Posts Tagged pregnancy

[WEB SITE] Rates of Pregnancy, Live Births Similar Among Women With and Without Epilepsy

Sexual activity and rates of ovulation were also similar among women with epilepsy and those without the disorder.

Sexual activity and rates of ovulation were also similar among women with epilepsy and those without the disorder.

Women with epilepsy who are seeking to become pregnant and have no known infertility or related disorders have a similar probability of achieving pregnancy, time to pregnancy, and live birth rates as do women without epilepsy, according to the results of the observational Women With Epilepsy Pregnancy Outcomes and Deliveries prospective cohort study (ClinicalTrials.gov identifier: NCT01259310), which was published in JAMA Neurology.

The investigators sought to examine whether women with epilepsy with no prior diagnosis of infertility or a related disorder were as likely to become pregnant within 12 months as their peers without epilepsy. A cohort of women with epilepsy and healthy controls who were seeking pregnancy were enrolled at 4 academic medical centers in the United States and were followed for up to 21 months. Participants between 18 and 40 years of age who were seeking pregnancy were enrolled within 6 months of having discontinued contraception. Data were evaluated from November 2015 to June 2017.

The primary study outcome was the proportion of women who attained pregnancy within 12 months after enrollment. Secondary outcomes included time to pregnancy, pregnancy outcomes, sexual activity, rates of ovulation, and analysis of disease-related factors in women with epilepsy.

A total of 197 women were included in the study — 89 with epilepsy and 108 controls. Overall, 72.1% of the participants were white. The mean age of the women was 31.9±3.5 years in those with epilepsy and 31.1±4.2 years in the controls. Among the women with epilepsy, 60.7% (54 of 89) achieved pregnancy compared with 60.2% (65 of 108) of those without epilepsy. The median time to attaining pregnancy did not differ significantly between the groups (women with epilepsy: 6.0 months; 95% CI, 3.8-10.1; controls: 9.0 months; 95% CI, 6.5-11.2; =.30).

Sexual activity and rates of ovulation were also similar among women with epilepsy and those without the disorder. Overall, 81.5% (44 of 54) of pregnancies in women with epilepsy and 81.5% (53 of 65) of pregnancies in women without epilepsy resulted in live births.

The investigators concluded that the results of this study should help reassure and encourage women with epilepsy without a prior diagnosis of infertility or an associated disorder, as well as their clinicians, when planning to become pregnant, based on the similar times to achieving pregnancy and similar pregnancy outcomes reported.

Reference

Pennell PB, French JA, Harden CL, et al. Fertility and birth outcomes in women with epilepsy seeking pregnancy [published online April 30, 2018]. JAMA Neurol. doi: 10.1001/jamaneurol.2018.0646

via Rates of Pregnancy, Live Births Similar Among Women With and Without Epilepsy

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[WEB SITE] Briefing: Epilepsy and pregnancy

Epilepsy drug Sodium valproate has been linked to birth defects

Epilepsy drug Sodium valproate has been linked to birth defects

  • There are more than 20 epilepsy drugs now available to clinicians.
  • Some are known to interfere with the contraceptive pill, so it is important to ensure patients are on the right medication if there is a risk of unplanned pregnancy.

Read more: Women with epilepsy urged to seek medical advice before conceiving

– Women with epilepsy who take anti-epileptic drugs are at higher risk than the general population of having a baby with a major malformation: 4-10 per cent, compared to 2-3 per cent, but this varies between drugs.

– In April, doctors in the UK were banned from prescribing the epilepsy drug sodium valproate to women of childbearing age unless they sign a waiver acknowledging the risks. It has been linked to around 20,000 cases of infants being born with disabilities since the 1970s.

 

via Briefing: Epilepsy and pregnancy | HeraldScotland

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[WEB SITE] Women with Epilepsy Achieve Same Pregnancy Rate as Peers

  • by Judy George, Contributing Writer, MedPage Today. 

Women with epilepsy were at no disadvantage in getting pregnant as their peers without epilepsy, the prospective Women with Epilepsy: Pregnancy Outcomes and Deliveries (WEPOD) study found.

About 60% of women in both groups became pregnant within a year of discontinuing contraception, according to Page Pennell, MD, of Brigham and Women’s Hospital in Boston and co-authors.

