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Lupattelli A, Branquinho M, Cardoso C, Tauqeer F, Bjørndal LD, Fonseca A. Psychometric properties of the Decisional Conflict Scale in a sample of perinatal women with depressive symptoms: A study in Portugal and Norway. PATIENT EDUCATION AND COUNSELING 2024; 127:108337. [PMID: 38820986 DOI: 10.1016/j.pec.2024.108337] [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: 11/03/2023] [Revised: 04/10/2024] [Accepted: 05/20/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE To assess the psychometric properties, i.e., reliability and construct validity of the 16-item Decisional Conflict Scale (DCS) and sub-scales in women with perinatal depressive symptoms in Norway and Portugal. METHODS We included 415 women in Portugal and 163 in Norway (≥18 years) who were pregnant or had given birth in the last 12 months and presenting with active depressive symptoms. Women replied to the original DCS items. We conducted confirmatory factor analysis, estimated internal consistency reliability, and examined factorial invariance across country, perinatal status, and treatment uptake. RESULTS The DCS factor model had good fit to the data, with all items loading significantly on their respective factor (.585 to .958). There was configural invariance of the DCS across countries, treatment, and perinatal status. The internal consistency of the total DCS (Cronbach's alpha) was .958, and for the subscales it ranged from .798 to .947. CONCLUSIONS The DCS is a valid and reliable measure of the decisional conflict in women with perinatal depressive symptoms in Portugal and Norway. PRACTICE IMPLICATIONS Measuring the extent of decisional conflict regarding treatment and the effect of multiple interventions towards its reduction, is critical to facilitate the decision-making process of women with perinatal mental illness.
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Affiliation(s)
- Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
| | - Mariana Branquinho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Catarina Cardoso
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Fatima Tauqeer
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Ludvig D Bjørndal
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Ana Fonseca
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
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Callovini T, Montanari S, Bardi F, Barbonetti S, Rossi S, Caso R, Mandracchia G, Margoni S, Brugnami A, Paolini M, Manfredi G, Giudice LL, Segatori D, Zanzarri A, Onori L, Calderoni C, Benini E, Marano G, Massetti M, Fiaschè F, Di Segni F, Janiri D, Simonetti A, Moccia L, Grisoni F, Ruggiero S, Bartolucci G, Biscosi M, Ferrara OM, Bernardi E, Monacelli L, Giannico AM, De Berardis D, Battisti G, Ciliberto M, Brisi C, Lisci FM, D’Onofrio AM, Restaino A, Di Benedetto L, Anesini MB, Boggio G, Specogna E, Crupi A, De Chiara E, Caroppo E, Ieritano V, Monti L, Chieffo DPR, Rinaldi L, Camardese G, Cuomo I, Brugnoli R, Kotzalidis GD, Sani G, Mazza M. Obstetric Outcomes in Women on Lithium: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:4872. [PMID: 39201016 PMCID: PMC11355283 DOI: 10.3390/jcm13164872] [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: 07/24/2024] [Revised: 08/12/2024] [Accepted: 08/16/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Lithium taken during pregnancy was linked in the past with increased risk for foetal/newborn malformations, but clinicians believe that it is worse for newborn children not to treat the mothers' underlying psychiatric illness. We set to review the available evidence of adverse foetal outcomes in women who received lithium treatment for some time during their pregnancy. Methods: We searched four databases and a register to seek papers reporting neonatal outcomes of women who took lithium during their pregnancy by using the appropriate terms. We adopted the PRISMA statement and used Delphi rounds among all the authors to assess eligibility and the Cochrane Risk-of-Bias tool to evaluate the RoB of the included studies. Results: We found 28 eligible studies, 10 of which met the criteria for inclusion in the meta-analysis. The studies regarded 1402 newborn babies and 2595 women exposed to lithium. Overall, the systematic review found slightly increased adverse pregnancy outcomes for women taking lithium for both the first trimester only and any time during pregnancy, while the meta-analysis found increased odds for cardiac or other malformations, preterm birth, and a large size for gestational age with lithium at any time during pregnancy. Conclusions: Women with BD planning a pregnancy should consider discontinuing lithium when euthymic; lithium use during the first trimester and at any time during pregnancy increases the odds for some adverse pregnancy outcomes. Once the pregnancy has started, there is no reason for discontinuing lithium; close foetal monitoring and regular blood lithium levels may obviate some disadvantages of lithium administration during pregnancy.
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Affiliation(s)
- Tommaso Callovini
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Silvia Montanari
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Francesca Bardi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Sara Barbonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Sara Rossi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Romina Caso
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuseppe Mandracchia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Stella Margoni
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Andrea Brugnami
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marco Paolini
- Department of Psychiatry, Università Vita-Salute San Raffaele, 20132 Milan, Italy;
| | - Giovanni Manfredi
- UOC Psichiatria, Sant’Andrea University Hospital, Università La Sapienza of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy;
| | - Luca Lo Giudice
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Daniele Segatori
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Andrea Zanzarri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Onori
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Claudia Calderoni
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Elisabetta Benini
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuseppe Marano
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marco Massetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Federica Fiaschè
- ASL RM1, Presidio Ospedaliero San Filippo Neri, Servizio Psichiatrico di Diagnosi e Cura, Via Giovanni Martinotti, 20, 00135 Rome, Italy;
| | - Federica Di Segni
- ASL Roma 2, Dipartimento di Salute Mentale, Servizio Per Le Dipendenze Patologiche Distretto 7, Via dei Sestili 7, 00174 Rome, Italy;
| | - Delfina Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessio Simonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Lorenzo Moccia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Flavia Grisoni
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Sara Ruggiero
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giovanni Bartolucci
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marco Biscosi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Ottavia Marianna Ferrara
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Evelina Bernardi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Leonardo Monacelli
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessandro Michele Giannico
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | | | - Giulia Battisti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Michele Ciliberto
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Caterina Brisi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Francesco Maria Lisci
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Antonio Maria D’Onofrio
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Antonio Restaino
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Di Benedetto
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Maria Benedetta Anesini
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gianluca Boggio
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Elettra Specogna
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Arianna Crupi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Emanuela De Chiara
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Emanuele Caroppo
- Department of Mental Health, Local Health Authority Roma 2, 00159 Rome, Italy;
| | - Valentina Ieritano
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Laura Monti
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.M.); (D.P.R.C.)
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.M.); (D.P.R.C.)
- Department Women Children and Public Health, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Lucio Rinaldi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giovanni Camardese
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Ilaria Cuomo
- ASL RM1, UOC SM Distretto XIII ASL Roma 1, CSM Via Boccea 271271, 00168 Rome, Italy;
| | - Roberto Brugnoli
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Georgios D. Kotzalidis
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marianna Mazza
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy; (T.C.); (S.M.); (F.B.); (S.B.); (S.R.); (R.C.); (G.M.); (S.M.); (A.B.); (L.L.G.); (D.S.); (A.Z.); (L.O.); (E.B.); (M.M.); (D.J.); (A.S.); (L.M.); (F.G.); (S.R.); (G.B.); (M.B.); (O.M.F.); (E.B.); (L.M.); (A.M.G.); (G.B.); (M.C.); (C.B.); (F.M.L.); (A.M.D.); (A.R.); (L.D.B.); (M.B.A.); (G.B.); (E.S.); (A.C.); (E.D.C.); (V.I.); (L.R.); (G.C.); (R.B.); (G.D.K.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
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Meng LC, Lin CW, Chuang HM, Chen YY, Shang CY, Wu CY, Chen LK, Hsiao FY. Prescription Patterns and Predisposing Factors of Benzodiazepine and Z-Hypnotic Use During Pregnancy: A Nationwide Cohort Study. Pharmacoepidemiol Drug Saf 2024; 33:e5847. [PMID: 38898542 DOI: 10.1002/pds.5847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/04/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE The use of benzodiazepines and Z-hypnotics during pregnancy has raised significant concerns in recent years. However, there are limited data that capture the prescription patterns and predisposing factors in use of these drugs, particularly among women who have been long-term users of benzodiazepines and Z-hypnotics before pregnancy. METHODS This population-based cohort study comprised 2 930 988 pregnancies between 2004 and 2018 in Taiwan. Women who were dispensed benzodiazepines or Z-hypnotics during pregnancy were identified and further stratified into groups based on their status before pregnancy: long-term users (with a supply of more than 180 days within a year), short-term users (with a supply of less than 180 days within a year), and nonusers. Trends in the use of benzodiazepines or Z-hypnotics and concomitant use with antidepressants or opioids were assessed. Logistic regression models were utilized to identify factors associated with use of these drugs during pregnancy, and interrupted time series analyses (ITSA) were employed to evaluate utilization patterns of these drugs across different pregnancy-related periods. RESULTS The overall prevalence of benzodiazepine and Z-hypnotic use was 3.5% during pregnancy. Among prepregnancy long-term users, an upward trend was observed. The concomitant use of antidepressants or opioids among exposed women increased threefold (from 8.6% to 23.1%) and sixfold (from 0.3% to 1.7%) from 2004 to 2018, respectively. Women with unhealthy lifestyle behaviors, such as alcohol abuse (OR 2.48; 95% CI, 2.02-3.03), drug abuse (OR 10.34; 95% CI, 8.46-12.64), and tobacco use (OR 2.19; 95% CI, 1.96-2.45), as well as those with psychiatric disorders like anxiety (OR 6.99; 95% CI, 6.77-7.22), insomnia (OR 15.99; 95% CI, 15.55-16.45), depression (OR 9.43; 95% CI, 9.07-9.80), and schizophrenia (OR 21.08; 95% CI, 18.76-23.69), and higher healthcare utilization, were more likely to use benzodiazepines or Z-hypnotics during pregnancy. ITSA revealed a sudden decrease in use of benzodiazepines and Z-hypnotics after recognition of pregnancy (level change -0.55 percentage point; 95% CI, -0.59 to -0.51). In contrast, exposures to benzodiazepines and Z-hypnotics increased significantly after delivery (level change 0.12 percentage point; 95% CI, 0.09 to 0.16). CONCLUSIONS In this cohort study, an increased trend of benzodiazepine and Z-hypnotic use during pregnancy among prepregnancy long-term users, as well as concomitant use with antidepressants or opioids were found. The findings have highlighted the existence of various risk factors associated with the use of these drugs during pregnancy. Utilization patterns varied across different stages of pregnancy, highlighting the need for prescription guidelines and educational services for women using these drugs during pregnancy.
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Affiliation(s)
- Lin-Chieh Meng
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | - Hui-Min Chuang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Taiwan Drug Relief Foundation, Taipei, Taiwan
| | - Yi-Yung Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chi-Yung Shang
- Department of Psychiatry, National Taiwan University Hospital, and College of Medicine, Taipei, Taiwan
| | - Chia-Yi Wu
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
- Taiwanese Society of Suicidology, Taiwan Suicide Prevention Center, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital Managed by Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
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4
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Sani G, Callovini T, Ferrara OM, Segatori D, Margoni S, Simonetti A, Lisci FM, Marano G, Fischetti A, Kotzalidis GD, Di Segni F, Fiaschè F, Janiri D, Moccia L, Manfredi G, Alcibiade A, Brisi C, Grisoni F, Stella G, Bernardi E, Brugnami A, Ciliberto M, Spera MC, Caso R, Rossi S, Boggio G, Mastroeni G, Abate F, Conte E, Quintano A, De Chiara L, Monti L, Camardese G, Rinaldi L, Koukopoulos AE, Chieffo DPR, Angeletti G, Mazza M. Is Antipsychotic Drug Use During Pregnancy Associated with Increased Malformation Rates and Worsening of Maternal and Infant Outcomes? A Systematic Review. Curr Neuropharmacol 2024; 22:CN-EPUB-140389. [PMID: 38766824 PMCID: PMC11451318 DOI: 10.2174/1570159x22666240516151449] [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: 09/29/2023] [Revised: 10/17/2023] [Accepted: 10/29/2023] [Indexed: 05/22/2024] Open
Abstract
There is much debate about continuing antipsychotic medication in patients who need it when they become pregnant because benefits must be weighed against potential teratogenic and malformation effects related to antipsychotics themselves. To address this, we conducted a systematic review on the PubMed, PsycINFO and CINHAL databases and the ClinicalTrials.gov register using the following strategy: (toxicity OR teratogenicity OR malformation* OR "birth defect*" OR "congenital abnormality" OR "congenital abnormalities" OR "brain changes" OR "behavioral abnormalities" OR "behavioral abnormalities") AND antipsychotic* AND (pregnancy OR pregnant OR lactation OR delivery OR prenatal OR perinatal OR post-natal OR puerperium) on September 27, 2023. We found 38 studies to be eligible. The oldest was published in 1976, while most articles were recent. Most studies concluded that the antipsychotics, especially the second-generation antipsychotics, were devoid of teratogenic potential, while few studies were inconclusive and recommended replication. Most authoritative articles were from the Boston area, where large databases were implemented to study the malformation potential of psychiatric drugs. Other reliable databases are from Northern European registers. Overall conclusions are that antipsychotics are no more related to malformations than the disorders themselves; most studies recommend that there are no reasons to discontinue antipsychotic medications in pregnancy.
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Affiliation(s)
- Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ottavia Marianna Ferrara
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Daniele Segatori
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Stella Margoni
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessio Simonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Maria Lisci
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Marano
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessia Fischetti
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Georgios D. Kotzalidis
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Federica Di Segni
- Psychiatry Residency Training Programme, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Federica Fiaschè
- ASL RM1, Presidio Ospedaliero San Filippo Neri, Servizio Psichiatrico di Diagnosi e Cura, Via Martinotti, 20, 00136 Rome, Italy
| | - Delfina Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lorenzo Moccia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Manfredi
- UOC Psichiatria, Day Hospital, Sant'Andrea Teaching Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Alessandro Alcibiade
- Psychiatry Residency Training Programme, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy
- Marina Militare Italiana (Italian Navy), Defense Ministry of Italy, Piazza della Marina, 4, 00196 Rome, Italy
| | - Caterina Brisi
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Flavia Grisoni
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gianmarco Stella
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Evelina Bernardi
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Brugnami
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Michele Ciliberto
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Chiara Spera
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Romina Caso
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sara Rossi
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gianluca Boggio
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulia Mastroeni
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesca Abate
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Eliana Conte
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Early Intervention Unit, ASL Roma 3, 00152 Rome, Italy
| | - Anna Quintano
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lavinia De Chiara
- Struttura Residenziale Psichiatrica Samadi S.p.A., via di Grottarossa Km. 2.200, 00189 Rome, Italy and Centro Lucio Bini, Via Crescenzio 42, 00193 Rome, Italy
| | - Laura Monti
- UOS Clinical Psychology, Clinical Government, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Camardese
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lucio Rinaldi
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alexia E. Koukopoulos
- Azienda Ospedaliera Universitaria Policlinico Umberto I, Viale dell’Università 30, 00185 Rome, Italy and Centro Lucio Bini, Via Crescenzio 42, 00193 Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- UOS Clinical Psychology, Clinical Government, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Women, Children and Public Health Department, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Gloria Angeletti
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy
| | - Marianna Mazza
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Wang Z, Yuen AS, Wong KH, Chan AY, Coghill D, Simonoff E, Lau WC, Wong IC, Park S, Man KK. Association between prenatal antipsychotic exposure and the risk of attention-deficit/hyperactivity disorder and autism spectrum disorder: a systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 160:105635. [PMID: 38499117 DOI: 10.1016/j.neubiorev.2024.105635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/20/2024]
Abstract
The paucity of evidence regarding the safety of gestational antipsychotic exposure has led to treatment discontinuation in pregnant women with severe mental health conditions. This systematic review and meta-analysis aimed to summarise the current evidence on the association between gestational antipsychotic exposure and attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children (Study protocol registered in PROSPERO:CRD42022311354). Five studies included in our meta-analysis with around 8.6 million pregnancy episodes in nine different countries/regions. Results from our meta-analysis indicate that the heightened risks of ASD and ADHD in children gestationally exposed to antipsychotics appear to be attributable to maternal characteristics, rather than having a causal relationship with the antipsychotic exposure during pregnancy. The results underscore the importance of meticulously monitoring the neurodevelopment of children born to mothers with mental illnesses, which can facilitate early interventions and provide requisite support.
