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Salisbury AL, Anderson GM, Yang A, Stika CS, Rasmussen-Torvik LJ, Gollan JK, Wisner KL. Fetal behavior and gestational serotonin reuptake inhibitor exposure: relationships between behavior, drug dosage, plasma drug level, and a measure of drug bioeffect. Neuropsychopharmacology 2024:10.1038/s41386-024-01923-1. [PMID: 39127823 DOI: 10.1038/s41386-024-01923-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 08/12/2024]
Abstract
Determination of the relationships between drug dosage, maternal and infant (cord blood) plasma drug concentrations, and serotonin reuptake inhibitor (SRI) bioeffect on offspring neurobehavior is crucial to assessing the effects of gestational SRI exposure. Measurement of maternal and cord blood platelet serotonin (5-HT) provides an index of inhibitory bioeffect at the 5-HT transporter and complements other measures of drug exposure. Three groups of mother-infant pairs were evaluated: (1) mothers with depression untreated with SRIs (DEP, n = 17), (2) mothers treated for depression with SRIs (DEP + SRI, n = 17), and (3) mothers who were not depressed and untreated (ND, n = 29). Fetal movement was assessed using a standardized ultrasound imaging and rating protocol. Maternal and cord blood platelet 5-HT levels were obtained from all participants. For the SRI + DEP group, maternal and infant plasma drug concentrations and an estimate of third-trimester maternal SRI drug exposure were obtained. As expected, substantially lower median platelet 5-HT levels were observed in the DEP + SRI group than in the non-exposed, combined ND and DEP groups. In non-exposed mothers and infants, platelet 5-HT levels were not affected by the presence of maternal depression. Lower maternal and infant platelet 5-HT levels were associated with more immature fetal movement quality. Although these data are limited by small sample size, the bioeffect index of in vivo platelet 5-HT transporter inhibition appears to provide a valuable approach for elucidating and possibly predicting the effects of gestational SRI exposure on fetal and perinatal neurobehavior.
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Affiliation(s)
- Amy L Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, VA, 23298-0567, USA.
- Department of Pediatrics, Women & Infants Hospital, Alpert Medical School at Brown University, Providence, RI, USA.
| | - George M Anderson
- Child Study Center and the Department of Laboratory Medicine, Yale University School of Medicine, 230 S. Frontage Rd., New Haven, CT, 06525, USA
| | - Amy Yang
- AY Analytics, Chicago, IL, 60611, USA
| | - Catherine S Stika
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Suite 1000, Chicago, IL, 60611, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Jacqueline K Gollan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Suite 1000, Chicago, IL, 60611, USA
| | - Katherine L Wisner
- Children's National Hospital, Developing Brain Institute, 111 Michigan Ave., NW, 20001, Washington, DC, USA
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Conradt E, Tronick E, Lester BM. Evidence for neurobehavioral risk phenotypes at birth. Pediatr Res 2024:10.1038/s41390-024-03353-7. [PMID: 38907044 DOI: 10.1038/s41390-024-03353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/11/2024] [Accepted: 04/15/2024] [Indexed: 06/23/2024]
Abstract
Observations of newborn behavior provide clinicians and researchers with a first description of the neurobehavioral organization of the newborn that is largely independent of the postnatal environment. The Neonatal Network Neurobehavioral Scale (NNNS) was developed in 2004 to evaluate how prenatal exposure to substances such as cocaine is related to neurobehavioral outcomes. There are now 156 empirical articles published using the NNNS, which we review and summarize. Z-scores from published studies using the NNNS were compiled and aggregated supporting the replicability of three newborn neurobehavioral phenotypes: one typical and two that are predictive of later cognitive and behavioral delay; hyper- and hypo-dysregulated newborns. These phenotypes emerged from independent samples and research groups and were identified in a variety of populations, including infants with prenatal substance exposure, preterm infants, and healthy term infants. Our findings show that newborn neurobehavior can be measured in a reliable and valid manner and that certain behavioral phenotypes, identifiable at birth, can predict neurodevelopmental challenges. These findings have important clinical utility. Intervening early with infants exhibiting these risk phenotypes may prevent later neurodevelopmental delay. IMPACT: We reviewed all empirical studies published using the Neonatal Network Neurobehavioral Scale and found evidence for two replicable stress phenotypes that predict later behavioral outcomes. This study highlights the utility of the Neonatal Network Neurobehavioral Scale for early identification of newborn neurodevelopmental risk phenotypes. Early identification of neurodevelopmental risk, when neuroplasticity is high, may ultimately reduce the burden of subsequent neurobehavioral problems through early intervention.
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Affiliation(s)
- Elisabeth Conradt
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA.
| | - Edward Tronick
- University of Massachusetts Chan Medical School, Departments of Psychiatry and Pediatrics, Worcester, MA, USA
| | - Barry M Lester
- Brown University Alpert Medical School; Departments of Psychiatry and Pediatrics, Providence, RI, USA
- Women and Infants Hospital of Rhode Island, Center for Children and Families, Department of Pediatrics, Providence, RI, USA
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Constaín GA, Ocampo Saldarriaga MV, Franco Vásquez JGF, Naranjo LF, Restrepo Conde C, Estrada Muñoz D, Chaverra López L, Buriticá González JB. Psychiatric disorders in pregnant women admitted to the high-risk obstetric service in a Colombian university clinic between 2013 and 2017. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2024; 53:17-25. [PMID: 38670824 DOI: 10.1016/j.rcpeng.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 01/12/2022] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To determine the psychiatric diagnoses and treatments of patients admitted to the high-risk obstetric service who underwent a consultation with a liaison psychiatrist. METHODS A descriptive observational study that included pregnant women from the high-risk obstetric service of a highly specialised clinic in Medellín, who had a liaison psychiatry consultation between 2013 and 2017. The main variables of interest were psychiatric and obstetric diagnoses and treatments, in addition to biopsychosocial risk factors. RESULTS A total of 361 medical records were screened, with 248 patients meeting the inclusion criteria. The main prevailing psychiatric diagnosis was major depressive disorder (29%), followed by adaptive disorder (21.8%) and anxiety disorders (12.5%). The pharmacologic treatments most used by the psychiatry service were SSRI antidepressants (24.2%), trazodone (6.8%) and benzodiazepines (5.2%). The most common primary obstetric diagnosis was spontaneous delivery (46.4%), and the predominant secondary obstetric diagnoses were hypertensive disorder associated with pregnancy (10.4%), gestational diabetes (9.2%) and recurrent abortions (6.4%). Overall, 71.8% of the patients had a high biopsychosocial risk. CONCLUSIONS The studied population's primary psychiatric disorders were major depressive disorder, adjustment disorder and anxiety disorders, which implies the importance of timely recognition of the symptoms of these perinatal mental pathologies, together with obstetric and social risks, in the prenatal consultation. Psychiatric intervention should be encouraged considering the negative implications of high biopsychosocial risk in both mothers and children.
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Affiliation(s)
- Gustavo A Constaín
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Departamento de Psiquiatría, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia.
| | - María Victoria Ocampo Saldarriaga
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Departamento de Psiquiatría, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - José Gabriel Franco Franco Vásquez
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Departamento de Psiquiatría, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Luisa Fernanda Naranjo
- Departamento de Psiquiatría, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Cristóbal Restrepo Conde
- Departamento de Psiquiatría, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Daniel Estrada Muñoz
- Departamento de Obstetricia y Ginecología, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
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Abdelhafez M, Ahmed K, Ahmed N, Ismail M, Mohd Daud MNB, Ping NPT, Eldiasty A, Amri MFB, Jeffree MS, Kadir F, pg Baharuddin DM, Bolong MFB, Hayati F, BtAzizan N, Sumpat D, Syed Abdul Rahim SS, Abdel Malek EH. Psychiatric illness and pregnancy: A literature review. Heliyon 2023; 9:e20958. [PMID: 37954333 PMCID: PMC10632674 DOI: 10.1016/j.heliyon.2023.e20958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Background Women of reproductive age frequently suffer from psychiatric disorders. The risk of developing anxiety, bipolar, and depressive disorders is especially significant during the perinatal period. Objectives This article aims to identify and discuss the different psychiatric conditions that might affect pregnant women and update the mother's carers about the recent and updated bidirectional relationship between psychiatric disease and adverse pregnancy outcomes, As well as the most updates in diagnostic and management strategies. Methods A thorough analysis of the literature was conducted using database searches in EMBASE, Science Direct, Google Scholar, Scopus, and PubMed to obtain the objectives and aim of the study. Results The presence of maternal mental illness during pregnancy has been linked to preterm delivery, newborn hypoglycemia, poor neurodevelopmental outcomes, and disturbed attachment. Placental anomalies, small-for-gestational-age foetuses, foetal discomfort, and stillbirth are among more undesirable perinatal outcomes. Conclusions Pregnancy-related psychiatric disorders are frequent. The outcomes for pregnant women, infants, and women's health are all improved by proper diagnosis and treatment of psychiatric problems.
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Affiliation(s)
- MohsenM.A. Abdelhafez
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - KarimA.M. Ahmed
- Department of Dermatology, Helios Saint Johannes Klinikum, Duisburg, Germany
| | - NashwaA.M. Ahmed
- Department of Orthodontics, Faculty of Dental and Oral Surgery, Ahram Canadian University, Egypt
| | - MohdHamdy Ismail
- Owner and Leading Clinician, Ulti Care Dental Clinics, Cairo, Egypt
| | - Mohd Nazri Bin Mohd Daud
- Family Medicine Unit, Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Nicholas Pang Tze Ping
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - AyaM. Eldiasty
- Department of Dermatology, Helios Saint Johannes Klinikum, Duisburg, Germany
| | - Mohd Fariz Bin Amri
- Department of Pathology and Microbiology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Mohammad Saffree Jeffree
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Fairrul Kadir
- Department of Emergency Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Dg Marshitah pg Baharuddin
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Mohammed Firdaus Bin Bolong
- Department of Emergency Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Nornazirah BtAzizan
- Department of Clinical Pathology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Doreen Sumpat
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | | | - Ehab Helmy Abdel Malek
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
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Wagner E, Bień K, Łomża A, Grunwald A, Kimber-Trojnar Ż, Libera A, Leszczyńska-Gorzelak B. Stress of Prematurity in the Experience of the COVID-19 Pandemic-Current State of Knowledge. Life (Basel) 2023; 13:1757. [PMID: 37629614 PMCID: PMC10455823 DOI: 10.3390/life13081757] [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: 07/09/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Stress is a process that triggers various physiological, hormonal and psychological mechanisms in response to a threat, which significantly affects the health of an individual. The COVID-19 pandemic introduced a lot of social changes that required constant adaptation to unfavorable conditions. The aim of the study was to assess the impact of stress related to this pandemic on pregnant women, mothers of premature infants and their families, and on obstetric complications, particularly preterm birth. A comprehensive literature review was performed using electronic databases such as Pubmed, Science Direct and Google Scholar. Keywords such as: "prematurity"; "pregnancy"; "stress"; "COVID-19" and various combinations of the above were used. Maternal stress and anxiety increase the levels of corticotropin-releasing hormone (CRH) in the placenta, which in turn affects the incidence of preterm birth and many other related maternal and neonatal complications. In addition, it was found that SARS-CoV-2 infection may increase the risk of this phenomenon. The COVID-19 pandemic has adversely affected preterm birth rates and the mental health of mothers of preterm infants, exacerbating their negative experience of having a premature baby. More research is needed to demonstrate the long-term effects of COVID-19 stress on prematurity.
