This week, we have some data from our National Pregnancy Registry of Psychiatric Medications looking at infants exposed to quetiapine (Seroquel). Consistent with other studies we have seen recently, there appears to be no increase in risk of major malformations. There is also an interesting paper from DiFlorio and colleagues which assesses risk for postpartum relapse in women with bipolar disorder. In a review, Adamson and colleagues explore the impact of maternal anxiety during pregnancy on the infant’s neurodevelopment using neuroimaging techniques.
Ruta Nonacs, MD PhD
Risk of Major Malformations in Infants Following First-Trimester Exposure to Quetiapine.
Cohen LS, Góez-Mogollón L, Sosinsky AZ, Savella GM, Viguera AC, Chitayat D, Hernández-Díaz S, Freeman MP.Am J Psychiatry. 2018 Aug 16.
152 women with first-trimester exposure to quetiapine were compared with 205 control subjects without any second-generation antipsychotic exposure. For the 155 infants born to women in the exposed group (including three sets of twins), two major malformations were confirmed (1.3%), compared with three major malformations among the 210 infants born in the unexposed group (including five sets of twins) (1.4%).
Stratification of the risk of bipolar disorder recurrences in pregnancy and postpartum.
Di Florio A, Gordon-Smith K, Forty L, Kosorok MR, Fraser C, Perry A, Bethell A, Craddock N, Jones L, Jones I. Br J Psychiatry. 2018 Sep;213(3):542-547.
Previous perinatal history of affective psychosis or depression was the most significant predictor of a perinatal recurrence (odds ratio (OR) = 8.5, 95% CI 5.04-14.82 and OR = 3.6, 95% CI 2.55-5.07 respectively) but even parous women with bipolar disorder without a previous perinatal mood episode were at risk following a subsequent pregnancy, with 7% developing postpartum psychosis.
Adamson B, Letourneau N, Lebel C. J Affect Disord. 2018 Aug 8;241:117-126.
Ten articles were identified, and all found a significant association between antenatal maternal anxiety and child neurodevelopment. Studies vary considerably in their methods with five studies employing electroencephalography (EEG), one using magnetoencephalography (MEG), and the rest employing magnetic resonance imaging (MRI).
Galbally M, Watson SJ, Teti D, Lewis AJ. J Affect Disord. 2018 Oct 1;238:218-225.
Maternal antepartum depression and antidepressant use were not significant predictors of infant sleep problems. Likewise, infant sleep problems were not significant predictors of postpartum depression. However, maternal cognitions about infant sleep, characterised by maternal expectations to immediately attend to their crying child, did demonstrate positive reciprocal effects with infant nocturnal waking between six and 12 months postpartum.
The Role of Circadian Rhythms in Postpartum Sleep and Mood.
Gallaher KGH, Slyepchenko A, Frey BN, Urstad K, Dørheim SK. Sleep Med Clin. 2018 Sep;13(3):359-374.
Circadian rhythm disturbances were strongly correlated with depression, social factors and mothers`s exposure to light postpartum. Future research should include larger, prospective studies as well as randomized controlled trials for measuring effect of circadian rhythm interventions on postpartum mental health outcomes.
Sleeping problems during pregnancy-a risk factor for postnatal depressiveness.
Pietikäinen JT, Polo-Kantola P, Pölkki P, Saarenpää-Heikkilä O, Paunio T, Paavonen EJ. Arch Womens Ment Health. 2018 Aug 18.
Poor general sleep quality (AOR 1.87, 95% CI 1.21-2.88), tiredness during the day (AOR 2.19, 95% CI 1.41-3.38), short sleep ??6 and ??7 h, sleep latency >?20 min, and sleep loss ??2 h were associated with postnatal depressiveness (all p?<?.050).
Sleep and Sleep Disorders in the Menopausal Transition.
Baker FC, Lampio L, Saaresranta T, Polo-Kantola P. Sleep Med Clin. 2018 Sep;13(3):443-456.
Findings from polysomnographic studies are less consistent in showing disrupted sleep in menopausal transition independent of aging; further prospective studies are needed. Hormone therapy alleviates subjective sleep disturbances, particularly if vasomotor symptoms are present. However, because of contraindications, other options should be considered. Further work is needed to develop preventive and treatment strategies for alleviating sleep disturbances to ensure better health, quality of life, and productivity in midlife women.
Sangsawang B, Wacharasin C, Sangsawang N. Arch Womens Ment Health. 2018 Aug 16.
This systematic review suggests that 6 of 13 studies from both psychological and psychosocial interventions including (1) home-visiting intervention, (2) prenatal antenatal and postnatal educational program, (3) CBT psycho-educational, (4) the REACH program based on interpersonal therapy, and (5) infant massage training were successful in reducing rates of PPD symptoms in adolescent mothers as compared to mothers who did not receive the intervention.
Maternal depressive symptoms, self-focus, and caregiving behavior.
Humphreys KL, King LS, Choi P, Gotlib IH. J Affect Disord. 2018 Oct 1;238:465-471.
Maternal depression my foster cognitive styles that interfere with the caregiving relationship, affecting behavior in parent-child interactions that may increase the risk for the intergenerational transmission of depression. Higher levels of depressive symptoms were associated with pronoun use in narratives (i.e., greater “I” and reduced “we” use), reflecting increased self-focus and psychological distancing. Furthermore, increased self-focus was associated with lower levels of caregiver warmth, and mediated the association between depressive symptoms and caregiving warmth.
Zhang H, Shao S, Su Q, Yao D, Sun H, Ding D, Dang S, Wang S, Zhu Z, Li H. J Affect Disord. 2018 Oct 1;238: 526-533.
The infants of mothers with prenatal anxiety scored higher on measures of irritability than the infants of mothers without anxiety. Lower levels of serum prolactin and serotonin and higher serum cortisol were found in the newborns of anxious mothers compared to the control group. The level of serum prolactin in newborns were negatively correlated to the scores of irritability items. After 7 rounds of Neonatal Behavioral Observation (NBO) interventions, the anxiety scores of mothers and the irritability scores of newborns in the NBO intervention group were lower than those of the control group.
Kurzeck AK, Kirsch B, Weidinger E, Padberg F, Palm U. Brain Sci. 2018 Aug 14;8(8) Free Article
detected 13 medical articles dealing with tDCS for depression in pregnancy. Overall, the scientific evidence for the use of tDCS in pregnancy is sparse, but promising. Further studies are required.
Symptoms of Depression and Preterm Birth Among Black Women.
Nutor JJ, Slaughter-Acey JC, Giurgescu C, Misra DP. MCN Am J Matern Child Nurs. 2018 Sep/Oct;43(5):252-258.
Approximately, 17% of women had a preterm birth (PTB) and 20% of women in the sample had a CES-D scores ?23. Women who had CES-D score ?23 were about 70% more likely to have a PTB compared with women with CES-D scores <23 (PR = 1.68, 95% CI: 1.24-2.16) after adjustment for both general social support and father of the baby support.