Trusted Information for Healthy Pregnancies
depression
Men Get Postpartum Depression Too
Jun 7th
While postpartum depression (PPD) is typically considered to be a woman’s illness, a number of studies have suggested that, although men do not experience any of the dramatic physiologic or hormonal changes that go along with pregnancy, new fathers may also suffer from PPD. The most recent study was a meta-analysis published in the May [...]
Antidepressant tied to risk of newborn heart defect
May 4th
Women who use the antidepressant bupropion during early pregnancy may have an increased risk of having a baby with a particular type of heart defect, a new study suggests.
Researchers caution that it is not clear whether the medication, marketed as Wellbutrin, is the cause. And even if it is, they say, the absolute risk of the heart defect would be small -- affecting just 2 out of every 1,000 infants born to women who used bupropion during the first trimester.
But the findings, published in the American Journal of Obstetrics & Gynecology, do add to questions about the risks of using antidepressants during early pregnancy.
Some studies have already linked other antidepressants -- including some of the commonly used selective serotonin reuptake inhibitors (SSRIs) -- to higher-than-average, though small, risks of certain birth defects.
A study last year, for example, found that among nearly half a million Danish children born between 1996 and 2003, the risk of heart defects was elevated among those whose mothers had used SSRIs such as fluoxetine (Prozac), sertraline (Zoloft) and citalopram (Celexa) during early pregnancy.
In this latest study, researchers found that among more than 12,700 U.S. infants born between 1997 and 2004, those whose mothers used bupropion during early pregnancy had more than double the risk of heart defects known as left outflow tract defects, compared with infants whose mothers had not used the drug.
Left outflow defects affect the flow of blood from the heart's left chambers to the rest of the body. In this study, the most common type of this defect was coarctation of the aorta -- a narrowing in the body's main artery that, in children, typically requires surgical repair.
The findings do not mean, however, that depressed women on bupropion should stop taking it if they are planning a pregnancy, according to the researchers.
"I think it's important that women understand that they should not just stop taking their medication," said Dr. Jennita Reefhuis, a senior epidemiologist at the U.S. Centers for Disease Control and Prevention and one of the researchers on the study.
Instead, she told Reuters Health, women should talk with their doctors, ideally when they are planning a pregnancy rather than after they conceive.
The potential risk of birth defects from using antidepressants must be weighed against the risks of a woman stopping her current depression therapy, Reefhuis said.
"This study needs to be replicated before we can say anything conclusive," Reefhuis said, noting that the findings point to an association between bupropion and left outflow defects, but cannot by itself prove cause-and-effect.
If the association is causal, she said, the absolute risk to any one woman would be small. For every 1,000 births, there are an estimated 0.8 cases of left outflow tract heart defects; based on the current findings, that rate would be 2 per 1,000 among women who use bupropion in the first trimester.
Reefhuis also pointed out that with any pregnancy, the overall risk of having a baby with some form of birth defect is 3 percent.
Guidelines released last year by the American Psychiatric Association and the American College of Obstetricians and Gynecologists state that psychotherapy may be an effective alternative to antidepressants for pregnant women with mild to moderate depression.
However, the guidelines say, women with a history of more severe depression, or other major psychiatric disorders, may need to continue with their medication.
Bupropion is also prescribed for smoking cessation, under the brand-name Zyban. In the case of smoking cessation, Reefhuis said, it may be easier for women to find an effective alternative to the drug.
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Depression while pregnant ‘linked to violent behaviour in children’
Feb 5th
Mothers who suffer from 'baby blues' while pregnant are four times as likely to have children who become violent teenagers, a new study shows.
The link remained even if the mothers did not suffer depression after their children were born.
Research has previously suggested that postnatal depression can affect a child's subsequent behavior.
But experts from Cardiff and Bristol universities and King's College London believe that theirs is one of the first studies to look at the effects of suffering depression before a child's birth.
Many women are depressed during their pregnancy and research by Tommy's, the baby charity, suggests that it may even be more common before the birth of a child than after.
It is estimated that as many as between 10 and 15 per cent of women could suffer the condition while they are expecting.
Prof Dale F Hay, from Cardiff University, who led the latest study, said: "Much attention has been given to the effects of postnatal depression on young infants, but depression during pregnancy may also affect the unborn child."
The study looked at 120 mothers from the Bristol area.
The researchers interviewed the women while they were pregnant, after they gave birth and when their children were aged four, 11, and 16 years old.
Their findings, published in the journal Child Development, show that women who were depressed while they were pregnant were four times as likely to have children who were violent by the age of 16 as the other mothers.
