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Wecker SN, Dammert AS, Scholz C, Krüger M, Hauer J, Brickmann C. Neonatal therapy after maternal central neurotropic drug exposure-a retrospective cohort study. J Matern Fetal Neonatal Med 2024; 37:2356038. [PMID: 38830822 DOI: 10.1080/14767058.2024.2356038] [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: 02/24/2024] [Accepted: 05/10/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Evaluation of neonatal morbidity after maternal central neurotropic drug exposure. METHODS Retrospective single-center level-III neonatology cohort analysis of neonates after CND from 2018 to 2021. Control group of neonates born to mothers without CND cared for at the maternity ward. RESULTS Significantly more frequent therapy need of neonates with CND [OR 23 (95% CI: 7.8-62); RR 14 (95% CI: 5.4-37); p < 0.01]. Neonates after CND had lower Apgar-scores LM 1 [CND 8.1; CG 8.6; p < 0.05]; LM 5 [CND 9; CG 9.7; p < 0.01]; LM 10 [CND 9.6; CG 9.9; p < 0.05]. The first symptom occurred in 95.35% within 24 h (mean: 3.3 h). CND group showed significantly more often preterm delivery [OR 3.5; RR 3.2; p < 0.05], and especially cumulative multiple symptoms [OR 9.4; RR 6.6; p < 0.01] but no correlation to multiple maternal medication use (p = 0.3). CONCLUSIONS Neonates exposed to CND are at increased risk for postnatal therapy, often due to multiple symptoms. Neonates should be continuously monitored for at least 24 h.
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Affiliation(s)
- Sabrina Nicole Wecker
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of General Pediatrics, Medical Center, Perinatal Center, München Klinik Harlaching, Munich, Germany
- shared first authorship
| | - Ann Sophie Dammert
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of General Pediatrics, Medical Center, Perinatal Center, München Klinik Harlaching, Munich, Germany
- shared first authorship
| | - Christoph Scholz
- Division of Gynecology and Obstetrics, Medical Center, Perinatal Center, München Klinik Harlaching, Munich, Germany
| | - Marcus Krüger
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of General Pediatrics, Medical Center, Perinatal Center, München Klinik Harlaching, Munich, Germany
| | - Julia Hauer
- Department of Pediatrics, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Brickmann
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of General Pediatrics, Medical Center, Perinatal Center, München Klinik Harlaching, Munich, Germany
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2
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Ng’oma M, Atif N, Meltzer-Brody S, Chirwa E, Stewart RC. Piloting a psychosocial intervention for perinatal depression, the Thinking Healthy Programme-Peer delivered (THPP), in a primary care setting in Lilongwe District, Malawi. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002128. [PMID: 38691572 PMCID: PMC11062519 DOI: 10.1371/journal.pgph.0002128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Abstract
Despite the evidence for the effectiveness of psychosocial interventions for perinatal depression, their uptake is low in Low- and Middle-Income Countries. Reasons for this include the lack of contextually adapted interventions and mental health specialists to deliver them. This study aimed to test the acceptability and feasibility of a psychosocial intervention for perinatal depression, the Thinking Healthy Programme-Peer Delivered, adapted for use in rural Malawi. A multi-method evaluation of feasibility and acceptability of the intervention was conducted using a one-group pretest-posttest quasi-experimental design and an exploratory qualitative study. Pre-post intervention change in depression scores (paired t-test) and recruitment, retention and session adherence rates were calculated. Qualitative data were collected through 29 in-depth interviews (22 mothers and 7 peer volunteers) and 1 Focus Group Discussion (18 mothers). Thematic analysis approach was used to analyse qualitative data. Seven (7) out of 8 peer volunteers were successfully trained to deliver the intervention. A total of 31 pregnant women with Edinburgh Postnatal Depression Scale (EPDS) score ≥12 were offered intervention, of whom 24 were enrolled (recruitment rate 77.4%). Out of these 24 women, 22 completed the intervention (retention rate 91.6%). Mean difference between pre- and post-test EPDS scores one week after 8th session was 7.59 (95% CI 4.98 to 10.19), p<0.001. Qualitative evaluation showed that the intervention was acceptable despite some challenges including stigma and issues around incentivization of peer volunteers. The Thinking Healthy Programme-Peer Delivered, adapted for use in Malawi, was feasible to deliver and acceptable to its target population. The intervention may be useful in management of perinatal depression in primary care settings in Malawi. However, definitive trials are needed to evaluate its effectiveness.
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Affiliation(s)
- Mwawi Ng’oma
- Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Programs Department, St John of God Hospitaller Services, Lilongwe, Malawi
| | - Najia Atif
- Human Development Research Foundation, Islamabad, Pakistan
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ellen Chirwa
- Department of Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Robert C. Stewart
- Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
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3
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Hall SV, Pangori A, Tilea A, Schroeder A, Admon LK, Zivin K. Antidepressant Prescriptions Increased For Privately Insured People With Perinatal Mood And Anxiety Disorder, 2008-20. Health Aff (Millwood) 2024; 43:514-522. [PMID: 38560803 PMCID: PMC11164068 DOI: 10.1377/hlthaff.2023.01448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
We aimed to determine whether antidepressant prescriptions for perinatal mood and anxiety disorder (PMAD) increased after several professional organizations issued clinical recommendations in 2015 and 2016. This serial, cross-sectional, logistic regression analysis evaluated changes in antenatal and postpartum antidepressant prescriptions among commercially insured people who had a live-birth delivery as well as a PMAD diagnosis during the period 2008-20. For people with antenatal PMAD, the odds of an antenatal antidepressant prescription decreased 3 percent annually from 2008 to 2016 and increased by 32 percent in 2017, and the annual rate of change increased 5 percent for 2017-20 compared with 2008-16. For people with postpartum PMAD, the odds of a postpartum antidepressant prescription decreased 2 percent annually from 2008 to 2016 and experienced no significant change in 2017, but the annual rate of change increased 3 percent for 2017-20 compared with 2008-16. The clinical recommendations issued in 2015 and 2016 were associated with increased antidepressant prescriptions for PMAD, particularly for antenatal PMAD. These findings indicate that clinical recommendations represent an effective tool for changing prescribing patterns.
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Affiliation(s)
| | | | | | | | | | - Kara Zivin
- Kara Zivin, University of Michigan, Veterans Affairs Ann Arbor Healthcare System, and Mathematica, Ann Arbor, Michigan
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4
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Kwak M, Fogel J, Tetrokalashvili M. Utilization of Mental Health Services Within 1 Year of Delivery among Different Language Groups. South Med J 2024; 117:175-181. [PMID: 38569603 DOI: 10.14423/smj.0000000000001671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Cultural differences can affect postpartum mental health disorders and the utilization of mental health services. We compared women speaking English, Spanish, Russian, and Urdu/Bengali/Punjabi from postpartum through 1 year after delivery. METHODS This was a retrospective study of 3478 pregnant women from a public hospital in New York City. The primary outcome was a composite outcome of the presence of any of the following: diagnosis of depressive disorder, diagnosis of anxiety disorder, visit to a behavioral health service provider, and/or psychiatric admission. The secondary outcome was healthcare provider referral to a behavioral health service provider. RESULTS Languages spoken were English (n = 1881), Spanish (n = 694), Russian (n = 600), and Urdu/Bengali/Punjabi (n = 303). The language groups differed significantly (P = 0.02) for the composite outcome, with English having the greatest percentage (3.5%) and Russian the lowest percentage (1.2%). The language groups significantly differed for referral to behavioral health (P = 0.04), with Spanish having the greatest percentage (1.6%) and Russian the lowest percentage (0.2%). Anxiety disorder history (odds ratio [OR] 10.43, 95% confidence interval [CI] 4.75-22.91, P < 0.001) and psychiatric disorder history (OR 5.26, 95% CI 2.13-8.49, P < 0.001) were each significantly associated with increased odds for the composite outcome. Anxiety disorder history (OR 6.42, 95% CI 1.92-21.45, P = 0.003) and elevated depressive symptoms (OR 4.92, 95% CI 2.04-11.83, P < 0.001) each were significantly associated with increased odds for referral to behavioral health. CONCLUSIONS Russian language was associated with lower utilization of mental health services postpartum. These findings can help clinicians determine among postpartum women who will be affected with mental health concerns and who will seek treatment for mental health concerns.
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Affiliation(s)
- Minsu Kwak
- From the Department of Obstetrics and Gynecology, South Brooklyn Health, Brooklyn, New York
| | - Joshua Fogel
- Department of Management, Marketing, and Entrepreneurship, Brooklyn College, Brooklyn, New York
| | - Maggie Tetrokalashvili
- From the Department of Obstetrics and Gynecology, South Brooklyn Health, Brooklyn, New York
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5
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Wagner GJ, Gwokyalya V, Faherty L, Akena D, Nakigudde J, Ngo V, McBain R, Ghosh-Dastidar B, Beyeza-Kashesya J, Nakku J, Kyohangirwe L, Nabitaka LK, Lukwata H, Mukasa B, Wanyenze RK. Effects of M-DEPTH Model of Depression Care on Maternal HIV Viral Suppression and Adherence to the PMTCT Care Continuum Among HIV-Infected Pregnant Women in Uganda: Results from a Cluster Randomized Controlled Trial at Pregnancy Completion. AIDS Behav 2023; 27:2902-2914. [PMID: 36907945 PMCID: PMC10386969 DOI: 10.1007/s10461-023-04014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 03/14/2023]
Abstract
Perinatal depression has been shown to impede adherence to antiretroviral therapy (ART) and the prevention of mother-to-child transmission (PMTCT) care continuum; therefore, treating perinatal depression may result in increased viral suppression and PMTCT adherence. We examined the effects of the M-DEPTH (Maternal Depression Treatment in HIV) depression care model (including antidepressants and individual Problem Solving Therapy) on depression, maternal viral suppression and adherence to PMTCT care processes in an ongoing cluster-randomized controlled trial of 391 HIV-infected pregnant women (200 usual care; 191 intervention) with at least mild depressive symptoms enrolled across 8 antenatal care clinics in Uganda. At baseline, 68.3% had clinical depression and 41.7% had detectable HIV viral load. Adjusted repeated-measures multivariable regression models found that the intervention group was nearly 80% less likely to be clinically depressed [Adjusted OR (95% CI) 0.22 (0.05, 0.89)] at the 2-month post-pregnancy assessment, compared to the control group. However, the intervention and control groups did not differ meaningfully on maternal viral suppression, ART adherence, and other PMTCT care processes and outcomes. In this sample of women who were mostly virally suppressed and ART adherent at baseline, the depression care model had a strong effect on depression alleviation, but no downstream effects on viral suppression or other PMTCT care processes.Trial Registration NIH Clinical Trial Registry NCT03892915 (clinicaltrials.gov).
