A meta-analysis of selective serotonin reuptake inhibitors (SSRIs) use during prenatal depression and risk of low birth weight and small for gestational age

Zhao, Xiaofeng; Liu, Qian; Cao, Suxia; Pang, Jianyue; Zhang, Huijie; Feng, Tao; Deng, Yajie; Yao, Jing; Li, Hengfen

doi:10.1016/j.jad.2018.08.061

Cited by 43 publications

(35 citation statements)

References 59 publications

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“…These findings support the consensus associating intrauterine growth restriction with SSRIs: [20,22,60,68] SGA <3 rd centile was more prevalent amongst those exposed to antidepressants in trimesters 2 or 3, particularly at higher doses; prevalence was lower if antidepressants were discontinued after trimester 1 [92 and 45 exposed infants] [69]. Discontinuation of antidepressants was significantly associated with SGA <10th centile, but this outcome is only a modest predictor of childhood morbidity.…”

Section: Discussionsupporting

confidence: 81%

Antidepressant prescriptions, discontinuation, depression and perinatal outcomes, including breastfeeding: A population cohort analysis

et al. 2019

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ObjectivesTo explore associations between exposure to antidepressants, their discontinuation, depression [medicated or unmediated] and preterm birth [<37 and <32 weeks], small for gestational age (SGA) [<10th and <3rd centiles], breastfeeding [any] at 6–8 weeks.MethodsDesign: A population-based cohort study.Setting: The Secure Anonymised Information Linkage [SAIL] databank in Wales, linking maternal primary care data with infant outcomes.Participants: 107,573, 105,331, and 38,725 infants born 2000–2010 with information on prematurity, SGA and breastfeeding respectively, after exclusions.Exposures: Maternal antidepressant prescriptions in trimesters 2 or 3, discontinuation after trimester 1, recorded diagnosis of depression [medicated or unmediated] in pregnancy.Methods: Odds ratios for adverse pregnancy outcomes were calculated, adjusted for smoking, parity, socio-economic status, and depression.ResultsExclusive formula feeding at 6–8 weeks was associated with prescriptions in trimesters 2 or 3 for any antidepressants (adjusted odds ratio [aOR] 0.81, 95% confidence intervals 0.67–0.98), SSRIs [aOR 0.77, 0.62–0.95], particularly higher doses [aOR 0.45, 0.23–0.86], discontinuation of antidepressants or SSRIs after trimester 1 (aOR 0.70, 0.57–0.83 and 0.66, 0.51–0.87), diagnosis of depression aOR 0.76 [0.70–0.82), particularly if medicated (aOR 0.70, 0.58–0.85), rather than unmedicated (aOR 0.87, 0.82–0.92). Preterm birth at <37 and <32 weeks’ gestation was associated with diagnosis of depression (aOR 1.27, 1.17–1.38, and 1.33, 1.09–1.62), particularly if medicated (aOR 1.56, 1.23–1.96, and 1.63, 0.94–2.84); birth at <37 weeks was associated with antidepressants, (aOR 1.24, 1.04–1.49]. SGA <3rd centile was associated with antidepressants (aOR 1.43, 1.07–1.90), and SSRIs (aOR 1.46, 1.06–2.00], particularly higher doses [aOR 2.10, 1.32–3.34]. All adverse outcomes were associated with socio-economic status and smoking.ImplicationsExposure to antidepressants or depression increased risks of exclusive formula feeding at 6–8 weeks, and prescription of antidepressants was associated with SGA <3rd centile. Prescription of antidepressants offers a useful marker to target additional support and additional care before and during pregnancy and lactation.

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Section: Discussionsupporting

confidence: 81%

Antidepressant prescriptions, discontinuation, depression and perinatal outcomes, including breastfeeding: A population cohort analysis

et al. 2019

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“…Increased pro-BDNF levels in the prefrontal cortex and ventral tegmental area, and reduced levels of m-BDNF in the prefrontal cortex and hippocampus are observed in different studies using animal models of depression (Lippmann et al, 2007; Shirayama et al, 2015; Hashimoto, 2016; Zhao G. et al, 2016; Zhao M. et al, 2016). Despite this, studies with humans that analyze pro-BDNF/m-BDNF ratio in blood are infrequent, and few studies showed changed ratio in patients with major depression (Yoshida et al, 2012; Zhou et al, 2013; Sodersten et al, 2014; Zhao et al, 2017). Both m-BDNF, BDNF pro-peptide and pro-BDNF can interact with Trk and p75 NTR receptor, although each one exhibits different biological activities (Mizui et al, 2014; Porcher et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Modulation of Serum Brain-Derived Neurotrophic Factor by a Single Dose of Ayahuasca: Observation From a Randomized Controlled Trial

