Depression and Anxiety During Pregnancy: Clinical ... - IngentaConnect

1 downloads 0 Views 112KB Size Report
Mónica Flores-Ramos. 1,*, Norma Galindo-Sevilla. 1 ... Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Av. México Xochimilco 101, México City. Abstract: ...
Send Orders for Reprints to [email protected] Current Psychiatry Reviews, 2013, 9, 325-330

325

Depression and Anxiety During Pregnancy: Clinical Aspects Mónica Flores-Ramos1,*, Norma Galindo-Sevilla1, Armando Córdova Barrios1, Phillipe Leff Gelman1, Carlos Cruz Fuentes2 and Javier Mancilla-Ramírez1 1

Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Montes Urales 800, México City; 2Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Av. México Xochimilco 101, México City Abstract: Depression and anxiety are common during pregnancy. Depression is associated with preterm birth, low birth weight, and intrauterine growth restriction. Risk factors related to depression and anxiety during pregnancy are poor social support, poor quality of intimate relationship, poverty and previous episodes to depression and anxiety. When these mental disorders are untreated, poor health behaviors are observed in pregnant patients including inadequate nutrition, smoking, drug use and failure to attend medical appointments. Inadequate maternal-fetal attachment is developed when mother is depressed. Self-harm is another situation of concern in depressed pregnant women. On the other side associated risks to antidepressant and anxiolytic treatment during pregnancy have to be considered, it has been reported miscarriage, perinatal death, lower birth weight, preterm birth and lower Apgar scores related to psychotropic drug use during pregnancy. Increased risk of malformation is still controversial, as well as developmental effects in children of mothers exposed to of psychotropic drugs. In this review we explore literature related to depression and anxiety during pregnancy to weigh risk and benefits of their treatment in the mother and the baby.

Keywords: Depression, anxiety, pregnancy, antidepressants, anxiolytic. 1. INTRODUCTION Depression and anxiety are common disorders during pregnancy; evidence suggests that the prevalence of depression in women during pregnancy is similar to the prevalence observed in similarly aged non-pregnant women [1]. Therefore physicians should have knowledge about the prevention and treatment of these disorders during pregnancy. It have been suggested a link between enhanced levels of depression and anxiety symptoms during pregnancy and adverse obstetric, fetal and neonatal outcome [2]. On the other side, risks associated with prenatal exposure to psychotropic drugs, specifically antidepressants and anxiolytic drugs have been reported by several authors. The aim of this article was to review studies assessing prevalence of anxiety and depression during pregnancy and their impact on obstetric, fetal and neonatal outcome; associated factors to depressive and anxiety symptomatology during pregnancy, risks of untreated depression during pregnancy, and therapeutic options of depression and anxiety during pregnancy. 2. DEPRESSION AND ANXIETY PREVALENCE DURING PREGNANCY Depression is characterized by affective, cognitive, psychomotor and circadian rhythm alterations that cause clinically significant distress or impairment in social, occupational and other important areas of functioning [3]. *Address correspondence to this author at the Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Montes Urales 800, México City; Tel: (52) 55 55209900; E-mail: [email protected] 1875-6441/13 $58.00+.00

According to the World Health Organization (WHO), by the year 2020, major depressive disorder will become the second leading cause of disease worldwide, as measured by disability-adjusted life years [4]. Mood disorders are twice as common among women as men [5]. Consequently, depression appears more frequently in women than in men. It has been proposed that hormone fluctuations may predispose some women to depressive symptomatology [6]. The reported prevalence of depression ranges from 1.5 cases per 100 adults in Taiwan to 5.8 cases per 100 adults in New Zealand [7]. Previously, pregnancy was considered a “protector” against mental disabilities, especially depression. However, current evidence suggests that the prevalence of depression in women during pregnancy is similar to the prevalence observed in similarly aged non-pregnant women [1]. The reported prevalence rates of depression may fluctuate depending on the evaluation instrument. Based on the Edinburgh Postnatal Depression Scale (EPDS), Ortega et al [8] reported a prevalence rate for depression of 22% among pregnant women, whereas a multicenter study [9] reported a prevalence rate for depression of 30.7% during pregnancy using the Beck Depression Inventory (BDI) for scores higher than 16 points. A systematic review reported that the prevalence rates for depression were 7.4%, 12.8%, and 12.0% for the first, second, and third trimesters, respectively [10]. Moreover, Yonkers et al [11] reported that 13% of women used antidepressants at some time during their pregnancy. Consequently, health practitioners should be aware of the importance of a diagnosis of depression during pregnancy, ways to prevent this condition, associated risks of © 2013 Bentham Science Publishers