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | | | - Laura Faherty
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Dickens Akena
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Janet Nakigudde
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Victoria Ngo
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
- City University of New York, Graduate School of Public Health and Health Policy, New York, USA
| | - Ryan McBain
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | | | - Jolly Beyeza-Kashesya
- Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
- Makerere University, School of Medicine, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral Mental Hospital, Kampala, Uganda
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Abstract
Perinatal depression is a common psychiatric condition that has negative effects on pregnancy and infant outcomes. Screening for the condition is relatively easy and should be done routinely in all medical care of the pregnant and postpartum woman and her infant. The risk-benefit analysis favors the use of antidepressant medications during pregnancy and lactation compared with the risk of untreated maternal depression. Other, nonpharmacological treatments will be discussed as well as new treatments, including a new class of medications that act on the inhibitory GABAergic neurotransmitter system.
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Affiliation(s)
- Anne Louise Stewart
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, PO Box 800548, Charlottesville, VA 22908, USA
| | - Jennifer L Payne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, PO Box 800548, Charlottesville, VA 22908, USA.
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7
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Mayer JLW, Yang A, Wisner KL, Stika CS, Gollan JK. Factors Associated with Depressive and Anxiety Symptom Trajectories Across Pregnancy and Postpartum in Selective Serotonin Reuptake Inhibitor-Treated Individuals. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2023; 5:144-147. [PMID: 38077274 PMCID: PMC10698702 DOI: 10.1176/appi.prcp.20230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
Objective The primary purpose of this article is to identify factors that are associated with worsening mood and anxiety trajectories across the perinatal period among pregnant individuals receiving treatment with a selective-serotonin reupdate inhibitor. Methods This secondary analysis of primary data from the original article, Trajectories of Depressive and Anxiety Symptoms Across Pregnancy and Postpartum in Selective Serotonin Reuptake Inhibitor-Treated Women, explores if number of lifetime episodes of depression as characterized in the Mini-International Neuropsychiatric Interview, elevated maternal adverse childhood experiences (ACE) score, or specific obstetric or neonatal factors from the Peripartum Events Scale (PES) were associated with membership in trajectory groups with the highest symptom burden. Results No difference in ACE scores or obstetric or neonatal factors were associated with membership in the trajectory groups using Wilcoxon rank sum tests and bi-variable logistic regression. The trajectory group with the highest anxiety symptom burden experienced more lifetime episodes of depression compared to other groups (odds ratio = 1.17, 95% confidence intervals, 1.02-1.34, p = 0.03). Conclusions Congruent with other studies, we found a high prevalence of co-occurring mood and anxiety symptoms and that past episodes of depression remain an important historical risk factor for perinatal symptom burden. This reinforces that past experiences of depression increase not only the risk of future symptoms but also higher symptom burden during antidepressant treatment.
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Affiliation(s)
- Jessica L. W. Mayer
- Asher Center for the Study and Treatment of Depressive DisordersDepartment of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Amy Yang
- Asher Center for the Study and Treatment of Depressive DisordersDepartment of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Katherine L. Wisner
- Asher Center for the Study and Treatment of Depressive DisordersDepartment of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Catherine S. Stika
- Department of Obstetrics and GynecologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jacqueline K. Gollan
- Asher Center for the Study and Treatment of Depressive DisordersDepartment of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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8
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Spiess D, Abegg VF, Chauveau A, Rath J, Treyer A, Reinehr M, Kuoni S, Oufir M, Potterat O, Hamburger M, Simões-Wüst AP. Transplacental passage of hyperforin, hypericin, and valerenic acid. Front Pharmacol 2023; 14:1123194. [PMID: 37063288 PMCID: PMC10103840 DOI: 10.3389/fphar.2023.1123194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
Safe medications for mild mental diseases in pregnancy are needed. Phytomedicines from St. John’s wort and valerian are valid candidates, but safety data in pregnancy are lacking. The transplacental transport of hyperforin and hypericin (from St. John’s wort), and valerenic acid (from valerian) was evaluated using the ex vivo cotyledon perfusion model (4 h perfusions, term placentae) and, in part, the in vitro Transwell assay with BeWo b30 cells. Antipyrine was used for comparison in both models. U(H)PLC-MS/MS bioanalytical methods were developed to quantify the compounds. Perfusion data obtained with term placentae showed that only minor amounts of hyperforin passed into the fetal circuit, while hypericin did not cross the placental barrier and valerenic acid equilibrated between the maternal and fetal compartments. None of the investigated compounds affected metabolic, functional, and histopathological parameters of the placenta during the perfusion experiments. Data from the Transwell model suggested that valerenic acid does not cross the placental cell layer. Taken together, our data suggest that throughout the pregnancy the potential fetal exposure to hypericin and hyperforin – but not to valerenic acid – is likely to be minimal.
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Affiliation(s)
- Deborah Spiess
- Department of Obstetrics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Division of Pharmaceutical Biology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Vanessa Fabienne Abegg
- Division of Pharmaceutical Biology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Antoine Chauveau
- Division of Pharmaceutical Biology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Joshua Rath
- Department of Obstetrics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Treyer
- Division of Pharmaceutical Biology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Michael Reinehr
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Sabrina Kuoni
- Department of Obstetrics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mouhssin Oufir
- Division of Pharmaceutical Biology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Olivier Potterat
- Division of Pharmaceutical Biology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Matthias Hamburger
- Division of Pharmaceutical Biology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- *Correspondence: Matthias Hamburger, ; Ana Paula Simões-Wüst,
| | - Ana Paula Simões-Wüst
- Department of Obstetrics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- *Correspondence: Matthias Hamburger, ; Ana Paula Simões-Wüst,
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Bhat RS, Alonazi M, Al-Daihan S, El-Ansary A. Prenatal SSRI Exposure Increases the Risk of Autism in Rodents via Aggravated Oxidative Stress and Neurochemical Changes in the Brain. Metabolites 2023; 13:metabo13020310. [PMID: 36837929 PMCID: PMC9963091 DOI: 10.3390/metabo13020310] [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: 01/09/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
The mechanisms underlying selective serotonin reuptake inhibitor (SSRI) use during pregnancy as a major autism risk factor are unclear. Here, brain neurochemical changes following fluoxetine exposure and in an autism model were compared to determine the effects on autism risk. The study was performed on neonatal male western albino rats which were divided into Groups one (control), two (propionic acid [PPA]-induced autism model), and three (prenatal SSRI-exposed newborn rats whose mothers were exposed to 5 mg/kg of fluoxetine over gestation days 10-20). SSRI (fluoxetine) induced significant neurochemical abnormalities in the rat brain by increasing lipid peroxide (MDA), Interferon-gamma (IFN-γ), and caspase-3 levels and by depleting Glutathione (GSH), Glutathione S-transferases (GST), Catalase, potassium (K+), and Creatine kinase (CK) levels, similarly to what has been discovered in the PPA model of autism when compared with control. Prenatal fluoxetine exposure plays a significant role in asset brain damage in newborns; further investigation of fluoxetine as an autism risk factor is thus warranted.
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Affiliation(s)
- Ramesa Shafi Bhat
- Biochemistry Department, College of Science, King Saud University, Riyadh 11495, Saudi Arabia
- Correspondence:
| | - Mona Alonazi
- Biochemistry Department, College of Science, King Saud University, Riyadh 11495, Saudi Arabia
| | - Sooad Al-Daihan
- Biochemistry Department, College of Science, King Saud University, Riyadh 11495, Saudi Arabia
| | - Afaf El-Ansary
- Central Research Laboratory, Female Campus, King Saud University, Riyadh 11495, Saudi Arabia
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Gimbel LA, Blue NR, Allshouse AA, Silver RM, Gimbel B, Grobman WA, Haas DM, Simhan HN, Mercer BM, Hatfield T. Pregnancy outcomes and anxiety in nulliparous women. J Matern Fetal Neonatal Med 2022; 35:8681-8690. [PMID: 34747312 PMCID: PMC9097789 DOI: 10.1080/14767058.2021.1998441] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine pregnancy outcomes in women with treated and untreated anxiety in a well-characterized cohort. STUDY DESIGN Secondary analysis of the NuMoM2b study, a prospective multi-center cohort of nulliparous women. Anxiety was assessed at 6 weeks 0 days - 13 weeks 6 days using the State Trait Anxiety Inventory (STAI-T). Women were divided into three groups: anxiety and medical treatment, anxiety and no medical treatment, and no anxiety (controls). The primary outcome was a composite of preterm birth, small for gestational age infant, placental abruption (clinically diagnosed), and hypertensive disorders of pregnancy. Multivariable logistic regression was used to adjust for potential confounding variables. RESULTS Among 8293 eligible women, 24% (n = 1983) had anxiety; 311 were treated medically. The composite outcome (preterm birth, small for gestational age infant, placental abruption, hypertensive disorders of pregnancy) occurred more often in women with untreated anxiety than controls (28.6% vs 25.9%, p=.02), with no difference between treated anxiety and controls (27.7% vs 25.9%, p=.49). After adjustment for confounders, including controlling for depression, there were no differences in the primary outcome among groups. Untreated anxiety remained associated with increased odds of neonatal intensive care unit admission. CONCLUSION Anxiety occurred in almost a quarter of nulliparas. There was no association between treated or untreated anxiety and our primary outcome of adverse pregnancy outcomes after adjustment for confounders. However, neonates born to women with untreated anxiety were at increased risk for NICU admission.
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Affiliation(s)
- Lauren A. Gimbel
- Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - Nathan R. Blue
- Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - Amanda A. Allshouse
- Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - Robert M. Silver
- Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - Bruce Gimbel
- Psychiatry, Saint Mary Mercy Hospital, Livonia, MI, USA
| | | | - David M. Haas
- Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hyagriv N. Simhan
- Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Brian M. Mercer
- Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA
| | - Tamera Hatfield
- Obstetrics and Gynecology, University of California Irvine College of Health Sciences, Irvine, CA, USA
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11
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Sullivan-Baca E, Modiano YA, McKenney KM, Carlew AR. Pregnancy-related stroke through a neuropsychology lens. Clin Neuropsychol 2022:1-20. [PMID: 36215407 DOI: 10.1080/13854046.2022.2131631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/28/2022] [Indexed: 11/03/2022]
Abstract
Objective: Stroke represents a primary cause of morbidity and mortality in pregnant and postpartum people. While pregnancy-related stroke has drawn increased attention in certain domains of health research (e.g. obstetrics, neurology), neuropsychology has yet to contribute to this literature. Given neuropsychologists' crucial role in stroke evaluation and rehabilitation efforts, our field is poised to offer insights into this important topic. Method: This review presents facts about pregnancy-related stroke most relevant for neuropsychologists, including epidemiology, risk factors, and mechanisms, alongside clinical considerations and open areas of inquiry. Structured in the format of a traditional neuropsychological evaluation, we walk readers through factors to consider in record review, the clinical interview, and providing feedback and recommendations. Conclusions: Pregnancy-related stroke can be associated with marked functional disability and decreased quality of life, and it is notable that prevalence rates are increasing. Presenting at a time when people are experiencing adjustment to a new phase of life, and most commonly affecting women of color and other vulnerable populations, pregnancy-related stroke is a unique condition warranting special attention within the broader stroke discourse. This review aims to serve as a starting point for neuropsychologists to better understand the unique attributes of pregnancy-related stroke through a neuropsychology lens. Beyond that, it aims to promote broader meaningful discussion of neuropsychology's role in women's health.