The children were also more likely to exhibit other forms of anti-social behavior, the research found.
However, the study also found that women who had been angry or disruptive teenagers themselves were more likely to go on to be depressed while they were pregnant.
Prof Hay added: "Although it's not yet clear exactly how depression in pregnancy might set infants on a pathway toward increased anti-social behavior, our findings suggest that women with a history of conduct problems who become depressed in pregnancy may be in special need of support."
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Acupuncture Found Effective Against Depression During Pregnancy
Feb 4th
In a study to be presented February 4 at the Society for Maternal-Fetal Medicine's (SMFM) annual meeting, The Pregnancy Meeting ™, in Chicago, researchers will unveil findings that show that acupuncture may be an effective treatment for depression during pregnancy.
"Depression during pregnancy is an issue of concern because it has negative effects on both the mother and the baby as well as the rest of the family," said Dr. Schnyer, one of the study's authors.
About 10% of pregnant women meet criteria for major depression and almost 20% have increased symptoms of depression during pregnancy. The rates of depression in pregnant women are comparable to rates seen among similarly aged non-pregnant women and among women during the postpartum period, but there are far fewer treatment studies of depression during pregnancy than during the postpartum period.
Dealing with depression is difficult for pregnant women because the use of anti-depressants poses concerns to the developing fetus and women are reluctant to take medications during pregnancy.
In the study, an evaluator-blinded randomized trial, 150 participants who met the Diagnostic & Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for Major Depressive Disorder were randomized to receive either acupuncture specific for depression (SPEC, n=52) or one of two active controls: control acupuncture (CTRL, n=49) or massage (MSSG, n=49). Treatments lasted eight weeks (12 sessions). Junior acupuncturists masked to treatment assignment needled participants at points prescribed by senior acupuncturists. Massage therapists and patients were not blinded. The primary outcome was the Hamilton Rating Scale for Depression, administered by blinded raters at baseline and after four and eight weeks of treatment. Data were analyzed using mixed effects models and by intent-to-treat.
The results showed that the women who received SPEC experienced a significantly greater decrease in depression severity compared to the combined controls or CTRL acupuncture alone. They also had a higher response rate (63.0%) than the combined controls or CTRL acupuncture alone. Symptom reduction and response rates did not differ significantly between controls (CTRL 37.5% and MSSG 50.0%). Mild and transient side effects were reported by 43/150 participants (4 in MSSG; 19 in CTRL, 20 in SPEC). Significantly fewer participants reported side-effects in MSSG than the two acupuncture groups.
"The results of our study show that the acupuncture protocol we tested could be a viable treatment option for depression during pregnancy" said Dr. Schnyer.
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Massage Reduces Depression in Pregnant Women
Jan 26th
New research shows massage therapy reduced depression in pregnant women, and also reduced the incidence of massaged women's babies being born prematurely.
The study was conducted by researchers at the Touch Research Institutes, where pioneering research about massage has been conducted since 1992.
Pregnant women diagnosed with major depression were given 12 weeks of massage, twice per week, by their significant other. A control group did not receive massage, according to an abstract published on www.pubmed.gov.
The massage-therapy group versus the control group not only had reduced depression by the end of the massage-therapy period, they also had reduced depression and cortisol levels during the postpartum period.
The massaged women's newborns were also less likely to be born prematurely and low birthweight, pubmed noted, and they had lower cortisol levels and performed better on the Brazelton Neonatal Behavioral Assessment habituation, orientation and motor scales.
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Stress, Anxiety Can Up Risk of Depression in Pregnancy
Jan 22nd
Stress, history of depression, lack of social support and unintended pregnancy are among the major factors that contribute to increased risk of depression in pregnant women, a new study shows.
Other important factors are maternal anxiety, domestic violence and having public insurance coverage, said the University of Michigan researchers, who reviewed 159 studies conducted between 1980 and 2008.
The study appears in the January issue of the American Journal of Obstetrics & Gynecology.
Depression, which occurs in about 12.7 percent of pregnant women, can cause problems for mothers and babies, including pre-term delivery, preeclampsia, sleep disturbances and disrupted mother-infant bonding.
It's important for physicians to know how to identify depression in pregnant women, said the study authors, who noted that not all women who test positive on depression screening tests have or will develop clinical depression.
"We are hoping that [health-care] providers can use the presence or absence of risk factors such as those identified in our study to enhance their assessments for depression in addition to the information they obtain from the screening test," study author Dr. Christie A. Lancaster, a clinical lecturer in the obstetrics and gynecology department at U-M, said in a news release.
