Maternal use of antidepressants during pregnancy and risks for adverse perinatal outcomes: a meta-analysis

Xing, Dexiu; Wu, Rong; Wang, Tingting

doi:10.1016/j.jpsychores.2020.110231

Cited by 21 publications

(18 citation statements)

References 60 publications

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“…In high-income countries, ~5–15% of pregnant women meet the criteria for depression and/or clinical anxiety [ 2 – 4 ], and these rates are even higher in low- and middle- income countries [ 4 , 5 ]. Consequently, the use of antidepressant drugs (ADDs) during pregnancy has greatly increased, and is expected to escalate given the overall rise of depression worldwide [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Some recent human studies seem to suggest that the use of SSRIs during pregnancy could pose a risk for the developmental health of the offspring [ 7 ], increasing, for example, the risk of preterm delivery [ 15 , 16 ], low birth weight and cardiac defects [ 15 , 17 ]; the development of mental illness [ 18 – 20 ]; and alterations in the hypothalamic-pituitary-adrenal (HPA) axis and the serotoninergic system [ 21 , 22 ]. However, the results of human studies are equivocal, with other reports finding no such associations [ 23 ], and few are graded as high-quality evidence [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

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A novel murine model to study the impact of maternal depression and antidepressant treatment on biobehavioral functions in the offspring

et al. 2021

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Antenatal psychopathology negatively affects obstetric outcomes and exerts long-term consequences on the offspring’s wellbeing and mental health. However, the precise mechanisms underlying these associations remain largely unknown. Here, we present a novel model system in mice that allows for experimental investigations into the effects of antenatal depression-like psychopathology and for evaluating the influence of maternal pharmacological treatments on long-term outcomes in the offspring. This model system in based on rearing nulliparous female mice in social isolation prior to mating, leading to a depressive-like state that is initiated before and continued throughout pregnancy. Using this model, we show that the maternal depressive-like state induced by social isolation can be partially rescued by chronic treatment with the selective serotonin reuptake inhibitor, fluoxetine (FLX). Moreover, we identify numerous and partly sex-dependent behavioral and molecular abnormalities, including increased anxiety-like behavior, cognitive impairments and alterations of the amygdalar transcriptome, in offspring born to socially isolated mothers relative to offspring born to mothers that were maintained in social groups prior to conception. We also found that maternal FLX treatment was effective in preventing some of the behavioral and molecular abnormalities emerging in offspring born to socially isolated mothers. Taken together, our findings suggest that the presence of a depressive-like state during preconception and pregnancy has sex-dependent consequences on brain and behavioral functions in the offspring. At the same time, our study highlights that FLX treatment in dams with a depression-like state can prevent abnormal behavioral development in the offspring.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A novel murine model to study the impact of maternal depression and antidepressant treatment on biobehavioral functions in the offspring

et al. 2021

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“…In contrast, Xing and colleagues concluded in their meta‐analysis (including 48 cohort and 6 case–control studies) that children exposed to antidepressants during pregnancy had increased risks of preterm birth, low birth weight and admissions to neonatal intensive care units compared with newborns of depressed but unmedicated mothers. Risks of spontaneous abortions, low APGAR scores at 5 min or neonatal convulsions were higher when mothers were treated with antidepressant medication during pregnancy compared to newborns of healthy mothers 25 . For SSRIs, a higher risk of cardiovascular defects in infants exposed to SSRIs in utero 26 as well as adverse but self‐limiting effects on neonatal adaption after placental exposure 27 are discussed, while exposure through breastfeeding results in much lower drug concentrations with an relative infant drug doses of <10% for SSRIs.…”

Section: Discussionmentioning

confidence: 96%

Psychotropic medication in pregnancy and lactation and early development of exposed children