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Affiliation(s)
| | - Yosefa A Modiano
- Vivian L Smith Department of Neurosurgery, UT Health Neurosciences, McGovern Medical School, Houston, TX, USA
| | - Kathryn M McKenney
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anne R Carlew
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
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12
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Fairbrother N, Albert A, Collardeau F, Keeney C. The Childbirth Fear Questionnaire and the Wijma Delivery Expectancy Questionnaire as Screening Tools for Specific Phobia, Fear of Childbirth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084647. [PMID: 35457513 PMCID: PMC9028446 DOI: 10.3390/ijerph19084647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/14/2022] [Accepted: 04/02/2022] [Indexed: 12/04/2022]
Abstract
Background: Perinatal anxiety and related disorders are common (20%), distressing and impairing. Fear of childbirth (FoB) is a common type of perinatal anxiety associated with negative mental health, obstetrical, childbirth and child outcomes. Screening can facilitate treatment access for those most in need. Objectives: The purpose of this research was to evaluate the accuracy of the Childbirth Fear Questionnaire (CFQ) and the Wijma Delivery Expectations Questionnaire (W-DEQ) of FoB as screening tools for a specific phobia, FoB. Methods: A total of 659 English-speaking pregnant women living in Canada and over the age of 18 were recruited for the study. Participants completed an online survey of demographic, current pregnancy and reproductive history information, as well as the CFQ and the W-DEQ, and a telephone interview to assess specific phobia FoB. Results: Symptoms meeting full and subclinical diagnostic criteria for a specific phobia, FoB, were reported by 3.3% and 7.1% of participants, respectively. The W-DEQ met or exceeded the criteria for a “good enough” screening tool across several analyses, whereas the CFQ only met these criteria in one analysis and came close in three others. Conclusions: The W-DEQ demonstrated high performance as a screening tool for a specific phobia, FoB, with accuracy superior to that of the CFQ. Additional research to ensure the stability of these findings is needed.
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Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Correspondence: ; Tel.: +1-250-0519-5390 (ext. 36439)
| | - Arianne Albert
- Women’s Health Research Institute, Vancouver, BC V6H 2N9, Canada;
| | - Fanie Collardeau
- Department of Psychology, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Cora Keeney
- Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
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Wang F, Zhu H, Yang X, Liao F. Effects of internet-based cognitive behavioral therapy on postpartum depression: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28964. [PMID: 35244060 PMCID: PMC8896531 DOI: 10.1097/md.0000000000028964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Postpartum depression is one of the most common complications during the postpartum period. In recent years, internet-based psychological interventions have made significant progress and provided a new psychotherapy model. Internet-based cognitive behavioral therapy (ICBT) for postpartum depression has achieved good results. However, the effectiveness of ICBT for postpartum depression reported by different studies still remains inconsistent. Therefore, a meta-analysis was used to further evaluate the efficacy of ICBT for postpartum depression, aiming to provide evidence to support nonpharmacological intervention strategies in the clinic. METHODS The databases of PubMed, Web of Science, Scopus, Cochrane Library, Embase, China Scientific Journal Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Data will be searched. The randomized controlled trials of ICBT will be included for postpartum depression published before February 2022. Two independent researchers will independently complete literature selection, risk of bias assessment and data extraction. The disagreements will be discussed with a third party for the final decision. Cochrane Risk of Bias Assessment Tool will be used for literature quality assessment. Data processing will be conducted by RevMan 5.4 software. RESULTS The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSIONS For the question whether ICBT for postpartum depression is efficacy, this study can provide more comprehensive and strong evidence. ETHICS AND DISSEMINATION The ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/EQJDH.
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Affiliation(s)
- Fang Wang
- Department of Obstetrics and Gynaecology, The National Hospital Of Enshi Autonomous Prefecture, Enshi, Hubei Province, China
| | - Hongcheng Zhu
- Department of Obstetrics and Gynaecology, The National Hospital Of Enshi Autonomous Prefecture, Enshi, Hubei Province, China
| | - Xiaoju Yang
- Department of Obstetrics and Gynaecology, The National Hospital Of Enshi Autonomous Prefecture, Enshi, Hubei Province, China
| | - Fang Liao
- Department of Obstetrics and Gynaecology, The National Hospital Of Enshi Autonomous Prefecture, Enshi, Hubei Province, China
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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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Abstract
Active peripartum psychiatric illness is associated with adverse outcomes for exposed pregnancies/children. Likely due to high rates of obesity, pregnant women with psychiatric illness also have higher rates of preeclampsia, cesarean section, and gestational diabetes. Postpartum depression is associated with lower IQ, slower language development, and behavioral problems in exposed children. Discontinuing psychiatric medications for pregnancy increases risk for relapse significantly, and the postpartum time period is high risk for developing psychiatric illness. Obstetricians-gynecologists are front-line providers for psychiatric care of women during peripartum. This article provides a framework and knowledge base for management of psychiatric illness during peripartum.
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Affiliation(s)
- Jennifer L Payne
- Johns Hopkins Women's Mood Disorders Center, Johns Hopkins School of Medicine, 550 North Broadway, Suite 305, Baltimore, MD 21025, USA.
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16
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Brown JVE, Wilson CA, Ayre K, Robertson L, South E, Molyneaux E, Trevillion K, Howard LM, Khalifeh H. Antidepressant treatment for postnatal depression. Cochrane Database Syst Rev 2021; 2:CD013560. [PMID: 33580709 PMCID: PMC8094614 DOI: 10.1002/14651858.cd013560.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Depression is one of the most common morbidities of the postnatal period. It has been associated with adverse outcomes for women, children, the wider family and society as a whole. Treatment is with psychosocial interventions or antidepressant medication, or both. The aim of this review is to evaluate the effectiveness of different antidepressants and to compare their effectiveness with placebo, treatment as usual or other forms of treatment. This is an update of a review last published in 2014. OBJECTIVES To assess the effectiveness and safety of antidepressant drugs in comparison with any other treatment (psychological, psychosocial, or pharmacological), placebo, or treatment as usual for postnatal depression. SEARCH METHODS We searched Cochrane Common Mental Disorders's Specialized Register, CENTRAL, MEDLINE, Embase and PsycINFO in May 2020. We also searched international trials registries and contacted experts in the field. SELECTION CRITERIA We included randomised controlled trials (RCTs) of women with depression during the first 12 months postpartum that compared antidepressant treatment (alone or in combination with another treatment) with any other treatment, placebo or treatment as usual. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the study reports. We requested missing information from study authors wherever possible. We sought data to allow an intention-to-treat analysis. Where we identified sufficient comparable studies we pooled data and conducted random-effects meta-analyses. MAIN RESULTS We identified 11 RCTs (1016 women), the majority of which were from English-speaking, high-income countries; two were from middle-income countries. Women were recruited from a mix of community-based, primary care, maternity and outpatient settings. Most studies used selective serotonin reuptake inhibitors (SSRIs), with treatment duration ranging from 4 to 12 weeks. Meta-analysis showed that there may be a benefit of SSRIs over placebo in response (55% versus 43%; pooled risk ratio (RR) 1.27, 95% confidence interval (CI) 0.97 to 1.66); remission (42% versus 27%; RR 1.54, 95% CI 0.99 to 2.41); and reduced depressive symptoms (standardised mean difference (SMD) -0.30, 95% CI -0.55 to -0.05; 4 studies, 251 women), at 5 to 12 weeks' follow-up. We were unable to conduct meta-analysis for adverse events due to variation in the reporting of this between studies. There was no evidence of a difference between acceptability of SSRI and placebo (27% versus 27%; RR 1.10, 95% CI 0.74 to 1.64; 4 studies; 233 women). The certainty of all the evidence for SSRIs was low or very low due to the small number of included studies and a number of potential sources of bias, including high rates of attrition. There was insufficient evidence to assess the efficacy of SSRIs compared with other classes of antidepressants and of antidepressants compared with other pharmacological interventions, complementary medicines, psychological and psychosocial interventions or treatment as usual. A substantial proportion of women experienced adverse effects but there was no evidence of differences in the number of adverse effects between treatment groups in any of the studies. Data on effects on children, including breastfed infants, parenting, and the wider family were limited, although no adverse effects were noted. AUTHORS' CONCLUSIONS There remains limited evidence regarding the effectiveness and safety of antidepressants in the management of postnatal depression, particularly for those with more severe depression. We found low-certainty evidence that SSRI antidepressants may be more effective in treating postnatal depression than placebo as measured by response and remission rates. However, the low certainty of the evidence suggests that further research is very likely to have an important impact on our effect estimate. There is a continued imperative to better understand whether, and for whom, antidepressants or other treatments are more effective for postnatal depression, and whether some antidepressants are more effective or better tolerated than others. In clinical practice, the findings of this review need to be contextualised by the extensive broader literature on antidepressants in the general population and perinatal clinical guidance, to inform an individualised risk-benefit clinical decision. Future RCTs should focus on larger samples, longer follow-up, comparisons with alternative treatment modalities and inclusion of child and parenting outcomes.
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Affiliation(s)
- Jennifer Valeska Elli Brown
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Cochrane Common Mental Disorders, University of York, York, UK
| | - Claire A Wilson
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Karyn Ayre
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lindsay Robertson
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Emily South
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Emma Molyneaux
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kylee Trevillion
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hind Khalifeh
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Stevens NR, Miller ML, Soibatian C, Otwell C, Rufa AK, Meyer DJ, Shalowitz MU. Exposure therapy for PTSD during pregnancy: a feasibility, acceptability, and case series study of Narrative Exposure Therapy (NET). BMC Psychol 2020; 8:130. [PMID: 33298159 PMCID: PMC7727253 DOI: 10.1186/s40359-020-00503-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Prenatal posttraumatic stress disorder (PTSD) is a significant complication of pregnancy linked to increased risk of adverse perinatal outcomes. Although 1 in 5 pregnant trauma-exposed individuals have PTSD, most PTSD treatment trials exclude participants who are pregnant, and none focus on treatment specifically during pregnancy. Moreover, access to mental health treatment is particularly challenging in low-resource settings with high rates of trauma. This study examined implementation of Narrative Exposure Therapy (NET), a short-term evidence-based PTSD treatment, in an urban prenatal care setting. Partial telehealth delivery was used to increase accessibility. Study aims were to examine (a) feasibility, (b) acceptability, and (c) case-based treatment outcomes associated with NET participation. Method Eight pregnant participants (median age = 27, median gestational week in pregnancy = 22.5) received up to six sessions of NET with partial telehealth delivery. PTSD and depression symptoms were assessed at pre-treatment intake (T1), at each session (T2), and 1-week post-treatment (T3). A multiple case study approach was used to examine recruitment and engagement, retention, treatment completion, treatment barriers, use of telehealth, participants’ experiences of treatment, and PTSD and depression symptoms. Results Nine of the 16 participants (56%) who were invited to participate engaged in treatment, and one dropped out after the first session. Eight participants completed the minimum “dose” of 4 NET sessions (N = 8/9, 89%). Seven participants gave the highest ratings of treatment acceptability. The most frequently reported barriers to treatment were competing priorities of work and caring for other children. Pre-post treatment symptom measures revealed clinically meaningful change in PTSD severity for nearly all participants (7/8, 88%). Conclusions Results suggest that a brief exposure therapy PTSD treatment can be successfully implemented during pregnancy, suggesting promising results for conducting a larger-scale investigation. Trial registration ClinicalTrials.gov, NCT04525469. Registered 20 August 2020–Retrospectively registered, https://register.clinicaltrials.gov/prs/app/template/EditRecord.vm?epmode=View&listmode=Edit&uid=U00058T2&ts=3&sid=S000A59A&cx=-w1vnvn
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Affiliation(s)
- Natalie R Stevens
- Rush University Medical Center, 1645 West Jackson Blvd, Chicago, IL, 60612, USA.
