Selected Pregnancy and Delivery Outcomes After Exposure to Antidepressant Medication

Ross, Lori E.; Grigoriadis, Sophie; Mamisashvili, Lana; VonderPorten, Emily H.; Roerecke, Michael; Rehm, Jürgen; Dennis, Cindy‐Lee; Koren, Gideon; Steiner, Meir; Mousmanis, Patricia; Cheung, Amy

doi:10.1001/jamapsychiatry.2013.684

Cited by 239 publications

(170 citation statements)

References 92 publications

(101 reference statements)

Supporting

Mentioning

155

Contrasting

Unclassified

Order By: Relevance

“…(53) A meta-analysis of 13 studies, primarily in LMICs, concluded that the most effective interventions for mothers with depression included infant massage and support groups Antidepressants for treatment of antenatal depression, on the other hand, have been associated with small but significant increases in preterm birth and reductions in birth weight. (59,60) Persistence of depression (into the postnatal period and beyond) seems to be of particular importance in relation to cognitive development, including achievement of developmental milestones, and language development. (56) Recent trials from Bangladesh(61) and Uganda (62) suggest that group-based parenting programmes can improve maternal mental health in community settings and young children's cognitive and receptive language scores.…”

Section: Maternal Stress Depression and Mental Disordersmentioning

confidence: 99%

Nurturing care: promoting early childhood development

et al. 2017

View full text Add to dashboard Cite

The Sustainable Development Goals (SDGs) provide a historic opportunity to implement at scale interventions to promote Early Childhood Development (ECD). While the evidence base for the importance of ECD has grown, the research is distributed across sectors, populations, and settings with diversity noted in the scope and focus. In this paper, we provide a comprehensive updated analyses of ECD interventions across five sectors: health; nutrition; education; child protection; and social protection. Our review concludes that to make interventions, successful, smarter and sustainable, they need to be implemented as multi-sectoral intervention packages anchored in "nurturing care". The recommendations emphasize that intervention packages should be applied at developmentally appropriate times during the life-course, target multiple risks, and build on existing delivery platforms for feasibility of scale-up. While interventions will continue to improve with the growth of developmental science, the evidence is now strong that parents, caregivers, and families need to be supported in providing nurturing care and protection for young children to achieve their developmental potential.

show abstract

Section: Maternal Stress Depression and Mental Disordersmentioning

confidence: 99%

Nurturing care: promoting early childhood development

et al. 2017

View full text Add to dashboard Cite

show abstract

“…57,58 There have been small but significant associations between the use of SSRI/SNRIs and spontaneous abortions, as well as shorter gestational age, preterm delivery, and lower APGAR scores in neonates. [59][60][61] Additionally, an increased risk of persistent pulmonary hypertension of the newborn has been associated with third trimester SSRI/SNRI exposure; 62 the absolute risk, however, is small-3 to 4 cases per thousand. 63 Third trimester exposure has been related to neonatal withdrawal symptoms, such as jitteriness, irritability, tremulousness, difficulty feeding, difficulty sleeping, hypertonia, and other adverse symptoms such as seizures.…”

Section: Antidepressantsmentioning

confidence: 99%

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Misri

Abizadeh

Sanders

et al. 2015

Journal of Women's Health

102

View full text Add to dashboard Cite

Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.

show abstract

“…We selected 2 specific antidepressants (fluoxetine and paroxetine) for a separate analysis of their effect on malformations where sufficient data were available, as more information was available for them compared to others. All analyses were conducted with Stata statistical software, version 10.1 (StataCorp LP) 29 and similar to our other work in Ross et al 30 …”

Section: Statistical Analysesmentioning

confidence: 99%

Antidepressant Exposure During Pregnancy and Congenital Malformations: Is There an Association?

Grigoriadis¹,

VonderPorten²,

Mamisashvili³

et al. 2013

J. Clin. Psychiatry

Self Cite

152

117

View full text Add to dashboard Cite

Objective: Depression is often not optimally treated during pregnancy, partially because of conflicting data regarding antidepressant medication risk. This meta-analysis was conducted to determine whether antenatal antidepressant exposure is associated with congenital malformations and to assess the effect of known methodological limitations. Data Sources: EMBASE, CINAHL, PsycINFO, and MEDLINE were searched from their start dates to June 2010. Keywords of various combinations were used, including, but not limited to depressive/mood disorder, pregnancy, antidepressant drug/agent, congenital malformation, and cardiac malformation. Study Selection: English language studies reporting congenital malformations associated with antidepressants were included. Of 3,074 abstracts reviewed, 735 studies were retrieved and 27 studies were included. Data Extraction: Two reviewers working independently assessed article quality. Data on use of any antidepressant, including fluoxetine and paroxetine specifically, were extracted. Outcomes included congenital malformations, major congenital malformations, cardiovascular defects, septal heart defects (ventral septal defects and atrial septal defects), and ventral septal defects only. Results: Nineteen studies were above quality threshold and make up the primary meta-analyses. Pooled relative risks (RRs) were derived by using random-effects methods. Antidepressant exposure was not associated with congenital malformations (RR = 0.93; 95% CI, 0.85-1.02; P = .113) or major malformations (RR = 1.07; 95% CI, 0.99-1.17; P = .095). However, increased risk for cardiovascular malformations (RR = 1.36; 95% CI, 1.08-1.71; P = .008) and septal heart defects (RR = 1.40; 95% CI, 1.10-1.77; P = .005) were found; the RR for ventral septal defects was similar to septal defects, although not significant (RR = 1.54; 95% CI, 0.71-3.33; P = .274). Pooled effects were significant for paroxetine and cardiovascular malformations (RR = 1.43; 95% CI, 1.08-1.88; P = .012). These results are contrasted with those addressing methodological limitations but are typically consistent. Conclusions: Overall, antidepressants do not appear to be associated with an increased risk of congenital malformations, but statistical significance was found for cardiovascular malformations. Results were robust in several sensitivity analyses. Given that the RRs are marginal, they may be the result of uncontrolled confounders. Although the RRs were statistically significant, none reached clinically significant levels.

show abstract

Selected Pregnancy and Delivery Outcomes After Exposure to Antidepressant Medication

Cited by 239 publications

References 92 publications

Nurturing care: promoting early childhood development

Nurturing care: promoting early childhood development

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Antidepressant Exposure During Pregnancy and Congenital Malformations: Is There an Association?

Contact Info

Product

Resources

About