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Drugs for depression, anxiety tied to preterm birth
Jan 21st
Pregnant women who take certain drugs for depression or anxiety may have heightened risks of preterm delivery or other birth complications, according to a new study.
Researchers found that among nearly 3,000 women who gave birth in Washington State, those who started taking antidepressants known as selective serotonin reuptake inhibitors (SSRIs) in the second or third trimester had a higher risk of preterm birth.
Compared with their counterparts not on the medications, these women were nearly five times more likely to deliver prematurely.
The same risk was not seen, however, among women who started on an SSRI before pregnancy or during the first trimester. SSRIs include drugs like sertraline (Zoloft), paroxetine (Paxil) and fluoxetine (Prozac).
The researchers also found a higher risk of preterm delivery among women who took anti-anxiety drugs known as benzodiazepines, regardless of when they began treatment.
Those drugs, which include medications like lorazepam (Ativan) and alprazolam (Xanax), were linked to higher risks of other complications as well - including low birth weight, newborn respiratory distress and a low Apgar score, a standard measure of newborn health.
The findings of the study are published in the American Journal of Obstetrics & Gynecology.
Exactly what the study means for women on SSRIs or benzodiazepines is not entirely clear. A major limitation is that it could not estimate the benefits of treatment, lead researcher Dr. Ronit Calderon-Margalit, of the Hebrew University-Hadassah School of Public Health in Jerusalem, noted in an email to Reuters Health.
Any risks of using the medications during pregnancy need to be balanced against the risks of leaving depression and anxiety disorders untreated.
"It is very important to have other studies of the risks associated with (these) drugs, but also of benefits associated with treating mothers," said Calderon-Margalit, who was at the University of Washington in Seattle at the time of the study.
In addition, SSRIs did not appear to present equal risks for all women. Calderon-Margalit described the antidepressant findings as "mostly reassuring" for women who start the drugs before pregnancy or in the first trimester -- as most SSRI users in the study had.
The study included 2,793 pregnant women, 11 percent of whom used a psychiatric medication during pregnancy. Of these, 138 were on an SSRI, while 85 used a benzodiazepine.
Among women who were not on any medication, 9 percent gave birth prematurely, versus nearly half of women on benzodiazepines.
Meanwhile, 14 percent of women on SSRIs had a preterm birth, but the elevated risk turned out to be concentrated among those who started an antidepressant after the first trimester. Of those 21 women, 16 delivered prematurely.
Several other birth complications, often related to preterm birth, were also higher-than-average among women on benzodiazepines.
Seventeen percent of their newborns suffered respiratory distress syndrome and one-third ended up in the neonatal intensive care unit. Those figures were 3 percent and 6 percent, respectively, among newborns whose mothers had not used psychiatric medications during pregnancy.
Calderon-Margalit pointed out that most women on benzodiazepines used lorazepam (Ativan), so it is possible that the risks are associated mainly with that drug. However, further research is needed to determine whether any particular medications carry particular risks.
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Premature Birth Tied to Later Behavioral Problems
Dec 16th
Children who were born prematurely and at a very low weight may have an increased risk of certain behavior problems and symptoms of depression and anxiety, research suggests.
As the survival rates of very preterm newborns have improved in recent years, studies have uncovered some of the potential long-term challenges these infants will face - including lower IQ and higher rates of behavioral problems compared with their peers born at term.
In the new study, researchers found that among 104 7- to 16-year-olds they assessed, the 49 who were born very prematurely had higher rates of hyperactivity and attention problems, as well as symptoms of depression and anxiety.
The higher risk was not explained by lower IQ scores, however. Nor was families' socioeconomic status an important factor in children's odds of behavioral or emotional issues.
Instead, birth weight itself was the strongest factor, the researchers report in the journal Pediatrics.
The finding "suggests that in children born prematurely, behavioral issues might be more biologically based and not easily compensated for by improvements in the environment," explained lead researcher Dr. Amy L. Conrad, of the University of Iowa College of Medicine in Iowa City.
"It does not mean that environment can't help," she told Reuters Health in an email, "just that it might not have as strong of an impact as for children born at term and of average birth weight."
In addition, while the study found that parents of premature children reported more behavioral and emotional symptoms than other parents did, most kids did not have significant problems.
According to Conrad, 18 percent of preterm children had hyperactivity/inattention problems that were in the "clinical range" -- or significant enough to warrant therapy -- while 14 percent had depression or anxiety symptoms in that range.