| | - Michelle L Miller
- Rush University Medical Center, 1645 West Jackson Blvd, Chicago, IL, 60612, USA
| | - Christina Soibatian
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Caitlin Otwell
- Rush University Medical Center, 1645 West Jackson Blvd, Chicago, IL, 60612, USA
| | - Anne K Rufa
- Rush University Medical Center, 1645 West Jackson Blvd, Chicago, IL, 60612, USA
| | - Danie J Meyer
- Vivo International, P.O. Box, 5108D-78430, Konstanz, Germany
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18
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Price SM, Caughey AB. The impact of prenatal care on pregnancy outcomes in women with depression. J Matern Fetal Neonatal Med 2020; 35:3948-3954. [PMID: 33167722 DOI: 10.1080/14767058.2020.1844655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Depression occurs in 7-13% of pregnant women and is associated with increased risk during pregnancy including increased rates of cesarean delivery, preterm birth, and preeclampsia. Prenatal care is thought to decrease adverse outcomes in pregnancy. This study aimed to examine how delayed access to prenatal care affects maternal and neonatal outcomes in a cohort of women suffering from depression. STUDY DESIGN This is a retrospective cohort study of linked vital statistics and hospital discharge data among singleton, non-anomalous births in California between 2005 and 2008 comparing outcomes of all women with depression who received prenatal care prior to the third trimester versus women with depression who received prenatal care only during the third trimester or none at all. Outcomes included birthweight, stillbirth, neonatal demise, preeclampsia, preterm delivery and infant death. Statistical methods for outcome analysis included chi-square and multivariate logistic regression, adjusting for statistically significant and biologically plausible coexisting risk factors such as age, parity, gestational age, ethnicity, socioeconomic status, and substance abuse. RESULTS Of the 14,242 women with depression in our sample, those with no prenatal care prior to the third trimester of gestation had higher odds of stillbirth (7.50; 2.34-23.97), neonatal death (4.42; 1.14-17.18), preterm delivery before 32 weeks (2.13; 1.08-4.17), SGA <5% (1.76; 1.10-2.81) and severe preeclampsia (1.92; 1.03-13.58). CONCLUSION In women with depression during pregnancy, receiving late or no prenatal care prior to the third trimester of pregnancy is associated with greater odds of neonatal and maternal morbidities, as well as, greater odds of fetal and neonatal mortality.
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Affiliation(s)
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
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19
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Mackiewicz Seghete KL, Graham AM, Lapidus JA, Jackson ELA, Doyle OJ, Feryn AB, Moore LA, Goodman SH, Dimidjian S. Protocol for a mechanistic study of mindfulness based cognitive therapy during pregnancy. Health Psychol 2020; 39:758-766. [PMID: 32833477 PMCID: PMC7869507 DOI: 10.1037/hea0000870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Preventive interventions for postpartum depression (PPD) are critical for women at elevated risk of PPD. Mindfulness based cognitive therapy - perinatal depression (MBCT-PD) is a preventive intervention that has been shown to reduce risk for PPD in women with a prior history of depression. The objective of this clinical trial is to examine two potential mechanisms of action of MBCT-PD, emotion regulation and cognitive control, using behavioral and neuroimaging methods. METHOD This baseline protocol describes a randomized control trial (RCT) with two arms, MBCT-PD and treatment as usual (TAU). We plan on enrolling 74 females with a prior history of a major depressive episode, with 37 participants randomized to each arm. Participants in the MBCT-PD arm will receive MBCT-PD during pregnancy, and the TAU group will receive standard prenatal care. All participants will complete the Center for Epidemiological Studies Depression Scale - Revised (CESD-R), Emotion Regulation Questionnaire (ERQ), and classic Stroop task at multiple points from pregnancy through six months postpartum. Participants will also complete an fMRI scan at six weeks postpartum. RESULTS All primary outcomes are collected at six weeks postpartum. Primary behavioral outcomes include: depressive symptoms on the CESD-R, cognitive reappraisal on the ERQ, and Stroop task performance. In parallel, the primary neurobiological outcomes include whole-brain activation during fMRI tasks when participants 1) regulate emotional responding and 2) engage cognitive control. CONCLUSIONS This results of this innovative RCT will help identify potential behavioral and neurobiological mechanisms of action of preventive interventions for PPD for in-depth examination in larger scale RCTs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Alice M Graham
- Department of Psychiatry, Oregon Health & Science University
| | - Jodi A Lapidus
- OHSU-PSU School of Public Health, Oregon Health & Science University
| | | | - Olivia J Doyle
- Department of Behavioral Neuroscience, Oregon Health & Science University
| | - Alicia B Feryn
- OHSU-PSU School of Public Health, Oregon Health & Science University
| | | | | | - Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado Boulder
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20
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Jana S, Sarkar S, Morris SA. Recent developments towards the synthesis of paroxetine: A 3,4-disubstituted piperidine. Tetrahedron 2020. [DOI: 10.1016/j.tet.2020.131215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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Zemestani M, Fazeli Nikoo Z. Effectiveness of mindfulness-based cognitive therapy for comorbid depression and anxiety in pregnancy: a randomized controlled trial. Arch Womens Ment Health 2020; 23:207-214. [PMID: 30982086 DOI: 10.1007/s00737-019-00962-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 03/20/2019] [Indexed: 12/15/2022]
Abstract
Pregnant women are at high risk of mood and anxiety disorders, and options for non-pharmacological treatment are limited. Mindfulness-based cognitive therapy (MBCT) has strong evidence among people with mood and anxiety disorders, but limited studies reported the effectiveness of MBCT on perinatal comorbid conditions. This study aimed to examine the effects of an 8-week MBCT intervention on pregnant women with comorbid depression and anxiety. In this randomized controlled study, 38 pregnant women with a diagnosis of depression and varying levels of comorbid anxiety disorders were randomly assigned to either MBCT or a control group. Scores on the Beck Depression Inventory-II, Beck Anxiety Inventory, Emotion Regulation Questionnaire, and Scales of Psychological Wellbeing were used as outcome measures at baseline, after MBCT, and through 1-month follow-up. Intent to treat analyses provided preliminary evidence that MBCT can be effective in reducing depressive and anxiety symptoms and in enhancing the use of adaptive emotion regulation strategies and psychological well-being. Improvements in outcomes were maintained 1 month. Results provide cross-cultural support for MBCT as a treatment for depression and anxiety in pregnant women. This brief and non-pharmacological treatment can be used to improve maternal psychological health.
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Affiliation(s)
- Mehdi Zemestani
- Department of Clinical Psychology, University of Kurdistan, Sanandaj, Iran.
| | - Zahra Fazeli Nikoo
- Department of Clinical Psychology, University of Kurdistan, Sanandaj, Iran
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22
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Brown JVE, Wilson CA, Ayre K, South E, Molyneaux E, Trevillion K, Howard LM, Khalifeh H. Antidepressant treatment for postnatal depression. Hippokratia 2020. [DOI: 10.1002/14651858.cd013560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jennifer Valeska Elli Brown
- University of York; Mental Health and Addiction Research Group, Department of Health Sciences; York UK
- University of York; Cochrane Common Mental Disorders; York UK
| | - Claire A Wilson
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Karyn Ayre
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Emily South
- University of York; Centre for Reviews and Dissemination; York UK
| | - Emma Molyneaux
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Kylee Trevillion
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Louise M Howard
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Hind Khalifeh
- King's College London; Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience; London UK
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23
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Cox EQ, Killenberg S, Frische R, McClure R, Hill M, Jenson J, Pearson B, Meltzer-Brody SE. Repetitive transcranial magnetic stimulation for the treatment of postpartum depression. J Affect Disord 2020; 264:193-200. [PMID: 32056750 DOI: 10.1016/j.jad.2019.11.069] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/10/2019] [Accepted: 11/12/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Postpartum depression (PPD) is a common and gravely disabling health concern. Repetitive transcranial magnetic stimulation (rTMS) is an FDA approved treatment for major depression and may be a valuable tool in the treatment of PPD. The treatment effect of rTMS is rapid, generally well tolerated, without systemic effects, and without medication exposure to a fetus and/or breastfed infant. METHODS Six women with PPD received 20 sessions of 10 Hz rTMS over the left dorsolateral prefrontal cortex (DLPFC) over a 4 week period. Psychiatric rating scales (BDI, EPDS, STATI), cognitive assessments (MMSE, Trails B, List Generation) and breastfeeding practices were surveyed at baseline and post rTMS treatment. BDI and EPDS were obtained weekly, as well as 3 months and 6 months post study conclusion. RESULTS Average BDI, EPDS, and STAI scores declined over the 4-week duration of rTMS treatment. Of the six patients, four achieved remission as assessed by EPDS and one achieved remission and two responded as assessed by BDI. Mean BDI and EPDS scores at 3 and 6 months follow-up remained below levels at study entry. No evidence of cognitive changes or breastfeeding disruptions. LIMITATIONS This was an exploratory study with small sample size with no sham control arm. Daily administration of rTMS provides potential for confounding of behavioral activation in the otherwise often isolative postpartum period. CONCLUSIONS rTMS was safe and well tolerated among participants with evidence of sustained improvements in depression and anxiety scores. This study supports rTMS as a promising non-pharmacologic treatment modality for perinatal depression.
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Affiliation(s)
- E Q Cox
- Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive Campus Box 7160, Chapel Hill, NC 27514, United States.
| | - S Killenberg
- Disability Determination Services, 40 Fountain Street, Providence, RI 02903, United States.
| | - R Frische
- Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive Campus Box 7160, Chapel Hill, NC 27514, United States.
| | - R McClure
- Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive Campus Box 7160, Chapel Hill, NC 27514, United States.
| | - M Hill
- Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive Campus Box 7160, Chapel Hill, NC 27514, United States.
| | - J Jenson
- Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive Campus Box 7160, Chapel Hill, NC 27514, United States.
| | - B Pearson
- Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive Campus Box 7160, Chapel Hill, NC 27514, United States.
| | - S E Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive Campus Box 7160, Chapel Hill, NC 27514, United States.
