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Abujilban S, Al-Omari H, Issa E, ALhamdan A, Al-Nabulsi L, Mrayan L, Mahmoud KF, Kernohan WG. Effectiveness of Telephone-Based Interpersonal Psychotherapy on Antenatal Depressive Symptoms: A Prospective Randomized Controlled Trial in The Kingdom of Jordan. J Am Psychiatr Nurses Assoc 2024; 30:635-645. [PMID: 37148251 DOI: 10.1177/10783903231171595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Jordanian pregnant women report high prevalence of antenatal depressive symptoms, compared to their counterparts internationally. One potential nonpharmacological intervention is Interpersonal Psychotherapy (IPT), accessed by telephone. AIM The aim of this study is to compare the depressive symptom level(s) among Jordanian pregnant women who received IPT treatment with those who received routine antenatal care. METHODS A prospective randomized controlled trial design was used. Following ethical approval, a sample of 100 pregnant women (50 in each group) at 24 to 37 weeks gestation, was drawn from one governmental public hospital. Seven sessions (each half an hour) of telephone-based IPT were offered twice weekly to those assigned to the intervention arm: one pretherapy orientation, five intermediates, and one closing session. The Edinburgh Postnatal Depression Scale was administered before and after the intervention. Analysis of covariance was used to detect the intervention effect. The two groups were matched based on demographic and health characteristics. RESULTS Compared to the control group, pregnant women who received the intervention reported fewer depressive symptoms. CONCLUSIONS Midwives and general nurses should screen all pregnant women for symptoms of depression. The effectiveness of IPT treatment in alleviating depressive symptoms indicates the importance of using such supportive interventions by midwives and general nurses, who are trained in psycho-educational counseling techniques. Moreover, data provided by this study may encourage policymakers to legislate policies that make psychotherapists available and accessible in antenatal care units and ensure that staff have adequate training via continuing education programs to screen for antenatal depressive symptoms.
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Affiliation(s)
- Sanaa Abujilban
- Sanaa Abujilban, PhD, MSN, CPT, RM, RN, Department of Maternal, Child and Family Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Hasan Al-Omari
- Hasan Al-Omari, PhD, ARNP, RN, Department of Community and Mental Health Nursing, Faculty of Nursing. The Hashemite University, Zarqa, Jordan
| | - Esra'a Issa
- Esra'a Issa, MSN, Department of Maternal, Child and Family Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Ayat ALhamdan
- Ayat ALhamdan, MSN, National Center Hospital for Mental Health, Amman, Jordan
| | - Lama Al-Nabulsi
- Lama Al-nabulsi, MSN, King Hussein Cancer Center, Amman, Jordan
| | - Lina Mrayan
- Lina Mrayan, PhD, Department of Maternal, Child and Family Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Khadejah F Mahmoud
- Khadejah F. Mahmoud, PhD, MSN, RN, Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - W George Kernohan
- W. George Kernohan, PhD, School of Nursing, Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
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Domingues RR, Beard AD, Connelly MK, Wiltbank MC, Hernandez LL. Fluoxetine-induced perinatal morbidity in a sheep model. Front Med (Lausanne) 2022; 9:955560. [PMID: 35991651 PMCID: PMC9386076 DOI: 10.3389/fmed.2022.955560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Selective serotonin reuptake inhibitors (SSRI) are the most common antidepressants used by pregnant women. However, adverse pregnancy outcomes have been described in women taking SSRI during pregnancy—placental lesions, premature birth, poor neonatal adaptation. We aimed to investigate the effects of fluoxetine (Prozac® most commonly used SSRI) treatment during the last month of gestation on pregnancy complications, placental and neonatal health in a non-depressed sheep model. On day 119 ± 1 postbreeding (experimental day 0; E0) of a 151-day expected gestation, Hampshire ewes were randomly assigned to receive fluoxetine (n = 9 ewes, 15 lambs; daily intravenously treatment with 10 mg/kg on E0 and E1 and 5 mg/kg daily thereafter until parturition) or to a control group (n = 10; 14 lambs; vehicle only). Blood samples from ewes were collected throughout the experimental period and postpartum; blood from lambs were collected postpartum. Analysis of variance was used for statistical analysis. Fluoxetine treatment reduced placentome growth during the last month of pregnancy. Gestation length was decreased by 4.5 days in fluoxetine-treated ewes. Birthweight was reduced in lambs exposed to fluoxetine in utero; weights remained decreased until postnatal day 3. Placentome diameter by birthweight ratio was not different between groups suggesting that the decreased placentome diameter was accompanied by decreased lamb birthweight. During the first week postnatal, lambs exposed to fluoxetine in utero had decreased blood pH and decreased total carbon dioxide, bicarbonate, and base excess and increased lactate (days 3–6), collectively indicative of metabolic acidemia. Additionally, ionized calcium was decreased between postnatal days 0 to 4 in lambs exposed to fluoxetine in utero. Using a non-depressed animal model clearly defines a role for SSRI on the occurrence of perinatal complications and neonatal morbidity. The decreased placentome diameter, shortened gestation, decreased birthweight, decreased calcium levels, and neonatal acidemia suggest the occurrence of intrauterine growth restriction. The persistence of neonatal acidemia for several days postpartum suggests poor neonatal adaptation to extrauterine environment.