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Affiliation(s)
| | | | | | | | - Żaneta Kimber-Trojnar
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (E.W.); (K.B.); (A.Ł.); (A.G.); (A.L.); (B.L.-G.)
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Eleftheriou G, Zandonella Callegher R, Butera R, De Santis M, Cavaliere AF, Vecchio S, Pistelli A, Mangili G, Bondi E, Somaini L, Gallo M, Balestrieri M, Albert U. Consensus Panel Recommendations for the Pharmacological Management of Pregnant Women with Depressive Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6565. [PMID: 37623151 PMCID: PMC10454549 DOI: 10.3390/ijerph20166565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION The initiative of a consensus on the topic of antidepressant and anxiolytic drug use in pregnancy is developing in an area of clinical uncertainty. Although many studies have been published in recent years, there is still a paucity of authoritative evidence-based indications useful for guiding the prescription of these drugs during pregnancy, and the data from the literature are complex and require expert judgment to draw clear conclusions. METHODS For the elaboration of the consensus, we have involved the scientific societies of the sector, namely, the Italian Society of Toxicology, the Italian Society of Neuropsychopharmacology, the Italian Society of Psychiatry, the Italian Society of Obstetrics and Gynecology, the Italian Society of Drug Addiction and the Italian Society of Addiction Pathology. An interdisciplinary team of experts from different medical specialties (toxicologists, pharmacologists, psychiatrists, gynecologists, neonatologists) was first established to identify the needs underlying the consensus. The team, in its definitive structure, includes all the representatives of the aforementioned scientific societies; the task of the team was the evaluation of the most accredited international literature as well as using the methodology of the "Nominal Group Technique" with the help of a systematic review of the literature and with various discussion meetings, to arrive at the drafting and final approval of the document. RESULTS The following five areas of investigation were identified: (1) The importance of management of anxiety and depressive disorders in pregnancy, identifying the risks associated with untreated maternal depression in pregnancy. (2) The assessment of the overall risk of malformations with the antidepressant and anxiolytic drugs used in pregnancy. (3) The evaluation of neonatal adaptation disorders in the offspring of pregnant antidepressant/anxiolytic-treated women. (4) The long-term outcome of infants' cognitive development or behavior after in utero exposure to antidepressant/anxiolytic medicines. (5) The evaluation of pharmacological treatment of opioid-abusing pregnant women with depressive disorders. CONCLUSIONS Considering the state of the art, it is therefore necessary in the first instance to frame the issue of pharmacological choices in pregnant women who need treatment with antidepressant and anxiolytic drugs on the basis of data currently available in the literature. Particular attention must be paid to the evaluation of the risk/benefit ratio, understood both in terms of therapeutic benefit with respect to the potential risks of the treatment on the pregnancy and on the fetal outcome, and of the comparative risk between the treatment and the absence of treatment; in the choice prescription, the specialist needs to be aware of both the potential risks of pharmacological treatment and the equally important risks of an untreated or undertreated disorder.
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Affiliation(s)
- Georgios Eleftheriou
- Italian Society of Toxicology (SITOX), via Giovanni Pascoli 3, 20129 Milan, Italy
- Poison Control Center, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Riccardo Zandonella Callegher
- Italian Society of Psychiatry (SIP), piazza Santa Maria della Pietà 5, 00135 Rome, Italy
- Psychiatry Unit, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Raffaella Butera
- Italian Society of Toxicology (SITOX), via Giovanni Pascoli 3, 20129 Milan, Italy
- Poison Control Center, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Marco De Santis
- Italian Society of Obstetrics and Gynecology (SIGO), via di Porta Pinciana 6, 00187 Rome, Italy
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Anna Franca Cavaliere
- Italian Society of Obstetrics and Gynecology (SIGO), via di Porta Pinciana 6, 00187 Rome, Italy
- Department of Gynecology and Obstetrics, Fatebenefratelli Gemelli, Isola Tiberina, 00186 Rome, Italy
| | - Sarah Vecchio
- Italian Society of Toxicology (SITOX), via Giovanni Pascoli 3, 20129 Milan, Italy
- Ser.D Biella—Drug Addiction Service, 13875 Biella, Italy
| | - Alessandra Pistelli
- Italian Society of Toxicology (SITOX), via Giovanni Pascoli 3, 20129 Milan, Italy
- Division of Clinic Toxicology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy
| | - Giovanna Mangili
- Italian Society of Neonatology (SIN), Corso Venezia 8, 20121 Milan, Italy
- Department of Neonatology, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Emi Bondi
- Italian Society of Psychiatry (SIP), piazza Santa Maria della Pietà 5, 00135 Rome, Italy
- Department of Psychiatry, ASST Papa Giovanni XXIII, 24100 Bergamo, Italy
| | - Lorenzo Somaini
- Ser.D Biella—Drug Addiction Service, 13875 Biella, Italy
- Italian Society of Addiction Diseases (SIPAD), via Tagliamento 31, 00198 Rome, Italy
| | - Mariapina Gallo
- Poison Control Center, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy
- Italian Society for Drug Addiction (SITD), via Roma 22, 12100 Cuneo, Italy
| | - Matteo Balestrieri
- Psychiatry Unit, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Italian Society of Neuropsychopharmacology (SINPF), via Cernaia 35, 00158 Rome, Italy
| | - Umberto Albert
- Italian Society of Psychiatry (SIP), piazza Santa Maria della Pietà 5, 00135 Rome, Italy
- Italian Society of Neuropsychopharmacology (SINPF), via Cernaia 35, 00158 Rome, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34128 Trieste, Italy
- Division of Clinic Psychiatry, Azienda Sanitaria Universitaria Giuliano-Isontina, 34148 Trieste, Italy
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Zheng X, Zhu Z, Chen J, He J, Zhu Y, Zhang L, Qu F. Efficacy of cognitive behavioural therapy for insomnia or sleep disturbance in pregnant women: A systematic review ad meta-analysis. J Sleep Res 2023; 32:e13808. [PMID: 36529887 DOI: 10.1111/jsr.13808] [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] [Revised: 11/10/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
During pregnancy many women may experience negative emotions and sleep disturbances. This systematic review and meta-analysis was conducted to assess the efficacy of cognitive behavioural therapy for insomnia (CBT-I) or sleep disturbance in pregnant women. From the earliest available publications to 15 April 2022, seven electronic literature databases were searched: PubMed, Web of Science, Cochrane Library, Embase, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP Database for Chinese Science and Technology Journal. Randomised controlled trials of CBT-I in pregnant women with insomnia or sleep disorders were included. The methodological bias of the included studies was assessed using the Cochrane risk of bias tool. The meta-analysis was performed using RevMan 5.4 software. Stata Statistical Software: Release 15 was used for sensitivity analysis and publication bias. We included eight randomised controlled trials involving 743 pregnant women. Meta-analysis showed that, compared with the control group, CBT-I significantly improved the Insomnia Severity Index (mean difference [MD] = -4.25, 95% confidence interval [CI, -6.32, -2.19], p < 0.001), The Pittsburgh Sleep Quality Index (MD = -3.30, 95% CI [-4.81, -1.79], p < 0.001), sleep onset latency (standardised mean difference [SMD] = -1.25, 95% CI [-2.01, -0.50], p = 0.001), anxiety (SMD = -0.99, 95% CI [-1.32, -0.67], p < 0.001), and depression (SMD = -0.40, 95% CI [-0.72, -0.07], p = 0.02). No significant differences were found in total sleep time (SMD = 0.31, 95% CI [-0.54, 1.17], p = 0.47) and sleep efficiency (SMD = 0.80, 95% CI [-0.53, 2.13], p = 0.24). CBT-I significantly improved pregnant women's sleep quality, insomnia severity, depression, and anxiety. This meta-analysis provides evidence that CBT-I is valid for insomnia or sleep disturbances during pregnancy.
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Affiliation(s)
- Xinyi Zheng
- Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Zheng Zhu
- Tianjin University of Traditional Chinese Medical, Tianjin, China
| | - Juan Chen
- Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiaying He
- Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuhang Zhu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lei Zhang
- Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Fan Qu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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8
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Conradt E, Camerota M, Maylott S, Lester BM. Annual Research Review: Prenatal opioid exposure - a two-generation approach to conceptualizing neurodevelopmental outcomes. J Child Psychol Psychiatry 2023; 64:566-578. [PMID: 36751734 DOI: 10.1111/jcpp.13761] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 02/09/2023]
Abstract
Opioid use during pregnancy impacts the health and well-being of two generations: the pregnant person and the child. The factors that increase risk for opioid use in the adult, as well as those that perpetuate risk for the caregiver and child, oftentimes replicate across generations and may be more likely to affect child neurodevelopment than the opioid exposure itself. In this article, we review the prenatal opioid exposure literature with the perspective that this is not a singular event but an intergenerational cascade of events. We highlight several mechanisms of transmission across generations: biological factors, including genetics and epigenetics and the gut-brain axis; parent-child mechanisms, such as prepregnancy experience of child maltreatment, quality of parenting, infant behaviors, neonatal opioid withdrawal diagnosis, and broader environmental contributors including poverty, violence exposure, stigma, and Child Protective Services involvement. We conclude by describing ways in which intergenerational transmission can be disrupted by early intervention.
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Affiliation(s)
- Elisabeth Conradt
- Department of Psychiatry, Duke University, Durham, NC, USA.,Department of Pediatrics, Duke University, Durham, NC, USA
| | - Marie Camerota
- Brown Center for the Study of Children at Risk, Department of Psychiatry and Pediatrics, Alpert Medical School of Brown University and Women and Infants Hospital of Rhode Island, Providence, RI, USA
| | - Sarah Maylott
- Department of Psychiatry, Duke University, Durham, NC, USA
| | - Barry M Lester
- Brown Center for the Study of Children at Risk, Department of Psychiatry and Pediatrics, Alpert Medical School of Brown University and Women and Infants Hospital of Rhode Island, Providence, RI, USA
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9
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Brumbaugh JE, Ball CT, Crook JE, Stoppel CJ, Carey WA, Bobo WV. Poor Neonatal Adaptation After Antidepressant Exposure During the Third Trimester in a Geographically Defined Cohort. Mayo Clin Proc Innov Qual Outcomes 2023; 7:127-139. [PMID: 36938114 PMCID: PMC10017424 DOI: 10.1016/j.mayocpiqo.2023.02.002] [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: 03/09/2023] Open
Abstract
Objective To examine the associations between antidepressant exposure during the third trimester of pregnancy, including individual drugs, drug doses, and antidepressant combinations, and the risk of poor neonatal adaptation (PNA). Patients and Methods The Rochester Epidemiology Project medical records-linkage system was used to study infants exposed to selective serotonin reuptake inhibitors (SSRIs; n=1014), bupropion, (n=118), serotonin-norepinephrine reuptake inhibitors (n=80), antidepressant combinations (n=20), or other antidepressants (n=22) during the third trimester (April 11, 2000-December 31, 2013). Poor neonatal adaptation was defined based on a review of medical records. Poisson regression was used to examine the risk of PNA with serotonergic antidepressant and drug combinations compared with that with bupropion monotherapy as well as with high- vs standard-dose antidepressants. When possible, analyses were performed using propensity score (PS) weighting. Results Forty-four infants were confirmed cases of PNA. Serotonin-norepinephrine reuptake inhibitor monotherapy, antidepressant combinations, and paroxetine monotherapy were associated with a significantly higher risk of PNA than bupropion monotherapy in unweighted analyses. High-dose SSRI exposure was associated with a significantly increased risk of PNA in unadjusted (relative risk, 2.61; 95% confidence interval, 1.35-5.04) and PS-weighted models (relative risk, 2.29; 95% confidence interval, 1.17-4.48) compared with standard-dose SSRI exposure. The risk of PNA was significantly higher with high-dose paroxetine and sertraline than with standard doses in the PS-weighted analyses. The other risk factors for PNA included maternal anxiety disorders. Conclusion Although the frequency of PNA in this cohort was low (3%-4%), the risk of PNA was increased in infants exposed to serotonergic antidepressants, particularly with SSRIs at higher doses, during the third trimester of pregnancy compared with that in infants exposed to standard doses. Potential risk factors for PNA also included third-trimester use of paroxetine (especially at higher doses) and maternal anxiety.