Median time to pregnancy, sexual activity, and ovulatory rates were similar in each group, too, they reported online in JAMA Neurology.

These findings have two meanings, Pennell noted. First, they tell neurologists “that their female patients with epilepsy in their practice who want to become pregnant will have no additional difficulties becoming pregnant just because of their epilepsy,” she said.

But an equally important message is that women with epilepsy are at risk of unplanned pregnancy.

“It is important to always keep this in mind when choosing which medications to prescribe and to recommend supplemental folic acid,” Pennell told MedPage Today. “Other studies have reported that beginning supplemental folic acid prior to pregnancy is important to lower the risk of neurodevelopmental problems and autistic features in the children of women with epilepsy on anti-epileptic drugs.”

Maternal use of valproate (Depakote) in pregnancy has been tied to autism and impaired cognitive development in children, prompting FDA warnings about using the drug during pregnancy. A European Medicines Agency committee recently advised that valproate use be restricted in fertile women unless they participate in a pregnancy prevention program.

Research indicates that prenatal exposure to newer anti-epileptic drugs like levetiracetam (Keppra) or topiramate (Topamax) is not linked to reduced cognitive abilities in children, but a recent study indicates that women on anti-seizure medications who did not take folic acid supplements before conception had a substantially increased risk of having offspring with autistic traits.

Previous studies also have suggested that women with epilepsy may have lower fertility especially if they use multiple anti-seizure medications, but WEPOD is the first prospective study of pregnancy that included controls, the authors noted. All women in WEPOD planned their pregnancy in advance, distinguishing it from pregnancy registry or population studies.

In WEPOD, the researchers followed women with a steady male partner who wanted to become pregnant within a year of ending contraception, excluding women with a history of infertility or related disorders.

Patients recorded sexual activity and menstrual bleeding through a custom smartphone application, a web-based interface, or a paper diary. Patients in the epilepsy group also tracked their medication use and seizures.

A total of 88 women with epilepsy and 109 healthy controls enrolled in the WEPOD study throughout four U.S. academic centers. Most participants (72.1%) were white. The average age of women with epilepsy was about 32, and the average age of controls was about 31. Most women with epilepsy used monotherapy to control seizures: 44.8% used lamotrigine (Lamictal) and 28.7% used levetiracetam.

In total, 60.7% of women with epilepsy achieved pregnancy, as did 60.2% of controls.

After controlling for key covariates like age, body mass index (BMI), parity, and race, the median time to pregnancy was similar in each group: 6 months (95% CI 3.8-10.1) for women with epilepsy, and 9 months (95% CI 6.5-11.2; P=0.30) for controls. In both groups, the same proportion (81.5%) of pregnancies resulted in a live birth. No epilepsy factors were significant.

These findings allow neurologists “to provide hope, backed up by data, that if a woman with epilepsy does not have a prior gynecologic diagnosis related to infertility, then she will have the same likelihood of achieving pregnancy and same pregnancy outcomes as her female peers,” Pennell said.

The study does not answer whether women with epilepsy have different rates of infertility or polycystic ovary syndrome (PCOS) because women with these diagnoses were excluded, the authors noted. While prior research indicates that PCOS occurs more frequently in women with epilepsy, the researchers did not include these women in the study to give physicians information about the “more common clinical scenario of women with epilepsy without a preexisting diagnosis of infertility or associated disorders” who want to become pregnant.

The authors listed several other limitations: Some women may have become pregnant before they could be recruited. And it’s possible the researchers did not account for unmeasured differences between women with epilepsy and controls that may have occurred because the study used multiple sources of recruitment.

 

via Women with Epilepsy Achieve Same Pregnancy Rate as Peers | Medpage Today

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[ARTICLE] Fertility and Birth Outcomes in Women With Epilepsy Seeking Pregnancy – Full Text

Key Points

Question  Do women with epilepsy without a prior diagnosis of infertility or related disorders have the same likelihood of achieving pregnancy as their peers without epilepsy?

Findings  This multicenter cohort study of 89 women with epilepsy and 108 control women found no difference in the proportion of women who achieved pregnancy less than 12 months after enrollment in the study. Among women with epilepsy, 54 (60.7%) achieved pregnancy vs 65 (60.2%) among control women.

Meaning  Women with epilepsy without a history of infertility or related disorders seeking pregnancy had similar likelihood of achieving pregnancy compared with their peers without epilepsy.