326 Current Psychiatry Reviews, 2013, Vol. 9, No. 4

untreated depression during pregnancy and therapeutic options for depressed pregnant women. 3. FACTORS ASSOCIATED WITH DEPRESSIVE AND ANXIOUS SYMPTOMATOLOGY DURING PREGNANCY Several factors have been associated with the presence of depressive symptoms during pregnancy. One such factor is social support; a previous study reported that women suffering from depression during pregnancy perceived less support from their spouses [12]. Similarly, a recent study designed to evaluate the association between the quality of key relationships and depression in women in their third trimester of pregnancy found that lower-quality relationships between key family members was strongly associated with third-trimester depression [13]. In another prospective study [14], the authors observed that women with higher-quality support experienced less postpartum depression. In addition to a lack of partner support, Hartley et al [15] observed that intimate partner violence, low household income and younger age were strong predictors of depression during pregnancy in a community-based controlled trial with 1062 pregnant women. Intimate partner violence (IPV) is more common among depressed women (including major and minor depression) than among non-depressed women during pregnancy [16]. Some authors have recognized IPV as a risk factor for perinatal depression [15, 17]. In a systematic review conducted by Lancaster et al [18], anxiety was strongly associated with a greater likelihood of antepartum depressive symptoms in bivariate analyses. Furthermore, life stress, a history of depression, a lack of social support, unintended pregnancy, Medicaid insurance, domestic violence, lower income, lower education, smoking, single status, and poor relationship quality were associated with depressive symptoms in the bivariate analysis. In a multivariate analysis, life stress, lack of social support and domestic violence were significantly associated with antepartum depressive symptoms. Several authors [19, 20] have observed that, similar to depressive episodes in non-pregnant women, a previous depressive episode an important risk factor for depression during pregnancy. According to Lara et al [9], 59% of women who suffer depressive symptoms during pregnancy report that they have experienced depressive symptomatology in the past. 4. RISKS OF UNTREATED DEPRESSION DURING PREGNANCY The consequences of depression during pregnancy should be considered not only for pregnant women but also for the fetus and the newborn. Pregnant women are not exempt from suicidal thoughts, and suicide is the second leading cause of death in women who suffer from depression during pregnancy or the postpartum period [21]. A report from the Centers for Disease Control and Prevention’s (CDC) National Violent Death Reporting System that analyzed the rates of pregnancy-associated (occurring during pregnancy or in the first year postpartum) homicide and suicide in a multistate sample found a pregnancy-associated suicide rate

Flores-Ramos et al.

of 2.0 per 100,000 live births; 45.7% of these deaths occurred during pregnancy, and the rest occurred during the postpartum period. It is noteworthy that 54.3% of suicidal mothers experienced problems with a current or former intimate partner that appear to have contributed to the suicide [22]. Suicide attempts have been observed in 5% of high-risk pregnant women. In this particular population group, suicide risk is increased by clinical symptoms such as insomnia, hypersomnia, fatigue or lack of energy, increased or decreased appetite, lack of interest in daily activities, low mood, feelings of hopelessness or guilt, decreased concentration and psychomotor retardation or agitation [23]. In the case of a group of self-poisoned pregnant women, it was observed that their peak age was between 18 and 20 years, 62% were experiencing their first pregnancy, 55% were unmarried, and the women had lower socioeconomic status [24]. In the general population, observed characteristics associated with a high risk of suicide in the perinatal period include a current or past history of psychiatric disorders, younger age, being unmarried or unemployed, unplanned pregnancy, addiction to illicit drugs and/or alcohol, lack of effective psychosocial support, and experience of episodes of sexual or physical violence [25]. In the postpartum period, the suicide risk was estimated for 5.7% of women assessed for a trial of psychotherapy for postpartum depression, according to the Mini-International Neuropsychiatric Interview (MINI). In a population-based sample of women, the suicide risk was 11.1%, assessed with the same questionnaire [26]. Poor health behaviors during pregnancy are more common in depressed women and may include the use of cigarettes, alcohol and other drugs, which increase the risk of adverse effects on infant outcome [27]. Elevated symptoms of anxiety or depression may increase the probability of binge drinking during pregnancy [28]. Poor nutrition is also observed in depressed women during pregnancy [29], as is poor prenatal medical care [26]. In addition, depressive symptoms during pregnancy are significantly associated with an increase in the pre-delivery length of stay. This association is mediated, in part, by antepartum complications, even after controlling for sociodemographic factors [30]. Antenatal depression is a good predictor of postpartum depression. Wilson et al reviewed the literature related to psychosocial risk factors associated with adverse postpartum family outcomes and observed a strong association between antenatal depression and postpartum depression, with good evidence of this association [31]. Similarly, Piacentini et al [32] evaluated 595 women during the antenatal period to identify psychosocial risk factors for postpartum depression. They observed that depression and anxiety during pregnancy were strong predictors of postnatal depression. Another consequence of perinatal depression is compromised maternal-fetal attachment (MFA). Both postpartum depression and major depressive disorder during pregnancy negatively affect MFA, but this association is not evident for antidepressant use or anxiety during pregnancy [33].

