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Michel H, Potapow A, Dechant MJ, Brandstetter S, Wellmann S, Köninger A, Melter M, Apfelbacher C, Kabesch M, Gerling S. Effect of QT interval-prolonging drugs taken in pregnancy on the neonatal QT interval. Front Pharmacol 2023; 14:1193317. [PMID: 37608894 PMCID: PMC10440430 DOI: 10.3389/fphar.2023.1193317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/18/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction: Acquired QT interval prolongations due to drug side effects can result in detrimental arrhythmia. Maternal use of placenta-permeable drugs may lead to fetal exposure, thus leading to an increased risk of neonatal QT prolongation and arrhythmia. Objectives: This study aimed to evaluate the influence of maternal QT-prolonging medication on the neonatal QT interval. Methods: In the prospective KUNO-Kids health study, an ongoing population-based birth cohort, we classified maternal medications according to the known risk of QT interval prolongation. Effects on the neonatal QT interval were tested by linear regression analyses, correcting for perinatal confounders (birth weight, gestational age, birth mode, and age at ECG recording). Subgroup analyses were performed for selective serotonin reuptake inhibitors, proton pump inhibitors, and antihistamine dimenhydrinate. Logistic regression analysis was performed using a QTc of 450 ms as the cut-off value. Results: A total of 2,550 pregnant women received a total of 3,990 medications, of which 315 were known to increase the risk of QT prolongation, resulting in 105 (4.1%) neonates exposed in the last month of pregnancy. Overall, the mean age of the neonates at ECG was 1.9 days and the mean QTc (Bazett) was 414 ms. Univariate (regression coefficient -2.62, p = 0.288) and multivariate (regression coefficient -3.55, p = 0.146) regression analyses showed no significant effect of fetal medication exposure on the neonatal QT interval, neither in the overall nor in the subgroup analysis. Logistic regression analysis showed no association of exposure to maternal medication with an increased risk of neonatal QT interval prolongation (OR (odds ratio) 0.34, p = 0.14). Conclusion: The currently used maternal medication results in a relevant number of fetuses exposed to QT interval-prolonging drugs. In our cohort, exposure was found to have no effect on the neonatal QT interval.
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Affiliation(s)
- Holger Michel
- University Children’s Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of John, University of Regensburg, Regensburg, Germany
| | - Antonia Potapow
- University Children’s Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of John, University of Regensburg, Regensburg, Germany
| | - Markus-Johann Dechant
- University Children’s Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of John, University of Regensburg, Regensburg, Germany
| | - Susanne Brandstetter
- University Children’s Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of John, University of Regensburg, Regensburg, Germany
- Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Sven Wellmann
- University Children’s Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of John, University of Regensburg, Regensburg, Germany
| | - Angela Köninger
- Clinic of Obstetrics and Gynecology St. Hedwig, University of Regensburg, Regensburg, Germany
| | - Michael Melter
- University Children’s Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of John, University of Regensburg, Regensburg, Germany
- Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Economics, University of Magdeburg, Magdeburg, Germany
| | - Michael Kabesch
- University Children’s Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of John, University of Regensburg, Regensburg, Germany
- Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Stephan Gerling
- University Children’s Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of John, University of Regensburg, Regensburg, Germany
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Plijter IS, Verkerk AO, Wilders R. The Antidepressant Paroxetine Reduces the Cardiac Sodium Current. Int J Mol Sci 2023; 24:ijms24031904. [PMID: 36768229 PMCID: PMC9915920 DOI: 10.3390/ijms24031904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023] Open
Abstract
A considerable amount of literature has been published on antidepressants and cardiac ion channel dysfunction. The antidepressant paroxetine has been associated with Brugada syndrome and long QT syndrome, albeit on the basis of conflicting findings. The cardiac voltage-gated sodium channel (NaV1.5) is related to both of these syndromes, suggesting that paroxetine may have an effect on this channel. In the present study, we therefore carried out patch clamp experiments to examine the effect of paroxetine on human NaV1.5 channels stably expressed in human embryonic kidney 293 (HEK-293) cells as well as on action potentials of isolated rabbit left ventricular cardiomyocytes. Additionally, computer simulations were conducted to test the functional effects of the experimentally observed paroxetine-induced changes in the NaV1.5 current. We found that paroxetine led to a decrease in peak NaV1.5 current in a concentration-dependent manner with an IC50 of 6.8 ± 1.1 µM. In addition, paroxetine caused a significant hyperpolarizing shift in the steady-state inactivation of the NaV1.5 current as well as a significant increase in its rate of inactivation. Paroxetine (3 µM) affected the action potential of the left ventricular cardiomyocytes, significantly decreasing its maximum upstroke velocity and amplitude, both of which are mainly regulated by the NaV1.5 current. Our computer simulations demonstrated that paroxetine substantially reduces the fast sodium current of human left ventricular cardiomyocytes, thereby slowing conduction and reducing excitability in strands of cells, in particular if conduction and excitability are already inhibited by a loss-of-function mutation in the NaV1.5 encoding SCN5A gene. In conclusion, paroxetine acts as an inhibitor of NaV1.5 channels, which may enhance the effects of loss-of-function mutations in SCN5A.
