Adrienne Einarson

• RN,PhD
• Retired at Utrecht University

RationaleKnowledge transfer and translation (KT) has become an important component in health care systems worldwide. Antidepressant use in pregnancy has become a controversial subject for a number of reasons, including differing interpretations of study results.Methods Selected key articles were indentified and retrieved from the literature. Releva...

We would like to reiterate that, based on scientific evidence, psychotropic drugs in general do not pose a significant teratogenic risk.1,2 Even paroxetine, which women are advised to avoid in pregnancy, is associated with an only marginal increase in risk (odds ratio [OR] 1.29, 95% confidence interval [95%CI] 1 : 11 to 1 : 49), not exceeding the p...

Background: 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. Objective: To evaluate possible adverse effects of antid...

Objective: The authors conducted a prospective, comparative observational study to evaluate the risk of major anomalies following exposure to lithium during pregnancy. Method: A total of 183 lithium-exposed pregnancies of women who contacted the Israeli Teratology Information Service were followed up (90.2% in the first trimester) and compared w...

Objective: Pregnant women and their health care professionals commonly believe that use of medications during pregnancy may be harmful to the unborn fetus. The objective of this study was to evaluate the risk perception of psychotropic drug use in pregnancy among physicians in different medical specialties. Method: This was a convenience survey...

Healthcare professionals' (HCPs') perception of risk associated with drug use in pregnancy may have an impact on the pharmacological treatment of some women. The aim of this study was to examine this risk perception in a sample of Swiss HCPs with a special focus on their knowledge and use of available specialised information sources. An online, Fre...

Depression is a common illness during pregnancy, yet it often goes undetected and/or untreated. Untreated depression during pregnancy has been associated with increased rates of adverse maternal, obstetrical and fetal outcomes; consequently, it is crucial to manage these women effectively and adequately during this vulnerable time of their lives. T...

Question: When some of my patients who are taking antidepressants learn they are pregnant, they become anxious and confront me with the following statement: "I need this medication, but have heard so many conflicting stories from my friends and on the Internet and in the media that I am not sure if I should continue taking it." How do I advise the...

Objectives: Our objectives were to 1) determine whether first-trimester use of gabapentin is associated with an increased risk for major malformations; 2) examine rates of spontaneous abortions, therapeutic abortions, stillbirths, mean birth weight and gestational age at delivery; and 3) examine rates of poor neonatal adaptation syndrome following...

Because this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text. Many more women than men are diagnosed with depression, most often between 25 and 44 years of age when women are of childbearing age, and approximately 10% to 15% will experience depression during pregnancy. Therefore, a substanti...

Method. In this observational multicenter cohort study, data on duloxetine exposure were collected prospectively from either women or their health care providers who had requested information regarding the use of duloxetine during pregnancy. These data came mainly from national teratogen information services that provide evidence-based information...

Many studies examining the teratogenic potential of antidepressants have been published. A variety of observational designs have been used with apparent conflicting results, although odds ratios were rarely >2. To examine whether these apparent differences were associated with research methods such as model, comparison groups, data source, data col...

We aimed to estimate the reliability of the 4-item Perceived Stress Scale (PSS) and its validity in predicting maternal depression and quality of life (QoL). Data regarding stress, depression and QoL were collected during pregnancy among a sub-sample from the Organization of Teratology Information Specialists Antidepressants in Pregnancy Cohort. Th...

Counseling about medication safety during pregnancy is delivered inconsistently. The objectives were to determine public preferences and willingness to pay (WTP) for attributes of counseling regarding antidepressant use during pregnancy. Attributes reflected counseling via a telephone Teratology Information Service (TIS) or a visit to a general pra...

An association between PPHN and antidepressant use in pregnancy has been reported. We sought to examine this relationship. A review of the literature was performed, to evaluate this association. Six published studies fulfilled our criteria for inclusion, with only three studies large enough to have the power to detect an association. There appears...

Results of previous studies on the safety of antidepressants during pregnancy have been conflicting. The primary objective of this study was to investigate whether first-trimester exposure to antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), was associated with increased risk of congenital malformations. The secondary o...