Depression and Anxiety During Pregnancy

Perinatal outcomes in depressed mothers have been evaluated in some studies. The findings include increased incidence of low birth weight (LBW) in babies of depressed mothers, risk of preterm birth and intrauterine growth restriction. A systematic review and meta-analysis of studies conducted in developing countries reported that children of mothers with depression or depressive symptoms were more likely to be underweight or stunted. A sub-analysis of three selected longitudinal studies showed that this effect was important; the OR was 2.2 for underweight and 2.0 for stunting [34]. We can assume that these findings are related to poverty or the psychosocial profiles of women in developing countries, but comparisons between different populations show that perinatal depression is significantly associated with LBW in women from the United States and European social democracies as well as in women from developing countries. However, the risk of LBW associated with antenatal depression is significantly larger in developing countries [35]. Another perinatal outcome related to depressive symptomatology is preterm birth. Controversial results have been found by several authors [36, 37, 38]. These results may be explained by methodological differences in the studies, such as the screening instruments used, the time of screening and the sample size. A recent large cohort study aimed to clarify the association between preterm birth and antenatal depression by evaluating 14,157 women using the Edinburgh postnatal depression scale. The authors classified the participants as “at risk” of depression (score 12 or giving any response other than “never” to the question describing thoughts of self-harm) or “not at risk” of depression. The findings showed a significant relationship between depressive symptoms and preterm birth, even after adjusting for maternal age, race/ethnicity, prior preterm delivery, and insurance status [39]. Theories that attempt to explain the relationship between antenatal depression and perinatal outcomes suggest that the hypothalamo-pituitary-adrenal (HPA) axis hyperactivity observed in depressed women may influence birth outcome. Increased HPA axis activity produces an increase in the release of corticotropin-releasing hormone (CRH) from the placenta via the actions of catecholamines and cortisol [40]. In addition, it has been observed that elevated CRH at 28 and 33 weeks of gestation is associated with spontaneous preterm birth [41, 42]. The relationship among maternal depression, low birth weight and prematurity may be mediated by maternal cortisol and norepinephrine. The biochemical and physiological profiles of newborns of depressed women are similar to those of their mothers, showing elevated cortisol, lower levels of dopamine and serotonin, greater relative right frontal EEG activation and lower vagal tone [43]. 5. SOME CONSIDERATIONS ABOUT ANXIETY DURING PREGNANCY Evaluation of anxiety symptoms during pregnancy is uncommon despite the high comorbidity between depression and anxiety observed in the general population [44]. According to Ibanez et al [45], comorbidity between anxiety and depression is observed in 13.2% of pregnant women and 7.9% of women are only “anxious” during pregnancy. However, the reported comorbidity between anxiety and

Current Psychiatry Reviews, 2013, Vol. 9, No. 4

327

depression during pregnancy has been reported to be as high as 70% in a cross-sectional study [46]. Similar to depressive symptoms, anxiety during pregnancy is a strong predictor of postpartum anxiety [47]. However, the relationship between anxiety during pregnancy and perinatal outcomes has been infrequently studied. Some authors suggest that there is no association between maternal anxiety and birth weight [48], but Teixera et al [49] observed an association between maternal anxiety in pregnancy and an increased uterine artery resistance index. Two subsequent papers [2, 50] (a critical review of the literature and a systematic review) agreed that the data were insufficient to claim that antenatal maternal anxiety is associated with low birth weight of offspring. Preterm birth [51], low APGAR scores [52] and difficult infant temperament [53] are also observed in the children of women who suffer from anxiety during pregnancy. Symptomatic anxiety or anxiety disorders, such as panic disorder [54] and generalized anxiety disorder [55], have been associated with pregnancy complications and adverse perinatal outcomes. Moreover, comorbidity of depression and anxiety during pregnancy seems to lead to a greater incidence of prematurity than the incidence observed in children of mothers with depressive disorder or anxiety alone [56]. The importance of this relationship increases when we consider that preterm birth may have various consequences during infancy, childhood [57, 58] and adulthood [59, 60]. A rationale to explain the effects of anxiety on perinatal variables is the high levels of CRH [61] and cortisol [62] that have been observed in women who delivered preterm. When comorbidity between anxiety and depression prevails, higher cortisol and norepinephrine and lower dopamine and serotonin levels have been observed compared with neonates of women suffering only from anxiety or depression [56]. 6. THERAPEUTIC OPTIONS FOR DEPRESSION AND ANXIETY DURING PREGNANCY Ideally, pregnancy should be planned in women affected by a psychiatric condition. Both psychiatrists and gynecologists should recommend birth control methods to patients or, if the patient wishes to become pregnant, ways to foster the best conditions for a successful pregnancy. Unfortunately, this approach is not adopted in clinical practice. A low percentage of women receive any form of pre-pregnancy counseling. Most women do not plan their pregnancies, and exposure to psychotropic medications occurs frequently. Moreover, it has been observed that exposure to more than one psychotropic medication is not uncommon [63]. Risks associated with prenatal exposure to psychotropic drugs, specifically antidepressants and anxiolytic drugs, have been reported by several authors and include miscarriage [64-67] and perinatal death [68-70]. A recent populationbased study reported that women with antenatal drug exposure showed increased risks for all non-live pregnancy outcomes than women with no history of depression or anxiety [71]. Lower birth weight, younger gestational age at birth and lower Apgar scores have also been reported due to exposure