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Affiliation(s)
- Ingmar S. Plijter
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Arie O. Verkerk
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Ronald Wilders
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Correspondence:
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QTc Interval Reference Values and Their (Non)-Maturational Factors in Neonates and Infants: A Systematic Review. CHILDREN 2022; 9:children9111771. [DOI: 10.3390/children9111771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022]
Abstract
QTc interval measurement is a widely used screening tool to assess the risk of cardiac diseases, arrhythmias, and is a useful biomarker for pharmacovigilance. However, the interpretation of QTc is difficult in neonates due to hemodynamic maturational changes and uncertainties on reference values. To describe trends in QTc values throughout infancy (1 year of life), and to explore the impact of (non)-maturational changes and medicines exposure, a structured systematic review (PROSPERO CRD42022302296) was performed. In term neonates, a decrease was observed over the first week of life, whereafter values increased until two months of age, followed by a progressive decrease until six months. A similar pattern with longer QTc values was observed in preterms. QTc is influenced by cord clamping, hemodynamic changes, therapeutic hypothermia, illnesses and sleep, not by sex. Cisapride, domperidone and doxapram result in QTc prolongation in neonates. Further research in this age category is needed to improve primary screening practices and QTcthresholds, earlier detection of risk factors and precision pharmacovigilance.
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Associations Between Maternal Depression, Antidepressant Use During Pregnancy, and Adverse Pregnancy Outcomes: An Individual Participant Data Meta-analysis. Obstet Gynecol 2021; 138:633-646. [PMID: 34623076 DOI: 10.1097/aog.0000000000004538] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the associations of depressive symptoms and antidepressant use during pregnancy with the risks of preterm birth, low birth weight, small for gestational age (SGA), and low Apgar scores. DATA SOURCES MEDLINE, EMBASE, ClinicalTrials.gov, and PsycINFO up to June 2016. METHODS OF STUDY SELECTION Data were sought from studies examining associations of depression, depressive symptoms, or use of antidepressants during pregnancy with gestational age, birth weight, SGA, or Apgar scores. Authors shared the raw data of their studies for incorporation into this individual participant data meta-analysis. TABULATION, INTEGRATION, AND RESULTS We performed one-stage random-effects meta-analyses to estimate odds ratios (ORs) with 95% CIs. The 215 eligible articles resulted in 402,375 women derived from 27 study databases. Increased risks were observed for preterm birth among women with a clinical diagnosis of depression during pregnancy irrespective of antidepressant use (OR 1.6, 95% CI 1.2-2.1) and among women with depression who did not use antidepressants (OR 2.2, 95% CI 1.7-3.0), as well as for low Apgar scores in the former (OR 1.5, 95% CI 1.3-1.7), but not the latter group. Selective serotonin reuptake inhibitor (SSRI) use was associated with preterm birth among women who used antidepressants with or without restriction to women with depressive symptoms or a diagnosis of depression (OR 1.6, 95% CI 1.0-2.5 and OR 1.9, 95% CI 1.2-2.8, respectively), as well as with low Apgar scores among women in the latter group (OR 1.7, 95% CI 1.1-2.8). CONCLUSION Depressive symptoms or a clinical diagnosis of depression during pregnancy are associated with preterm birth and low Apgar scores, even without exposure to antidepressants. However, SSRIs may be independently associated with preterm birth and low Apgar scores. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42016035711.
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The effect of antenatal selective serotonin reuptake inhibitor exposure on the corrected QT interval of neonates. J Perinatol 2021; 41:1515-1518. [PMID: 33850289 DOI: 10.1038/s41372-021-01057-y] [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: 02/08/2021] [Revised: 02/26/2021] [Accepted: 03/29/2021] [Indexed: 11/09/2022]
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Abstract
A female neonate with in utero selective serotonin reuptake inhibitor exposure presented with bradycardia shortly after birth. Electrocardiography showed severe QT prolongation and second-degree atrioventricular block. Over time QT-times spontaneously normalised and genetic testing did not show mutations associated with long QT syndrome making maternal selective serotonin reuptake inhibitor usage the most likely explanation for the observed severe transient neonatal QT prolongation.
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Kahankova R, Martinek R, Jaros R, Behbehani K, Matonia A, Jezewski M, Behar JA. A Review of Signal Processing Techniques for Non-Invasive Fetal Electrocardiography. IEEE Rev Biomed Eng 2019; 13:51-73. [PMID: 31478873 DOI: 10.1109/rbme.2019.2938061] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Fetal electrocardiography (fECG) is a promising alternative to cardiotocography continuous fetal monitoring. Robust extraction of the fetal signal from the abdominal mixture of maternal and fetal electrocardiograms presents the greatest challenge to effective fECG monitoring. This is mainly due to the low amplitude of the fetal versus maternal electrocardiogram and to the non-stationarity of the recorded signals. In this review, we highlight key developments in advanced signal processing algorithms for non-invasive fECG extraction and the available open access resources (databases and source code). In particular, we highlight the advantages and limitations of these algorithms as well as key parameters that must be set to ensure their optimal performance. Improving or combining the current or developing new advanced signal processing methods may enable morphological analysis of the fetal electrocardiogram, which today is only possible using the invasive scalp electrocardiography method.
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Nezvalová-Henriksen K, Spigset O, Brandlistuen RE, Ystrom E, Koren G, Nordeng H. Effect of prenatal selective serotonin reuptake inhibitor (SSRI) exposure on birthweight and gestational age: a sibling-controlled cohort study. Int J Epidemiol 2018; 45:2018-2029. [PMID: 27188860 DOI: 10.1093/ije/dyw049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 11/14/2022] Open
Abstract
Background Up to 10% of women are exposed to selective serotonin reuptake inhibitors (SSRIs) during pregnancy. Information on their effect on birthweight and gestational age remains conflicting. The aim of this sibling-controlled prospective cohort study is to address shared geneticand family-level confounding to investigate the effects of prenatal SSRI exposure and maternal depression on birthweight and gestational age. Methods We used the Norwegian Mother and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN). Our study population consisted of 27 756 siblings; 194 were prenatally exposed to SSRIs and 27 500 were unexposed to any antidepressant medication. Random and fixed effects analysis with propensity score adjustment was used to evaluate the effectson birthweight and gestational age. Results SSRI exposure during two or more trimesters was associated with a decrease in birthweight of 205 g [95% confidence interval (CI) -372 to - 38] and a decrease in gestational length of 4.9 days (95% CI - 9.1 to - 1.4). Neither maternal SSRI use in one trimester, lifetime history of major depression nor depressive symptoms during pregnancy were associated with these pregnancy outcomes (for non-pharmacologically treated depression in two periods in pregnancy, +5 g (95% CI - 56 to + 67) and +4.9 days (95% CI - 4.7 to + 14.7), respectively). Conclusions Prenatal exposure to SSRIs during two or more trimesters may decrease birthweight and gestational length. Our results indicate that neither maternal depression nor shared genetics and family environment fully explain this association.