Abstract

Importance  Prior studies report lower birth rates for women with epilepsy (WWE) but have been unable to differentiate between biological and social contributions. To our knowledge, we do not have data to inform WWE seeking pregnancy if their likelihood of achieving pregnancy is biologically reduced compared with their peers.

Objective  To determine if WWE without a prior diagnosis of infertility or related disorders are as likely to achieve pregnancy within 12 months as their peers without epilepsy.

Design, Setting, and Participants  The Women With Epilepsy: Pregnancy Outcomes and Deliveries study is an observational cohort study comparing fertility in WWE with fertility in control women (CW) without epilepsy. Participants were enrolled at 4 academic medical centers and observed up to 21 months from November 2010 to May 2015. Women seeking pregnancy aged 18 to 40 years were enrolled within 6 months of discontinuing contraception. Exclusion criteria included tobacco use and a prior diagnosis of infertility or disorders that lower fertility. Eighteen WWE and 47 CW declined the study, and 40 WWE and 170 CW did not meet study criteria. The Women With Epilepsy: Pregnancy Outcomes and Deliveries electronic diary app was used to capture data on medications, seizures, sexual activity, and menses. Data were analyzed from November 2015 to June 2017.

Main Outcomes and Measures  The primary outcome was proportion of women who achieved pregnancy within 12 months after enrollment. Secondary outcomes were time to pregnancy using a proportional hazard model, pregnancy outcomes, sexual activity, ovulatory rates, and analysis of epilepsy factors in WWE. All outcomes were planned prior to data collection except for time to pregnancy.

Results  Of the 197 women included in the study, 142 (72.1%) were white, and the mean (SD) age was 31.9 (3.5) years among the 89 WWE and 31.1 (4.2) among the 108 CW. Among 89 WWE, 54 (60.7%) achieved pregnancy vs 65 (60.2%) among 108 CW. Median time to pregnancy was no different between the groups after controlling for key covariates (WWE: median, 6.0 months; 95% CI, 3.8-10.1; CW: median, 9.0 months; 95% CI, 6.5-11.2; P = .30). Sexual activity and ovulatory rates were similar in WWE and CW. Forty-four of 54 pregnancies (81.5%) in WWE and 53 of 65 pregnancies (81.5%) in CW resulted in live births. No epilepsy factors were significant.

Conclusions and Relevance  Women with epilepsy seeking pregnancy without prior known infertility or related disorders have similar likelihood of achieving pregnancy, time to pregnancy, and live birth rates compared with their peers without epilepsy.

Introduction

Approximately 12.5 million women of childbearing age worldwide have epilepsy.1 Most studies suggest birth rates in women with epilepsy (WWE) to be 37% to 88% of other groups.2,3 Conversely, the Northern Finland Birth Cohort4 reported the number of children born to WWE did not differ from the reference group overall, although epilepsy not in remission was associated with fewer children. None of these studies collected information about the desire or attempts to achieve pregnancy. Birth rates could be lower in WWE because of social factors (eg, lower marriage rates or lower rates of seeking pregnancy) and/or biological factors (eg, decreased ovulatory rates). A UK survey5 reported 33% of WWE respondents were not considering having children because of their epilepsy. Neurologists do not have the information needed to counsel their female patients who desire pregnancy whether they are as likely to achieve pregnancy and to have a live birth as their peers.

We designed this study to determine whether WWE without a preexisting diagnosis of infertility or associated disorders who are following their clinically determined treatment regimen differ from women without epilepsy when attempting to achieve pregnancy. The primary aim was the proportion of women achieving pregnancy within 1 year. Secondary aims were comparisons between WWE and women without epilepsy for (1) live birth rates, (2) time to achieve pregnancy, (3) sexual activity rates, and (4) ovulatory rates. An additional secondary aim was to explore seizure and medication factors within WWE that could affect fertility.