328 Current Psychiatry Reviews, 2013, Vol. 9, No. 4

to selective serotonin reuptake inhibitors (SSRI) [72, 73]. However, a recent study did not find a significantly increased risk of malformation, preterm birth, or low birth weight following prenatal exposure to antidepressants [74]. SSRI use has been associated with infant convulsions [75], persistent pulmonary hypertension [76], pulmonary diseases [77], and increased need for laxatives [78] in the newborn. Teratogenic effects are another source of concern for women taking psychotropic drugs. In the case of SSRIs, inconsistent results related to cardiac malformations have been observed during first-trimester use [79]. Paroxetine is the only drug in this group that apparently increases the risk of cardiac malformations [80]. Other malformations observed in the newborns of mothers treated with SSRIs include anencephaly, craniosynostosis, and omphalocele [81, 82]. No increase in the rate of congenital malformations has been observed with mirtazapine [83], serotonin/ noradrenaline reuptake inhibitors or noradrenaline reuptake inhibitors [84]. The developmental effects of psychotropic drug use during pregnancy on infants remain unclear. It seems that SSRIs do not interfere with infants' psychological and cognitive development, but information is scarce for other drugs, such as antipsychotics, benzodiazepines, lithium, and lamotrigine [85, 86]. With respect to anxiolytic drugs, benzodiazepines should be avoided due to a slightly increased risk of oral cleft with in-utero exposure during the organogenesis period [87] and a risk of floppy infant syndrome and withdrawal symptoms when used in the third trimester [88]. Non-pharmacological treatments for depression should be considered during pregnancy. Some psychotherapeutic interventions may be effective in reducing depressive and anxiety symptoms during pregnancy. Reports suggest the utility of a brief psychoanalytic intervention [89] and mindfulness-based cognitive group therapy [90]. A metaanalysis of treatments for perinatal depression found that individual therapy was more effective than group therapy, and interpersonal therapy had a greater effect size compared to control conditions than did interventions that included a cognitive-behavioral component [91]. Mind-body interventions, including autogenic training, biofeedback, hypnotherapy, imagery, meditation, prayer, auto-suggestion, tai-chi and yoga, may benefit pregnant women who suffer from anxiety [92]. 7. CONCLUSIONS When it is necessary to prescribe a psychotropic drug, a risk-benefit analysis should be performed. Risks have been associated with untreated perinatal anxiety and depression, including perinatal complications, impaired maternal-fetal attachment, and suicide. However, psychotropic drugs used to treat depression and anxiety are also related to adverse effects, such as teratogenicity, alteration in perinatal outcomes, and behavioral consequences in newborns. Some benefits may be obtained from psychotherapy and mindbody interventions, but additional studies are necessary to

Flores-Ramos et al.

assess the efficacy of these interventions in the treatment of depression and anxiety during pregnancy. The most important action is to prevent unplanned prenatal exposure to psychotropic drugs and to evaluate with the patient the best time for conception. CONFLICT OF INTEREST Authors manifest that we don’t have any conflict of interest. ACKNOWLEDGEMENTS Declared none. REFERENCES [1]

[2]