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Affiliation(s)
| | - Olav Spigset
- Department of Clinical Pharmacology, St Olav's University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ragnhild Eek Brandlistuen
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway.,Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Eivind Ystrom
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Gideon Koren
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway.,Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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Bravo K, Eugenín JL, Llona I. Perinatal Fluoxetine Exposure Impairs the CO2 Chemoreflex. Implications for Sudden Infant Death Syndrome. Am J Respir Cell Mol Biol 2017; 55:368-76. [PMID: 27018763 DOI: 10.1165/rcmb.2015-0384oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
High serotonin levels during pregnancy affect central nervous system development. Whether a commonly used antidepressant such as fluoxetine (a selective serotonin reuptake inhibitor) taken during pregnancy may adversely affect respiratory control in offspring has not been determined. The objective was to determine the effect of prenatal-perinatal fluoxetine exposure on the respiratory neural network in offspring, particularly on central chemoreception. Osmotic minipumps implanted into CF-1 mice on Days 5-7 of pregnancy delivered 7 milligrams per kilogram per day of fluoxetine, achieving plasma levels within the range found in patients. Ventilation was assessed in offspring at postnatal Days 0-40 using head-out body plethysmography. Neuronal activation was evaluated in the raphe nuclei and in the nucleus tractus solitarius by c-Fos immunohistochemistry during normoxic eucapnia and hypercapnia (10% CO2). Respiratory responses to acidosis were evaluated in brainstem slices. Prenatal-perinatal fluoxetine did not affect litter size, birth weight, or the postnatal growth curve. Ventilation under eucapnic normoxic conditions was similar to that of control offspring. Fluoxetine exposure reduced ventilatory responses to hypercapnia at P8-P40 (P < 0.001) but not at P0-P5. At P8, it reduced hypercapnia-induced neuronal activation in raphe nuclei (P < 0.05) and nucleus tractus solitarius (P < 0.01) and the acidosis-induced increase in the respiratory frequency in brainstem slices (P < 0.05). Fluoxetine applied acutely on control slices did not modify their respiratory response to acidosis. We concluded that prenatal-perinatal fluoxetine treatment impairs central respiratory chemoreception during postnatal life. These results are relevant in understanding the pathogenesis of respiratory failures, such as sudden infant death syndrome, associated with brainstem serotonin abnormalities and the failure of respiratory chemoreflexes.
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Affiliation(s)
- Karina Bravo
- Laboratorio de Sistemas Neurales, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
| | - Jaime L Eugenín
- Laboratorio de Sistemas Neurales, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
| | - Isabel Llona
- Laboratorio de Sistemas Neurales, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
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Bogen DL, Hanusa BH, Perel JM, Sherman F, Mendelson MA, Wisner KL. Corrected QT Interval and Methadone Dose and Concentrations in Pregnant and Postpartum Women. J Clin Psychiatry 2017; 78:e1013-e1019. [PMID: 28994902 PMCID: PMC7044002 DOI: 10.4088/jcp.16m11318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/02/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Methadone is a standard treatment for opioid dependence in pregnancy; however, its impact on maternal corrected QT interval (QTc) has not been evaluated. We studied the association between methadone dose and enantiomer-specific plasma concentrations and QTc among pregnant and postpartum women and newborns. We assessed the relevance of QTc screening guidelines for pregnant women and infants. METHODS From 2006 to 2008, plasma methadone concentrations were measured during pregnancy, postpartum, and in cord blood in women treated for opioid dependence at a single treatment program. Electrocardiograms (ECGs) were obtained at peak methadone concentrations in mothers and within 48 hours of birth for infants. Pearson correlations were performed at each time point for QTc and R-methadone, S-methadone, and total methadone concentrations and ratio of R-methadone/S-methadone concentrations. RESULTS Mean (SD) daily methadone dose for the 25 women was 94.2 (39.1) mg during pregnancy and 112.5 (46.6) mg postpartum. During the third trimester, higher methadone dose and R-methadone concentration correlated with longer QTc (Pearson r = 0.67, P < .001 and Pearson r = 0.49, P = .02, respectively), while S-methadone concentration, R-methadone/S-methadone concentration ratio, and total methadone concentration did not. Postpartum, QTc did not significantly correlate with dose or enantiomer concentrations. Infant QTc did not correlate with maternal dose at delivery or enantiomer-specific cord methadone concentrations. In pregnant and postpartum women, 13% and 17%, respectively, had QTc ≥ 450 ms, as did 19% of infants. CONCLUSIONS QTc correlated with dose and R-methadone concentration during the third trimester. However, longer QTc was common among women during and after pregnancy. Given the relatively high rate of QTc > 450 ms, an ECG before and after methadone initiation is advisable for pregnant and postpartum women.
