Neonatal growth outcomes at birth and one month postpartum following in utero exposure to antidepressant medication

School of Psychology, Deakin University, Melbourne, Victoria, Australia.
Australian and New Zealand Journal of Psychiatry (Impact Factor: 3.77). 05/2010; 44(5):482-7. DOI: 10.3109/00048670903559593
Source: PubMed

ABSTRACT Method: A prospective case-control study recruited 27 pregnant women taking antidepressant medication and 27 matched controls who were not taking antidepressant medication in pregnancy at an obstetric hospital in Melbourne, Australia. Of the 27 women taking medication, 25 remained on medication in the third trimester. A purpose-designed self-report questionnaire and the Beck Depression Inventory-II were completed in pregnancy, after birth and at one month postpartum. In addition information was collected on exposed and non-exposed infants including Apgar scores, birthweight/length/head circumference and gestational age at birth. Weight/length/head circumference was again collected at 1 month of age. Results: Infants exposed to antidepressants in utero were eightfold more likely to be born at a premature gestational age, had significantly lower birthweight and were smaller in length and head circumference than non-exposed infants. There was no association between birth outcomes and maternal depression. At 1 month, the difference in weight in the exposed group became significantly greater than the control group. Conclusion: Antidepressant exposure in utero may affect gestational age at birth and neonatal outcomes independently of antenatal maternal depression. Further studies are needed to examine whether these findings vary according to the type of antidepressant prescribed and follow up growth and development in exposed infants beyond 1 month.

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    ABSTRACT: It is estimated that 14.5% of women suffer depression in pregnancy [Sit, D.K.Y., Flint, C., Svidergol, D., White, J., Wimer, M., Bish, B., & Wisner, K.L. (2009). An emerging best practice model for perinatal depression care. Psychiatric Services, 60, 1429–1431. Retrieved from = 18], which has been linked to a number of negative outcomes such as higher levels of preterm delivery, reduced cognitive development and poor mother–baby connection [Judd, F., Stafford, L., Gibson, P., & Ahrens, J. (2011). The early motherhood service: An acceptable and accessible perinatal mental health service. Australasian Psychiatry, 19, 240–246. doi:10.3109/10398562.2011.562294]. The lack of clarity surrounding safety information has impacted treatment decisions with general practitioners (GPs) reportedly feeling hesitant to prescribe antidepressants [Bilszta, J.L., Tsuchiya, S., Han, K., Buist, A.E., & Einarson, A. (2011). Primary care physicians attitudes and practices regarding antidepressant use during pregnancy: A survey of two countries. Archive of Women's Mental Health, 14, 71–75. doi:10.1007/s00737-010-0197-8], yet the usage of perinatal depression guidelines among GPs is reportedly low [Kean, L.J., Hamilton, J., & Shah, P. (2011). Antidepressants for mothers: What are we prescribing? Scottish Medical Journal, 56, 94–97. doi:10.1258/smj.2011.011034]. Therefore, this study aimed to explore the opinions of GPs on how clinical guidelines for perinatal depression facilitated them to empower pregnant women to make an informed decision about the use of antidepressants in pregnancy. Using qualitative methodology, semi-structured interviews were conducted with one GP from eight practices in Derry City, Northern Ireland. The main areas explored in the interview schedule were guidelines on perinatal depression, GP understanding of ‘patient empowerment’, GP practice policy on patient decision making, constraints of treatment decisions and a discussion on which health promotion model was most reflective of their views on the provision of healthcare. Only some of the GPs were aware of the National Institute National Institute for Health and Clinical Excellence Clinical Excellence [NICE (2007). Antenatal and postnatal mental health: Clinical management and service guidance (Clinical Guideline No. CG45). Retrieved from] perinatal depression guidelines but acknowledged that they were generic and lacked utility, instead they relied on their own professional experience and patient knowledge to make decisions. Involving patients in treatment decision making was viewed as central to patient empowerment; however, its application in routine practice was often limited by complex clinical scenarios. Findings from this study suggested an identified need for a local specialist perinatal service to provide evidence-based information and timely support. An empowerment model for the improvement of perinatal depression has been developed from the study findings as a framework for women, their community and their GPs.
    02/2013; 15(1):3-28. DOI:10.1080/14623730.2013.781872
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    ABSTRACT: In pregnant women with major depression, the overarching goal of treatment is to achieve or maintain maternal euthymia, thus limiting both maternal and fetal exposure to the harmful effects of untreated or incompletely treated depression. However, the absence of uniformly effective therapies with guaranteed obstetric and fetal safety makes the treatment of major depression during pregnancy among the most formidable of clinical challenges. Clinicians and patients are still faced with conflicting data and expert opinion regarding the reproductive safety of antidepressants in pregnancy, as well as large gaps in our understanding of the effectiveness of most antidepressants and nonpharmacological alternatives for treating antenatal depression. In this paper, we provide a clinically focused review of the available information on potential maternal and fetal risks of untreated maternal depression during pregnancy, the effectiveness of interventions for maternal depression during pregnancy, and potential obstetric, fetal, and neonatal risks associated with antenatal antidepressant use.
    Drug, Healthcare and Patient Safety 09/2014; 6:109-29. DOI:10.2147/DHPS.S43308
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    ABSTRACT: To date, many studies have been published regarding the safety of antidepressant use in pregnancy. However, most have been regarding a possible association with major malformations and there have been relatively few studies that have examined other infant outcomes specifically.
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Jun 6, 2014