Depression and Anxiety in Pregnancy
Main Article Content
Keywords
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Abstract
The risk of depression in women is greatest during the child-bearing years. Considering that about 50% of pregnancies are unplanned, women may become pregnant while on antidepressants, may have their depression or anxiety relapse during pregnancy or postpartum, or may be unwell and untreated before and during pregnancy and the postpartum period. The impact of the symptoms of depression and anxiety can cause risk to the mother and also have a negative effect on child development. This presentation is intended to assist in understanding the impact of untreated maternal depression and anxiety on fetus, neonate, child and mother; to review the effects of fetal exposure to psychotropic medications (antidepressants); and to summarize general management of perinatal mood/anxiety disorders.
References
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18. Nordeng H, Spigset O. Treatment with selective serotonin reuptake inhibitors in the third trimester of pregnancy: effects on the infant. Drug Saf 2005;28(7):565-81.
19. Koren G, Matsui D, Einarson A, Knoppert D, Steiner M. Is maternal use of selective serotonin reuptake inhibitors in the third trimester of pregnancy harmful to neonates? Can Med Assoc J 2005; 172(11):1457-9.
20. Chambers CD, Johnson KA, Dick LM, Felix RJ, Jones KL. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med 1996;335(14):1010-5.
21. Laine K, Heikkinen T, Ekblad U, Kero P. Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations. Arch Gen Psychiatry 2003 Jul;60(7):720-6.
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26. Misri S, Kostaras X. Benefits and risks to mother and infant of drug treatment for postnatal depression. Drug Saf 2002;25(13):903-11.
2. Kornstein SG. Gender differences in depression: implications for treatment. J Clin Psychiatry 1997;58(Suppl 15):12-8.
3. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 2004;103(4):698-709.
4. ACOG Committee on Practice Bulletins--Obstetrics. ACOG Practice Bulletin No. 92: Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol 2008;111(4):1001-20.
5. Henry AL, Beach AJ, Stowe ZN, Newport DJ. The fetus and maternal depression: implications for antenatal treatment guidelines. Clin Obstet Gynecol 2004 Sep;47(3):535-46.
6. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Depression during Pregnancy: Overview of Clinical Factors. Clin Drug Invest 2004;24(3):157-79.
7. Bonari L, Pinto N, Ahn E, Einarson A, Steiner M, Koren G. Perinatal risks of untreated depression during pregnancy. Can J Psychiatry 2004;49(11):726-35.
8. Misri S, Oberlander TF, Fairbrother N, et al. Relation between prenatal maternal mood and anxiety and neonatal health. Can J Psychiatry 2004;49(10):684-9.
9. O'Connor TG, Heron J, Glover V; Alspac Study Team. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. J Am Acad Child Adolesc Psychiatry 2002;41(12):1470-7.
10. Mennes M, Stiers P, Lagae L, Van den Bergh B. Long-term cognitive sequelae of antenatal maternal anxiety: involvement of the orbitofrontal cortex. Neurosci Biobehav Rev 2006;30(8):1078-86.
11. Llewellyn AM, Stowe ZN, Nemeroff CB. Depression during pregnancy and the puerperium. J Clin Psychiatry 1997;58(Suppl 15):26-32.
12. Cohen LS, Rosenbaum JF. Psychotropic drug use during pregnancy: weighing the risks. J Clin Psychiatry 1998;59(Suppl 2):18-28.
13. Brennan PA, Pargas R, Walker EF, Green P, Newport DJ, Stowe Z. Maternal depression and infant cortisol: influences of timing, comorbidity and treatment. J Child Psychol Psychiatry 2008 Oct;49 (10):1099-107.
14. Hemels ME, Einarson A, Koren G, Lanctôt KL, Einarson TR. Antidepressant use during pregnancy and the rates of spontaneous abortions: a meta-analysis. Ann Pharmacother 2005;39(5):803-9.
15. Rahimi R, Nikfar S, Abdollahi M. Pregnancy outcomes following exposure to serotonin reuptake inhibitors: a meta-analysis of clinical trials. Reprod Toxicol 2006;22(4):571-5.
16. Suri R, Altshuler L, Hellemann G, Burt VK, Aquino A, Mintz J. Effects of antenatal depression and antidepressant treatment on gestational age at birth and risk of preterm birth. Am J Psychiatry 2007;164(8):1206-13.
17. Davis RL, Rubanowice D, McPhillips H, et al.; HMO Research Network Center for Education, Research in Therapeutics. Risks of congenital malformations and perinatal events among infants exposed to antidepressant medications during pregnancy. Pharmacoepidemiol Drug Saf 2007;16(10):1086-94.
18. Nordeng H, Spigset O. Treatment with selective serotonin reuptake inhibitors in the third trimester of pregnancy: effects on the infant. Drug Saf 2005;28(7):565-81.
19. Koren G, Matsui D, Einarson A, Knoppert D, Steiner M. Is maternal use of selective serotonin reuptake inhibitors in the third trimester of pregnancy harmful to neonates? Can Med Assoc J 2005; 172(11):1457-9.
20. Chambers CD, Johnson KA, Dick LM, Felix RJ, Jones KL. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med 1996;335(14):1010-5.
21. Laine K, Heikkinen T, Ekblad U, Kero P. Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations. Arch Gen Psychiatry 2003 Jul;60(7):720-6.
22. Chambers CD, Hernandez-Diaz S, Van Marter LJ, et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med 2006;354(6):579-87.
23. Nulman I, Rovet J, Stewart DE, et al. Neurodevelopment of children exposed in utero to antidepressant drugs. N Engl J Med 1997;336(4):258-62.
24. Nulman I, Rovet J, Stewart DE, et al. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry 2002;159 (11):1889-95.
25. Wisner KL, Zarin DA, Holmboe ES, et al. Risk-benefit decision making for treatment of depression during pregnancy. Am J Psychiatry 2000;157(12):1933-40.
26. Misri S, Kostaras X. Benefits and risks to mother and infant of drug treatment for postnatal depression. Drug Saf 2002;25(13):903-11.