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.

Remote Schooling Supports for Linguistically Diverse Parents of Students With Disabilities

2021 ◽  
pp. 105345122110510
Author(s):  
María Cioè-Peña
Keyword(s):  
Students With Disabilities ◽  
Language Impairment ◽  
English Learners ◽  
Linguistically Diverse ◽  
Autism Spectrum ◽  
Policy And Practice ◽  
Speech And Language Impairment ◽  
Marginalized Learners ◽  
High Incidence Disabilities

Remote schooling has increased in prevalence. Although remote schooling may feel novel, remote and online educational requirements have been consistent parts of the educational landscape for years. Remote schooling increases learning opportunities within the home, magnifying the need for home-school collaborations to support the academic and socio-emotional development of marginalized learners in urban settings, particularly multiply marginalized learners such as students classified as English learners who also have a high incidence disabilities (e.g., learning disability, speech and language impairment, autism spectrum disorder). Much policy and practice around remote schooling centers on ensuring students have access to devices and technology; little consideration is given to what happens after devices are distributed, especially within culturally and linguistically diverse households. This paper explores considerations to be made before, during, and after engaging in remote schooling, whether it’s for short- or long-term use, to ensure that students who are dually classified are not digitally excluded during remote schooling.

scholarly journals Cognition in pregnancy and motherhood: prospective cohort study

2010 ◽  
Vol 196 (2) ◽  
pp. 126-132 ◽  
Author(s):  
Helen Christensen ◽  
Liana S. Leach ◽  
Andrew Mackinnon
Keyword(s):  
Cohort Study ◽  
Prospective Cohort ◽  
Late Pregnancy ◽  
Cognitive Change ◽  
Biased Sampling ◽  
Cognitive Deterioration ◽  
Negative Findings ◽  
In Pregnancy

BackgroundResearch has reported that pregnant women and mothers become forgetful. However, in these studies, women are not recruited prior to pregnancy, samples are not representative and studies are underpowered.AimsThe current study sought to determine whether pregnancy and motherhood are associated with brief or long-term cognitive deterioration using a representative sample and measuring cognition during and before the onset of pregnancy and motherhood.MethodWomen aged 20–24 years were recruited prospectively and assessed in 1999, 2003 and 2007. Seventy-six women were pregnant at follow-up assessments, 188 became mothers between study waves and 542 remained nulliparous.ResultsNo significant differences in cognitive change were found as a function of pregnancy or motherhood, although late pregnancy was associated with deterioration on one of four tests of memory and cognition.ConclusionsThe hypothesis that pregnancy and motherhood are associated with persistent cognitive deterioration was not supported. Previous negative findings may be a result of biased sampling.

To treat or not to treat: maternal depression, SSRI use in pregnancy and adverse neonatal effects

2006 ◽  
Vol 36 (12) ◽  
pp. 1663-1670 ◽  
Author(s):  
MARIE-PAULE AUSTIN
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Absolute Risk ◽  
Late Pregnancy ◽  
Postnatal Period ◽  
Regulatory Body ◽  
Retrospective Case ◽  
Increased Risk ◽  
Adverse Neonatal Outcomes ◽  
A Prospective Study ◽  
In Pregnancy

Recent pharmaceutical company and regulatory body circulars warning against the use of selective serotonin reuptake inhibitors (SSRIs) in late pregnancy have left clinicians in somewhat of a quandary as to how to manage their more severely depressed patients in pregnancy. Conversely, up to 75% of depressed women ceasing their antidepressants periconceptually will relapse. Studies reporting on adverse neonatal outcomes following exposure to SSRIs in the latter half of pregnancy suggest that the fetus is exposed to significant concentrations of these medications during this time. Adverse neonatal effects affecting the respiratory, gastrointestinal and neurological systems are, however, predominantly mild and self-limiting. One small retrospective case study suggests that SSRI exposure in the latter half of pregnancy may be associated with an increased risk of persistent pulmonary hypertension of the neonate (PPHN), however, the absolute risk of developing PPHN remains very small and these findings will require replication with a prospective study. While the studies to date suggest the need to closely monitor SSRI-exposed neonates in the immediate postnatal period, preferably with a neonatal withdrawal scale and access to neonatology services, there is currently no clear argument for women to be weaned off their SSRI in late pregnancy. The decision to use SSRIs at this time will have to be made on a case-by-case basis in close consultation with the mother and her partner.

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 Mood instability, depression, and anxiety in pregnancy and adverse neonatal outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hua Li ◽  
Angela Bowen ◽  
Rudy Bowen ◽  
Nazeem Muhajarine ◽  
Lloyd Balbuena
Keyword(s):  
Depression Scale ◽  
Late Pregnancy ◽  
Neonatal Outcomes ◽  
Depression And Anxiety ◽  
Logistic Regression Models ◽  
Mood Instability ◽  
Antenatal Depressive Symptoms ◽  
Adverse Neonatal Outcomes ◽  
The Relationship ◽  
In Pregnancy

Abstract Background Antenatal women experience an increased level of mood and anxiety symptoms, which have negative effects on mothers’ mental and physical health as well as the health of their newborns. The relation of maternal depression and anxiety in pregnancy with neonate outcomes is well-studied with inconsistent findings. However, the association between antenatal mood instability (MI) and neonatal outcomes has not been investigated even though antenatal women experience an elevated level of MI. We sought to address this gap and to contribute to the literature about pregnancy neonate outcomes by examining the relationship among antenatal MI, depression, and anxiety and neonatal outcomes. Methods A prospective cohort of women (n = 555) participated in this study at early pregnancy (T1, 17.4 ± 4.9 weeks) and late pregnancy (T2, 30.6 ± 2.7 weeks). The Edinburgh Postnatal Depression Scale (EPDS) was used to assess antenatal depressive symptoms, anxiety was measured by the EPDS anxiety subscale, and mood instability was measured by a visual analogue scale with five questions. These mood states together with stress, social support, as well as lifestyle were also examined in relation to neonatal outcomes using chi-square tests and logistic regression models. Results Mood instability, depression, and anxiety were unrelated to adverse neonatal outcomes. Only primiparous status was associated with small for gestational age after Bonferroni correction. Conclusions We report no associations between antenatal mood symptoms including MI, depression, and anxiety and neonatal outcomes. More studies are required to further explore the relationship between antenatal mood instability, depression, and anxiety and neonatal outcomes.