To our knowledge, no prior studies prospectively compared WWE with women without epilepsy attempting to conceive. Our study approach excluded women with known infertility diagnosis or diagnoses associated with reproductive disorders (eg, polycystic ovary syndrome [PCOS]). This study specifically addressed the woman who arrives in clinic with no reason to suspect infertility other than an epilepsy diagnosis.[…]

Continue —>  Fertility and Birth Outcomes in Women With Epilepsy Seeking Pregnancy | Epilepsy and Seizures | JAMA Neurology | JAMA Network

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[Abstract] Pregnancy outcomes among women with epilepsy: A retrospective cohort study

Abstract

Objective

The objective of this study was to compare adverse pregnancy outcomes between pregnancies that involve epilepsy and those that do not and are identified as normal for the purposes of this paper.

Methods

A retrospective cohort study was carried out by accessing the maternal–fetal medicine (MFM) database to identify and review records of singleton pregnancies with epilepsy but with no other underlying disease (study group). A parallel group of low-risk pregnancies was randomly allocated as the control group. The adverse outcomes between the two groups were compared. The primary outcomes included rates of spontaneous abortion, small for gestational age (SGA), preterm birth (PTB), low birth weight (LBW), and preeclampsia.

Results

From a total of 44,708 deliveries, 148 pregnancies involving mothers with epilepsy and a control group of 1480 normal pregnancies were compared. The rates of spontaneous abortion, PTB, LBW, and cesarean section were slightly but significantly higher in the study group with a relative risk of 6.6 (95% confidence interval (CI): 1.9–23.3), 1.6 (95% CI: 1.1–2.2), 1.6 (95% CI: 1.1–2.3), and 1.5 (95% CI: 1.1–2.1), respectively, whereas other adverse outcomes were comparable. In the subgroup analysis, adverse outcomes tended to be higher in women with active epilepsy. However, only the rates of SGA in the group in which the disorder is active and PTB in the presence of seizures within 6 months of conception were significantly increased.

Conclusions

Pregnancies with epilepsy, even in cases with multidisciplinary care and no other risk factors, are still significantly associated with higher adverse outcomes.

 

via Pregnancy outcomes among women with epilepsy: A retrospective cohort study

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[Slideshow] Comparing the Safety of Antiepilepsy Drugs in Pregnancy

Comparing the Safety of Antiepilepsy Drugs in Pregnancy

Mar 26, 2018

What are the risks of birth defects and perinatal outcomes for infants exposed to various AEDs in utero?

Source: http://www.neurologytimes.com/slideshows/comparing-safety-antiepilepsy-drugs-pregnancy

 

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[WEB SITE] Moms-to-be, take note. European experts advise against epilepsy drug in pregnancy

The compound, valproate, is also used for migraine and bipolar disorder, and doctors already advised against prescribing the medicine for pregnant women in France.

Updated: Feb 10, 2018 13:45 IST

Valproate medicines are licenced under different names by national drugs authorities.

Valproate medicines are licenced under different names by national drugs authorities.(Shutterstock)

An expert committee of Europe’s medicines watchdog recommended Friday that a drug used to treat epilepsy and linked to malformations in children not be used in pregnancy. The compound, valproate, is also used for migraine and bipolar disorder, and doctors already advised against prescribing the medicine for pregnant women in France. France’s medicines regulator, known by the acronym ANSM, asked the London-based European Medicines Agency (EMA) to conduct a risk review.

The EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) said in a statement Friday it was recommending that valproate not be used by pregnant women for any of the three medical conditions. For women suffering from epilepsy, however, it may be impossible for some to stop after becoming pregnant, it said. These may have to continue treatment, though with “appropriate specialist care”. The experts also advised against prescribing the drug for women “from the time they become able to have children”, unless using contraception.

Valproate medicines are licenced under different names by national drugs authorities. The committee recommendations will now go to another body of the EMA, which deals with concerns over drugs that are not centrally authorised in the EU. Last April, a preliminary study showed that valproate caused “severe malformations” in as many as 4,100 children in France since the drug was first marketed in the country in 1967.
Women who took the drug during pregnancy to treat epilepsy were four times more likely to give birth to babies with congenital malformations, said a report of the French National Agency for the Safety of Medicines (ANSM) and the national health insurance administration. Birth defects included spina bifida — a condition in which the spinal cord does not form properly and can protrude through the skin — as well as defects of the heart and genital organs. The risk of autism and developmental problems was also found to be higher.
via Moms-to-be, take note. European experts advise against epilepsy drug in pregnancy | fitness | Hindustan Times

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[WEB SITE] European experts advise against epilepsy drug in pregnancy

PARIS, France (AFP) — An expert committee of Europe’s medicines watchdog recommended Friday that a drug used to treat epilepsy and linked to malformations in children not be used in pregnancy.