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Del Casale A, Sorice S, Padovano A, Simmaco M, Ferracuti S, Lamis DA, Rapinesi C, Sani G, Girardi P, Kotzalidis GD, Pompili M. Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD). Curr Neuropharmacol 2020; 17:710-736. [PMID: 30101713 PMCID: PMC7059159 DOI: 10.2174/1570159x16666180813155017] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/06/2018] [Accepted: 08/12/2018] [Indexed: 02/07/2023] Open
Abstract
Background: Obsessive-compulsive disorder (OCD) is associated with affective and cognitive symptoms causing personal distress and reduced global functioning. These have considerable societal costs due to healthcare service utilization. Objective: Our aim was to assess the efficacy of pharmacological interventions in OCD and clinical guidelines, providing a comprehensive overview of this field. Methods: We searched the PubMed database for papers dealing with drug treatment of OCD, with a specific focus on clinical guidelines, treatments with antidepressants, antipsychotics, mood stabilizers, off-label medications, and pharmacogenomics. Results: Prolonged administration of selective serotonin reuptake inhibitors (SSRIs) is most effective. Better results can be obtained with a SSRI combined with cognitive behavioral therapy (CBT) or the similarly oriented exposure and response prevention (ERP). Refractory OCD could be treated with different strategies, including a switch to another SSRI or clomipramine, or augmentation with an atypical antipsychotic. The addition of medications other than antipsychotics or intravenous antidepressant administration needs further investigation, as the evidence is inconsistent. Pharmacogenomics and personalization of therapy could reduce treatment resistance. Conclusions: SSRI/clomipramine in combination with CBT/ERP is associated with the optimal response compared to each treatment alone or to other treatments. New strategies for refractory OCD are needed. The role of pharmacogenomics could become preponderant in the coming years.
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Affiliation(s)
- Antonio Del Casale
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Serena Sorice
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Alessio Padovano
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Simmaco
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | | | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Chiara Rapinesi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Paolo Girardi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Pompili
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
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Hanko C, Bittner A, Junge-Hoffmeister J, Mogwitz S, Nitzsche K, Weidner K. Course of mental health and mother-infant bonding in hospitalized women with threatened preterm birth. Arch Gynecol Obstet 2019; 301:119-128. [PMID: 31828434 DOI: 10.1007/s00404-019-05406-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Pregnancy complications (PC) with signs of threatened preterm birth are often associated with lengthy hospital stays, which have been shown to be accompanied by anxiety, depressive symptoms, and increased stress level. It remains unclear, whether the perinatal course of mental health of these women differs from women without PC and whether there may be differences in the postpartum mother-infant bonding. METHODS In a naturalistic longitudinal study with two measurements (24-36th weeks of gestation and 6 weeks postpartum), we investigated depression (EPDS), anxiety (STAI-T), stress (PSS), and postpartum mother-infant bonding (PBQ) in women with threatened preterm birth (N = 75) and women without PC (N = 70). For data evaluation, we used means of frequency analysis, analysis of variance with repeated measurements, and t-tests for independent samples. RESULTS The patient group showed significantly higher rates of depression, anxiety, and stress during inpatient treatment in pregnancy, as well as 6 weeks postpartum compared to the control group. While depression and anxiety decreased over time in both groups, stress remained at the same level 6 weeks postpartum as in pregnancy. We found no significant differences in mother-infant bonding between the two groups at all considered PBQ scales. CONCLUSION It is recommended to pay attention to the psychological burden of all obstetric patients as a routine to capture a psychosomatic treatment indication. A general bonding problem in women with threatened preterm birth was not found. Nevertheless, increased maternal stress, anxiety, and depressiveness levels during pregnancy may have a negative impact on the development of the fetus.
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Affiliation(s)
- Cornelia Hanko
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Antje Bittner
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Juliane Junge-Hoffmeister
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Sabine Mogwitz
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Katharina Nitzsche
- Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Coffman KL, Ash P. Medicating During Pregnancy. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:380-381. [PMID: 32047385 PMCID: PMC7011295 DOI: 10.1176/appi.focus.20190034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Kelly L Coffman
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
| | - Peter Ash
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
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Wu P, Velez Edwards DR, Gorrindo P, Sundermann AC, Torstenson ES, Jones SH, Chan RL, Hartmann KE. Association between First Trimester Antidepressant Use and Risk of Spontaneous Abortion. Pharmacotherapy 2019; 39:889-898. [PMID: 31278762 DOI: 10.1002/phar.2308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE The potential for maternal antidepressant use to influence the risk of spontaneous abortion, one of the most important adverse pregnancy outcomes, is not clear. We aimed to assess whether first trimester antidepressant exposure was associated with an increased risk of spontaneous abortion. DESIGN Community-based prospective cohort study (Right from the Start). SETTING Eight metropolitan areas in North Carolina, Tennessee, and Texas. PARTICIPANTS A total of 5451 women (18 years of age or older) who were planning to conceive or were pregnant (before 12 weeks of completed gestation) and were enrolled in the study between 2000 and 2012; of those women, 223 used antidepressants (selective serotonin reuptake inhibitors [SSRIs] only [170], SSRIs and non-SSRIs [9], and non-SSRIs only [44]) during their first trimester, and 5228 did not (never users). Measurements and Main Results First trimester antidepressant use was determined during a first trimester telephone interview. Spontaneous abortion was self-reported and verified by medical records. The association of first trimester antidepressant use and spontaneous abortion was assessed by using Cox proportional hazard regression. Among the 5451 women enrolled, 223 (4%) reported first trimester antidepressant use, and 659 (12%) experienced a spontaneous abortion. SSRIs were the most common class of antidepressants used (179 [80%]). Compared with women who never used antidepressants during the first trimester of pregnancy, women who reported antidepressant use were 34% (adjusted hazard ratio [aHR] 1.34, 95% confidence interval [CI] 0.97-1.85) more likely to experience a spontaneous abortion after adjusting for covariates. Women who reported ever using SSRIs were 45% (aHR 1.45, 95% CI 1.02-2.06) more likely to experience a spontaneous abortion compared with never users. When time of loss relative to the time of interview was taken into consideration, the association between first trimester SSRI use and spontaneous abortion was significant only among those with losses before the interview (aHR 1.49, 95% CI 1.04-2.13) but was not significant among those with losses after the interview (aHR 0.43, 95% CI 0.06-3.15). CONCLUSION The association between use of first trimester antidepressants, particularly SSRI use, and spontaneous abortion was significant only among women whose exposure status was assessed after loss. In this instance, reporting bias may create a spurious association. Future studies should take the timing of data collection relative to the timing of loss into consideration.
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Affiliation(s)
- Pingsheng Wu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee.,Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Phillip Gorrindo
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexandra C Sundermann
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric S Torstenson
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah H Jones
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ronna L Chan
- Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, North Carolina
| | - Katherine E Hartmann
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
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Wagner GJ, McBain RK, Akena D, Ngo V, Nakigudde J, Nakku J, Chemusto H, Beyeza-Kashesya J, Gwokyalya V, Faherty LJ, Kyohangirwe L, Nabitaka LK, Lukwata H, Linnemayr S, Ghosh-Dastidar B, Businge J, Mukasa B, Wanyenze RK. Maternal depression treatment in HIV (M-DEPTH): Study protocol for a cluster randomized controlled trial. Medicine (Baltimore) 2019; 98:e16329. [PMID: 31277180 PMCID: PMC6635242 DOI: 10.1097/md.0000000000016329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Over one-third of human immunodeficiency virus (HIV)-infected pregnant women are clinically depressed, increasing the risk of mother-to-child transmission (MTCT) of HIV, as well as negative birth and child development outcomes. This study will evaluate the efficacy and cost-effectiveness of an evidence-based stepped care treatment model for perinatal depression (maternal depression treatment in HIV [M-DEPTH]) to improve adherence to prevention of MTCT care among HIV+ women in Uganda. METHODS Eight antenatal care (ANC) clinics in Uganda will be randomized to implement either M-DEPTH (n=4) or usual care (n=4) for perinatal depression among 400 pregnant women (n=50 per clinic) between June 2019 and August 2022. At each site, women who screen positive for potential depression will be enrolled and followed for 18 months post-delivery, assessed in 6-month intervals: baseline, within 1 month of child delivery or pregnancy termination, and months 6, 12, and 18 following delivery. Primary outcomes include adherence to the prevention of mother-to-child transmission (PMTCT) care continuum-including maternal antiretroviral therapy and infant antiretrovial prophylaxis, and maternal virologic suppression; while secondary outcomes will include infant HIV status, post-natal maternal and child health outcomes, and depression treatment uptake and response. Repeated-measures multivariable regression analyses will be conducted to compare outcomes between M-DEPTH and usual care, using 2-tailed tests and an alpha cut-off of P <.05. Using a micro-costing approach, the research team will relate costs to outcomes, examining the incremental cost-effectiveness ration (ICER) of M-DEPTH relative to care as usual. DISCUSSION This cluster randomized controlled trial will be one of the first to compare the effects of an evidence-based depression care model versus usual care on adherence to each step of the PMTCT care continuum. If determined to be efficacious and cost-effective, this study will provide a model for integrating depression care into ANC clinics and promoting adherence to PMTCT. TRIAL REGISTRATION NIH Clinical Trial Registry NCT03892915 (clinicaltrials.gov).
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Affiliation(s)
| | | | | | - Victoria Ngo
- RAND Corporation, Santa Monica, CA
- City University of New York Graduate School of Public Health and Health Policy, New York, NY
| | | | | | | | | | | | - Laura J. Faherty
- RAND Corporation, Santa Monica, CA
- Boston University School of Medicine, Boston, MA
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Abstract
The use of psychotropic drugs during pregnancy and breastfeeding remains a controversial topic. There are several reasons for the controversy, ranging from the misperception that pregnancy is protective against mental illness, to the notion that women should be "pure" during pregnancy and avoid all extraneous substance use, and finally, to the stigma and misunderstanding of psychiatric illness and underestimation of how serious it can be. Fortunately, the currently available data are reassuring for most psychiatric medications-properly controlled studies indicate little to no risk for most (but not all) psychiatric medications.
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Affiliation(s)
- Jennifer L Payne
- Johns Hopkins School of Medicine, 550 North Broadway, Suite 305, Baltimore, MD 21205, USA.
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Association of periodontal disease with depression and adverse birth outcomes: Results from the Perinatal database; Finger Lakes region, New York State. PLoS One 2019; 14:e0215440. [PMID: 30998794 PMCID: PMC6472778 DOI: 10.1371/journal.pone.0215440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 04/02/2019] [Indexed: 11/19/2022] Open
Abstract
Preterm and low birth weight infants are at greater risk for mortality and a variety of health and developmental problems. Data from the Finger Lakes Perinatal Data System database on 316,956 deliveries occurring between 2004–2014 and pregnancy outcomes were analyzed to assess the association of periodontal (gum) disease with depression, other maternal factors and adverse birth outcomes. Adjusted effects of periodontal disease and depression on adverse birth outcomes were estimated using multiple logistic regression models and path analysis. Having preterm delivery was associated significantly with depression (OR = 1.177; 95% CI: [1.146, 1.208]), having adequate health care (OR = 1.638; 95% CI: [1.589, 1.689]), smoking during pregnancy (OR = 1.259; 95% CI: [1.220, 1.300]), and being less educated (OR = 1.214; 95% CI: [1.174, 1.256]). Having low birth weight was significantly associated with depression (OR = 1.206; 95% CI: [1.170, 1.208]), smoking during pregnancy (OR = 1.855; 95% CI: [1.793, 1.919]), and being less educated (OR = 1.322; 95% CI: [1.275, 1.370]). Periodontal disease was significantly associated with alcohol use during pregnancy (OR = 1.314; 95% CI: [1.227, 1.407]) and white race (OR = 1.192; 95% CI: [1.167, 1.217]). Depression was significantly associated with periodontal disease (OR = 1.762; 95% CI: [1.727, 1.797]) and alcohol use during pregnancy (OR = 1.470; 95% CI: [1.377, 1.570]). We concluded that a positive association existed between depression during pregnancy and adverse birth outcomes, and that depression served as a mediator in the association of periodontal disease with adverse birth outcomes.
