Episodes of Mood Disorders in 2,252 Pregnancies and Postpartum Periods

Viguera, Adele C.; Tondo, Leonardo; Koukopoulos, Alexia E.; Reginaldi, Daniela; Lepri, Beatrice; Baldessarini, Ross J.

doi:10.1176/appi.ajp.2011.11010148

Cited by 241 publications

(208 citation statements)

References 41 publications

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“…An observational study of mood disorders in 2252 pregnancies and postpartum periods demonstrated that women with bipolar disorders were at particularly high risk of developing major depression in the postpartum period (prevalence: 19% and 29% in women with bipolar I disorder and bipolar II disorder, respectively). 62 Likewise, it has been shown that women with a history of psychotic disorder are at higher risk of postpartum psychiatric illness, in particular non-psychotic anxiety and depressive disorders. 63 The severity of these illnesses is highlighted by case reports of suicide among these women.…”

Section: Discontinuation and Factors Associated With Discontinuation mentioning

confidence: 99%

“…As discussed in Discontinuation and factors associated with discontinuation of psychotropic medication in pregnancy previous research has demonstrated that both women with a psychotic disorder and women with mood disorders are at a particularly high risk of developing major depression and affective psychosis in the postpartum period. 62,63 Some observational studies have sought to compare the risks of relapse of mental illnesses during and after pregnancy in relation to psychotropic treatment. [65][66][67][68] Newport et al 65 observed 16 women who stopped lamotrigine treatment for bipolar disorder in pregnancy.…”

Section: Restarting and Factors Associated With Restarting Of Psychotmentioning

confidence: 99%

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Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Petersen

McCrea

Sammon

et al. 2016

Health Technol Assess

133

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BackgroundAlthough many women treated with psychotropic medication become pregnant, no psychotropic medication has been licensed for use in pregnancy. This leaves women and their health-care professionals in a treatment dilemma, as they need to balance the health of the woman with that of the unborn child. The aim of this project was to investigate the risks and benefits of psychotropic medication in women treated for psychosis who become pregnant.Objective(s)(1) To provide a descriptive account of psychotropic medication prescribed before pregnancy, during pregnancy and up to 15 months after delivery in UK primary care from 1995 to 2012; (2) to identify risk factors predictive of discontinuation and restarting of lithium (multiple manufacturers), anticonvulsant mood stabilisers and antipsychotic medication; (3) to examine the extent to which pregnancy is a determinant for discontinuation of psychotropic medication; (4) to examine prevalence of records suggestive of adverse mental health, deterioration or relapse 18 months before and during pregnancy, and up to 15 months after delivery; and (5) to estimate absolute and relative risks of adverse maternal and child outcomes of psychotropic treatment in pregnancy.DesignRetrospective cohort studies.SettingPrimary care.ParticipantsWomen treated for psychosis who became pregnant, and their children.InterventionsTreatment with antipsychotics, lithium or anticonvulsant mood stabilisers.Main outcome measuresDiscontinuation and restarting of treatment; worsening of mental health; acute pre-eclampsia/gestational hypertension; gestational diabetes; caesarean section; perinatal death; major congenital malformations; poor birth outcome (low birthweight, preterm birth, small for gestational age, low Apgar score); transient poor birth outcomes (tremor, agitation, breathing and muscle tone problems); and neurodevelopmental and behavioural disorders.Data sourcesClinical Practice Research Datalink database and The Health Improvement Network primary care database.ResultsPrescribing of psychotropic medication was relatively constant before pregnancy, decreased sharply in early pregnancy and peaked after delivery. Antipsychotic and anticonvulsant treatment increased over the study period. The recording of markers of worsening mental health peaked after delivery. Pregnancy was a strong determinant for discontinuation of psychotropic medication. However, between 40% and 76% of women who discontinued psychotropic medication before or in early pregnancy restarted treatment by 15 months after delivery. The risk of major congenital malformations, and neurodevelopmental and behavioural outcomes in valproate (multiple manufacturers) users was twice that in users of other anticonvulsants. The risks of adverse maternal and child outcomes in women who continued antipsychotic use in pregnancy were not greater than in those who discontinued treatment before pregnancy.LimitationsA few women would have received parts of their care outside primary care, which may not be captured in this analysis. Likewise, the analyses were based on prescribing data, which may differ from usage.ConclusionsPsychotropic medication is prescribed before, during and after pregnancy. Many women discontinue treatment before or during early pregnancy and then restart again in late pregnancy or after delivery. Our results support previous associations between valproate and adverse child outcomes but we found no evidence of such an association for antipsychotics.Future workFuture research should focus on (1) curtailing the use of sodium valproate; (2) estimating the benefits of psychotropic drug use in pregnancy; and (3) investigating the risks associated with lifestyle choices that are more prevalent among women using psychotropic drugs.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