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Affiliation(s)
- Zixuan Wang
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, United Kingdom; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region China
| | - Andrew Sc Yuen
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Kirstie Htw Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom; Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region China
| | - Adrienne Yl Chan
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region China; Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom; Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region China; Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
| | - David Coghill
- Department of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Wallis Cy Lau
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region China; Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom; Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region China; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ian Ck Wong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region China; Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom; Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region China; Aston Pharmacy School, Aston University, Birmingham, United Kingdom; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sohee Park
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region China; Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.
| | - Kenneth Kc Man
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region China; Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom; Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region China; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
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6
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Honybun E, Cockle E, Malpas CB, O'Brien TJ, Vajda FJ, Perucca P, Rayner G. Neurodevelopmental and Functional Outcomes Following In Utero Exposure to Antiseizure Medication: A Systematic Review. Neurology 2024; 102:e209175. [PMID: 38531021 DOI: 10.1212/wnl.0000000000209175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/04/2023] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To undertake a systematic review of the available literature to examine the relationship between prenatal antiseizure medication (ASM) exposure and adverse postnatal neurodevelopmental outcomes, focusing on social, emotional, behavioral, and adaptive domains of human function, and the frequency of neurodevelopmental and psychiatric disorders in ASM-exposed offspring. METHODS Electronic searches of MEDLINE, PsychINFO, and EMBASE were conducted and limited to studies published between 1990 and 2023 in English. Studies were eligible if they prospectively or retrospectively reported neurodevelopmental outcomes of ASM-exposed offspring. The Newcastle-Ottawa scale was used to conduct methodologic quality assessments of included studies, and a narrative synthesis integrated the review findings. RESULTS Forty-three studies were included. Valproate has been consistently associated with a 2- to 4-fold increased risk of autism spectrum disorder (ASD), 2- to 5-fold increased risk of intellectual disability (ID), and poor adaptive functioning. Growing evidence indicates that topiramate is associated with a 2-fold increased risk of ASD and 3- to 4-fold increased risk of ID. The risks of adverse neurodevelopmental outcomes for valproate and topiramate seem to be dose dependent. Phenobarbital has been suggested to be associated with deleterious neurodevelopmental effects, but data are limited. Levetiracetam has recently been linked with an increased risk of attention deficit hyperactivity disorder and anxiety disorders in a single study. Carbamazepine has been associated with variable neurodevelopmental outcomes. Lamotrigine seems to be "safe" in terms of postnatal neurodevelopment. Data for oxcarbazepine, phenytoin, and clonazepam are limited but seem to have little-to-no risk of adverse outcomes. Evidence for the remaining ASMs, including gabapentin, pregabalin, lacosamide, zonisamide, clobazam, perampanel, ethosuximide, or brivaracetam, is lacking. Several methodologic limitations impeded data synthesis, including heterogeneity in outcome measures and small samples of monotherapy exposures. DISCUSSION The findings of this review support the conclusion that valproate and topiramate use during pregnancy is associated with a significantly increased risk of neurodevelopmental effects on the fetus. Apart from lamotrigine, which seems to be free of adverse neurodevelopmental effects, data for the other ASMs are mixed or inadequate to draw definite conclusions. Further research into the neurodevelopmental effects of prenatal exposure to ASMs, including most newer agents, is much needed.
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Affiliation(s)
- Eliza Honybun
- From the Melbourne School of Psychological Sciences (E.H., C.B.M., G.R.), The University of Melbourne; Epilepsy Research Centre (E.H., P.P., G.R.), Department of Medicine, Austin Hospital, The University of Melbourne; Department of Neuroscience (E.C., C.B.M., T.J.O.B., F.J.V., P.P., G.R.), Central Clinical School, Monash University; Department of Neurology (E.C., C.B.M., T.J.O.B., P.P., G.R.), The Alfred Hospital; Department of Neurology (C.B.M., T.J.O.B., F.J.V., P.P.), Royal Melbourne Hospital; Department of Medicine (C.B.M., T.J.O.B., F.J.V.), Royal Melbourne Hospital, The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health; and Department of Clinical Neuropsychology (G.R.), Austin Health, Melbourne, Australia
| | - Emily Cockle
- From the Melbourne School of Psychological Sciences (E.H., C.B.M., G.R.), The University of Melbourne; Epilepsy Research Centre (E.H., P.P., G.R.), Department of Medicine, Austin Hospital, The University of Melbourne; Department of Neuroscience (E.C., C.B.M., T.J.O.B., F.J.V., P.P., G.R.), Central Clinical School, Monash University; Department of Neurology (E.C., C.B.M., T.J.O.B., P.P., G.R.), The Alfred Hospital; Department of Neurology (C.B.M., T.J.O.B., F.J.V., P.P.), Royal Melbourne Hospital; Department of Medicine (C.B.M., T.J.O.B., F.J.V.), Royal Melbourne Hospital, The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health; and Department of Clinical Neuropsychology (G.R.), Austin Health, Melbourne, Australia
| | - Charles B Malpas
- From the Melbourne School of Psychological Sciences (E.H., C.B.M., G.R.), The University of Melbourne; Epilepsy Research Centre (E.H., P.P., G.R.), Department of Medicine, Austin Hospital, The University of Melbourne; Department of Neuroscience (E.C., C.B.M., T.J.O.B., F.J.V., P.P., G.R.), Central Clinical School, Monash University; Department of Neurology (E.C., C.B.M., T.J.O.B., P.P., G.R.), The Alfred Hospital; Department of Neurology (C.B.M., T.J.O.B., F.J.V., P.P.), Royal Melbourne Hospital; Department of Medicine (C.B.M., T.J.O.B., F.J.V.), Royal Melbourne Hospital, The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health; and Department of Clinical Neuropsychology (G.R.), Austin Health, Melbourne, Australia
| | - Terence J O'Brien
- From the Melbourne School of Psychological Sciences (E.H., C.B.M., G.R.), The University of Melbourne; Epilepsy Research Centre (E.H., P.P., G.R.), Department of Medicine, Austin Hospital, The University of Melbourne; Department of Neuroscience (E.C., C.B.M., T.J.O.B., F.J.V., P.P., G.R.), Central Clinical School, Monash University; Department of Neurology (E.C., C.B.M., T.J.O.B., P.P., G.R.), The Alfred Hospital; Department of Neurology (C.B.M., T.J.O.B., F.J.V., P.P.), Royal Melbourne Hospital; Department of Medicine (C.B.M., T.J.O.B., F.J.V.), Royal Melbourne Hospital, The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health; and Department of Clinical Neuropsychology (G.R.), Austin Health, Melbourne, Australia
| | - Frank J Vajda
- From the Melbourne School of Psychological Sciences (E.H., C.B.M., G.R.), The University of Melbourne; Epilepsy Research Centre (E.H., P.P., G.R.), Department of Medicine, Austin Hospital, The University of Melbourne; Department of Neuroscience (E.C., C.B.M., T.J.O.B., F.J.V., P.P., G.R.), Central Clinical School, Monash University; Department of Neurology (E.C., C.B.M., T.J.O.B., P.P., G.R.), The Alfred Hospital; Department of Neurology (C.B.M., T.J.O.B., F.J.V., P.P.), Royal Melbourne Hospital; Department of Medicine (C.B.M., T.J.O.B., F.J.V.), Royal Melbourne Hospital, The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health; and Department of Clinical Neuropsychology (G.R.), Austin Health, Melbourne, Australia
| | - Piero Perucca
- From the Melbourne School of Psychological Sciences (E.H., C.B.M., G.R.), The University of Melbourne; Epilepsy Research Centre (E.H., P.P., G.R.), Department of Medicine, Austin Hospital, The University of Melbourne; Department of Neuroscience (E.C., C.B.M., T.J.O.B., F.J.V., P.P., G.R.), Central Clinical School, Monash University; Department of Neurology (E.C., C.B.M., T.J.O.B., P.P., G.R.), The Alfred Hospital; Department of Neurology (C.B.M., T.J.O.B., F.J.V., P.P.), Royal Melbourne Hospital; Department of Medicine (C.B.M., T.J.O.B., F.J.V.), Royal Melbourne Hospital, The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health; and Department of Clinical Neuropsychology (G.R.), Austin Health, Melbourne, Australia
| | - Genevieve Rayner
- From the Melbourne School of Psychological Sciences (E.H., C.B.M., G.R.), The University of Melbourne; Epilepsy Research Centre (E.H., P.P., G.R.), Department of Medicine, Austin Hospital, The University of Melbourne; Department of Neuroscience (E.C., C.B.M., T.J.O.B., F.J.V., P.P., G.R.), Central Clinical School, Monash University; Department of Neurology (E.C., C.B.M., T.J.O.B., P.P., G.R.), The Alfred Hospital; Department of Neurology (C.B.M., T.J.O.B., F.J.V., P.P.), Royal Melbourne Hospital; Department of Medicine (C.B.M., T.J.O.B., F.J.V.), Royal Melbourne Hospital, The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health; and Department of Clinical Neuropsychology (G.R.), Austin Health, Melbourne, Australia
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Madley-Dowd P, Rast J, Ahlqvist VH, Zhong C, Martin FZ, Davies NM, Lyall K, Newschaffer C, Tomson T, Magnusson C, Rai D, Lee BK, Forbes H. Trends and patterns of antiseizure medication prescribing during pregnancy between 1995 and 2018 in the United Kingdom: A cohort study. BJOG 2024; 131:15-25. [PMID: 37340193 PMCID: PMC10730765 DOI: 10.1111/1471-0528.17573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/19/2023] [Accepted: 06/04/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE To examine antiseizure medication (ASM) prescription during pregnancy. DESIGN Population-based drug utilisation study. SETTING UK primary and secondary care data, 1995-2018, from the Clinical Practice Research Datalink GOLD version. POPULATION OR SAMPLE 752 112 completed pregnancies among women registered for a minimum of 12 months with an 'up to standard' general practice prior to the estimated start of pregnancy and for the duration of their pregnancy. METHODS We described ASM prescription across the study period, overall and by ASM indication, examined patterns of prescription during pregnancy including continuous prescription and discontinuation, and used logistic regression to investigate factors associated with those ASM prescription patterns. MAIN OUTCOME MEASURES Prescription of ASMs during pregnancy and discontinuation of ASMs before and during pregnancy. RESULTS ASM prescription during pregnancy increased from 0.6% of pregnancies in 1995 to 1.6% in 2018, driven largely by an increase in women with indications other than epilepsy. Epilepsy was an indication for 62.5% of pregnancies with an ASM prescription and non-epilepsy indications were present for 66.6%. Continuous prescription of ASMs during pregnancy was more common in women with epilepsy (64.3%) than in women with other indications (25.3%). Switching ASMs was infrequent (0.8% of ASM users). Factors associated with discontinuation included age ≥35, higher social deprivation, more frequent contact with the GP and being prescribed antidepressants or antipsychotics. CONCLUSIONS ASM prescription during pregnancy increased between 1995 and 2018 in the UK. Patterns of prescription around the pregnancy period vary by indication and are associated with several maternal characteristics.
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Affiliation(s)
- Paul Madley-Dowd
- - Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- - Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, BS8 2BN, United Kingdom
| | - Jessica Rast
- - A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
- - Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Viktor H. Ahlqvist
- - Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, BS8 2BN, United Kingdom
- - Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Caichen Zhong
- - A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
| | - Florence Z. Martin
- - Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- - Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, BS8 2BN, United Kingdom
| | - Neil M. Davies
- - Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, BS8 2BN, United Kingdom
- - K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Norway
- - Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, London W1T 7NF
- - Department of Statistical Sciences, University College London, London WC1E 6BT, UK
| | - Kristen Lyall
- - Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Craig Newschaffer
- - College of Health and Human Development, The Pennsylvania State University, USA
| | - Torbjörn Tomson
- - Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Cecilia Magnusson
- - Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- - Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Dheeraj Rai
- - Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- - Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, BS8 2BN, United Kingdom
- - NIHR Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
- - Avon and Wiltshire Partnership NHS Mental Health Trust, Bristol, United Kingdom
| | - Brian K. Lee
- - A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
- - Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
- - Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Harriet Forbes
- - Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- - Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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8
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Ornoy A, Echefu B, Becker M. Valproic Acid in Pregnancy Revisited: Neurobehavioral, Biochemical and Molecular Changes Affecting the Embryo and Fetus in Humans and in Animals: A Narrative Review. Int J Mol Sci 2023; 25:390. [PMID: 38203562 PMCID: PMC10779436 DOI: 10.3390/ijms25010390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Valproic acid (VPA) is a very effective anticonvulsant and mood stabilizer with relatively few side effects. Being an epigenetic modulator, it undergoes clinical trials for the treatment of advanced prostatic and breast cancer. However, in pregnancy, it seems to be the most teratogenic antiepileptic drug. Among the proven effects are congenital malformations in about 10%. The more common congenital malformations are neural tube defects, cardiac anomalies, urogenital malformations including hypospadias, skeletal malformations and orofacial clefts. These effects are dose related; daily doses below 600 mg have a limited teratogenic potential. VPA, when added to other anti-seizure medications, increases the malformations rate. It induces malformations even when taken for indications other than epilepsy, adding to the data that epilepsy is not responsible for the teratogenic effects. VPA increases the rate of neurodevelopmental problems causing reduced cognitive abilities and language impairment. It also increases the prevalence of specific neurodevelopmental syndromes like autism (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). High doses of folic acid administered prior to and during pregnancy might alleviate some of the teratogenic effect of VPA and other AEDs. Several teratogenic mechanisms are proposed for VPA, but the most important mechanisms seem to be its effects on the metabolism of folate, SAMe and histones, thus affecting DNA methylation. VPA crosses the human placenta and was found at higher concentrations in fetal blood. Its concentrations in milk are low, therefore nursing is permitted. Animal studies generally recapitulate human data.