Unlabelled: QUESTION A: patient of mine who recently learned she was 6 weeks pregnant had received the recombinant human papillomavirus (HPV) quadrivalent vaccine at 4 weeks of gestation. She is quite worried about how this will affect her baby. What is known about the safety of the HPV vaccine during pregnancy? Answer: The HPV vaccine is genera...

The two highest-ranking winners of the 2011 CIHR/CMAJ competition for Top Achievements in Health Research are Daniel Drucker, and Gideon Koren and colleagues for the Motherisk team. In the following essay, Dr. Koren and colleagues describe the work of the Motherisk team in the area of fetal-maternal toxicity. The essay by Dr. Drucker and synopses o...

The use of antidepressants by women during pregnancy continues to be a controversial subject, with conflicting information regarding the safety of this group of drugs. We sought (1) to determine the impact of information, advice, and comments women received from health care providers, family, and media about use of antidepressants during pregnancy,...

Women are often exposed to various medications and medical conditions during pregnancy. Unrealistically high maternal teratogenic risk perception, related to these exposures, may lead to abrupt discontinuation of therapy and (or) termination of a wanted pregnancy. The association between maternal depression and the teratogenic risk perception has n...

Escitalopram is a serotonin reuptake inhibitor prescribed for depression and anxiety. There is a paucity of information regarding safety in pregnancy. The objective of this study was to determine whether escitalopram is associated with an increased risk for major malformations or other adverse outcomes following use in pregnancy. The authors analyz...

Well-executed knowledge transfer and translation (KT) has become a vital part of effective health management. Following the thalidomide disaster, women and their health care providers became fearful of medications and environmental exposures that could affect the health of the unborn child. Therefore, it is important to disseminate evidenced-based...

Question: Some of my pregnant patients wish to travel to malaria-endemic regions. Are there medications that can be used safely during pregnancy for malaria prophylaxis? Answer: Pregnant women should avoid travel to malaria-endemic areas if possible. However, if travel cannot be avoided, measures to prevent mosquito bites, along with an effectiv...

A community pharmacist is frequently the first healthcare professional who is asked to give advice regarding medication use during pregnancy. As 50% of pregnancies are unplanned, a woman often discovers she is pregnant while already taking a medication and visits a pharmacy which is easily accessible, to enquire if she has harmed her baby by this a...

Question: I have been encouraging pregnant women to receive both the H1N1 and influenza vaccines since I became aware of Health Canada's guidelines. However, some of the women in my practice have heard conflicting information, often from media sources, and they are hesitant to be vaccinated. What is the evidence behind these guidelines, and should...

Both nausea and vomiting and depression are common conditions affecting women during pregnancy. Several studies have linked depression with nausea and vomiting of pregnancy (NVP); however, researchers were unable to determine whether depression was caused by NVP or by a pre-existing condition. To determine whether NVP is associated with depression...

The objective of this study was to report the outcomes of intrauterine pregnancies misdiagnosed as ectopic and exposed to methotrexate, a major teratogen. We report the outcomes of all subjects who sought consultation after exposure to high-dose methotrexate to induce abortion in presumed ectopic pregnancies, which were later identified as viable i...

Question: Several of my female patients of reproductive age seem to be depressed. Is there a simple tool I can use to screen them? Answer: Motherisk is using the Edinburgh Postnatal Depression Scale to screen for depression. This simple questionnaire is filled out by women while in the waiting room. Using this tool has helped us identify large n...

Question: Many of my female patients complain about acne, unwanted hair growth, and other skin problems that have only developed since they became pregnant. Are products used for these types of benign skin conditions safe to use in pregnancy, as it is understandable that women want to look their best at this important time in their lives? Answer:...

Introduction: Depression during pregnancy can affect up to 20% of all women and may be treated effectively with antidepressants. Currently, information on > 20,000 women exposed to antidepressants with pregnancy outcomes is available in the literature. However, there is a continuing fear of physicians prescribing and women taking these drugs durin...