[3] [4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

Gaynes BN, Gavin N, Meltzer Brody S, Lohr KN, Swinson T, Gartlehner G et al. Perinatal depression: Prevalence, screening accuracy, and screening outcomes. Evid. Rep. Technol. Asses. (Summ) 2005; 119: 1-8. Alder J, Fink N, Bitzer J, Hösli L, Holzgreve W. Depression and anxiety during pregnancy: a risk factor for obstetric , fetal and neonatal outcome? A critical review of the literature. J. Matern. Fetal Neonatal Med. 2007; 20(3): 189-209. American Psychiatric Association. DSM-IV-TR. Manual diagnósticoy estadístico de los trastornos mentales IV. Barcelona Masson, 2003. Murray CJL, López AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. The Lancet 1997; 349: 1498-1504. Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS et al. Cross-national associations between gender and mental disorders in the WHO World Mental Health Surveys. Arch. Gen. Psychiatry 2009; 66(7): 785-795. Soares CN, Zytek B. Reproductive hormone sensitivity and risk for depression across the female life cycle: A continuum of vulnerability?. J. Psychiatry Neurosci. 2008; 33(4): 331–343. Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, Hwu HG et al. Cross-National epidemiology of Major depression and Bipolar disorder. JAMA 1996; 276(4): 293-299. Ortega L, Lartigue T, Figueroa ME. Prevalencia de depresión a través de la escala perinatal de Edimburgo (EPDS). Perinatol. Reprod. Hum. 2001; 15: 11-21. Lara MA, Navarro C, Navarrete L, Cabrera A, Almanza J, Morales F et al. Síntomas depresivos en el embarazo y factores asociados, en pacientes de tres instituciones de la ciudad de México. Salud Mental 2006; 29(4): 55-62. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet. Gynecol. 2004;103: 698-709. Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL, Stotland N et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Gen. Hosp. Psychiatry 2009; 31(5): 403-413. O´Hara MW. Social support, life events, and depression during pregnancy and the puerperium. Arch. Gen. Psychiatry 1986; 43(6): 569-573. Senturk V, Abas M, Berksun O, Stewart R. Social support and antenatal depression in extended and nuclear family environments in Turkey: a cross-sectional survey. BMC Psychiatry 2011; 24: 11-48. Collins NL, Dunkel-Schetter C, Lobel M, Scrimshaw SC. Social support in pregnancy: psychosocial correlates of birth outcomes and postpartum depression. J. Pers. Soc. Psychol. 1993; 65(6): 1243-1258. Hartley M, Tomlinson M, Greco E, Scott Comulada W, Stewart J, le Roux I et al. Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod. Health 2011; 2: 8-9.

Depression and Anxiety During Pregnancy [16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24] [25] [26]

[27]

[28]

[29]

[30]

[31]

[32]

[33]

[34]

[35]

[36]

[37]

Melville JL, Gavin A, Guo Y, Fan M, Katon WJ. Depressive disorders during pregnancy. Prevalence and risk factors in a large Urban sample. Obstet. Gynecol. 2010; 116: 1064-1070. Valentine JM, Rodriguez MA, Lapeyrouse L, Zhang M. Recent intimate partner violence as a prenatal predictor of maternal depression in the first year postpartum among Latinas. Arch. Womens Ment. Health. 2011; 14(2): 135-143. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk factors for depressive symptoms during pregnancy: a systematic review. Am. J. Obstet. Gynecol. 2010; 202(1): 5-14. Alvarado R, Perucca E, Neves E, Rojas M, Monardes J, Olea E et al. Cuadros depresivos durante el embarazo y factores asociados. Rev. Chil. Obstet. Ginecol. 1993; 58(2): 135-141. Nasreen HE, Kabir ZN, Forsell Y, Edhborg M. Prevalence and associated factors of depressive and anxiety symptoms during pregnancy: a population based study in rural Bangladesh. BMC Womens Health 2011; 11: 22. Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and the postpartum. Arch. Women Ment. Health. 2005; 8 (2): 77-87. Lancaster C, Singh V, Campbell J, Flynn H, Gold KJ. Homicide and suicide during the perinatal period. Obstet. Gynecol. 2011;118: 1056–63. Benute GR, Nomura MR, Jorge VM, Nonnenmacher D, Fráquas Jr R, Lucia MC et al. Risk of suicide in high risk pregnancy: an exploratory study. Rev. Assoc. Med. Bras. 2011; 57(5): 583-587. Czeizel AE. Attempted suicide and pregnancy. J. Inj. Violence Res. 2011; 3(1): 45-54. Gentile S. Suicidal mothers. J. Inj. Violence Res. 2011; 3(2): 90-97. Pinheiro RT, da Silva RA, Magalhaes PV, Horta BL, Pinheiro K.A. Two studies on suicidality in the postpartum. Acta Psych. Scand. 2008; 118(2): 160-163. Zuckerman B, Amaro H, Bauchner H, Cabral H. Depressive symptoms during pregnancy: relationship to poor health behaviors. Am. J. Obstet. Gynecol. 1989; 160: 1107-1111. Leis JA, Heron J, Stuart EA, Mendelson T. Association between depressive and anxious symptoms and prenatal alcohol use. Matern. Child Health 2012; 16(6): 1304-1311. Fowles ER Murphey C. Nutrition and mental health in early pregnancy: a pilot study. J Midwifery Womens Health 2009; 54(1): 73-77. Palladino LC, Flynn HA, Richardson C, Marcus SM, Johnson TR, Davis M.M. Lengthened predelivery stay and antepartum complications in women with depressive symptoms during pregnancy. J. Womens Health (Larchmt) 2011; 20(6): 953-962. Wilson LM, Reid AJ, Midmer DK, Bringer A, Carroll JC, Stewart DE. Antenatal psychosocial risk factors associated with adverse postpartum family outcomes. CMAJ 1996; 154(6): 785-799. Piacentini D, Leveni D, Primerano G, Cattaneo M, Volpi L, Biffi G et al. Prevalence and risk factors of postnatal depression among women attending antenatal courses. Epidemiol. Psychiatr. Soc. 2009; 18(3): 214-220. McFarland J, Salisbury AL, Battle CL, Hawes K, Halloran K, Lester BM. Major depressive disorder during pregnancy and emotional attachment to the fetus. Arch. Womens Ment. Health. 2011; 14(5): 425-434. Surkan PJ, Kennedy CE, Hurley KM, Black MM. Maternal depression and childhood growth in developing countries: systematic review and meta-analysis. Bull. World Health Org. 2011; 287: 607615D. Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch. Gen. Psychiatry 2010; 67(10): 1012-1024. Goedhart G, Snijders AC, Hesselink AE, van Poppel MN, Bonsel GJ, Vrijkottie TG. Maternal depressive symptoms in relation to perinatal mortality and morbidity: results from a large multiethnic cohort study. Psychosom. Med. 2010; 72: 769-76. Andersson L, Sundstrom-Poromaa I, Wulff M, Astrom M, Bixo M. Neonatal outcome following maternal antenatal depression and anxiety: a population-based study. Am. J. Epidemiol. 2004; 159: 872-81.