Leutritz

Braam

Preis

et al. 2022

Brit J Clinical Pharma

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There is still limited knowledge about alterations of blood concentrations of psychotropic drugs during pregnancy, the transfer of psychotropic drugs into breastmilk and the effects on exposed children. We investigated changes in concentrations of psychopharmacological medication during pregnancy and lactation in serum and breastmilk at different time points in a naturalistic sample of 60 mothers and observed the development of the exposed children in the first 12 months. We found a decrease in serum concentrations from the first to the second trimester of amitriptyline, duloxetine, escitalopram, quetiapine and sertraline. Citalopram stayed rather stable during pregnancy, sertraline levels interestingly increased again from the second to the third trimester. High concentration‐by‐dose ratios in breastmilk were found for venlafaxine as well as lamotrigine, low for quetiapine and clomipramine. Similarly, clomipramine and quetiapine showed low milk/serum–penetration ratios. Regarding the birth outcome measures in children, we found no significant differences between in utero exposed compared to nonexposed newborns. There were no significant differences in the development in the first 12 months. Psychotropic medication in the peripartum needs a balancing of risks and benefits and a continuous therapeutic drug monitoring can be a guidance for clinicians to monitor drug alteration patterns, which are likely to occur due to physiological pregnancy‐associated changes in pharmacokinetics. Accordingly, therapeutic drug monitoring can optimize a medication in pregnancy and lactation with the lowest effective dose.

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“…33 Our results in a Catalan population coincide with the ones published by the BIFAP database founding a risk for abortion for the use of antidepressants and anxiolytics during pregnancy, and the metanalysis by Xing et al found similar risk of abortion for antidepressants. 30,34 Two observational studies in Danish population did not nd any risk for mirtazapine or duloxetine speci cally, neither one for uoxetine with American population. [35][36][37] Women can already be on antidepressants or anxiolytics when becoming pregnant or initiate these treatments during the pregnancy, and up to now no clear conclusions to guide their use during pregnancy have been established.…”

Section: Discussionmentioning

confidence: 99%

Drug exposure during pregnancy: A case-control study of abortions of a Catalan Primary Care Database

Gómez-Lumbreras

Vázquez

Vilaplana-Carnerero

et al. 2022

Preprint

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Background: Exposure to medicines during pregnancy is frequent, even more during first trimester as pregnant women might not be aware of their condition. Aiming to establish potential relationship of earlier exposure to medicines and risk of abortion we conducted an observational study. Methods: this is a retrospective case-control study of abortions (cases) and live birth pregnancies (controls) matched by mother age using SIDIAP database (Catalan Primary Health electronic health records database). Exposure to medicines while pregnant was considered to assess the risk of abortion during the first trimester. The odds ratio was estimated by a conditional logistic regression and adjust by health conditions and medicines exposures. Results: A total of 60,350 episodes of abortions were matched to 118,085 live birth/completed pregnancy episodes. Cases had higher rates of alcohol intake (9.9% vs 7.2%), smoking (4.5% vs 3.6%) and of previous abortions (9.9% vs 7.8%). Anxiety (30.3% and 25.1%), respiratory diseases (10.6% and 9.2%) and migraine (8.2% and 7.3%), for cases and controls respectively, were the most frequent baseline conditions. Cases had higher rate of exposure to medicines [40,148 (66.5%) vs 37636 (68.9%), p<0.001, cases and controls respectively]. A risk for abortion was found for antihistamines for systemic use (ORadj 1.23, 95%CI 1.19-1.27), antidepressants (ORadj 1.11, 95%CI 1.06-1.17), anxiolytics (ORadj 1.31, 95%CI 1.26-1.73), and anti-inflammatory and rheumatic products, non-steroids (ORadj 1. 63, 95%CI 1.59-1.67). Conclusions: These highest rate of medicines exposures during the first trimester of pregnancy and their relationship with abortion highlights the relevance of prescription to women with childbearing potential and may lead to better family planning information and contraception plans. Registration: EUPAS37675

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Maternal use of antidepressants during pregnancy and risks for adverse perinatal outcomes: a meta-analysis

Cited by 21 publications

References 60 publications

A novel murine model to study the impact of maternal depression and antidepressant treatment on biobehavioral functions in the offspring

A novel murine model to study the impact of maternal depression and antidepressant treatment on biobehavioral functions in the offspring

Psychotropic medication in pregnancy and lactation and early development of exposed children

Drug exposure during pregnancy: A case-control study of abortions of a Catalan Primary Care Database

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