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Affiliation(s)
- Asher Ornoy
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel; (B.E.); (M.B.)
- Department of Medical Neurobiology, Hebrew University Hadassah Medical School, Jerusalem 9112102, Israel
| | - Boniface Echefu
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel; (B.E.); (M.B.)
| | - Maria Becker
- Department of Morphological Sciences and Teratology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel; (B.E.); (M.B.)
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9
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Frayne J, Seddon S, Lebedevs T, Milroy T, Teh B, Nguyen T. General practitioner perceptions and experiences of managing perinatal mental health: a scoping review. BMC Pregnancy Childbirth 2023; 23:832. [PMID: 38042768 PMCID: PMC10693076 DOI: 10.1186/s12884-023-06156-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/24/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND General Practitioners (GPs) are involved in preconception, pregnancy, and postnatal care. Overall, mental health remains a significant contributor to disease burden affecting 1 in 4 pregnant women. Psychotropic medication prescribing occurs in almost 1 in 12 pregnancies, and appears to be increasing, along with the prevalence of mental health disorders in women of reproductive age. Perinatal mental health management is therefore not an unlikely scenario within their clinical practice. This scoping review aims to map current research related to GPs perceptions and experiences of managing perinatal mental health. METHOD A comprehensive search strategy using nine electronic databases, and grey literature was undertaken between December 2021 and February 2023. Relevant studies were sourced from peer review databases using key terms related to perinatal mental health and general practitioners. Search results were screened on title, abstract and full text to assess those meeting inclusion criteria and relevance to the research question. RESULTS After screening, 16 articles were included in the scoping review. The majority focused on perinatal depression. Findings support that GPs express confidence with diagnosing perinatal depression but report issues of stigma navigating a diagnosis. Over the last two decades, prescribing confidence in perinatal mental health remains variable with concerns for the safety profile of medication, low level of confidence in providing information and a strong reliance on personal experience. Despite the establishment of perinatal guidelines by countries, the utilisation of these and other existing resources by GPs appears from current literature to be infrequent. Many challenges exist for GPs around time pressures, a lack of information and resources, and difficulty accessing referral to services. CONCLUSION Recommendations following this scoping review include targeted perinatal education programs specific for GPs and embedded within training programs and the development of practice guidelines and resources specific to general practice that recognises time, services, and funding limitations. To achieve this future research is first needed on how guidelines and resources can be developed and best delivered to optimise GP engagement to improve knowledge and enhance patient care.
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Affiliation(s)
- Jacqueline Frayne
- Medical School, Discipline of General practice, The University of Western Australia, Crawley, Australia.
| | - Sarah Seddon
- Medical School, Discipline of General practice, The University of Western Australia, Crawley, Australia
| | - Tamara Lebedevs
- Pharmacy Department, Women's and Newborn Health Service, King Edward Memorial Hospital, Subiaco, Australia
| | - Talila Milroy
- Medical School, Discipline of General practice, The University of Western Australia, Crawley, Australia
| | - Beverly Teh
- South Metropolitan Health Services, Perth, Australia
| | - Thinh Nguyen
- Peel and Rockingham Kwinana Mental Health Services, Rockingham, Australia
- Medical School, Discipline of Psychiatry, The University of Western Australia, Crawley, Australia
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10
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Vickery PB. Concepts for selection and utilization of psychiatric medications in pregnancy. Ment Health Clin 2023; 13:255-267. [PMID: 38058594 PMCID: PMC10696173 DOI: 10.9740/mhc.2023.12.255] [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: 03/13/2023] [Accepted: 08/14/2023] [Indexed: 12/08/2023] Open
Abstract
Psychiatric illness may develop or relapse during pregnancy, and understanding best practices is paramount. In 2017, the British Association for Psychopharmacology (BAP) consensus guidance on the use of psychotropic medication preconception, in pregnancy, and postpartum was released. The BAP guidelines provide concise evidence and additional insight and flexibility for use of psychiatric medication. Key takeaways of these guidelines are highlighted serving as a concise reference for practitioners. Additionally, practice points, such as recommendations for rapid tranquilization and the role of long-acting injectable antipsychotic medications as well as additional insights to the growing body of literature associated with psychiatric medications in pregnancy since 2017 are summarized. Providers are strongly encouraged to stay up to date to provide optimal care for pregnant patients and their babies.
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11
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Liu X, Kolding L, Momen N, Gasse C, Pedersen LH. Maternal antipsychotic use during pregnancy and congenital malformations. Am J Obstet Gynecol MFM 2023; 5:100950. [PMID: 37015311 DOI: 10.1016/j.ajogmf.2023.100950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Existing data may underestimate the potential teratogenic effects of prenatal antipsychotic exposure because of lacking data on miscarriages and induced abortions. OBJECTIVE This study aimed to present a comprehensive analysis based on information on pregnancies ending in termination, miscarriage, stillbirth, and live birth. STUDY DESIGN We conducted a population-based cohort study in Denmark of clinically recognized singleton pregnancies with the first-trimester scan performed from 2008 to 2017. We compared the risk of major malformations between pregnancies exposed to antipsychotics in the first trimester and unexposed pregnancies. In secondary analyses, the comparison was made with pregnancies of women who used antipsychotics before but not during pregnancy (discontinuers). We used weighted log-binomial regression to estimate adjusted prevalence ratios and propensity score fine stratifications for confounding control. We performed 4 sensitivity analyses, including a sibling-controlled analysis. RESULTS Of the 503,158 pregnancies, 1252 (0.2%) were of women who filled an antipsychotic prescription in the first trimester. Major malformations were present in 7.3% of antipsychotic-exposed pregnancies, 5.1% of unexposed pregnancies, and 6.0% of discontinuers' pregnancies. The adjusted prevalence ratio was 1.23 (95% confidence interval, 1.01-1.50) among exposed pregnancies compared with unexposed pregnancies. The prevalence ratio was attenuated to 1.14 (95% confidence interval, 0.88-1.48) compared with discontinuers and 1.08 (95% confidence interval, 0.47-2.49) in the sibling analysis. Similar findings were observed with cardiac malformations. Results were consistent for classes and individual antipsychotics, and remained robust across the 4 sensitivity analyses. CONCLUSION Our findings suggest limited or no overall teratogenic effect of first-trimester antipsychotic exposure. For individual antipsychotics, with estimations based on very few cases, further studies with sufficient sample sizes are warranted.
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Affiliation(s)
- Xiaoqin Liu
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark (Drs Liu and Momen).
| | - Line Kolding
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark (Drs Kolding and Pedersen)
| | - Natalie Momen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark (Drs Liu and Momen)
| | - Christiane Gasse
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Drs Gasse and Pedersen); Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark (Dr Gasse); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark (Dr Gasse)
| | - Lars Henning Pedersen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark (Drs Kolding and Pedersen); Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Drs Gasse and Pedersen); Department of Biomedicine, Aarhus University, Aarhus, Denmark (Dr Pedersen)
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12
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Kulkarni J, Gurvich C, Gilbert H, Worsley R, Li Q, Karimi L. The use of first and second-generation antipsychotic drugs and the potential to develop gestational diabetes mellitus among perinatal patients with psychosis. Schizophr Res 2023; 254:22-26. [PMID: 36758325 DOI: 10.1016/j.schres.2023.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
There is limited knowledge about the effects of antipsychotic exposure on the development of gestational diabetes mellitus (GDM) in women with mental illness. Studies have demonstrated an association between antipsychotic medications and metabolic problems such as weight gain and diabetes mellitus in non-pregnant patients with psychiatric disorders. GDM increases the risk of adverse maternal outcomes, including pregnancy-induced hypertension, antepartum and postpartum haemorrhage, and caesarean delivery. The National Register of Antipsychotic Medication in Pregnancy (NRAMP) is a prospective Australian cohort study that observed women who took antipsychotics during pregnancy. Data from 205 women were extracted for the final analysis and included women who took first or second-generation antipsychotics (FGA,SGA) during the first trimester of pregnancy (at minimum) and had a diagnosis of a psychotic disorder (n = 180). The comparison (non-exposed) group (n = 25) were women with psychosis who chose not to take any antipsychotic during the first trimester (at minimum). The comparison groups were not matched, although groups were homogenous in terms of sex, age range, diagnosis and perinatal status. The results of logistic regression analysis revealed that women who were exposed to FGAs, SGAs were seven and five times, respectively, more likely to develop GDM compared to non-exposed groups. When adjusted for confounding variables such as BMI and family history of diabetes, the potential of developing GDM decreased for women taking SGAs. In conclusion, the risk of developing GDM is lower in women taking SGAs compared with women taking FDAs. In addition, family history of diabetes and BMI adds to the risk.
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Affiliation(s)
- Jayashri Kulkarni
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia.
| | - Caroline Gurvich
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Heather Gilbert
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Roisin Worsley
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Qi Li
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia.
| | - Leila Karimi
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia
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Lin HY, Lin FJ, Katz AJ, Wang IT, Wu CH. Antipsychotic Use in Early Pregnancy and the Risk of Maternal and Neonatal Complications. Mayo Clin Proc 2022; 97:2086-2096. [PMID: 36210203 DOI: 10.1016/j.mayocp.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 03/21/2023]
Abstract
OBJECTIVE To assess the association between antipsychotic use in early pregnancy and the risk of maternal and neonatal metabolic complications. METHODS We conducted a population-based retrospective cohort study (January 1, 2010, to December 31, 2016) using the Health and Welfare Database in Taiwan. Pregnant women (18 to 49 years of age) were grouped as antipsychotic users (ie, received oral antipsychotic monotherapy during the first 20 weeks of pregnancy) and nonusers. Antipsychotic users were further categorized into first-generation antipsychotic and second-generation antipsychotic users. Propensity score methods, including matching and inverse probability of treatment weighting, were used to balance covariates. Conditional logistic regression and Cox proportional hazards models were used to compare risks of maternal (gestational diabetes mellitus, preterm birth) and neonatal (low birth weight [LBW], macrosomia) outcomes. RESULTS Antipsychotic users had a notably higher risk of preterm birth compared with nonusers (adjusted HR, 1.29; 95% CI, 1.04 to 1.60), but the risk of gestational diabetes mellitus (HR, 1.21; 95% CI, 0.94 to 1.56), LBW (odds ratio [OR], 1.07; 95% CI, 0.84 to 1.37), and macrosomia (OR, 1.36; 95% CI, 0.63 to 2.92) did not differ between the two groups. Among women who received antipsychotics, the odds of LBW were significantly higher in second-generation antipsychotic users compared with first-generation antipsychotic users (adjusted OR, 1.32; 95% CI, 1.04 to 1.68). CONCLUSION This study found that using antipsychotics in early pregnancy did not result in a greater risk of metabolic complications both for mothers and newborns. For women requiring treatment with antipsychotics during pregnancy, they should be monitored for the risk of preterm birth and low infant birth weight.
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Affiliation(s)
- Hsuan-Yu Lin
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei City, Taiwan
| | - Fang-Ju Lin
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei City, Taiwan; Graduate Institute of Clinical Pharmacy and School of Pharmacy, College of Medicine, National Taiwan University; Department of Pharmacy, National Taiwan University Hospital
| | - Aaron J Katz
- Departments of Population Health and Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS, USA; Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - I-Te Wang
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei City, Taiwan; Department of Obstetrics and Gynecology, Taipei Medical University Hospital
| | - Chung-Hsuen Wu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei City, Taiwan.
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14
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Fitzpatrick KE, Quigley MA, Smith DJ, Kurinczuk JJ. Planned mode of birth after previous caesarean section and women's use of psychotropic medication in the first year postpartum: a population-based record linkage cohort study. Psychol Med 2022; 52:3210-3221. [PMID: 33504384 PMCID: PMC9693703 DOI: 10.1017/s0033291720005322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/02/2020] [Accepted: 12/17/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Policy in many high-income settings supports giving pregnant women with previous caesarean section a choice between an elective repeat caesarean section (ERCS) or planning a vaginal birth after previous caesarean (VBAC), provided they have no contraindications to VBAC. Despite the potential for this choice to influence women's mental health, evidence about the associated effect to counsel women and identify potential targets for intervention is limited. This study investigated the association between planned mode of birth after previous caesarean and women's subsequent use of psychotropic medications. METHODS A population-based cohort study of 31 131 women with one or more previous caesarean sections who gave birth to a term singleton in Scotland between 2010 and 2015 with no prior psychotropic medications in the year before birth was conducted using linked Scottish national datasets. Cox regression was used to investigate the association between planned mode of birth and being dispensed psychotropic medications in the first year postpartum adjusted for socio-demographic, medical, pregnancy-related factors and breastfeeding. RESULTS Planned VBAC (n = 10 220) compared to ERCS (n = 20 911) was associated with a reduced risk of the mother being dispensed any psychotropic medication [adjusted hazard ratio (aHR) 0.85, 95% confidence interval (CI) 0.78-0.92], an antidepressant (aHR 0.83, 95% CI 0.76-0.90), and at least two consecutive antidepressants (aHR 0.83, 95% CI 0.75-0.91) in the first year postpartum. CONCLUSIONS Women giving birth by ERCS were more likely than those having a planned VBAC to be dispensed psychotropic medication including antidepressants in the first year postpartum. Further research is needed to establish the reasons behind this new finding.