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Affiliation(s)
- Rafael R. Domingues
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, United States
| | - Adam D. Beard
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, United States
| | - Meghan K. Connelly
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Milo C. Wiltbank
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, United States
| | - Laura L. Hernandez
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, United States
- *Correspondence: Laura L. Hernandez
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Liu K, Garcia A, Park JJ, Toliver AA, Ramos L, Aizenman CD. Early Developmental Exposure to Fluoxetine and Citalopram Results in Different Neurodevelopmental Outcomes. Neuroscience 2021; 467:110-121. [PMID: 34048796 DOI: 10.1016/j.neuroscience.2021.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/25/2022]
Abstract
Although selective serotonin reuptake inhibitors are commonly prescribed for prenatal depression, there exists controversy over adverse effects of SSRI use on fetal development. Few studies have adequately isolated outcomes due to SSRI exposure and those due to maternal psychiatric conditions. Here, we directly investigated outcomes of exposure to widely-used SSRIs Fluoxetine and Citalopram on the developing nervous system of Xenopus laevis tadpoles, using an integrative experimental approach. We exposed tadpoles to low doses of Citalopram and Fluoxetine during a critical developmental period and found that different experimental groups displayed opposing behavioral effects. While both groups showed reduced schooling behavior, the Fluoxetine group showed increased seizure susceptibility and reduced startle habituation. In contrast, Citalopram treated tadpoles had decreased seizure susceptibility and increased habituation. Both groups had abnormal dendritic morphology in the optic tectum, a brain area important for behaviors tested. Whole-cell electrophysiological recordings of tectal neurons showed no differences in synaptic function; however, tectal cells from Fluoxetine-treated tadpoles had decreased voltage gated K+ currents while cells in the Citalopram group had increased K+ currents. Both behavioral and electrophysiological findings indicate that cells and circuits in the Fluoxetine treated optic tecta are hyperexcitable, while the Citalopram group exhibits decreased excitability. Taken together, these results show that early developmental exposure to SSRIs is sufficient to induce neurodevelopmental effects, however these effects can be complex and vary depending on the SSRI. This may explain some discrepancies across human studies, and further underscores the importance of serotonergic signaling for the developing nervous system.
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Affiliation(s)
- Karine Liu
- Department of Neuroscience, Brown University, United States
| | - Alfonso Garcia
- Department of Neuroscience, Brown University, United States
| | - Jenn J Park
- Department of Neuroscience, Brown University, United States
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Whitaker-Fornek JR, Nelson JK, Lybbert CW, Pilarski JQ. Development and regulation of breathing rhythms in embryonic and hatchling birds. Respir Physiol Neurobiol 2019; 269:103246. [DOI: 10.1016/j.resp.2019.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/19/2019] [Accepted: 06/23/2019] [Indexed: 11/28/2022]
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SSRIs and SNRIs (SRI) in Pregnancy: Effects on the Course of Pregnancy and the Offspring: How Far Are We from Having All the Answers? Int J Mol Sci 2019; 20:ijms20102370. [PMID: 31091646 PMCID: PMC6567187 DOI: 10.3390/ijms20102370] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/31/2022] Open
Abstract
Serotonin has important roles in the development of the brain and other organs. Manipulations of synaptic serotonin by drugs such as serotonin reuptake inhibitors (SRI) or serotonin norepinephrine reuptake inhibitors (SNRI) might alter their development and function. Of interest, most studies on the outcome of prenatal exposure to SRI in human have not found significant embryonic or fetal damage, except for a possible, slight increase in cardiac malformations. In up to a third of newborns exposed to SRI, exposure may induce transient neonatal behavioral changes (poor neonatal adaptation) and increased rate of persistent pulmonary hypertension. Prenatal SRI may also cause slight motor delay and language impairment but these are transient. The data on the possible association of prenatal SRIs with autism spectrum disorder (ASD) are inconsistent, and seem to be related to pre-pregnancy treatment or to maternal depression. Prenatal SRIs also appear to affect the hypothalamic hypophyseal adrenal (HPA) axis inducing epigenetic changes, but the long-term consequences of these effects on humans are as yet unknown. SRIs are metabolized in the liver by several cytochrome P450 (CYP) enzymes. Faster metabolism of most SRIs in late pregnancy leads to lower maternal concentrations, and thus potentially to decreased efficacy which is more prominent in women that are rapid metabolizers. Studies suggest that the serotonin transporter SLC6A4 promoter is associated with adverse neonatal outcomes after SRI exposure. Since maternal depression may adversely affect the child's development, one has to consider the risk of SRI discontinuation on the fetus and the child. As with any drug treatment in pregnancy, the benefits to the mother should be considered versus the possible hazards to the developing embryo/fetus.