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Affiliation(s)
- Jane E. Brumbaugh
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Colleen T. Ball
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Julia E. Crook
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | | | - William A. Carey
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - William V. Bobo
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, FL
- Correspondence: Address to William V. Bobo, MD, MPH, Mayo Clinic Florida, Davis 4N, 4500 San Pablo Road, Jacksonville, FL 32224.
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Lester BM, Davis JM. Disarray in the perinatal management of neonatal abstinence syndrome. Pediatr Res 2022; 91:727-728. [PMID: 34815528 DOI: 10.1038/s41390-021-01848-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/31/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Barry M Lester
- Departments of Psychiatry and Pediatrics, Center for the Study of Children at Risk, Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI, USA.
| | - Jonathan M Davis
- Department of Pediatrics, Tufts Children's Hospital, The Tufts Clinical and Translational Research Institute, Tufts University School of Medicine, Boston, MA, USA
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11
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Bakhireva LN, Sparks A, Herman M, Hund L, Ashley M, Salisbury A. Severity of neonatal opioid withdrawal syndrome with prenatal exposure to serotonin reuptake inhibitors. Pediatr Res 2022; 91:867-873. [PMID: 34588611 PMCID: PMC9128601 DOI: 10.1038/s41390-021-01756-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/30/2021] [Accepted: 09/12/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the severity of neonatal opioid withdrawal syndrome (NOWS) in infants prenatally exposed to medications for opioid use disorder (MOUD) and serotonin reuptake inhibitors (SRI). METHODS A prospective cohort included 148 maternal-infant pairs categorized into MOUD (n = 127) and MOUD + SRI (n = 27) groups. NOWS severity was operationalized as the infant's need for pharmacologic treatment with opioids, duration of hospitalization, and duration of treatment. The association between prenatal SRI exposure and the need for pharmacologic treatment (logistic regression), time-to-discharge, and time-to-treatment discontinuation (Cox proportional hazards modeling) was examined after adjusting for the type of maternal MOUD, use of hydroxyzine, other opioids, benzodiazepines/sedatives, alcohol, tobacco, marijuana, gestational age, and breastfeeding. RESULTS Infants in the MOUD + SRI group were more likely to receive pharmacologic treatment for NOWS (OR = 3.58; 95% CI: 1.31; 9.76) and had a longer hospitalization (median: 11 vs. 6 days; HR = 0.54; 95% CI: 0.33; 0.89) compared to the MOUD group. With respect to time-to-treatment discontinuation, no association was observed in infants who received treatment (HR = 0.59; 95% CI: 0.26, 1.32); however, significant differences were observed in the entire sample (HR = 0.55; 95% CI: 0.34, 0.89). CONCLUSIONS Use of SRIs among pregnant women on MOUD might be associated with more severe NOWS. IMPACT A potential drug-drug interaction between maternal SRIs and opioid medications that inhibit the reuptake of serotonin has been hypothesized but not carefully evaluated in clinical studies. Results of this prospective cohort indicate that the use of SRIs among pregnant women on MOUD is associated with more severe neonatal opioid withdrawal syndrome. This is the first prospective study which carefully examined effect modification between the type of maternal MOUD and SRI use on neonatal outcomes. This report lays the foundation for treatment optimization in pregnant women with co-occurring mental health and substance use disorders.
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Affiliation(s)
- Ludmila N Bakhireva
- Department of Pharmacy Practice and Administrative Sciences, Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, NM, albuquerque, USA.
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, NM, albuquerque, USA.
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, School of Medicine, University of New Mexico, NM, albuquerque, USA.
| | - Aydan Sparks
- Department of Pharmacy Practice and Administrative Sciences, Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, NM, albuquerque, USA
| | - Michael Herman
- Department of Pharmacy, University of New Mexico Hospital, NM, albuquerque, USA
| | - Lauren Hund
- School of Law, University of New Mexico, NM, albuquerque, USA
| | - Malia Ashley
- Department of Pharmacy, University of New Mexico Hospital, NM, albuquerque, USA
- Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, NM, albuquerque, USA
| | - Amy Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
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12
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Schroeder R, Nguyen L, Pieper AA, Stevens HE. Maternal treatment with P7C3-A20 protects from impaired maternal care after chronic gestational stress. Behav Brain Res 2022; 416:113558. [PMID: 34453970 PMCID: PMC8573727 DOI: 10.1016/j.bbr.2021.113558] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/04/2021] [Accepted: 08/23/2021] [Indexed: 01/09/2023]
Abstract
Chronic stress during pregnancy harms both the mother and developing child, and there is an urgent unmet need to understand this process in order to develop protective treatments. Here, we report that chronic gestational stress (CGS) causes aberrant maternal care behavior in the form of increased licking and grooming, decreased nursing, and increased time spent nest building. Treatment of CGS-exposed dams with the NAD+-stabilizing agent P7C3-A20 during pregnancy and postpartum, however, preserved normal maternal care behavior. CGS also caused abnormally low weight gain during gestation and postpartum, which was partially ameliorated by maternal treatment with P7C3-A20. Dams also displayed hyperactive locomotion after CGS, which was not affected by P7C3-A20. Although dams did not display a classic depressive-like phenotype after CGS, some changes in anxiety- and depressive-like behaviors were observed. Our results highlight the need for further characterization of the effects of chronic gestational stress on maternal care behavior and provide clues to possible protective mechanisms.
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Affiliation(s)
- Rachel Schroeder
- Department of Psychiatry, University of Iowa, Iowa City, IA,Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, IA
| | - Lynn Nguyen
- Department of Psychiatry, University of Iowa, Iowa City, IA
| | - Andrew A. Pieper
- Harrington Discovery Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106 USA,Department of Psychiatry, Case Western Reserve University,Department of Neuroscience, Case Western Reserve University, Cleveland, OH 44106 USA,University of Texas Southwestern Medical Center, Dallas, Texas USA,Institute for Transformative Molecular Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA,Geriatric Research Education and Clinical Centers, Louis Stokes Cleveland VAMC, Cleveland, OH 44106 USA,Weill Cornell Autism Research Program, Weill Cornell Medicine of Cornell University, NY, NY, USA
| | - Hanna E. Stevens
- Department of Psychiatry, University of Iowa, Iowa City, IA,Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, IA
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13
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Kautzky A, Slamanig R, Unger A, Höflich A. Neonatal outcome and adaption after in utero exposure to antidepressants: A systematic review and meta-analysis. Acta Psychiatr Scand 2022; 145:6-28. [PMID: 34486740 DOI: 10.1111/acps.13367] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/16/2021] [Accepted: 09/01/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) and anxiety disorders are both common and especially challenging during pregnancy. Considering possible risks of intrauterine drug exposure of the child, the role of psychopharmacological treatment is ambiguous and various negative obstetric outcomes were inconsistently associated with medication. Consequently, a critical examination of peri- and postnatal phenomena associated with intrauterine exposure to antidepressants based on serotonin reuptake inhibition (SRI) and subsumed under the term "poor neonatal adaptation syndrome" (PNAS) is urgently called for. METHODS A comprehensive literature search was conducted, revealing a total number of 33 relevant studies and 69 individual outcomes among 3025 screened studies. Seventeen outcomes allowed meta-analytic evaluation (random effects model). Measures for heterogeneity (I2 ) and contour-enhanced funnel plots were generated. RESULTS Single studies showed increased risks for deficits in neurological functioning and autonomous adaptation in SRI exposed infants. Meta-analytical evaluation showed increased symptom occurrence or severity in exposed neonates for low APGAR scores, birth weight, size for gestational age, preterm delivery, neuromuscular and autonomous regulation, and higher rates of admission to specialized care. Mostly, increased risk after SRI exposure was supported by comparison to unexposed infants born to mothers diagnosed with depression. CONCLUSION Whereas statistically significant evidence for various effects of intrauterine exposure to SRI was found, the clinical relevance remains unresolved because of inherently low data quality in this research domain and insufficiently defined samples and outcomes. More systematic research under ethical considerations is required to improve multiprofessional counseling in the many women dealing with MDD during pregnancy and the peripartum.
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Affiliation(s)
- Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Annemarie Unger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Anna Höflich
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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14
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Acute Delivery Room Resuscitation of Neonates Exposed to Selective Serotonin Reuptake Inhibitors. J Pediatr 2021; 232:103-108.e2. [PMID: 33453205 DOI: 10.1016/j.jpeds.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether full-term neonates with in utero exposure to selective serotonin reuptake inhibitors (SSRI) require respiratory support in the delivery room, as indicated by the standardized Neonatal Resuscitation Program algorithm, significantly more often than nonexposed neonates. STUDY DESIGN In this retrospective cohort study, we extracted data from medical records of full-term neonates with and without in utero SSRI exposure, defined as documentation of third trimester maternal SSRI treatment. A hospital-based sample was identified at Northwestern Medical Hospital in Chicago, Illinois. Full-term singleton newborns identified in a 6-month period (n = 4933) were selected for study. Neonates with a major congenital anomaly were excluded. The primary outcome was initiation of respiratory support in the delivery room, as indicated by the Neonatal Resuscitation Program algorithm. RESULTS Of the 4933 full-term singleton neonates, 3.3% were exposed to SSRI in utero. Respiratory support was initiated significantly more often in SSRI exposed (12.9%) than unexposed (4.2%) neonates (covariate-adjusted OR, 4.04; 95% CI, 2.40-6.49). In utero SSRI exposure also was associated with a higher rate of neonatal intensive care unit admission (covariate-adjusted OR, 2.19; 95% CI, 1.30-3.50) and 1-minute Apgar score of ≤5 (covariate-adjusted OR, 3.51; 95% CI, 2.07-5.67). CONCLUSIONS In this cohort, in utero SSRI exposure was associated with a significantly greater odds of resuscitation in the delivery room as well as neonatal intensive care unit admission. Although the mechanism underlying these associations have not been determined and causality cannot be assumed, these findings support a recommendation that third trimester SSRI exposure be considered a risk factor for needing resuscitation.