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Affiliation(s)
- Kathryn E. Fitzpatrick
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A. Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Daniel J. Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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15
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Sagué-Vilavella M, Solé E, Pinzón-Espinosa J, Sandra-Hernández A, Roda E, Vieta E, Roca A. Obstetric outcomes regarding the use of lithium in pregnant women with bipolar disorders: a prospective cohort study. Arch Womens Ment Health 2022; 25:729-737. [PMID: 35522327 DOI: 10.1007/s00737-022-01234-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/25/2022] [Indexed: 11/02/2022]
Abstract
Lithium is the mood stabilizer of choice for the prevention of bipolar relapse over the perinatal period. A critical issue is its safety of the mother and the developing fetus. This study aims to compare obstetric outcomes in women with bipolar disorders (BD) regarding treatment with lithium during pregnancy. We enrolled a cohort of pregnant women with BD that received care at the Perinatal Mental Health Unit of a tertiary hospital between January 2005 and March 2017. The exposed group received lithium during pregnancy, whereas the unexposed group did not. The main outcomes were obstetric complications during pregnancy, during labor and delivery, neonatal complications, and congenital malformations. Demographic and clinical data were described using measures of frequency, central tendency, and dispersion. Between-group differences were calculated with chi-square, Fisher's test, t-tests, or Mann-Whitney U test. Our cohort included 100 pregnant women with BD: 53 (53%) used lithium during pregnancy, and 47 (47%) did not. There were no significant differences in obstetric complications, neonatal complications, or congenital anomalies. Nonetheless, newborns of lithium-treated women had lower Apgar scores at 1 min (mean 8.2 ± 1.6 vs. 8.9 ± 0.6, p = 0.026) and 5 min (9.6 ± 0.8 vs. 9.9 ± 0.5, p = 0.015). Our findings do not identify worse obstetric outcomes in women with BD that take lithium during pregnancy, except for an impact on newborn Apgar scores. Lithium might be an adequate treatment for pregnant women with BD, especially for those with a high recurrence risk, and always after an individualized risk-benefit assessment.
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Affiliation(s)
- Maria Sagué-Vilavella
- Bipolar and Unipolar Disorders Unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain
| | - Eva Solé
- Institute of Neuroscience, Perinatal Mental Health Unit, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain. .,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Catalonia, Spain. .,Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain.
| | - Justo Pinzón-Espinosa
- Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain.,Department of Mental Health, Parc Tauli University Hospital, Sabadell, Barcelona, Spain.,Department of Clinical Psychiatry, School of Medicine, University of Panama, Panama, Spain
| | - Ana Sandra-Hernández
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Catalonia, Spain.,Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain.,Department of Maternal-Fetal Medicine, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain
| | - Ester Roda
- Institute of Neuroscience, Perinatal Mental Health Unit, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Unipolar Disorders Unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Catalonia, Spain.,Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Alba Roca
- Institute of Neuroscience, Perinatal Mental Health Unit, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Catalonia, Spain
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16
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Lefebvre A, Pouchon A, Bioulac S, Mallet J, Polosan M, Dondé C. Management of schizophrenia in women during the perinatal period: a synthesis of international recommendations. Expert Opin Pharmacother 2022; 23:1337-1350. [PMID: 35835161 DOI: 10.1080/14656566.2022.2102421] [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: 11/04/2022]
Abstract
INTRODUCTION The perinatal period in schizophrenia is associated with high risk of psychotic relapse and pregnancy/child outcomes. The extent to which antipsychotics may potentially affect the fetus or the child development is unclear and debated. Even though guidelines have been developed, there is a lack of consensual recommendations regarding the optimal strategy to manage schizophrenia during the perinatal period. AREAS COVERED This systematic review describes the current state of evidence with respect to the impact of recommended interventions for schizophrenia during the perinatal period, including childbearing age, pregnancy and post-partum. It compares recent international treatment guidelines for this specific group of women. Last, this review presents a set of major points to be discussed with patients and relatives for shared-decision making and a summary of key recommendations from the international guidelines. EXPERT OPINION Although treatment guidelines may be of significant help, discrepancies exist across them regarding the management of antipsychotics for schizophrenia women during the perinatal period. Shared decision-making and advance directives represent useful patient-centered approaches during this specific period. Further cohort-based evidence is needed to better identify maternal and fetal risks associated to antipsychotic treatment exposure.
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Affiliation(s)
| | - Arnaud Pouchon
- Univ. Grenoble Alpes, Inserm, U1216, Adult Psychiatry Department CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Stéphanie Bioulac
- Laboratoire de Psychologie et Neurocognition (CNRS-UMR 5105), Université Grenoble Alpes; Service Psychiatrie de l'enfant et l'adolescent, CHU Grenoble Alpes, France
| | - Jasmina Mallet
- Université de Paris, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France
| | - Mircea Polosan
- Univ. Grenoble Alpes, Inserm, U1216, Adult Psychiatry Department CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Clément Dondé
- Univ. Grenoble Alpes, Inserm, U1216, Adult Psychiatry Department CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000 Grenoble, France; Psychiatry Department, CH Alpes-Isère, F-38000 Saint-Egrève, France
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17
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Efficacy and Safety of Transcranial Electric Stimulation during the Perinatal Period: A Systematic Literature Review and Three Case Reports. J Clin Med 2022; 11:jcm11144048. [PMID: 35887812 PMCID: PMC9318834 DOI: 10.3390/jcm11144048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: The perinatal period is an at-risk period for the emergence or decompensation of psychiatric disorders. Transcranial electrical stimulation (tES) is an effective and safe treatment for many psychiatric disorders. Given the reluctance to use pharmacological treatments during pregnancy or breastfeeding, tES may be an interesting treatment to consider. Our study aims to evaluate the efficacy and safety of tES in the perinatal period through a systematic literature review followed by three original case reports. Method: Following PRISMA guidelines, a systematic review of MEDLINE and ScienceDirect was undertaken to identify studies on tES on women during the perinatal period. The initial research was conducted until 31 December 2021 and search terms included: tDCS, transcranial direct current stimulation, tACS, transcranial alternating current stimulation, tRNS, transcranial random noise stimulation, pregnancy, perinatal, postnatal, and postpartum. Results: Seven studies reporting on 33 women during the perinatal period met the eligibility criteria. No serious adverse effects for the mother or child were reported. Data were limited to the use of tES during pregnancy in patients with schizophrenia or unipolar depression. In addition, we reported three original case reports illustrating the efficacy and safety of tDCS: in a pregnant woman with bipolar depression, in a pregnant woman with post-traumatic stress disorder (sham tDCS), and in a breastfeeding woman with postpartum depression. Conclusions: The results are encouraging, making tES a potentially safe and effective treatment in the perinatal period. Larger studies are needed to confirm these initial results, and any adverse effects on the mother or child should be reported. In addition, research perspectives on the medico-economic benefits of tES, and its realization at home, are to be investigated in the future.
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18
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Heinonen E, Forsberg L, Nörby U, Wide K, Källén K. Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study. BMJ Open 2022; 12:e061328. [PMID: 35768086 PMCID: PMC9244682 DOI: 10.1136/bmjopen-2022-061328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the admission rate to neonatal care and neonatal morbidity after maternal use of antipsychotics during pregnancy. DESIGN A population-based register study. SETTING Information on all singleton births between July 2006 and December 2017 in Sweden including data on prescription drugs, deliveries and infants' health was obtained from the Swedish Medical Birth Register, the Prescribed Drug Register and the Swedish Neonatal Quality Register. Exposed infants were compared with unexposed infants and with infants to mothers treated with antipsychotics before or after but not during pregnancy. PARTICIPANTS The cohort comprised a total of 1 307 487 infants, of whom 2677 (0.2%) were exposed to antipsychotics during pregnancy and 34 492 (2.6%) had mothers who were treated before/after the pregnancy. OUTCOME MEASURES The primary outcome was admission rate to neonatal care. Secondary outcomes were the separate neonatal morbidities. RESULTS Of the exposed infants, 516 (19.3%) were admitted to neonatal care compared with 98 976 (7.8%) of the unexposed infants (adjusted risk ratio (aRR): 1.7; 95% CI: 1.6 to 1.8), with a further increased risk after exposure in late pregnancy. The highest relative risks were seen for withdrawal symptoms (aRR: 17.7; 95% CI: 9.6 to 32.6), neurological disorders (aRR: 3.4; 95% CI: 2.4 to 5.7) and persistent pulmonary hypertension (aRR: 2.1; 95% CI: 1.4 to 3.1) when compared with unexposed infants. The absolute risks for these outcomes were however low among the exposed infants, 1.3%, 1.8% and 1.0%, respectively, and the relative risks were lower when compared with infants to mothers treated before/after the pregnancy. CONCLUSION Fetal exposure to antipsychotics was associated with an increased risk of neonatal morbidity. The effects in the exposed infants seem transient and predominantly mild, and these findings do not warrant discontinuation of a necessary treatment but rather increased monitoring of these infants. The increased risk of persistent pulmonary hypertension requires further studies.
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Affiliation(s)
- Essi Heinonen
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Lisa Forsberg
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Nörby
- Department of Clinical Sciences, Centre of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
- Health and Medical Care Administration, Region Stockholm, Stockholm, Sweden
| | - Katarina Wide
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Källén
- Department of Clinical Sciences, Centre of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
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Šumilo D, Nirantharakumar K, Willis BH, Rudge GM, Martin J, Gokhale K, Thayakaran R, Adderley NJ, Chandan JS, Okoth K, Harris IM, Hewston R, Skrybant M, Deeks JJ, Brocklehurst P. Long-term impact of pre-incision antibiotics on children born by caesarean section: a longitudinal study based on UK electronic health records. Health Technol Assess 2022; 26:1-160. [PMID: 35781133 DOI: 10.3310/zyzc8514] [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: 11/22/2022] Open
Abstract
BACKGROUND Since changes in the national guidance in 2011, prophylactic antibiotics for women undergoing caesarean section are recommended prior to skin incision, rather than after the baby's umbilical cord has been clamped. Evidence from randomised controlled trials conducted outside the UK has shown that this reduces maternal infectious morbidity; however, the prophylactic antibiotics also cross the placenta, meaning that babies are exposed to them around the time of birth. Antibiotics are known to affect the gut microbiota of the babies, but the long-term effects of exposure to high-dose broad-spectrum antibiotics around the time of birth on allergy and immune-related diseases are unknown. OBJECTIVES We aimed to examine whether or not in-utero exposure to antibiotics immediately prior to birth compared with no pre-incisional antibiotic exposure increases the risk of (1) asthma and (2) eczema in children born by caesarean section. DESIGN This was a controlled interrupted time series study. SETTING The study took place in primary and secondary care. PARTICIPANTS Children born in the UK during 2006-18 delivered by caesarean section were compared with a control cohort delivered vaginally. INTERVENTIONS In-utero exposure to antibiotics immediately prior to birth. MAIN OUTCOME MEASURES Asthma and eczema in children in the first 5 years of life. Additional secondary outcomes, including other allergy-related conditions, autoimmune diseases, infections, other immune system-related diseases and neurodevelopmental conditions, were also assessed. DATA SOURCES The Health Improvement Network (THIN) and the Clinical Practice Research Datalink (CPRD) primary care databases and the Hospital Episode Statistics (HES) database. Previously published linkage strategies were adapted to link anonymised data on mothers and babies in these databases. Duplicate practices contributing to both THIN and the CPRD databases were removed to create a THIN-CPRD data set. RESULTS In the THIN-CPRD and HES data sets, records of 515,945 and 3,945,351 mother-baby pairs were analysed, respectively. The risk of asthma was not significantly higher in children born by caesarean section exposed to pre-incision antibiotics than in children whose mothers received post-cord clamping antibiotics, with an incidence rate ratio of 0.91 (95% confidence interval 0.78 to 1.05) for diagnosis of asthma in primary care and an incidence rate ratio of 1.05 (95% confidence interval 0.99 to 1.11) for asthma resulting in a hospital admission. We also did not find an increased risk of eczema, with an incidence rate ratio of 0.98 (95% confidence interval 0.94 to1.03) and an incidence rate ratio of 0.96 (95% confidence interval 0.71 to 1.29) for diagnosis in primary care and hospital admissions, respectively. LIMITATIONS It was not possible to ascertain the exposure to pre-incision antibiotics at an individual level. The maximum follow-up of children was 5 years. CONCLUSIONS There was no evidence that the policy change from post-cord clamping to pre-incision prophylactic antibiotics for caesarean sections during 2006-18 had an impact on the incidence of asthma and eczema in early childhood in the UK. FUTURE WORK There is a need for further research to investigate if pre-incision antibiotics have any impact on developing asthma and other allergy and immune-related conditions in older children. STUDY REGISTRATION This study is registered as researchregistry3736. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 30. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Dana Šumilo
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Midlands Health Data Research UK, University of Birmingham, Birmingham, UK
| | - Brian H Willis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gavin M Rudge
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rasiah Thayakaran
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kelvin Okoth
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Isobel M Harris
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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20
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Meherali S, Rahim KA, Campbell S, Lassi ZS. Does Digital Literacy Empower Adolescent Girls in Low- and Middle-Income Countries: A Systematic Review. Front Public Health 2022; 9:761394. [PMID: 34976923 PMCID: PMC8716589 DOI: 10.3389/fpubh.2021.761394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The vast majority (90%) of the world's adolescents aged 10–19 live in low- and middle-income countries (LMICs); and in those resource-limited settings, girls face distinct challenges across multiple health, social, and economic domains. Gender equality and girls' empowerment are key goals in their own right and are central to all other development goals. Digital literacy is a great enabler for the empowerment of young girls. This systematic review aims to assess the range and nature of digital literacy interventions implemented to empower adolescent girls in LMICs and identify evidence about adolescent girls' access and use of digital technologies in LMICs. Methods: We conducted a systematic review of studies following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards for systematic reviews. Two reviewers selected studies, conducted quality assessments, and extracted data by using standard forms. The collected data include the design of the study, type of digital literacy intervention, target audience, intervention received, intervention reach, data analysis, and study outcomes. The review is registered with PROSPERO (CRD42020216756). Results: Thirty-five studies met the eligibility for inclusion and of those, 11 were experimental studies (randomized controlled trial = 6; quasi-experimental = 2; before-after with no control = 3), 11 were cross-sectional/descriptive studies, seven studies used a mixed-method approach, and six were qualitative studies on digital literacy interventions to empower young girls in LMICs. The majority of digital literacy interventions were designed and implemented to improve sexual and reproductive health rights and decision-making of adolescent girls in LMICs (n = 33). Only three papers reported the use of digital media for health-related information and decision making, while only one reported on educational and social empowerment. Discussion: Our findings suggest that digital literacy interventions such as mobile phones, mobile health tools, media exposure, access to the internet, internet-based educational strategies, social media exposure are effective to empower adolescent girls to access health services and information and also enhance the access to educational resources. However, we found inconclusive evidence on the effectiveness of digital literacy to enhance girls' access to financial services and economic empowerment. More rigorous studies with long-term follow-ups to assess the effectiveness of such interventions to empower adolescent girls in LMICs are urgently needed.