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Affiliation(s)
- Debra L. Bogen
- Department of Pediatrics, University of Pittsburgh School of Medicine, Division of General Academic Pediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania,Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania,Corresponding author: Debra L. Bogen, MD, FAAP, FABM, University of Pittsburgh School of Medicine, Division of General Academic Pediatrics, Children’s Hospital of Pittsburgh, 3414 Fifth Ave, CHOB 3rd floor, Pittsburgh, PA 15213 ()
| | - Barbara H. Hanusa
- Department of Pediatrics, University of Pittsburgh School of Medicine, Division of General Academic Pediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - James M. Perel
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
| | - Frederick Sherman
- Department of Pediatrics, University of Pittsburgh School of Medicine, Division of Pediatric Cardiology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marla A. Mendelson
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katherine L. Wisner
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Behar J, Zhu T, Oster J, Niksch A, Mah DY, Chun T, Greenberg J, Tanner C, Harrop J, Sameni R, Ward J, Wolfberg AJ, Clifford GD. Evaluation of the fetal QT interval using non-invasive fetal ECG technology. Physiol Meas 2016; 37:1392-403. [PMID: 27480078 DOI: 10.1088/0967-3334/37/9/1392] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Non-invasive fetal electrocardiography (NI-FECG) is a promising alternative continuous fetal monitoring method that has the potential to allow morphological analysis of the FECG. However, there are a number of challenges associated with the evaluation of morphological parameters from the NI-FECG, including low signal to noise ratio of the NI-FECG and methodological challenges for getting reference annotations and evaluating the accuracy of segmentation algorithms. This work aims to validate the measurement of the fetal QT interval in term laboring women using a NI-FECG electrocardiogram monitor. Fetal electrocardiogram data were recorded from 22 laboring women at term using the NI-FECG and an invasive fetal scalp electrode simultaneously. A total of 105 one-minute epochs were selected for analysis. Three pediatric electrophysiologists independently annotated individual waveforms and averaged waveforms from each epoch. The intervals measured on the averaged cycles taken from the NI-FECG and the fetal scalp electrode showed a close agreement; the root mean square error between all corresponding averaged NI-FECG and fetal scalp electrode beats was 13.6 ms, which is lower than the lowest adult root mean square error of 16.1 ms observed in related adult QT studies. These results provide evidence that NI-FECG technology enables accurate extraction of the fetal QT interval.
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Affiliation(s)
- Joachim Behar
- Biomedical Engineering Faculty, Technion-IIT, Haifa, Israel. University of Oxford, Oxford, UK
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Urato AC. Are the SSRI antidepressants safe in pregnancy? Understanding the debate. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2016; 27:93-9. [PMID: 26410012 DOI: 10.3233/jrs-150646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rates of antidepressant use during pregnancy are rising worldwide. It is, therefore, essential to determine the effects of these medications in pregnancy and on the developing fetus. OBJECTIVE To review the two main explanatory models for understanding the effects of antidepressant use during pregnancy and compare the evidence to support them. METHODS Review, synthesis, and discussion of the available literature. RESULTS The preponderance of the basic science, animal data, and human studies supports the view that the Harmful Chemical Model is the best explanatory framework for understanding the effects of the SSRI antidepressants during pregnancy. They do not appear to be helpful medications that produce better outcomes for moms and babies. They are not like using insulin in pregnant diabetics. Their profile fits more with a harmful chemical exposure. CONCLUSIONS The totality of the scientific evidence convincingly suggests that the SSRI antidepressants are chemicals that do cause fetal harm and that the FDA should strongly consider changing the FDA Category from C to D for the entire class. This move would provide appropriate warning to the public while still allowing for use in selected cases.
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Affiliation(s)
- Adam C Urato
- Tufts University School of Medicine, Maternal-Fetal Medicine Attending Physician, Tufts Medical Center, Boston, MA, USA.,MetroWest Medical Center, Framingham, MA, USA
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Bellantuono C, Vargas M, Mandarelli G, Nardi B, Martini MG. The safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and breastfeeding: a comprehensive review. Hum Psychopharmacol 2015; 30:143-51. [PMID: 25784291 DOI: 10.1002/hup.2473] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 02/12/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The present study provides a comprehensive review of the existing literature on the safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and lactation. METHODS Studies published in English, reporting the use of SNRIs in pregnant and/or breastfeeding women, were identified by searching MEDLINE/Pubmed, PsycINFO, and EMBASE. RESULTS Twenty-nine studies were included in the review. Altogether, the initial evidence coming from the reviewed studies suggests a lack of association between SNRIs and an increased risk of major congenital malformations. Conversely, exposure to SNRIs seems to be significantly associated with an increased risk of some perinatal complications. No neonatal adverse events emerged, so far, in the few studies concerning the safety of SNRIs during breastfeeding. CONCLUSIONS Available data suggest that venlafaxine is relatively safe during pregnancy, in particular as far as major malformations are concerned, whereas considering the small number of studies published, no definitive conclusions can be drawn on its safety during breastfeeding. Because of the few studies so far published, the safety of duloxetine during pregnancy and breastfeeding remains to be well established.
