the Department of Obstetrics Gynaecology, Rabin Medical Centre and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv (AB), the Department of Anesthesia, Shaare Zedek Medical Centre (AI), Hebrew University (AI), the Pain Clinic, Hadassah Hospital, Hebrew University, Jerusalem (KA) and the Department of Anesthesia, Critical Care and Pain Medicine, Tel Aviv Medical Centre, Tel-Aviv, Israel (CFW)
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Borchers LR, Dennis EL, King LS, Humphreys KL, Gotlib IH. Prenatal and postnatal depressive symptoms, infant white matter, and toddler behavioral problems. J Affect Disord 2021; 282:465-471. [PMID: 33422824 PMCID: PMC7889716 DOI: 10.1016/j.jad.2020.12.075] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Maternal depression is prevalent during and following pregnancy and is related to adverse outcomes in offspring. Perinatal depression is associated with risk for difficulties in offspring; however, the mechanisms underlying this association are not clear. We examined whether maternal prenatal and postnatal depressive symptoms were associated with infant white matter organization and with behavioral problems in toddlerhood. METHODS 37 mother-infant dyads (20 male; ages 5.95-7.66 months) participated in this study. We conducted diffusion MRI with infants during natural sleep. Mothers reported on their prenatal and postnatal depressive symptoms at six months postpartum. We calculated fractional anisotropy (FA), radial, axial, and mean diffusivity, and assessed offspring behavioral problems at age 18 months. RESULTS Prenatal depressive symptoms were associated with FA of the corpus callosum; postnatal depressive symptoms were not associated with FA of limbic tracts or corpus callosum segmentations. Higher levels of prenatal depressive symptoms were associated with higher FA and lower radial diffusivity of the corpus callosum genu; FA of this region was positively associated with behavioral problems at age 18 months. LIMITATIONS This study had a small sample size; therefore, findings should be replicated. Further, we used retrospective reports of maternal prenatal depression, but validated them in this study. CONCLUSIONS Depressive symptoms during pregnancy may affect infant corpus callosum development and, in turn, offspring behaviors. These findings suggest that early maternal stress accelerates infant neurodevelopment in a manner that may increase risk for behavioral problems. Thus, efforts to reduce maternal prenatal depression should be a public health priority.
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Affiliation(s)
- Lauren R Borchers
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, 94305, United States.
| | - Emily L Dennis
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, 94305, United States; Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, United States
| | - Lucy S King
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, 94305, United States
| | - Kathryn L Humphreys
- Department of Psychology and Human Development, Vanderbilt University, 230 Appleton Place, #552, Nashville, TN, 37203, United States
| | - Ian H Gotlib
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, 94305, United States
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11
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Wisner KL, Oberlander TF, Huybrechts KF. The Association Between Antidepressant Exposure and Birth Defects-Are We There Yet? JAMA Psychiatry 2020; 77:1215-1216. [PMID: 32777006 DOI: 10.1001/jamapsychiatry.2020.1512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Katherine L Wisner
- Northwestern University School of Medicine, Asher Center for the Study and Treatment of Depressive Disorders, Chicago, Illinois.,Northwestern University School of Medicine, Department of Psychiatry, Chicago, Illinois.,Northwestern University School of Medicine, Department of Obstetrics and Gynecology, Chicago, Illinois
| | - Tim F Oberlander
- University of British Columbia, School of Population and Public Health, Department of Pediatrics, Vancouver, British Columbia, Canada
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12
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Abstract
OBJECTIVE Mothers are known to be reliable reporters of smoking during pregnancy, type of delivery, and birth weight when compared with medical records. Few studies have considered whether the timing of retrospective collection affects the mother's retrospective self-report. We examined the consistency of maternal retrospective recall of prenatal experiences, behaviors, and basic birth outcomes between 6 months and 8 years postpartum. METHOD We examined 117 mothers (62% White, 44% living in a committed relationship, median high school education) from the Early Growth and Development Study (EGDS). EGDS is a longitudinal adoption study that includes birth mothers of children born between 2003 and 2009 who were involved in a domestic adoption. Using the modified life history calendar and a pregnancy screener, mothers reported on their prenatal health behaviors, prenatal substance use, and labor and delivery at 6 months and 8 years postpartum. Cohen κ was calculated to examine consistency, and χ tests were used to test differences by parity and maternal education. RESULTS Mothers' recall was very good for recall of the type of delivery and good for smoking during pregnancy, medicine used for labor induction, and specific medical problems (i.e., pre-eclampsia, sexually transmitted infections, and kidney infections). Recall consistency was poor for illicit drug use, specific prenatal tests performed (i.e., amniocentesis and emergency room visits), and using drugs other than an epidural during delivery. CONCLUSION This study provides support for using retrospective collection of maternal self-report on some prenatal experiences up to 8 years postpartum and offers a potential way to more accurately collect self-reported prenatal experiences.
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13
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Thompson SF, Klein MR, Ruberry EJ, Kiff CJ, Moran L, Zalewski M, Lengua LJ. Clarifying the unique effects of pre‐ and postnatal depression on pre‐schoolers' adjustment. INFANT AND CHILD DEVELOPMENT 2020. [DOI: 10.1002/icd.2202] [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]
Affiliation(s)
| | - Melanie R. Klein
- Department of Psychology University of Washington Seattle Washington USA
| | - Erika J. Ruberry
- Department of Psychology University of Washington Seattle Washington USA
| | - Cara J. Kiff
- Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior Los Angeles, CA USA
| | - Lyndsey Moran
- Department of Psychiatry, McLean Hospital Belmont, MA USA
| | | | - Liliana J. Lengua
- Department of Psychology University of Washington Seattle Washington USA
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14
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School-age social behavior and pragmatic language ability in children with prenatal serotonin reuptake inhibitor exposure. Dev Psychopathol 2020; 32:21-30. [PMID: 30728091 DOI: 10.1017/s0954579418001372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Studies examining associations between fetal serotonin reuptake inhibitor (SRI) exposure and child autism spectrum disorder (ASD) diagnoses or delayed language remain mixed and rarely prospectively follow children or employ gold-standard assessments. We prospectively followed a cohort of mother-child dyads from pregnancy through early elementary school (N = 178), and obtained maternal and alternate-caregiver ratings of behaviors related to ASD (N = 137), as well as direct, gold-standard assessments of child ASD symptoms and pragmatic language among dyads who experienced prenatal depression and either took SRIs or were medication free during pregnancy (N = 44). Prenatal SRI exposure was related to maternal ratings of ASD-related behaviors (β = 0.24 95% confidence interval; CI [0.07, 0.48]), and, among boys, alternative caregiver ratings (males-only β = 0.28 95% CI [0.02, 0.55], females-only β = -0.21 95% CI [-0.63, 0.08]). However, results of our direct assessments suggest an association between SRI exposure and reduced pragmatic language scores (β = -0.27, 95% CI [-0.53, -0.01], but not ASD (Autism Diagnostic Observation Schedule β = 0.14 95% CI [-0.15, 0.41]; Social Responsiveness Scale β = 0.08 95% CI [-0.25, 0.40]). These discrepancies point to issues regarding how ASD is assessed, and the possibility that SRIs may be more strongly associated with language or other broader behaviors that coincide with ASD. Larger prospective studies that incorporate thorough, gold-standard assessments of ASD, language, and other ASD-related behaviors are needed.
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15
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Vega ML, Newport GC, Bozhdaraj D, Saltz SB, Nemeroff CB, Newport DJ. Implementation of Advanced Methods for Reproductive Pharmacovigilance in Autism: A Meta-Analysis of the Effects of Prenatal Antidepressant Exposure. Am J Psychiatry 2020; 177:506-517. [PMID: 32375539 DOI: 10.1176/appi.ajp.2020.18070766] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Observational studies of prenatal antidepressant safety are hindered by methodological concerns, including susceptibility to surveillance bias. Some studies address potential bias by using alternative strategies to operationalize study comparison groups. In a meta-analysis of the association between prenatal antidepressant exposure and autism risk, the authors examined the utility of comparison group operationalization in reducing surveillance bias. METHODS A systematic search of multiple databases through August 2017 was conducted, selecting controlled observational studies of the association of prenatal antidepressant exposure with autism. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis produced summary effect measures with 95% confidence intervals stratified by comparator group composition, antidepressant class, and trimester of exposure. RESULTS Fourteen studies were included, with 13 reporting results using a population-based comparison group, five using a psychiatric control group, and four using a discordant-sibling control group. Eight of the 14 studies were rated poor because of inadequate control for prenatal depression and maternal ethnicity. Autism risk estimates after prenatal exposure to any antidepressant were decidedly different for population-based designs (hazard ratio=1.42, 95% CI=1.18, 1.70; odds ratio=1.58, 95% CI=1.25, 1.99) compared with psychiatric control (hazard ratio=1.14, 95% CI=0.84, 1.53; odds ratio=1.24, 95% CI=0.93, 1.66) and discordant-sibling (hazard ratio=0.97, 95% CI=0.68, 1.37; odds ratio=0.85, 95% CI=0.54, 1.35) designs. Findings for prenatal exposure to selective serotonin reuptake inhibitors were similar. Meta-regression of population-based studies demonstrated that despite statistical adjustment, ethnicity differences remained a significant source of study heterogeneity. CONCLUSIONS In this meta-analysis, neither psychiatric control nor discordant-sibling designs supported an association between prenatal antidepressant exposure and autism. Discordant-sibling designs effectively addressed surveillance bias in pharmacovigilance reports derived from national registries and other large databases.