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6
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Neurobehavioral risks of SSRIs in pregnancy: Comparing human and animal data. Reprod Toxicol 2017; 72:191-200. [DOI: 10.1016/j.reprotox.2017.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/20/2017] [Accepted: 05/04/2017] [Indexed: 12/19/2022]
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7
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Ornoy A, Koren G. Selective Serotonin Reuptake Inhibitors during Pregnancy: Do We Have Now More Definite Answers Related to Prenatal Exposure? Birth Defects Res 2017; 109:898-908. [DOI: 10.1002/bdr2.1078] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/17/2017] [Accepted: 06/06/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Asher Ornoy
- Laboratory of Teratology, Department of Medical Neurobiology; Hebrew University Hadassah Medical School Jerusalem and Maccabi Research Institute and Tel Aviv University; Tel Aviv Israel
| | - Gideon Koren
- Laboratory of Teratology, Department of Medical Neurobiology; Hebrew University Hadassah Medical School Jerusalem and Maccabi Research Institute and Tel Aviv University; Tel Aviv Israel
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Shen Z, Gao S, Li SX, Zhang T, Liu C, Lv H, Zhang Y, Gong T, Xu X, Ji C, Wu Q, Li D. Sertraline use in the first trimester and risk of congenital anomalies: a systemic review and meta-analysis of cohort studies. Br J Clin Pharmacol 2017; 83:909-922. [PMID: 27770542 PMCID: PMC5346877 DOI: 10.1111/bcp.13161] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/15/2016] [Accepted: 10/19/2016] [Indexed: 01/27/2023] Open
Abstract
AIM To perform a meta-analysis of available cohort studies on the association between sertraline use by pregnant women in the first trimester and the findings of congenital anomalies in infants. METHODS A comprehensive search of articles published from the index date up to 31st December 2015 investigating the aforementioned associations was conducted on PubMed and Web of Science. Mesh headings used included the terms "serotonin reuptake inhibitor," "sertraline," "congenital anomalies" and "obstetrical outcome." RESULTS Twelve cohort studies that involved 6 468 241 pregnant women were identified. We summarized odds ratios (ORs) and 95% confidence intervals (CIs) of congenital anomalies using the random-effects model. Pregnant women who used sertraline in the first trimester had a statistically significant increased risk of infant cardiovascular-related malformations (OR = 1.36; 95% CI = 1.06-1.74; I2 = 64.4%; n = 12) as well as atrial and/or ventricular septal defects (OR = 1.36, 95% CI = 1.06-1.76; I2 = 62.2%; n = 8). Additionally, positive but nonsignificant associations between sertraline use and congenital anomalies of the nervous system (OR = 1.39; 95% CI = 0.83-2.32; I2 = 0%; n = 5), digestive system (OR = 1.23; 95% CI = 0.76-1.98; I2 = 0%; n = 5), eye, ear, face and neck (OR = 1.08; 95% CI = 0.33-3.55; I2 = 32.1%; n = 3), urogenital system (OR = 1.03; 95% CI = 0.73-1.46; I2 = 0%; n = 5), and musculoskeletal system (OR = 0.97; 95% CI = 0.69-1.36; I2 = 0%; n = 5) were observed. CONCLUSION This meta-analysis suggested that the use of sertraline use by pregnant women in the first trimester had an increased risk of cardiovascular-related malformations as well as atrial and/or ventricular septal defects in infants. Meanwhile, nonsignificant associations between sertraline use and other congenital anomalies were found. More cohort studies are warranted to provide detailed results of other congenital anomalies.