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15
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Perzow SED, Hennessey EMP, Hoffman MC, Grote NK, Davis EP, Hankin BL. Mental health of pregnant and postpartum women in response to the COVID-19 pandemic. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 4:100123. [PMID: 33649750 PMCID: PMC7904453 DOI: 10.1016/j.jadr.2021.100123] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 12/21/2022] Open
Abstract
Background The COVID-19 pandemic has been uniquely challenging for pregnant and postpartum women. Uncontrollable stress amplifies risk for maternal depression and anxiety, which are linked to adverse mother and child outcomes. This study examined change in internalizing symptoms from before to during the COVID-19 pandemic among pregnant and postpartum women longitudinally, and investigated moderation by loneliness and other contextual risk factors. Methods 135 women (Mage = 31.81; 26% Latina, 55% non-Hispanic White, 11% Black; 39% low-income) enrolled in an existing prospective study completed self-report questionnaires including the EPDS and STAI-short form during early pregnancy, prior to COVID-19, and during COVID-19. Results Depressive symptoms were higher during COVID-19 compared to pre-COVID-19 and just as high as during early pregnancy. Anxiety symptoms were higher during COVID-19 compared to both pre-COVID-19 and early pregnancy. Higher loneliness was associated with increased depressive symptoms during COVID-19. Greater COVID-19 specific adversity was linked to greater increases in internalizing symptoms during COVID-19. Lower income-to-needs-ratio most strongly predicted symptoms during early pregnancy. Limitations The present study is longitudinal, but the correlational nature of the data precludes causal conclusions regarding the effect of the pandemic on mental health. Conclusion Longitudinal analyses suggest the COVID-19 pandemic resulted in increased internalizing symptoms among diverse pregnant and postpartum women. Interpersonal and contextual factors exacerbate risk and the impact of the pandemic on women's mental health. Identifying mothers at-risk for depression and anxiety may increase treatment utilization, mitigate fetal and infant exposure to maternal depression and anxiety, and help prevent adverse child outcomes.
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Affiliation(s)
| | | | - M Camille Hoffman
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, USA
| | - Nancy K Grote
- University of Washington, School of Social Work, USA
| | - Elysia Poggi Davis
- University of Denver, Department of Psychology, USA.,University of California, Irvine Department of Psychiatry and Human Behavior, USA
| | - Benjamin L Hankin
- The University of Illinois at Urbana-Champaign, Department of Psychology, USA
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16
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Diazepam and Its Disinfection Byproduct Promote the Early Development of Nervous System in Zebrafish Embryos. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020. [DOI: 10.1155/2020/8878143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The widely used diazepam, as central nervous system inhibitor, has found to be ubiquitous in surface water and drinking water. Moreover, a series of byproducts such as 2-methylamino-5-chlorobenzophenone (MACB) were generated after the chlorine disinfection process. However, little information is available about the neurobiological effects of these emerging chemicals at low doses, especially on infants and children. Here, we exposed zebrafish (Danio rerio) embryos to diazepam and MACB at 0.05, 0.5, and 5 nM, which were equivalent to environmental levels. Both diazepam and MACB increased the somite number and promoted nervous development of transgenic zebrafish [Tg (elavl3: EGFP) larvae] at 72 hours postfertilization ( hpf). Both diazepam and MACB also disrupted the homeostasis of adenosine monophosphate, valine, methionine, and fumaric acid in zebrafish embryos at 12 hpf. Additionally, the locomotor behavior activity of zebrafish was significantly enhanced after 120-hour sustained exposure to diazepam or MACB. Moreover, the mRNA expression levels of oct4, sox2, and nanog, modulating the pluripotency and self-renewal, were upregulated by diazepam and MACB in zebrafish embryo. Altogether, diazepam and MACB stimulate developmental neurogenesis and may induce neuronal excitotoxicity at quite low doses. These results indicated that the chronic exposure to psychoactive drugs may pose a potential risk to the development of the nervous system in infancy.
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17
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Traylor CS, Johnson JD, Kimmel MC, Manuck TA. Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review. Am J Obstet Gynecol MFM 2020; 2:100229. [PMID: 32995736 PMCID: PMC7513755 DOI: 10.1016/j.ajogmf.2020.100229] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/03/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022]
Abstract
Both acute and chronic stress can cause allostatic overload, or long-term imbalance in mediators of homeostasis, that results in disruptions in the maternal-placental-fetal endocrine and immune system responses. During pregnancy, disruptions in homeostasis may increase the likelihood of preterm birth and preeclampsia. Expectant mothers traditionally have high rates of anxiety and depressive disorders, and many are susceptible to a variety of stressors during pregnancy. These common life stressors include financial concerns and relationship challenges and may be exacerbated by the biological, social, and psychological changes occurring during pregnancy. In addition, external stressors such as major weather events (eg, hurricanes, tornados, floods) and other global phenomena (eg, the coronavirus disease 2019 pandemic) may contribute to stress during pregnancy. This review investigates recent literature published about the use of nonpharmacologic modalities for stress relief in pregnancy and examines the interplay between psychiatric diagnoses and stressors, with the purpose of evaluating the feasibility of implementing nonpharmacologic interventions as sole therapies or in conjunction with psychotherapy or psychiatric medication therapy. Further, the effectiveness of each nonpharmacologic therapy in reducing symptoms of maternal stress is reviewed. Mindfulness meditation and biofeedback have shown effectiveness in improving one's mental health, such as depressive symptoms and anxiety. Exercise, including yoga, may improve both depressive symptoms and birth outcomes. Expressive writing has successfully been applied postpartum and in response to pregnancy challenges. Although some of these nonpharmacologic interventions can be convenient and low cost, there is a trend toward inconsistent implementation of these modalities. Future investigations should focus on methods to increase ease of uptake, ensure each option is available at home, and provide a standardized way to evaluate whether combinations of different interventions may provide added benefit.
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Affiliation(s)
- Claire S. Traylor
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Jasmine D. Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Mary C. Kimmel
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Tracy A. Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC,Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC,Corresponding author: Tracy A. Manuck, MD
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18
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Early life fluoxetine treatment causes long-term lean phenotype in skeletal muscle of rats exposed to maternal lard-based high-fat diet. Biomed Pharmacother 2020; 131:110727. [PMID: 32927255 DOI: 10.1016/j.biopha.2020.110727] [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: 03/20/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 11/21/2022] Open
Abstract
There is a concern about early life exposure to Selective Serotonin Reuptake Inhibitors (SSRI) in child development and motor system maturation. Little is known, however, about the interaction of environmental factors, such as maternal nutrition, associated with early exposure to SSRI. The increased maternal consumption of high-fat diets is worrisome and affects serotonin system development with repercussions in body phenotype. This study aimed to assess the short- and long-term effects of neonatal fluoxetine treatment on the body and skeletal muscle phenotype of rats exposed to a maternal lard-based high-fat (H) diet during the perinatal period. A maternal lard-based high-fat diet causes reduced birth weight, a short-term reduction in type IIA fibers in the soleus muscle, and in type IIB fibers in the Extensor Digitorum Longus (EDL) muscle, reducing Lactate Dehydrogenase (LDH) activity in both muscles. In the long-term, the soleus showed reduced muscle weight, smaller area and perimeter of muscle fibers, while the EDL muscle showed reduced Citrate Synthase (CS) activity in offspring from the rats on the maternal lard-based high-fat diet. Early-life exposure to fluoxetine reduced body weight and growth and reduced soleus weight and enzymatic activity in young rats. Exposure to neonatal fluoxetine in adult rats caused a decreased body mass index, less food intake, and reduced muscle weight with reduced CS and LDH activity. Neonatal fluoxetine in young rats exposed to a maternal lard-based high-fat diet caused reduced body weight and growth, reduced soleus weight as well as area and perimeter of type I muscle fibers. In adulthood, there was a reduction in food intake, increased proportion of IIA type fibers, reduced area and perimeter of type IIB, and reduction in levels of CS activity in EDL muscle. Neonatal fluoxetine treatment in rats exposed to a maternal lard-based, high-fat diet induces a reduction in muscle weight, an increase in the proportion of oxidative fibers and greater oxidative enzymatic activity in adulthood.
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19
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Salisbury AL, Papandonatos GD, Stroud LR, Smith AK, Brennan PA. Prenatal antidepressant exposures and gastrointestinal complaints in childhood: A gut-brain axis connection? Dev Psychobiol 2020; 62:816-828. [PMID: 32167584 PMCID: PMC7709733 DOI: 10.1002/dev.21966] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/27/2019] [Accepted: 02/13/2020] [Indexed: 01/16/2023]
Abstract
Selective serotonin/norepinephrine reuptake inhibitors (collectively, SRIs) are the most commonly prescribed antidepressant agents for the treatment of depression in pregnancy. SRIs affect maternal and placental serotonin signaling, which might impact fetal brain development. Alterations in serotonin signaling might also impact the developing gut-brain axis (GBA) via alterations in the fetal enteric nervous system (ENS). Emerging evidence suggests that gestational SRI exposure may be associated with offspring gastrointestinal problems. However, prospective human studies of the effects of fetal SRI exposure on the ENS and function are absent in the literature. In this paper we present data demonstrating significant associations between prenatal SRI exposure and children's gastrointestinal (GI) problems in two well-characterized, prospective cohorts of preschool and later childhood individuals. The results support the hypothesis that prenatal SRI exposure can increase the risk for childhood GI difficulties. Further research is warranted on the potential SRI-induced changes to the child gut including the role of the microbiome and the GBA in the development of GI problems.
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Affiliation(s)
- Amy L. Salisbury
- Brown Center for the Study of Children at Risk, Women and Infants Hospital of Rhode Island, Providence, RI, USA
- Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Laura R. Stroud
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Alicia K. Smith
- Department of Gynecology and Obstetrics, Dept of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA 30322
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20
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Mesches GA, Wisner KL, Betcher HK. A common clinical conundrum: Antidepressant treatment of depression in pregnant women. Semin Perinatol 2020; 44:151229. [PMID: 32085857 PMCID: PMC7214132 DOI: 10.1016/j.semperi.2020.151229] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Depression during pregnancy is associated with adverse maternal, pregnancy, and infant outcomes. Treatment during pregnancy requires a balanced discussion of the risks of both drug exposure and untreated depression. An updated review of the epidemiology, outcomes, and management of maternal depression is presented. Adverse outcomes are associated with both maternal depression and antidepressants. Research gaps include data on the longitudinal developmental trajectory of offspring exposed to antidepressants compared to depression, with assessment of in utero symptom exposure and environmental exposures. Additionally, neonatal syndrome associated with antidepressant use during pregnancy has no consensus definition or mechanistic explanation. With sophisticated large-scale epidemiologic studies, there has been progress in distinguishing the impact of depression processes from medication used for treatment. Optimal treatment of perinatal depression includes close symptom monitoring and medication adjustments to maintain symptom remission. This evolving field requires frequent consultation with reproductive data sources included in this article.
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Affiliation(s)
- Gabrielle A. Mesches
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine L. Wisner
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hannah K. Betcher
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Mayo Clinic, Rochester, MN, USA
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21
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Araujo JSAD, Delgado IF, Paumgartten FJR. Antenatal exposure to antidepressant drugs and the risk of neurodevelopmental and psychiatric disorders: a systematic review. CAD SAUDE PUBLICA 2020; 36:e00026619. [DOI: 10.1590/0102-311x00026619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 12/02/2019] [Indexed: 12/17/2022] Open
Abstract
Abstract: This study investigated whether antenatal exposure to antidepressants (ADs) increases the risks of autism spectrum disorders (ASD), attention deficit/hyperactivity disorders (ADHD), schizophrenia and other mental illnesses, and cognitive and developmental deficits in infants or preschool children. PubMed, EMBASE, BIREME/BVS databases were searched to identify studies examining associations of ADs in pregnancy with neurodevelopmental and psychiatric disorders. Twenty studies addressed ASD and/or ADHD risks while 30 focused on developmental and cognitive deficits in infants or preschool children. Most studies detected no association of antenatal AD with ASD after adjustment of risk ratios for maternal depression or psychiatric disorders. Some studies showed that maternal depression, regardless of whether it is treated or untreated, increased ASD risks. Seven out of 8 studies found no increase in ADHD risk associated with antenatal exposure to selective serotonin reuptake inhibitors, the most commonly used AD. No consistent evidence was found linking AD in pregnancy to neurocognitive developmental deficits in infants or preschool children. A residual confounding by indication (depression severity) remained in almost all studies. This systematic review found no consistent evidence suggesting that ADs in pregnancy increase risks of ASD, ADHD, and neurocognitive development deficits. Some studies, however, found evidence that maternal depression increases ASD risks.
