Effect of maternal fluoxetine administration on uterine blood flow, fetal blood gas status, and growth.
ABSTRACT Clinical depression, diagnosed in 5-15% of women during pregnancy, increases the risk of negative pregnancy outcomes including an increased incidence of low birth weight newborns and preterm delivery. Fluoxetine, a selective serotonin reuptake inhibitor, is often prescribed to treat depression due to its efficacy, high margin of safety, and mild side effects. However, fluoxetine initially increases plasma serotonin concentration, and serotonin causes uterine vasoconstriction in sheep, which could result in fetal hypoxemia. To assess fetal fluoxetine effects, late-gestation pregnant sheep were surgically prepared for the measurement of blood gases, heart rate, blood pressure, and uterine artery blood flow (n = 29). Ewes received a 70-mg bolus i.v. infusion of fluoxetine over 2 min in 10 mL of sterile water followed by continuous infusion at a rate of 100 microg/min for 8 d (n = 14), or continuous infusion of sterile water (n = 15). Transient decreases in uterine artery blood flow, fetal PO(2), and oxygen saturation were observed within the first 15 min after fluoxetine exposure, which did not return to normal values by 24 h. Fetal pH decreased and PCO(2) increased over the first 4 h with a return to normal by 24 h. However, there were no differences in uterine artery blood flow, blood gas status, or cardiovascular measures between the control and fluoxetine group over the rest of the 8-d infusion period. Thus, fluoxetine exposure during pregnancy has transient effects on fetal status that may be of developmental consequence if they occur repetitively.
[show abstract] [hide abstract]
ABSTRACT: The objective of this article is to review the literature as to the presence of depression during and after pregnancy and some of its clinical implications; and to present a simple statistical aide for screening purposes. Clinical depression affects at least one in five women of childbearing age. During pregnancy, this figure does not diminish and not only signals problems for the pregnant woman but also for the child, measurably so into adolescence. Postpartum depression, but even more so antepartum depression, are medical conditions that negatively affect mother and child, and need to be detected as early as possible to avoid or limit the use of pharmacological treatments with possible side effects. The obstetrician should regularly test for depression from the very first moments of planning for a child, and use the test results for a "pregnancy mood profile". This profile requires only a few minutes and is very simple to complex. It could serve for early control of depression during pregnancy as well as determine the risk for postpartum depression and thus serve as a pre-alert for postpartum suicide.European Journal of Obstetrics & Gynecology and Reproductive Biology 11/2004; 116(2):125-30. · 1.97 Impact Factor
European Journal of Obstetrics & Gynecology and Reproductive Biology 11/2004; · 1.97 Impact Factor
Article: Uterine blood flow in a psychiatric population: impact of maternal depression, anxiety, and psychotropic medication.[show abstract] [hide abstract]
ABSTRACT: Accumulating evidence suggests that fetal exposure to maternal psychiatric symptoms is associated with future risk for psychopathology. One potential pathway is distress-linked constriction in uterine or umbilical blood flow (UBF). With approximately 6.6% of pregnant women taking an antidepressant, an ecologically valid investigation of this hypothesis must consider the potential concomitant influence of pharmacotherapy on UBF. Pregnant women (n = 101) with lifetime histories of mental illness were evaluated every 4 to 6 weeks during gestation for mood symptoms and medication use; women underwent an ultrasound examination for UBF at approximately 25 weeks gestation. No associations were observed between UBF and three assessments of maternal prenatal depression and anxiety (acute: coincident with the UBF scan; proximal: within 2 weeks of the scan; chronic: serial symptom ratings). Chronic and acute use of bupropion was associated with reduced UBF, even after controlling for pregnancy complications. Chronic use of atypical antipsychotics also was associated with decreased UBF. There were no associations between serotonergic antidepressant use and UBF. Contrary to a popular hypothesis, depression and anxiety-associated reductions in UBF may not be a pathway by which risk is conferred during prenatal development. However, while requiring replication, our findings suggest that prenatal bupropion exposure may be associated with reductions in UBF.Biological psychiatry 06/2012; 72(6):483-90. · 8.93 Impact Factor