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Affiliation(s)
- Monica L Vega
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami (Vega, Bozhdaraj, Saltz); Department of Psychology, University of South Florida St. Petersburg (G.C. Newport); Department of Psychiatry (Nemeroff, D.J. Newport), University of Texas at Austin Dell Medical School, Austin
| | - Graham C Newport
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami (Vega, Bozhdaraj, Saltz); Department of Psychology, University of South Florida St. Petersburg (G.C. Newport); Department of Psychiatry (Nemeroff, D.J. Newport), University of Texas at Austin Dell Medical School, Austin
| | - Durim Bozhdaraj
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami (Vega, Bozhdaraj, Saltz); Department of Psychology, University of South Florida St. Petersburg (G.C. Newport); Department of Psychiatry (Nemeroff, D.J. Newport), University of Texas at Austin Dell Medical School, Austin
| | - Samantha B Saltz
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami (Vega, Bozhdaraj, Saltz); Department of Psychology, University of South Florida St. Petersburg (G.C. Newport); Department of Psychiatry (Nemeroff, D.J. Newport), University of Texas at Austin Dell Medical School, Austin
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami (Vega, Bozhdaraj, Saltz); Department of Psychology, University of South Florida St. Petersburg (G.C. Newport); Department of Psychiatry (Nemeroff, D.J. Newport), University of Texas at Austin Dell Medical School, Austin
| | - D Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami (Vega, Bozhdaraj, Saltz); Department of Psychology, University of South Florida St. Petersburg (G.C. Newport); Department of Psychiatry (Nemeroff, D.J. Newport), University of Texas at Austin Dell Medical School, Austin
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16
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Falletta L, Abbruzzese S, Fischbein R, Shura R, Eng A, Alemagno S. Work Reentry After Childbirth: Predictors of Self-Rated Health in Month One Among a Sample of University Faculty and Staff. Saf Health Work 2020; 11:19-25. [PMID: 32206370 PMCID: PMC7078554 DOI: 10.1016/j.shaw.2019.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 08/05/2019] [Accepted: 12/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background Childbirth represents a significant transition for women, with physical and psychological sequelae. Reentry to the workplace during the postpartum period is understudied, with implications for maternal well-being and job-related outcomes. This study's aim was to examine selected pregnancy, childbirth, and return-to-work correlates of overall self-rated health within the first month of work reentry after maternity leave. Methods Between December 2016 and January 2017, we surveyed women employed at a large, public Midwestern university who had given birth in the past five years (N = 249) to examine self-rated overall health in the first month of work reentry. Using ordinal logistic regression, we examined whether physical or psychological health problems during pregnancy, childbirth complications, length of maternity leave, and depression and anxiety at work reentry were related to overall health. Results Women who experienced depression (odds ratio [OR] = 0.096 [95% confidence interval {CI} = 0.019 to 0.483, p = 0.004]) and anxiety (OR = 0.164, [95% CI = 0.042 to 0.635, p = 0.009]) nearly every day reported worse health at work reentry than those with no symptoms. Controlling for demographics and mental health, women who experienced medical problems during pregnancy (OR = 0.540 [95% CI = 0.311 to .935, p = 0.028]) were more likely to report poor health, while taking a longer maternity leave (OR = 14.552 [95% CI = 4.934 to 42.918, p < 0.001]) was associated with reporting better health at work reentry. Conclusion Women who experience medical complications during pregnancy, return to the workplace too soon after birth, and experience mental health symptoms are vulnerable physically as they return to work.
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Affiliation(s)
- Lynn Falletta
- Kent State University, College of Public Health, Moulton Hall, 800 Hilltop Drive, Kent, OH, 44242, USA
| | - Stephanie Abbruzzese
- Kent State University, College of Public Health, Moulton Hall, 800 Hilltop Drive, Kent, OH, 44242, USA
| | - Rebecca Fischbein
- Northeast Ohio Medical University, Family and Community Medicine, 4209 State Route 44, Rootstown, OH, 44272, USA
| | - Robin Shura
- Kent State University at Stark, Department of Sociology, 6000 Frank Avenue NW, North Canton, OH, 44720, USA
| | - Abbey Eng
- Kent State University, College of Public Health, Moulton Hall, 800 Hilltop Drive, Kent, OH, 44242, USA
| | - Sonia Alemagno
- Kent State University, College of Public Health, Moulton Hall, 800 Hilltop Drive, Kent, OH, 44242, USA
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17
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van Gelder MMHJ, de Jong LAA, Te Winkel B, Olyslager EJH, Vorstenbosch S, van Puijenbroek EP, Verbeek ALM, Roeleveld N. Assessment of medication use during pregnancy by Web-based questionnaires, pharmacy records and serum screening. Reprod Toxicol 2019; 84:93-97. [PMID: 30615926 DOI: 10.1016/j.reprotox.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/28/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare assessment of early pregnancy medication exposure using three methods of data collection. METHODS Serum samples were obtained from 752 women participating in the PRegnancy and Infant DEvelopment (PRIDE) Study before gestational week 17. For 52 women using medication at the date of blood sampling according to Web-based questionnaires or pharmacy records, we analysed serum samples using untargeted liquid chromatography time-of-flight spectrometry. RESULTS Medication was detected in 18 serum samples (35%). Medications taken orally for chronic conditions reported in the questionnaire were detected in serum and vice versa. Pharmacy records did not identify additional exposed women, but missed exposure in 5 women mainly due to unavailability. We observed substantial discordance between the three methods for inhaled medication, dermatological preparations, and medications for short-term use, which went often undetected in serum. CONCLUSIONS It remains challenging to assess medication use in large-scale studies as no 'gold standard' is currently available.
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Affiliation(s)
- Marleen M H J van Gelder
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands; Radboud REshape Innovation Center, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Lutea A A de Jong
- Department of Pharmacy, Gelre Hospitals, P.O. Box 9014, 7300 DS, Apeldoorn, the Netherlands.
| | - Bernke Te Winkel
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, the Netherlands.
| | - Erik J H Olyslager
- Department of Pharmacy, Gelre Hospitals, P.O. Box 9014, 7300 DS, Apeldoorn, the Netherlands.
| | - Saskia Vorstenbosch
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, the Netherlands.
| | - Eugène P van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, the Netherlands; PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands.
| | - André L M Verbeek
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
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18
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Cammack AL, Hogue CJ, Drews-Botsch CD, Kramer MR, Pearce BD, Knight B, Stowe ZN, Newport DJ. An exploratory study of whether pregnancy outcomes influence maternal self-reported history of child maltreatment. CHILD ABUSE & NEGLECT 2018; 85:145-155. [PMID: 29478731 PMCID: PMC6529201 DOI: 10.1016/j.chiabu.2018.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/19/2018] [Accepted: 01/25/2018] [Indexed: 06/08/2023]
Abstract
Childhood maltreatment is common and has been increasingly studied in relation to perinatal outcomes. While retrospective self-report is convenient to use in studies assessing the impact of maltreatment on perinatal outcomes, it may be vulnerable to bias. We assessed bias in reporting of maltreatment with respect to women's experiences of adverse perinatal outcomes in a cohort of 230 women enrolled in studies of maternal mental illness. Each woman provided a self-reported history of childhood maltreatment via the Childhood Trauma Questionnaire at two time points: 1) the preconception or prenatal period and 2) the postpartum period. While most women's reports of maltreatment agreed, there was less agreement for physical neglect among women experiencing adverse perinatal outcomes. Further, among women who discrepantly reported maltreatment, those experiencing adverse pregnancy outcomes tended to report physical neglect after delivery but not before, and associations between physical neglect measured after delivery and adverse pregnancy outcomes were larger than associations that assessed physical neglect before delivery. There were larger associations between post-delivery measured maltreatment and perinatal outcomes among women who had not previously been pregnant and in those with higher postpartum depressive symptoms. Although additional larger studies in the general population are necessary to replicate these findings, they suggest retrospective reporting of childhood maltreatment, namely physical neglect, may be prone to systematic differential recall bias with respect to perinatal outcomes. Measures of childhood maltreatment reported before delivery may be needed to validly estimate associations between maternal exposure to childhood physical neglect and perinatal outcomes.
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Affiliation(s)
- Alison L Cammack
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Carol J Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Carolyn D Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Brad D Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Bettina Knight
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719, USA
| | - D Jeffrey Newport
- Departments of Psychiatry & Behavioral Sciences and Obstetrics & Gynecology, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14 Street, Suite 1446, Miami, FL 33136, USA
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19
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Dean DC, Planalp EM, Wooten W, Kecskemeti SR, Adluru N, Schmidt CK, Frye C, Birn RM, Burghy CA, Schmidt NL, Styner MA, Short SJ, Kalin NH, Goldsmith HH, Alexander AL, Davidson RJ. Association of Prenatal Maternal Depression and Anxiety Symptoms With Infant White Matter Microstructure. JAMA Pediatr 2018; 172:973-981. [PMID: 30177999 PMCID: PMC6190835 DOI: 10.1001/jamapediatrics.2018.2132] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Maternal depression and anxiety can have deleterious and lifelong consequences on child development. However, many aspects of the association of early brain development with maternal symptoms remain unclear. Understanding the timing of potential neurobiological alterations holds inherent value for the development and evaluation of future therapies and interventions. OBJECTIVE To examine the association between exposure to prenatal maternal depression and anxiety symptoms and offspring white matter microstructure at 1 month of age. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 101 mother-infant dyads used a composite of depression and anxiety symptoms measured in mothers during the third trimester of pregnancy and measures of white matter microstructure characterized in the mothers' 1-month offspring using diffusion tensor imaging and neurite orientation dispersion and density imaging performed from October 1, 2014, to November 30, 2016. Magnetic resonance imaging was performed at an academic research facility during natural, nonsedated sleep. MAIN OUTCOMES AND MEASURES Brain mapping algorithms and statistical models were used to evaluate the association between maternal depression and anxiety and 1-month infant white matter microstructure as measured by diffusion tensor imaging and neurite orientation dispersion and density imaging findings. RESULTS In the 101 mother-infant dyads (mean [SD] age of mothers, 33.22 [3.99] years; mean age of infants at magnetic resonance imaging, 33.07 days [range, 18-50 days]; 92 white mothers [91.1%]; 53 male infants [52.5%]), lower 1-month white matter microstructure (decreased neurite density and increased mean, radial, and axial diffusivity) was associated in right frontal white matter microstructure with higher prenatal maternal symptoms of depression and anxiety. Significant sex × symptom interactions with measures of white matter microstructure were also observed, suggesting that white matter development may be differentially sensitive to maternal depression and anxiety symptoms in males and females during the prenatal period. CONCLUSIONS AND RELEVANCE These data highlight the importance of the prenatal period to early brain development and suggest that the underlying white matter microstructure is associated with the continuum of prenatal maternal depression and anxiety symptoms.