The compound, valproate, is also used for migraine and bipolar disorder, and doctors already advised against prescribing the medicine for pregnant women in France.

France’s medicines regulator, known by the acronym ANSM, asked the London-based European Medicines Agency (EMA) to conduct a risk review.

The EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) said in a statement Friday it was recommending that valproate not be used by pregnant women for any of the three medical conditions.

For women suffering from epilepsy, however, it may be impossible for some to stop after becoming pregnant, it said. These may have to continue treatment, though with “appropriate specialist care”.

The experts also advised against prescribing the drug for women “from the time they become able to have children”, unless using contraception.

Valproate medicines are licenced under different names by national drugs authorities.

The committee recommendations will now go to another body of the EMA, which deals with concerns over drugs that are not centrally authorised in the EU.

Last April, a preliminary study showed that valproate caused “severe malformations” in as many as 4,100 children in France since the drug was first marketed in the country in 1967.

Women who took the drug during pregnancy to treat epilepsy were four times more likely to give birth to babies with congenital malformations, said a report of the French National Agency for the Safety of Medicines (ANSM) and the national health insurance administration.

Birth defects included spina bifida — a condition in which the spinal cord does not form properly and can protrude through the skin — as well as defects of the heart and genital organs.

The risk of autism and developmental problems was also found to be higher.

via European experts advise against epilepsy drug in pregnancy

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[ARTICLE] Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review – Full Text

Abstract

Question

What are the attitudes, barriers and enablers to physical activity perceived by pregnant women?

Design

In a systematic literature review, eight electronic databases were searched: AMED, CINAHL, Embase, Joanna Briggs Institute, Medline, PsycInfo, SPORTDiscus (from database inception until June 2016) and PubMed (from 2011 until June 2016). Quantitative data expressed as proportions were meta-analysed. Data collected using Likert scales were synthesised descriptively. Qualitative data were analysed thematically using an inductive approach and content analysis. Findings were categorised as intrapersonal, interpersonal or environmental, based on a social-ecological framework.

Participants

Pregnant women.

Intervention

Not applicable.

Outcome measures

Attitudes and perceived barriers and enablers to physical activity during pregnancy.

Results

Forty-nine articles reporting data from 47 studies (7655 participants) were included. Data were collected using questionnaires, interviews and focus groups. Meta-analyses of proportions showed that pregnant women had positive attitudes towards physical activity, identifying it as important (0.80, 95% CI 0.52 to 0.98), beneficial (0.71, 95% CI 0.58 to 0.83) and safe (0.86, 95% CI 0.79 to 0.92). This was supported by themes emerging in 15 qualitative studies that reported on attitudes (important, 12 studies; beneficial, 10 studies). Barriers to physical activity were predominantly intrapersonal such as fatigue, lack of time and pregnancy discomforts. Frequent enablers included maternal and foetal health benefits (intrapersonal), social support (interpersonal) and pregnancy-specific programs. Few environmental factors were identified. Little information was available about attitudes, barriers and enablers of physical activity for pregnant women with gestational diabetes mellitus who are at risk from inactivity.

Conclusion

Intrapersonal themes were the most frequently reported barriers and enablers to physical activity during pregnancy. Social support also played an enabling role. Person-centred strategies using behaviour change techniques should be used to address intrapersonal and social factors to translate pregnant women’s positive attitudes into increased physical activity participation.

Introduction

Physical activity has substantial benefits for women with uncomplicated pregnancies, minimal risks, and is recommended in pregnancy guidelines.1, 2, 3 The benefits of physical activity during pregnancy include improved physical fitness,3, 4, 5 reduced risk of excessive weight gain,6 reduced risk of pre-eclampsia and pre-term birth,7reduced low back pain,8, 9 improved sleep,10 reduced anxiety and depressive symptoms,11, 12 and improved health perception13 and self-reported body image.14