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22
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Betcher HK, Wisner KL. Psychotropic Treatment During Pregnancy: Research Synthesis and Clinical Care Principles. J Womens Health (Larchmt) 2019; 29:310-318. [PMID: 31800350 DOI: 10.1089/jwh.2019.7781] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Psychiatric illnesses are common in women of childbearing age. The perinatal period is a particularly high-risk time for depression, bipolar, and anxiety disorders. Methods: The scope of the public health problem of perinatal mental disorders is discussed followed by an examination of the specific research methods utilized for the study of birth and developmental outcomes associated with maternal mental illness and its treatment. The evidence on exposure to common psychotropics during pregnancy and breastfeeding is reviewed. Results: Selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitor medications are not associated with higher rates of birth defects or long-term changes in mental development after adjustment for confounding factors associated with underlying psychiatric illness. Lithium exposure is associated with an increased risk for fetal cardiac malformations, but this risk is lower than previously thought (absolute risk of Ebstein's anomaly 6/1,000). Antipsychotics, other than risperidone and potentially paliperidone, have not been associated with an increase in birth defects; olanzapine and quetiapine have been linked with an elevated risk of gestational diabetes. Due to the dramatic physiological changes of pregnancy and enhanced hepatic metabolism, drug doses may need to be adjusted during pregnancy to sustain efficacy. Untreated maternal psychiatric illness also carries substantial risks for the mother, fetus, infant, and family. Conclusions: The goal of perinatal mental health treatment is to optimally provide pharmacotherapy to mitigate the somatic and psychosocial burdens of maternal psychiatric disorders. Regular symptom monitoring during pregnancy and postpartum and medication dose adjustments to sustain efficacy constitutes good practice.
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Affiliation(s)
- Hannah K Betcher
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Katherine L Wisner
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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23
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Cavarsan CF, Gorassini MA, Quinlan KA. Animal models of developmental motor disorders: parallels to human motor dysfunction in cerebral palsy. J Neurophysiol 2019; 122:1238-1253. [PMID: 31411933 PMCID: PMC6766736 DOI: 10.1152/jn.00233.2019] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/12/2022] Open
Abstract
Cerebral palsy (CP) is the most common motor disability in children. Much of the previous research on CP has focused on reducing the severity of brain injuries, whereas very few researchers have investigated the cause and amelioration of motor symptoms. This research focus has had an impact on the choice of animal models. Many of the commonly used animal models do not display a prominent CP-like motor phenotype. In general, rodent models show anatomically severe injuries in the central nervous system (CNS) in response to insults associated with CP, including hypoxia, ischemia, and neuroinflammation. Unfortunately, most rodent models do not display a prominent motor phenotype that includes the hallmarks of spasticity (muscle stiffness and hyperreflexia) and weakness. To study motor dysfunction related to developmental injuries, a larger animal model is needed, such as rabbit, pig, or nonhuman primate. In this work, we describe and compare various animal models of CP and their potential for translation to the human condition.
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Affiliation(s)
- Clarissa F Cavarsan
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island
| | - Monica A Gorassini
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Katharina A Quinlan
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island
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Kothari A, de Laat J, Dulhunty JM, Bruxner G. Perceptions of pregnant women regarding antidepressant and anxiolytic medication use during pregnancy. Australas Psychiatry 2019; 27:117-120. [PMID: 30382755 DOI: 10.1177/1039856218810162] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to explore attitudes and decision-making by pregnant women regarding antidepressant and anxiolytic use during pregnancy. METHOD An observational study at an outer metropolitan hospital in Brisbane, Queensland. Pregnant women presenting for their first antenatal clinic visit were invited to complete a questionnaire. Participants were asked about current or previous antidepressant/anxiolytic use, influences on drug decision-making and the adequacy of information received. Perceptions were measured on a 7-point Likert scale. RESULTS A total of 503 pregnant women were surveyed. The background prevalence of anxiety and depression was 30.0% (151), with 9.3% (47) respondents using antidepressant or anxiolytic medications during the current pregnancy. Of these 47 women, 68% ceased these medications during or while trying to become pregnant, most commonly due to potential side effects to the baby (16), health professional advice (8) and symptomatology that was under control (7). While the effect was modest, decision-making was most strongly influenced by general practitioners, family and the internet. CONCLUSIONS Most women cease antidepressant/anxiolytic medication before and during pregnancy for reasons other than stability of condition. This study reveals an unmet need for accessible reliable information to guide pregnant women and their care providers.
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Affiliation(s)
- Alka Kothari
- Senior Staff Specialist, Obstetrics and Gynaecology, Redcliffe Hospital, Redcliffe, QLD, and; Deputy Head Northside Clinical School, University of Queensland School of Medicine, Saint Lucia, QLD, Australia
| | - John de Laat
- Fellow of the Royal Australian College of General Practitioners, Australia
| | - Joel M Dulhunty
- Senior Staff Specialist and Director of Research and Medical Education Redcliffe Hospital, Redcliffe, QLD, and; Adjunct Professor, Queensland University of Technology, Brisbane, QLD, Australia
| | - George Bruxner
- Senior Staff Specialist and Clinical Lead Consultation-Liaison Psychiatry Service Redcliffe and Caboolture Hospitals, Metro-North Mental Health Service, Caboolture, QLD, Australia
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25
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Abstract
Perinatal depression is associated with serious risks for the mother, baby, and family. When considering treating perinatal depression with a drug indicated for the treatment of depression, the major concerns are whether the drug increases the risks of teratogenicity, pregnancy complications, poor neonatal adaptation, or neurodevelopmental disorders. Although different studies have produced different results, the majority have not shown increases in risk for selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, or the noradrenergic/dopaminergic drug bupropion. In this review we will discuss the reproductive safety data for these medications as well as monoamine oxidase inhibitors and benzodiazepines.
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26
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Gopalan P, Moses-Kolko E, Valpey R, Shenai N, Smith E. Benzodiazepine withdrawal in pregnant women with opioid use disorders: An observational study of current clinical practices at a tertiary obstetrical hospital. Gen Hosp Psychiatry 2019; 57:29-33. [PMID: 30669023 DOI: 10.1016/j.genhosppsych.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND As more patients are admitted for medical complications related to opioid use disorders, physicians are called upon to manage withdrawal from co-occurring substance use disorders. We present an observational study of pregnant women with comorbid opioid and sedative-hypnotic use disorders hospitalized for benzodiazepine withdrawal. OBJECTIVES Our primary aims were to assess current practices in withdrawal management in the perinatal period in patients admitted to an antepartum unit at a tertiary care setting with comorbid opioid and sedative-hypnotic use disorders; specifically, to identify patterns of withdrawal management, including the type of withdrawal protocol utilized, the total dosage of benzodiazepine used during that protocol, to assess patient variables associated with higher dosing, and to analyze neonatal outcomes. METHODS A chart review of psychiatry consultations for benzodiazepine withdrawal in antepartum women was conducted for patients seen over a 3 year period with manual extraction of patient age, number of pregnancies, modality of benzodiazepine withdrawal management (symptom-triggered versus standing benzodiazepine taper), total amount of benzodiazepine used during the detoxification period, active methadone conversion versus stable methadone dose on admission, and average fetal heart tones during the withdrawal detoxification period. RESULTS The majority of patients (83%) were undergoing methadone conversion or were stable on methadone maintenance. The mean cumulative benzodiazepine dose used was 8.3 ± 10.5 mg in lorazepam equivalents. Women placed on a symptom-triggered protocol received lower mean benzodiazepine doses (2.4 ± 6.9 mg) compared to those on a benzodiazepine taper in conjunction with a symptom-triggered protocol (17.9 ± 20.6 mg; p < 0.001). Women who started methadone during admission tended to receive lower mean lorazepam doses (7.1 ± 10.4) compared to women admitted on stable outpatient doses of methadone (11.5 ± 10.6; p = 0.07). Using t-test and chi-square analyses on a subgroup of women (N = 50), no differences were found between women placed on a taper compared to a symptom-triggered scale alone in neonatal outcomes such as APGARS, NICU admissions, and preterm delivery with low rates of complications in both groups. CONCLUSIONS A symptom-triggered benzodiazepine withdrawal protocol was associated with significantly lower total benzodiazepine use compared to standing taper regimens. Women started on methadone during admission tended to receive lower lorazepam doses compared to women admitted on stable doses of methadone. Preliminary maternal/neonatal outcomes were similar between symptom-triggered and taper groups.
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Affiliation(s)
- Priya Gopalan
- University of Pittsburgh, Department of Psychiatry, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States of America.
| | - Eydie Moses-Kolko
- University of Pittsburgh, Department of Psychiatry, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States of America
| | - Robin Valpey
- University of Pittsburgh, Department of Psychiatry, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States of America
| | - Neeta Shenai
- University of Pittsburgh, Department of Psychiatry, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States of America
| | - Erin Smith
- University of British Columbia, Department of Psychiatry, 4500 Oak Street, Vancouver V6H 3N1, Canada
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27
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Zhang X, Yang Y, Zhang J, Yang Y, Shen F, Shen J, Shao B. Determination of emerging chlorinated byproducts of diazepam in drinking water. CHEMOSPHERE 2019; 218:223-231. [PMID: 30471503 DOI: 10.1016/j.chemosphere.2018.11.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/28/2018] [Accepted: 11/11/2018] [Indexed: 06/09/2023]
Abstract
Diazepam (DZP) is often found in source water and drinking water at dozens of nanograms per liter levels. The transformation of DZP in water chlorination disinfection process has aroused new concern because the toxic disinfection byproducts (DBPs) might be produced. However, the DBPs of DZP have not been fully identified, and their occurrence levels in drinking water have not been reported. In our chlorination experiment, five emerging DBPs of diazepam: (5-chloro-2-(methylamino) phenyl) (phenyl)methanone (BP-246), 6-chloro-1-methyl-4-phenylquinazolin-2(1H)-one (BP-271), N-(2-benzoyl-4,6-dichlorophenyl)formamide (BP-294), methyl-(2-benzoyl-4-chlorophenyl) (methyl)carbamate (BP-304 (1)) and 6-chloro-4-methoxy-1-methyl-4-phenyl-1,4-dihydro2H -benzo[d][1,3]oxazin-2-one (BP-304 (2)), were tentatively identified by high-resolution mass spectrometry and further characterized by nuclear magnetic resonance spectroscopy. We developed a trace analytical method for the analysis of these five DBPs in drinking water based on solid-phase extraction (SPE) followed liquid chromatography coupled with electrospray ionization tandem mass spectrometric detection. Ultrahigh sensitivities were achieved with limits of detection as low as 7 pg per liter. The recoveries at different spiking levels were all higher than 80% except for that of BP-246. Four of the DBPs and DZP were detected in real drinking water samples at concentrations ranging from several to dozens of nanograms per liter with relatively high detection frequencies. This is the first report on the existence of DZP-DBPs in drinking water. The method and results will be useful for further studies on the occurrence, toxicity, human exposure and control measures of these DBPs.