Current Psychiatry Reviews, 2013, Vol. 9, No. 4 [38]

[39]

[40]

[41]

[42]

[43]

[44]

[45]

[46]

[47]

[48] [49]

[50]

[51]

[52]

[53]

[54]

[55]

[56]

329

Hoffman S, Hatch MC. Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women. Heath Psychol. 2000; 19: 535-43. Straub H, Adams M, Kim JJ, Silver RK. Antenatal depressive symptoms increase the likelihood of preterm birth. Am. J. Obstet. Gynecol. 2012; 207(4): 329. Bonari L, Pinto N, Ahn E, Einarson A, Steiner M, Coren G. Perinatal risks of untreated depression during pregnancy. Can. J. Psychiatry 2004; 49(11): 726-735. Moawad AH, Goldenberg RL, Mercer B, Meis PJ, Iams JD, Das A et al. The preterm prediction study: the value of serum alkaline phosphatase, alpha-fetoprotein, plasma corticotropin-releasing hormone, and other serum markers for the prediction of spontaneous preterm birth. Am. J. Obstet. Gynecol. 2002; 186(5): 990-996. Madhwa PD, Garite TJ, Porto M, Glynn L, Chicz-DeMet A, Dunkel-Schetter C et al. Placental corticotropin-releasing hormone(CRH), spontaneous preterm birth, and fetal growth restriction: a prospective investigation. Am. J. Obstet. Gynecol. 2004; 191(4):1063-1069. Field T, Diego M, Hernandez-Reif M. Prenatal depression effects on the fetus and new-born: a review. Infant. Behav. Dev. 2006; 29: 445-455. Lamers F, van Oppen P, Comijs CH, Smit JH, Spinhoven P, van Balkom AJ et al. Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J. Clin. Psychiatry 2011; 72(3): 341-348. Ibanez G, Charles MA, Forhan A, Magnin G, Thiebaugeorges O, Kaminsky M et al. Depression and anxiety in women during pregnancy and neonatal outcome: Data from the EDEN motherchild cohort. Early Hum. Dev., 2012, 88(8), 643-649. Ali, N.S.; Azam, I.S.; Ali, B.S.; Tabbusum, G.; Moin, S.S. Frequency and associated factors for anxiety and depression in pregnant women: a hospital based cross-sectional study. Scientific World Journal 2012; PMID: 22629180 [abstract in PubMed] Herson J, O´Connor T, Evans J, Golding J, Glover V. The ALSPAC Study Team. The Course of anxiety and depression through pregnancy and the postpartum in a community sample. J. Affect. Disord. 2004; 80: 65-73. Perkin M. Cited studies did not show relation between maternal anxiety and birth weight. BMJ. 1999; 318(7193): 1288. Teixeira J, Fisl N, Glover V. Association between maternal anxiety in pregnancy and increased uterine artery resistance index. Cohort based study. BMJ 1999; 318: 153-157. Araújo DM, Pereira N, Kac G. Anxiety during pregnancy, prematurity and low birth weight: a systematic literature review. Cad. Saude Publica 2007; 23(4): 747-756. Rondó P, Ferreira R, Nogueira F, Ribeiro M, Lobert H, Artes R. Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation. Eur. J. Clin. Nutr. 2003; 57: 266-272. Berle J, Mykletun A, Daltveit A, Rasmussen S, Holsten F, Dahl A. Neonatal outcomes in offspring of women with anxiety and depression during pregnancy. A linkage study from the NordTrondelag Health Study (HUNT) and Medical Birth Registry of Norway. Arch. Womens Ment. Health 2005; 8: 181-189. Austin M, Hadzi-Pavlovic D, Leader L, Saint K, Parker G. Maternal trait anxiety, depression and life event stress in pregnancy: relationships with infant temperament. Early Hum. Dev. 2005; 81: 183-190. Bánhidy F, Acs N, Puhó E, Czeizel AE. Association between maternal panic disorders and pregnancy complications and delivery outcomes. Eur. J. Obtet. Gynecol. Reprod. Biol. 2006; 124(1): 47-52. Uguz F, Gezginc K, Yazici F. Are major depression and generalized anxiety disorder associated with intrauterine growth restriction in pregnant women? A case-control study. Gen. Hosp. Psychiatry 2011; 33(6): 640. Field T, Diego M, Hernandez-Rief M, Figuereido B, Deeds O, Ascencio A et al. Comorbid depression and Anxiety effects on pregnancy and neonatal outcomes. Infant. Behav. Dev. 2010; 33(1): 23.

