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: 2.41). 12/2004; 49(11):726-35.
Source: PubMed

ABSTRACT 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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    • "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 · 3.10 Impact Factor
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    • "Results of antidepressant reproductive safety studies, however , have been inconclusive or conflicting (Einarson and Einarson 2005; Hemels et al. 2005; Koren and Nordeng 2012), and many adverse neonatal outcomes associated with fetal antidepressant exposure have also been linked with untreated gestational depression (Bonari et al. 2004; Wisner et al. 2009b), causing uncertainty about the risks versus benefits of antidepressant use in pregnancy (Kuehn 2009). "
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    ABSTRACT: The purpose of this study was to assess whether antidepressant prescribing during pregnancy decreased following release of U.S. and Canadian public health advisory warnings about the risk of perinatal complications with antidepressants. We analyzed data from 228,876 singleton pregnancies among women (aged 15-44 years) continuously enrolled in Tennessee Medicaid with full pharmacy benefits (1995-2007). Antidepressant prescribing was determined through outpatient pharmacy dispensing files. Information on sociodemographic and clinical factors was obtained from enrollment files and linked birth certificates. An interrupted time series design with segmented regression analysis was used to quantify the impact of the advisory warnings (2002-2005). Antidepressant prescribing rates increased steadily from 1995 to 2001, followed by sharper increases from 2002 to late 2004. Overall antidepressant prescribing prevalence was 34.51 prescriptions [95 % confidence interval (CI) 33.37-35.65] per 1,000 women in January 2002, and increased at a rate of 0.46 (95 % CI 0.41-0.52) prescriptions per 1,000 women per month until the end of the pre-warning period (May 2004). During the post-warning period (October 2004-June 2005), antidepressant prescribing decreased by 1.48 (95 % CI 1.62-1.35) prescriptions per 1,000 women per month. These trends were observed for both selective serotonin reuptake inhibitors (SSRI) and non-SSRI antidepressants, although SSRI prescribing decreased at a greater rate. We conclude that antidepressant prescribing to pregnant women in Tennessee Medicaid increased from 1995 to late 2004. U.S. and Canadian public health advisories about antidepressant-associated perinatal complications were associated with steady decreases in antidepressant prescribing from late 2004 until the end of the study period, suggesting that the advisory warnings were impactful on antidepressant prescribing in pregnancy.
    Archives of Women s Mental Health 10/2013; 17(1). DOI:10.1007/s00737-013-0383-6 · 1.96 Impact Factor
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    • "Untreated perinatal depression and anxiety may have potentially adverse consequences for the mother and child. Women who are depressed engage in more high-risk behaviours and are less likely to receive adequate prenatal care (Bonari et al., 2004). Their pregnancies are more likely to end prematurely, result in operative deliveries, and have more obstetrical complications (Chung et al., 2001). "
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    ABSTRACT: We conducted a review of research literature related to anxiety, depression, and mood problems in Indigenous women in Canada, the United States (including Hawaii), Australia, and New Zealand. Quantitative and qualitative research studies published between 1980 and March 2010 were reviewed. The initial search revealed 396 potential documents, and after being checked for relevance by two researchers, data were extracted from 16 quantitative studies, one qualitative research article, and one dissertation. Depression is a common problem in Indigenous pregnant and postpartum women; however, the prevalence and correlates of anxiety and mood disorders are understudied. The review identified four key areas where further research is needed: (a) longitudinal, population-based studies; (b) further validation and modification of appropriate screening tools; (c) exploration of cultural diversity and meaning of the lived experiences of antenatal and postpartum depression, anxiety, and mood disorders; and (d) development of evidence-informed practices for researchers and practitioners through collaborations with Aboriginal communities to better understand and improve mental health of women of childbearing age.
    Transcultural Psychiatry 09/2013; 51(1). DOI:10.1177/1363461513501712 · 0.99 Impact Factor
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