Question: One of my patients is studying to become a dental hygienist. Owing to the program requirements, she received several vaccinations last week, including measles-mumps-rubella, varicella, and hepatitis B (HB) vaccines, as well as a tetanus booster. However, today a blood test confirmed that she is currently 6 weeks pregnant. What is known a...

During the H1N1 influenza pandemic in 2009, The Motherisk Program, a counselling service providing teratology information, received many calls from pregnant women inquiring about the safety of the H1N1 vaccine. We wished to explore pregnant women's perception of risk and the factors associated with deciding whether or not to receive the vaccine. Pr...

Question: One of my patients is a pregnant woman in her first trimester with a history of recurrent genital herpes. She is concerned about whether use of her antiviral medication will adversely affect her baby. What should I tell her? Answer: Studies have shown that the use of acyclovir or valacyclovir is not associated with an increase in birth...

Question: There has been a great deal of discussion in both the medical and lay literature about the use of probiotics to improve general health. Subsequently, pregnant women have been asking me if probiotics used for treating conditions such as bacterial vaginosis and diarrhea are safe to use during pregnancy and lactation. Answer: Current data...

I thank Mintzes and associates for their comments. I should have stated that neither study by Nakhai-Pour and colleagues1 or Motherisk2 could make any definitive conclusions, although I stand by my comment that “if there is a true increased risk of spontaneous abortion caused by gestational use of antidepressants, it is very small.”3 The small ris...

Depression in pregnancy or antenatal depression (AD) occurs in approximately one in five women, with potentially deleterious effects to the mother and fetus. People are encouraged to get treatment for depression; however, pregnant women can experience stigma when they reach out for help with depression. Research indicates that healthcare profession...

Little is known about the practices of primary care physicians regarding the prescribing of antidepressants during pregnancy. An anonymous survey was administered to a group of nonrandomly selected Australian general practitioners (n = 61 out of 77) and randomly selected Canadian family physicians (n = 35 out of 111). Responses to a hypothetical sc...

A single study has been published documenting an increased risk for adverse pregnancy outcomes following use of more than one antidepressant during pregnancy. To examine whether multiple antidepressant use is associated with increased rates of major malformations, spontaneous abortions (SA), therapeutic abortions (TA), stillbirths, preterm birth, l...

Psychiatric disorders are relatively common among women of childbearing age, who may become pregnant while they are taking psychotropic drugs. There remains a high level of anxiety regarding their safety among women and healthcare providers alike, most likely because of the conflicting studies that have been published in the literature and warnings...

Purpose: Making decisions about using medications during pregnancy, particularly anti-depressants, requires appropriate information. It is not known what format is preferred for receiving counseling and information services on medication use during pregnancy. Two common sources are family doctors and teratology information services (TIS, which oper...

Teratology Information Services (TIS) provide health care professionals and the public with information regarding the safety and/or risk of exposures during pregnancy and lactation, mainly via telephone consultations. An international comparison of clinical practices at TIS has never been conducted. The survey objective was to compare international...

The majority of pregnant women experience nausea and vomiting during pregnancy. However, nausea and vomiting in pregnancy is not always nausea and vomiting of pregnancy (NVP). The differential diagnosis of nausea and vomiting in pregnancy can be extensive and the underlying cause can sometimes be difficult to diagnose. However, the timing or onset...

Beliefs about medication may impact a woman's decision to take a needed medication during pregnancy. While many women will be faced with decisions regarding medication use during pregnancy, there is a paucity of research on this topic in the literature. To study pregnant women's beliefs about medication and factors that determine those beliefs. A q...

Question: Montelukast is used more and more by my patients with asthma. Is it safe to use during pregnancy? Answer: Cumulative data, including a recent Motherisk study, are very reassuring regarding the use of this drug to treat pregnant patients with asthma.

Nausea and vomiting of pregnancy (NVP) is a common medical condition in pregnancy with significant physical and psychological morbidity. Up to 90% of women will suffer from NVP symptoms in the first trimester of pregnancy with up to 2% developing hyperemesis gravidarum which is NVP at its worst, leading to hospitalization and even death in extreme...