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Affiliation(s)
- Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | | | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Zohra S Lassi
- Department of Medicine, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
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21
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Brand BA, Haveman YRA, de Beer F, de Boer JN, Dazzan P, Sommer IEC. Antipsychotic medication for women with schizophrenia spectrum disorders. Psychol Med 2022; 52:649-663. [PMID: 34763737 PMCID: PMC8961338 DOI: 10.1017/s0033291721004591] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 12/24/2022]
Abstract
There are significant differences between men and women in the efficacy and tolerability of antipsychotic drugs. Here, we provide a comprehensive overview of what is currently known about the pharmacokinetics and pharmacodynamics of antipsychotics in women with schizophrenia spectrum disorders (SSDs) and translate these insights into considerations for clinical practice. Slower drug absorption, metabolism and excretion in women all lead to higher plasma levels, which increase the risk for side-effects. Moreover, women reach higher dopamine receptor occupancy compared to men at similar serum levels, since oestrogens increase dopamine sensitivity. As current treatment guidelines are based on studies predominantly conducted in men, women are likely to be overmedicated by default. The risk of overmedicating generally increases when sex hormone levels are high (e.g. during ovulation and gestation), whereas higher doses may be required during low-hormonal phases (e.g. during menstruation and menopause). For premenopausal women, with the exceptions of quetiapine and lurasidone, doses of antipsychotics should be lower with largest adjustments required for olanzapine. Clinicians should be wary of side-effects that are particularly harmful in women, such as hyperprolactinaemia which can cause oestrogen deficiency and metabolic symptoms that may cause cardiovascular diseases. Given the protective effects of oestrogens on the course of SSD, oestrogen replacement therapy should be considered for postmenopausal patients, who are more vulnerable to side-effects and yet require higher dosages of most antipsychotics to reach similar efficacy. In conclusion, there is a need for tailored, female-specific prescription guidelines, which take into account adjustments required across different phases of life.
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Affiliation(s)
- Bodyl A. Brand
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Yudith R. A. Haveman
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Franciska de Beer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Janna N. de Boer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Iris E. C. Sommer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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22
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Momen NC, Robakis T, Liu X, Reichenberg A, Bergink V, Munk-Olsen T. In utero exposure to antipsychotic medication and psychiatric outcomes in the offspring. Neuropsychopharmacology 2022; 47:759-766. [PMID: 34750566 PMCID: PMC8782838 DOI: 10.1038/s41386-021-01223-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/13/2021] [Accepted: 10/21/2021] [Indexed: 02/03/2023]
Abstract
Information on neurodevelopmental effects of antenatal exposure to antipsychotics is limited to 10 studies, all examining children up to 5 years of age or less. The paper aimed to investigate the association between in utero exposure to antipsychotics and psychiatric outcomes in children using Danish nationwide registers. In total, 9011 liveborn singletons born 1998-2015 in Denmark whose mothers took antipsychotic medication before pregnancy were identified. Children whose mothers continued to take antipsychotics during pregnancy were compared with children of mothers who discontinued antipsychotics before pregnancy. As a negative control, paternal antipsychotic use in the same window was investigated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression for the primary outcome of psychiatric disorders, as well for subcategories of psychiatric disorders. In total, 9.9% of children in the discontinuation group and 11.0% of children in the continuation group received a psychiatric disorder diagnosis during follow-up. The adjusted HR for psychiatric disorders among offspring in the continuation group compared to the discontinuation group was 1.10 (95% CI 0.93-1.30). For antipsychotic use in the fathers, the HR was 1.05 (95% CI 0.89-1.24). The study does not provide evidence of increased risk of psychiatric disorders among children of women who continue antipsychotic treatment during pregnancy. This was observed after accounting for the underlying risk conferred by maternal psychiatric disorders. This suggests women who need to continue antipsychotic medications during pregnancy can do so without adverse psychiatric outcomes for offspring.
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Affiliation(s)
- Natalie C. Momen
- grid.7048.b0000 0001 1956 2722National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Thalia Robakis
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY USA
| | - Xiaoqin Liu
- grid.7048.b0000 0001 1956 2722National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Abraham Reichenberg
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY USA ,grid.59734.3c0000 0001 0670 2351Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.59734.3c0000 0001 0670 2351The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.59734.3c0000 0001 0670 2351Seaver Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Veerle Bergink
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY USA ,grid.5645.2000000040459992XDepartment of Psychiatry, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Trine Munk-Olsen
- grid.7048.b0000 0001 1956 2722National Centre for Register-based Research, Aarhus University, Aarhus, Denmark ,grid.452548.a0000 0000 9817 5300iPSYCH-Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722CIRRAU-Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
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23
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Heinonen E, Forsberg L, Nörby U, Wide K, Källén K. Antipsychotic Use During Pregnancy and Risk for Gestational Diabetes: A National Register-Based Cohort Study in Sweden. CNS Drugs 2022; 36:529-539. [PMID: 35220525 PMCID: PMC9095513 DOI: 10.1007/s40263-022-00908-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We aimed to study whether antipsychotic use during pregnancy is associated with gestational diabetes. METHODS This was a Swedish national register-based cohort study on the Medical Birth Register and the Prescribed Drug Register including all 1,307,487 singleton births between July 2006 and December 2017. Antipsychotics were divided into first-generation antipsychotics (n = 728), high-risk metabolic second-generation antipsychotics including olanzapine, clozapine and quetiapine (n = 1710), and other second-generation antipsychotics (n = 541). The risks for gestational diabetes, foetal growth disturbances, pre-eclampsia, caesarean section and preterm labour were assessed. Women treated during pregnancy were compared to women not treated during pregnancy and to women who used antipsychotics before/after but not during pregnancy. RESULTS The crude risk ratio for gestational diabetes for women treated with high-risk metabolic second-generation antipsychotics during pregnancy was 2.2 (95% confidence interval [CI] 1.6-2.9) compared to untreated pregnant women (n = 1,296,539) and 1.8 (95% CI 1.4-2.5) compared to women treated before/after pregnancy (n = 34,492). After adjustment for maternal factors including body mass index, the risk ratios were 1.8 (95% CI 1.3-2.4) and 1.6 (95% CI 1.2-2.1). Exposed infants had an increased risk of being large for gestational age: adjusted risk ratios 1.6 (95% CI 1.3-1.9) and 1.3 (95% CI 1.1-1.6) compared to no maternal antipsychotic use during pregnancy and maternal use before/after the pregnancy. Other antipsychotics were not associated with metabolic risks. CONCLUSIONS Olanzapine, clozapine and quetiapine used during pregnancy were associated with increased risks for gestational diabetes and the infant being large for gestational age. Enhanced metabolic monitoring should be considered for pregnant women using these drugs.
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Affiliation(s)
- Essi Heinonen
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14157, Stockholm, Sweden. .,Department of Paediatrics, Unit of Neonatology at Karolinska University Hospital, Stockholm, Sweden.
| | - Lisa Forsberg
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14157 Stockholm, Sweden
| | - Ulrika Nörby
- Department of Clinical Sciences, Centre of Reproduction, Epidemiology, Tornblad Institute, Lund University, Lund, Sweden ,Health and Medical Care Administration, Region Stockholm, Stockholm, Sweden
| | - Katarina Wide
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14157 Stockholm, Sweden ,Department of Pediatrics, Unit of Emergency Pediatrics at Karolinska University Hospital, Stockholm, Sweden
| | - Karin Källén
- Department of Clinical Sciences, Centre of Reproduction, Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
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Taiwan Expert Consensus Recommendations for Switching to Aripiprazole Long-Acting Once-Monthly in Patients with Schizophrenia. J Pers Med 2021; 11:jpm11111198. [PMID: 34834550 PMCID: PMC8621108 DOI: 10.3390/jpm11111198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 12/21/2022] Open
Abstract
In the last decade, long-acting injectable antipsychotics has been widely used in schizophrenia. Aripiprazole long-acting once-monthly (AOM) is the only long-acting dopamine partial agonist antipsychotic approved for schizophrenia; however, a literature search revealed no guidance on safely switching from oral and long-acting injectable antipsychotics to AOM. This study aimed to develop recommendations of AOM use based on existing data and expert consensus. A committee of 30 experts in psychopharmacology from major hospitals across Taiwan was invited. A modified Delphi method was conducted, consisting of two rounds of questionnaires, literature review, three rounds of face-to-face discussion meeting, and two rounds of anonymous voting. The consensus recommendations were developed based on existing data, clinical experiences, and consensus opinions, with 80% agreement among panel members required for final adoption. The panel developed nine consensus statements of switching to AOM for both acute and stable schizophrenia patients receiving oral or long-acting injectable atypical antipsychotics. Recommendations regarding dose adjustment of oral medication and pregnancy/breastfeeding were also included. The nine consensus recommendations provide a guidance on safely switching to AOM. Substantial gaps in knowledge, and more research is necessary.
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Wang Z, Chan AYL, Coghill D, Ip P, Lau WCY, Simonoff E, Brauer R, Wei L, Wong ICK, Man KKC. Association Between Prenatal Exposure to Antipsychotics and Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, Preterm Birth, and Small for Gestational Age. JAMA Intern Med 2021; 181:1332-1340. [PMID: 34398171 PMCID: PMC8369381 DOI: 10.1001/jamainternmed.2021.4571] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The risk of birth and neurodevelopmental complications with prenatal exposure to antipsychotics is unclear. OBJECTIVE To evaluate the association between prenatal antipsychotics exposure and the risk of birth and neurodevelopmental problems. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included children born between January 2001 and January 2015 with follow-up to December 2019 who were identified by the Hong Kong Clinical Data Analysis and Reporting System. Pregnancies with maternal antidepressant/lithium exposure were removed. Primary analyses compared gestationally exposed and gestationally nonexposed individuals with propensity score fine stratification. Additional analyses included gestationally exposed individuals vs those with past exposure and a sibling-matched analysis to evaluate the effect of confounding by indication. EXPOSURES Prenatal antipsychotic exposure. MAIN OUTCOMES AND MEASURES Preterm birth (<37 gestational weeks), small for gestational age (birth weight <2 standard deviations below the mean for gestational age), and first diagnosis of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children. RESULTS The cohorts included 333 749 mother-child pairs for ADHD (mean [SD] maternal age at delivery, 31.46 [5.03] years) and 411 251 pairs for ASD, preterm birth, and small for gestational age analyses (mean [SD] maternal age at delivery, 31.56 [5.01] years). There were 13 196 children (3.95%) with a diagnosis of ADHD, 8715 (2.12%) with ASD, 33 891 (8.24%) preterm, and 7009 (1.70%) who were small for gestational age. The weighted hazard ratio (wHR) was 1.16 (95% CI, 0.83-1.61) for ADHD and 1.06 (95% CI, 0.70-1.60) for ASD, while the weighted odds ratio (wOR) was 1.40 (95% CI, 1.13-1.75) for preterm birth and 1.36 (95% CI, 0.86-2.14) for small for gestational age when comparing gestationally exposed with gestationally nonexposed individuals. Additional analyses showed no association when comparing gestationally exposed individuals with those with past exposure (ADHD: wHR, 0.99; 95% CI, 0.60-1.61; ASD: wHR, 1.10; 95% CI, 0.58-2.08; preterm birth: wOR, 0.93; 95% CI, 0.70-1.24; small for gestational age: wOR, 1.21; 95% CI, 0.66-2.20) and in a sibling-matched analysis (ADHD: wHR, 0.41; 95% CI, 0.04-4.93; ASD: wHR, 0.90; 95% CI, 0.40-2.01; preterm birth: wOR, 1.25; 95% CI, 0.85-1.82; small for gestational age: wOR, 0.86, 95% CI, 0.32-2.31). CONCLUSIONS AND RELEVANCE In this cohort study, the findings did not suggest that prenatal antipsychotics exposure increased the risk of ADHD, ASD, or small for gestational age. In the primary analysis, there was a small increased risk of preterm birth, but additional analyses comparing gestationally exposed individuals with those with past exposure and comparing gestationally exposed with gestationally nonexposed siblings did not support an increased risk. Given the benefits of treating psychosis during pregnancy, our findings do not support a recommendation for women to discontinue receipt of their regular antipsychotic treatment during pregnancy.
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Affiliation(s)
- Zixuan Wang
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England
| | - Adrienne Y L Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China.,Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, the Netherlands
| | - David Coghill
- Department of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Wallis C Y Lau
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, England
| | - Ruth Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China
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Orsolini L, Sceusa F, Pompili S, Mauro A, Salvi V, Volpe U. Severe and persistent mental illness (SPMI) in pregnancy and breastfeeding: focus on second-generation long acting injectable antipsychotics. Expert Opin Drug Saf 2021; 20:1207-1224. [PMID: 33966552 DOI: 10.1080/14740338.2021.1928634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Introduction: Pregnant women and fetuses are more likely than ever to be exposed to antipsychotic drugs (APs) during pregnancy and postpartum period. Second-generation APs (SGA) are increasingly used among women in reproductive age. Key outcomes (i.e., congenital malformations, pregnancy and maternal outcomes, neonatal/infant risks, and developmental/long-term outcomes) following the exposure to APs remain limited in number and size and yield of inconsistent findings overall, particularly regarding long-acting injectable AP (LAI-APs) formulations.Areas covered: The review aims at providing a summary of current knowledge on potential risks and safety profile of LAI-APs during pregnancy and breastfeeding, specifically focusing on SGA.Expert opinion: The management of safety and tolerability of long-acting injectable AP (LAI-APs) is far from having solid scientific evidence. In fact, due to ethical reasons, there is a lack of randomized clinical trials that limits the reliability and generalizability of the available data on LAI-APs safety profile during the perinatal period, being limited in the scientific literature only to isolated case reports. Therefore, it seems to be important for the future pathways to perinatal mental health care, providing a network of specialized clinicians and systematically collecting data of pregnant/puerperal women on oral and/or LAI APs-therapy about mother and infant outcomes.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Francesca Sceusa
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Simone Pompili
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Antonella Mauro
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Virginio Salvi
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
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Wang Z, Wong ICK, Man KKC, Alfageh BH, Mongkhon P, Brauer R. The use of antipsychotic agents during pregnancy and the risk of gestational diabetes mellitus: a systematic review and meta-analysis. Psychol Med 2021; 51:1028-1037. [PMID: 31969198 DOI: 10.1017/s003329171900401x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Previous studies have found contradicting results with regard to the use of antipsychotics during pregnancy and the risk of gestational diabetes mellitus (GDM). We aimed to evaluate the association between antipsychotic use in pregnancy and GDM. METHODS A systematic literature search was conducted in PubMed, EMBASE, PsycINFO and Cochrane Library databases up to March 2019, for data from observational studies assessing the association between gestational antipsychotic use and GDM. Non-English studies, animal studies, case reports, conference abstracts, book chapters, reviews and summaries were excluded. The primary outcome was GDM. Estimates were pooled using a random effect model, with the I2 statistic used to estimate heterogeneity of results. Our study protocol was registered with PROSPERO number: CRD42018095014. RESULTS In total 10 cohort studies met the inclusion criteria in our systematic review with 6642 exposed and 1 860 290 unexposed pregnancies. Six studies were included in the meta-analysis with a pooled adjusted relative risk of 1.24 overall [95% confidence interval (CI) 1.09-1.42]. The I2 result suggested low heterogeneity between studies (I2 = 6.7%, p = 0.373). CONCLUSION We found that the use of antipsychotic medications during pregnancy is associated with an increased risk of GDM in mothers. However, the evidence is still insufficient, especially for specific drug classes. We recommend more studies to investigate this association for specific drug classes, dosages and comorbidities to help clinicians to manage the risk of GDM if initiation or continuation of antipsychotic prescriptions during pregnancy is needed.