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Affiliation(s)
- Xin Zhang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, 100193, China; Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, Beijing, 100013, China; School of Public Health, Capital Medical University, Beijing, 100069, China
| | - Yunjia Yang
- Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
| | - Jing Zhang
- Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
| | - Yi Yang
- Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
| | - Fan Shen
- Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
| | - Jianzhong Shen
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, 100193, China
| | - Bing Shao
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, 100193, China; Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, Beijing, 100013, China.
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28
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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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29
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Major depressive disorder during pregnancy: Psychiatric medications have minimal effects on the fetus and infant yet development is compromised. Dev Psychopathol 2018; 30:773-785. [PMID: 30068426 DOI: 10.1017/s0954579418000639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Psychotropic medication use and psychiatric symptoms during pregnancy each are associated with adverse neurodevelopmental outcomes in offspring. Commonly, studies considering medication effects do not adequately assess symptoms, nor evaluate children when the effects are believed to occur, the fetal period. This study examined maternal serotonin reuptake inhibitor and polypharmacy use in relation to serial assessments of five indices of fetal neurobehavior and Bayley Scales of Infant Development at 12 months in N = 161 socioeconomically advantaged, non-Hispanic White women with a shared risk phenotype, diagnosed major depressive disorder. On average fetuses showed the expected development over gestation. In contrast, infant average Bayley psychomotor and mental development scores were low (M = 84.10 and M = 89.92, range of normal limits 85-114) with rates of delay more than 2-3 times what would be expected based on this measure's normative data. Controlling for prenatal and postnatal depressive symptoms, prenatal medication effects on neurobehavioral development were largely undetected in the fetus and infant. Mental health care directed primarily at symptoms may not address the additional psychosocial needs of women parenting infants. Speculatively, prenatal serotonin reuptake inhibitor exposure may act as a plasticity rather than risk factor, potentially enhancing receptivity to a nonoptimal postnatal environment in some mother-infant dyads.
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30
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Grove K, Lewis AJ, Galbally M. Prenatal Antidepressant Exposure and Child Motor Development: A Meta-analysis. Pediatrics 2018; 142:peds.2018-0356. [PMID: 29929995 DOI: 10.1542/peds.2018-0356] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT There is increasing use of antidepressants in pregnancy and hence children exposed in utero. Contradictory studies exist in the literature in which researchers report on the potential impact of antenatal antidepressant exposure on subsequent child motor development. OBJECTIVE Our objective in this systematic review and meta-analysis was to determine whether antenatal antidepressant exposure increases the risk of impaired motor development in children. DATA SOURCES We searched PsychINFO, Embase, Medline, PubMed, and Scopus up to July 24, 2017. STUDY SELECTION English-language cohort and case control studies in which researchers report primary data from a motor assessment of infants or children after any antidepressant exposure in pregnancy were included. DATA EXTRACTION Of the 329 studies identified, there were 160 articles screened, 24 were included in the systematic review, and 18 met inclusion criteria for the meta-analysis. RESULTS The total pooled results were based on random effects models and revealed a significant association between exposure to antidepressants during pregnancy and overall occurrence of poorer motor outcomes in children (effect size = 0.22; 95% confidence interval = 0.07 to 0.37) with a moderate degree of heterogeneity (I2 = 56.6%). LIMITATIONS There was variation in the measurement both of exposure and motor development across the identified study, and few followed up to later childhood or beyond. CONCLUSIONS A small increased risk of poorer motor development may exist for children who are exposed to antidepressant medications during pregnancy. However, the marked methodological variation among studies and the limited control for possible confounds warrants cautious interpretation of these findings.
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Affiliation(s)
- Katherine Grove
- Department of Psychiatry, Graylands Hospital, Mount Claremont, Australia
| | - Andrew J Lewis
- School of Psychology and Exercise Science, Murdoch University, Perth, Australia
| | - Megan Galbally
- School of Psychology and Exercise Science, Murdoch University, Perth, Australia; .,School of Medicine, The University of Notre Dame Australia, Fremantle, Australia; and.,King Edward Memorial Hospital, Subiaco, Australia
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31
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Considerations in Treating Insomnia During Pregnancy: A Literature Review. PSYCHOSOMATICS 2018; 59:341-348. [DOI: 10.1016/j.psym.2018.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 11/23/2022]
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32
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Videman M, Tokariev A, Saikkonen H, Stjerna S, Heiskala H, Mantere O, Vanhatalo S. Newborn Brain Function Is Affected by Fetal Exposure to Maternal Serotonin Reuptake Inhibitors. Cereb Cortex 2018; 27:3208-3216. [PMID: 27269962 DOI: 10.1093/cercor/bhw153] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Recent experimental animal studies have shown that fetal exposure to serotonin reuptake inhibitors (SRIs) affects brain development. Modern recording methods and advanced computational analyses of scalp electroencephalography (EEG) have opened a possibility to study if comparable changes are also observed in the human neonatal brain. We recruited mothers using SRI during pregnancy (n = 22) and controls (n = 62). Mood and anxiety of mothers, newborn neurology, and newborn cortical function (EEG) were assessed. The EEG parameters were compared between newborns exposed to drugs versus controls, followed by comparisons of newborn EEG features with maternal psychiatric assessments. Neurological assessment showed subtle abnormalities in the SRI-exposed newborns. The computational EEG analyses disclosed a reduced interhemispheric connectivity, lower cross-frequency integration, as well as reduced frontal activity at low-frequency oscillations. These effects were not related to maternal depression or anxiety. Our results suggest that antenatal serotonergic treatment might change newborn brain function in a manner compatible with the recent experimental studies. The present EEG findings suggest links at the level of neuronal activity between human studies and animal experiments. These links will also enable bidirectional translation in future studies on the neuronal mechanisms and long-term neurodevelopmental effects of early SRI exposure.
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Affiliation(s)
- Mari Videman
- Division of Pediatric Neurology, Department of Children and Adolescents.,BABA Center, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Anton Tokariev
- Department of Children's Clinical Neurophysiology, HUS Medical Imaging Center and Children's Hospital.,Department of Biosciences, University of Helsinki, Helsinki, Finland
| | - Heini Saikkonen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Susanna Stjerna
- Department of Children's Clinical Neurophysiology, HUS Medical Imaging Center and Children's Hospital
| | - Hannu Heiskala
- Division of Pediatric Neurology, Department of Children and Adolescents
| | - Outi Mantere
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, McGill University, Montréal, Canada.,Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, Canada
| | - Sampsa Vanhatalo
- Department of Children's Clinical Neurophysiology, HUS Medical Imaging Center and Children's Hospital
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Velez ML, McConnell K, Spencer N, Montoya L, Tuten M, Jansson LM. Prenatal buprenorphine exposure and neonatal neurobehavioral functioning. Early Hum Dev 2018; 117:7-14. [PMID: 29223912 DOI: 10.1016/j.earlhumdev.2017.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/15/2017] [Accepted: 11/21/2017] [Indexed: 11/16/2022]
Abstract
AIMS Assessments of effects of prenatal opioid exposure on the neonate have consisted principally of evaluations of neonatal abstinence syndrome (NAS) to determine the need for pharmacotherapy. The purpose of this study was to comprehensively evaluate the effects of gestational maternal buprenorphine maintenance on newborn neurobehavioral functioning. STUDY DESIGN Maternal substance use history and psychosocial demographics that can contribute to the neurobehavioral functioning of the infant were explored. Infants were assessed using the NICU Network Neurobehavioral Scale (NNNS) to measure their neurologic and behavioral functioning and signs of stress/abstinence on days 3, 14 and 30 of life. SUBJECTS Participants were 41 pregnant buprenorphine-maintained women and their infants. RESULTS Maternal buprenorphine dose at delivery was negatively correlated with infant quality of movement and self-regulation, and positively correlated with the central nervous system parameters of stress/abstinence at day 3 of life. As maternal buprenorphine dose increased, the mean morphine dose that the infant required for NAS treatment significantly increased. No differences were found when comparing the NNNS domain scores between infants who required pharmacotherapy for NAS versus those who did not at day 3 of life. CONCLUSIONS Buprenorphine exposure during pregnancy can alter neonatal neurobehavioral and physiological responses to stimuli. A systematic evaluation of the newborn's functional domains above NAS assessment alone is crucial to address the challenges created by neurobehavioral dysregulation associated with substance exposure, improve caregiver/infant interaction and developmental trajectory. Comprehensive pre/postnatal treatment of buprenorphine-maintained mothers can lead to healthier outcomes for the dyad.
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Affiliation(s)
- Martha L Velez
- Johns Hopkins University School of Medicine, Department of Pediatrics, United States.
| | - Krystle McConnell
- Johns Hopkins University School of Medicine, Department of Pediatrics, United States
| | - Nancy Spencer
- Johns Hopkins Bayview Hospital, Department of Nursing, United States
| | - Lina Montoya
- University of California at Berkeley, Department of Biostatistics, United States
| | - Michelle Tuten
- University of Maryland School of Social Work, United States
| | - Lauren M Jansson
- Johns Hopkins University School of Medicine, Department of Pediatrics, United States
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34
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Kraft WK. Buprenorphine in Neonatal Abstinence Syndrome. Clin Pharmacol Ther 2018; 103:112-119. [PMID: 29105752 PMCID: PMC5739935 DOI: 10.1002/cpt.930] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 12/25/2022]
Abstract
Infants exposed in utero to opioids will demonstrate a withdrawal syndrome known as neonatal abstinence syndrome (NAS). Buprenorphine is a long-acting opioid with therapeutic use in medication-assisted treatment of opioid dependency in adults and adolescents. Emerging data from clinical trials and treatment cohorts demonstrate the efficacy and safety of sublingual buprenorphine for those infants with NAS who require pharmacologic treatment. Pharmacometric modeling will assist in defining the exposure-response relationships and facilitate dose optimization.
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Affiliation(s)
- Walter K Kraft
- Sidney Kimmel Medical College of Thomas Jefferson University, Department of Pharmacology and Experimental Medicine, Philadelphia, Pennsylvania, USA
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35
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Pharmacokinetics and Pharmacogenetics of Selective Serotonin Reuptake Inhibitors During Pregnancy: An Observational Study. Ther Drug Monit 2017; 39:197-201. [PMID: 28045861 DOI: 10.1097/ftd.0000000000000370] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND An involvement of selective serotonin reuptake inhibitors (SSRIs) in increasing the risk of malformations, neonatal withdrawal syndrome, has been suggested recently. Here, we aimed to investigate the contribution of individual pharmacogenetics of SSRI on infants' outcome. We also estimated the umbilical/maternal plasma SSRI concentration ratio in the pregnant women still on SSRI therapy at the time of delivery. METHODS Thirty-four pregnant women, referred to our hospital from January 2011 to July 2015, who were given SSRIs in the third trimester, and related children, were considered. The umbilical/maternal plasma SSRI concentration ratio was estimated in 15 mothers still on SSRI therapy at the time of delivery. For patients with pharmacokinetic analyses, blood samples were collected for pharmacogenetic analyses. RESULTS Nineteen newborns presented clinical signs possibly related to drug toxicity. A high umbilical/maternal plasma ratio of SSRI was observed in 10 of the 15 evaluated newborns. Five mothers were intermediate metabolizers and 1 a poor metabolizer for the major CYP enzyme involved in pharmacokinetic pathway. CONCLUSIONS Individualized psychopharmacologic treatment that takes into account the mother's exposure to SSRI concentrations and eventually her genetic background may become the standard of care to maximize drug benefit and minimize risks to the newborn.