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Affiliation(s)
- Zi‐Qi Shen
- Department of Obstetrics and GynecologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Shan‐Yan Gao
- Department of Clinical EpidemiologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Shawn Xiang Li
- International Education CollegeChina Medical UniversityShenyangChina
| | - Tie‐Ning Zhang
- Department of PediatricsShengjing Hospital of China Medical UniversityShenyangChina
| | - Cai‐Xia Liu
- Department of Obstetrics and GynecologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Hai‐Chen Lv
- Department of CardiologyFirst Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Yuan Zhang
- Department of EmergencyShengjing Hospital of China Medical UniversityShenyangChina
| | - Ting‐Ting Gong
- Department of Obstetrics and GynecologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Xin Xu
- Department of Clinical EpidemiologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Chao Ji
- Department of Clinical EpidemiologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Qi‐Jun Wu
- Department of Clinical EpidemiologyShengjing Hospital of China Medical UniversityShenyangChina
| | - Da Li
- Department of Obstetrics and GynecologyShengjing Hospital of China Medical UniversityShenyangChina
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Akkaş Yılmaz E, Gülümser Ç. The risk factors, consequences, treatment, and importance of gestational depression. Turk J Obstet Gynecol 2015; 12:102-113. [PMID: 28913052 PMCID: PMC5558373 DOI: 10.4274/tjod.42744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/07/2014] [Indexed: 12/01/2022] Open
Abstract
Nowadays, mental problems have become an important health issue, the most frequent of which in pregnancy is depression. Gestational depression is known to increase gestational complications and negatively affect maternal and fetal health. The frequency of gestational depression and depressive symptoms are 10-30%. Risk factors vary according to genetic, psychologic, environmental, social, and biologic factors. Maternal morbidity and mortality rates increase in pregnant women who do not receive treatment, obstetric complications and negative fetal consequences are seen, and the incidence of postpartum depression increases. Due to all these important consequences, healthcare providers who manage pregnant women should be informed about the frequency, symptoms, and screening methods of postpartum depression, the significance of the consequences of undiagnosed and untreated depression on the health of mother and baby, and the importance of early diagnosis. Pregnant women who are at risk should be screened and detected, and directed to related centers. In this review, we briefly review the definition of gestational depression, its frequency, risk factors, complications, screening, treatments, and the procedures that need to be performed the diagnostic process.
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Affiliation(s)
- Elif Akkaş Yılmaz
- Sami Ulus Women and Children's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Çağrı Gülümser
- Başkent University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
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Goodman DJ, Milliken CU, Theiler RN, Nordstrom BR, Akerman SC. A Multidisciplinary Approach to the Treatment of Co-occurring Opioid Use Disorder and Posttraumatic Stress Disorder in Pregnancy: A Case Report. J Dual Diagn 2015; 11:248-57. [PMID: 26457976 PMCID: PMC4762276 DOI: 10.1080/15504263.2015.1104484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Perinatal opioid use disorders negatively impact maternal and neonatal outcomes and are a public health problem of increasing severity. More than half of women with a substance use disorder have a history of posttraumatic stress disorder that, if not adequately addressed, can impede substance use disorder treatment. This case report describes complexities in the treatment of a pregnant woman with opioid use disorder and posttraumatic stress disorder and reviews the psychotherapeutic and pharmacologic approaches available to treat these co-occurring disorders in pregnancy. This case demonstrates the importance of early screening and intervention for co-occurring posttraumatic stress disorder in pregnant women who use substances in a closely coordinated, multidisciplinary approach to improve outcomes for women and their infants.