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Treating Obsessive-Compulsive Disorder in the Postpartum Period: Diagnostic and Cultural Considerations. Harv Rev Psychiatry 2019; 26:82-89. [PMID: 28795979 DOI: 10.1097/hrp.0000000000000146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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32
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Developmental fluoxetine exposure in zebrafish reduces offspring basal cortisol concentration via life stage-dependent maternal transmission. PLoS One 2019; 14:e0212577. [PMID: 30789953 PMCID: PMC6383989 DOI: 10.1371/journal.pone.0212577] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 02/05/2019] [Indexed: 12/13/2022] Open
Abstract
Fluoxetine (FLX) is a pharmaceutical used to treat affective disorders in humans, but as environmental contaminant also affects inadvertently exposed fish in urban watersheds. In humans and fish, acute FLX treatment and exposure are linked to endocrine disruption, including effects on the reproductive and stress axes. Using the zebrafish model, we build on the recent finding that developmental FLX exposure reduced cortisol production across generations, to determine possible parental and/or life-stage-dependent (age and/or breeding experience) contributions to this phenotype. Specifically, we combined control and developmentally FLX-exposed animals of both sexes (F0) into four distinct breeding groups mated at 5 and 9 months, and measured offspring (F1) basal cortisol at 12 dpf. Basal cortisol was lower in F1 descended from developmentally FLX-exposed F0 females bred at 5, but not 9 months, revealing a maternal, life-stage dependent effect. To investigate potential molecular contributions to this phenotype, we profiled maternally deposited transcripts involved in endocrine stress axis development and regulation, epigenetic (de novo DNA methyltransferases) and post-transcriptional (miRNA pathway components and specific miRNAs) regulation of gene expression in unfertilized eggs. Maternal FLX exposure resulted in decreased transcript abundance of glucocorticoid receptor, dnmt3 paralogues and miRNA pathway components in eggs collected at 5 months, and increased transcript abundance of miRNA pathway components at 9 months. Specific miRNAs predicted to target stress axis transcripts decreased (miR-740) or increased (miR-26, miR-30d, miR-92a, miR-103) in eggs collected from FLX females at 5 months. Increased abundance of miRNA-30d and miRNA-92a persisted in eggs collected from FLX females at 9 months. Clustering and principal component analyses of egg transcript profiles separated eggs collected from FLX-females at 5 months from other groups, suggesting that oocyte molecular signatures, and miRNAs in particular, may serve as predictive tools for the offspring phenotype of reduced basal cortisol in response to maternal FLX exposure.
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Yamamoto-Sasaki M, Yoshida S, Takeuchi M, Tanaka-Mizuno S, Ogawa Y, Furukawa TA, Kawakami K. Association between antidepressant use during pregnancy and autism spectrum disorder in children: a retrospective cohort study based on Japanese claims data. Matern Health Neonatol Perinatol 2019; 5:1. [PMID: 30652008 PMCID: PMC6327597 DOI: 10.1186/s40748-018-0096-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/17/2018] [Indexed: 12/17/2022] Open
Abstract
Background Studies using data from Western countries have raised concerns that treating pregnant women with antidepressants may increase the risk of autism spectrum disorders (ASDs) in their offspring. However, to date, the studies are inconclusive. We therefore examined the association between antidepressant use and ASD using claims data collected in Japan. Methods This retrospective cohort study was based on claims data from mothers and their children from January 2005 to July 2014, obtained from the Japan Medical Data Center. The information from mothers and children was linked using the family identification code. Information on antidepressant prescriptions during pregnancy was extracted from the database. To collect information on ASD, children for whom data were available 24 months or more after birth were followed up from birth through July 2014 or up until their withdrawal from the database. To ensure appropriate diagnosis of ASD, mother-child pairs where the children's data did not cover the 24 months after birth or pairs where children had a diagnosis of ASD within only 23 months after birth were excluded from the study cohort. We used logistic regression analyses to evaluate the association between antidepressant use during pregnancy and the children's ASD diagnosis. All statistical analyses were performed using IBM SPSS (Statistical Package for the Social Sciences) Statistics ver. 21.0. Results Of the 53,864 eligible mother-child pairs, 26,925 met the study criteria. Crude analysis showed that the ASD prevalence in children was significantly higher with any antidepressant use than with non-use (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.08, 4.95). However, when the analysis was adjusted for the confounding effect of maternal depression during pregnancy, statistical significance was lost (OR, 0.76; CI, 0.27, 2.18). Conclusions After adjustment for confounders, we found no significant association between antidepressant use during pregnancy and ASD in children in Japan. This result provides additional evidence to support the idea that antidepressant use during pregnancy itself is not associated with an increase in ASD in children. In addition, this represents the first evidence based on Asian data.
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Affiliation(s)
- Madoka Yamamoto-Sasaki
- 1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho Sakyo-ku, Kyoto, 606-8501 Japan
| | - Satomi Yoshida
- 1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho Sakyo-ku, Kyoto, 606-8501 Japan
| | - Masato Takeuchi
- 1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho Sakyo-ku, Kyoto, 606-8501 Japan
| | - Sachiko Tanaka-Mizuno
- 2Department of Medical Statistics, Shiga University of Medical Science, Setatsukinowacho Otsu, Shiga, 520-2121 Japan
| | - Yusuke Ogawa
- 3Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho Sakyo-ku, Kyoto, 606-8501 Japan
| | - Toshiaki A Furukawa
- 4Department of Health Promotion and Human Behavior, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho Sakyo-ku, Kyoto, 606-8501 Japan
| | - Koji Kawakami
- 1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho Sakyo-ku, Kyoto, 606-8501 Japan
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Corti S, Pileri P, Mazzocco MI, Mandò C, Moscatiello AF, Cattaneo D, Cheli S, Baldelli S, Pogliani L, Clementi E, Cetin I. Neonatal Outcomes in Maternal Depression in Relation to Intrauterine Drug Exposure. Front Pediatr 2019; 7:309. [PMID: 31403037 PMCID: PMC6676795 DOI: 10.3389/fped.2019.00309] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 07/09/2019] [Indexed: 12/14/2022] Open
Abstract
Background: SSRIs (Selective Serotonin Reuptake Inhibitors) are the most useful drugs to treat depression during pregnancy. Intrauterine exposure to SSRIs may increase the risk of growth restriction, preterm birth and neonatal complications. However, advantages in treating depression seem to exceed potential drug side effects in respect un-treated depression. SSRIs undergo extensive hepatic first-pass metabolism with the involvement of several cytochrome P450 (CYPs) enzymes. Genetic polymorphisms may influence the expression and activity of CYPs genes. The first aim of this study was to evaluate neonatal outcomes in depressed mothers exposed to SSRIs during pregnancy. SSRIs pharmacogenetics was also evaluated in a subset of mothers and fetuses. Methods: In this case-control study, cases (n = 42) were Caucasian women with a diagnosis of depression and/or anxiety, treated with SSRIs for the whole pregnancy. Controls (n = 85) were Caucasian women without a psychiatric diagnosis and not exposed to SSRIs during pregnancy. Exclusion criteria for both groups were other psychotropic drugs, anti-epileptics, drug of abuse, alcohol addiction, maternal or fetal infectious diseases, fetal/neonatal chromosomal genetic abnormalities. Maternal and fetal blood samples were obtained at delivery to analyze genotype in 33 cases. Results: The population was homogenous for demographic, anthropometric, socio-economic and obstetric variables except for smoking and mean hemoglobin values before delivery. Obstetric features were comparable. Newborns exposed to SSRIs during fetal life were significantly more likely to be Low Birth Weight (LBW) (birth weight <2,500 g) (p = 0.01), had significantly lower mean Apgar scores at 1' (p = 0.006) and at 5' (p = 0.023) and worse Apgar distribution at 1' (p = 0.017) and at 5' (p = 0.013). Fifty-six percent of newborns presented one or more symptoms consistent with poor neonatal adaptation syndrome (PNAS). Pharmacogenetic analysis at delivery did not show significant differences in the frequencies of obstetric or neonatal complications in relation to polymorphisms. Conclusions: We found that newborns exposed to SSRIs are at increased risk of poor neonatal outcomes in terms of low birth weight, low Apgar scores and, clinically, poor neonatal adaptation syndrome. Preliminary pharmacogenetic analysis showed that the degree of CYPs alterations, that depends on polymorphisms, may influence neonatal outcomes.
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Affiliation(s)
- Silvia Corti
- Department of Mother and Child, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Paola Pileri
- Department of Mother and Child, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Martina I Mazzocco
- Department of Mother and Child, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Chiara Mandò
- Department of Mother and Child, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Anna F Moscatiello
- Department of Mother and Child, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Dario Cattaneo
- Clinical Pharmacology Unit, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, University of Milan, Milan, Italy
| | - Stefania Cheli
- Clinical Pharmacology Unit, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, University of Milan, Milan, Italy
| | - Sara Baldelli
- Clinical Pharmacology Unit, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, University of Milan, Milan, Italy
| | - Laura Pogliani
- Department of Mother and Child, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Emilio Clementi
- Clinical Pharmacology Unit, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, University of Milan, Milan, Italy.,IRCCS E. Medea Institute, Bosisio Parini, Italy
| | - Irene Cetin
- Department of Mother and Child, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
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35
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Depresión en el embarazo. ACTA ACUST UNITED AC 2019; 48:58-65. [DOI: 10.1016/j.rcp.2017.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 02/15/2017] [Accepted: 07/10/2017] [Indexed: 11/19/2022]
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36
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Mohammad KI, Abu Awad D, Creedy DK, Gamble J. Postpartum depression symptoms among Syrian refugee women living in Jordan. Res Nurs Health 2018; 41:519-524. [PMID: 30431160 DOI: 10.1002/nur.21919] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 10/06/2018] [Indexed: 11/08/2022]
Abstract
Postpartum depression (PPD) is recognized as a common maternal health problem, but few studies have investigated the postpartum mental health of refugee women. In this cross-sectional study, we investigated the prevalence of PPD symptoms and associated factors among Syrian refugee women living in north Jordan. Women (N = 365) were recruited from four health care centers in Ramtha and Jarash, cities in northern Jordan. Participants completed a demographic data form, the Edinburgh Postnatal Depression Scale (EPDS), and the Maternal Social Support Scale at 6-8 weeks postpartum. Half (49.6%; n = 181) of the Syrian refugee women scored >12 on the EPDS. PPD symptoms were significantly associated with low social support, low monthly income, and recent immigration (less than 2 years). There is a high level of PPD symptoms among Syrian refugee women, many of whom are living in poverty and with limited social support. The results highlight the need for immediate action by governments to support childbearing refugee women with early screening for psychosocial risk and respond to women's physical and mental health, and social needs through interservice collaboration. Social support programs would meet an important need for these women, as would ongoing assessment by health professionals and early intervention for women who screen positive for PPD.