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Affiliation(s)
- Z Wang
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - I C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China
| | - K K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China
| | - B H Alfageh
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - P Mongkhon
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - R Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
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Wang Z, Brauer R, Man KKC, Alfageh B, Mongkhon P, Wong ICK. Prenatal exposure to antipsychotic agents and the risk of congenital malformations in children: A systematic review and meta-analysis. Br J Clin Pharmacol 2021; 87:4101-4123. [PMID: 33772841 DOI: 10.1111/bcp.14839] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/18/2021] [Accepted: 03/19/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the association between antipsychotic use in pregnancy and the risk of congenital malformations in children. DATA SOURCES Searches of PubMed, EMBASE, PsycINFO and Cochrane Library were conducted from inception to 06 January 2020 using keywords: antipsychotics, pregnancy, pregnancy complication and congenital abnormalities. STUDY SELECTION Of 38 reports initially identified as being of potential interest, 13 studies met our inclusion criteria: English observational studies that examined the association between gestational antipsychotic use and congenital malformations in children. DATA EXTRACTION Data were extracted independently by 2 investigators including the publication year, study site, study period, data source, study design, sample size, medication exposure, exposure period and pregnancy definition, exposure as well as outcome ascertainment, selection of study and comparison group, confounding adjustment, statistical analysis, and method of linkage between mother and children. Risk estimates were pooled using a random-effect model and the I2 statistic was used to evaluate the degree of heterogeneity. RESULTS Thirteen studies met our systematic review inclusion criteria. Six studies with a total of 2 515 272 pregnancy episodes were included in our meta-analysis, which provided a pooled adjusted risk ratio of 1.23, 95% confidence interval: 0.96-1.58. The I2 result showed moderate heterogeneity between studies (I2 = 35.2%, P = .173). CONCLUSION We did not find strong evidence of an association between prenatal exposure to antipsychotic medications and the risk of congenital malformations in children. We recommend further studies investigate this association, focusing on specific medication classes and dose responses, which would help clinicians decide whether to prescribe certain antipsychotics during pregnancy.
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Affiliation(s)
- Zixuan Wang
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Ruth Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Basmah Alfageh
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.,College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Pajaree Mongkhon
- School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Wang Z, Man KKC, Ma T, Howard LM, Wei L, Wong ICK, Brauer R. Association between antipsychotic use in pregnancy and the risk of gestational diabetes: Population-based cohort studies from the United Kingdom and Hong Kong and an updated meta-analysis. Schizophr Res 2021; 229:55-62. [PMID: 33243714 DOI: 10.1016/j.schres.2020.11.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/06/2020] [Accepted: 11/15/2020] [Indexed: 11/20/2022]
Abstract
AIMS To investigate whether exposure to antipsychotic medications during pregnancy is associated with gestational diabetes mellitus (GDM) in United Kingdom (UK) and Hong Kong (HK) population cohorts. METHODS Two population-based cohort studies were conducted using data from the UK The Health Improvement Network (THIN) and HK Clinical Data Analysis and Reporting System (CDARS). Nondiabetic women who received any type of antipsychotic medicine before their first pregnancy were included in our cohorts. The exposed group comprised women who continued using antipsychotics from the start of pregnancy to delivery (continuers), while the comparison group included women who were prescribed antipsychotics before the start of pregnancy but stopped during pregnancy (discontinuers). GDM was identified using GDM diagnosis and/or clinicians reported GDM. Odds ratios (ORs) with a 95% confidence interval (CI) were calculated to assess the association between antipsychotic use during pregnancy and GDM. Propensity Score fine-stratification weighting was used to adjust for potential confounding factors. RESULTS 3114 women with registered first pregnancies (2351 in THIN and 763 in CDARS) were included. 5.49% (2.55% in THIN and 14.55% in CDARS) were diagnosed with GDM. The adjusted OR of GDM in continuers was 0.73 (95% CI: 0.43-1.25) in THIN and 1.16 (95% CI: 0.78-1.73) in CDARS compared with discontinuers. CONCLUSIONS Our results do not suggest an increased risk of GDM in women who continued using antipsychotics during pregnancy compared to women who stopped. Based on these results, women should not stop their regular antipsychotics prescriptions in pregnancy due to the fear of GDM.
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Affiliation(s)
- Zixuan Wang
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tiantian Ma
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ruth Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.
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The association between mental illness, psychotropic medication use and hypertensive disorders in pregnancy: A multicentre study. Pregnancy Hypertens 2021; 24:22-26. [PMID: 33636509 DOI: 10.1016/j.preghy.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 10/20/2020] [Accepted: 02/04/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Women with severe mental illnesses (SMI) may have elevated rates of hypertensive disorders in pregnancy (HDP) due to an accumulation of risk factors. This study aims to determine the prevalence rate of HPD within a population of women with SMI and to report on rates within different mental illness diagnoses and types of medication exposure. STUDY DESIGN A retrospective multicentre study of 521 pregnant women attending specialised antenatal clinics for the management of established SMI. MAIN OUTCOME MEASURES Measures included sociodemographic characteristics, pregnancy complications, mental health diagnosis and psychotropic medication use. RESULTS Overall, 14% of women in the study had HDP. Compared to women with non-affective psychotic and other non-psychotic disorders (10.3%), women with depression and anxiety disorders demonstrated an increased risk of having a diagnosis of HDP (18.8%; RR = 1.82 [95% CI: 1.01, 3.29], p = .048). Log-binomial regression demonstrated that both a BMI in the overweight and obese range (RR = 3.37 [95% CI: 1.04, 10.95], p = .044) and continuous SNRI treatment throughout pregnancy (RR = 2.79 [95% CI; 1.33, 5.83], p = .006) were significant predictors of HDP, after adjusting for maternal age, gestational diabetes, and other mental health diagnoses. CONCLUSION Women with severe mental illnesses have elevated risk of developing HPD. Management remains complex and should address their comorbid risk profiles, and weigh up the risks and benefits of psychotropic medication use, given these results provide evidence of elevated rates of HDP associated with exposure to SNRI when taken throughout pregnancy.
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Sun YF, Chang Q, Wu QJ, Gao SY, Zang ST, Liu YS, Zhao YH. Association between maternal antenatal depression and neonatal Apgar score: A systematic review and meta-analysis of prospective cohort studies. J Affect Disord 2021; 278:264-275. [PMID: 32977264 DOI: 10.1016/j.jad.2020.09.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/13/2020] [Accepted: 09/11/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Antenatal depression is common, but most women with the condition choose to remain untreated. The Apgar score, an important indicator of newborn health, has been reported to be influenced by antenatal depression; thus, maternal antenatal depression, as reflected by a poor Apgar score, may harm children's health. AIM To conduct a systematic review and meta-analysis to explore whether maternal antenatal depression is associated with the neonatal Apgar score. METHODS We registered the protocol for this study with PROSPERO (CRD42019137585). We searched PubMed, Embase, Web of Science, and the Cochrane Library for published papers that reported the association between depression and Apgar score from inception to December 4, 2019. Two reviewers independently screened and selected the studies according to the inclusion and exclusion criteria, and extracted data according to the predesigned table. Stata version 12.0 software was used to analyze data. RESULTS We finally identified 13 studies for inclusion, including a total of 12017 women. We did not find an association between antenatal depression and the 1 min Apgar score of neonates (mean difference= -0.03, 95% CI= -0.15-0.09) or the risk of a low Apgar score (OR=1.82, 95% CI=0.51 to 3.13). We found that antenatal depression increased the risk of a low Apgar score at 5 min (OR= 1.91, 95% CI= 1.23-2.59), but the association between the 5 min Apgar score and antenatal depression was not significant (mean difference= -0.001, 95% CI= -0.07-0.07). The results of the subgroup analyses also indicated that there was no association between the 5 min Apgar score and antenatal depression. CONCLUSIONS Antenatal depression increased the risk of a low 5 min Apgar score; however, we did not find a difference in the mean and distribution of neonatal Apgar scores of mothers with depression and mothers without depression.
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Affiliation(s)
- Yi-Fei Sun
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning, MA 110004, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qing Chang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning, MA 110004, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning, MA 110004, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shan-Yan Gao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning, MA 110004, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Si-Tian Zang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning, MA 110004, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ya-Shu Liu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning, MA 110004, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu-Hong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning, MA 110004, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China.
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Grigoriadis S, Graves L, Peer M, Mamisashvili L, Ruthirakuhan M, Chan P, Hennawy M, Parikh S, Vigod SN, Dennis CL, Steiner M, Brown C, Cheung A, Dawson H, Rector N, Guenette M, Richter M. Pregnancy and Delivery Outcomes Following Benzodiazepine Exposure: A Systematic Review and Meta-analysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:821-834. [PMID: 32148076 PMCID: PMC7658418 DOI: 10.1177/0706743720904860] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Understanding the effects of benzodiazepines (BZDs) on maternal/fetal health remains incomplete despite their frequent use. This article quantifies the effects of antenatal BZD exposure on delivery outcomes. DATA SOURCES Medline, PsycINFO, CINAHL, Embase, and the Cochrane Library were searched till June 30, 2018. STUDY SELECTION English-language cohort studies comparing antenatal BZD exposure to an unexposed group on any delivery outcome were eligible. In all, 23,909 records were screened, 56 studies were assessed, and 14 studies were included. DATA EXTRACTION Two reviewers independently assessed quality and extracted data. Estimates were pooled using random effects meta-analysis. Sub-analyses examined several potential moderators including timing of exposure. RESULTS There were 9 outcomes with sufficient data for meta-analysis. Antenatal BZD exposure was significantly associated with increased risk of 6 outcomes initially: spontaneous abortion (pooled odds ratio = 1.86; 95% confidence interval [CI], 1.43 to 2.42), preterm birth (1.96; 95% CI, 1.25 to 3.08), low birth weight (2.24; 95% CI, 1.41 to 3.88), low Apgar score (2.19; 95% CI, 1.94 to 2.47), Neonatal Intensive Care Unit (NICU) admission (2.61; 95% CI, 1.64 to 4.14), and induced abortion (2.04; 95% CI, 1.23 to 3.40). There was significant heterogeneity between studies for most outcomes without consistent moderators. Birth weight (mean difference [MD]: -151.35 g; 95% CI, -329.73 to 27.03), gestational age (-0.49 weeks; 95% CI, -1.18 to 0.19), and small for gestational age (SGA; 1.42; 95% CI, 1.00 to 2.01) did not show significant associations although after adjusting for publication bias, gestational age, and SGA became significant, totaling 8 significant outcomes. CONCLUSIONS Antenatal BZD exposure appears to be statistically associated with increased risk of several adverse perinatal outcomes. Although confounds cannot be ruled out, NICU admission does appear clinically relevant and consistent with the antidepressant literature.
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Affiliation(s)
- Sophie Grigoriadis
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Lisa Graves
- Department of Family and Community Medicine, Homer Stryker MD School of Medicine, 4175Western Michigan University, Kalamazoo, MI, USA
| | - Miki Peer
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Lana Mamisashvili
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Myuri Ruthirakuhan
- Department of Pharmacology and Toxicology, 282299Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Parco Chan
- Department of Pharmacology and Toxicology, 282299Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Mirna Hennawy
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Supriya Parikh
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Simone Natalie Vigod
- Department of Psychiatry, University of Toronto, Ontario, Canada.,Department of Psychiatry, 7985Women's College Hospital, University of Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, 7938University of Toronto, Ontario, Canada
| | - Meir Steiner
- Department of Psychiatry & Behavioural Neurosciences, St. Joseph's Healthcare Hamilton, McMaster University, Ontario, Canada
| | - Cara Brown
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Amy Cheung
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | | | - Neil Rector
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Melanie Guenette
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.,Division of Neurology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Margaret Richter
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
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Smith HC, Saxena S, Petersen I. Postnatal checks and primary care consultations in the year following childbirth: an observational cohort study of 309 573 women in the UK, 2006-2016. BMJ Open 2020; 10:e036835. [PMID: 33229397 PMCID: PMC7684667 DOI: 10.1136/bmjopen-2020-036835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe women's uptake of postnatal checks and primary care consultations in the year following childbirth. DESIGN Observational cohort study using electronic health records. SETTING UK primary care. PARTICIPANTS Women aged 16-49 years who had given birth to a single live infant recorded in The Health Improvement Network (THIN) primary care database in 2006-2016. MAIN OUTCOME MEASURES Postnatal checks and direct consultations in the year following childbirth. RESULTS We examined 1 427 710 consultations in 309 573 women who gave birth to 241 662 children in 2006-2016. Of these women, 78.7% (243 516) had a consultation at the time of the postnatal check, but only 56.2% (174 061) had a structured postnatal check documented. Teenage women (aged 16-19 years) were 12% less likely to have a postnatal check compared with those aged 30-35 years (incidence rate ratio (IRR) 0.88, 95% CI 0.85 to 0.91) and those living in the most deprived versus least deprived areas were 10% less likely (IRR 0.90, 95% CI 0.88 to 0.92). Women consulted on average 4.8 times per woman per year and 293 049 women (94.7%) had at least one direct consultation in the year after childbirth. Consultation rates were higher for those with a caesarean delivery (7.7 per woman per year, 95% CI 7.7 to 7.8). Consultation rates peaked during weeks 5-10 following birth (11.8 consultations/100 women) coinciding with the postnatal check. CONCLUSIONS Two in 10 women did not have a consultation at the time of the postnatal check and four in 10 women have no record of receiving a structured postnatal check within the first 10 weeks after giving birth. Teenagers and those from the most deprived areas are among the least likely to have a check. We estimate up to 350 400 women per year in the UK may be missing these opportunities for timely health promotion and to have important health needs identified following childbirth.
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Affiliation(s)
- Holly Christina Smith
- Department of Primary Care and Population Health, University College London, London, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
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Ijaz S, Blanca Bolea, Davies S, Savović J, Richards A, Sullivan S, Moran P. Antipsychotic Polypharmacy and Metabolic Syndrome in Schizophrenia: A Review of Systematic Reviews. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:482-492. [PMID: 33343261 DOI: 10.1176/appi.focus.18307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted with permission from BMC Psychiatry (2018) 18:275).