Question: I have a patient who has just found out she is pregnant, and she is currently taking paroxetine for severe anxiety and depression. Owing to conflicting results from different studies, as well as my patient hearing about the lawsuit against GlaxoSmithKline, I did try her on other antidepressants; however, only paroxetine was effective, so...

The Motherisk Alcohol and Substance Use Helpline at The Hospital for Sick Children in Toronto, Canada, is a unique telephone service providing evidence-based information on the negative effects associated with alcohol and substance use in pregnancy and lactation. We describe the characteristics of the service, the demographics of the callers, and t...

There is a dearth of information on paternal drug exposure at the time of conception. The Motherisk Program, established in 1985, is a teratology information and clinical consultation service on drug safety during pregnancy and lactation, as well as paternal exposure (PEx). Here, we reviewed for the first time our experience with PEx. This was an o...

Question: A patient who just found out that she is pregnant and suffers from migraine headaches informs me that she has been taking naratriptan. She indicates that she is planning on breastfeeding her baby and might need to continue treatment. How safe are the medications from this class of drugs during pregnancy and breastfeeding? Answer: Accum...

Question: Many of my pregnant and breastfeeding patients suffer from allergies and frequently ask me about the safety of antihistamines during pregnancy and breastfeeding. Should I advise them to use the older sedating medications? I have heard that they might be safer than the newer nonsedating class of drugs. Or have the newer ones been studied...

Question: After hearing about outbreaks of illness resulting from Listeria and Salmonella, many of my patients are wondering about the risks of food-borne illnesses during pregnancy and what they can do to reduce their chances of contracting them. Answer: Although heating or cooking food is the best way to inactivate food-borne pathogens, improv...

QUESTION: My patient is taking a medication for a chronic condition and has just found out that she is 6 weeks pregnant. The US Food and Drug Administration (FDA) has assigned this medication to pregnancy risk category D, and the Compendium of Pharmaceuticals and Specialties provides no additional data. How should I interpret this information, and...

It is important to evaluate the safety of antipsychotic drugs in pregnancy and the postpartum, especially as most women with schizophrenia need to continue their treatment during pregnancy and breastfeeding. With the increasing use of second generation antipsychotics, which cause less hyperprolactinemia-induced infertility than was the case with ol...

Question: In addition to suffering from nausea and vomiting of pregnancy, which is being treated with antiemetics, some of my pregnant patients complain of heartburn and acid reflux. Should these symptoms also be treated and, if so, which acid-reducing medications are safe for use during pregnancy? Answer: Increased severity of nausea and vomiti...

To compare the rates of low birth weight, preterm delivery and small for gestational age (SGA), in pregnancy outcomes among women who were exposed and nonexposed to antidepressants during pregnancy. At The Motherisk Program, we analyzed pregnancy outcomes of 1,243 women in our database who took various antidepressants during their pregnancy. Nine h...

Question: My pregnant patients frequently ask about taking pain medications, sometimes for chronic conditions. What is known about the safety of using analgesics in therapeutic doses for acute or chronic pain during pregnancy? Answer: Commonly prescribed pain medications appear to be relatively safe to use during pregnancy. None of the analgesic...

Perception of risk may impact a woman's decision to take a needed drug during pregnancy. There is a paucity of research on this topic in the literature. (1) To evaluate the perception of risk of 17 commonly used drugs and other substances by pregnant women. (2) To investigate which sources of information regarding exposures during pregnancy were mo...

Montelukast (Singulair) is a selective leukotriene receptor antagonist (LTRA) indicated for the maintenance treatment of asthma. Currently, there are limited prospective, comparative studies in the literature examining the safety of montelukast use in pregnancy. The primary objective of this study was to determine whether exposure to montelukast du...

Question: Many of my patients have asked me if they should defer dental treatment until after they have given birth. Is there any risk associated with performing dental treatments during pregnancy? Answer: Appropriate and timely dental care can lead to improved pregnancy outcomes as well as greater comfort for the woman. The treatment of periodo...

