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Medical disorders in pregnancy

Shari I Lusskin, Sabrina J Khan, Carrie Ernst, Sally Habib, Madeleine E Fersh, Elizabeth S Albertini
Perinatal depression is associated with serious risks for the mother, baby, and family. When considering treating perinatal depression with a drug indicated for the treatment of depression, the major concerns are whether the drug increases the risks of teratogenicity, pregnancy complications, poor neonatal adaptation, or neurodevelopmental disorders. Although different studies have produced different results, the majority have not shown increases in risk for selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, or the noradrenergic/dopaminergic drug bupropion...
March 20, 2018: Clinical Obstetrics and Gynecology
Alison S Poulton, Bruce Armstrong, Ralph K Nanan
BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is common and may require treatment in adulthood. We aimed to investigate the treatment patterns and perinatal outcomes of women with any history of stimulant treatment for ADHD. METHODS: We used health records of the New South Wales (NSW, Australia) population to compare perinatal outcomes of women treated with stimulants (dexamphetamine or methylphenidate) for ADHD from 1982 to 2012 who gave birth between 1994 and 2012, with perinatal outcomes of women with no known ADHD or stimulant treatment (comparison cohort)...
March 19, 2018: CNS Drugs
Michael Thomson, Verinder Sharma
PURPOSE OF REVIEW: The management of bipolar disorder during pregnancy requires difficult treatment decisions be made by both women and their clinicians. There is little consensus on management despite the high prevalence of bipolar disorder in reproductive-aged women. In this review, we have summarized the available literature and discuss the balancing of risks associated with treatment decisions. RECENT FINDINGS: Cohort studies have shown a high relapse rate in women with bipolar disorder who discontinue mood-stabilizing medications...
March 17, 2018: Current Psychiatry Reports
Misbah Salim, Verinder Sharma, Kelly K Anderson
We conducted a systematic review of the literature to determine the prevalence of mood episode recurrences during pregnancy among women with bipolar disorder. Included studies (n = 11) had wide variation in the reported proportions of pregnant women with bipolar disorder who experienced a recurrence (median = 24%, range = 4-73%). There is some evidence that pregnant women are more likely to have a depressive or mixed episode, rather than hypomanic or manic. The extant literature cannot answer the question of how pregnancy affects the course of bipolar disorder; it merely informs us of the effect of medication discontinuation during pregnancy...
March 17, 2018: Archives of Women's Mental Health
Julia F Litzky, Maya A Deyssenroth, Todd M Everson, Barry M Lester, Luca Lambertini, Jia Chen, Carmen J Marsit
BACKGROUND: Depression and/or anxiety during pregnancy have been associated with impaired fetal growth and neurodevelopmental. Because placental imprinted genes play a central role in fetal development and respond to environmental stressors, we hypothesized that imprinted gene expression would be affected by prenatal depression and anxiety. METHODS: Placental gene expression was compared between mothers with prenatal depression and/or anxiety/obsessive compulsive disorder/panic and control mothers without psychiatric history (n=458) in the Rhode Island Child Health Study...
March 14, 2018: Pediatric Research
Nancy Byatt, Lucille Cox, Tiffany A Moore Simas, Nisha Kini, Kathleen Biebel, Padma Sankaran, Holly A Swartz, Linda Weinreb
To elucidate (1) the challenges associated with under-recognition of bipolar disorder in obstetric settings, (2) barriers pregnant and postpartum women with bipolar disorder face when trying to access psychiatric care, and (3) how obstetric settings can identify such women and connect them with mental health services. Structured, in-depth interviews were conducted with 25 pregnant and postpartum women recruited from obstetric practices who scored ≥ 10 on the Edinburgh Postnatal Depression Scale and met DSM-IV criteria for bipolar disorder I, II, or not otherwise specified using the Mini International Neuropsychiatric Interview...
March 13, 2018: Archives of Women's Mental Health
Josep Estadella, Laura Villamarín, Anna Feliu, Josep Perelló, Joaquim Calaf
Iron deficiency anemia is the most frequent cause of anemia world-wide and is a very common disorder in daily medical practice. Heavy menstrual bleeding (menorrhagia) and pregnancy and delivery can cause significant iron loss leading to severe anemia The aim of the present study was to characterize the population requiring intravenous iron and identify whether gynecological and obstetric iron loss are frequent indications for treatment. MATERIAL AND METHODS: Restrospective, single center study performed in a tertiary level university hospital from January 2014 to December 2016...