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Affiliation(s)
- Cesario Bellantuono
- Psychiatric Unit and DEGRA Center, United Hospitals of Ancona and Academic Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
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QTc interval prolongation and torsade de pointes associated with second-generation antipsychotics and antidepressants: a comprehensive review. CNS Drugs 2014; 28:887-920. [PMID: 25168784 DOI: 10.1007/s40263-014-0196-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We comprehensively reviewed published literature to determine whether it supported the link between corrected QT (QTc) interval prolongation and torsade de pointes (TdP) for the 11 second-generation antipsychotics and seven second-generation antidepressants commonly implicated in these complications. Using PubMed and EMBASE, we identified four thorough QT studies (one each for iloperidone, ziprasidone, citalopram, and escitalopram), 40 studies specifically designed to assess QTc interval prolongation or TdP, 58 publications based on data from efficacy and safety trials, 18 toxicology studies, and 102 case reports. Thorough QT studies, QTc prolongation-specific studies, and studies based on efficacy and safety trials did not link drug-associated QTc interval prolongation with TdP. They only showed that the drugs reviewed caused varying degrees of QTc interval prolongation, and even that information was not clear and consistent enough to stratify individual drugs for this risk. The few toxicology studies provided valuable information but their findings are pertinent only to situations of drug overdose. Case reports were most informative about the drug-QTc interval prolongation-TdP link. At least one additional well established risk factor for QTc prolongation was present in 92.2 % of case reports. Of the 28 cases of TdP, six (21.4 %) experienced it with QTc interval <500 ms; 75 % of TdP cases occurred at therapeutic doses. There is little evidence that drug-associated QTc interval prolongation by itself is sufficient to predict TdP. Future research needs to improve its precision and broaden its scope to better understand the factors that facilitate or attenuate progression of drug-associated QTc interval prolongation to TdP.
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Mago R, Tripathi N, Andrade C. Cardiovascular adverse effects of newer antidepressants. Expert Rev Neurother 2014; 14:539-51. [DOI: 10.1586/14737175.2014.908709] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
INTRODUCTION Several concerns have been raised regarding the reproductive safety of the antidepressants most frequently used in clinical practice, such as selective serotonin reuptake inhibitors (SSRIs). AREAS COVERED This article aims to assess the risk/benefit ratio of the use of alternative pharmacological options, specifically tricyclic antidepressants (TCAs) in pregnancy and puerperium. EXPERT OPINION Although TCAs have been prescribed for several decades, their own teratogenic potential to cause structural defects remains undetermined. However, some signals seem to exist suggesting that prenatal clomipramine exposure may increase the risk of cardiac defects. Moreover, TCAs have been associated with the risk of prenatal antidepressant exposure syndrome. Among TCAs, clomipramine seems to be associated with more severe and prolonged neonatal symptoms. However, some findings of this syndrome reported with SSRI use, such as persistent pulmonary hypertension of the newborn, necrotizing enterocolitis and QT prolongation, have not been described after TCA exposure. Hence, current evidence suggests that, as a group, a preference of TCAs over SSRIs in early pregnancy is not justified. In contrast, there appears to be a small gain in safety if TCAs (with the exception of clomipramine) are used in late pregnancy. Among this class of antidepressants, nortriptyline seems to be safest medication for use during breastfeeding.
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Affiliation(s)
- Salvatore Gentile
- Mental Health Center Cava de' Tirreni - Vietri sul Mare, Department of Mental Health, ASL Salerno , Cava de' Tirreni, Piazza Galdi, 841013 Cava de' Tirreni (Salerno) , Italy +39 089 4455439 ; +39 089 4455440 ;
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Pearlstein T. Use of Psychotropic Medication during Pregnancy and the Postpartum Period. WOMENS HEALTH 2013; 9:605-15. [DOI: 10.2217/whe.13.54] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Women with active psychiatric disorders who become pregnant face treatment dilemmas. Although results from studies are inconsistent, small but significant, risks on birth outcomes occur with exposure to untreated disorders, as well as to psychotropic medications. Prenatal antidepressant medication exposure may increase the risk for spontaneous miscarriage, preterm birth, cardiac malformations, persistent pulmonary hypertension of the newborn and postnatal adaptation syndrome. The use of valproate is contraindicated during pregnancy due to teratogenicity and neurocognitive delay and deficits. This review of selected studies will highlight some of the current issues with the use of psychotropic medications during pregnancy and the postpartum period.
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Affiliation(s)
- Teri Pearlstein
- Alpert Medical School of Brown University, Women's Medicine Collaborative, 146 West River Street, Providence, RI 02904, USA, Tel.: +1 401 793 7020, Fax: +1 401 793 7407,
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Källén B, Borg N, Reis M. The use of central nervous system active drugs during pregnancy. Pharmaceuticals (Basel) 2013; 6:1221-86. [PMID: 24275849 PMCID: PMC3817603 DOI: 10.3390/ph6101221] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/10/2013] [Accepted: 09/25/2013] [Indexed: 12/03/2022] Open
Abstract
CNS-active drugs are used relatively often during pregnancy. Use during early pregnancy may increase the risk of a congenital malformation; use during the later part of pregnancy may be associated with preterm birth, intrauterine growth disturbances and neonatal morbidity. There is also a possibility that drug exposure can affect brain development with long-term neuropsychological harm as a result. This paper summarizes the literature on such drugs used during pregnancy: opioids, anticonvulsants, drugs used for Parkinson's disease, neuroleptics, sedatives and hypnotics, antidepressants, psychostimulants, and some other CNS-active drugs. In addition to an overview of the literature, data from the Swedish Medical Birth Register (1996-2011) are presented. The exposure data are either based on midwife interviews towards the end of the first trimester or on linkage with a prescribed drug register. An association between malformations and maternal use of anticonvulsants and notably valproic acid is well known from the literature and also demonstrated in the present study. Some other associations between drug exposure and outcome were found.