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Affiliation(s)
| | - Elizabeth M. Planalp
- Waisman Center, University of Wisconsin, Madison,Department of Psychology, University of Wisconsin, Madison
| | - William Wooten
- Center for Healthy Minds, University of Wisconsin, Madison
| | | | | | - Cory K. Schmidt
- Waisman Center, University of Wisconsin, Madison,Center for Healthy Minds, University of Wisconsin, Madison
| | - Corrina Frye
- Center for Healthy Minds, University of Wisconsin, Madison
| | - Rasmus M. Birn
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison,Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
| | - Cory A. Burghy
- Center for Healthy Minds, University of Wisconsin, Madison
| | | | - Martin A. Styner
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill,Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill
| | - Sarah J. Short
- Center for Healthy Minds, University of Wisconsin, Madison
| | - Ned H. Kalin
- Waisman Center, University of Wisconsin, Madison,Department of Psychology, University of Wisconsin, Madison,Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
| | - H. Hill Goldsmith
- Waisman Center, University of Wisconsin, Madison,Department of Psychology, University of Wisconsin, Madison
| | - Andrew L. Alexander
- Waisman Center, University of Wisconsin, Madison,Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison,Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
| | - Richard J. Davidson
- Waisman Center, University of Wisconsin, Madison,Department of Psychology, University of Wisconsin, Madison,Center for Healthy Minds, University of Wisconsin, Madison,Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
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20
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Abstract
BACKGROUND Early-life factors can be associated with future health outcomes and are often measured by maternal recall. METHODS We used data from the North Carolina Early Pregnancy Study and Follow-up to characterize long-term maternal recall. We used data from the Early Pregnancy Study as the gold standard to evaluate the accuracy of prepregnancy weight, early pregnancy behaviors, symptoms and duration of pregnancy, and child's birthweight reported at follow-up, for 109 women whose study pregnancies had resulted in a live birth. RESULTS Most (81%) participants reported a prepregnancy weight at follow-up that correctly classified them by BMI category. Women reported experiencing pregnancy symptoms later at follow-up than what they reported in the Early Pregnancy Study. Accuracy of reporting of early pregnancy behaviors varied based on exposure. Overall, women who had abstained from a behavior were more likely to be classified correctly. Sensitivity of reporting was 0.14 for antibiotics, 0.30 for wine, 0.71 for brewed coffee, and 0.82 for vitamins. Most misclassification at follow-up was due to false-negative reporting. Among women who gave birth to singletons, 94% could report their child's correct birthweight within ½ pound and 86% could report duration of pregnancy within 7 days at follow-up. CONCLUSIONS Self-report of prepregnancy weight, duration of pregnancy, and child's birthweight after almost 30 years was good, whereas self-reported pregnancy-related exposures resulted in higher levels of reporting error. Social desirability appeared to influence women's report of their behaviors at follow-up. Self-reported assessment of confidence in the recalled information was unrelated to accuracy.
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21
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van Gelder MMHJ, Vorstenbosch S, te Winkel B, van Puijenbroek EP, Roeleveld N. Using Web-Based Questionnaires to Assess Medication Use During Pregnancy: A Validation Study in 2 Prospectively Enrolled Cohorts. Am J Epidemiol 2018; 187:326-336. [PMID: 29401360 DOI: 10.1093/aje/kwx239] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/02/2017] [Indexed: 01/27/2023] Open
Abstract
Medication use is often underreported in paper-based questionnaires or interviews. Web-based questionnaires may improve recall of medication use, but data on their validity are currently lacking. Participants in the Pregnancy and Infant Development (PRIDE) Study (2014-2016; n = 557) and the Pregnancy Drug Registry (pREGnant) (2015-2016; n = 169) completed a 6-week paper-based medication diary during gestational weeks 19-24 or 26-31. In week 34, they completed a Web-based questionnaire with questions on medication names, time period and frequency of use, and quantity taken. To assess the degree of underreporting, we calculated the questionnaire's sensitivity using the medication diary as the reference standard. Sensitivity was high for many medication groups, including antiepileptic medication (sensitivity (Sn) = 0.96, 95% confidence interval (CI): 0.89, 1.00), antacids (Sn = 0.89, 95% CI: 0.86, 0.93), and iron preparations (Sn = 0.81, 95% CI: 0.64, 0.98). However, medications for short-term use were underreported more frequently, with sensitivities of 0.54 (95% CI: 0.35, 0.72) for antihistamines, 0.63 (95% CI: 0.57, 0.69) for analgesic and antipyretic agents, and 0.57 (95% CI: 0.51, 0.64) for acetaminophen. Shortening the period of time between exposure and questionnaire administration increased sensitivity substantially. In conclusion, underreporting in Web-based questionnaires is limited for many medication groups. In prospective studies, underreporting of medications for short-term use may be reduced by decreasing the interval between consecutive questionnaires.
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Affiliation(s)
- Marleen M H J van Gelder
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud REshape Innovation Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Saskia Vorstenbosch
- Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, the Netherlands
| | - Bernke te Winkel
- Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, the Netherlands
| | - Eugène P van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, the Netherlands
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Pediatrics, Radboudumc Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
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22
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Paediatric-onset coronary artery anomalies in pregnancy: a single-centre experience and systematic literature review. Cardiol Young 2017; 27:1529-1537. [PMID: 28412993 DOI: 10.1017/s1047951117000658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Individuals with childhood-onset coronary artery anomalies are at increased risk of lifelong complications. Although pregnancy is thought to confer additional risk, a few data are available regarding outcomes in this group of women. We sought to define outcomes of pregnancy in this unique population. METHODS We performed a retrospective survey of women with paediatric-onset coronary anomalies and pregnancy in our institution, combined with a systematic review of published cases. We defined paediatric-onset coronary artery anomalies as congenital coronary anomalies and inflammatory arteriopathies of childhood that cause coronary aneurysms. Major cardiovascular events were defined as pulmonary oedema, sustained arrhythmia requiring treatment, stroke, myocardial infarction, cardiac arrest, or death. RESULTS A total of 25 surveys were mailed, and 20 were returned (80% response rate). We included 46 articles from the literature, which described cardiovascular outcomes in 82 women (138 pregnancies). These data were amalgamated for a total of 102 women and 194 pregnancies; 59% of women were known to have paediatric-onset coronary artery anomalies before pregnancy. In 23%, the anomaly was unmasked during or shortly after pregnancy. The remainder, 18%, was diagnosed later in life. Major cardiovascular events occurred in 14 women (14%) and included heart failure (n=5, 5%), myocardial infarction (n=7, 7%), maternal death (n=2, 2%), cardiac arrest secondary to ventricular fibrillation (n=1, 1%), and stroke (n=1, 1%). The majority of maternal events (13/14, 93%) occurred in women with no previous diagnosis of coronary disease. CONCLUSIONS Women with paediatric-onset coronary artery anomalies have a 14% risk of adverse cardiovascular events in pregnancy, indicating the need for careful assessment and close follow-up. Prospective, multicentre studies are required to better define risk and predictors of complications during pregnancy.
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Andrade SE, Bérard A, Nordeng HME, Wood ME, van Gelder MMHJ, Toh S. Administrative Claims Data Versus Augmented Pregnancy Data for the Study of Pharmaceutical Treatments in Pregnancy. CURR EPIDEMIOL REP 2017; 4:106-116. [PMID: 29399433 PMCID: PMC5780544 DOI: 10.1007/s40471-017-0104-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose of Review Administrative claims databases, which collect reimbursement-related information generated from healthcare encounters, are increasingly used to evaluate medication safety in pregnancy. We reviewed the strengths and limitations of claims-only databases and how other data sources may be used to improve the accuracy and completeness of information critical for studying medication safety in pregnancy. Recent Findings Research on medication safety in pregnancy requires information on pregnancy episodes, mother-infant linkage, medication exposure, gestational age, maternal and birth outcomes, confounding factors, and (in some studies) long-term follow-up data. Claims data reliably identifies live births and possibly other pregnancies. It allows mother-infant linkage and has prospectively collected prescription medication information. Its diagnosis and procedure information allows estimation of gestational age. It captures maternal medical conditions but generally has incomplete data on reproductive and lifestyle factors. It has information on certain, typically short-term maternal and infant outcomes that may require chart review confirmation. Other data sources including electronic health records and birth registries can augment claims data or be analyzed alone. Interviews, surveys, or biological samples provide additional information. Nationwide and regional birth and pregnancy registries, such as those in several European and North American countries, generally contain more complete information essential for pregnancy research compared to claims-only databases. Summary Claims data offers several advantages in medication safety in pregnancy research. Its limitations can be partially addressed by linking it with other data sources or supplementing with primary data collection. Rigorous assessment of data quality and completeness is recommended regardless of data sources.