March 6, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Kinke Lommerse, Marian Knight, Manisha Nair, Catherine Deneux-Tharaux, Thomas van den Akker
Poor maternal mental health is an important contributor to maternal mortality, which remains a global health priority as expressed in the sustainable development goals. Although underreported and neglected, psychiatric disorders in pregnant women or following childbirth have been shown to increase the risk of death from obstetric and medical conditions in pregnancy and puerperium as well as suicide up to one year postpartum (1,2). Therefore, increased attention to maternal mental health is needed. Many maternal suicides are preventable...
March 12, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
M Simermann, S Rothenburger, B Auburtin, J-M Hascoët
INTRODUCTION: Denial of pregnancy remains a phenomenon little known to healthcare professionals. Yet its repercussions are far from negligible. The aim of this study was to assess whether denial of pregnancy has an impact on the infant's development. PATIENTS AND METHOD: This prospective study included 51 full-term infants born in Nancy Regional Maternity Hospital between 1 January 2009 and 30 June 2015. In this study, the development of the children was followed longitudinally...
March 7, 2018: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
John J McCarthy, Ernest J Vasti, Martin H Leamon, Joseph Graas, Coburn Ward, Catherine Fassbender
OBJECTIVES: Pregnancy profoundly alters drug metabolism, accelerating clearance and confounding medication management, primarily through induction of CYP450 enzymes. Methadone is a CYP450 substrate with altered pharmacokinetics during pregnancy. We report on the use of serum methadone/metabolite ratios (MMRs) to monitor changes in methadone metabolism through the perinatal period and to objectively guide methadone dosing. Previous research found average MMRs in nonpregnant populations of between 11...
March 7, 2018: Journal of Addiction Medicine
Masaaki Sawada, Aiko Kakigano, Shinya Matsuzaki, Tsuyoshi Takiuchi, Kazuya Mimura, Keiichi Kumasawa, Masayuki Endo, Yutaka Ueda, Kiyoshi Yoshino, Tadashi Kimura
AIM: Previous studies have shown adverse obstetric outcomes of the laparoscopic resection of a rudimentary horn. Our study aimed to investigate the obstetric outcome in our institution and to review previous studies. METHODS: Using a retrospective analysis, data were reviewed from singleton pregnancies with maternal uterine anomalies at a medical center in Osaka, Japan, between January 2011 and March 2016. The uterine anomaly cases were divided into a 'postlaparoscopic resection of the rudimentary horn' group (study group) and an 'other uterine anomalies' (bicornuate uterus, uterine didelphys and unicornuate uterus) group (control group)...
March 8, 2018: Journal of Obstetrics and Gynaecology Research
Anna Simone Frank, Angela Lupattelli, Hedvig Nordeng
INTRODUCTION: Approximately 3% to 5% of pregnant women have hypothyroidism. Despite the potential impact of untreated hypothyroidism on infant neurodevelopment, few studies have investigated the risk factors associated with discontinuation of thyroid hormone replacement therapy (THRT) in pregnancy. We aimed to identify such factors in a population of women using THRT prior to pregnancy. MATERIAL AND METHODS: Data from the Norwegian Mother and Child Cohort Study were linked to records in the Medical Birth Registry of Norway...
March 7, 2018: Acta Obstetricia et Gynecologica Scandinavica
Chittaranjan Andrade
The use of attention-deficit/hyperactivity disorder (ADHD) medications during pregnancy has increased in recent years. An earlier article in this column examined whether psychostimulant medications, used to treated ADHD and related disorders, increase the risk of major congenital malformations in pregnancies with first trimester exposure to these drugs. This article examines whether amphetamines, methylphenidate, and atomoxetine exposure during early and late pregnancy are associated with other adverse gestational outcomes...
January 2018: Journal of Clinical Psychiatry
Amy L Haycraft
Opioid use disorder (OUD) in pregnancy is increasing, which often results in poor maternal and neonatal outcomes including neonatal abstinence syndrome (NAS) as a result of lack of prenatal care and inadequate substance use disorder management. Practice guidelines have been developed to manage OUD during and after pregnancy for mother and baby, but barriers exist, limiting comprehensive implementation. To reduce the impact of OUD in pregnancy and associated maternal and neonatal sequela, implementing compassionate evidence-based care and a non-punitive response is needed...