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Section: Discontinuation and Factors Associated With Discontinuation mentioning

confidence: 99%

Section: Restarting and Factors Associated With Restarting Of Psychotmentioning

confidence: 99%

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Petersen

McCrea

Sammon

et al. 2016

Health Technol Assess

133

View full text Add to dashboard Cite

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“…Certain populations have higher rates of PPD including 30% in women with a history of depression and 52% of women with bipolar disorder (Viguera et al, 2011). A growing body of evidence indicates that increased sensitivity to gonadal hormone levels such as estrogen mediate the biological vulnerability to PPD.…”

Section: Introductionmentioning

confidence: 99%

Replication of Epigenetic Postpartum Depression Biomarkers and Variation with Hormone Levels

Osborne

Clive

Kimmel

et al. 2015

Neuropsychopharmacol

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DNA methylation variation at HP1BP3 and TTC9B is modified by estrogen exposure in the rodent hippocampus and was previously shown to be prospectively predictive of postpartum depression (PPD) when modeled in antenatal blood. The objective of this study was to replicate the predictive efficacy of the previously established model in women with and without a previous psychiatric diagnosis and to understand the effects of changing hormone levels on PPD biomarker loci. Using a statistical model trained on DNA methylation data from N = 51 high-risk women, we prospectively predicted PPD status in an independent N = 51 women using first trimester antenatal gene expression levels of HP1BP3 and TTC9B, with an area under the receiver operator characteristic curve (AUC) of 0.81 (95% CI: 0.69-0.92, po5 × 10 − 4 ). Modeling DNA methylation of these genes in N = 240 women without a previous psychiatric diagnosis resulted in a cross-sectional prediction of PPD status with an AUC of 0.81 (95% CI: 0.68-0.93, p = 0.01). TTC9B and HP1BP3 DNA methylation at early antenatal time points showed moderate evidence for association to the change in estradiol and allopregnanolone over the course of pregnancy, suggesting that epigenetic variation at these loci may be important for mediating hormonal sensitivity. In addition both loci showed PPD-specific trajectories with age, possibly mediated by age-associated hormonal changes. The data add to the growing body of evidence suggesting that PPD is mediated by differential gene expression and epigenetic sensitivity to pregnancy hormones and that modeling proxies of this sensitivity enable accurate prediction of PPD.

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“…Women of childbearing age have been reported to be of particular risk, especially during the first postpartum year (Viguera et al, 2011;Yonkers et al, 2011). The prevalence of less severe forms of depression is less well known, but one study reported the presence of depressive symptoms in almost 40% of a sample of inner-city mothers (Heneghan, Silver, Bauman, Westbrook, & Stein, 1998).…”

mentioning

confidence: 99%

The Relationship Among Caregiver Depressive Symptoms, Parenting Behavior, and Family-Centered Care

Davis

Myers

Logsdon

et al. 2016

Journal of Pediatric Health Care

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Episodes of Mood Disorders in 2,252 Pregnancies and Postpartum Periods

Cited by 241 publications

References 41 publications

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Replication of Epigenetic Postpartum Depression Biomarkers and Variation with Hormone Levels

The Relationship Among Caregiver Depressive Symptoms, Parenting Behavior, and Family-Centered Care

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