Studies' Take-Home: Ask about Mothers' Prenatal Exposures

By Jancin, Bruce | Clinical Psychiatry News, December 2018 | Go to article overview

Studies' Take-Home: Ask about Mothers' Prenatal Exposures


Jancin, Bruce, Clinical Psychiatry News


BARCELONA -- Prenatal exposure to selective serotonin reuptake inhibitors late in pregnancy was associated with a significantly increased risk of anxious and / or depressed behaviors at 5 years of age in the prospective Norwegian Mother and Child Cohort Study.

Other than that specific red flag, however, the outcomes of in utero exposure to maternal SSRIs were reassuringly benign. Prenatal exposure during early or mid-pregnancy was not associated with increased risk of anxious /depressed behaviors, compared with nonexposure; that adverse effect was restricted to exposure at week 29 of pregnancy or later. Nor did in utero exposure to maternal SSRIs during any time in pregnancy pose an increased risk for pediatric externalizing, emotional, or social problems in this observational study of 8,359 Norwegian mother-child dyads, Josefina Castro-Fornieles, MD, PhD, observed at the annual congress of the European College of Neuropsychopharmacology.

The huge Norwegian study was among what she considers the four most important studies in child/ adolescent psychiatry published through the first three-quarters of 2018. The others she highlighted were a large longitudinal observational study showing that persistent maternal postnatal depression was strongly associated with a variety of pediatric behavioral disturbances documented during assessments at ages 3.5, 16, and 18 years; a Philadelphia study showing that multiple traumatic stressful events or any assaultive trauma experienced by children or adolescents were independendy associated with significant psychopathology and neurocognitive deficits; and a Dutch brain MRI study that pinpointed a reduction in gray-matter volume in the anterior cingulate cortex as a potential key mediator of the neurobiologie aftereffects of childhood sexual abuse.

She selected those studies because they shared a common theme, one that constituted her key take-home message: "When recording antecedents during a clinical assessment, both with adults and children, it is clear that we have to ask in a more detailed way --using validated scales and interviews if possible --about the mother's prenatal problems, including psychopharmacological treatment. And it's also important to ask about life events; abuse during childhood and adolescence can be really important. We can modulate our treatment depending upon whether there is an influence of any of these aspects," said Dr. Castro-Fornieles, director of the Clinical Institute of Neuroscience at the Hospital Clinic of Barcelona and a recent past-president of the Spanish Society for Child and Adolescent Psychiatry.

The following are her Top 4 studies:

The Norwegian Mother and Child Cohort Study

The increased risk of anxious and/or depressed behaviors in children exposed to selective serotonin reuptake inhibitors late in pregnancy did not emerge until the year-5 assessment; it wasn't evident at the 1.5- or 3-year evaluations.

The investigators emphasized a key lesson from their study: the importance of following children with late-pregnancy exposure to maternal SSRI therapy for development of symptoms of anxiety and / or depression (J Am Acad Child Adolesc Psychiatry. 2018 Mar;57[3]:200-8). Dr. Castro-Fornieles strongly endorsed that recommendation. However, she noted what she considers an important limitation: Even though the University of Oslo investigators adjusted for numerous potential confounders in their risk models, it's not possible in a study such as this to control for genetic and environmental risk factors.

The Avon longitudinal study

Maternal postnatal depression is common, affecting roughly 10% of mothers. But it is not invariably associated with adverse mental health outcomes in their children. This study of nearly 10,000 mothers and their children sought to identify which children were at most risk. Using the Edinburgh Postnatal Depression Scale, the international team of investigators categorized maternal postnatal depression as moderate, marked, or severe. …

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