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Affiliation(s)
- Susan E Andrade
- 1Meyers Primary Care Institute, Fallon Community Health Plan, Reliant Medical Group, University of Massachusetts Medical School, 425 North Lake Avenue, Worcester, MA 01605 USA
| | - Anick Bérard
- 2Faculty of Pharmacy, and CHU Ste-Justine Research Center, University of Montreal, 3175 Côte-Ste-Catherine, Montreal, QC H3T 1C5 Canada
| | - Hedvig M E Nordeng
- 3Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box 1068, Blindern, 0316 Oslo, Norway.,4Department of Child Health, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, 0403 Oslo, Norway
| | - Mollie E Wood
- 3Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box 1068, Blindern, 0316 Oslo, Norway
| | - Marleen M H J van Gelder
- 5Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.,6Radboud REshape Innovation Center, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Sengwee Toh
- 7Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215 USA
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24
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de Jonge L, de Walle HEK, de Jong-van den Berg LTW, van Langen IM, Bakker MK. Actual Use of Medications Prescribed During Pregnancy: A Cross-Sectional Study Using Data from a Population-Based Congenital Anomaly Registry. Drug Saf 2016; 38:737-47. [PMID: 26041497 PMCID: PMC4513216 DOI: 10.1007/s40264-015-0302-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction and Aim Data from prescription databases are increasingly being used to study associations between maternal medications used in pregnancy and congenital anomalies. We therefore investigated the extent to which prescriptions reflect the actual use of medication during pregnancy, and whether medicines used during pregnancy are taken according to the prescribed dosage and duration. Methods We performed a cross-sectional study in a population-based congenital anomaly register (EUROCAT Northern Netherlands). We included 202 women who had at least one prescription during their pregnancy and who gave birth between 2009 and 2011. Compliance with the prescribed medication was verified by telephone interview. We calculated the compliance rates for several medication groups by dividing the number of mothers who confirmed they had taken the medication by the total number to whom it had been prescribed. Compliance was positive if the mother confirmed she took the medication, even if she only took one of several prescriptions from the same medication group. For each prescription taken, we also determined whether her use conformed to the prescribed dosage and duration. Results During the first trimester, the compliance rates ranged from 0.84 (for chronic diseases) to 0.92 (for pregnancy-related symptoms). Most of the medications actually taken were used at the prescribed dosage or lower. More than half of the medications actually taken were used for the duration prescribed or shorter. Conclusion Prescription records are generally a relatively reliable source of data for research into associations between medication use in pregnancy and congenital anomalies compared with other data sources. Pharmacy records of medication use in pregnancy might represent an overestimation, which should be taken into account. However, our results show that, except for ‘corticosteroids, dermatological preparations’; ‘ear, eye, nose and throat preparations’; and ‘anxiolytics, hypnotics and sedatives’, this overestimation generally seems minimal. Electronic supplementary material The online version of this article (doi:10.1007/s40264-015-0302-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Linda de Jonge
- University of Groningen, University Medical Center Groningen, Department of Genetics, EUROCAT Registration Northern Netherlands, Groningen, The Netherlands,
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25
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Širvinskienė G, Žemaitienė N, Jusienė R, Šmigelskas K, Veryga A, Markūnienė E. Smoking during pregnancy in association with maternal emotional well-being. MEDICINA-LITHUANIA 2016; 52:132-8. [PMID: 27170487 DOI: 10.1016/j.medici.2016.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 02/11/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of the study was to investigate psychosocial predictors of smoking during pregnancy. MATERIALS AND METHODS It was a cross-sectional analysis of a prospective birth-cohort study. The participants were 514 mothers of full-term infants. Women completed questionnaires during hospital stay after delivery. Questionnaire included items on sociodemographic characteristics, planning and emotional acceptance of pregnancy, reproductive history, health-related behavior, emotional well-being, and relationships with a partner. RESULTS Smoking during pregnancy was reported by 14.8% of the participants. Prenatal smoking was associated with secondary or lower education, maternal age less than 20 years, childbirth outside of marriage, history of elective abortion, unplanned pregnancy, lack of positive emotional acceptance of pregnancy by mother and father, emotional distress and alcohol consumption during pregnancy. Smoking during pregnancy remained significantly associated with prenatal alcohol consumption, previous elective abortion, and lack of positive emotional acceptance of pregnancy by mother even after adjustment for maternal age, education, and family structure. CONCLUSIONS Results support an idea of complexity of the relationships among smoking, alcohol use, and emotional well-being. Lack of positive emotional acceptance of pregnancy by mother and history of elective abortions can be considered as possible associates of smoking during pregnancy and suggest that strengthening of positive attitudes toward motherhood could add to lower smoking rates among pregnant women.
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Affiliation(s)
- Giedrė Širvinskienė
- Department of Health Psychology, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Nida Žemaitienė
- Department of Health Psychology, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Roma Jusienė
- Department of General Psychology, Psychological Innovations and Research Training Center, Faculty of Philosophy, Vilnius University, Vilnius, Lithuania
| | - Kastytis Šmigelskas
- Department of Health Psychology, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aurelijus Veryga
- Department of Health Psychology, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eglė Markūnienė
- Department of Neonatology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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26
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Johnson KC, Smith AK, Stowe ZN, Newport DJ, Brennan PA. Preschool outcomes following prenatal serotonin reuptake inhibitor exposure: differences in language and behavior, but not cognitive function. J Clin Psychiatry 2016; 77:e176-82. [PMID: 26930533 PMCID: PMC5512164 DOI: 10.4088/jcp.14m09348] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 02/20/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To test the hypothesis that prenatal exposure to serotonin reuptake inhibitors (SRIs) is associated with language and behavioral outcomes in preschool-aged children, while accounting for confounds such as concomitant exposures and maternal mental illness. METHOD An observational, prospective, longitudinal study of mental illness in pregnancy was conducted at a university-based women's mental health clinic (April 2010-November 2012). A sample of 178 mother-child dyads participated in a laboratory visit at preschool age (2.5-5.5 years). The majority of women (87%) received psychotropic medication during pregnancy. Psychiatric status (based on DSM-IV), other medication use, and substance use were serially assessed and tested as confounds. Primary outcome measures included standardized measures of expressive language and cognitive function and mother and alternate caregiver ratings of child behavior problems, including the Pervasive Developmental Disorders (PDD) subscale of the Child Behavior Checklist. RESULTS Linear regression analyses revealed that, after controlling for relevant covariates, expressive language scores from the Test of Early Language Development, 3rd edition, were negatively associated with prenatal SRI exposure (β = -0.15, t = -2.41), while the PDD behavioral problems subscales completed by alternate caregivers and mothers were positively associated with prenatal SRI exposure (β = 0.17, t = 2.01; β = 0.16, t = 2.00, respectively). Cognitive function, measured using the Differential Ability Scales, 2nd edition, was not associated with any medication exposures. CONCLUSIONS The current data suggest a small but significant association between prenatal SRI exposure and preschool outcomes, including expressive language and behavior problems. These data corroborate data from recent, population-based studies, although overall, published findings are mixed. Replication and identification of moderating risk factors are needed to understand potential clinical implications.
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Affiliation(s)
- Katrina C. Johnson
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Alicia K. Smith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Zachary N. Stowe
- Departments of Psychiatry, Pediatrics, and Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - D. Jeffrey Newport
- Departments of Psychiatry & Behavioral Health and Obstetrics & Gynecology, University of Miami, Miami, FL
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27
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House SJ, Tripathi SP, Knight BT, Morris N, Newport DJ, Stowe ZN. Obsessive-compulsive disorder in pregnancy and the postpartum period: course of illness and obstetrical outcome. Arch Womens Ment Health 2016; 19:3-10. [PMID: 26173597 PMCID: PMC4715787 DOI: 10.1007/s00737-015-0542-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 07/05/2015] [Indexed: 10/23/2022]
Abstract
The study aimed to examine the course of obsessive-compulsive disorder (OCD) across pregnancy and its impact on obstetric and neonatal outcomes. Women enrolled prior to 20-week gestation in a prospective, observational study. The Structured Clinical Interview for DSM-IV was completed to obtain lifetime Axis I diagnoses. A total of 56 women with OCD were followed at 1 to 3-month intervals through 52 weeks postpartum. Each visit, the Yale-Brown Obsessive Compulsive Scale (YBOCS), clinical assessment, and medication/exposure tracking were performed. Obstetric and neonatal data were abstracted from the medical record. In subjects with OCD, associations between perinatal obsessive-compulsive symptoms (OCSs) and outcomes were examined. Additionally, outcomes were compared to 156 matched psychiatric patients without OCD. Maternal age inversely correlated with the YBOCS scores across the study period (β = -0.5161, p = .0378). Cesarean section was associated with increased OCSs in the postpartum period compared to vaginal delivery (β = 5.3632, p = 0.043). No associations were found between severity of perinatal obsessions or compulsions and any specific obstetric or neonatal complications. Subjects without OCD had higher frequency of fetal loss compared to mothers with OCD (χ (2) = 4.03, p = 0.043). These novel prospective data fail to identify an association of OCSs with adverse outcomes. In contrast, there is an association of delivery method and younger maternal age with increased postnatal symptoms of OCD. Psychiatric subjects without OCD may have a higher risk of miscarriage and intrauterine fetal demise compared to subjects with OCD.