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36
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Pregnancy and postpartum antidepressant use moderates the effects of sleep on depression. Arch Womens Ment Health 2017; 20:621-632. [PMID: 28488099 PMCID: PMC6940595 DOI: 10.1007/s00737-017-0726-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
This study examined the course of antidepressant use, sleep quality, and depression severity from pregnancy through 6-month postpartum in women with and without a depressive disorder during pregnancy. Women (N = 215) were interviewed during pregnancy, 1- and 6-month postpartum. Mixed linear models were used to examine the longitudinal course and inter-relationships for the time-varying variables of antidepressant use, subjective sleep quality, and depression severity. Pregnant women with a depressive disorder who did not use antidepressants had more variable depression severity over time with improvements in depression severity by 6-month postpartum. In contrast, the depression severity of their medicated counterparts remained stable and high throughout. Pregnant women without a depressive disorder had worse sleep quality when using antidepressants compared with when they were not. Antidepressant use significantly strengthened the magnitude of the effect of sleep quality on depression severity in women with a depressive disorder during pregnancy. When prenatally depressed women use antidepressants, their sleep disturbance is more highly linked to depression severity than when they do not. Furthermore, antidepressants are not adequately treating the sleep disturbance of these women or their remitted counterparts, leaving both groups vulnerable to significant negative mental and physical health outcomes.
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Stroud LR, Papandonatos GD, Parade SH, Salisbury AL, Phipps MG, Lester B, Padbury JF, Marsit CJ. Prenatal Major Depressive Disorder, Placenta Glucocorticoid and Serotonergic Signaling, and Infant Cortisol Response. Psychosom Med 2017; 78:979-990. [PMID: 27763986 PMCID: PMC6541396 DOI: 10.1097/psy.0000000000000410] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Extending prior studies of prenatal adversity and depressive symptoms, we tested associations between maternal prenatal major depressive disorder (MDD) and infant cortisol regulation. Based on prior findings by our group, we also tested placenta glucocorticoid (HSD11B2 methylation) and serotonin (SLC6A4 gene expression) signaling as moderators of links between prenatal MDD and infant cortisol. METHODS Participants were 153 mother-infant pairs from a low-income, diverse sample (M [SD] age = 26 [6] years). Repeated structured diagnostic interviews were used to identify mothers with (a) prenatal MDD, (b) preconception-only MDD, and (c) controls. Placenta samples were assayed for HSD11B2 methylation and SLC6A4 gene expression. Infant salivary cortisol response to a neurobehavioral examination was assessed at 1 month. RESULTS Daughters of prenatal MDD mothers had 51% higher baseline (ratio = 1.51; 95% confidence interval [CI] = 1.01-2.27; p = .045) and 64% higher stress responsive cortisol (ratio = 1.64; 95% CI = 1.05-2.56; p = .03) than daughters of controls and 75% higher stress-responsive cortisol (ratio = 1.75; 95% CI = 1.04-2.94; p = .04) than daughters of preconception-only MDD mothers. HSD11B2 methylation moderated links between prenatal MDD and baseline cortisol (p = .02), with 1% methylation decreases associated with 9% increased baseline cortisol in infants of prenatal MDD mothers (ratio = 1.09; 95% CI = 1.01-1.16). SLC6A4 expression moderated links between prenatal MDD and cortisol response among boys alone (p = .007), with 10-fold increases in expression associated with threefold increases in stress-responsive cortisol (ratio = 2.87; 95% CI = 1.39-5.93) in sons of control mothers. CONCLUSIONS Results highlight specificity of associations between prenatal versus preconception MDD and cortisol regulation and the importance and complexity of placenta glucocorticoid and serotonergic pathways underlying the intergenerational transmission of risk from maternal adversity.
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Affiliation(s)
- Laura R. Stroud
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital
| | | | - Stephanie H. Parade
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
- Bradley/Hasbro Children’s Research Center, Department of Psychology
| | - Amy L. Salisbury
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
- Department of Pediatrics, Warren Alpert Medical School, Brown University
- Women & Infants’ Hospital of Rhode Island
| | - Maureen G. Phipps
- Women & Infants’ Hospital of Rhode Island
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University
| | - Barry Lester
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
- Department of Pediatrics, Warren Alpert Medical School, Brown University
- Women & Infants’ Hospital of Rhode Island
| | - James F. Padbury
- Department of Pediatrics, Warren Alpert Medical School, Brown University
- Women & Infants’ Hospital of Rhode Island
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38
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Angelotta C, Wisner KL. Treating Depression during Pregnancy: Are We Asking the Right Questions? Birth Defects Res 2017; 109:879-887. [DOI: 10.1002/bdr2.1074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/13/2017] [Accepted: 06/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Cara Angelotta
- Northwestern University; Feinberg School of Medicine, Department of Psychiatry
| | - Katherine L. Wisner
- Northwestern University; Feinberg School of Medicine, Department of Psychiatry
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McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, Green L, Gregoire A, Howard LM, Jones I, Khalifeh H, Lingford-Hughes A, McDonald E, Micali N, Pariante CM, Peters L, Roberts A, Smith NC, Taylor D, Wieck A, Yates LM, Young AH. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol 2017; 31:519-552. [PMID: 28440103 DOI: 10.1177/0269881117699361] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, owing to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk. These consensus guidelines aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.
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Affiliation(s)
- R Hamish McAllister-Williams
- 1 Institute of Neuroscience, Newcastle University, Newcastle, UK.,2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David S Baldwin
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,4 University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Abby Easter
- 6 Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eilish Gilvarry
- 2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,7 Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Vivette Glover
- 8 Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Lucian Green
- 9 Ealing, Hounslow, Hammersmith & Fulham Perinatal Mental Health Service, West London Mental Health Trust, London, UK
| | - Alain Gregoire
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,10 Hampshire Perinatal Mental Health Service, Winchester, UK
| | - Louise M Howard
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | - Ian Jones
- 13 National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Hind Khalifeh
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Elizabeth McDonald
- 15 Royal College of Psychiatrists, London, UK.,16 East London Foundation Trust, London, UK.,17 Tavistock and Portman NHS Foundation Trust, London, UK
| | - Nadia Micali
- 18 Behavioural and Brain Sciences Unit, GOSH Institute of Child Health, University College London, London, UK
| | - Carmine M Pariante
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Ann Roberts
- 20 St Martin's Healthcare Services CIC, Leeds, UK.,21 Hertfordshire Partnership University NHS Foundation Trust, Hatfield, Hertfordshire, UK.,22 Postgraduate School of Medicine, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Natalie C Smith
- 23 Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, County Durham, UK
| | - David Taylor
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,24 Institute of Pharmaceutical Science, King's College London, London, UK
| | - Angelika Wieck
- 25 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,26 University of Manchester, Manchester, UK
| | - Laura M Yates
- 27 UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,28 Institute of Genetic Medicine, Newcastle University, Newcastle, UK
| | - Allan H Young
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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40
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Yang A, Ciolino JD, Pinheiro E, Rasmussen-Torvik LJ, Sit DKY, Wisner KL. Neonatal Discontinuation Syndrome in Serotonergic Antidepressant-Exposed Neonates. J Clin Psychiatry 2017; 78:605-611. [PMID: 28570796 PMCID: PMC7087396 DOI: 10.4088/jcp.16m11044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/20/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine whether infants exposed in utero to serotonin reuptake inhibitor (SRI) antidepressants or a DSM-IV-TR-defined mood disorder have significantly more neonatal discontinuation signs compared to an unexposed group of infants at 2-4 weeks after birth. METHODS This secondary analysis was derived from 2 observational studies with enrollment from July 2000 to December 2011 in Cleveland, Ohio, and Pittsburgh, Pennsylvania. Mothers (n = 214) belonged to one of 3 groups based on exposure status during pregnancy: (1) Comparison-women who did not take psychotropics during pregnancy and had no major mood disorder; (2) SRI-exposed-women with a mood disorder who were taking an SRI but no benzodiazepines; and (3) Mood Disorder-women with depression or bipolar disorder who did not take psychotropic medications. The infants were examined for signs according to the Finnegan Scale by evaluators blind to maternal exposure status. RESULTS The rates of sign presence (defined as a score ≥ 2 on the Finnegan Scale) in the SRI, Mood Disorder, and Comparison groups were similar at 34.1%, 35.1%, and 30.4%, respectively. Women in the SRI group had a significantly higher preterm birth rate (24.4%) compared to the other 2 groups (7.4% and 8.9% in the Mood Disorder and Comparison groups, respectively; P = .012). Preterm newborns had a significantly higher sign rate compared to full-term newborns (54% vs 31%, P = .020). We observed a significant relationship between Finnegan signs and preterm birth. CONCLUSIONS The presence of neonatal signs at 2-4 weeks was more closely associated with prematurity than with in utero SRI or mood disorder exposure. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT00279370 and NCT00585702.
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Affiliation(s)
- Amy Yang
- Biostatistics Collaboration Center, Department of
Preventive Medicine Feinberg School of Medicine Northwestern University, Chicago,
Illinois
| | - Jody D. Ciolino
- Biostatistics Collaboration Center, Department of
Preventive Medicine Feinberg School of Medicine Northwestern University, Chicago,
Illinois
| | - Emily Pinheiro
- Asher Center for the Study and Treatment of Depressive
Disorders Department of Psychiatry and Behavioral Sciences, Northwestern University,
Chicago, Illinois
| | | | - Dorothy K. Y. Sit
- Department of Psychiatry and Behavioral Science Feinberg
School of Medicine, Northwestern University, Chicago, Illinois
| | - Katherine L. Wisner
- Norman and Helen Asher Professor of Psychiatry and
Behavioral Sciences, and Obstetrics and Gynecology, Asher Center for the Study and
Treatment of Depressive Disorders, Northwestern University Feinberg School of
Medicine, Chicago, Illinois,Corresponding author: Katherine
L. Wisner, MD, Asher Center for the Study and Treatment of Depressive Disorders
Northwestern University Feinberg School of Medicine, 676 North Saint Clair St,
Ste 1000, Chicago, IL 60611
()
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Abstract
This clinical case conference discusses the treatment of a pregnant woman with opioid use disorder in a comprehensive care program that includes buprenorphine pharmacotherapy. The presentation summarizes common experiences that pregnant women who receive buprenorphine pharmacotherapy face, and also what their prenatally opioid-exposed children confront in the immediate postpartum period. It describes the elements of a successful comprehensive care model and corollary neonatal abstinence syndrome treatment regimen. Expert commentary is included on issues that arise in the buprenorphine induction and maintenance throughout the prenatal and postpartum periods and in the treatment of co-occurring mental health problems during both the prenatal and postpartum periods, particularly the treatment of depression. There is also expert commentary on the care of opioid-exposed neonates, with attention to the treatment for neonatal abstinence syndrome.