et al. 2019

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Serotonergic psychedelics are emerging as potential antidepressant therapeutic tools, as suggested in a recent randomized controlled trial with ayahuasca for treatmentresistant depression. Preclinical and clinical studies have suggested that serum brainderived neurotrophic factor (BDNF) levels increase after treatment with serotoninergic antidepressants, but the exact role of BDNF as a biomarker for diagnostic and treatment of major depression is still poorly understood. Here we investigated serum BDNF levels in healthy controls (N = 45) and patients with treatment-resistant depression (N = 28) before (baseline) and 48 h after (D2) a single dose of ayahuasca or placebo. In our sample, baseline serum BDNF levels did not predict major depression and the clinical characteristics of the patients did not predict their BDNF levels. However, at baseline, serum cortisol was a predictor of serum BDNF levels, where lower levels of serum BDNF were detected in a subgroup of subjects with hypocortisolemia. Moreover, at baseline we found a negative correlation between BDNF and serum cortisol in volunteers with eucortisolemia. After treatment (D2) we observed higher BDNF levels in both patients and controls that ingested ayahuasca (N = 35) when compared to placebo (N = 34). Furthermore, at D2 just patients treated with ayahuasca (N = 14), and not with placebo (N = 14), presented a significant negative correlation between serum BDNF levels and depressive symptoms. This is the first double-blind randomized placebo-controlled clinical trial that explored the modulation of BDNF in response to a psychedelic in patients with depression. The results suggest a potential link between the observed antidepressant effects of ayahuasca and changes in serum BDNF, which contributes to the emerging view of using psychedelics as an antidepressant. This trial is registered at http://clinicaltrials.gov (NCT02914769).

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“…that support an association between depressive symptoms as measured by the EPDS and adverse birth outcomes such as LBW, PTB, or in this case, SGA. On the other hand, the study does not move towards filling the noted gaps in current understanding of the causal nature of maternal depressive symptoms, including 1) whether associations merely reflect the importance of pre-conception depressive symptoms, 2) whether key covariates such as medication usage and medical history (Zhao, et al (2018) 3 ) can be accounted for, and 3) as mentioned by other reviewers, whether associations remain across subclinical scores. Nor does it address some of the local needs they refer to in their introduction.…”

Section: Minor Points Regarding Organization and Data Presentationmentioning

confidence: 99%

“…Low birth weight (LBW; <2500 g), a marker of poor intrauterine growth, leads to the double burden of stunting in childhood and predisposes to obesity in adolescence 1,2 . The pathways triggered by LBW lead to perpetuating, independent cycles of ill health 3,4 . More than one million babies are born with LBW in India every year.…”

Section: Introductionmentioning

confidence: 99%

Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India

et al. 2020

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Background: Annually, more than a million low birthweight (LBW) is born in India, often afflicting disadvantaged families. Several studies have undertaken the association of poverty, nutritional status, and obstetric factors with LBW. Through our study, we aimed to examine the possibility of any relation between the Edinburgh Postnatal Depression Scale (EPDS) score measured during pregnancy with the incidence of babies born Small for Gestational Age (SGA). Methods: Pregnant women attending the antenatal clinic at a public hospital between 14 to 32 weeks were recruited from April 2016 to Oct 2017. The EPDS was administered to assess depression through face-to-face interviews. Newborn anthropometry was performed post-delivery. For analysis, birth weight <10 percentile was classified as SGA. Results: Prevalence of depressive symptoms (EPDS score >11) was 16.5% (n=108/654) in antenatal mothers. These women delivered a higher proportion of SGA babies (21.3 v/s 15.8) compared to women with no symptoms. The odds of women giving birth to a child with SGA were twice as high for women with EPDS scores >11 (adjusted OR = 2.03; 95% CI = 1.12 – 3.70) compared to the women with EPDS scores of ≤11, The EPDS 12 (Adjusted OR = 1.96; 95% CI = 1.04 – 3.69) and EPDS 13 (Adjusted OR = 2.42; 95% CI = 1.24 – 4.70) cut-off categories also proved to be a risk factor for SGA with significant p-value (0.0006 and 0.0003) and the individuals with more than 13 EPDS score is found to have the highest odds of SGA. Conclusions: We found a strong association of antenatal depressive symptoms during pregnancy with SGA measured by EPDS. Thus, we recommend the implementation of timely and effective screening, diagnostic services, and evidence-based antenatal mental health services to combat SGA and further associated-metabolic syndromes.

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A meta-analysis of selective serotonin reuptake inhibitors (SSRIs) use during prenatal depression and risk of low birth weight and small for gestational age

Cited by 43 publications

References 59 publications

Antidepressant prescriptions, discontinuation, depression and perinatal outcomes, including breastfeeding: A population cohort analysis

Antidepressant prescriptions, discontinuation, depression and perinatal outcomes, including breastfeeding: A population cohort analysis

Modulation of Serum Brain-Derived Neurotrophic Factor by a Single Dose of Ayahuasca: Observation From a Randomized Controlled Trial

Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India

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