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Affiliation(s)
- Samuel J House
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA.
| | - Shanti P Tripathi
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA
| | - Bettina T Knight
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA
| | - Natalie Morris
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA
| | - D Jeffrey Newport
- Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Zachary N Stowe
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham, Box 843, Little Rock, AR, 72205, USA
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28
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Tai CG, Graff RE, Liu J, Passarelli MN, Mefford JA, Shaw GM, Hoffmann TJ, Witte JS. Detecting gene-environment interactions in human birth defects: Study designs and statistical methods. ACTA ACUST UNITED AC 2015; 103:692-702. [PMID: 26010994 DOI: 10.1002/bdra.23382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/25/2015] [Accepted: 03/30/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND The National Birth Defects Prevention Study (NBDPS) contains a wealth of information on affected and unaffected family triads, and thus provides numerous opportunities to study gene-environment interactions (G×E) in the etiology of birth defect outcomes. Depending on the research objective, several analytic options exist to estimate G×E effects that use varying combinations of individuals drawn from available triads. METHODS In this study, we discuss important considerations in the collection of genetic data and environmental exposures. RESULTS We will also present several population- and family-based approaches that can be applied to data from the NBDPS including case-control, case-only, family-based trio, and maternal versus fetal effects. For each, we describe the data requirements, applicable statistical methods, advantages, and disadvantages. CONCLUSION A range of approaches can be used to evaluate potentially important G×E effects in the NBDPS. Investigators should be aware of the limitations inherent to each approach when choosing a study design and interpreting results.
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Affiliation(s)
- Caroline G Tai
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Rebecca E Graff
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Jinghua Liu
- Institute for Human Genetics, University of California San Francisco, San Francisco, California
| | - Michael N Passarelli
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Joel A Mefford
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Institute for Human Genetics, University of California San Francisco, San Francisco, California
| | - John S Witte
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Institute for Human Genetics, University of California San Francisco, San Francisco, California.,Department of Urology, University of California San Francisco, San Francisco, California.,UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
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29
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Sanger C, Iles JE, Andrew CS, Ramchandani PG. Associations between postnatal maternal depression and psychological outcomes in adolescent offspring: a systematic review. Arch Womens Ment Health 2015; 18:147-162. [PMID: 25269760 DOI: 10.1007/s00737-014-0463-2] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 09/12/2014] [Indexed: 11/28/2022]
Abstract
Postnatal depression (PND) affects approximately 10-20 % of new mothers in developed countries, with accumulating research documenting its adverse impact on not only the mother but also the wider family. Longitudinal studies assessing potential effects of maternal PND on offspring are mounting, and it is therefore timely to investigate the long-term psychological outcomes for adolescent offspring who were exposed to PND in infancy. PsycINFO, Medline, and Embase databases were searched with key terms for English language abstracts. Papers of 16 were identified that examined associations between PND and internalising problems, externalising problems, psychopathology, psychosocial, and cognitive outcomes of adolescent offspring. Impaired offspring cognitive outcomes reflected some of the most consistent findings. Conflicting evidence was found for an effect of PND on adolescent offspring internalising and externalising problems and overall psychopathology. Psychosocial outcomes in offspring adolescents indicated a specific adverse effect, although based on only two studies. Significant gender differences across outcomes were found. It was concluded that PND possibly increases risk vulnerability in the presence of recurrent, concurrent, and antenatal maternal depression but that these latter factors alone may be the stronger specific predictors. Limitations of the review are discussed as well as implications for future research and clinical practice.
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Affiliation(s)
- Camilla Sanger
- Academic Unit of Child & Adolescent Psychiatry, The Centre for Mental Health, Hammersmith Hospital Campus Imperial College London, Du Cane Road, London, W2 0NN, UK. .,Warneford Hospital, The Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, OX3 7JX, UK.
| | - Jane E Iles
- Academic Unit of Child & Adolescent Psychiatry, The Centre for Mental Health, Hammersmith Hospital Campus Imperial College London, Du Cane Road, London, W2 0NN, UK
| | - Catharina S Andrew
- Berkshire Healthcare NHS Foundation Trust, Talking Health Service, 25 Erleigh Road, Reading, RG1 5LR, UK
| | - Paul G Ramchandani
- Academic Unit of Child & Adolescent Psychiatry, The Centre for Mental Health, Hammersmith Hospital Campus Imperial College London, Du Cane Road, London, W2 0NN, UK
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Martin A, Horowitz C, Balbierz A, Howell EA. Views of women and clinicians on postpartum preparation and recovery. Matern Child Health J 2015; 18:707-13. [PMID: 23775250 DOI: 10.1007/s10995-013-1297-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To explore important domains of women's postpartum experiences as perceived by postpartum mothers and obstetricians/midwives, and to investigate how postpartum care could enhance patient preparation for the postpartum period. Qualitative research study was conducted to explore women's and clinicians' perceptions of the postpartum experience. Four focus groups of postpartum women (n = 45) and two focus groups of obstetric clinicians (n = 13) were held at a large urban teaching hospital in New York City. All focus groups were audio recorded, transcribed, and analyzed using grounded theory. Four main themes were identified: lack of women's knowledge about postpartum health and lack of preparation for the postpartum experience, lack of continuity of care and absence of maternal care during the early postpartum period, disconnect between providers and postpartum mothers, and suggestions for improvement. Mothers did not expect many of the symptoms they experienced after childbirth and were disappointed with the lack of support by providers during this critical time in their recovery. Differences existed in the major postpartum concerns of mothers and clinicians. However, both mothers and clinicians agreed that preparation during the antepartum period could be beneficial for postpartum recovery. Results from this study indicate that many mothers do not feel prepared for the postpartum experience. Study findings raise the hypothesis that capturing patient-centered domains that define the postpartum experience and integrating these domains into patient care may enhance patient preparation for postpartum recovery and improve postpartum outcomes.
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Affiliation(s)
- Anika Martin
- Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
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31
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The relationship between maternal-fetal attachment and cigarette smoking over pregnancy. Matern Child Health J 2014; 18:1017-22. [PMID: 23892790 DOI: 10.1007/s10995-013-1330-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cigarette smoking during pregnancy is one of the most preventable causes of infant morbidity and mortality, yet 80 % of women who smoked prior to pregnancy continue to smoke during pregnancy. Past studies have found that lower maternal-fetal attachment predicts smoking status in pregnancy, yet past research has not examined whether maternal-fetal attachment predicts patterns or quantity of smoking among pregnant smokers. The aim of this study was to examine the relationship between maternal-fetal attachment and patterns of maternal smoking among pregnant smokers. We used self-reported and biochemical markers of cigarette smoking in order to better understand how maternal-fetal attachment relates to the degree of fetal exposure to nicotine. Fifty-eight pregnant smokers participated in the current study. Women completed the Maternal-Fetal Attachment Scale, reported weekly smoking behaviors throughout pregnancy using the Timeline Follow Back interview, and provided a saliva sample at 30 and 35 weeks gestation and 1 day postpartum to measure salivary cotinine concentrations. Lower maternal-fetal attachment scores were associated with higher salivary cotinine at 30 weeks gestation and 1 day postpartum. As well, women who reported lower fetal attachment reported smoking a greater maximum number of cigarettes per day, on average, over pregnancy. Lower maternal-fetal attachment is associated with greater smoking in pregnancy. Future research might explore whether successful smoking cessation programs improve maternal assessments of attachment to their infants.
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Rouse MH, Goodman SH. Perinatal depression influences on infant negative affectivity: timing, severity, and co-morbid anxiety. Infant Behav Dev 2014; 37:739-51. [PMID: 25459792 DOI: 10.1016/j.infbeh.2014.09.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 08/26/2014] [Accepted: 09/29/2014] [Indexed: 02/04/2023]
Abstract
Accumulating evidence suggests that antenatal depression predicts infants' negative affectivity, albeit with variable effect sizes. With a prospective longitudinal design, we sought to explain that variability by addressing questions about timing of the depression across pregnancy and the early postpartum, the role of high symptom levels relative to diagnosed depression, comorbidity with anxiety, and the potential mediating role of neuroendocrine functioning. Primiparous women (n=77) with histories of depression prior to pregnancy were assessed for cortisol levels monthly beginning by mid-pregnancy. Depression symptom levels and diagnostic status were similarly assessed monthly in pregnancy and also until infants reached three months of age, when mothers completed the Infant Behavior Questionnaire-Revised to measure infant negative affectivity. Antenatal depression symptoms and infant negative affectivity were positively associated (r=.39). Controlling for depression symptom levels in other trimesters, only second trimester depression symptoms predicted higher infant negative affectivity (β=.44). With postpartum depression symptom levels in the model, only antenatal depression symptoms predicted infant negative affectivity (β=.45). In the context of depression, neither antenatal anxiety symptoms nor anxiety disorder diagnosis were associated with infant NA scores. The hypothesized role of elevated maternal cortisol as a mechanism for the association between antenatal depression and infant NA was not supported. Our findings contribute to efforts to more precisely identify infants of perinatally depressed mothers who are at greater risk for elevated negative affectivity, suggesting a window of vulnerability in mid pregnancy and the need for further study of potential mechanisms.
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Affiliation(s)
- Matthew H Rouse
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - Sherryl H Goodman
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States.
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Abstract
OBJECTIVE To examine sociodemographic factors, pregnancy-associated psychosocial stress and depression, health risk behaviors, prepregnancy medical and psychiatric illness, pregnancy-related illnesses, and birth outcomes as risk factors for post-partum depression (PPD). METHODS A prospective cohort study screened women at 4 and 8 months of pregnancy and used hierarchical logistic regression analyses to examine predictors of PPD. The study sample include 1,423 pregnant women at a university-based high risk obstetrics clinic. A score of ≥10 on the Patient Health Questionnaire-9 (PHQ-9) indicated clinically significant depressive symptoms. RESULTS Compared with women without significant postpartum depressive symptoms, women with PPD were significantly younger (p<0.0001), more likely to be unemployed (p=0.04), had more pregnancy associated depressive symptoms (p<0.0001) and psychosocial stress (p<0.0001), were more likely to be smokers (p<0.0001), were more likely to be taking antidepressants (ADs) during pregnancy (p=0.002), were less likely to drink any alcohol during pregnancy (p=0.02), and were more likely to have prepregnancy medical illnesses, including diabetes (p=0.02) and neurologic conditions (p=0.02). CONCLUSION Specific sociodemographic and clinical risk factors for PPD were identified that could help physicians target depression case finding for pregnant women.