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Affiliation(s)
- Daisy J Goodman
- a Department of Obstetrics and Gynecology , Dartmouth-Hitchcock Medical Center and Geisel School of Medicine , Lebanon , New Hampshire , USA
| | - Catherine U Milliken
- b Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
| | - Regan N Theiler
- a Department of Obstetrics and Gynecology , Dartmouth-Hitchcock Medical Center and Geisel School of Medicine , Lebanon , New Hampshire , USA
| | - Benjamin R Nordstrom
- b Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
| | - Sarah C Akerman
- b Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Volodina MA, Merchieva SA, Sebentsova EA, Glazova NY, Manchenko DM, Andreeva LA, Levitskaya NG, Kamensky AA, Myasoedov NF. Effects of neonatal fluvoxamine administration to white rats and their correction by semax treatment. BIOL BULL+ 2014. [DOI: 10.1134/s106235901403011x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Glazova NY, Merchieva SA, Volodina MA, Sebentsova EA, Manchenko DM, Kudrun VS, Levitskaya NG. Effects of neonatal fluvoxamine administration on the physical development and activity of the serotoninergic system in white rats. Acta Naturae 2014; 6:98-105. [PMID: 25349718 PMCID: PMC4207564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs), including fluvoxamine, are widely used to treat depressive disorders in pregnant women. These antidepressants effectively penetrate through the placental barrier, affecting the fetus during the critical phase of neurodevelopment. Some clinical studies have linked prenatal exposure to SSRIs with increased neonatal mortality, premature birth, decreased fetal growth and delay in psychomotor development. However, the effects of prenatal exposure to SSRIs remain unknown. The administration of SSRIs in rodents during the first postnatal weeks is considered as an model for studying the effects of prenatal SSRIs exposure in human. The aim of this work was to study the acute effects of chronic fluvoxamine (FA) administration in white rat pups. The study was carried out in male and female rat pups treated with FA (10 mg/kg/day, intraperitoneally) from postnatal days 1 to 14. The lethality level, body weight, age of eye opening, and motor reflex maturation were recorded. The contents of biogenic amines and their metabolites in different brain structures were also determined. It was shown that neonatal FA administration led to increased lethality level, reduced body weight, and delayed maturation of motor reflexes. Furthermore, increased noradrenalin level in hypothalamus, serotonin level in hippocampus and serotonin metabolite 5-HIAA level in frontal cortex, hypothalamus, hippocampus, and striatum were observed in drug-treated animals compared to the control group. We can conclude that the altered activity of the serotoninergic system induced by fluvoxamine administration at early developmental stages leads to a delay in physical and motor development.
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Affiliation(s)
- N. Yu. Glazova
- Institute of Molecular Genetics, Russian Academy of Sciences, Kurchatov Sq., 2, 123182 Moscow, Russia
| | - S. A. Merchieva
- Biological Faculty, Lomonosov State University, Moscow, Leninskie Gory, 1/12, Russia
| | - M. A. Volodina
- Biological Faculty, Lomonosov State University, Moscow, Leninskie Gory, 1/12, Russia
| | - E. A. Sebentsova
- Institute of Molecular Genetics, Russian Academy of Sciences, Kurchatov Sq., 2, 123182 Moscow, Russia
| | - D. M. Manchenko
- Biological Faculty, Lomonosov State University, Moscow, Leninskie Gory, 1/12, Russia
| | - V. S. Kudrun
- Institute of Pharmacology, Baltyiskaya str, 8, 125315, Moscow, Russia
| | - N. G. Levitskaya
- Institute of Molecular Genetics, Russian Academy of Sciences, Kurchatov Sq., 2, 123182 Moscow, Russia
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Ornoy A, Koren G. Selective serotonin reuptake inhibitors in human pregnancy: on the way to resolving the controversy. Semin Fetal Neonatal Med 2014; 19:188-94. [PMID: 24321501 DOI: 10.1016/j.siny.2013.11.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There has been an increase in the use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy. However, in the last 10 years, in spite of a vast literature regarding use in pregnancy there seems to be some confusion as to the possible risk of these drugs, especially related to cardiovascular anomalies. In addition, there are data on developmental follow-up studies that raise the question of possible slight developmental and neurobehavioral problems. The purpose of the present review is therefore to critically summarize the current evidence for the risk/benefit analysis of SSRI use in human pregnancy. Although most studies have not shown an increase in the overall risk of major malformations, several have suggested that the use of SSRIs may be associated with a small increased risk for cardiovascular malformations. However, new compelling evidence shows that this apparent increased risk occurs also in women with untreated depression, highlighting the probable ascertainment bias involved in many of these studies. Persistent pulmonary hypertension of the newborn (PPHN) has also been described with an absolute risk of <1%; however, here too, higher rates were described among offspring of women with untreated depression. Poor neonatal adaptation has been described in up to 30% of neonates exposed to SSRIs late in pregnancy. Of the few postnatal developmental follow-up studies, there are no significant developmental problems. The literature on SSRIs in pregnancy is somewhat confusing but when analysing all prospective cohort data there seems to be no demonstrable increase in the rate of major anomalies or developmental disorders. When evaluating the risk/benefit ratio of SSRI treatment in pregnancy, the risk associated with treatment discontinuation - e.g. higher frequency of relapse, increased risk of preterm delivery and postpartum depression - appear to outweigh the potential, unproven risks of treatment. Moreover, maternal depression may negatively affect the child's development, emphasizing the importance of prevention by appropriate treatment during pregnancy with the least minimal effective dose.