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[Antipsychotics during pregnancy: a systematic review]. DER NERVENARZT 2020; 92:494-500. [PMID: 33000289 DOI: 10.1007/s00115-020-01006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The benefits and risks of treatment with antipsychotics during pregnancy must be weighed up carefully and individually because antipsychotics can penetrate the placental barrier and prescription is off-label. OBJECTIVE Evaluation of the risks and benefits of administering antipsychotics during pregnancy or for women who wish to become pregnant regarding teratogenic effects, risk of fetal death and stillbirths, perinatal complications, persisting postnatal impairments or disorders and gestational diabetes. METHODS A systematic review of the literature is provided to aid the selection of psychotropic drugs during pregnancy and in determining whether to begin, continue or switch an antipsychotic treatment during pregnancy. RESULTS Large, well-designed and controlled studies are missing; however, most studies suggest that the group of antipsychotics seem to be safe in terms of teratogenicity during pregnancy, at least in monotherapy. CONCLUSION Treating mental illnesses during pregnancy requires an individual assessment of the benefits and risks. The risk of an untreated mental illness versus the benefit of a suitable treatment with antipsychotics and the potential harm to the infant must be evaluated. If certain rules are observed and a suitable antipsychotic is selected the risk to the newborn child and/or mother during pregnancy can be minimized, however, a decision about subsequent medication can only be indirectly made from the results of this study.
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Understanding and Responding to Prescribing Patterns of Sodium Valproate-Containing Medicines in Pregnant Women and Women of Childbearing Age in Western Cape, South Africa. Drug Saf 2020; 44:41-51. [PMID: 32844313 PMCID: PMC7813724 DOI: 10.1007/s40264-020-00987-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Growing evidence of the teratogenic potential of sodium valproate (VPA) has changed prescribing practices across the globe; however, the impact of this research and the consequent dissemination of a Dear Health Care Professional Letter (DHCPL) in December 2015, recommending avoidance of the teratogen VPA in women of childbearing age (WOCBA) and pregnant women in South Africa, is unknown. We explored trends and reasons for VPA use among pregnant women and WOCBA in the public sector in Western Cape Province from 1 January 2015 to 31 December 2017. METHODS Using the provincial health information exchange that collates routine electronic health data via unique patient identifiers, we analysed clinical and pharmacy records from 2015 to 2017 to determine prescription patterns of VPA and other antiepileptic drug (AED) and mood-stabilising medicine (MSM) use in WOCBA and pregnant women. Senior clinicians and policy makers were consulted to understand the determinants of VPA use. RESULTS At least one VPA prescription was dispensed to between 8205 (0.79%) and 9425 (0.94%) WOBCA from a cohort of approximately 1 million WOCBA attending provincial health care facilities per year. Prescriptions were more likely in HIV-infected women compared with HIV-uninfected women (1.1-1.3% vs. 0.7-0.9%; p < 0.001). VPA use in WOCBA remained stable at 0.8-0.9% over the review period despite the 2016 DHCPL. VPA was the most prescribed AED/MSM, constituting 43.2-45.5% of all WOCBA taking at least one such agent, while lamotrigine, the other recommended first-line agent, was only prescribed in 7.8-8.9% of WOCBA. Over 3 years, approximately 663 pregnancies were exposed to VPA, with a steady rise in the number of exposures each year (n = 204, 214 and 245, respectively). CONCLUSION Despite warnings, VPA remained the most frequently prescribed AED or MSM in WOCBA. Contributing factors are described.
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Comprehensive Measurements of Intrauterine and Postnatal Exposure to Lamotrigine. Clin Pharmacokinet 2020; 58:535-543. [PMID: 30255309 DOI: 10.1007/s40262-018-0713-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to measure and investigate correlations of lamotrigine concentrations in maternal as well as umbilical cord blood, amniotic fluid, and breast milk to account for the distribution of the drug. METHODS Concentrations of lamotrigine were measured in 19 mother-infant pairs at the time of delivery. To account for the penetration ratio into amniotic fluid, cord blood and breast milk, the concentration of lamotrigine in the particular environment was divided by the concentration in maternal serum. A no-intercept model was applied for associations between maternal serum concentrations, amniotic fluid, umbilical cord blood, and breast milk concentrations. RESULTS The mean daily dosage of lamotrigine was 351.32 mg (range 50-650 mg). We detected associations between maternal serum and amniotic fluid (β = 0.088, p < 0.001), as well as umbilical cord (β = 0.939, p < 0.001) and breast milk (β = 0.964, p < 0.001). The median penetration ratio into amniotic fluid, cord blood, and breast milk was 0.68, 0.92, and 0.77, respectively. CONCLUSIONS Lamotrigine concentrations in amniotic fluid, cord blood, and breast milk give evidence that the fetus/newborn is constantly exposed to lamotrigine. Maternal serum concentrations predicted exposure via amniotic fluid, umbilical cord, and breast milk. Data suggest that therapeutic drug monitoring can be recommended as part of the clinical routine in psychopharmacotherapy for pregnant or breastfeeding women.
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Cohen JM, Cesta CE, Furu K, Einarsdóttir K, Gissler M, Havard A, Hernandez-Diaz S, Huybrechts KF, Kieler H, Leinonen MK, Li J, Reutfors J, Schaffer A, Selmer R, Yu Y, Zoega H, Karlstad Ø. Prevalence trends and individual patterns of antiepileptic drug use in pregnancy 2006-2016: A study in the five Nordic countries, United States, and Australia. Pharmacoepidemiol Drug Saf 2020; 29:913-922. [PMID: 32492755 DOI: 10.1002/pds.5035] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/16/2020] [Accepted: 05/07/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To describe recent international trends in antiepileptic drug (AED) use during pregnancy and individual patterns of use including discontinuation and switching. METHODS We studied pregnancies from 2006 to 2016 within linked population-based registers for births and dispensed prescription drugs from Denmark, Finland, Iceland, Norway, Sweden, and New South Wales, Australia and claims data for public and private insurance enrollees in the United States. We examined the prevalence of AED use: the proportion of pregnancies with ≥1 prescription filled from 3 months before pregnancy until birth, and individual patterns of use by trimester. RESULTS Prevalence of AED use in almost five million pregnancies was 15.3 per 1000 (n = 75 249) and varied from 6.4 in Sweden to 34.5 per 1000 in the publicly-insured US population. AED use increased in all countries in 2006-2012 ranging from an increase of 22% in Australia to 104% in Sweden, and continued to rise or stabilized in the countries in which more recent data were available. Lamotrigine, clonazepam, and valproate were the most commonly used AEDs in the Nordic countries, United States, and Australia, respectively. Among AED users, 31% only filled a prescription in the 3 months before pregnancy. Most filled a prescription in the first trimester (59%) but few filled prescriptions in every trimester (22%). CONCLUSIONS Use of AEDs in pregnancy rose from 2006 to 2016. Trends and patterns of use of valproate and lamotrigine reflected the safety data available during this period. Many women discontinued AEDs during pregnancy while some switched to another AED.
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Affiliation(s)
- Jacqueline M Cohen
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Carolyn E Cesta
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kari Furu
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristjana Einarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Alys Havard
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department for Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maarit K Leinonen
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Schaffer
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Randi Selmer
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Yongfu Yu
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Helga Zoega
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Øystein Karlstad
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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The early overgrowth theory of autism spectrum disorder: Insight into convergent mechanisms from valproic acid exposure and translational models. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2020. [PMID: 32711813 DOI: 10.1016/bs.pmbts.2020.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The development of new approaches for the clinical management of autism spectrum disorder (ASD) can only be realized through a better understanding of the neurobiological changes associated with ASD. One strategy for gaining deeper insight into the neurobiological mechanisms associated with ASD is to identify converging pathogenic processes associated with human idiopathic clinicopathology that are conserved in translational models of ASD. In this chapter, we first present the early overgrowth theory of ASD. Second, we introduce valproic acid (VPA), one of the most robust and well-known environmental risk factors associated with ASD, and we summarize the rapidly growing body of animal research literature using VPA as an ASD translational model. Lastly, we will detail the mechanisms of action of VPA and its impact on functional neural systems, as well as discuss future research directions that could have a lasting impact on the field.
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40
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Cohen JM, Selmer R, Furu K, Karlstad Ø. Interrupted time series analysis to assess changes in prescription filling around conception and implications for exposure misclassification. Pharmacoepidemiol Drug Saf 2020; 29:745-749. [PMID: 32128905 DOI: 10.1002/pds.4974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 11/07/2022]
Abstract
PURPOSE Medication exposures in pregnancy are often defined by one or more prescription fills. Harmful effects could be underestimated if rapid discontinuation of use after pregnancy recognition is common. We used conception, a critical biological period, as an intervention in a novel application of interrupted time series analysis (ITSA). METHODS Among 645 049 pregnancies from the Medical Birth Registry (2005-2015) linked to the Norwegian Prescription Database, we modeled the total number of prescription fills in the 12 weeks before and after estimated conception date with ITSA. We examined psychostimulants, antidepressants, antipsychotics, and antiepileptics (AEDs; separated by use for epilepsy or other indications). We used relative measures (%) to compare model coefficients. We also compared number of pregnancies defined as exposed when the earliest fill considered was 30 days before the last menstrual period (LMP -30 days), LMP, or estimated conception date (LMP +14 days). RESULTS We observed a sudden decline in prescription fills from 2 weeks after conception and decreasing fills thereafter for psychostimulants, antidepressants, AEDs for other indications, and antipsychotics excluding incident users. Fills for AEDs for epilepsy did not fall after conception. Only 77% of pregnancies with fills for psychostimulants from LMP and 58% with fills from LMP -30 days had fills from conception. Similar figures for AEDs for epilepsy were 99% and 96%. CONCLUSIONS This application shows that ITSA can help researchers understand rapid changes in patient behavior around conception that have consequences for exposure misclassification in pregnancy drug safety studies. ITSA results can help pharmacoepidemiologists guide study exposure definitions.
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Affiliation(s)
- Jacqueline M Cohen
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Randi Selmer
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Furu
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Øystein Karlstad
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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Solé E, Roca A, Torres A, Hernández AS, Fernández N, Díaz CN, Vieta E, Garcia-Esteve L. Obstetric complications in bipolar disorder: Psychiatric factors and the risk of caesarean section. Eur Neuropsychopharmacol 2020; 32:47-55. [PMID: 31911063 DOI: 10.1016/j.euroneuro.2019.12.115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022]
Abstract
Bipolar Disorder (BD) is a chronic psychiatric condition with somatic morbidity that requires continuous mood stabilizing treatment to prevent relapses. Pregnant women with BD have shown an increased rate of caesarean section (C-Section) in comparison with women without BD. Because specific differentiated profiles between mothers with BD that require C-Section and those that do not require C-Section have not been largely discussed, we aim to explore the risk factors associated with the type of delivery in pregnant women with BD. A prospective cohort study was conducted at the Perinatal Mental Health Unit. 100 pregnant women with BD were followed throughout their pregnancy by obstetric and psychiatric services at the same hospital. The cohort was developed in order to compare psychiatric and obstetric outcomes between women with BD that required C-Section (N = 40) versus women that did not require C-Section (N = 60). Final regression models showed an increased risk for obstetric complications during labour (OR 4,52, 95% CI 1,66-12,29), higher rates of hypothyroidism (OR 3,73, 95% CI 1,04-13,73) and treatment with lithium + antidepressant (OR 4,24, 95% CI 1,34-13,40) amongst the C-Section group when compared to the non-C-Section group. In our sample, women with BD treated with lithium plus antidepressant, with hypothyroidism and without obstetric complications have a 70,5% probability of C-Section. In conclusion, psychopharmacology and thyroid function might help understanding which women with BD will have more probability of C-Section. The implementation of more targeted interventions in selected patients might be useful to avoid complications during delivery.
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Affiliation(s)
- Eva Solé
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain; Bipolar and Depressives Disorder Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Alba Roca
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain; Vulnerability, Psychopathology and Gender Research Group, Generalitat de Catalunya, Catalonia, Spain
| | - Anna Torres
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain; Vulnerability, Psychopathology and Gender Research Group, Generalitat de Catalunya, Catalonia, Spain
| | - Ana Sandra Hernández
- Department of Maternal-Fetal Medicine, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Noemí Fernández
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Carmen Naranjo Díaz
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressives Disorder Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Lluïsa Garcia-Esteve
- Perinatal Mental Health Unit, Department of Psychiatry and Clinical Psychology, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain; Vulnerability, Psychopathology and Gender Research Group, Generalitat de Catalunya, Catalonia, Spain
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42
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Wang Z, Ho PWH, Choy MTH, Wong ICK, Brauer R, Man KKC. Advances in Epidemiological Methods and Utilisation of Large Databases: A Methodological Review of Observational Studies on Central Nervous System Drug Use in Pregnancy and Central Nervous System Outcomes in Children. Drug Saf 2020; 42:499-513. [PMID: 30421346 DOI: 10.1007/s40264-018-0755-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Studies have used various epidemiological approaches to study associations between central nervous system (CNS) drug use in pregnancy and CNS outcomes in children. Studies have generally focused on clinical adverse effects, whereas variations in methodologies have not received sufficient attention. OBJECTIVE Our objective was to review the methodological characteristics of existing studies to identify any limitations and recommend further research. METHODS A systematic literature search was conducted on observational studies listed in PubMed from 1 January 1946 to 21 September 2017. Following independent screening and data extraction, we conducted a review addressing the trends of relevant studies, differences between various data sources, and methods used to address bias and confounders; we also conducted statistical analyses. RESULTS In total, 111 observational studies, 25 case-control studies, and 86 cohort studies were included in the review. Publications dating from 1978 to 2006 mainly focused on antiepileptic drugs, but research on antidepressants increased from 2007 onwards. Only one study focused on antipsychotic use during pregnancy. A total of 46 studies obtained data from an administrative database/registry, 20 from ad hoc disease registries, and 41 from ad hoc clinical samples. Most studies (58%) adjusted the confounding factors using general adjustment, whereas only a few studies used advanced methods such as sibling-matched models and propensity score methods; 42 articles used univariate analyses and 69 conducted multivariable regression analyses. CONCLUSION Multiple factors, including different study designs and data sources, have led to inconsistent findings in associations between CNS drug use in pregnancy and CNS outcomes in children. Researchers should allow for study designs with clearly defined exposure periods, at the very least in trimesters, and use advanced confounding adjustment methodology to increase the accuracy of the findings.