Physical activity is also important for pregnant women with comorbidities and complications such as obesity1 or gestational diabetes mellitus (GDM).15, 16, 17 Physical activity assists with weight control and reduces the risk of GDM in obese pregnant women.1 In women diagnosed with GDM (a common pregnancy-related complication occurring in 3.5 to 12% of pregnancies),15, 16 physical activity is beneficial as an adjunctive intervention in the management of glycaemic control.15, 17, 18, 19, 20 Managing glycaemic control is critical for reducing adverse effects associated with poorly controlled GDM.21 Consequently, aerobic exercise performed at moderate intensity for 30 minutes on most days of the week is recommended for healthy pregnant women,1, 3 those with GDM15, 22,23 and those who are overweight or obese.24

Despite well-documented health benefits,1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 24, 25, 26, 27 60 to 80% of pregnant women28, 29, 30, 31 – including those who are overweight or obese31 – and more than 60% of women with GDM32 do not participate in physical activity as recommended. Pregnant women from backgrounds other than Caucasian are also less likely to engage in physical activity.29 However, to improve pregnant women’s participation in physical activity (ie, leisure time physical activities or structured exercise programs), we need to understand their attitudes to it, the reasons why they do not engage in physical activity, and enablers that could be harnessed to design effective physical activity interventions or programs that facilitate behaviour change and thereby improve their participation in physical activity during pregnancy.

The inclusion of behaviour change techniques into physical activity interventions has been reported as helpful in improving physical activity levels during pregnancy.33 Behaviour change techniques such as goal setting, planning and education to shape knowledge appear most effective when delivered with face-to-face feedback about goal achievement.33 However, to facilitate uptake of these effective physical activity interventions, clinicians need to know which barriers, enablers and attitudes are common among pregnant women, so they can effectively target their education and evidence-based behaviour change strategies. A systematic review of barriers, enablers and attitudes of pregnant women to physical activity would provide valuable information to enable clinicians to effect a positive behaviour change of increased physical activity in this group.

Identification of women’s attitudes and perceptions of barriers and enablers to physical activity in pregnancy could be informed by quantitative or qualitative research approaches. A review that collates data from studies using either method would benefit from the advantages of each: improving generalisability and providing deeper insights into pregnant women’s beliefs and perceptions about physical activity during pregnancy. Inclusion of qualitative findings may assist in better understanding the factors that can influence women’s attitudes and perceptions. Such deeper understanding would provide valuable insight that clinicians can use to plan strategies to encourage pregnant women – in particular at-risk groups of women such as those with GDM – to participate in physical activity. It would also inform the design of realistic and acceptable interventions to be tested in an effectiveness study. No systematic review has collated quantitative data or provided a meta-summary of attitudes and perceptions of barriers and enablers to physical activity in pregnant women.

Therefore, the research question for this review was:

What are the attitudes, barriers and enablers to physical activity perceived by pregnant women, including women diagnosed with gestational diabetes mellitus?

Continue —> Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review – Journal of Physiotherapy

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[BLOG POST] Antidepressants During Pregnancy Dangerous for the Child?

Antidepressants During Pregnancy Bad for Child Health

Depression is sometimes described as a disease of modernity, as sharp changes in lifestyle during the last century or so have given rise to many chronic disorders including or linked to depression. Depression is a state of low mood: the person affected tends to lose interest in previously enjoyable activities. In severe cases, self-harm is also possible. Fortunately, there are many options available today to help treat this condition.

Research studies and statistics show that although pregnant women are less prone to major depression, they are more inclined to minor depressive episodes. The prevalence of depression can be anywhere between 8–16% among pregnant women. There are also higher chances that diagnosis of depression is overlooked in pregnant women.

The treatment of depression is quite challenging in pregnancy, as medical specialists have to weigh the benefits of treatment against the risks for the mother and the health of her unborn baby. Furthermore, the health professional has to take into consideration the risks and benefits of any such therapy to the long-term health of the child. New research seems to indicate that treatment of pregnant women with antidepressant drugs may increase the risk of autism, disturbances in motor function, and mental health problem in children. Some of these issues may become clear later in the life, thus studying this subject remains a challenge for researchers.

Why treat depression in pregnancy?

There is a widespread misconception that depression is not as threatening as other medical illnesses. Thus, treating depression is viewed as a matter of choice or even a luxury. Moreover, many patients that are on antidepressant drugs before pregnancy are in the remissive stage. Therefore, their doctors may think of discontinuing the therapy.