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Affiliation(s)
- Wayne Katon
- 1 Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle, Washington
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Harrington RA, Lee LC, Crum RM, Zimmerman AW, Hertz-Picciotto I. Prenatal SSRI use and offspring with autism spectrum disorder or developmental delay. Pediatrics 2014; 133:e1241-8. [PMID: 24733881 PMCID: PMC4006441 DOI: 10.1542/peds.2013-3406] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To examine associations between prenatal use of selective serotonin reuptake inhibitors (SSRIs) and the odds of autism spectrum disorders (ASDs) and other developmental delays (DDs). METHODS A total of 966 mother-child pairs were evaluated (492 ASD, 154 DD, 320 typical development [TD]) from the Childhood Autism Risks from Genetics and the Environment (CHARGE) Study, a population-based case-control study. Standardized measures confirmed developmental status. Interviews with biological mothers ascertained prenatal SSRI use, maternal mental health history, and sociodemographic information. RESULTS Overall, prevalence of prenatal SSRI exposure was lowest in TD children (3.4%) but did not differ significantly from ASD (5.9%) or DD (5.2%) children. Among boys, prenatal SSRI exposure was nearly 3 times as likely in children with ASD relative to TD (adjusted odds ratio [OR]: 2.91; 95% confidence interval [CI]: 1.07-7.93); the strongest association occurred with first-trimester exposure (OR: 3.22; 95% CI: 1.17-8.84). Exposure was also elevated among boys with DD (OR: 3.39; 95% CI: 0.98-11.75) and was strongest in the third trimester (OR: 4.98; 95% CI: 1.20-20.62). Findings were similar among mothers with an anxiety or mood disorder history. CONCLUSIONS In boys, prenatal exposure to SSRIs may increase susceptibility to ASD or DD. Findings from published studies on SSRIs and ASD continues to be inconsistent. Potential recall bias and residual confounding by indication are concerns. Larger samples are needed to replicate DD results. Because maternal depression itself carries risks for the fetus, the benefits of prenatal SSRI use should be carefully weighed against potential harms.
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Affiliation(s)
| | - Li-Ching Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and
| | - Rosa M. Crum
- Departments of Epidemiology, Psychiatry, and Mental Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Andrew W. Zimmerman
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts; and
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences and the MIND Institute, University of California, Davis, Davis, California
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Antiemetic medications in pregnancy: a prospective investigation of obstetric and neurobehavioral outcomes. Am J Obstet Gynecol 2014; 210:270.e1-7. [PMID: 24412116 PMCID: PMC10019290 DOI: 10.1016/j.ajog.2014.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/18/2013] [Accepted: 01/06/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The study goal was to examine the impact of commonly prescribed antiemetic medications in pregnancy on neurobehavioral and obstetric outcomes. STUDY DESIGN Five hundred thirty-three women accounting for 550 live births (17 multiple gestations) enrolled before 16 weeks' gestation participating in an observational longitudinal study of stress and pharmacologic exposure in pregnancy at Emory Women's Mental Health Program were included in this study. Maternal report of exposure to medications was documented by weeks of use. Obstetric and neonatal data were obtained from medical records. The Neonatal Behavioral Assessment Scale was completed by certified raters at age 7 days. The Child Behavior Checklist (CBCL) was completed by the mother between 17 and 66 months of age. Comparison of groups was conducted using χ(2) and Wilcoxon rank-sum tests. Spearman correlation analysis was used for CBCL percentile scores to evaluate duration of exposure. RESULTS The exposed group (n = 143) was comprised of children whose mothers received promethazine or ondansetron during pregnancy. Unexposed children (n = 407) were used for comparison. Neonatal Behavioral Assessment Scale data 7 days (range, 2-77) was available on 345 infants (exposed n = 102; unexposed n = 243), and a total of 247 CBCLs (exposed n = 51; unexposed n = 196) at 29 (range, 17-66) months of age. No significant differences were seen using Neonatal Behavioral Assessment Scale and CBCL. Statistically significant differences were seen in gestational age at delivery (0.3 weeks) and birthweight (110 g). CONCLUSION No clinically significant adverse neurobehavioral effects or obstetric outcomes were identified. This is reassuring as promethazine and ondansetron are commonly prescribed during pregnancy.
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Bourke CH, Stowe ZN, Owens MJ. Prenatal antidepressant exposure: clinical and preclinical findings. Pharmacol Rev 2014; 66:435-65. [PMID: 24567054 DOI: 10.1124/pr.111.005207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Pharmacological treatment of any maternal illness during pregnancy warrants consideration of the consequences of the illness and/or medication for both the mother and unborn child. In the case of major depressive disorder, which affects up to 10-20% of pregnant women, the deleterious effects of untreated depression on the offspring can be profound and long lasting. Progress has been made in our understanding of the mechanism(s) of action of antidepressants, fetal exposure to these medications, and serotonin's role in development. New technologies and careful study designs have enabled the accurate sampling of maternal serum, breast milk, umbilical cord serum, and infant serum psychotropic medication concentrations to characterize the magnitude of placental transfer and exposure through human breast milk. Despite this progress, the extant clinical literature is largely composed of case series, population-based patient registry data that are reliant on nonobjective means and retrospective recall to determine both medication and maternal depression exposure, and limited inclusion of suitable control groups for maternal depression. Conclusions drawn from such studies often fail to incorporate embryology/neurotransmitter ontogeny, appropriate gestational windows, or a critical discussion of statistically versus clinically significant. Similarly, preclinical studies have predominantly relied on dosing models, leading to exposures that may not be clinically relevant. The elucidation of a defined teratological effect or mechanism, if any, has yet to be conclusively demonstrated. The extant literature indicates that, in many cases, the benefits of antidepressant use during pregnancy for a depressed pregnant woman may outweigh potential risks.
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Avni-Barron O, Hoagland K, Ford C, Miller LJ. Preconception planning to reduce the risk of perinatal depression and anxiety disorders. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ray S, Stowe ZN. The use of antidepressant medication in pregnancy. Best Pract Res Clin Obstet Gynaecol 2013; 28:71-83. [PMID: 24211026 DOI: 10.1016/j.bpobgyn.2013.09.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/06/2013] [Accepted: 09/27/2013] [Indexed: 01/08/2023]
Abstract
The use of antidepressant medications during pregnancy has stimulated much professional and public debate. As a consequence, considerable data on the reproductive safety of antidepressants has been generated that exceeds the available information for most, if not all, other classes of medications that may be used in the perinatal period. Despite progress to date, definitive conclusions are limited by the methodological issues inherent to clinical research involving illness versus treatment effects in pregnancy. A notable shortcoming is the limited discussion of statistically significant (a mathematical determination) versus clinically significant (incorporation of incidence and effect sizes into practical relevance). Research emphasises completing an individualised 'risk-benefit' assessment, which is a laudable goal but falls short in providing succinct practical guidelines that includes the key educational points for patients. In this chapter, we focus on areas in which the preponderance of data are consistent, and there is concordance with the preclinical literature to generate a practical approach for antidepressant use in pregnancy.
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Affiliation(s)
- Shona Ray
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zachary N Stowe
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Pediatrics and Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street 843, Little Rock, AR 72205-7199, USA.
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Huerta-Ramírez R, Bertsch J, Cabello M, Roca M, Haro JM, Ayuso-Mateos JL. Diagnosis delay in first episodes of major depression: a study of primary care patients in Spain. J Affect Disord 2013; 150:1247-50. [PMID: 23827532 DOI: 10.1016/j.jad.2013.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 06/10/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Diagnosis delay may negatively influence the clinical course of major depression; however, few studies have analysed the role of environmental factors on diagnosis delay. This study was aimed to identify personal and environmental factors related to a longer delay. METHODS A cross-sectional observational study with 3615 primary care patients with a first diagnosis of major depression was conducted. Diagnosis delay was defined as the time between onset of symptoms and diagnosis of major depression. RESULTS Mean of delay was 9.89 weeks. Lower years of education, triggering stressful life events before the current episode, history of previous undiagnosed depressive episodes and somatic comorbidity were related to longer delay. Health system variables, such as urban setting, public health care setting, younger doctors and female doctors were also related to a longer delay. LIMITATIONS Onset of first depressive symptoms was retrospectively collected. The cross-sectional design does not allow making inferences about the temporal ordering between predictors and outcomes. CONCLUSIONS Both personal and environmental variables were related to diagnosis delay. Identification of these factors helps to design early diagnosis programs to ultimate reduce the morbidity associated with major depression.
