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E.06.02 Impact of prenatal exposure to SSRIs or maternal depression disorder on infant developmental outcomes
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E.06. Psychopharmacology in pregnancy and post partum
E.06. Psychopharmacology in pregnancy and post partum E.06.01 Maternal and fetal effects of antipsychotic drugs in pregnancy M. Galbally1 ° , A.J. Lewis2 , M. Snellen1 1 Mercy Hospital for Women, Perinatal Mental Health, Heidelberg, Australia; 2 Deakin University, School of Psychology, Melbourne, Australia Antipsychotics are one of the earliest psychotropic medications and yet one of the groups of medications with the least information on effects in pregnancy [1]. Nevertheless rates of prescription in adults are on the rise with a study of Australian prescribing between 2000–2011 finding a 217.7% increase in their prescription [2]. This trend in wider utilization of antipsychotics makes understanding the risk profile and available evidence in pregnancy relevant for a broader group of clinicians and women. This includes pregnancy, neonatal and longer term outcomes. Despite the limited knowledge about their safety in pregnancy this must be balanced against their central role in the management of Schizophrenia and Bipolar disorder. Schizophrenia and Bipolar disorder are associated with increased pregnancy complications and postpartum risks, such as; reduced maternal sensitivity and increased risk of abuse and neglect [3]. In addition, these offspring are ‘high-risk’ as a result of genetic but also psychosocial risk for poorer developmental outcomes and increased risk of developing a mental illness [4]. These findings of poorer outcomes for women and children are increased when women remain symptomatic, thus supporting the notion of the importance of effective treatment during the perinatal period. Therefore, while the data is limited, the use of antipsychotics to keep women well is often the pragmatic choice. In addition to understanding the evidence in pregnancy, there are also a number of practical tools developed for use in obstetric settings to ensure the safe use of antipsychotics in pregnancy and improve outcomes for mothers and infants [5].
E.06.02 Impact of prenatal exposure to SSRIs or maternal depression disorder on infant developmental outcomes K.L. Wisner1 ° 1 Northwestern University Feinberg School of Medicine, Chicago, USA Objective: To examine the impact of prenatal exposure to both serotonin reuptake inhibitors (SRI) and maternal major depressive disorder (MDD) on infant mental and motor functioning and growth. Method: The study of mental and motor function included 166 mother-infant dyads: 68 with prenatal MDD/SRI (n = 41) or MDD/No SRI exposure (n = 27) and 98 non-exposed controls. Maternal depression and SRI exposure assessments were completed at 20, 30, and 36 prenatal weeks and 12, 26, 52, and 78 weeks postpartum. The Bayley Scales of Infant Development with the psychomotor (PDI), cognitive (MDI), and behavioral (BRS) components was administered and growth parameters obtained. All outcome data were obtained by raters was blind to depression and SSRI exposure status. Results: Neither prenatal exposure to MDD/SRI nor MDD/No SRI significantly impacted overall PDI, MDI or BRS scores [1]. We observed a significant SRI exposure by time interaction for the PDI (p = 0.038). MDD/SRI exposure was associated with lower PDI scores at 26 and 52 weeks compared with non-exposed infants; however, the difference was no longer significant at 78 weeks. Both adjusted and unadjusted analyses revealed that neither MDD nor SSRI exposure was associated with infant weight, length, or head circumference [2]. Conclusions: Consistent with previous studies, we found no impact of prenatal MDD/SRI exposure on mental development. Less favorable PDI scores were observed in the first year; notably, these scores remained well within the normative range and no significant difference was observed across the longitudinal period of study. Growth was similar across groups in the first year. References
References [1] Galbally, M., Snellen, M., Power, J., 2014. Antipsychotic drugs in pregnancy: a review of their maternal and fetal effects. Therapeutic Advances in Drug Safety 5, 100–109. [2] Stephenson, C.P., Karanges, E., McGregor, I.S., 2013. Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011. Australian and New Zealand Journal of Psychiatry 47, 74−87. [3] Abel, K.A., K. Howard, LM., 2014. Schizophrenia, psychopharmacology and pregnancy, in: Galbally, M.,Snellen, M., Lewis, A. (Ed.), Psychopharmacology and Pregnancy-Treatment Efficacy, Risks, and Guidelines. Springer. [4] Hameed, M., Lewis, A.J., 2015. Offspring of parents with schizophrenia: A systematic review of developmental features across childhood. Harvard Review of Psychiatry. In Press [5] Galbally, M., Snellen, M., Walker, S., Permezel, M., 2010. Management of antipsychotic and mood stabilizer medication in pregnancy: recommendations for antenatal care. The Australian and New Zealand Journal of Psychiatry 44, 99–108. Disclosure statement: In the past MG has received speaking fees from Astra Zeneca and Lundbeck and has received a research grant from Pfizer.
[1] Santucci, A.K., Singer, L.T., Eng, H., Wisniewski, S.R., Luther, J.M., Sit, D.K., Hanusa, B.H., Wisner, K.L., 2014. Impact of prenatal exposure to serotonin reuptake inhibitors or maternal major depressive disorder on infant developmental outcomes. J Clin Psych 75: 1088– 1095. [2] Wisner, K.L., Bogen, D.L., Sit, D., McShea, M., Hughes, C., Rizzo, D., Confer, A., Luther, J., Eng, H., Wisniewski, S.W., 2013. Does Fetal Exposure to SSRIs or Maternal Depression Impact Infant Growth? Am J Psych 170 (5) 485−93, 2013. PMCID: PMC Journal—In Process. Disclosure statement: The Department of Psychiatry at Northwestern University receives contractual fees for Dr. Wisner’s consultation to Quinn Emanuel Urquhart & Sullivan, LLP (New York City), who represent Pfizer Pharmaceutical Company.