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Affiliation(s)
- Bengt Källén
- Tornblad Institute, Lund University, Biskopsgatan 7, Lund SE-223 62, Sweden
| | - Natalia Borg
- Department of Statistics, Monitoring and Analyses, National Board of Health and Welfare, Stockholm SE-106 30, Sweden; E-Mail:
| | - Margareta Reis
- Department of Medical and Health Sciences, Clinical Pharmacology, Linköping University, Linköping SE-581 85, Sweden; E-Mail:
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Czaja AS, Valuck RJ, Anderson HD. Comparative safety of selective serotonin reuptake inhibitors among pediatric users with respect to adverse cardiac events. Pharmacoepidemiol Drug Saf 2013; 22:607-14. [DOI: 10.1002/pds.3420] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 01/15/2013] [Accepted: 01/20/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Angela S. Czaja
- Department of Pediatrics, School of Medicine; University of Colorado; Aurora CO USA
- Children's Hospital Colorado; Aurora CO USA
| | - Robert J. Valuck
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado; Aurora CO USA
- Department of Epidemiology, Colorado School of Public Health; University of Colorado; Aurora CO USA
- Department of Family Medicine, School of Medicine; University of Colorado; Aurora CO USA
| | - Heather D. Anderson
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado; Aurora CO USA
- Department of Epidemiology, Colorado School of Public Health; University of Colorado; Aurora CO USA
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Urato AC, Domar AD. Reply: Risks of untreated depression outweigh any risks of SSRIs. Hum Reprod 2013; 28:1146-8. [PMID: 23406972 DOI: 10.1093/humrep/det008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Domar AD, Moragianni VA, Ryley DA, Urato AC. The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond. Hum Reprod 2012; 28:160-71. [PMID: 23117129 DOI: 10.1093/humrep/des383] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the current literature on the safety and efficacy of selective serotonin reuptake inhibitor (SSRI) use in infertile women? SUMMARY ANSWER There is little evidence that infertile women benefit from taking an SSRI, therefore they should be counseled appropriately about the risks and be advised to consider alternate safer treatments to treat depressive symptoms. WHAT IS KNOWN ALREADY SSRI use is associated with possible reduced infertility treatment efficacy as well as higher rates of pregnancy loss, preterm birth, pregnancy complications, neonatal issues and long-term neurobehavioral abnormalities in offspring. STUDY DESIGN, SIZE, DURATION Review of existing literature. PARTICIPANTS/MATERIALS, SETTING, METHODS We conducted a review of all published studies that evaluate females with depressive symptoms who are taking antidepressant medications and who are experiencing infertility. MAIN RESULTS AND THE ROLE OF CHANCE Antidepressant use during pregnancy is associated with increased risks of miscarriage, birth defects, preterm birth, newborn behavioral syndrome, persistent pulmonary hypertension of the newborn and possible longer term neurobehavioral effects. There is no evidence of improved pregnancy outcomes with antidepressant use. There is some evidence that psychotherapy, including cognitive-behavioral therapy as well as physical exercise, is associated with significant decreases in depressive symptoms in the general population; research indicates that some forms of counseling are effective in treating depressive symptoms in infertile women. LIMITATIONS, REASONS FOR CAUTION Our findings are limited by the availability of published studies in the field, which are often retrospective and of small size. WIDER IMPLICATIONS OF THE FINDINGS Practitioners who care for infertility patients should have a thorough understanding of the published literature so that they can adequately counsel their patients. STUDY FUNDING/COMPETING INTEREST(S) None.
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Affiliation(s)
- A D Domar
- Boston IVF, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, 130 Second Avenue, Waltham, MA 02451, USA.
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FETAL EFFECTS OF SELECTIVE SEROTONIN REUPTAKE INHIBITOR TREATMENT DURING PREGNANCY: IMMEDIATE AND LONGER TERM CHILD OUTCOMES. ACTA ACUST UNITED AC 2012. [DOI: 10.1017/s0965539512000095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ababneh D, Ritchie H, Webster WS. Antidepressants Cause Bradycardia and Heart Block in GD 13 Rat Embryos In Vitro. ACTA ACUST UNITED AC 2012; 95:184-93. [DOI: 10.1002/bdrb.21003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Deena Ababneh
- Department of Anatomy and Histology; Sydney Medical School; University of Sydney; Sydney; Australia
| | - Helen Ritchie
- Discipline of Biomedical Sciences,; Sydney Medical School; University of Sydney; Sydney; Australia
| | - William S. Webster
- Department of Anatomy and Histology; Sydney Medical School; University of Sydney; Sydney; Australia
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Dubnov-Raz G, Hemilä H, Vurembrand Y, Kuint J, Maayan-Metzger A. Maternal use of selective serotonin reuptake inhibitors during pregnancy and neonatal bone density. Early Hum Dev 2012; 88:191-4. [PMID: 21890289 DOI: 10.1016/j.earlhumdev.2011.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 07/24/2011] [Accepted: 08/06/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRI) are commonly used to treat depression in pregnant women. Several adverse effects of prenatal SSRI exposure on the offspring have been described, including decreased growth. SSRI use by adults decreases bone mineral density, but this effect had not been examined in infants. AIM To examine growth parameters and bone mineral density of infants born to mothers using SSRIs during pregnancy. STUDY DESIGN Anthropometric variables and bone density were compared between 40 newborns exposed to SSRIs in utero, and 40 gestational-age matched control infants. Tibial bone speed of sound, a marker of bone density and strength, was measured using quantitative ultrasound. The difference in bone speed of sound between the two groups was compared using linear models, adjusting for relevant confounders. RESULTS Infants in the SSRI-exposed group were shorter, with a marginal statistical significance (49.3±2.1 vs. 50.1±1.3cm, p=0.07), while mean birth weight did not differ substantially between study groups. Head circumference was significantly smaller in the SSRI group (33.8±1.2 vs 34.4±1.1cm, p=0.005), remaining so even after adjustment for several confounders. No considerable difference was found in the bone speed of sound between SSRI-exposed infants and controls (3011±116 vs. 3029±129m/s). CONCLUSIONS We found no evidence that prenatal SSRI exposure hindered neonatal bone quality, yet a marginally shorter length and a smaller head circumference raise the possibility of an effect on bone growth. We conclude that the effect of SSRIs on fetal bone density seems minimal or absent.