For the study, Conrad's team had 104 children and teenagers take standard intelligence tests, while their parents and teachers completed a standard questionnaire on behavioral issues. Forty-nine of the kids had been born significantly preterm -- between the 24th and 33rd week of pregnancy. A normal pregnancy lasts 40 weeks.
Their birth weights ranged from "extremely low" -- less than 2.2 pounds -- to "very low," or between 2.2 and 3.3 pounds.
In general, parents of preterm children reported more behavioral issues than parents of children born full-term, with the highest rates among children with extremely low birth weights. The link between birth weight and behavior did not fade after the researchers factored in children's age, gender, IQ and socioeconomic status.
It's possible that very low birth weight affected some children's brain development in a way that made them more vulnerable to behavioral problems.
Source
FDA Updates Warning for Pregnant Women on Antiepileptic Drugs
Dec 4th
The FDA has issued a statement reminding patients and doctors that valproate sodium, valproic acid, and divalproex products increase the risk of birth defects in babies exposed to the chemicals during pregnancy.
The medications - used to treat epilepsy since 1978 and more recently for bipolar disorder and migraine - can cause neural tube defects, craniofacial defects, and cardiovascular malformations in unborn children during the first trimester. This is often before many women know they are pregnant, the FDA said in a statement.
Use of the products increases neural tube defects during the first 12 weeks of pregnancy from one in 1,500 to one in 20, on average, the FDA noted.
Babies born to women taking valproate for epilepsy are more than three times as likely to have birth defects as those born to women on a different therapy (10.7%, 95% CI 6.3% to 16.9% versus 2.9%, 95% CI 2.0% to 4.1%), according to data from the North American Antiepileptic Drug Pregnancy Registry.
The FDA cautioned women of childbearing potential to take valproate only if it is essential for managing a medical condition. Those taking the drug who are not planning pregnancy should use contraception, the agency said.
Women planning to become pregnant can reduce the risk of congenital neural tube defects by taking folic acid before and during the first trimester of pregnancy, the FDA noted.
The agency also noted a danger to pregnant mothers and their child if epilepsy or bipolar disorder is left untreated while the baby is developing. Likewise, it reminded doctors and patients of a major risk associated with ceasing valproate therapy suddenly.
The FDA recommended that women talk with healthcare professionals before stopping use of valproate products if they become pregnant.
It also recommended women who become pregnant while taking valproate or other antiepileptic drugs enroll in the North American Antiepileptic Drug Pregnancy Registry to help gather more information on the safety of the medications during pregnancy.
Source
Many Pregnant Women Take Drugs Harmful to Baby
Nov 30th
With the help of their doctors, women planning to become pregnant should take an inventory of the medications they take, researchers from Canada advise.
In a study, they found that many pregnant women still take medications long known to cause birth defects.
Some medications with known fetal risk, such as drugs that control epilepsy, are essential during pregnancy, Dr. Anick Berard, at the University of Montreal in Quebec, noted in an email correspondence to Reuters Health.
Other medications, such as those that treat severe acne, anxiety and psychiatric drugs, antibiotics, and many drugs prescribed for heart disease and medical conditions, "can and should be avoided," according to Berard.
Women should understand the side effects of any drug they are taking -- especially drugs treating a chronic condition -- and plan pregnancies to avoid or minimize risks such drugs pose to babies, Berard added.
For the 5 years between January 1998 and the last day of 2002, Berard and colleagues analyzed the prescriptions filled by pregnant women for drugs available at the time and known to pose fetal risks.
Their report, in BJOG: An International Journal of Obstetrics and Gynecology, shows 56 percent of 109,344 pregnant women filled at least one medication prescription. A total of 6.3 percent (6,871 women) did so for at least one medication known to pose a risk to the fetus.
"These pregnancies were associated with an elevated number of (pregnancy terminations) and babies born with major (birth defects) in comparison with the expected numbers in the population," they note.
Specifically, terminations occurred in 47 percent of the pregnancies exposed to drugs with known fetal risks. Six percent of these pregnancies ended in miscarriage.
By contrast, in the much larger non-exposed group about 36 percent of the pregnancies had been terminated and fewer than 5 percent ended in miscarriage.
Berard's team further identified birth defects in 8.2 percent of 2,842 infants exposed to risky drugs during gestation and available for assessment, compared with 7.1 percent of the 59,287 infants not exposed. This is "a statistically significant difference," they note.
They emphasize, however, that it cannot be concluded that the drug exposure caused the birth defects. These pregnancies may have also been exposed to other harmful agents or maternal health conditions, they point out.
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