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Affiliation(s)
- Asher Ornoy
- Hebrew University Hadassah Medical School, Jerusalem, Israel; Israeli Teratology Information Service, Israel Ministry of Health, Jerusalem, Israel.
| | - Gideon Koren
- Israeli Teratology Information Service, Israel Ministry of Health, Jerusalem, Israel; Motherisk Program, Division of Clinical Pharmacology/Toxicology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
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Ban L, Gibson JE, West J, Fiaschi L, Sokal R, Smeeth L, Doyle P, Hubbard RB, Tata LJ. Maternal depression, antidepressant prescriptions, and congenital anomaly risk in offspring: a population-based cohort study. BJOG 2014; 121:1471-81. [PMID: 24612301 PMCID: PMC4232879 DOI: 10.1111/1471-0528.12682] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2013] [Indexed: 11/29/2022]
Abstract
Objective To estimate risks of major congenital anomaly (MCA) among children of mothers prescribed antidepressants during early pregnancy or diagnosed with depression but without antidepressant prescriptions. Design Population-based cohort study. Setting Linked UK maternal–child primary care records. Population A total of 349 127 singletons liveborn between 1990 and 2009. Methods Odds ratios adjusted for maternal sociodemographics and comorbidities (aORs) were calculated for MCAs, comparing women with first-trimester selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) and women with diagnosed but unmedicated depression, or women without diagnosed depression. Main outcome measures Fourteen system-specific MCA groups classified according to the European Surveillance of Congenital Anomalies and five specific heart anomaly groups. Results Absolute risks of MCA were 2.7% (95% confidence interval, 95% CI, 2.6–2.8%) in children of mothers without diagnosed depression, 2.8% (95% CI 2.5–3.2%) in children of mothers with unmedicated depression, and 2.7% (95% CI 2.2–3.2%) and 3.1% (95% CI 2.2–4.1%) in children of mothers with SSRIs or TCAs, respectively. Compared with women without depression, MCA overall was not associated with unmedicated depression (aOR 1.07, 95% CI 0.96–1.18), SSRIs (aOR 1.01, 95% CI 0.88–1.17), or TCAs (aOR 1.09, 95% CI 0.87–1.38). Paroxetine was associated with increased heart anomalies (absolute risk 1.4% in the exposed group compared with 0.8% in women without depression; aOR 1.78, 95% CI 1.09–2.88), which decreased marginally when compared with women with diagnosed but unmedicated depression (aOR 1.67, 95% CI 1.00–2.80). Conclusions Overall MCA risk did not increase with maternal depression or with antidepressant prescriptions. Paroxetine was associated with increases of heart anomalies, although this could represent a chance finding from a large number of comparisons undertaken.
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Affiliation(s)
- L Ban
- Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK
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Sokal R, Tata LJ, Fleming KM. Sex prevalence of major congenital anomalies in the United Kingdom: a national population-based study and international comparison meta-analysis. ACTA ACUST UNITED AC 2014; 100:79-91. [PMID: 24523198 PMCID: PMC4016755 DOI: 10.1002/bdra.23218] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 11/08/2013] [Accepted: 12/21/2013] [Indexed: 11/11/2022]
Abstract
Background The aim of this study was to assess sex differences in major congenital anomaly (CA) diagnoses within a national population sample; to examine the influence of sociodemographic and maternal factors on these risks; and to conduct a meta-analysis using estimates from other population-based studies. Methods We conducted a population-based study in a United Kingdom research database of prospectively collected primary care data (The Health Improvement Network) including children born 1990 to 2009 (n = 794,169) and identified major CA diagnoses using EUROCAT (European Surveillance of Congenital Anomalies) classification. Prevalence ratios (PR) were used to estimate the risk of CA in males compared with females for any CA, system-specific subgroups and specific CA diagnoses. In a subpopulation of children whose medical records were linked to their mothers', we assessed the effect of adjusting for sociodemographic and maternal factors on sex odds ratios. PRs were pooled with measures from previously published studies. Results The prevalence of any CA was 307/10,000 in males (95% CI, 302–313) and 243/10,000 in females (95% CI, 238–248). Overall the risk of any CA was 26% greater in males (PR (male: female) 1.26, 95% CI, 1.23–1.30) however there was considerable variation across specific diagnoses. The magnitude and direction of risk did not change for any specific CA upon adjustment for sociodemographic and maternal factors. Our PRs were highly consistent with those from previous studies. Conclusion The overall risk of CA is greater in males than females, although this masked substantial variation by specific diagnoses. Sociodemographic and maternal factors do not appear to affect these risks. Birth Defects Research (Part A) 100:79–91, 2014. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Rachel Sokal
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
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Stuart S, Koleva H. Psychological treatments for perinatal depression. Best Pract Res Clin Obstet Gynaecol 2013; 28:61-70. [PMID: 24269903 DOI: 10.1016/j.bpobgyn.2013.09.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 09/03/2013] [Accepted: 09/16/2013] [Indexed: 12/27/2022]
Abstract
Perinatal depression is prevalent and greatly affects the mother and infant. Fortunately, empirically validated psychological treatments are available for postpartum depression and depression during pregnancy. Primary among these are interpersonal psychotherapy and cognitive-behavioural therapy, which have been shown to be effective for perinatal women across the spectrum from mild to severe depression. At present, interpersonal psychotherapy is better validated than antidepressant medication for perinatal depression, and should be considered as a first-line treatment option, especially for pregnant and breast-feeding women who are depressed. More studies are needed to evaluate further the relative efficacy of psychotherapy and medication, and more thoroughly test other psychological treatments.
