scholarly journals Antenatal exposure to antidepressant drugs and the risk of neurodevelopmental and psychiatric disorders: a systematic review

2020 ◽  
Vol 36 (2) ◽  
Author(s):  
Jessica Salvador Areias de Araujo ◽  
Isabella Fernandes Delgado ◽  
Francisco José Roma Paumgartten
Keyword(s):  
Systematic Review ◽  
Preschool Children ◽  
Maternal Depression ◽  
Psychiatric Disorders ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Drugs ◽  
Autism Spectrum ◽  
Mental Illnesses ◽  
Attention Deficit Hyperactivity Disorders ◽  
In Pregnancy

Abstract: This study investigated whether antenatal exposure to antidepressants (ADs) increases the risks of autism spectrum disorders (ASD), attention deficit/hyperactivity disorders (ADHD), schizophrenia and other mental illnesses, and cognitive and developmental deficits in infants or preschool children. PubMed, EMBASE, BIREME/BVS databases were searched to identify studies examining associations of ADs in pregnancy with neurodevelopmental and psychiatric disorders. Twenty studies addressed ASD and/or ADHD risks while 30 focused on developmental and cognitive deficits in infants or preschool children. Most studies detected no association of antenatal AD with ASD after adjustment of risk ratios for maternal depression or psychiatric disorders. Some studies showed that maternal depression, regardless of whether it is treated or untreated, increased ASD risks. Seven out of 8 studies found no increase in ADHD risk associated with antenatal exposure to selective serotonin reuptake inhibitors, the most commonly used AD. No consistent evidence was found linking AD in pregnancy to neurocognitive developmental deficits in infants or preschool children. A residual confounding by indication (depression severity) remained in almost all studies. This systematic review found no consistent evidence suggesting that ADs in pregnancy increase risks of ASD, ADHD, and neurocognitive development deficits. Some studies, however, found evidence that maternal depression increases ASD risks.

POSSIBLE CONFOUNDERS IN THE REPORTED ASSOCIATION BETWEEN AUTISM SPECTRUM DISORDER (ASD) AND EXPOSURE TO SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) DURING PREGNANCY

2015 ◽  
Vol 101 (1) ◽  
pp. e1.16-e1
Author(s):  
Pauline De Bruyne ◽  
Eran Barzilay ◽  
Gideon Koren
Keyword(s):  
Risk Factors ◽  
Maternal Depression ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Causal Relation ◽  
Meta Analysis ◽  
Underlying Disease ◽  
Autism Spectrum ◽  
Care Seeking ◽  
Increased Risk ◽  
Health Care Seeking Behaviour

BackgroundAutism has been in the forefront of public concern because of reported increase in prevalence and growing interest in the role of environmental risk factors in autism. A recent meta-analysis by Man et al. (2015) reported an increased risk of ASD in children of mothers exposed to SSRIs during pregnancy (adjusted OR 1.81, 95% CI 1.47–2.24). However, association may not imply a causal relation between SSRI exposure and ASD. We hypothesize that underlying disease might have confounded the published result.Materials and methodsA literature review was performed in order to identify possible confounders in the reported association. The list of search terms included but was not limited to following terms: ‘Pregnancy', ‘maternal', ‘depression', ‘child behaviour', ‘health care seeking behaviour'.ResultsRetrieved articles were classified in following four domains of possible confounders: 1/ direct link between depression and ASD, 2/effect of depression on interaction with the child, 3/effect of depression on other risk factors of ASD and 4/ascertainment bias. In the last domain, we examined the effect of depression on the way mothers perceive and report on the behaviour of their child and the effect of maternal depression on healthcare seeking behaviour. Analysis suggests that there are important merits to all those four domains.ConclusionBecause of obvious ethical reasons, research on exposure during pregnancy is mostly restricted to systematic review and meta-analysis of observational studies. Although this has resulted in a treasury of information, possible confounders must be taken into account when interpreting the results.

Maternal SSRI exposure increases the risk of autistic offspring: A meta-analysis and systematic review

2017 ◽  
Vol 45 ◽  
pp. 161-166 ◽  
Author(s):  
S. Andalib ◽  
M.R. Emamhadi ◽  
S. Yousefzadeh-Chabok ◽  
S.K. Shakouri ◽  
P.F. Høilund-Carlsen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Autism Spectrum Disorder ◽  
Prenatal Exposure ◽  
Odds Ratio ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Meta Analysis ◽  
Autism Spectrum ◽  
Serotonin Reuptake Inhibitors ◽  
Spectrum Disorder