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Affiliation(s)
- Gal Dubnov-Raz
- Exercise, Nutrition and Lifestyle Clinic, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIMITTEL IN SCHWANGERSCHAFT UND STILLZEIT 2012. [PMCID: PMC7271212 DOI: 10.1016/b978-3-437-21203-1.10002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Urato AC. Antidepressants and Pregnancy: Continued Evidence of Harm—Still No Evidence of Benefit. ACTA ACUST UNITED AC 2012. [DOI: 10.1891/1559-4343.13.3.190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Antidepressant medication use during pregnancy is increasing. It is essential that women of childbearing age, pregnant women, and their health care providers be aware of the risks, benefits, and alternatives prior to taking these agents. The best available evidence suggests that antidepressant use by pregnant women may be associated with miscarriage, birth defects, preterm birth, decreased birth weight, neonatal behavioral syndrome, persistent pulmonary hypertension in the newborn, neonatal electrocardiogram (EKG) changes, and behavioral effects. Evidence of benefit is lacking. The hope that improved maternal mood through medication would lead to better pregnancy results has not been realized; the antidepressant-exposed pregnancies are faring worse. The available evidence raises the question: Are we exposing a generation of women and their babies to drugs that are causing significantly more harm than good?
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Autret-Leca É, Cissoko H, Jonville-Béra AP. Risque néonatal des médicaments pris à la fin de la grossesse. Therapie 2011; 66:431-6. [DOI: 10.2515/therapie/2011057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 06/20/2011] [Indexed: 11/20/2022]
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Sit D, Perel JM, Wisniewski SR, Helsel JC, Luther JF, Wisner KL. Mother-infant antidepressant concentrations, maternal depression, and perinatal events. J Clin Psychiatry 2011; 72:994-1001. [PMID: 21824458 PMCID: PMC3158589 DOI: 10.4088/jcp.10m06461] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 10/26/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The authors explored the relationship of cord-maternal antidepressant concentration ratios and maternal depression with perinatal events and preterm birth. METHOD The investigators examined 21 mother-infant pairs that had antidepressant exposure during pregnancy. The antidepressants included serotonin reuptake inhibitors (SRIs) and nortriptyline (a norepinephrine inhibitor and mild SRI). The mothers were evaluated with the Structured Clinical Interview for DSM-IV. Depression ratings were repeated at 20, 30, and 36 weeks' pregnancy. At delivery, investigators assessed cord and maternal antidepressant concentrations, neonatal outcomes on the Peripartum Events Scale (PES), and gestational weeks at birth. The investigators performed this study at the Women's Behavioral HealthCARE Program, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pennsylvania, from April 2003 until September 2006. RESULTS Mean ± SD cord-to-maternal concentration ratios were 0.52 ± 0.35 (range, 0.00-1.64) for the parent drug and 0.54 ± 0.17 (range, 0.28-0.79) for the metabolite. Nine of 21 mothers (43%) had a major depressive episode. From examining the maximum depression ratings, the mean ± SD Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms Version score was 16.0 ± 7.6. One third (7/21) of infants had at least 1 perinatal event (PES ≥ 1). The frequency of deliveries complicated by any perinatal event was similar in depressed and nondepressed mothers. There was no significant association between perinatal events and cord-to-maternal antidepressant concentration ratios or maternal depression levels. Exposure to short half-life antidepressants compared to fluoxetine resulted in more perinatal events (7/16 = 44% vs 0/5 = 0%; P = .06). Fourteen percent (3/21) of infants were preterm. Preterm birth was not associated with cord-to-maternal metabolite concentration ratios, depression levels, or exposure to fluoxetine. CONCLUSIONS Antidepressant-exposed infants experienced a limited number of transient perinatal events. No association between cord-maternal concentration ratios or maternal depression and perinatal events could be identified. Contrary to other reports, we detected no increased risk for perinatal events with fluoxetine therapy compared to the short half-life antidepressants. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00279370.
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Affiliation(s)
- Dorothy Sit
- Women's Behavioral HealthCARE, Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O'Hara St, Oxford 410, Pittsburgh, PA 15213, USA.
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Reis M, Källén B. Delivery outcome after maternal use of antidepressant drugs in pregnancy: an update using Swedish data. Psychol Med 2010; 40:1723-1733. [PMID: 20047705 DOI: 10.1017/s0033291709992194] [Citation(s) in RCA: 252] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Concerns have been expressed about possible adverse effects of the use of antidepressant medication during pregnancy, including risk for neonatal pathology and the presence of congenital malformations. METHOD Data from the Swedish Medical Birth Register (MBR) from 1 July 1995 up to 2007 were used to identify women who reported the use of antidepressants in early pregnancy or were prescribed antidepressants during pregnancy by antenatal care: a total of 14 821 women with 15 017 infants. Maternal characteristics, maternal delivery diagnoses, infant neonatal diagnoses and the presence of congenital malformations were compared with all other women who gave birth, using the Mantel-Haenszel technique and with adjustments for certain characteristics. RESULTS There was an association between antidepressant treatment and pre-existing diabetes and chronic hypertension but also with many pregnancy complications. Rates of induced delivery and caesarean section were increased. The preterm birth rate was increased but not that of intrauterine growth retardation. Neonatal complications were common, notably after tricyclic antidepressant (TCA) use. An increased risk of persistent pulmonary hypertension of the newborn (PPHN) was verified. The congenital malformation rate was increased after TCAs. An association between use of paroxetine and congenital heart defects was verified and a similar effect on hypospadias was seen. CONCLUSIONS Women using antidepressants during pregnancy and their newborns have increased pathology. It is not clear how much of this is due to drug use or underlying pathology. Use of TCAs was found to carry a higher risk than other antidepressants and paroxetine seems to be associated with a specific teratogenic property.
