Why do we need to identify and treat women with depression who experience during pregnancy? We have long known that postpartum depression can negatively affect the development of children, the large study from Tuovinen and colleagues clearly shows that depression during pregnancy can have negative effects on the child’s development, predicting lower scores on measures of developmental milestones, fine and gross motor skills, communication, problem solving, and personal/social skills.
One of the primary reasons women and their caregivers may avoid or terminate medications for the treatment for depression is concern regarding the reproductive safety of antidepressants. Janecka and colleagues have published a study in JAMA Psychiatry which hopefully can help to allay these fears, observing that exposure to antidepressants, and a host of other psychotropic drugs, was not associated with an increased risk of autism in exposed offspring. (You can read our post on this article here.)
Ruta Nonacs, MD PhD
Maternal depressive symptoms during and after pregnancy and child developmental milestones.
Tuovinen S, Lahti-Pulkkinen M, Girchenko P, Lipsanen J, Lahti J, Heinonen K, Reynolds RM, Hämäläinen E, Kajantie E, Laivuori H, Pesonen AK, Villa PM, Räikkönen K. Depress Anxiety. 2018 Aug;35(8):732-741.
Higher mean maternal depressive symptom and consistently clinically relevant symptomatology during pregnancy predicted lower total developmental milestones, fine and gross motor, communication, problem solving, and personal/social skills scores in children. Although maternal depressive symptoms up to 12 months after pregnancy and in early childhood also predicted lower developmental milestones scores, developmental milestones scores were the lowest in children whose mothers’ depressive symptoms were above the clinical cutoff either only during pregnancy, both during and up to 12 months after pregnancy, or at each three time-points.
Janecka M, Kodesh A, Levine SZ, Lusskin SI, Viktorin A, Rahman R, Buxbaum JD, Schlessinger A, Sandin S, Reichenberg A. JAMA Psychiatry. 2018 Oct 31.
This population-based case-control study investigates the association of prenatal exposure to medications that interfere with different neurotransmitter systems with the risk of autism spectrum disorders in offspring. No association is observed between exposure to SSRIs or other antidepressants and risk for ASD.
Jacques N, de Mola CL, Joseph G, Mesenburg MA, da Silveira MF. J Affect Disord. 2019 Jan 15;243:201-208.
Six studies were included in this review (170,371). Children of mothers with prenatal and postnatal depressive symptoms or depression had 1.44 (CI95% 1.10 – 1.89) greater risk of hospitalization, and children of mothers with postnatal depressive symptoms or depression had 1.93 (CI95% 1.02-3.64) greater risk of death before one year of age than those whose mothers did not have the disorder.
Prenatal Treatment and Outcomes of Women With Opioid Use Disorder.
Brogly SB, Saia KE, Werler MM, Regan E, Hernández-Díaz S. Obstet Gynecol. 2018 Oct;132(4):916-922.
Fifty-nine women (52.2%) were treated initially with prenatal buprenorphine and 54 (47.8%) with methadone; 49.6% also were taking concomitant psychotropic medications. Opioid use relapse did not differ by treatment (44.7% overall). Thirteen (22.5%) of 59 women treated with buprenorphine transitioned to methadone mainly because of positive opioid screens. Overall, 23.0% (n=26) of the cohort discontinued clinical care. The number of pregnancy losses was small (three therapeutic abortions, four miscarriages, one stillbirth), with an overall live birth rate of 90.8% (95% CI 82.7-95.9).
Neonatal Outcomes in a Medicaid Population With Opioid Dependence.
Brogly SB, Hernández-Diaz S, Regan E, Fadli E, Hahn KA, Werler MM. Am J Epidemiol. 2018 Jun 1;187(6):1153-1161.
A total of 477 women in MAX were treated with methadone and 543 with buprenorphine. After adjusting for confounders, infants exposed to buprenorphine versus methadone were at decreased risk for preterm birth (RR=0.45, CI 0.34, 0.61) and low birth weight (RR=0.75, 95% CI: 0.51, 1.11) for low birth weight.
Neuenschwander R, Hookenson K, Brain U, Grunau RE, Devlin AM, Weinberg J, Diamond A, Oberlander TF. Dev Psychopathol. 2018 Aug;30(3):953-969.
In 107 Canadian children born to women with anxious and/or depressive symptoms during pregnancy, researchers found that in boys but not girls, depressed and/or anxious prenatal maternal mood is associated with heightened diurnal cortisol levels in everyday settings, as well as heightened cortisol reactivity to a lab challenge and that this heightened reactivity was associated with poorer executive functioning.
Gustafsson HC, Goodman SH, Feng T, Choi J, Lee S, Newport DJ, Knight B, Pingeton B, Stowe ZN, Monk C. Dev Psychopathol. 2018 Aug;30(3):773-785.
Controlling for prenatal and postnatal depressive symptoms, prenatal medication effects on neurobehavioral development were largely undetected in the fetus and infant.
Maguire PN, Clark GI, Wootton BM. J Anxiety Disord. 2018 Oct 15;60:26-34.
A total of 13 studies met the inclusion criteria and were included in the meta-analysis. The pooled within-group mean effect size was large across the treatment groups from pre-treatment to post-treatment when combining all of the studies (i.e., controlled and uncontrolled studies; k = 14; d = 0.90; 95% CI: 0.63-1.17). Heterogeneity was high (I2?=?88.55).
A systematic review of acupuncture and Chinese herbal medicine for postpartum depression.
Yang L, Di YM, Shergis JL, Li Y, Zhang AL, Lu C, Guo X, Xue CC. Complement Ther Clin Pract. 2018 Nov;33:85-92.
Fifteen CHM, and three acupuncture studies were included. Low quality evidence suggested that CHM alone or combined with antidepressants as add-on therapy may reduce symptoms of depression compared to placebo or antidepressants on the Edinburgh Postnatal Depression Scale (EPDS). There was no statistically significant difference between acupuncture and antidepressants. Adverse events were rare.
Type of delivery is not associated with maternal depression.
Faisal-Cury A, Menezes PR. Arch Womens Ment Health. 2018 Nov 9.
Type of delivery was classified as uncomplicated spontaneous vaginal delivery (UVD) (no episiotomy and no more than a first-degree perineal laceration), complicated vaginal delivery (CVD) (episiotomy or more than a second-degree perineal laceration), and cesarean delivery (CD). There was no association between type of delivery and maternal depression.
Risk analysis of suicidal ideations and postpartum depression with antenatal alpha methyldopa use.
Nayak AS, Nachane HB. Asian J Psychiatr. 2018 Oct 29;38:42-44.
Out of the 100 postpartum women assessed, 77.78% of the women who were prescribed alpha methyldopa (for hypertension, marketed under the name Aldomet) had significant postpartum depression. There was statistically significant risk of postpartum depression associated with alpha methyldopa (p?=?0.026, OR?=?6.45). There was no increased suicidal risk with use of alpha methyldopa.