Perinatal risks of untreated depression during pregnancy

The Hospital for Sick Children and the Department of of Pharmacology, University of Toronto, Toronto, Ontario.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.55). 12/2004; 49(11):726-35.
Source: PubMed


To review the literature on the perinatal risks involved in untreated depression during pregnancy.
We searched Medline and medical texts for all studies pertaining to this area up to the end of April 2003. Key phrases entered were depression and pregnancy, depression and pregnancy outcome, and depression and untreated pregnancy. We did not include bipolar depression.
While there is wide variability in reported effects, untreated depression during pregnancy appears to carry substantial perinatal risks. These may be direct risks to the fetus and infant or risks secondary to unhealthy maternal behaviours arising from the depression. Recent human data suggest that untreated postpartum depression, not treatment with antidepressants in pregnancy, results in adverse perinatal outcome.
The biological dysregulation caused by gestational depression has not received appropriate attention: most studies focus on the potential but unproven risks of psychotropic medication. No in-depth discussion of the role of psychotherapy is available. Because they are not aware of the potentially catastrophic outcome of untreated maternal depression, this imbalance may lead women suffering from depression to fear teratogenic effects and refuse treatment.

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    • "Goodman et al., 2014; Lilliecreutz et al., 2010; Robinson et al., 1992; Sockol et al., 2011; van Zoonen et al., 2014) and/ or medication (e.g. Wisner et al., 2009) might improve maternal disorders and offspring outcomes, but during pregnancy and lactation potential risks and benefits have to be evaluated (Arch et al., 2012; Bonari et al., 2004; Wisner et al., 2009). Psychotherapies involving the family and interventions designed to improve mother-infantinteraction are promising strategies that need further research attention (Sockol et al., 2011; Stein et al., 2014). "
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    ABSTRACT: Peripartum anxiety and depressive disorders are associated with adverse consequences for mother and child. Thus, it is important to examine risk factors, correlates and course patterns of anxiety and depressive disorders during pregnancy and after delivery. In the prospective-longitudinal Maternal Anxiety in Relation to Infant Development (MARI) Study, n=306 expectant mothers were recruited from gynaecological outpatient settings in Germany and completed up to seven waves of assessment from early pregnancy until 16 months postpartum. Anxiety and depressive disorders and potential risk factors/correlates were assessed with the Composite International Diagnostic Interview for Women (CIDI-V), medical records and additional questionnaires. Although peripartum anxiety and depressive disorders appeared to be persistent in some women, others reported major changes with heterogeneous courses and shifts between diagnoses and contents. There was a considerable amount of incident disorders. Strongest predictors for peripartum anxiety and depressive disorders were anxiety and depressive disorders prior to pregnancy, but psychosocial (e.g. maternal education), individual (e.g. low self-esteem), and interpersonal (e.g. partnership satisfaction, social support) factors were also related. Knowing the aims of the study, some participants may have been more encouraged to report particular symptoms, but if so, this points to the importance of a comprehensive assessment in perinatal care. Peripartum time is a sensitive period for a considerable incidence or persistence/recurrence of anxiety and depressive disorders albeit the course may be rather heterogeneous. Interventional studies are needed to examine whether an alteration of associated factors could help to prevent peripartum anxiety and depressive disorders. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 01/2015; 175C:385-395. DOI:10.1016/j.jad.2015.01.012 · 3.38 Impact Factor
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    • "The larger risk estimates documented for some non-SSRI antidepressants176,178,182 may reflect greater severity of underlying depression, since these agents are not generally considered immediate first-line therapeutic options. Moreover, many studies did not clearly distinguish between spontaneous and induced abortions,161,181 which could have resulted in biased estimates of spontaneous abortion risk with antidepressant use, given that maternal depression itself may increase the risk of elective termination of pregnancy.183,184 "
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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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    • "In addition, abnormal duration of labor, type of delivery, intrauterine growth restriction, and preterm birth have been considered adverse pregnancy outcomes. Prenatal depression prevalence estimates range from 10% to 25% [53] [54] [55] [56] [57], and it is a significant risk factor for miscarriage, preterm birth, and low birth weight [53,58–62]. Sleep disturbances are more frequent in depressed than in non-depressed women during pregnancy, especially in early gestation [57,63–65]. "
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    ABSTRACT: Objectives Short sleep duration, poor sleep quality, and insomnia frequently characterize sleep in pregnancy during all three trimesters. We aimed to review: (i) the clinical evidence of the association between conditions of sleep loss during pregnancy and adverse pregnancy outcomes; and (ii) to discuss the potential pathophysiological mechanisms that may be involved. Methods A systematic search of cross-sectional, longitudinal studies, using Medline, Embase, and PsychINFO, using MeSH headings and key words for conditions of sleep loss such as ‘insomnia’ or ‘poor sleep quality’ or ‘short sleep duration’ and ‘pregnancy outcome’ was made for papers published between January 1, 1960 and July 2013. Results Twenty studies met inclusion criteria for sleep loss and pregnancy outcome: seven studies on prenatal depression, three on gestational diabetes, three on hypertension, pre-eclampsia/eclampsia, six on length of labor/type of delivery, eight on preterm birth and three on birth grow/birth weight. Two main results emerged: (i) conditions of chronic sleep loss are related to adverse pregnancy outcomes; (ii) chronic sleep loss yields a stress-related hypothalamic–pituitary–adrenal axis and abnormal immune/inflammatory, reaction, which, in turn, influences pregnancy outcome negatively. Conclusion Chronic sleep loss frequently characterizes sleep throughout the course of pregnancy and it may contribute to adverse pregnancy outcomes. Common pathophysiological mechanisms emerged as being related to stress system activation. We propose that according to the allostatic load hypothesis, chronic sleep loss in pregnancy may also be regarded as both a result of stress and as a physiological stressor per se, leading to stress ‘overload’. It may account for adverse pregnancy outcomes and somatic and mental disorders in pregnancy.
    Sleep Medicine 08/2014; 15(8). DOI:10.1016/j.sleep.2014.02.013 · 3.15 Impact Factor
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