March 1, 2018: Journal of Psychosocial Nursing and Mental Health Services
G Skalley, S Rodríguez-Villar
Threatening refractory metabolic acidosis due to short-term starvation nondiabetic ketoacidosis is rarely reported. Severe ketoacidosis due to starvation itself is a rare occurrence, and more so in pregnancy with a concomitant stressful clinical situation. This case report presents a nondiabetic woman admitted in intensive care for respiratory failure type 1 during the third trimester of pregnancy with a severe metabolic acidosis refractory to medical treatment. We diagnosed the patient with acute starvation ketoacidosis based on her history and the absence of other causes of high anion gap metabolic acidosis after doing a rigorous analysis of her acid-base disorder...
February 27, 2018: Revista Española de Anestesiología y Reanimación
Angela Lupattelli, Mollie Wood, Eivind Ystrom, Svetlana Skurtveit, Marte Handal, Hedvig Nordeng
OBJECTIVE: To evaluate the effect of prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) on children's behavioral, emotional, and social development by age 5 years, and over time since age 1.5 years. METHOD: The prospective Norwegian Mother and Child Cohort Study was linked to the Medical Birth Registry of Norway. We included women who reported depressive/anxiety disorders before and/or during pregnancy. Children born to women who used SSRIs in early (weeks 0-16), mid- (weeks 17-28), or late (> week 29) pregnancy were compared to those who were unexposed...
March 2018: Journal of the American Academy of Child and Adolescent Psychiatry
Kriti Joshi, Margaret Zacharin
BACKGROUND: Neonatal hyperthyroidism is rare, seen in infants of mothers with Graves' disease (GD), with transplacental transfer of thyroid-stimulating hormone receptor (TSHR) antibodies (TRAbs). We describe a neonate with severe hyperthyroidism due to TRAbs, born to a mother with autoimmune hypothyroidism. CASE PRESENTATION: A baby boy born preterm at 35 weeks had irritability, tachycardia and proptosis after birth. The mother had autoimmune hypothyroidism, from age 10, with thyroxine replacement and normal thyroid function throughout her pregnancy...
March 1, 2018: Journal of Pediatric Endocrinology & Metabolism: JPEM
Marko Merikukka, Sami Räsänen, Helinä Hakko, Tiina Ristikari, Mika Gissler, Mika Niemelä
This study aimed to systematically examine whether parental hospital-treated somatic illnesses, diagnosed during an offspring's childhood (1987-1995), are associated with later use of psychotropic medication (1996-2012) by the offspring. If so, which parental somatic illnesses, in particular, increase the likelihood for later use of psychotropic medication among the offspring. The 1987 Finnish Birth Cohort study yields longitudinal nationwide follow-up data that include a complete census of children born in a single year...
February 24, 2018: Preventive Medicine
Laurence Collin-Lévesque, Yosra El-Ghaddaf, Madeleine Genest, Martin Jutras, Grégoire Leclair, Etienne Weisskopf, Alice Panchaud, Ema Ferreira
BACKGROUND: Duloxetine and methylphenidate are commonly prescribed for the management of depression and attention-deficit/hyperactivity disorder (ADHD), respectively. However, little information is available concerning their safety during lactation. The purpose of this case series was to provide additional information to the medical literature concerning infant exposure to methylphenidate and duloxetine through breast milk. METHOD: Bioanalytical method (liquid chromatography coupled to mass spectrometry) was developed and validated before its use to determine the concentrations of both medications in breast milk samples...
February 27, 2018: Breastfeeding Medicine: the Official Journal of the Academy of Breastfeeding Medicine
Linda Nguyen, Laura R Lander, Kevin E O'Grady, Patrick J Marshalek, Adrienne Schmidt, Audra K Kelly, Hendrée E Jones
BACKGROUND AND OBJECTIVES: Rising concerns regarding diversion and misuse of mono-buprenorphine for treatment of pregnant women with opioid use disorders have sparked interest in the use of buprenorphine + naloxone to reduce misuse and diversion rates. Examined the relationship of prenatal buprenorphine + naloxone exposure to neonatal outcomes. METHODS: This is a retrospective chart review of 26 mother infant dyads in comprehensive medication-assisted treatment with buprenorphine + naloxone during pregnancy...
March 2018: American Journal on Addictions
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