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Affiliation(s)
- Khitam I Mohammad
- Maternal and Child Health and Midwifery Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Doaa Abu Awad
- Maternal and Child Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Debra K Creedy
- Maternal, Newborn and Families Research Collaborative, Menzies Institute of Health Queensland, Griffith University, Brisbane, Australia
| | - Jenny Gamble
- Maternal, Newborn and Families Research Collaborative, Menzies Institute of Health Queensland, Griffith University, Brisbane, Australia
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Thorsness KR, Watson C, LaRusso EM. Perinatal anxiety: approach to diagnosis and management in the obstetric setting. Am J Obstet Gynecol 2018; 219:326-345. [PMID: 29803818 DOI: 10.1016/j.ajog.2018.05.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/09/2018] [Accepted: 05/16/2018] [Indexed: 11/16/2022]
Abstract
Anxiety is common in women during the perinatal period, manifests with various symptoms and severity, and is associated with significant maternal morbidity and adverse obstetric and neonatal outcomes. Given the intimate relationship and frequency of contact, the obstetric provider is positioned optimally to create a therapeutic alliance and to treat perinatal anxiety. Time constraints, absence of randomized controlled trials, mixed quality of data, and concern for potential adverse reproductive outcomes all limit the clinician's ability to initiate informed risk-benefit discussions. Clear understanding of the role of the obstetric provider in the identification, stabilization, and initiation of medication and/or referral to psychotherapy for women with perinatal anxiety disorders is critical to maternal and neonatal wellbeing. Informed by our clinical practice as perinatal psychiatric providers, we have provided a concise summary of current research on the approach to the treatment of perinatal anxiety disorders in the obstetric setting that includes psychotherapy and supportive interventions, primary and adjuvant psychiatric medication, and general prescribing pearls. Medications that we examined include antidepressants, benzodiazepines, sedative-hypnotics, antihistamines, quetiapine, buspirone, propranolol, and melatonin. Further research into management of perinatal anxiety, particularly psychopharmacologic management, is warranted.
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Freeman MP, Góez-Mogollón L, McInerney KA, Davies AC, Church TR, Sosinsky AZ, Noe OB, Viguera AC, Cohen LS. Obstetrical and neonatal outcomes after benzodiazepine exposure during pregnancy: Results from a prospective registry of women with psychiatric disorders. Gen Hosp Psychiatry 2018; 53:73-79. [PMID: 29958100 DOI: 10.1016/j.genhosppsych.2018.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/02/2018] [Accepted: 05/28/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The goal of this analysis was to examine the effect of benzodiazepine use during pregnancy on maternal and neonatal outcomes in a cohort of women with psychiatric disorders. METHODS 794 evaluable women from the Massachusetts General Hospital National Pregnancy Registry for Psychiatric Medications were followed across pregnancy (N = 144 exposed to benzodiazepines and N = 650 unexposed). Data obtained through maternal report and medical records included maternal outcomes (cesarean section, preeclampsia) and neonatal outcomes (birth weight, breathing difficulty, feeding difficulty, head circumference, 5-minute Apgar score, muscular and/or extrapyramidal symptoms, NICU admission, prematurity). RESULTS In adjusted analyses, infants exposed to benzodiazepines in utero were more likely to be admitted to the NICU (OR: 2.02, 95% CI: 1.11, 3.66) and to have small head circumferences (OR: 3.89, 95% CI: 1.25, 12.03) compared to unexposed infants. Other neonatal adverse effects such as respiratory distress or muscular symptoms including hypotonia were not observed. There were no significant differences in adverse obstetrical outcomes. CONCLUSIONS Infants exposed to benzodiazepines during pregnancy had an increased risk of NICU admissions and small head circumferences. Confounding from psychiatric symptoms and other variables cannot be ruled out as contributors to these findings.
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Affiliation(s)
- Marlene P Freeman
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States.
| | - Lina Góez-Mogollón
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States
| | - Kathryn A McInerney
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States; Boston University School of Public Health, Department of Epidemiology, 715 Albany Street, The Talbot Building, T3E & T4E, Boston, MA 02118, United States
| | - Abigail C Davies
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States
| | - Taylor R Church
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States
| | - Alexandra Z Sosinsky
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States
| | - Olivia B Noe
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States
| | - Adele C Viguera
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States; Cleveland Clinic, Cleveland Clinic Neurological Institute, 6770 Mayfield Rd #226, Cleveland, OH 44123, United States
| | - Lee S Cohen
- Massachusetts General Hospital, Center for Women's Mental Health, 185 Cambridge St, Boston, MA 02114, United States
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Freedman R, Hunter SK, Hoffman MC. Prenatal Primary Prevention of Mental Illness by Micronutrient Supplements in Pregnancy. Am J Psychiatry 2018; 175:607-619. [PMID: 29558816 PMCID: PMC6984656 DOI: 10.1176/appi.ajp.2018.17070836] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Genes, infection, malnutrition, and other factors affecting fetal brain development are a major component of risk for a child's emotional development and later mental illnesses, including schizophrenia, bipolar disorder, and autism. Prenatal interventions to ameliorate that risk have yet to be established for clinical use. A systematic review of prenatal nutrients and childhood emotional development and later mental illness was performed. Randomized trials of folic acid, phosphatidylcholine, and omega-3 fatty acid supplements assess effects of doses beyond those adequate to remedy deficiencies to promote normal fetal development despite genetic and environmental risks. Folic acid to prevent neural tube defects is an example. Vitamins A and D are currently recommended at maximum levels, but women's incomplete compliance permits observational studies of their effects. Folic acid and phosphatidylcholine supplements have shown evidence for improving childhood emotional development associated with later mental illnesses. Vitamins A and D decreased the risk for schizophrenia and autism in retrospective observations. Omega-3 fatty acid supplementation during early pregnancy increased the risk for schizophrenia and increased symptoms of attention deficit hyperactivity disorder, but in later pregnancy it decreased childhood wheezing and premature birth. Studies are complicated by the length of time between birth and the emergence of mental illnesses like schizophrenia, compared with anomalies like facial clefts identified at birth. As part of comprehensive maternal and fetal care, prenatal nutrient interventions should be further considered as uniquely effective first steps in decreasing risk for future psychiatric and other illnesses in newborn children. [AJP at 175: Remembering Our Past As We Envision Our Future July 1959: Longitudinal Observations of Biological Deviations in a Schizophrenic Infant Barbara Fish described the course of an infant born with fluctuating motor problems who developed schizophrenia. (Am J Psychiatry 1959; 116:25-31 )].
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Affiliation(s)
- Robert Freedman
- From the Institute for Children’s Mental Disorders and the Departments of Psychiatry and of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora
| | - Sharon K. Hunter
- From the Institute for Children’s Mental Disorders and the Departments of Psychiatry and of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora
| | - M. Camille Hoffman
- From the Institute for Children’s Mental Disorders and the Departments of Psychiatry and of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora
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Prenatal fluoxetine modifies the behavioral and hormonal responses to stress in male mice: role for glucocorticoid insensitivity. Behav Pharmacol 2018; 28:345-355. [PMID: 28418941 DOI: 10.1097/fbp.0000000000000303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Women with major depressive disorder during pregnancy often use selective serotonin reuptake inhibitors (SSRIs) antidepressants. These drugs readily cross the placental barrier and impact the developing fetal brain. Recently, we reported that prenatal fluoxetine (FLX), an SSRI antidepressant drug, altered corticosterone and behavioral responses to stress in female mouse offspring. The present study assessed the effects of prenatal FLX on these responses in males. The results showed that prenatal FLX significantly augmented the corticosterone response to acute stress in young prepubescent mice. The corticosterone response to continuous stress was not affected by prenatal FLX irrespective of age. In addition, continuous stress reduced general activity, and anxiety-like and depressive-like behaviors in adult animals prenatally exposed to FLX, but not in controls. The dexamethasone suppression test showed that prenatal FLX induced a state of glucocorticoid insensitivity in adult males, indicating that the negative feedback control of the hypothalamic-pituitary-adrenal axis response to stress was disrupted. Together, these findings indicate that prenatal FLX altered hormonal and behavioral responses to stress and suggest a role for the development of glucocorticoid insensitivity in these effects. These findings may aid understanding of the limitations and precautions that should be taken in the use of SSRIs by pregnant women.
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Abstract
OBJECTIVES To review the evidence-based management of nausea and vomiting of pregnancy and hyperemesis gravidarum. EVIDENCE MEDLINE and Cochrane database searches were performed using the medical subject headings of treatment, nausea, vomiting, pregnancy, and hyperemesis gravidarum. The quality of evidence reported in these guidelines has been described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on Preventative Health Care. BENEFITS Nausea and vomiting of pregnancy has a profound effect on women's health and quality of life during pregnancy as well as a financial impact on the health care system, and its early recognition and management is recommended. COST: Costs, including hospitalizations, additional office visits, and time lost from work, may be reduced if nausea and vomiting in pregnancy is treated early. RECOMMENDATIONS
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Abstract
Women are more likely than men to experience depression throughout the life span. Sex differences in neurochemistry and brain structure, as well as societal factors may contribute to women's increased likelihood of depression. Pharmacological research targeting depression has historically excluded women, leading to a knowledge gap regarding effective antidepressant treatment in women. Antidepressant pharmacokinetics and pharmacodynamics are clearly different in men and women, necessitating a thoughtful approach to their prescription and management. Hormone changes associated with the menstrual cycle, pregnancy, and menopause also contribute to differences in depression and effective antidepressant use in women. Finally, it is important to consider potential interactions between antidepressant drugs and medications specifically used by women (oral contraceptives, tamoxifen, and estrogen).
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Affiliation(s)
- Christina Bourne
- Department of Psychiatry and Behavioral Sciences, Department of Family Medicine, University of California Davis, Sacramento, CA, USA
| | - Laura Kenkel
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA.
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Margolis KG. A role for the serotonin reuptake transporter in the brain and intestinal features of autism spectrum disorders and developmental antidepressant exposure. J Chem Neuroanat 2017; 83-84:36-40. [PMID: 28213183 PMCID: PMC5555828 DOI: 10.1016/j.jchemneu.2017.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 12/18/2022]
Abstract
Many disease conditions considered CNS-predominant harbor significant intestinal comorbidities. Serotonin (5-HT) and the serotonin reuptake transporter (SERT) have increasingly been shown to play important roles in both brain and intestinal development and long-term function. 5-HT and SERT may thus modulate critical functions in the development and perpetuation of brain-gut axis disease. We discuss the potential roles of 5-HT and SERT in the brain and intestinal manifestations of autism spectrum disorders and developmental antidepressant exposure. The potential therapeutic value of 5-HT4 modulation in the subsequent treatment of these conditions is also addressed.
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Affiliation(s)
- Kara Gross Margolis
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Morgan Stanley Children's Hospital, Columbia University Medical Center, United States.