The incidence of schizophrenia in the general population ranges from about 1% to 2%. Schizophrenia affects men and women equally, occurring in all cultures and socioeconomic classes. The peak age of onset in women is 25 to 35 years, which are also the peak childbearing years, and women with psychotic illnesses are likely to have more unplanned preg...

The use of antidepressants during pregnancy remains a controversial issue, and there is little information on the risk of spontaneous abortions following antidepressant exposure in early pregnancy. We sought to examine whether use of antidepressants increases the rates of spontaneous abortion (SA) and therapeutic abortion (TA) in women exposed in e...

To ascertain if antidepressants, as a group, increase the risk for major malformations, as well as assessing each individual antidepressant. At The Motherisk Program, we analyzed pregnancy outcomes of women (n = 1243) from prospectively collected cases in our database, who were exposed to antidepressants during their pregnancy. We then compared the...

The role of periconceptional folic acid supplementation in the prevention of neural tube defects (NTDs) has been well established. Maternal red blood cell (RBC) folate concentration is inversely associated with NTD risk, and concentrations above 906 nmol/L are associated with a low risk of NTDs. Current guidelines call for a minimum of 0.4 mg of fo...

Question: My pregnant patients often present with symptomatic vaginal yeast infections. Are the medications commonly used for the management of yeast infections safe to use during pregnancy? Answer: Existing data indicate that exposure to oral and topical antifungals, topical antiseptics, or corticosteroids during pregnancy is not associated wit...

Background There is a dearth of information on medication safety and counseling experience regarding paternal exposure (PEx) to drugs and chemicals in the peri‐conception period. The Motherisk Program, first established in Toronto, ON, Canada in 1985, is a teratology information and clinical consultation service with a focus on drug safety during p...

Question: Several of my pregnant patients use diuretics for hypertension. I have heard that diuretics cannot be used in pregnancy because of the reduction of plasma volume and the potential for decreasing placental perfusion, as well as a possible diabetogenic effect. Answer: Many studies--including a meta-analysis of almost 7000 neonates expose...

On May 7th 2008, our annual Motherisk Update was devoted to reproductive mental health, which is a part of life for many women of childbearing age. Presentations were delivered by experts int he fields of psychiatry, maternal/fetal pharmacology and obstetrics. Our goal was to improve patient care for a population that is particularly vulnerable to...

Psychiatric disorders are relatively common among women of childbearing age, who may be prescribed psychotropic drugs. There remains a high level of anxiety regarding their safety among patients and healthcare providers alike, most likely because of the conflicting studies that have been published in the literature and warnings from government orga...

Despite documented evidence of harm to fetus and infant, a substantial number of women continue to smoke during pregnancy and lactation. To examine the literature regarding smoking during pregnancy and breastfeeding to ascertain adverse effects as well as the efficacy of interventions to enable women to stop smoking in the perinatal period. A compr...

Question: Several of my pregnant patients who are hairdressers have asked me if exposure to products they use is harmful to their unborn babies. They also want to know if their pregnant clients' personal use of hair products should be of concern. Answer: There is no evidence of teratogenic effects for pregnant women exposed to these products fro...

Debate has recently arisen about the safety of paroxetine use in pregnancy, prompted by reports of increased risks for cardiac defects following first trimester exposure. We conducted a meta-analysis of nine studies. Three case-control studies (N = 30,247) found no increased risk of congenital malformations associated with paroxetine (OR = 1.18; 95...

Depression has been identified by the World Health Organization as a major cause of morbidity in the 21st century. As women between 25 and 44 yr represent the population at highest risk for depression, a substantial number are likely to become pregnant while suffering from this illness. In this chapter, we summarize the prevalence and clinical cour...

Question: I have several patients with inflammatory bowel disease (IBD) who are pregnant or planning pregnancies. What information can I give them regarding the possible effects of IBD on pregnancy and the medications used to treat IBD during pregnancy? Answer: Women with IBD appear to be at increased risk of giving birth prematurely, having low...