However, if a pregnant woman that is vulnerable to depression is not provided with antidepressant therapy, there is a higher risk of preterm birth, low birth weight, substance abuse in pregnancy (e.g., smoking and drinking alcohol), and a significantly higher risk of postpartum depression.

Research has shown that if antidepressants are discontinued for the period of the pregnancy, the relapse rate of major depression is as high as 60–70%. This can have severe consequences for the patient, family, and child. In addition, children born to mothers with untreated depression have higher levels of cortisol, which may have adverse impacts on their health.

Risks of antidepressants

As already mentioned, the use of antidepressants in pregnancy is a complicated issue due to possible dangers. Below are some of the common problems associated with the use of antidepressants during pregnancy.

Persistent pulmonary hypertension

This is a failure of lungs blood vessels to dilate in a child post-birth. Thus, a new-born may have breathing difficulties, a deficit of oxygen in the blood, leading to intubation. In many cases, outcomes may be fatal. This condition is also found to be related to maternal smoking, diabetes, and sepsis. Though the risk of persistent pulmonary hypertension in new-born increases up to six times with the use of antidepressants, at the same time there is a consensus among the medical community that non-use of antidepressants may be even more harmful.

Withdrawal symptoms

This is also called “poor neonatal adaptation.” These symptoms are common when a mother has been exposed to antidepressants during the third trimester of pregnancy. Some of the symptoms characteristic of this syndrome include difficulties in breathing, unstable body temperature, hypo- or hypertonia, irritability, constant crying, and seizures. Therefore, some specialists recommend tapering the dose of antidepressants in the third trimester.

Motor development

By motor development, we mean child’s ability to move around and handle the environment. There are clinical studies that indicate that the use of antidepressants during pregnancy may slow the motor development. A child may start walking later than other kids, or may have other problems related to movements.

Autism spectrum disorders

This is a neurodevelopmental disorder of children. Studies seem to show the modest increase in the risk of autism if a mother is exposed to antidepressants during the first trimester.  However, no link has been found if such treatment has been given before the pregnancy, nor much relationship has been demonstrated if the therapy was initiated in a later phase of pregnancy. Thus, researchers caution that decision of prescribing antidepressants should be taken on a case by case basis by analysing the risks and potential benefits for maternal and child health.

Psychiatric disorders

In one of the large-scale studies, scientists analysed the data of almost one million births, and they found that the use of antidepressants in pregnancy was related to higher risk of developing psychiatric disorders later in life. Nonetheless, at the same time, researchers cautioned against jumping to the quick conclusions because it is a well-known fact that mental disorders have relation to genetics. It means that women prescribed antidepressants during the pregnancy have higher chances of passing to children the genes that may result in psychiatric diseases later in life.

Although antidepressants may increase the risk of specific disorders in the new-born babies or may even have a negative impact later in the life, it does not mean that antidepressants should not be taken during the pregnancy. It is essential that women should not feel guilty about taking such drugs. The medical specialists must be aware of the risks and weigh them against the benefits before they prescribe antidepressants to pregnant women.

References

Casper, R.C., Fleisher, B.E., Lee-Ancajas, J.C., Gilles, A., Gaylor, E., DeBattista, A., Hoyme, H.E., 2003. Follow-up of children of depressed mothers exposed or not exposed to antidepressant drugs during pregnancy. J. Pediatr. 142, 402–408. doi:10.1067/mpd.2003.139

Croen, L.A., Grether, J.K., Yoshida, C.K., Odouli, R., Hendrick, V., 2011. Antidepressant Use During Pregnancy and Childhood Autism Spectrum Disorders. Arch. Gen. Psychiatry 68, 1104–1112. doi:10.1001/archgenpsychiatry.2011.73

Ko, J.Y., Farr, S.L., Dietz, P.M., Robbins, C.L., 2012. Depression and Treatment Among U.S. Pregnant and Nonpregnant Women of Reproductive Age, 2005–2009. J. Womens Health 2002 21, 830–836. doi:10.1089/jwh.2011.3466

Payne, J.L., Meltzer-Brody, S., 2009. Antidepressant Use During Pregnancy: Current Controversies and Treatment Strategies. Clin. Obstet. Gynecol. 52, 469–482. doi:10.1097/GRF.0b013e3181b52e20

Image via xusenru/Pixabay.

via Antidepressants During Pregnancy Dangerous for the Child? | Brain Blogger

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