AbstractBackground:Selective serotonin reuptake inhibitors (SSRIs) are the most common antidepressants used to preclude maternal pregnancy depression. There is a growing body of literature assessing the association of prenatal exposure to SSRIs with autism spectrum disorder (ASD). The present systematic review and meta-analysis reviewed the medical literature and pooled the results of the association of prenatal exposure to SSRIs with ASD.Methods:Published investigations in English by June 2016 with keywords of selective serotonin reuptake inhibitors, SSRI, autism spectrum disorder, ASD, pregnancy, childhood, children, neurodevelopment were identified using databases PubMed and PMC, MEDLINE, EMBASE, SCOPUS, and Google Scholar. Cochran's Q statistic-value (Q), degree of freedom (df), and I2 indices (variation in odds ratio [OR] attributable to heterogeneity) were calculated to analyze the risk of heterogeneity of the within- and between-study variability. Pooled odds ratio (OR) and 95% confidence interval (CI) were reported by a Mantel–Haenszel test.Results:There was a non-significant heterogeneity for the included studies ([Q = 3.61, df = 6, P = 0.730], I2 = 0%). The pooled results showed a significant association between prenatal SSRI exposure and ASD (OR = 1.82, 95% CI = 1.59–2.10, Z = 8.49, P = 0.00).Conclusion:The evidence from the present study suggests that prenatal exposure to SSRIs is associated with a higher risk of ASD.

scholarly journals The Association Between Non-prescription Analgesic Drug Use in Pregnancy and Neurodevelopmental Disorders: Protocol for an Umbrella Review

2020 ◽  
Author(s):  
Janell Kwok ◽  
Hildigunnur Anna Hall ◽  
Aja Louise Murray ◽  
Bonnie Auyeung
Keyword(s):  
Systematic Review ◽  
Drug Use ◽  
Systematic Reviews ◽  
Neurodevelopmental Disorders ◽  
Autism Spectrum ◽  
Analgesic Drug ◽  
Umbrella Review ◽  
Analgesic Drugs ◽  
In Pregnancy

Abstract BackgroundMaternal prenatal health has been shown to bean important influence on children’s developmental outcomes, which has led to an increased emphasis onprovidingmore information to supportclinical decisions in pregnancy. Several systematic reviewssuggest that analgesic drug use during pregnancy may haveneurodisruptive properties. However, no firm conclusions have yet been drawn onthe associations between prenatal analgesic drug use and children’s long-term development of neurodevelopmental disorderssuch as Autism Spectrum Disorder (ASD) or Attention-Deficit Hyperactivity Disorder (ADHD). Therefore, an umbrella review is proposed for the purpose of examining the associations between maternal analgesic drug use during pregnancy and diagnoses of neurodevelopmental disorders.MethodsIncluded systematic reviews will consist of studies examining the effect of maternal prenatal non-prescription analgesic drug use on children’s neurodevelopmental disorder status. Examined drugs will be restricted to those readilyaccessible and frequently used by pregnant women, and with characteristics that allow them to cross the placenta and directly affect fetal development. Outcomes will be restricted to formal clinical diagnoses of ASD and/or ADHD. Two reviewers will independently identify eligible reviews from six databases and a manual search of reference lists, consultation with field experts, and scan of pre-print archives.A third researcher will be consulted when consensus cannot be reached.Search strategy and data extraction will be based on the preferred reporting items for systematic review and meta-analysis (PRISMA) protocol and PRISMA-P checklist. Extracted data will also include short qualitative summaries by both reviewers. As part of quality assessment, astandardised measurement tool to assess systematic reviews (AMSTAR 2) will be used. A narrative synthesis is proposed to integrate findingsfrom different, potentially methodologically heterogeneousstudies. DiscussionThis umbrella review of associations between maternal prenatal use of non-prescription analgesic drugs andchildren’s neurodevelopmental disorders could allow for firmer conclusions to be drawn through the synthesis of all relevant published research. The synthesis of findings using high-quality evidence couldprovide more accurate healthcare information on the long-term effects of analgesic drugs on neurodevelopment, to better guide future clinical decisions during pregnancy. This review will also allow gaps and methodological differences in the literature to be identified, informing recommendations for future research.Systematic review registrationPROSPEROregistration number CRD42020179216.

scholarly journals A drug utilization study of antidepressant drugs in a tertiary care hospital

2017 ◽  
Vol 6 (6) ◽  
pp. 1405
Author(s):  
Vasundhara Yerkade ◽  
Riyaz Ahmed Siddiqui
Keyword(s):  
Psychiatric Disorders ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Tertiary Care Hospital ◽  
Psychiatric Patients ◽  
Tertiary Care ◽  
Antidepressant Drugs ◽  
Research Centre ◽  
Care Hospital ◽  
Prescribing Pattern ◽  
Case Record