E.06. Psychopharmacology in pregnancy and post partum
E.06. Psychopharmacology in pregnancy and post partum E.06.01 Maternal and fetal effects of antipsychotic drugs in pregnancy M. Galbally1 ° , A.J. Lewis2 , M. Snellen1 1 Mercy Hospital for Women, Perinatal Mental Health, Heidelberg, Australia; 2 Deakin University, School of Psychology, Melbourne, Australia Antipsychotics are one of the earliest psychotropic medications and yet one of the groups of medications with the least information on effects in pregnancy [1]. Nevertheless rates of prescription in adults are on the rise with a study of Australian prescribing between 2000–2011 finding a 217.7% increase in their prescription [2]. This trend in wider utilization of antipsychotics makes understanding the risk profile and available evidence in pregnancy relevant for a broader group of clinicians and women. This includes pregnancy, neonatal and longer term outcomes. Despite the limited knowledge about their safety in pregnancy this must be balanced against their central role in the management of Schizophrenia and Bipolar disorder. Schizophrenia and Bipolar disorder are associated with increased pregnancy complications and postpartum risks, such as; reduced maternal sensitivity and increased risk of abuse and neglect [3]. In addition, these offspring are ‘high-risk’ as a result of genetic but also psychosocial risk for poorer developmental outcomes and increased risk of developing a mental illness [4]. These findings of poorer outcomes for women and children are increased when women remain symptomatic, thus supporting the notion of the importance of effective treatment during the perinatal period. Therefore, while the data is limited, the use of antipsychotics to keep women well is often the pragmatic choice. In addition to understanding the evidence in pregnancy, there are also a number of practical tools developed for use in obstetric settings to ensure the safe use of antipsychotics in pregnancy and improve outcomes for mothers and infants [5].
E.06.02 Impact of prenatal exposure to SSRIs or maternal depression disorder on infant developmental outcomes K.L. Wisner1 ° 1 Northwestern University Feinberg School of Medicine, Chicago, USA Objective: To examine the impact of prenatal exposure to both serotonin reuptake inhibitors (SRI) and maternal major depressive disorder (MDD) on infant mental and motor functioning and growth. Method: The study of mental and motor function included 166 mother-infant dyads: 68 with prenatal MDD/SRI (n = 41) or MDD/No SRI exposure (n = 27) and 98 non-exposed controls. Maternal depression and SRI exposure assessments were completed at 20, 30, and 36 prenatal weeks and 12, 26, 52, and 78 weeks postpartum. The Bayley Scales of Infant Development with the psychomotor (PDI), cognitive (MDI), and behavioral (BRS) components was administered and growth parameters obtained. All outcome data were obtained by raters was blind to depression and SSRI exposure status. Results: Neither prenatal exposure to MDD/SRI nor MDD/No SRI significantly impacted overall PDI, MDI or BRS scores [1]. We observed a significant SRI exposure by time interaction for the PDI (p = 0.038). MDD/SRI exposure was associated with lower PDI scores at 26 and 52 weeks compared with non-exposed infants; however, the difference was no longer significant at 78 weeks. Both adjusted and unadjusted analyses revealed that neither MDD nor SSRI exposure was associated with infant weight, length, or head circumference [2]. Conclusions: Consistent with previous studies, we found no impact of prenatal MDD/SRI exposure on mental development. Less favorable PDI scores were observed in the first year; notably, these scores remained well within the normative range and no significant difference was observed across the longitudinal period of study. Growth was similar across groups in the first year. References
References [1] Galbally, M., Snellen, M., Power, J., 2014. Antipsychotic drugs in pregnancy: a review of their maternal and fetal effects. Therapeutic Advances in Drug Safety 5, 100–109. [2] Stephenson, C.P., Karanges, E., McGregor, I.S., 2013. Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011. Australian and New Zealand Journal of Psychiatry 47, 74−87. [3] Abel, K.A., K. Howard, LM., 2014. Schizophrenia, psychopharmacology and pregnancy, in: Galbally, M.,Snellen, M., Lewis, A. (Ed.), Psychopharmacology and Pregnancy-Treatment Efficacy, Risks, and Guidelines. Springer. [4] Hameed, M., Lewis, A.J., 2015. Offspring of parents with schizophrenia: A systematic review of developmental features across childhood. Harvard Review of Psychiatry. In Press [5] Galbally, M., Snellen, M., Walker, S., Permezel, M., 2010. Management of antipsychotic and mood stabilizer medication in pregnancy: recommendations for antenatal care. The Australian and New Zealand Journal of Psychiatry 44, 99–108. Disclosure statement: In the past MG has received speaking fees from Astra Zeneca and Lundbeck and has received a research grant from Pfizer.
[1] Santucci, A.K., Singer, L.T., Eng, H., Wisniewski, S.R., Luther, J.M., Sit, D.K., Hanusa, B.H., Wisner, K.L., 2014. Impact of prenatal exposure to serotonin reuptake inhibitors or maternal major depressive disorder on infant developmental outcomes. J Clin Psych 75: 1088– 1095. [2] Wisner, K.L., Bogen, D.L., Sit, D., McShea, M., Hughes, C., Rizzo, D., Confer, A., Luther, J., Eng, H., Wisniewski, S.W., 2013. Does Fetal Exposure to SSRIs or Maternal Depression Impact Infant Growth? Am J Psych 170 (5) 485−93, 2013. PMCID: PMC Journal—In Process. Disclosure statement: The Department of Psychiatry at Northwestern University receives contractual fees for Dr. Wisner’s consultation to Quinn Emanuel Urquhart & Sullivan, LLP (New York City), who represent Pfizer Pharmaceutical Company.