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Affiliation(s)
- Zixuan Wang
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London, WC1H 9JP, UK
| | - Phoebe W H Ho
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Michael T H Choy
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London, WC1H 9JP, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ruth Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London, WC1H 9JP, UK
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Entrance A, Tavistock Square, London, WC1H 9JP, UK. .,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong. .,Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, Gregory CJ, Haddad PM, Howes OD, Jones I, Joyce EM, Lewis S, Lingford-Hughes A, MacCabe JH, Owens DC, Patel MX, Sinclair JM, Stone JM, Talbot PS, Upthegrove R, Wieck A, Yung AR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2020; 34:3-78. [PMID: 31829775 DOI: 10.1177/0269881119889296] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.
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Affiliation(s)
- Thomas Re Barnes
- Emeritus Professor of Clinical Psychiatry, Division of Psychiatry, Imperial College London, and Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Richard Drake
- Clinical Lead for Mental Health in Working Age Adults, Health Innovation Manchester, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Carol Paton
- Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Stephen J Cooper
- Emeritus Professor of Psychiatry, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bill Deakin
- Professor of Psychiatry, Neuroscience & Psychiatry Unit, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - I Nicol Ferrier
- Emeritus Professor of Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine J Gregory
- Honorary Clinical Research Fellow, University of Manchester and Higher Trainee in Child and Adolescent Psychiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter M Haddad
- Honorary Professor of Psychiatry, Division of Psychology and Mental Health, University of Manchester, UK and Senior Consultant Psychiatrist, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Oliver D Howes
- Professor of Molecular Psychiatry, Imperial College London and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Jones
- Professor of Psychiatry and Director, National Centre of Mental Health, Cardiff University, Cardiff, UK
| | - Eileen M Joyce
- Professor of Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Shôn Lewis
- Professor of Adult Psychiatry, Faculty of Biology, Medicine and Health, The University of Manchester, UK, and Mental Health Academic Lead, Health Innovation Manchester, Manchester, UK
| | - Anne Lingford-Hughes
- Professor of Addiction Biology and Honorary Consultant Psychiatrist, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - James H MacCabe
- Professor of Epidemiology and Therapeutics, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Honorary Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - David Cunningham Owens
- Professor of Clinical Psychiatry, University of Edinburgh. Honorary Consultant Psychiatrist, Royal Edinburgh Hospital, Edinburgh, UK
| | - Maxine X Patel
- Honorary Clinical Senior Lecturer, King's College London, Institute of Psychiatry, Psychology and Neuroscience and Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
| | - Julia Ma Sinclair
- Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James M Stone
- Clinical Senior Lecturer and Honorary Consultant Psychiatrist, King's College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Trust, London, UK
| | - Peter S Talbot
- Senior Lecturer and Honorary Consultant Psychiatrist, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health, University of Birmingham and Consultant Psychiatrist, Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angelika Wieck
- Honorary Consultant in Perinatal Psychiatry, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Professor of Psychiatry, University of Manchester, School of Health Sciences, Manchester, UK and Centre for Youth Mental Health, University of Melbourne, Australia, and Honorary Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Sanchez Ortiz S, Llorente García A, Astasio P, Huerta C, Cea Soriano L. An algorithm to identify pregnancies in BIFAP Primary Care database in Spain: Results from a cohort of 155 419 pregnancies. Pharmacoepidemiol Drug Saf 2019; 29:57-68. [PMID: 31749191 DOI: 10.1002/pds.4910] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 11/07/2022]
Abstract
PURPOSE There has been a notable progress on the development of methods for identification of pregnancies using primary care databases. We aimed to evaluate the prescription of medications during pregnancy applying a novel algorithm. METHODS We identified pregnancies in women aged 15 to 49 years registered in the Database for Pharmacoepidemiological Research in Primary Care (BIFAP) between 2002 and 2015. The algorithm applied sequential cycles that searched in hierarchical order for indicators of conception, delivery or pregnancy loss, and other codes suggestive of pregnancy. Length of pregnancy was assessed by searching for last menstrual period (LMP) date, gestational age, and outcomes of pregnancy. Prescription of specific drugs during the pre-pregnancy period and first trimester and time trends during pregnancy were evaluated. RESULTS We identified a total of 155 419 pregnancies during the study period (77.5% completed pregnancies, 21.5% pregnancies losses, 0.8% ectopic pregnancies, and 0.2% stillbirths). Excluding vitamins and supplements, 43.8% of women received at least one prescription during the pre-pregnancy period and 68.4% during the first trimester. During the first trimester, the most commonly drugs prescribed were analgesics (16.3%) followed by antibiotics (11.8%). From 2002/2003 to 2014/2015, there was an increase of prescriptions for thyroid hormones (1.0% vs 4.7%), H2 blockers (1.0% vs 2.2%), and PPIs (1.4% vs 2.2%). While antidepressants (2.0% vs 1.5%) and benzodiazepines (3.1% vs 2.4%) decreased in the last period. CONCLUSION Having in mind the challenges of identifying pregnancies in health care databases, this study demonstrates the usefulness of BIFAP database for studies on drug utilization during pregnancy.
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Affiliation(s)
- Sara Sanchez Ortiz
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Ana Llorente García
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Paloma Astasio
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Consuelo Huerta
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Lucía Cea Soriano
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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Šumilo D, Nirantharakumar K, Willis BH, Rudge G, Martin J, Gokhale K, Thayakaran R, Adderley NJ, Chandan JS, Okoth K, Hewston R, Skrybant M, Deeks JJ, Brocklehurst P. Long-term impact of giving antibiotics before skin incision versus after cord clamping on children born by caesarean section: protocol for a longitudinal study based on UK electronic health records. BMJ Open 2019; 9:e033013. [PMID: 31558464 PMCID: PMC6773283 DOI: 10.1136/bmjopen-2019-033013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION In the UK, about a quarter of women give birth by caesarean section (CS) and are offered prophylactic broad-spectrum antibiotics to reduce the risk of maternal postpartum infection. In 2011, national guidance was changed from recommending antibiotics after the umbilical cord was cut to giving antibiotics prior to skin incision based on evidence that earlier administration reduces maternal infectious morbidity. Although antibiotics cross the placenta, there are no known short-term harms to the baby. This study aims to address the research gap on longer term impact of these antibiotics on child health. METHODS AND ANALYSIS A controlled interrupted time series study will use anonymised mother-baby linked routine electronic health records for children born during 2006-2018 recorded in UK primary care (The Health Improvement Network, THIN and Clinical Practice Research Datalink, CPRD) and secondary care (Hospital Episode Statistics, HES) databases. The primary outcomes of interest are asthma and eczema, two common allergy-related diseases in childhood. In-utero exposure to antibiotics immediately prior to CS will be compared with no exposure when given after cord clamping. The risk of outcomes in children delivered by CS will also be compared with a control cohort delivered vaginally to account for time effects. We will use all available data from THIN, CPRD and HES with estimated power of 80% and 90% to detect relative increase in risk of asthma of 16% and 18%, respectively at the 5% significance level. ETHICS AND DISSEMINATION Ethical approval has been obtained from the University of Birmingham Ethical Review Committee with scientific approvals obtained from the independent scientific advisory committees from the Medicines and Healthcare products Regulatory Agency for CPRD and the data provider, IQVIA for THIN. The results will be published in peer-reviewed journals, presented at national and international conferences and disseminated to stakeholders.
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Affiliation(s)
- Dana Šumilo
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, University of Birmingham, Birmingham, UK
| | - Brian H Willis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gavin Rudge
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rasiah Thayakaran
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kelvin Okoth
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Use of Prescribed Psychotropics during Pregnancy: A Systematic Review of Pregnancy, Neonatal, and Childhood Outcomes. Brain Sci 2019; 9:brainsci9090235. [PMID: 31540060 PMCID: PMC6770670 DOI: 10.3390/brainsci9090235] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022] Open
Abstract
This paper reviews the findings from preclinical animal and human clinical research investigating maternal/fetal, neonatal, and child neurodevelopmental outcomes following prenatal exposure to psychotropic drugs. Evidence for the risks associated with prenatal exposure was examined, including teratogenicity, neurodevelopmental effects, neonatal toxicity, and long-term neurobehavioral consequences (i.e., behavioral teratogenicity). We conducted a comprehensive review of the recent results and conclusions of original research and reviews, respectively, which have investigated the short- and long-term impact of drugs commonly prescribed to pregnant women for psychological disorders, including mood, anxiety, and sleep disorders. Because mental illness in the mother is not a benign event, and may itself pose significant risks to both mother and child, simply discontinuing or avoiding medication use during pregnancy may not be possible. Therefore, prenatal exposure to psychotropic drugs is a major public health concern. Decisions regarding drug choice, dose, and duration should be made carefully, by balancing severity, chronicity, and co-morbidity of the mental illness, disorder, or condition against the potential risk for adverse outcomes due to drug exposure. Globally, maternal mental health problems are considered as a major public health challenge, which requires a stronger focus on mental health services that will benefit both mother and child. More preclinical and clinical research is needed in order to make well-informed decisions, understanding the risks associated with the use of psychotropic medications during pregnancy.
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Solé E, Torres A, Roca A, Hernández AS, Roda E, Sureda B, Martin-Santos R, Vieta E, Garcia-Esteve L. Obstetric complications in bipolar disorder: The role of mental health disorders in the risk of caesarean section. J Affect Disord 2019; 252:458-463. [PMID: 31004826 DOI: 10.1016/j.jad.2019.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/25/2019] [Accepted: 04/07/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Women with Bipolar Disorder (BD) during pregnancy present a negative impact on them and their babies' health. Caesarean Section (C-Section) is an intervention to reduce complications associated with childbirth, but it also has risks, including maternal infections, anaesthetic and psychological complications. There are few studies that analyse the C-Section rates in women with BD compared to the general population. METHODS A case-control study was conducted in a general university hospital. 100 pregnant women with BD matched with 100 controls without psychiatric illness who were attending the same hospital at delivery. We compared obstetrical outcomes during pregnancy, Pre/During Labour, onset of labour and mode of delivery specifying the type of C-Section. RESULTS Rate of C-Section was significantly higher in BD group compared to the control group (OR=2, 95% CI 1,4-1,6). Case group had more somatic illness (SI) without treatment (P<, 001). BD (P=,021), primiparity (P=, 003), obstetric complications during pregnancy (P<, 001), obstetric complications during labour (P<,001), and SI with and without treatment (P<,001 and P=,007, respectively) were higher in women that required C- section. CONCLUSION Women with Bipolar Disorder have near two-fold increased risk of C-section than women without Bipolar Disorder of similar age, gestational age and parity. Somatic illness was more prevalent in BD group that required C-section and this relation probably is related to high probability of having somatic comorbidities in patients with BD.
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Affiliation(s)
- Eva Solé
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain; Bipolar Disorder Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Anna Torres
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Alba Roca
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Ana Sandra Hernández
- Department of Maternal-Fetal Medicine, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ester Roda
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Bàrbara Sureda
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain
| | - Rocío Martin-Santos
- Vulnerability, Psychopathology and Gender research group, Generalitat de Catalunya, Catalonia, Spain
| | - Eduard Vieta
- Bipolar Disorder Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Lluïsa Garcia-Esteve
- Perinatal Mental health Unit, Department of Psychiatry and Clinical Psychology, Institute of Neuroscience, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain; Vulnerability, Psychopathology and Gender research group, Generalitat de Catalunya, Catalonia, Spain
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Perceptions of medicine use among pregnant women: an interview-based study. Int J Clin Pharm 2019; 41:1021-1030. [PMID: 31104187 DOI: 10.1007/s11096-019-00840-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/19/2019] [Indexed: 12/30/2022]
Abstract
Background When women are in a condition that requires medicines during pregnancy they have to balance the health benefits of the medical treatment against the potential risk of harming their unborn child. Too high teratogenic risk perceptions among pregnant women can lead them to stop taking the medicine, worsening the symptoms for the mother and even harming their foetus. Many women today who use over-the-counter and prescribed medicines have been shown to change their medical behaviour when they become pregnant. Objective To explore in depth the perceptions of medication use among women during their pregnancy. Setting The Capital Region of Denmark. Methods Participants were recruited from social network groups on Facebook and from participants in lectures and antenatal classes for pregnant women in two hospitals. Two focus groups interviews and three individual semi-structured interviews were conducted. The interview guides were based on existing literature and relatively unstructured, with an emphasis on open-ended questions. Interview transcripts were analysed using the phenomenological approach of meaning condensation. Main Outcome measure Pregnant women's' perceptions of medicine including aspects related to their safety feeling of medicines and perceived support from health care professionals. Results The women believed that it is less safe to take medicines during pregnancy, largely due to the risk of the child getting a disease in the future, but also due to the risk of malformation. Lack of clinical tests and uncertainty about how the unborn child reacts to medications were reported causes of these concerns. Most participants were concerned about using medicines and avoided them if possible, including over-the counter medicines. Conversations with physicians had a calming effect although the physicians appeared to be unclear in their guidance regarding dietary supplements. Some women received conflicting information on the Internet. Several suggestions were made about how to reduce uncertainties about the safety of taking medicines during pregnancy. Conclusion Many pregnant women are concerned about how to use medicines. To reduce these concerns and ensure the appropriate use of medicines during pregnancy, initiatives are needed to strengthen evidence-based advice from health care professionals, especially during the first trimester.
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Breadon C, Kulkarni J. An update on medication management of women with schizophrenia in pregnancy. Expert Opin Pharmacother 2019; 20:1365-1376. [DOI: 10.1080/14656566.2019.1612876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Carolyn Breadon
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
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Silva PAD, Almeida LYD, Souza JD. The use of benzodiazepines by women cared for at a Family Health Unit. Rev Esc Enferm USP 2019; 53:e03419. [PMID: 30726334 DOI: 10.1590/s1980-220x2017038903419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 08/24/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Estimate the prevalence of benzodiazepine use by adult women at a Family Health Unit and identify the risk factors associated with this usage. METHOD Quantitative cross-sectional study that employed secondary data developed at a Family Health Unit in the state of São Paulo, Brazil. We collected the data from the following sources: medical charts, registration forms, and the archive of prescriptions from the pharmacy at the referred health unit. We employed the chi-squared, Student's t, and Mann-Whitney tests, as well as logistic regression analysis. RESULTS We identified 81 benzodiazepine users amongst 1,094 adult women (7.4%). Regarding the risk factors, the comparison between the groups of benzodiazepine users (n = 64) and non-users (n = 70) showed that having a chronic disease and using other psychotropic drugs were significantly associated with the use of benzodiazepines. CONCLUSION The prevalence found was lower than the described in previous studies performed in Primary Health Units. The group that must receive greater attention regarding the consumption of benzodiazepines is that of middle-aged women or older, with low education levels, and chronic illnesses.
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Affiliation(s)
- Paula Adriana da Silva
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | | | - Jacqueline de Souza
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Psiquiátrica e Ciências Humanas, Ribeirão Preto, SP, Brazil
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