Background: In psychiatric practice, antidepressant drugs are widely used group of drugs. Number of drugs are available in this group with diverse type of mechanisms and efficacy/safety profile. The objective for the study was to identify the prescribing pattern of antidepressant drugs in psychiatric patients at a tertiary care hospital and to see the distribution of antidepressant drugs in the sociodemographic group.Methods: It was a record based descriptive study which was carried out at NKP Salve Institute of Medical Sciences and Research Centre, Nagpur. Case record files of all the patients suffering from depression and other psychiatric disorders and treated with antidepressant drugs during the period of from 1st January 2015 to 31st December 2015 by institutional psychiatrists were analyzed for prescription pattern of antidepressant drugs and their age and sex wise distribution.Results: A total no. of 300 patients received antidepressant drugs. The most commonly prescribed drug was escitalopram in 121 (40.3%) patients followed by fluoxetine in 61 (20.3%) and clomipramine in 30 (10%) patients. Other drugs that were prescribed were mirtazapine in 24 (8%), nortryptiline in 21 (7%), venlafaxine in 13 (4.3%), fluvoxamine in 12 (4%), amitryptiline in 9 (3%), dothiepin in 5 (1.6%) and duloxetine in 4 (1.3%) patients. Also patients in the age group of 31-40 yrs and 21-30 yrs received most number of antidepressants i.e. 129 (40.3%) and 83 (27.6%) patients respectively. Females have received more antidepressant drugs as compared to males.Conclusions: Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed group of antidepressant drugs. Escitalopram followed by Fluoxetine were the most commonly prescribed drugs for the management of depression and other psychiatric disorders because of their better efficacy, safety, tolerability and less side effects as compared to TCAs. Females suffer more from depression and other psychiatric disorders as compared to males and the most vulnerable is 21 to 40 yrs of age.

scholarly journals Maternal acute and chronic inflammation in pregnancy is associated with common neurodevelopmental disorders: a systematic review

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Velda X. Han ◽  
Shrujna Patel ◽  
Hannah F. Jones ◽  
Timothy C. Nielsen ◽  
Shekeeb S. Mohammad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Autoimmune Diseases ◽  
Chronic Inflammation ◽  
Low Socioeconomic Status ◽  
Neurodevelopmental Disorders ◽  
Autism Spectrum ◽  
Maternal Risk ◽  
Meta Analyses ◽  
In Pregnancy

AbstractInflammation is increasingly recognized as a cause or consequence of common problems of humanity including obesity, stress, depression, pollution and disease states such as autoimmunity, asthma, and infection. Maternal immune activation (MIA), triggered by both acute and systemic chronic inflammation, is hypothesized to be one of the mechanisms implicated in the pathogenesis of neurodevelopmental disorders (NDD). Although there is substantial preclinical evidence to support the MIA hypothesis, the human evidence is disparate. We performed a systematic review on human studies examining associations between maternal inflammatory states and offspring NDDs (autism spectrum disorder- ASD, attention deficit hyperactivity disorder-ADHD, Tourette syndrome-TS). 32 meta-analyses and 26 additional individual studies were identified. Maternal states associated with ASD include obesity, gestational diabetes mellitus, pre-eclampsia, pollution, stress, depression, autoimmune diseases, and infection. Maternal states associated with ADHD include obesity, pre-eclampsia, smoking, low socioeconomic status (SES), stress, autoimmune disease, and asthma. Maternal states associated with TS include low SES, depression, and autoimmune diseases. Diverse maternal inflammatory states in pregnancy are associated with common offspring NDDs. Given the increased prevalence of NDDs, there is urgent need to explore relative and cumulative maternal risk factors and disease mechanisms. Defining preventable risk factors in high-risk pregnancies could mitigate the expression and severity of NDDs.

scholarly journals SSRIs and SNRIs (SRI) in Pregnancy: Effects on the Course of Pregnancy and the Offspring: How Far Are We from Having All the Answers?

2019 ◽  
Vol 20 (10) ◽  
pp. 2370 ◽  
Author(s):  
Asher Ornoy ◽  
Gideon Koren
Keyword(s):  
Maternal Depression ◽  
Language Impairment ◽  
Late Pregnancy ◽  
Autism Spectrum ◽  
Motor Delay ◽  
Adverse Neonatal Outcomes ◽  
Neonatal Adaptation ◽  
And Function ◽  
In Pregnancy

Serotonin has important roles in the development of the brain and other organs. Manipulations of synaptic serotonin by drugs such as serotonin reuptake inhibitors (SRI) or serotonin norepinephrine reuptake inhibitors (SNRI) might alter their development and function. Of interest, most studies on the outcome of prenatal exposure to SRI in human have not found significant embryonic or fetal damage, except for a possible, slight increase in cardiac malformations. In up to a third of newborns exposed to SRI, exposure may induce transient neonatal behavioral changes (poor neonatal adaptation) and increased rate of persistent pulmonary hypertension. Prenatal SRI may also cause slight motor delay and language impairment but these are transient. The data on the possible association of prenatal SRIs with autism spectrum disorder (ASD) are inconsistent, and seem to be related to pre-pregnancy treatment or to maternal depression. Prenatal SRIs also appear to affect the hypothalamic hypophyseal adrenal (HPA) axis inducing epigenetic changes, but the long-term consequences of these effects on humans are as yet unknown. SRIs are metabolized in the liver by several cytochrome P450 (CYP) enzymes. Faster metabolism of most SRIs in late pregnancy leads to lower maternal concentrations, and thus potentially to decreased efficacy which is more prominent in women that are rapid metabolizers. Studies suggest that the serotonin transporter SLC6A4 promoter is associated with adverse neonatal outcomes after SRI exposure. Since maternal depression may adversely affect the child’s development, one has to consider the risk of SRI discontinuation on the fetus and the child. As with any drug treatment in pregnancy, the benefits to the mother should be considered versus the possible hazards to the developing embryo/fetus.

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