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Affiliation(s)
- Scott Stuart
- University of Iowa, Department of Psychiatry, Women's Wellness and Counseling Service, 1-293 Medical Education Building, Iowa City, IA 52242, USA.
| | - Hristina Koleva
- University of Iowa, Department of Psychiatry, Women's Wellness and Counseling Service, USA
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Einarson A. Antidepressant use during pregnancy: navigating the sea of information. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:941-944. [PMID: 24029507 PMCID: PMC3771719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
QUESTION When some of my patients who are taking antidepressants learn they are pregnant, they become anxious and confront me with the following statement: "I need this medication, but have heard so many conflicting stories from my friends and on the Internet and in the media that I am not sure if I should continue taking it." How do I advise them, as I have also seen conflicting evidence in the scientific literature? ANSWER To date, antidepressants are the most studied drugs during pregnancy, with more than 30 000 outcomes examining increased risks of adverse effects on exposed infants. The results of the studies can appear to be conflicting owing to differing interpretation of statistical analysis and subsequent knowledge transfer and translation of the information. However, there does not appear to be a clinically significant increased risk of any of the adverse outcomes reported in peer-reviewed published studies that would preclude a woman from taking a needed antidepressant during pregnancy.
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Abstract
Many women with psychiatric disorders want to become mothers and only a minority seek advise prior to becoming pregnant. In those women, in whom pregnancy can be planned, the decision, if a medication is required for stabilisation and which one to choose if this is the case, is easier to make than in women in whom pregnancy occurs unplanned. The physician has to weigh the risk that a relapse of the psychiatric disorder during pregnancy poses to the foetus against the reproductive risk of psychotropic drugs. This presentation is intended to assist in understanding the general principles of pharmacotherapy during pregnancy as well as the morphological, perinatal and neurobehavioural toxicity of antidepressants, antipsychotics, benzodiazepines and mood stabilisers.
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Bellantuono C, Bozzi F, Orsolini L. Safety of escitalopram in pregnancy: a case series. Neuropsychiatr Dis Treat 2013; 9:1333-7. [PMID: 24043940 PMCID: PMC3772871 DOI: 10.2147/ndt.s45951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this paper is to report maternal and neonatal outcomes in pregnant women treated with escitalopram during pregnancy and breastfeeding. METHODS Women enrolled in the DEGRA Database at the Clinic of Affective Disorders in Pregnancy and Postpartum in Italy, treated during pregnancy with escitalopram and followed up throughout pregnancy, were included in this study. All patients provided written informed consent and the study was approved by the local ethics committee. Psychiatric diagnoses were assessed using the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition) Axis I Disorders and symptoms were assessed using the Hamilton Rating Scale for Depression (17 items) and Hamilton Rating Scale for Anxiety (14 items). Clinical and sociodemographic characteristics as well as maternal and neonatal outcomes were recorded. RESULTS The case histories of seven pregnant women treated for depression and/or anxiety disorders with escitalopram were reported. Four women were also treated with benzodiazepines. All pregnancies were full-term and all newborns had normal Apgar scores. There were no major malformations or miscarriages following exposure to escitalopram. Mild withdrawal syndrome was reported only in a newborn who was also exposed to a benzodiazepine. Two infants exposed to escitalopram during breastfeeding did not show any health problems. CONCLUSION Our experience with use of escitalopram in pregnant women did not reveal any maternal or neonatal concerns. However, considering the few cases analyzed and the paucity of published literature, no conclusions can be drawn on its safety profile in pregnancy and breastfeeding.