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Affiliation(s)
- M Reis
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
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Bigos KL, Pollock BG, Stankevich BA, Bies RR. Sex differences in the pharmacokinetics and pharmacodynamics of antidepressants: an updated review. ACTA ACUST UNITED AC 2010; 6:522-43. [PMID: 20114004 DOI: 10.1016/j.genm.2009.12.004] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2009] [Indexed: 01/05/2023]
Abstract
BACKGROUND An increasing number of studies have reported differences in the pharmacokinetics and/or pharmacodynamics of antidepressants between women and men. OBJECTIVES This article updates previously published literature describing sex differences in the pharmacokinetics and pharmacodynamics of antidepressants, and examines specific issues that face women with psychiatric illness. METHODS An English-language literature search was performed with the PubMed database (March 2003-December 2008) using combinations of the search terms sex, gender, and antidepressants. In addition, each antidepressant was identified in the 63rd edition of the Physicians' Desk Reference. RESULTS The current data suggest that the pharmacokinetics of antidepressants can be substantially different between women and men. Likewise, the response to antidepressants can be quite variable, including sex differences in adverse effects and time to response. CONCLUSIONS Despite the many sex differences reported, there is still little published work systematically evaluating potential sex differences in antidepressant pharmacokinetics and pharmacodynamics. More research is needed to guide the treatment of depression and other mental illnesses.
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Affiliation(s)
- Kristin L Bigos
- Clinical Brain Disorders Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA.
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On categorizing gestational, birth, and neonatal complications following late pregnancy exposure to antidepressants: the prenatal antidepressant exposure syndrome. CNS Spectr 2010; 15:167-85. [PMID: 20414166 DOI: 10.1017/s1092852900027449] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Late in utero exposure to antidepressants has been suspected of adversely impacting pregnancy outcome and compromising neonatal adaptation. Hence, the necessity exists to analyze published information on antidepressant use during late pregnancy to individuate potential recurrent patterns of iatrogenic complications. METHODS Computerized searches on MEDLINE, PsycINFO, ENBASE, and Cochrane Library through February 10, 2010 were performed for selecting literature information and investigating the safety of antidepressants when used during late pregnancy. RESULTS Antidepressant treatment during late pregnancy may increase the rates of poor pregnancy outcome and neonatal withdrawal/toxic reactions. CONCLUSIONS Because both gestational complications and neonatal adverse events acknowledge the same etiology, the author suggests including such iatrogenic events under the definition of prenatal antidepressant exposure syndrome, in order to increase clinicians' awareness about the spectrum of risks which may concern the mother-infant pair when antidepressant treatment is deemed indispensable during late pregnancy.
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Pavone LM, Spina A, Rea S, Santoro D, Mastellone V, Lombardi P, Avallone L. Serotonin transporter gene deficiency is associated with sudden death of newborn mice through activation of TGF-beta1 signalling. J Mol Cell Cardiol 2009; 47:691-7. [PMID: 19646988 DOI: 10.1016/j.yjmcc.2009.07.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 07/21/2009] [Accepted: 07/21/2009] [Indexed: 11/29/2022]
Abstract
The serotonin transporter (SERT) gene has been proposed as a candidate gene responsible for the sudden infant death syndrome (SIDS). In this study, for the first time we obtained a SERT-knockout (KO) mouse model which reproduces SIDS phenotype. SERT-KO mice were generated by mating SERT(Cre/+) heterozygous mice. The SERT-KO mouse embryos at the pre-natal stage E18.5 were lacking of SERT mRNA and protein expression in the heart. A premature death of 75% of SERT-KO mice occurred in the first week after birth. LacZ staining of whole mounts and tissue sections of the heart from SERT(Cre/+);ROSA26R adult mice and E18.5 embryos demonstrated a marked localized expression of SERT in the right ventricle, the conal region, the vasculature, the atrial septum, the ventricular valves, and the sinoatrial node of the conduction system. These data suggest a cardiac phenotype for the sudden death of SERT-KO mice. Histological analysis of heart sections showed that SERT-KO mice develop cardiac fibrosis. Increased collagen accumulation in the myocardium and the valvular and perivascular regions, and enhanced expression of alpha-smooth muscle actin were detected in the heart of SERT-KO mice versus wild-type (WT) mice. Interestingly, higher expression levels of the 5-HT2A receptor and increased levels of phospho-SMAD2/3 and phospho-ERK1/2 were detected in SERT-KO mouse heart versus WT mice. Overall, our findings provide i) new insights into the role of SERT gene in SIDS, and ii) the first in vivo validation of the molecular mechanism involving the activation of TGF-beta1 signalling in the cardiac fibrosis.
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Affiliation(s)
- Luigi Michele Pavone
- Department of Biological Structures, Functions and Technologies, University of Naples Federico II, Via F. Delpino 1, 80137 Naples, Italy.
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Courtney K. Use of SSRIs in pregnancy: neonatal implications. Nurs Womens Health 2009; 13:234-238. [PMID: 19523137 DOI: 10.1111/j.1751-486x.2009.01424.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Kathleen Courtney
- Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, OH, USA.
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Tuccori M, Testi A, Antonioli L, Fornai M, Montagnani S, Ghisu N, Colucci R, Corona T, Blandizzi C, Tacca MD. Safety concerns associated with the use of serotonin reuptake inhibitors and other serotonergic/noradrenergic antidepressants during pregnancy: A review. Clin Ther 2009; 31 Pt 1:1426-53. [DOI: 10.1016/j.clinthera.2009.07.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2009] [Indexed: 11/27/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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