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Affiliation(s)
- Raúl Huerta-Ramírez
- Complejo Asistencial Benito Menni. Hermanas Hospitalarias. Ciempozuelos, Madrid, Spain
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Brunner E, Falk DM, Jones M, Dey DK, Shatapathy CC. Olanzapine in pregnancy and breastfeeding: a review of data from global safety surveillance. BMC Pharmacol Toxicol 2013; 14:38. [PMID: 23902726 PMCID: PMC3750520 DOI: 10.1186/2050-6511-14-38] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 07/30/2013] [Indexed: 01/16/2023] Open
Abstract
Background Olanzapine use has been reported during pregnancy and breastfeeding, but there are no controlled clinical trials assessing the safety of olanzapine exposure to infants and fetuses. The purpose of this report was to review and analyze prospective post-marketing cases of pregnancy and breastfeeding with olanzapine, in order to guide clinicians and women on the use of olanzapine therapy during pregnancy and/or breastfeeding. Methods A worldwide safety database maintained by Eli Lilly and Company was searched for all spontaneous-reported data regarding olanzapine use during pregnancy and/or breastfeeding. Cases reported prior to pregnancy outcome were considered to be prospective, and follow-up was pursued after the delivery date to assess outcome. Results Outcome data were available for 610 prospectively identified pregnancies during which olanzapine was used. The majority of women had normal births (66%), although premature births were reported in 9.8% and perinatal conditions in 8% of the pregnancies. A total of 102 pregnancies reported olanzapine treatment during breastfeeding. In these infants, the most commonly reported adverse events were somnolence (3.9%), irritability (2%), tremor (2%), and insomnia (2%), although the majority of pregnancies reported no adverse events (82.3%). Conclusions The frequency of fetal outcomes in these prospectively identified pregnancies exposed to olanzapine did not differ from rates of outcomes reported in the general population. These data may be useful to help guide clinicians and women decide to continue, or discontinue, olanzapine therapy during pregnancy and/or breastfeeding, but should be considered within the limitations associated with spontaneously reported data. Women should notify their clinicians if they become pregnant or intend to become pregnant while being treated with olanzapine. Because of limited experience in humans, olanzapine should be used in pregnancy only when potential benefit justifies potential risk to the fetus. Olanzapine should only be considered during breastfeeding when the potential benefit justifies the potential risk to the infant.
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Affiliation(s)
- Elizabeth Brunner
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, Indiana 46285, USA.
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Lusby CM, Goodman SH, Bell MA, Newport DJ. Electroencephalogram patterns in infants of depressed mothers. Dev Psychobiol 2013; 56:459-73. [PMID: 23852456 DOI: 10.1002/dev.21112] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 02/26/2013] [Indexed: 12/19/2022]
Abstract
Electroencephalogram (EEG) patterns may reflect a vulnerability to depression. In an effort to understand their earliest origin, we examined their stability and consistency and their associations with perinatal depressive symptoms. Depressive symptoms were measured prospectively throughout the perinatal period in 83 women with histories of depression and/or anxiety. Infant's EEG was recorded during baseline, feeding, and play at 3 and 6 months of age. Prenatal and postpartum depressive symptoms interacted significantly to predict 3- and 6-month-olds' EEG asymmetry scores. Asymmetry scores were consistent across contexts, except from baseline to feeding and play at 6 months, and stable across ages, except during feeding. Changes in depressive symptoms across ages were not associated with changes in infant EEG. Findings highlight the importance of considering both prenatal and postpartum depressive symptoms in the prediction of infant EEG, as well as the need to consider context to understand stability of infant EEG patterns.
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Affiliation(s)
- Cara M Lusby
- Department of Psychology, Emory University, Atlanta, GA, 30322
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Maternal Recall of Prescription Medication Use During Pregnancy Using a Paper-Based Questionnaire. Drug Saf 2012; 36:43-54. [DOI: 10.1007/s40264-012-0004-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Monk C, Newport DJ, Korotkin JH, Long Q, Knight B, Stowe ZN. Uterine blood flow in a psychiatric population: impact of maternal depression, anxiety, and psychotropic medication. Biol Psychiatry 2012; 72:483-90. [PMID: 22695184 PMCID: PMC3424380 DOI: 10.1016/j.biopsych.2012.05.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 04/07/2012] [Accepted: 05/05/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND Accumulating evidence suggests that fetal exposure to maternal psychiatric symptoms is associated with future risk for psychopathology. One potential pathway is distress-linked constriction in uterine or umbilical blood flow (UBF). With approximately 6.6% of pregnant women taking an antidepressant, an ecologically valid investigation of this hypothesis must consider the potential concomitant influence of pharmacotherapy on UBF. METHODS Pregnant women (n = 101) with lifetime histories of mental illness were evaluated every 4 to 6 weeks during gestation for mood symptoms and medication use; women underwent an ultrasound examination for UBF at approximately 25 weeks gestation. RESULTS No associations were observed between UBF and three assessments of maternal prenatal depression and anxiety (acute: coincident with the UBF scan; proximal: within 2 weeks of the scan; chronic: serial symptom ratings). Chronic and acute use of bupropion was associated with reduced UBF, even after controlling for pregnancy complications. Chronic use of atypical antipsychotics also was associated with decreased UBF. There were no associations between serotonergic antidepressant use and UBF. CONCLUSIONS Contrary to a popular hypothesis, depression and anxiety-associated reductions in UBF may not be a pathway by which risk is conferred during prenatal development. However, while requiring replication, our findings suggest that prenatal bupropion exposure may be associated with reductions in UBF.
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Affiliation(s)
- Catherine Monk
- Department of Psychiatry, Behavioral Medicine, Columbia University, New York, New York, USA.
| | - D. Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, Women’s Mental Health Program, Emory University
| | | | - Qi Long
- Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Emory University
| | - Bettina Knight
- Department of Psychiatry and Behavioral Sciences, Women’s Mental Health Program, Emory University
| | - Zachary N. Stowe
- Department of Psychiatry and Behavioral Sciences, Women’s Mental Health Program, Emory University
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Johnson KC, LaPrairie JL, Brennan PA, Stowe ZN, Newport DJ. Prenatal antipsychotic exposure and neuromotor performance during infancy. ARCHIVES OF GENERAL PSYCHIATRY 2012; 69:787-94. [PMID: 22474072 PMCID: PMC4714592 DOI: 10.1001/archgenpsychiatry.2012.160] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Despite the expanding clinical utility of antipsychotics beyond psychotic disorders to include depressive, bipolar, and anxiety disorders, reproductive safety data regarding the neurodevelopmental sequelae of fetal antipsychotic exposure are scarce. OBJECTIVE To examine whether intrauterine antipsychotic exposure is associated with deficits in neuromotor performance and habituation in 6-month-old infants. DESIGN, SETTING, AND PARTICIPANTS A prospective controlled study was conducted from December 1999 through June 2008 at the Infant Development Laboratory of the Emory Psychological Center examining maternal-infant dyads (N=309) at 6 months postpartum with pregnancy exposure to antipsychotics (n=22), antidepressants (n=202), or no psychotropic agents (n=85). Examiners masked to maternal-infant exposure status administered a standardized neuromotor examination (Infant Neurological International Battery [INFANIB]) that tests posture, tone, reflexes, and motor skills and a visual habituation paradigm using a neutral female face. MAIN OUTCOME MEASURES The INFANIB composite score; number of trials required to achieve a 50% decrease in infant fixation during a visual habituation task; and mean time looking at the stimulus across 10 trials. RESULTS Infants prenatally exposed to antipsychotics (mean=64.71) showed significantly lower INFANIB scores than those with antidepressant (mean=68.57) or no psychotropic (mean=71.19) exposure, after controlling for significant covariates (F(2,281)=4.51; P=.01; partial η(2)=0.033). The INFANIB scores were also significantly associated with maternal psychiatric history, including depression, psychosis, and overall severity/chronicity (P's.05) and maternal depression during pregnancy was associated with less efficient habituation (r(245)=0.16; P.02). There were no significant differences regarding habituation between medication exposure groups. CONCLUSIONS Among 6-month-old infants, a history of intrauterine antipsychotic exposure, compared with antidepressant or no psychotropic exposure, was associated with significantly lower scores on a standard test of neuromotor performance, highlighting the need for further scrutiny of the reproductive safety and neurodevelopmental sequelae of fetal antipsychotic exposure. Disentangling medication effects from maternal illness effects, which also contributed, remains a critical challenge.
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Affiliation(s)
- Katrina C Johnson
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA.
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Newschaffer CJ, Croen LA, Fallin MD, Hertz-Picciotto I, Nguyen DV, Lee NL, Berry CA, Farzadegan H, Hess HN, Landa RJ, Levy SE, Massolo ML, Meyerer SC, Mohammed SM, Oliver MC, Ozonoff S, Pandey J, Schroeder A, Shedd-Wise KM. Infant siblings and the investigation of autism risk factors. J Neurodev Disord 2012; 4:7. [PMID: 22958474 PMCID: PMC3436647 DOI: 10.1186/1866-1955-4-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 04/18/2012] [Indexed: 12/31/2022] Open
Abstract
Infant sibling studies have been at the vanguard of autism spectrum disorders (ASD) research over the past decade, providing important new knowledge about the earliest emerging signs of ASD and expanding our understanding of the developmental course of this complex disorder. Studies focused on siblings of children with ASD also have unrealized potential for contributing to ASD etiologic research. Moving targeted time of enrollment back from infancy toward conception creates tremendous opportunities for optimally studying risk factors and risk biomarkers during the pre-, peri- and neonatal periods. By doing so, a traditional sibling study, which already incorporates close developmental follow-up of at-risk infants through the third year of life, is essentially reconfigured as an enriched-risk pregnancy cohort study. This review considers the enriched-risk pregnancy cohort approach of studying infant siblings in the context of current thinking on ASD etiologic mechanisms. It then discusses the key features of this approach and provides a description of the design and implementation strategy of one major ASD enriched-risk pregnancy cohort study: the Early Autism Risk Longitudinal Investigation (EARLI).