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Affiliation(s)
- Cesario Bellantuono
- Psychiatric Unit and DEGRA Center, United Hospital and Academic Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
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Bellantuono C, Tofani S, Di Sciascio G, Santone G. Benzodiazepine exposure in pregnancy and risk of major malformations: a critical overview. Gen Hosp Psychiatry 2013; 35:3-8. [PMID: 23044244 DOI: 10.1016/j.genhosppsych.2012.09.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 08/30/2012] [Accepted: 09/01/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Benzodiazepines (BDZs) safety profiles in pregnancy suggest that the risk of major malformations (MMs) cannot be considered simply as a "class effect". The aim of this paper was to review and update the available literature on the risks of MMs in women exposed to BDZs in the first trimester of pregnancy. METHODS PubMed was searched for English-language articles, from January 2001 to November 2011, introducing as keywords "teratogens", " major malformation", "foetus", "infant", "newborn", "pregnancy", in conjunction with "benzodiazepines" as a keyword or BDZ generic name as text words. RESULTS Twelve studies were selected for the review. BDZ exposure during the first trimester of pregnancy seems not to be associated with an increasing risk of congenital MMs. Diazepam and chlordiazepoxide should be considered drugs of first choice. CONCLUSIONS Data published in the last 10 years did not indicate an absolute contraindication in prescribing BDZs during the first gestational trimester. In any case, studies analyzed suffer from a number of methodological limitations such as lack of careful report of BDZ patterns of use in pregnancy, possible influences of recall bias, lack of controlling for confounding factors and lack of data concerning possible MMs in aborted fetuses.
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Affiliation(s)
- Cesario Bellantuono
- Psychiatric Unit, United Hospitals of Ancona and Department of Experimental and Clinical Medicine at the Polytechnic University of Marche, Ancona, Italy
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Bellantuono C, Bozzi F, Orsolini L, Catena-Dell'Osso M. The safety of escitalopram during pregnancy and breastfeeding: a comprehensive review. Hum Psychopharmacol 2012; 27:534-9. [PMID: 23044635 DOI: 10.1002/hup.2265] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 09/12/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Escitalopram (ESC) is considered one of the most effective selective serotonin reuptake inhibitors for the treatment of major depression. However, little is known on its potential risk of inducing major malformations (MMs) and perinatal complications (PCs). Hence, aim of the present study is to provide a comprehensive review of the available literature on the safety profile of ESC during pregnancy and breastfeeding. METHODS MEDLINE and PubMed databases were searched for English language articles by using the following keywords: escitalopram, selective serotonin reuptake inhibitors, major malformations, perinatal complications, pregnancy, and breastfeeding. RESULTS Although some cases of MMs have been reported after maternal exposure to ESC during early pregnancy, the rate of these adverse events is substantially in the range of those reported in unexposed women. On the contrary, exposure to ESC seems to be significantly associated with some PCs. No adverse effects have been reported in the few studies evaluating its safety during breastfeeding. CONCLUSIONS The available data seem to support the notion that ESC might be considered safe during pregnancy, in particular as far as MMs is concerned. However, similar to other selective serotonin reuptake inhibitors, it could be associated with an increased risk of PCs. Given the paucity of the studies published so far, no definitive conclusions can be drawn on its safety profile during breastfeeding.
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Koren G, Nordeng H. Antidepressant use during pregnancy: the benefit-risk ratio. Am J Obstet Gynecol 2012; 207:157-63. [PMID: 22425404 DOI: 10.1016/j.ajog.2012.02.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 01/14/2012] [Accepted: 02/14/2012] [Indexed: 11/25/2022]
Abstract
Antidepressants are used commonly in pregnancy. Physicians who provide health care for pregnant women with depression must balance maternal well-being with potential fetal risks of these medications. Over the last decade, scores of original and review articles have discussed whether selective serotonin reuptake inhibitors-selective serotonin norepinephrine reuptake inhibitors possess risks to the fetus; however, very little has been done to integrate these potential risks, if they exist, into an overall context of a benefit:risk ratio. This review aims at presenting an updated analysis of fetal and maternal exposure to selective serotonin or norepinephrine reuptake inhibitors to allow an evidence-based benefit:risk ratio. When a psychiatric condition necessitates pharmacotherapy, the benefits of such therapy far outweigh the potential minimal risks of cardiac malformations, primary pulmonary hypertension of the newborn infant, or poor neonatal adaptation syndrome.
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