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42
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Scheinost D, Sinha R, Cross SN, Kwon SH, Sze G, Constable RT, Ment LR. Does prenatal stress alter the developing connectome? Pediatr Res 2017; 81:214-226. [PMID: 27673421 PMCID: PMC5313513 DOI: 10.1038/pr.2016.197] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/30/2016] [Indexed: 12/22/2022]
Abstract
Human neurodevelopment requires the organization of neural elements into complex structural and functional networks called the connectome. Emerging data suggest that prenatal exposure to maternal stress plays a role in the wiring, or miswiring, of the developing connectome. Stress-related symptoms are common in women during pregnancy and are risk factors for neurobehavioral disorders ranging from autism spectrum disorder, attention deficit hyperactivity disorder, and addiction, to major depression and schizophrenia. This review focuses on structural and functional connectivity imaging to assess the impact of changes in women's stress-based physiology on the dynamic development of the human connectome in the fetal brain.
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Affiliation(s)
- Dustin Scheinost
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Rajita Sinha
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut,Department of Child Study, Yale School of Medicine, New Haven, Connecticut,Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut
| | - Sarah N. Cross
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Soo Hyun Kwon
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Gordon Sze
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - R. Todd Constable
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut,Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Laura R. Ment
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut,Department of Neurology, Yale School of Medicine, New Haven, Connecticut,()
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43
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Thomas E, Peacock PJ, Bates SE. Variation in the management of SSRI-exposed babies across England. BMJ Paediatr Open 2017; 1:e000060. [PMID: 29637109 PMCID: PMC5862225 DOI: 10.1136/bmjpo-2017-000060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Depression in pregnancy is commonly treated using selective serotonin reuptake inhibitors (SSRIs). A possible withdrawal syndrome following in utero exposure has been reported, but there is currently no UK guidance on the management of these neonates. METHODS All 160 neonatal units in England were asked for information regarding their management of SSRI-exposed babies. RESULTS Responses were obtained from 112/160 (70%) units. Only four units had a specific protocol for managing SSRI-exposed neonates. Twenty-one units (19%) conduct routine observations on exposed neonates, while 37 units (33%) would consider treating babies with signs of withdrawal or toxicity. CONCLUSIONS Very few neonatal units in England have specific guidelines for the management of babies exposed to SSRIs in utero, with practice varying greatly between units. Further research is needed on the outcomes of SSRI-exposed babies to support development of standardised evidence-based guidelines to ensure all mothers and babies receive similar high-quality care.
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Affiliation(s)
- Eliza Thomas
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Phil J Peacock
- Department of Paediatrics, Great Western Hospital, Swindon, UK
| | - Sarah E Bates
- Department of Paediatrics, Great Western Hospital, Swindon, UK
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44
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Selective serotonin reuptake inhibitors for depression in pregnancy. Am J Obstet Gynecol 2016; 215:722-730. [PMID: 27430585 DOI: 10.1016/j.ajog.2016.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/03/2016] [Accepted: 07/05/2016] [Indexed: 12/31/2022]
Abstract
Perinatal depression is associated with a high risk of morbidity and mortality and may have long-term consequences on child development. The US Preventive Services Task Force has recently recognized the importance of identifying and treating women with depression in the perinatal period. However, screening and accessing appropriate treatment come with logistical challenges. In many areas, there may not be sufficient access to psychiatric care, and, until these resources develop, the burden may inadvertently fall on obstetricians. As a result, understanding the risks of perinatal depression in comparison with the risks of treatment is important. Many studies of selective serotonin reuptake inhibitors in pregnancy fail to control for underlying depressive illness, which can lead to misinterpretation of selective serotonin reuptake inhibitor risk by clinicians. This review discusses the risks and benefits of selective serotonin reuptake inhibitor treatment in pregnancy within the context of perinatal depression. Whereas selective serotonin reuptake inhibitors may be associated with certain risks, the absolute risks are low and may be outweighed by the risks of untreated depression for many women and their offspring.
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45
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Park S, Nevin ABC, Cardozo-Pelaez F, Lurie DI. Pb exposure prolongs the time period for postnatal transient uptake of 5-HT by murine LSO neurons. Neurotoxicology 2016; 57:258-269. [PMID: 27771255 DOI: 10.1016/j.neuro.2016.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/27/2016] [Accepted: 10/17/2016] [Indexed: 01/09/2023]
Abstract
Pb exposure is associated with cognitive deficits including Attention Deficit Hyperactivity Disorder (ADHD) in children and alters auditory temporal processing in humans and animals. Serotonin has been implicated in auditory temporal processing and previous studies from our laboratory have demonstrated that developmental Pb decreases expression of serotonin (5-HT) in the adult murine lateral superior olive (LSO). During development, certain non-serotonergic sensory neurons, including auditory LSO neurons, transiently take up 5-HT through the serotonin reuptake transporter (SERT). The uptake of 5-HT is important for development of sensory systems. This study examines the effect of Pb on the serotonergic system in the LSO of the early postnatal mouse. Mice were exposed to moderate Pb (0.01mM) or high Pb (0.1mM) throughout gestation and postnatal day 4 (P4) and P8. We found that Pb exposure prolongs the normal developmental expression of 5-HT by LSO neurons and this is correlated with expression of SERT on LSO cell bodies. The prolonged expression of 5-HT by postnatal LSO neurons is correlated with decreased synaptic immunolabeling within the LSO. This Pb-associated decrease in synaptic density within the LSO could contribute to the auditory temporal processing deficits and cognitive deficits associated with developmental Pb exposure.
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Affiliation(s)
- Sunyoung Park
- Center for Structural and Functional Neuroscience, Center for Environmental Health Sciences, Department of Biomedical & Pharmaceutical Sciences, College of Health Professions and Biomedical Sciences, The University of Montana, Missoula, MT 59812, United States; Business Planning Department, Kyowa Hakko Kirin Korea Co., Ltd., Seoul, Republic of Korea
| | - Andrew B C Nevin
- Center for Structural and Functional Neuroscience, Center for Environmental Health Sciences, Department of Biomedical & Pharmaceutical Sciences, College of Health Professions and Biomedical Sciences, The University of Montana, Missoula, MT 59812, United States
| | - Fernando Cardozo-Pelaez
- Center for Structural and Functional Neuroscience, Center for Environmental Health Sciences, Department of Biomedical & Pharmaceutical Sciences, College of Health Professions and Biomedical Sciences, The University of Montana, Missoula, MT 59812, United States
| | - Diana I Lurie
- Center for Structural and Functional Neuroscience, Center for Environmental Health Sciences, Department of Biomedical & Pharmaceutical Sciences, College of Health Professions and Biomedical Sciences, The University of Montana, Missoula, MT 59812, United States.
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46
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Partridge MCA, Salisbury AL, LaGasse LL. Fine Motor Differences and Prenatal Serotonin Reuptake Inhibitors Exposure. J Pediatr 2016; 175:144-149.e1. [PMID: 27215778 PMCID: PMC4981505 DOI: 10.1016/j.jpeds.2016.04.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/07/2016] [Accepted: 04/19/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To examine fine motor differences between preschoolers with prenatal exposure to serotonin reuptake inhibitor (SRI) and children of mothers with major depressive disorder. STUDY DESIGN A subset of children (N = 40) from a larger study on the effects of prenatal SRI and untreated major depressive disorder participated in a kinematic task of visual motor and fine motor functions at ages 4-5 years: exposure to SRI (n = 15), untreated major depressive disorder exposure (n = 10), and the control group (n = 15). The task was to reach and secure a peg, then drop it in a small hole near the start position in the light condition with full visibility or in the glow condition in which a phosphorescent peg glows in the dark. Movement-tracking software measured the positioning of the moving hand and fingers. RESULTS In the glow condition, the group exposed to SRIs had a greater proportion of maximum aperture than the group with major depressive disorder, and the group exposed to SRIs was slower than the group with major depressive disorder to drop the peg into the hole. In the glow condition, the trajectory of the group exposed to SRI was less straight than the group with major depressive disorder, and the group with major depressive disorder had a straighter trajectory than the control group. CONCLUSION This study provides evidence that preschool aged children with prenatal SRI exposure have poorer fine motor and visual-motor control compared with those with prenatal untreated major depressive disorder.
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Affiliation(s)
- Marie-Claire A.E. Partridge
- Department of Neuroscience, Warren Alpert Medical School of Brown University,Brown Center for the Study of Children at Risk,Department of Pediatrics, Women and Infants Hospital of Rhode Island
| | - Amy L. Salisbury
- Brown Center for the Study of Children at Risk,Department of Pediatrics, Warren Alpert Medical School of Brown University, Women & Infants Hospital,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University,Department of Pediatrics, Women and Infants Hospital of Rhode Island
| | - Linda L. LaGasse
- Brown Center for the Study of Children at Risk,Department of Pediatrics, Warren Alpert Medical School of Brown University, Women & Infants Hospital,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University,Department of Pediatrics, Women and Infants Hospital of Rhode Island
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47
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Saia KA, Schiff D, Wachman EM, Mehta P, Vilkins A, Sia M, Price J, Samura T, DeAngelis J, Jackson CV, Emmer SF, Shaw D, Bagley S. Caring for Pregnant Women with Opioid Use Disorder in the USA: Expanding and Improving Treatment. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016; 5:257-263. [PMID: 27563497 PMCID: PMC4981621 DOI: 10.1007/s13669-016-0168-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF THE REVIEW Opioid use disorder in the USA is rising at an alarming rate, particularly among women of childbearing age. Pregnant women with opioid use disorder face numerous barriers to care, including limited access to treatment, stigma, and fear of legal consequences. This review of opioid use disorder in pregnancy is designed to assist health care providers caring for pregnant and postpartum women with the goal of expanding evidence-based treatment practices for this vulnerable population. RECENT FINDINGS We review current literature on opioid use disorder among US women, existing legislation surrounding substance use in pregnancy, and available treatment options for pregnant women with opioid use disorder. Opioid agonist treatment (OAT) remains the standard of care for treating opioid use disorder in pregnancy. Medically assisted opioid withdrawal ("detoxification") is not recommended in pregnancy and is associated with high maternal relapse rates. Extended release naltrexone may confer benefit for carefully selected patients. Histories of trauma and mental health disorders are prevalent in this population; and best practice recommendations incorporate gender-specific, trauma-informed, mental health services. Breastfeeding with OAT is safe and beneficial for the mother-infant dyad. SUMMARY Further research investigating options of OAT and the efficacy of opioid antagonists in pregnancy is needed. The US health care system can adapt to provide quality care for these mother-infant dyads by expanding comprehensive treatment services and improving access to care.
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Affiliation(s)
- Kelley A. Saia
- Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, 6th Floor, Boston, MA 02118 USA
| | - Davida Schiff
- Department of Pediatrics, Boston Medical Center, Boston, USA
| | | | - Pooja Mehta
- Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, 6th Floor, Boston, MA 02118 USA
| | - Annmarie Vilkins
- Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, 6th Floor, Boston, MA 02118 USA
| | - Michelle Sia
- Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, 6th Floor, Boston, MA 02118 USA
| | - Jordana Price
- Department of Family Medicine, Boston Medical Center, Boston, USA
| | - Tirah Samura
- Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, 6th Floor, Boston, MA 02118 USA
| | - Justin DeAngelis
- Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, 6th Floor, Boston, MA 02118 USA
| | | | | | - Daniel Shaw
- Department of Psychiatry, Boston Medical Center, Boston, USA
| | - Sarah Bagley
- Department of Internal Medicine, Boston Medical Center, Boston, USA
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