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Abstract
Postpartum psychiatric disorders represent a significant public health problem that has not been readily addressed, particularly in the primary care setting. As maternal mood and anxiety difficulties are associated with a number of adverse outcomes for the mother, her offspring and the family system, addressing these concerns during the perinatal period is of critical importance. Although researchers and clinicians have become increasingly aware of the problem, postpartum mood and anxiety disorders (PMADs) remain widely unrecognized and poorly understood by both patients and providers. As pediatric primary care providers encounter mothers repeatedly throughout the postpartum period, the pediatric clinician has the unique opportunity to intervene with mothers suffering from mental illness. Given the potentially devastating impact of PMADs across multiple domains, the purpose of this article is to provide guidelines for pediatric clinicians to better manage maternal mental illness within the primary care pediatric setting. As such, we review the categories and prevalence of PMADs and provide strategies for responding to a positive PMADs screen or concerns raised during surveillance of the mother-infant-dyad. In addition, we offer a summary of the literature on evidence-based treatments for PMADs to allow pediatricians to guide the parents of their patients towards the most effective interventions. Finally, we provide an overview of alternative treatment models that can facilitate the screening and treatment of behavioral health concerns within the primary care setting.
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Tak CR, Job KM, Schoen-Gentry K, Campbell SC, Carroll P, Costantine M, Brixner D, Birnbaum AK, Sherwin CMT. The impact of exposure to antidepressant medications during pregnancy on neonatal outcomes: a review of retrospective database cohort studies. Eur J Clin Pharmacol 2017; 73:1055-1069. [PMID: 28600701 DOI: 10.1007/s00228-017-2269-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/22/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Concerns with prescription antidepressant use in pregnant women have instigated the examination of potential associations between fetal exposure to antidepressant medication and outcomes including preterm delivery, congenital malformations, perinatal and post-natal adverse events, persistent pulmonary hypertension, and mortality. The retrospective cohort model is an often utilized study design. The objective of this review is to evaluate the literature on antidepressant use in pregnancy conducted as retrospective cohorts in national/regional medical, or claims databases that assess neonatal and infant outcomes for agreement between studies, ultimately providing a methodological and outcomes summary for future scientific endeavors. METHODS PubMed was searched for literature relating to antidepressant use and infant outcomes from the earliest available date through July 15, 2016. Studies with a retrospective cohort design and conducted in national/regional medical or claims databases were included. Searched outcomes included preterm delivery, congenital malformations, low birth weight, small for gestational age, persistent pulmonary hypertension of the newborn, and other select adverse events comprising low Apgar score (5 min), convulsions/seizures, respiratory distress/problems, fetal mortality, and infant mortality. RESULTS Of the 784 studies identified, 36 retrospective cohort studies met eligibility criteria. An increase in preterm delivery and respiratory distress/problems and no increase in congenital malformation or fetal and infant death were associated with prenatal use of prescription antidepressants by majority consensus (at least 2/3 [67%] of studies). CONCLUSIONS While consensus indicates that perinatal prescription antidepressant use has consequences for the fetus and infant, there are notable inconsistencies in the literature. More investigations that address prenatal exposure to depression and other important covariates are needed.
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Affiliation(s)
- Casey R Tak
- Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,Clinical Trials Office, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Kathleen M Job
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah of Medicine, SLC, Utah 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Katie Schoen-Gentry
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Sarah C Campbell
- Nelson Laboratories, Salt Lake City, UT, USA.,Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah Salt Lake City, Salt Lake City, UT, USA
| | - Patrick Carroll
- Women and Newborn Clinical Program, Department of Pediatrics, Dixie Regional Medical Center, Intermountain Healthcare, St. George, UT, USA.,Neonatal Services, Dixie Regional Medical Center, 544 East 400 South, St George, UT, 84770, USA
| | - Maged Costantine
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Diana Brixner
- Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.,Program in Personalized Health, Health Sciences Center, University of Utah, Salt Lake City, UT, USA
| | - Angela K Birnbaum
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Catherine M T Sherwin
- Clinical Trials Office, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA. .,Division of Clinical Pharmacology, Department of Pediatrics, University of Utah of Medicine, SLC, Utah 295 Chipeta Way, Salt Lake City, UT, 84108, USA. .,Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah Salt Lake City, Salt Lake City, UT, USA.
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Abstract
The use of psychotropic drugs during pregnancy and breastfeeding remains a controversial topic. There are several reasons for the controversy, ranging from the misperception that pregnancy is protective against mental illness, to the notion that women should be "pure" during pregnancy and avoid all extraneous substance use, and finally, to the stigma and misunderstanding of psychiatric illness and underestimation of how serious it can be. Fortunately, the currently available data are reassuring for most psychiatric medications-properly controlled studies indicate little to no risk for most (but not all) psychiatric medications.
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Affiliation(s)
- Jennifer L Payne
- Johns Hopkins School of Medicine, 550 North Broadway, Suite 305, Baltimore, MD 21205, USA.
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Li M, Chou SY. Modeling postpartum depression in rats: theoretic and methodological issues. DONG WU XUE YAN JIU = ZOOLOGICAL RESEARCH 2017; 37:229-36. [PMID: 27469254 DOI: 10.13918/j.issn.2095-8137.2016.4.229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The postpartum period is when a host of changes occur at molecular, cellular, physiological and behavioral levels to prepare female humans for the challenge of maternity. Alteration or prevention of these normal adaptions is thought to contribute to disruptions of emotion regulation, motivation and cognitive abilities that underlie postpartum mental disorders, such as postpartum depression. Despite the high incidence of this disorder, and the detrimental consequences for both mother and child, its etiology and related neurobiological mechanisms remain poorly understood, partially due to the lack of appropriate animal models. In recent decades, there have been a number of attempts to model postpartum depression disorder in rats. In the present review, we first describe clinical symptoms of postpartum depression and discuss known risk factors, including both genetic and environmental factors. Thereafter, we discuss various rat models that have been developed to capture various aspects of this disorder and knowledge gained from such attempts. In doing so, we focus on the theories behind each attempt and the methods used to achieve their goals. Finally, we point out several understudied areas in this field and make suggestions for future directions.
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Affiliation(s)
- Ming Li
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, 68588-0308 USA.
| | - Shinn-Yi Chou
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, 68588-0308 USA
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Nembhard WN, Tang X, Hu Z, MacLeod S, Stowe Z, Webber D. Maternal and infant genetic variants, maternal periconceptional use of selective serotonin reuptake inhibitors, and risk of congenital heart defects in offspring: population based study. BMJ 2017; 356:j832. [PMID: 28264803 PMCID: PMC6283388 DOI: 10.1136/bmj.j832] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective To evaluate whether the association between maternal periconceptional use of selective serotonin reuptake inhibitors (SSRIs) and increased risk of congenital heart defects in offspring is modified by maternal or infant genetic variants in folate, homocysteine, or transsulfuration pathways.Design Population based study. DNA from mothers, fathers, and infants was genotyped with an Illumina GoldenGate custom single nucleotide polymorphism panel. A hybrid design based on a log linear model was used to calculate relative risks and Bayesian false discovery probabilities (BFDP) to identify polymorphisms associated with congenital heart defects modified by SSRI use.Data sources Data from the US National Birth Defects Prevention Study on 1180 liveborn infants with congenital heart defects and 1644 controls, born 1997-2008.Main outcome measures Cases included infants with selected congenital heart defects and control infants had no major defects. SSRI use was obtained from telephone interviews with mothers.Results For women who reported taking SSRIs periconceptionally, maternal SHMT1 (rs9909104) GG and AGgenotypes were associated with a 5.9 and 2.4 increased risk of select congenital heart defects in offspring, respectively, versus the AA genotype (BFDP=0.69). Compared with the AA genotype, BHMT (rs492842 and rs542852) GG and AG genotypes were associated with twice the riskof congenital heart defects (BFDP=0.74 and 0.79, respectively). MGST1 (rs2075237) CC and ACgenotypes were associated with an increased risk compared with the GG genotype (8.0 and 2.8, respectively; BFDP=0.79). Single nucleotide polymorphism in infant genes in the folate (MTHFS rs12438477), homocysteine (TRDMT1 rs6602178 and GNMT rs11752813) and transsulfuration (GSTP1 rs7941395 and MGST1 rs7294985) pathways were also associated with an increased risk of congenital heart defects.Conclusions Common maternal or infant genetic variants in folate, homocysteine, or transsulfuration pathways are associated with an increased risk of certain congenital heart defects among children of women taking SSRIs during cardiogenesis.
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Affiliation(s)
- Wendy N Nembhard
- Division of Birth Defects Research, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, AR, 72202, USA
| | - Xinyu Tang
- Division of Biostatistics, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, AR, 72202 USA
| | - Zhuopei Hu
- Division of Biostatistics, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, AR, 72202 USA
| | - Stewart MacLeod
- Division of Birth Defects Research, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, AR, 72202, USA
| | - Zachary Stowe
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205, USA
| | - Daniel Webber
- Division of Birth Defects Research, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, AR, 72202, USA
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Increased symptoms of illness following prenatal stress: Can it be prevented by fluoxetine? Behav Brain Res 2017; 317:62-70. [DOI: 10.1016/j.bbr.2016.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 08/18/2016] [Accepted: 09/11/2016] [Indexed: 10/21/2022]
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50
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Dimidjian S, Goodman SH, Sherwood NE, Simon GE, Ludman E, Gallop R, Welch SS, Boggs JM, Metcalf CA, Hubley S, Powers JD, Beck A. A pragmatic randomized clinical trial of behavioral activation for depressed pregnant women. J Consult Clin Psychol 2017; 85:26-36. [PMID: 28045285 PMCID: PMC5699449 DOI: 10.1037/ccp0000151] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Depression among pregnant women is a prevalent public health problem associated with poor maternal and offspring development. Behavioral activation (BA) is a scalable intervention aligned with pregnant women's preference for nonpharmacological depression care. This is the first test of the effectiveness of BA for depression among pregnant women, which aimed to evaluate the effectiveness of BA as compared with treatment as usual (TAU). METHOD Pregnant women (mean age = 28.75 years; SD = 5.67) with depression symptoms were randomly assigned to BA (n = 86) or TAU (n = 77). Exclusion criteria included known bipolar or psychotic disorder or immediate self-harm risk. Follow-up assessment occurred 5 and 10 weeks postrandomization and 3 months postpartum using self-report measures of primary and secondary outcomes and putative targets. RESULTS Compared with TAU, BA was associated with significantly lower depressive symptoms (d = 0.34, p = .04) and higher remission (56.3% vs. 30.3%, p = .003). BA also demonstrated significant advantage on anxiety and perceived stress. Participants attended most BA sessions and reported high satisfaction. Participants in BA reported significantly higher levels of activation (d = 0.69, p < .0002) and environmental reward (d = 0.54, p < .003) than those who received TAU, and early change in both of these putative targets significantly mediated subsequent depression outcomes. CONCLUSIONS BA is effective for pregnant women, offering significant depression, anxiety, and stress benefits, with mediation analyses supporting the importance of putative targets of activation and environmental reward. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - Evette Ludman
- Group Health Research Institute, Group Health Cooperative
| | - Robert Gallop
- Department of Mathematics, Applied Statistics Program, West Chester University
| | | | | | | | - Sam Hubley
- Department of Family Medicine, University of Colorado School of Medicine
| | - J David Powers
- Kaiser Permanente Colorado Institute for Health Research
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research
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