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Affiliation(s)
- Craig J Newschaffer
- Department of Epidemiology and Biostatistics, Drexel School of Public Health, 1505 Race Street, Mail Stop 1033, Philadelphia, PA 19102, USA
| | - Lisa A Croen
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612, USA
| | - M Daniele Fallin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Danh V Nguyen
- Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Nora L Lee
- Department of Epidemiology and Biostatistics, Drexel School of Public Health, 1505 Race Street, Mail Stop 1033, Philadelphia, PA 19102, USA
| | - Carmen A Berry
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Homayoon Farzadegan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - H Nicole Hess
- Kaiser Permanente San Jose Medical Center, 6620 Via Del Oro, San Jose, CA 95119, USA
| | - Rebecca J Landa
- Kennedy Krieger Institute, 3901 Greenspring Avenue, 2nd Floor, Baltimore, MD 21211, USA
| | - Susan E Levy
- Center for Autism Research, The Children's Hospital of Philadelphia, 3535 Market Street, Suite 860, Philadelphia, PA 19104, USA
| | - Maria L Massolo
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612, USA
| | - Stacey C Meyerer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Sandra M Mohammed
- Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - McKenzie C Oliver
- Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Sally Ozonoff
- The MIND Institute, UC Davis Medical Center, 2825 50th Street, Sacramento, CA 95817, USA
| | - Juhi Pandey
- Center for Autism Research, The Children's Hospital of Philadelphia, 3535 Market Street, Suite 860, Philadelphia, PA 19104, USA
| | - Adam Schroeder
- Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Kristine M Shedd-Wise
- Department of Public Health Sciences, University of California, Davis, CA 95616, USA
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Katon WJ, Russo JE, Melville JL, Katon J, Gavin A. Depression in pregnancy is associated with preexisting but not pregnancy-induced hypertension. Gen Hosp Psychiatry 2012; 34:9-16. [PMID: 22055108 PMCID: PMC3253932 DOI: 10.1016/j.genhosppsych.2011.09.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 09/27/2011] [Accepted: 09/27/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim was to examine whether depression is associated with preexisting hypertension or pregnancy-induced hypertension in a large sample of women attending a university-based obstetrics clinic. METHODS In this prospective study, participants were 2398 women receiving ongoing prenatal care at a university-based obstetrics clinic from January 2004 through January 2009. Prevalence of depression was measured using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria based on the Patient Health Questionnaire-9 as well as the self-reported use of antidepressant medication. Evidence of preexisting hypertension, pregnancy-induced hypertension and preeclampsia/eclampsia was determined by obstetrician International Classification of Diseases, Ninth Revision codes. Logistic regression was used to quantify the association between hypertension in pregnancy and antenatal depression. RESULTS After adjusting for sociodemographic variables, chronic medical conditions, smoking and prior pregnancy complications, women with preexisting hypertension had an increased risk of any depression (minor, major, use of antidepressants) [odds ratio (OR)=1.55, 95% confidence interval (CI) 1.08-2.23) and major depression and/or use of antidepressants (OR=1.65, 95% CI 1.10-2.48) compared to women without hypertension. No differences were seen in risk of depression in women with pregnancy-induced hypertension or preeclampsia/eclampsia compared to those without hypertension. CONCLUSION Women with preexisting hypertension, but not pregnancy-induced hypertension, are more likely to meet criteria for an antenatal depressive disorder and/or to be treated with antidepressants and could be targeted by obstetricians for screening for depression and enhanced treatment.
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Affiliation(s)
- Wayne J. Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA,Corresponding Author Wayne Katon, M.D., Professor and Vice-Chair, Department of Psychiatry & Behavioral Sciences, Box 356560, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6560, PH: 206-543-7177 Fax: 206-221-5414
| | - Joan E. Russo
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Jennifer L. Melville
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA
| | - Jodie Katon
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Amelia Gavin
- School of Social Work, University of Washington, Seattle, WA
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Katon JG, Russo J, Gavin AR, Melville JL, Katon WJ. Diabetes and depression in pregnancy: is there an association? J Womens Health (Larchmt) 2011; 20:983-9. [PMID: 21668382 DOI: 10.1089/jwh.2010.2662] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Prior studies have reported inconsistent findings regarding the association of antenatal depression with pregnancy-related diabetes. This study examined the association of diabetes and antenatal depression. METHODS We conducted a cross-sectional analysis of baseline data from a prospective cohort study of pregnant women receiving prenatal care at a single University of Washington Medical Center clinic between January 2004 and January 2009. The primary exposure was diabetes in pregnancy (no diabetes, preexisting diabetes, or gestational diabetes [GDM]). Antenatal depression was defined by the Patient Health Questionnaire-9 (PHQ-9) score or current use of antidepressants. Antenatal depression was coded as (1) any depression (probable major or minor depression by PHQ-9 or current antidepressant use) and (2) major depression (probable major depression by PHQ-9 or current antidepressant use). Logistic regression was used to quantify the association between diabetes in pregnancy and antenatal depression. RESULTS The prevalences of preexisting diabetes, GDM, any antenatal depression, and major antenatal depression were 9%, 18%, 13.6%, and 9.8%, respectively. In the unadjusted analysis, women with preexisting diabetes had 54% higher odds of any antenatal depression compared to those without diabetes (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.08-2.21). After adjusting for important covariates the association was attenuated (OR 1.16, 95% CI 0.79-1.71). Results were similar for antenatal major depression. GDM was not associated with increased odds for any antenatal depression or antenatal major depression. CONCLUSIONS Neither preexisting diabetes nor GDM was independently associated with increased risk of antenatal depression.
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Affiliation(s)
- Jodie G Katon
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington 98195, USA.
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Pharmacoepidemiology of psychotropic drugs: examples of current research challenges on major public health issues. ACTA ACUST UNITED AC 2011. [DOI: 10.1017/s1121189x00000981] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SummaryBackground– As a large number of persons are exposed to prescribed psychotropic drugs, their utilisation and impact should be further explored at the population level.Aims– To illustrate the interest of pharmacoepidemiological studies of psychotropic drugs by selected examples of major public health issues.Method– Selective review of the literature. Results – Many questions remain unsolved regarding the behavioural teratogenicity of prenatal exposure to psychotropic drugs, the impact of their increasing use in children, the long-term cognitive consequences of exposure to benzodiazepines, and the risks associated with extension of indications of antipsychotic drugs.Conclusion– Pharmacoepidemiological studies need to be further developed owing to the large number of public health questions raised by the extensive and expanding use of psychotropic drugs.
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Ji S, Long Q, Newport DJ, Na H, Knight B, Zach EB, Morris NJ, Kutner M, Stowe ZN. Validity of depression rating scales during pregnancy and the postpartum period: impact of trimester and parity. J Psychiatr Res 2011; 45:213-9. [PMID: 20542520 PMCID: PMC2945623 DOI: 10.1016/j.jpsychires.2010.05.017] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 05/12/2010] [Accepted: 05/17/2010] [Indexed: 12/12/2022]
Abstract
The objective of the current study was to delineate the optimal cutpoints for depression rating scales during pregnancy and the postpartum period and to assess the perinatal factors influencing these scores. Women participating in prospective investigations of maternal mental illness were enrolled prior to 28 weeks gestation and followed through 6 months postpartum. At each visit, subjects completed self-rated depression scales--Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI) and clinician-rated scales--Hamilton Rating Scale for Depression (HRSD(17) and HRSD(21)). These scores were compared to the SCID Mood Module for the presence of fulfilling diagnostic criteria for a major depressive episode (MDE) during 6 perinatal windows: preconception; first trimester; 2nd trimester; 3rd trimester; early postpartum; and later postpartum. Optimal cutpoints were determined by maximizing the sum of each scale's sensitivity and specificity. Stratified ROC analyses determined the impact of previous pregnancy and comparison of initial to follow-up visits. A total of 534 women encompassing 640 pregnancies and 4025 follow-up visits were included. ROC analysis demonstrated that all 4 scales were highly predictive of MDE. The AUCs ranged from 0.857 to 0.971 and were all highly significant (p < .0001). Optimal cutpoints were higher at initial visits and for multigravidas and demonstrated more variability for the self-rated scales. These data indicate that both clinician-rated and self-rated scales can be effective tools in identifying perinatal episodes of major depression. However, the results also suggest that prior childbirth experiences and the use of scales longitudinally across the perinatal period influence optimal cutpoints.
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Affiliation(s)
- Shuang Ji
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Room 322, Atlanta, GA 30322
| | - Qi Long
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Room 322, Atlanta, GA 30322,To whom correspondence should be addressed: Qi Long, Ph.D., Assistant Professor, Department of Biostatistics and Bioinformatics, 1518 Clifton Rd. NE, Room 322, Rollins School of Public Health, Emory University, Atlanta, GA 30322, Office: (404) 712-9975, Fax: (404) 727-1370,
| | - D. Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1365 Clifton Rd NE, Suite B6100, Atlanta, GA 30322
| | - Hyeji Na
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1365 Clifton Rd NE, Suite B6100, Atlanta, GA 30322
| | - Bettina Knight
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1365 Clifton Rd NE, Suite B6100, Atlanta, GA 30322
| | - Elizabeth B. Zach
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1365 Clifton Rd NE, Suite B6100, Atlanta, GA 30322
| | - Natalie J. Morris
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1365 Clifton Rd NE, Suite B6100, Atlanta, GA 30322
| | - Michael Kutner
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Room 322, Atlanta, GA 30322
| | - Zachary N. Stowe
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1365 Clifton Rd NE, Suite B6100, Atlanta, GA 30322, Department of Gynecology and Obstetrics, Emory University School of Medicine
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Chatillon O, Even C. La dépression de l’antepartum : prévalence, diagnostic, traitement. Encephale 2010; 36:443-51. [DOI: 10.1016/j.encep.2010.02.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 11/20/2009] [Indexed: 11/16/2022]
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