In a large study from France (Blotière et al, 2019), researchers demonstrated that exposure to monotherapy with valproic acid was associated with 8 specific types of major congenital malformations (e.g., spina bifida, OR 19.4), and exposure to topiramate was associated with an increased risk of cleft lip (OR 6.8). No significant associations were found for lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, and gabapentin.
Two studies look at the accuracy of various screening instruments for the identification of substance use in women during pregnancy (Ondersma et al, 2019; Colman-Cowger et al, 2019). It turns out that there is considerable variation in how these screening tools perform.
Can ketamine be used to prevent postpartum depression? Ma and colleagues (2019) report on the use of ketamine in this setting. More on this next week.
Ruta Nonacs, MD PhD
PSYCHIATRIC ILLNESS DURING PREGNANCY
Bérard A, Sheehy O, Zhao JP, Chambers C, Roth M, Bozzo P, Johnson D, Kao K, Lavigne S, Wolfe L, Quinn D, Dieter K; MotherToBaby Collaborative Research Committee. Eur Neuropsychopharmacol. 2019 Jun 24.
Adjusting for potential confounders including maternal depression/anxiety before pregnancy, women who discontinued of antidepressant were 5.95 times as likely to have depression than non-users(95%CI: 1.54-23.02), and continued users without dosage modification were 4.59 times (95%CI: 1.44-14.64) more likely to have depression in the second-half of pregnancy. Those with dosage modifications were at a similar risk of depression during pregnancy as non-users (adjusted odds ratio 0.58, 95%CI: 0.06-5.52).
Puryear LJ, Nong YH, Correa NP, Cox K, Greeley CS. Matern Child Health J. 2019 Jun 20.
Of referred women 2172 (55.8%) completed an appointment with a mental health provider within 60 days of referral. Rates of completed appointments varied by the level of integration of the mental health provider and referring physician.
Silva DFO, Cobucci RN, Gonçalves AK, Lima SCVC. BMC Pregnancy Childbirth. 2019 Jun 24;19(1):212. Free Article
There is no definitive evidence about the relationship between Western dietary patterns and perinatal anxiety and depression.
Abrar A, Fairbrother N, Smith AP, Skoll A, Albert AYK. Birth. 2019 Jun 21.
Based on the five studies which met our inclusion criteria, findings provide evidence of higher levels of anxiety symptoms among pregnant women experiencing a medically complicated versus a medically uncomplicated pregnancy.
MEDICATIONS AND PREGNANCY
Blotière PO, Raguideau F, Weill A, Elefant E, Perthus I, Goulet V, Rouget F, Zureik M, Coste J, Dray-Spira R. Neurology. 2019 Jun 12.
Exposure to valproic acid was associated with 8 specific types of MCMs (e.g., spina bifida, OR 19.4, 95% CI 8.6-43.5), and exposure to topiramate was associated with an increased risk of cleft lip (6.8, 95% CI 1.4-20.0). No significant associations were found for lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, and gabapentin.
Huber-Mollema Y, Oort FJ, Lindhout D, Rodenburg R. Epilepsia. 2019 Jun;60(6):1069-1082.
Compared to population norms, a high proportion of children of mothers with epilepsy exposed prenatally to monotherapy with four common AEDs had clinical behavioral problems reported by parents.
POSTPARTUM PSYCHIATRIC ILLNESS
Ma JH, Wang SY, Yu HY, Li DY, Luo SC, Zheng SS, Wan LF, Duan KM. Psychiatry Res. 2019 Mar 16.
Nakamura Y, Nakatochi M, Kunimoto S, Okada T, Aleksic B, Toyama M, Shiino T, Morikawa M, Yamauchi A, Yoshimi A, Furukawa-Hibi Y, Nagai T, Ohara M, Kubota C, Yamada K, Ando M, Ozaki N. BMC Psychiatry. 2019 Jun 20;19(1):190. Free Article
Moraes EV, Toledo OR, David FL, Godoi BN, Monteiro KA, Deluqui TC, Teixeira TW, Carvalho AL, Avelino MM. BMC Psychiatry. 2019 Jun 26;19(1):199. Free Article
Clinical diagnosis of Zika virus during pregnancy was associated with a 20-fold increase in risk of severe PPD symptoms.
Hu J, Zhou B, Li Y, Deng Y, He Q, Ye J, Ning Y. Psychiatr Genet. 2019 Aug;29(4):97-102.
Wisner KL, Stika CS, Ciolino JD. JAMA Psychiatry. 2019 Jun 26.
Lewkowitz AK, Rosenbloom JI, Keller M, López JD, Macones GA, Olsen MA, Cahill AG. Am J Obstet Gynecol. 2019 Jun 18.
Within one year of hospital discharge after stillbirth, 4.0% (n=331) of women had an ED encounter or inpatient admission coded for psychiatric morbidity: the risk was nearly 2.5 times higher compared to livebirth. Women also had higher risk of having an ED encounter or inpatient admission coded for drug or alcohol use or dependence in the year following delivery of stillbirth versus livebirth (aOR 2.41).
Handler A, Zimmermann K, Dominik B, Garland CE. Matern Child Health J. 2019 Jun 24.
PERINATAL SUBSTANCE USE DISORDERS
Ondersma SJ, Chang G, Blake-Lamb T, Gilstad-Hayden K, Orav J, Beatty JR, Goyert GL, Yonkers KA. Addiction. 2019 Jun 19.
Of five screening instruments for substance use in pregnancy tested (Substance Use Risk Profile-Pregnancy (SURP-P), CRAFFT, 5Ps, Wayne Indirect Drug Use Screener (WIDUS) and the National Institute on Drug Abuse (Quick Screen), none showed both high sensitivity and high specificity, and area under the curve was low for nearly all measures.
Coleman-Cowger VH, Oga EA, Peters EN, Trocin KE, Koszowski B, Mark K. Obstet Gynecol. 2019 May;133(5):952-961. Free Article
The SURP-P and 4P’s Plus had high sensitivity and negative predictive values, making them more ideal screening tests than the NIDA Quick Screen-ASSIST.
MATERNAL MENTAL HEALTH AND CHILD OUTCOMES
Connell AM, Danzo S, Magee K, Uhlman R. J Affect Disord. 2019 May 1;250:241-248.