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.

scholarly journals Life-long persistence of infectious Zika virus: inflammation and behavioral sequela

2020 ◽  
Author(s):  
Derek D.C. Ireland ◽  
Mohanraj Manangeeswaran ◽  
Aaron Lewkowicz ◽  
Kaliroi Engel ◽  
Sarah M. Clark ◽  
...  
Keyword(s):  
Zika Virus ◽  
Post Infection ◽  
Late Pregnancy ◽  
Congenital Defects ◽  
Low Grade ◽  
Mrna Levels ◽  
Neurodevelopmental Disease ◽  
Behavioral Monitoring ◽  
In Pregnancy

AbstractThe recent spread of Zika virus (ZIKV) and its association with congenital defects and neurological disorders has created an urgent need to understand the pathogenesis of ZIKV and identify therapeutic strategies that will prevent or eliminate them. The neurodevelopmental defects associated with ZikV infections early in pregnancy are well documented, however the potential defects associated with infections in late pregnancy and perinatal period are less well characterized. Further, the long-term sequelae of these infections are not fully understood. Immunocompetent C57BL/6 mice infected at one day old (P1), which neurodevelopmentally model late pregnancy in humans, develop a transient neurological syndrome including unsteady gait, kinetic tremors, severe ataxia and seizures 10-15 days post-infection (dpi) but symptoms subside after a week, and most animals survive. Despite apparent recovery, MRI of convalescent mice shows reduced cerebellar volume that correlates with altered coordination and motor function as well as hyperactivity and impulsivity. Persistent mRNA levels of pro-inflammatory genes including Cd80, Il-1α, and Ifn-γ together with Cd3, Cd8 and perforin (PrfA), suggested the persistence of a low-grade inflammatory process. Further, the brain parenchyma of convalescent mice harbor multiple small foci with viral antigen, active apoptotic processes in neurons, and cellular infiltrates, surrounded by activated astrocytes and microglia as late as 1-year post-infection. Detection of negative-sense strand viral RNA and replication of virus derived from these convalescent mice by blinded passage in Vero cells confirmed that low levels of live ZikV persist in CNS of convalescent mice life-long. Our studies establish that Zika can establish reservoirs in CNS and suggest that anti-viral treatment that clears virus from the CNS as well as long-term neurological and behavioral monitoring may be needed for patients known to be exposed to ZikV at an early age.Author’s summaryThe congenital brain malformations associated with ZikV infections early in pregnancy are well documented, however whether apparently asymptomatic perinatal exposure could lead to long term sequelae is not fully understood. Using a non-lethal neonatal mouse model, we examine host-pathogen interactions, anatomical changes and behavioral patterns by following survivors of the acute infection for over 1 year. We discover that infectious Zika virus has the potential to remain in the CNS for life, lodged within small foci surrounded by gliosis and infiltrating immune cells that may act to limit the viral spread, but also interfere with healing and contribute to life-long neuropathic and behavioral sequelae. These results suggest that anti-viral treatment and long-term neurological and behavioral monitoring may be indicated for patients known to have been exposed to Zika virus, regardless of neurodevelopmental disease severity.

Development of Neural Structure and Function in Autism Spectrum Disorder: Potential Implications for Learning Language

2020 ◽  
Vol 29 (4) ◽  
pp. 1783-1797
Author(s):  
Kelly L. Coburn ◽  
Diane L. Williams
Keyword(s):  
Autism Spectrum Disorder ◽  
Language Development ◽  
Diffusion Tensor ◽  
Autism Spectrum ◽  
Language Intervention ◽  
Spectrum Disorder ◽  
Autistic Children ◽  
Neural Structure ◽  
Complex Information ◽  
And Function

Purpose Neurodevelopmental processes that begin during gestation and continue throughout childhood typically support language development. Understanding these processes can help us to understand the disruptions to language that occur in neurodevelopmental conditions, such as autism spectrum disorder (ASD). Method For this tutorial, we conducted a focused literature review on typical postnatal brain development and structural and functional magnetic resonance imaging, diffusion tensor imaging, magnetoencephalography, and electroencephalography studies of the neurodevelopmental differences that occur in ASD. We then integrated this knowledge with the literature on evidence-based speech-language intervention practices for autistic children. Results In ASD, structural differences include altered patterns of cortical growth and myelination. Functional differences occur at all brain levels, from lateralization of cortical functions to the rhythmic activations of single neurons. Neuronal oscillations, in particular, could help explain disrupted language development by elucidating the timing differences that contribute to altered functional connectivity, complex information processing, and speech parsing. Findings related to implicit statistical learning, explicit task learning, multisensory integration, and reinforcement in ASD are also discussed. Conclusions Consideration of the neural differences in autistic children provides additional scientific support for current recommended language intervention practices. Recommendations consistent with these neurological findings include the use of short, simple utterances; repetition of syntactic structures using varied vocabulary; pause time; visual supports; and individualized sensory modifications.

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