330 Current Psychiatry Reviews, 2013, Vol. 9, No. 4 [57]

[58] [59]

[60]

[61]

[62]

[63]

[64]

[65]

[66]

[67]

[68]

[69]

[70]

[71]

[72] [73]

[74]

[75]

Flores-Ramos et al.

Bhutta A, Cloves M, Casey PH, Cradock MM, Anand KJ. Cognitive and behavioral outcomes of School-aged children who were born pre-term: a meta-analysis. JAMA 2002; 288: 728-37. Saigal S, Doyle D. An overview of Mortality and Squealed of preterm birth from infancy to childhood. Lancet 2008; 371: 261-9. Hofman PL, Cutfield WS. Insulin sensitivity in people born preterm, with low or very low birth weight and small for gestational age. J. Endocrinol. Invest. 2006; 29(1): 2-8. Allin M, Rooney M, Graftth T, Cuddy M, Wyatt J, Rifkin L et al. Neurological Abnormalities in young adults born pre-term. J. Neural Neurosurg. Psychiatry 2006; 77: 495-9. Mancuso RA, Dunkel C, Rini CM, Roesch SC, Hobel KJ. Maternal Prenatal Anxiety and Corticotropin-Releasing Hormone Associated With Timing of Delivery. Psychosom. Med. 2004; 66(5): 762-769. Diego MA, Jones NA, Field T, Hernandez-Rief M, Schanberg S, Kuhn C et al. Maternal psychological distress, prenatal cortisol, and fetal weight. Psychosom. Med. 2006; 68(5): 747-753. Desai G, Babu GN, Chandra PS. Unplanned pregnancies leading to psychotropic exposure in women with mental illness –Findings from a perinatal psychiatry clinic. Indian J. Psychiatry 2012; 54(1): 59-63. Klieger-Grossmann C, Weitzner B, Panchaud A, Pistelli A, Einarson T, Koren G et al. Pregnancy outcomes following use of escitalopram: a prospective comparative cohort study. J. Clin. Pharmacol. 2012; 52(5): 766–770. Nakhai-Pour HR, Broy P, Bérard A. Use of antidepressants during pregnancy and the risk of spontaneous abortion. CMAJ; 182(10): 1031–1037. Pastuszak A, Schick-Boschetto B, Zuber C, Feldkamp M, Pinelli M, Sihn S et al. Pregnancy outcome following first-trimester exposure to fluoxetine (Prozac). JAMA 1993; 269(17): 2246–2248. Einarson A, Choi J, Einarson TR, Koren G. Rates of spontaneous and therapeutic abortions following use of antidepressants in pregnancy: results from a large prospective database. J. Obstet. Gynaecol. Can. 2009; 31(5): 452–456. Diav-Citrin O, Shechtman S, Weinbaum D, Wajnberg R, Avgil M, Di Gianantonio E et al. Paroxetine and fluoxetine in pregnancy: a prospective, multicentre, controlled, observational study. Br. J. Clin. Pharmacol. 2008; 66(5): 695–705. Wen SW, Yang Q, Garner P, Fraser W, Olatunbosun O, Nimrod C et al. Selective serotonin reuptake inhibitors and adverse pregnancy outcomes. Am. J. Obstet. Gynecol. 2006; 194(4): 961-966. Ornoy A, Arnon J, Shechtman S, Moerman L, Lukashova I. Is benzodiazepine use during pregnancy really teratogenic?. Reproductive Toxicology 1998; 12(5): 511-515. Ban L, Tata LJ, West J, Fiaschi L, Gibson JE. Live and Non-Live Pregnancy Outcomes among Women with Depression and Anxiety: A Population-Based Study. PLoS ONE 2012; 7(8): e43462. Simon GE, Cunningham ML, Davis RL. Outcomes of prenatal antidepressant exposure. Am. J. Psychiatry 2002; 159: 2055-61. Oberlander TF, Warburton W, Misri S, Aghajanian J, Hertzman C. Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data. Arch. Gen. Psychiatry 2006; 63: 898-906. Nordeng H, van Gelder MM, Spigset O, Koren G, Einarson A, Eberhard-Gran M. Pregnancy outcome after exposure to antidepressants and the role of maternal depression: results from the Norwegian Mother and Child Cohort Study. J. Clin. Psychopharmacol 2012; 32(2): 186-194. Hayes RM, Wu P, Shelton RC, Cooper WO, Dupont WD, Mitchel E et al. Maternal antidepressant use and adverse outcomes: a cohort study of 228,876 pregnancies. Am. J. Obstet. Gynecol. 2012; 207(1): 49.

