Major depressive disorder during pregnancy: Psychiatric medications have minimal effects on the fetus and infant yet development is compromised

Abstract

Psychotropic medication use and psychiatric symptoms during pregnancy each are associated with adverse neurodevelopmental outcomes in offspring. Commonly, studies considering medication effects do not adequately assess symptoms, nor evaluate children when the effects are believed to occur, the fetal period. This study examined maternal serotonin reuptake inhibitor and polypharmacy use in relation to serial assessments of five indices of fetal neurobehavior and Bayley Scales of Infant Development at 12 months in N = 161 socioeconomically advantaged, non-Hispanic White women with a shared risk phenotype, diagnosed major depressive disorder. On average fetuses showed the expected development over gestation. In contrast, infant average Bayley psychomotor and mental development scores were low (M = 84.10 and M = 89.92, range of normal limits 85-114) with rates of delay more than 2-3 times what would be expected based on this measure's normative data. Controlling for prenatal and postnatal depressive symptoms, prenatal medication effects on neurobehavioral development were largely undetected in the fetus and infant. Mental health care directed primarily at symptoms may not address the additional psychosocial needs of women parenting infants. Speculatively, prenatal serotonin reuptake inhibitor exposure may act as a plasticity rather than risk factor, potentially enhancing receptivity to a nonoptimal postnatal environment in some mother-infant dyads.

Inflammation predicts new onset of depression in men, but not in women within a prospective, representative community cohort

“…In women, lower age, a history of cancer, lower alcohol consumption, loneliness and baseline depression symptoms were predictive of depression, but not CRP. As consumption of alcohol is quite widespread in Germany, especially in social contexts, and as the recommended limit (for women) is reached with few drinks, the negative predictive valence of alcohol consumption might have been related to little social contact (and related social drinking) which aggravates the risk for depression 42 .…”

Added sugar intake during pregnancy: Fetal behavior, birth outcomes, and placental DNA methylation

“…Fetal movement and heart rate were acquired using a Toitu MT 325 fetal actocardiograph (Toitu Co., Ltd., Tokyo, Japan) via a single transabdominal Doppler transducer, while participants were in a semi‐recumbent position for 20 min (described in previous work Doyle et al., 2015; Gustafsson et al., 2018; Werner et al., 2007)). The fetal data were collected from the Toitu's output port, digitized at 50 Hz using a 16‐bit A/D card (National Instruments 16XE50), and analyzed offline.…”

“…To ensure that fetuses included in the study were developing typically, we measured their mean heart rate and heart rate variability (standard deviation) as described previously (Doyle et al., 2015; Gustafsson et al., 2018; Werner et al., 2007).…”

Maternal Serotonin Reuptake Inhibitor Antidepressants Have Acute Effects on Fetal Heart Rate Variability in Late Gestation

“…In SRI exposed fetuses, Mulder et al report increased motor activity in the second trimester and increased motor activity during quiet sleep state (i.e., stable fetal HR, low variability) in the third-trimester; however, SRI-treated mothers had comparable psychiatric symptoms to the unmedicated depressed group (28). Gustafsson et al also observed increased motor activity in SRI-exposed fetuses, but only prior to 30-weeks' gestation and found no SRI-related effect on fetal HR, HR variability, or HRmovement coupling (31). Conversely, lower fetal HR variability at 36-weeks' gestation and reduced cerebral blood flow resistance was observed in SRI-exposed fetuses (30), as well as elevated pulmonary blood flow in SRI-exposed fetuses who experienced transient respiratory difficulties at birth (29).…”

“…To date, only few studies have investigated whether outcomes of prenatal SRI exposure emerge before birth: during the period of drug exposure. Fetal SRI exposure has been associated with disrupted cardiovascular function (28)(29)(30) and increased fetal motor activity (28,(31)(32)(33); though, findings are not consistent, primarily due to variations in methodology, gestational age and the ability to account for maternal mood. In SRI exposed fetuses, Mulder et al report increased motor activity in the second trimester and increased motor activity during quiet sleep state (i.e., stable fetal HR, low variability) in the third-trimester; however, SRI-treated mothers had comparable psychiatric symptoms to the unmedicated depressed group (28).…”