Received: March 15, 2013

[76]

[77]

[78]

[79]

[80]

[81]

[82]

[83]

[84]

[85] [86]

[87]

[88]

[89]

[90]

[91]

[92]

Revised: April 14, 2013

Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N. Engl. J. Med. 2006; 354: 579-87. ter Horst PG, Bos HJ, de Jong-van de Berg LT, Wiffert B. In utero exposure to antidepressants and the use of drugs for pulmonary diseases in children. Eur. J. Clin. Pharmacol 2013; 69(3): 541-547. Nijenhuis CM, ter Horst PG, van Rein M, Wilfert B, de Jong-van de Berg LT. Disturbed development of the enteric nervous system after in utero exposure of selective serotonin re-uptake inhibitors and tricyclic antidepressants. Part 2: Testing the hypotheses. Br. J. Clin. Pharmacol 2012; 73(1): 126-134. Tuccori M, Montagnani S, Testi A, Ruggiero E, Mantarro S, Scollo C et al. Use of selective serotonin reuptake inhibitors during pregnancy and risk of major and cardiovascular malformations: an update. Postgrad. Med. 2010; 122(4): 49-65. Bar-Oz B, Einarson T, Einarson A, Boskovic R, O´Brien L, Malm H et al. Paroxetin and congenital malformations: meta-analysis and consideration of potential confounding factors. Clin. Ther. 2007; 29 (5): 918-926. Alwan S, Reefhuis J, Rasmussen SA, Olney RS, Friedman JM. Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects. National Birth Defects Prevention Study. NEJM 2007; 356: 2684–92. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet. Gynecol. 2008; 111(4): 1001-1020. Djulus J, Koren G, Einarson TR, Wilton R, Shakir S, Diav-Citrin O et al. Exposure to mirtazapine during pregnancy: a prospective, comparative study of birth outcomes. J. Clin. Psychiatry 2006; 67(8): 1280-1284. Lennestal R, Källén B. Delivery outcome in relation to maternal use of some recently introduced antidepressants. J. Clin. Psychopharmacol 2007; 27(6): 607-613. Gentile S. Neurodevelopmental effects of prenatal exposure to psychotropic medications. Depress. Anxiety 2010; 27(7): 675-686. Eberhard-Gran M, Eskild A, Opjordsmoen S. Treating mood disorders during pregnancy: safety considerations. Drug Saf. 2005; 28(8): 695-706. Dolovich LR, Addis A, Vaillancourt JM, Power JD, Koren G, Einarson TR. Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and casecontrol studies. BMJ 1998; 317: 839-43. Uzun S, Kosumplic O, Jakovljevik M, Sedic V. Side effects of treatment with benzodiazepines. Psychiatr. Danub 2010; 22(1): 9093. Nanzer N, Sancho Rossignol A, Righetti-Veltema M, Knauer D, Manzano J, Palacio Espasa S. Effects of a brief psychoanalytic intervention for perinatal depression. Arch. Womens Ment. Health 2012; 15(4): 259-268. Dunn C, Hanieh E, Roberts R, Powrie R. Mindful pregnancy and childbirth: effects of a mindfulness-based intervention on women's psychological distress and well-being in the perinatal period. Arch. Womens Ment. Health 2012; 15(2): 139-143. Sockol LE, Epperson CN, Barber JP. A meta-analysis of treatments for perinatal depression. Clin. Psycol. Rev. 2011; 31(5): 839-849. Marc I, Toureche N, Ernst E, Hodnett ED, Blanchet C, Dodin S et al. Mind-body interventions during pregnancy for preventing or treating women anxiety. Cochrane Database Syst Rev 2011; (7): CD007559.

Accepted: April 17, 2013